TifllP CHf Y Dl/gfC HQC CAN THg - SO 13-14/2018
8. David AN, Njokanma OF and Iroha E (2006), " Incidence of and factors associated with meconium staining of the amniotic fluid in a Nigerian University Teaching Hosphal", J Obstet Gynaecol, 26, pp. 518-520.
9. Demisew Amenu Son (2016), "Meconium Satined Amniotic Fluid: Factors affecting Maternal and Perinatal Outcomes at Jimma University Specialized Teaching Hospital, South West Ethiopia", Gynecol Obstet, 6(8), pp. 394-399.
I O.Greenwood C et al. (2003), "Meconium passed in labor: how reassuring is clear amniotic fluid", Obstet Gynaecol 102, pp. 89-93.
II .Grignaffini A et al. (2004), "Meconium stained fluid and fetal oxygen saturation measured by pulse oximetry during labour". Acta Bio Medica Ateneo Parmense, 75(1), pp. 45-52.
12.Krzyscin M et al. (2009), "Inttapartum amnioinftision for meconium-stained amniotic fhivX", Archives of Perinatal Medicine, 15(2), pp. 95-100.
13.Kyung A Lee et al. (2011), "The frequency of meconium-stained amniotic fluid increases as a function of the duration of labour". The Journal of Maternal-Fetal and Neonatal Medicine, 24(7), pp. 880-885.
(Ngdynhdnbdi: 17/11/2017-Ngdy duyjt ddng: 10/01/2018)
NGHIEN CUtJ © ^ C DIEM L A M SANG, SIEU A M DOPPLERVASANH GIA K E T QUA x t TRI CAC TRlTOlNG H Q P D A Y R O N Q U A N C 6 THAI
NHI TRONG C H U Y E N D ^ T A I K H O A SAN - B E N H V I E N DA KHOA TRUNG l/OfNG C A N THO>IAM 2016 - 2017
Vo Hodng Thf Lan Huan^, Buong My Link^*
1. Binh vijn da khoa Tay Ninh, 2. Trudng Dgi hoc YDugc Cdn Tha
* Email:[email protected] TOM T A T
Bat vdn di: ddy rdn qudn cd (DRQC) la bien chiing thudng gap cua ddy rdn trong thai iy khi vdo chuyen dg. chiim khodng 6-37%, gdy ra mdt sd bdt lgi cho thai. Muc tiiu nghiin ciru:
md td dgc diem ldm sdng, siiu dm Doppler vd ddnh gid kit qud xii tri cdc tru&ng hgp dmf ron qudn cd thai nhi trong chuyin da. Boi tugng vd phuang phdp: thiit ki md td cdt ngang tien cuu tren 202 thai phu cd ddu hiiu chuyen da that sg den sanh tgi khoa Sdn binh viin da khoa tnmg uang Cdn Tha. kit qua: 89,1% trudng hgp cd DRQC 1 vdng vd 10,9% cd tir 2 vdng DRQC trd len. 85,1% thai phg vdo chuyen dg giai dogn hogt ddng ldm 49,1% tnrdng hgp thay ddi nhjp tim thai. Trong 24,3% cd ddu hiju ldm sdng nghi ng& DRQC thai nhi; 17,3% dau dm i & vimg day fir cung, 23,3% ngdi thai khdng xudng/xudng dugc nhung bi keo len cao khi hit can co tir cimg, 3%
keo ddi giai dogn 2 chuyin dg. Gid tri RI vd S/D trung binh cua dgng mgch ndo giOa ldn lugt:
0,72 ± 0.05 vd 3.81 ± 0.70, trong dd nhdm DRQC > 2 vdng gidm han hdn so vdi nhdm DRQC 1 vdng. Gid tri RIvdS/D trung binh cita dgng mgch rdn ldn lugt 0,54 ± 0,05 vd2,30 ± 0,26, tiong dd nhdm DRQC > 2 vdng cao han hdn so vdi nhdm DRQC 1 vdng. Cdch thiic sinh: 17,5% sanh thudng; 0,5% sanh Forceps vd md lay thai chiem ty Ij cao 82.2%. Tinh tigng sa sinh sau sanh da sd diu khoe mgnh, Apgar tiung binh thai diim 1 phut: 6,8 ± 0,7 diim, sau 5phiit: 9,1 ±0,5 diim.
