脐带先露

2016-10-20 09:51 阅读: 编辑:sunyoung 来源:家有宝宝
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内容简介:脐带先露(presentation 0f lambilical COrd)又称隐性脐带脱垂,指胎膜未破时脐带位于胎先露部前方或一侧,亦称脐带前置。
?       实际是脐带轻度脱垂,也称脐带隐性脱垂。当胎膜破裂,脐带进一步脱出胎先露部的下方,经宫颈进入阴道内,甚至显露于外阴部,称脐带脱垂(prolapse.0f umbilical cord)。其发生率为0.4%一lO%。

脐带先露 分娩期并发症

?       一、病因

?       易发生在胎先露部不能衔接时:①胎头人盆困难如骨盆狭窄、头盆不称等;②胎位异常如臀先露、肩先露、枕后位等;③脐带过长;④羊水过多。

?       二、对孕妇和胎儿的影响

?       脐带先露或脱垂对产妇的影响不大只是增加手术产率。对胎儿则为害甚大。脐带先露或脱垂胎先露部尚未入盆,胎膜未破者,可仅在宫缩时胎先露部被迫下降,脐带可因一时性受压致使胎心率异常。若胎先露部已入盆胎膜已破者,脐带受压于胎者先露部与骨盆之间,引起胎儿缺氧胎心率必然有改变,甚至完全消失,以头先露最严重肩先露最轻。若脐带血循环阻断超过7~8分钟,则胎死宫内。

?       三、诊断要点

?       (一)此类并发症多见于臀位、横位、骨盆狭窄或宽大;在羊水过多、低位胎盘、脐带过长、多胎妊娠、早产及早期破膜时也可发生。

?       (二)胎心率变快或出现散发性变慢,胎动活跃,羊水中出现草绿色胎便,示有胎儿窘迫征象。

?       (三)肛诊可发现异常,先露部不是胎头或胎儿某部肢体,而是软组织,有搏动感,其速率与胎心相近。阴道检查时发现脐带位于先露之前或脱入阴道内,即可明确诊断。

?       四、治疗

?       一旦发现脐带先露或脱垂胎心尚存在,或虽有变异而未完全消失、或刚突然消失者表示胎儿尚存活,应在数分钟内娩出胎儿,宫口已开全胎头已入盆,应立即行产钳术或胎吸引术;臀位能掌握臀牵引技术者,应行臀牵引术;肩先露时能掌握内倒转技术及臀牵引术者,可立即实行。后两者若为产妇则较易实施。

?       实施臀牵引术无把握者,尤其是初产妇仍应行剖宫产术。若宫颈未完全扩张,应立即行剖宫产术在准备期间,产妇应采取头低臀高位,必要时用手将胎先露部推向骨盆入口以上以减轻脐带受压,术者的手保持在阴道内,使胎先露部不能再下降以消除脐带受压,脐带则应消毒后回纳阴道内。

?       脐带隐性脱垂胎膜未破,宫缩良好者,应取头臀高位(侧卧或仰卧)密切观察胎心率,待胎头入盆,宫颈逐渐扩张胎心仍保持良好者,可经阴道分娩。若为臀足位或肩先露者均应行剖宫产术。

?       若宫颈未完全扩张胎心好,无剖宫产条件或产妇及家属不同意行剖宫产者,可试用脐带还纳术脐带还纳术有多种方法,常用方法是产妇取头低臀高位,用一加大旁孔的肛管内置一金属条,将一消毒纱布条轻系于脱出脐带的下部,然后在肛管旁孔处以金属条插入棉布条圈内,然后将肛管送入宫腔底部,使脱出的脐带随肛管重新放入宫腔内随后先抽出金属条,再抽出肛管,脐带与所系的纱布条留于胎先露部以上仔细听胎心及密切观察脐带是否再次脱出,确定脐带还纳成功,应迅速转送至有条件医院行剖宫产或进行催产处理施行脐带还纳术前,应先把胎先露部推上,防止脐带受压因脐带还纳术的成功率不高,术前应向产妇及其家属说明。

      胎心已消失超过10分钟确定胎死宫内,应将情况通告家属,任其经阴道自然分娩为避免会阴裂伤,可行穿颅术。
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