Quantitative Analysis Of Degree Of Tightness Of Nuchal Cord And Evaluat It’s Relationship Of Fetal Intrauterine Hypoxia

Objective:To investigate the value of varying degrees of tightness of nuchal cord in predicting fetal hypoxia and choose the most valuable nuchal cord indexes for predicting fetal hypoxia, in order to provide evidences for evaluating fetal condition in the cavity of the uterus and how to deal with it.Methods:149women of singleton and late pregnancy whose age were22to38years old and gestational age36to41weeks were choosed as study objects. They did regular antenatal examination in Obstetrics and gynecology Hospital of Fudan University between April,2012and November,2012, and have no pregnancy complication, the fetuses were normal developed. Judge the nuchal cord depend on the impression and the color doppler flow. Observe the fetuses’neck from nuchal cord group for a circle, choose the cross-section in the deepest impression, make a line to connect the two skin edges. Measure the depth from the line to the deepest edge of the impression(D).Measure the area under the line asAl, and the area of the impression as A, calculate the proportion of Al in A. Next the peak systolic velocity (S) and end diastolic velocity (D)ratio(S/D), resistance index(RI)and pulsatility index (PI)of fetal umbilical artery, middle cerebral artery, renal artery were detected, storing images and datas were analyzed offline. They were divided into two groups,82cases in nuchal cord for one circle group and67cases no nuchal cord group. And then, the nuchal cord group divided into deep nuchal cord group and shallow nuchal cord group, respectively41cases. Followed up and recorded the delivery mode, changes of fetal heart rate, property of amniotic fluid and abnormal labor during delivery,1minute score of postpartum was conducted and babies were weighted by experienced midwives after fetal delivery. Count the stillbirth.Results:1.S/D value and PI value of RA in nuchal cord for one circle group were significantly higher than no nuchal cord group (P<0.05). RI value of RA and hemodynamic parameters of UA and MCA had no significant differences between the two groups (P>0.05). 2.The incidence of fetal hypoxia in fetuses and need to deal with the stage of labor with nuchal cord were significantly higher than normal group (P<0.05). The delivery mode had no significant differences between the two groups (P>0.05)3. Compare the deep nuchal cord group and shallow nuchal cord group respectively to the no nuchal cord group, S/D value and PI value of RA and S/D value of UA in deep nuchal cord group were significantly higher than normal group (P<0.05). That’s the most valuable nuchal cord indexes for predicting early fetal hypoxia.4.Draw the scatter diagram and regression curve of S/D value and PI value of RA and S/D value of UA, they were positive correlated to the A1/A%and D.5.Draw the receiver operating characteristic(ROC)of A1/A%and D. The sensitivity of using A1/A%value(>27.22%), D value(>5.485mm) to predict the occurrence of fetal hypoxia were respectively86.9%,76.0%; and the specificity were respectively62.5%,73.0%; and the area under curve (AUC)were respectively0.760cm2,0.784cm2.Conclusion:A1/A%and D are valuable nuchal cord indexes for predicting changes of hemodynamic parameters even fetal hypoxia, providing evidences for evaluating fetal condition in the cavity of the uterus and how to deal with it.