Kit lu&n: ddu chung ldm sdng phdt hien DRQC khd md nhgt, 24,3% cd ddu hiju nghi ngd DRQC thai nhi, khdng triju chiing 75.7%. Cdc trudng hgp DRQC > 2 vdng cd su thay ddi chi sd RI, S/D
T/^P CHf Y DLTpfC HQC CXN THO - S6 13-14/2018
cua ddng mgch rdn vd ndo giOa. Cdn cdn nhdc chi dinh md lay thai trong cdc trudng hgp DRQC nhieu vdng.
Tk khod: ddy rdn qudn cd thai nhi, ddng mgch rdn, dgng mgch ndo giiia ABSTRACT
STUDY O N CLINICAL CHARACTERISTICS, COLOR DOPPLER U L T R A L S O U N D A N D E V A L U A T I O N T H E OUTCOMES OF PREGNANCIES W I T H N U C H A L C O R D DURING LABOR AT CAN T H O
CENTRAL G E N E R A L HOSPITAL IN 2016-2017
Vo Hoang Thi Lan Huong', Duong My Linh^
1. Toy Ninh General Hospital 2. Can Tho University of Medicine and Pharmacy Background: nuchal cord is common complication of the umbilical cord during the labor.
The rate of nuchal cord from 6 - 37%. Objectives: describe the clinical characteristics, color Doppler ultrasound and evaluation the outcome of the fetal with nuchal cord during labor.
Materials and methods: a cross-sectional descriptive of 202 pregnant women have real signs of labor between completed gestational weeks 37 and 40. Residts: 89,1% had a single nuchal cord and 10.9% had two or more loops of cord. Of the 85,1% of women in active-stage labor: 49,1%
having exchanging the fetal heartbeats. 24,5% had clinical sings, that including: pain at the bottom of uterus (17.3%), moved the fetal position in the pelvis when it had the squeeze of uterus but it was pulled up when the uterus hadn't contiaction (23.3%); prolonged the second stage of labor (3%). The mean values RI and S/D of the middle cerebral artery were 0.72 ± 0,05 and 3.81 ± 0,7, the group having two or more loops cord was more decrease than the single nuchal cord group. The mean values RI and S/D ofumbilcal artery were 0,54±0,05 and 2,30^^0,26, the group having two or more loop cord was more increase than the single nuchal cord group.In study group, the rate of cesarean delivery was the highest (82,2%), vaginal delivery (17,5%), forceps assisted vaginal delivery (0,5%). The mean Apgar score at the 1 minutes was 6,8±0,7 at 1 minutes and 9,1±0,5 diim at 5 minutes. Conclusion: the clinical signs of nuchal cord weren't clear. The group having two or more loops had exchanged the value RI and S/D.
Keywords; nuchal cord, MCA, UA.
I. DAT VAN BE
Day rdn la cdu noi quan ttpng gifta mp va thai nhi, mang mdu do tuoi giau oxy cimg cdc chdy dmh duong tft me sang nudi thai ddng thdi tiep nhdn cdc san phim thua tu tiiai ttd vS tudn hoan me. Ddy rdn qudn cd Id tinh hudng kha phd biSn tten lam sang gdy nhiSu anh hudng tdi thai nhi: khi vao chuySn da vdi dp lyc con co tft cung Idm day rdn siet chat ldm gidm luu lupng tudn hoan sang thai cd the gay suy thai; gidm chieu dau hiiu dung day rdn gdy ban che bhih chinh ngdi thai, thai khdng Ipt, chuyen da keo ddi, tdng ty IS md ldy thai... Tuy nhien cac ddu chftng lam sang khd md nhat vd cdn nhieu ban cai, phat hien chu ySu thdng qua binh dnh sieu dm Doppler mau. Cung vdi su phat triSn hien dai, mftc dp phd biSn ciia sieu dm, dac biet siSu am Doppler mdu, de gay lam dung kSt qud sieu dm cd DRQC gay tam ly hoang mang cho thai php vd cd tiiS md r^ng nhung chi dinh mo ldy tiiai khdng can thilt.
Nhdm cung cdp nhiing bdng chiing phyc vu ldm sang, chiing toi tiSn hdnh nghiSn cftu dS tai nay vdi hai muc tiSu:
I. Md ta d^c diem lam sang, siSu am Dopier cdc trudng hap ddy rdn quan cd thai nhi ttong chuyin da t ^ khoa San-Benh vien da khoa tnmg uang C4n Tho.
TAP CHf Y DirOC HQC CAN THg - SO 13-14/2018
2. Danh gia kSt qua xft tii cac trudng hpp day rdn qudn cd thai nhi tiong chuySn da tai khoa Sdn- Benh viSn da khoa tiwig uong Cdn Tho.
U. D 6 I TU^ONG V A PHU-ONG PHAP NGHIEN ClTU 2.1. Doi tu-png nghiSn cihi
Tdt cdc cac thai phu cd ddu hieu chuyen da thdt sy den sanh tai khoa San-Benh vien Da Khoa Tning Uong Cdn Tho tft thdng 7/2016 - 4/2017.
TiSu chuan chpn mdu: Thai phu mang don thai, ngdi ddu cd tudi thai tft 37- 42 tudn (theo kmh cudi hodc siSu dm 3 tiidng ddu) cd ddu hieu chuyin da tiidt su. Sieu dm Doppler mau cd hinh dnh ddy rdn qudn cd. Nghi ngd DRQC tten lam sang.
Tieu chudn loai trft: thai chSt luu, thai di dang hoac thai bdt thudng. Nhau bong non, nhau tiSn dao, cham phdt triSn trong tft cung, tiiiSu di. Thai phy mac cac b^nh ly vS ndi tiSt, nhiSm trung, tdng huySt dp tii^ ky, benh ly ngogi khoa, khung chgu bdt thudng,...
Su dung cac chdt kich thich hoac thudc anh hudng dSn nhip tim thai. Thai phu rdi loan tdm thdn ho^c khdng ddng y tham gia nghien cftu. Khdng DRQC sau sanh.
2.2. Phirong phap nghiSn cihi
- ThiSt kS nghiSn cuu: md td cdt ngang tiSn cftu
- Co mau: 202 trudng hpp, phuong phdp chpn mau: chpn mau thuan tien.
- Ndi dung nghien cftu: Chung tdi tien hanh kham Idm sdng ghi nhgn giai doan chuySn da, ddu hieu dau vftng day tft cung, su tiSn trien cfta ngdi thai, thdi gian chuySn da;
kSt qua monitoring sdn khoa, kSt qua sieu dm doppler mau ddng^ thdi ghi nhan phuong phdp chdm dftt thai ky, tinh trang thai nhi sau sinh vd luc ra vien, sd vdng ddy rdn quan co, chieu ddi day rdn khi sinh, thdi gian ndm vien.
- Phuong phdp xu ly sd lieu: bang phdn mem SPSS 18.0.
i n . KET QUA NGHIEN CUtJ
3.1. Dac diSm chung cua doi tirong nghien cun
Tudi me trung binh ttong nghien cftu la 27,9 ± 5,7 tudi, nhd nhdt 15 tudi, Idn nhat 46 tudi. Tudi thai trung binh trong nghien cftu la 38,98 ± 1,04 tudn.
3.2. Dac diSm Idm sdng Bang I. Phan bd theo dac diem Iam sdng
Bac di^m ISm sSag Giai doan chuyen da: Tiem thai
Hoat dpng Dku hiSu lam sing nghi ngo^:
Khdng Co
- Dau vimg day tu cung - Ngoi cao long - Giai doan 2 keo dai Nhjp tim thai: Binh thixtmg
<110lan/phut
> 160 lin/phiit
So luong (n= 202) 30 172 153 88
35 47 6 102
2 98
Tvl6(%) 14,9 85,1 75,7 24,3
17,3 23,3 3,0 50,5
1,0 48,5 Chuyen da d giai doan boat dpng chiSm 85,1%, giai doan tiem thdi 14,9%. C6 24,3% trudng hpp cd ddu hiSu ldm sang nghi ngd cd sy hi$n di$n DRQC bao gdm 17,3%
dau vimg day tft cung; 23,3% ngdi ddu cao long, ngdi thai khdng xudng duoc h o ^ xudng dupe nhung bi kSo ISn cao khi het con co; 3% keo dai giai d o ^ 2 chuySn da. 75,7%
TAP CHI Y DITQC HQC CAN THg - SO 13-14/2018
khdng trieu chftng. 50,5% ttudng hpp cd nhip tim thai binh thudng, 1% cd nhip tim thai <
llOldn/phftt.
3.3. Sieu ^m Doppler Bang 2. Gid tri RI ddng m^ch nao gifta
Nhom tuoi thai (tuan) 37-<3S 38-<40 40-42
Chi sS RI ciia DM nao gii^a DRQC
1 vong 0,75 ± 0,05 0,73 ± 0,05 0,72 ±0,05
DRQC 2 vong 0,71 ±0,01 0,69 ±0,02 0,68 ±0,02
DRQC 3 VODg 0,69 ± 0,000
Trung binh
0,72 ±0,05 Bang 3. Gia tri S/D ddng mgch nao gifta
Nhdm tuoi thai (tuan) 37-<38 38-<40 40-42
S/D ciia DM nao giii^
DRQC 1 vong 4,39 ±1,03 3,86 ± 0,70 3,72 ± 0,60
DRQC 2 vong 3,9 ±0,26 3,38 ±0,35 3,44 ±0,33
DRQC 3 vong
3,40 ±0,00
Trung binh
3,81 ±0,70 Bang 4. Gia tri RI dpng mach ron
Nh6m tuoi thai (tuan) 37-<38 38-<40 40-42
Gia tri RI cua DM ron DRQC
1 vong 0,54 ±0,05 0,54 ± 0,04 0,5 ± 0,0
DRQC 2 vong 0,62 ± 0,006 0,59 ±0,013 0,59 ±0,013
DRQC 3 vong
0,59 ±0,00
Trung binh
0,54 ±0,05 Bdng 5. S/D ddng mach rdn
Nhom tuoi thai (tuan) 37-<38 38-<40 40-42
Gia tri S/D ciia DM r6n DRQC
1 vong 2,28 ±0,25 2,30 ± 0,29 2,22 ± 0,22
DRQC 2 vong 2,67 ±0,038 2,45 ±0,091 2,49 ±0,030
DRQC 3 vong 2,40 ±0,00
Trung binh
2,30 ±0,26 3.4. Ket qua xir tri
Trong 202 tmong hop co 35 tnrong hop (17,3%) sanh thuong, 0,5% sanh giup bang Forceps vi 82,2% md ldy thai. Trong do ngujjen iihan m6 liy thai chu yeu do: suy thai (38,6%); chuySn da ngung tiSn triSn (25,9%); vk mi cu (17,5%), 18,1% nguyen nhjin khac (thieu oi,....).
ChiSu dai day r6n trung bmh la 60,2 ± 8,7cm (ngan nhAt 32cm; dai nhat 96cm), da so c6 chiSu dai trong khoang 45 - 60cm (57,9%); 39,6% co chiSu d a tren 60cm va duoi 45cm chi chiSm 2,5%. Co m6i lien quan giQa chilu d^ day ron va so vong DRQC voi p = 0,000.
Apgar sau smh thai diSm Iphlit trung binh la: 6,8±0,7 diSm, sau 5 philt la: 9,1 ± 0,5 diSm. Trpng lupng so sinh trung binh la 3123,3 ± 328,6gram. Khong ghi nhan truong hop nao phai chuyin benh vien Nhi d6ng dieu tn.
Tlldi gian nam vi?n trung binh la 4,9 ± 1 ngay.
IV. BAN LUAN
TAP CHI Y Dl/QC HQC CAN THQ - SO 13-14/2018 4.1. Dac diSm chung ciia doi tirong nghiSn cihi
Tudi tiimg binh cfta tiiai phu la 27,9 ± 5,7 tu6i, da sd tdp tiimg ttong dp tudi sinh sdn 20 - 35 ttidi (84,7%) phft hpp vdi kdt qua cua Nguyen Thi My Linh (2012) [2] tudi tiung binh la 27,3 ± 5,1 tiidi vd Phong Thi Thanh^ Xuan (2014) [4] tudi me tiimg binh Ia27,4 ± 5,5 tudi, tudi nhd nhdt 16 tudi vd ldn nhdt 42 tudi. Tudi thai tiimg binh ttong nghien cuu la 38,98 ± 1,04 tiidn.
4.2. Dac diem ISm sang va cgin lam sang cua a6i t u ^ g nghiSn ciru
Trong 85,1% ttudng hpp vao chuydn da giai doan hoat ddng, dudi dp lue can co tii cung la day rdn bi sidt chat cd su thay ddi ki^u hinh nhip tim thai: 48,5% cd nhip tim tiiai
> IdOldn/phftt vd 1% nhip tim tiiai < 100 Idn/phut. K6t qua nghien cftu ghi nhdn 75,7%
tiudng hpp cd DRQC vao chuydn da khdng trieu chftng, tiong 24,3% dupe ghi nhan co ddu hieu nghi ngd cd DRQC gdm: 17,3% dau am I viing ddy tft cung, 23,3% ngdi tiiai khdng xudn dupe hodc xudng duac nhung bi keo Ien cao khi bgt con co tft cung, 3% keo ddi giai doan 2 chuySn da. Theo Nuriye Buyukkayaci Duman (2017) [9] ghi nhdn su khdc biet cd y nghia thdng ke gifta nhdm cd day rdn quan thai chiem 58,3% vd nhdm chung ve biSn chiing k6o ddi giai d o ^ 2 chuydn d? vdi p = 0,000. Ty le tiiai ph\i cd DRQC thai nhi tiong nghien cftu chiing tdi cd cd thai gian chuyen da giai doan 2 keo ddi thdp hon cd the do chi dinh md ldy thai tuong ddi rdng rai.
Sieu dm Doppler mdu: gid tti RI va S/D cfta ddng mach ndo gifta d nhdm DRQC tii 2 vdng ttd ISn gidm hon hdn so vdi nhdm DRQC I vdng. Tuy nhiSn, gid tti RI, S/D cua dpng mgch rdn nhdm DRQC tu 2 vdng trd di cao hon hdn so vdi nhdm DRQC 1 vdng. Ket qua cua chiing tdi tuong tu Nguyin Thi My Linh [2] cd gid tri RI vd S/D nhdm DRQC 2 vdng ldn lugt 0,69 ± 0,07 va 2,89 ± 1,08 gidm ddng kd so vdi nhdm I vdng DRQC vd nhdm khdng DRQC (p ldn luprt la 0,00 va 0,044) va Ting-ting X. (20II) [10] cung ghi nhdn gid tii RI va S/D ciia dpng mach nao gifta nhdm cd DRQC giam ddnh ke so nhdm khdng DRQC. Tuy nhien, Fangui Zhao (2015) [6] ghi nh|in khdng cd su khac biet gid tri RI vd S/D giua nhdm DRQC vd nhdm chung.
4.3. Ket qua xii tri dSy ron quan co
Trong 202 trudng hpp cd: 17,3% sanh thudng, 0,5% sanh giup bdng Forceps vd 82,2%
md lay thai. Ty le md ldy thai kha cao trong dd nguyen nhan chft ydu do: 38,6% suy thai; 22,9%
chuyen da ngung tien trien, 17,5% dau vet md cu.... Phu hpp vdi nghidn cftu cua Ld Thanh Binh (20i3) [I]. Theo Nguyen Huu Dipu Oanh (2009) [3] 53,7% md ldy tiiai, 43,2% sanh thudng, 3,1% smih giiip. Su khac biet nay cd thd do ttong nghien cftu cua chung tdi ghi nhgn da sd cac thai phu cd DRQC thai nhi vdo chuyen da giai ^ a n boat dpng, dudi ^ luc con ca tii cung lam 49,5% cd sv bien d6i nhip tim thai vd khdng thS theo ddi sanh tiiudng qua ngd dm dao md phai chdm diit thai ky bdng phuong phdp md lay thai.
ChiSu ddi ddy rdn trung binh sau sinh la 60,2 ± 8,7cm, cd mdi USn quan gifta chieu ddi ddy rdn vd sd vong DRQC (p <0,OOI). Theo nghien cftu Nguyin Hiiu DiSu Oanh [3]
ghi nhgn chieu dai tnmg binh ddy rdn Id 53 cm, ngan nhdt la 30cm vd ddi nhat Id 90cm.
Theo Phan Trudng Sang [5] ghi nhan chieu dai ddy rdn trung binh la 56,3cm, dai nhdt la 90cm vd ngdn nhdt Id 28cm.
Chi sd Apgar tnmg binh thdi diem I phut: 6,8 ± 0,8 diem vd sau 5 phut ddnh ^id l?i Id 9,1 ± 0,5 diSm - chi cdn 01 be ng^t nhe vdi Apgar 5 phut tiong khodng 6 -7 diem vd khdng trudng hpp nao sau sinh phai chuySn BV Nhi Ddng, 100% be sau sinh deu khe mgnh.Ket qud cua chung tdi tuong ddng vdi Liangcheng Wang (2016) [8] ghi nh|in Apgar
TAP CHt Y DirOfC HOC CAN THO - SO 13-14/2018
1 va 5 phiit > 7 diem Ian luot chiSm 98,7% va 99,9% va khong co su khac biet chi s6 Apgar giua nhom c6 DRQC vi nhom chiing.
Thoi gian nam vien trung binh la 4,9 ± 1 ngay, 2% truong hop nam vien keo dai tren 7 ngay va nguyen nhSn chu yeu do dau vet mo, chua trung tien duoc hoac do chinh nguoi nha thai phu yeu ciu,...
V. KET L U ^
24,3% thai phu co diu hieu lam sang nghi ngo DRQC trong do co 17,3% thai phu CO bieu hien dau viing day tir cung, dau am i keo dai ngoai con co; 23,3% ngoi dau cao long hoac ngoi thai bi keo len cao khi het con co tir cung; 3 % chuyen da giai doan 2 keo dai. Gia tri RI va S/D trung binh cua DM nao giiia la RI = 0,72 ± 0,05; S/D = 3,8 ± 0,70;
gia tri chi s6 RI va S/D trung bmh cua DM r6n la RI = 0,54 ± 0,05; S/D = 2,30 ± 0,26. Ket qua xu tri thai ky: sanh thuong 17,3%, sanh biing Forceps 0,5% va 82,2% m6 liy thai. Sau sanh CO 89,1% truong hop DR(JC 1 voiig, 10,4% truang hop DRQC 2 vong va 0,5%
DRQC 3 vong. Apgar 1 phut < 7 diim chiim 87,1% va 12,9% co Apgar 1 phut > 7 diim.
100%! truong hop me va be sau sinh deu khoe manh khi xuSt vien. Thoi gian nam vien trung binh la 4,9 ± 1 ngay.
TAI LIEU T H A M K H A O
1. Le Thanh Binh (2013), Khdo sdt mdi lien quan giira day rdn qudn cd thai nhi vd kieu hinh nhfp tim thai trong giai dogn chuyin dg tai Khoa Sdn BVDKTWCT, Luan van tdt nghiep bac Sl da khoa,Trudng Dai hpc Y Dupe Can Tha.
2. Nguyen Thj My Linh va cac cpng su (2012), Gid tri sieu dm Doppler trong chdn dodn ddy rdn qudn cd tgi BV DKTT An Giang.
3. Nguyen Hihi Dieu Oanh (2009), Khdo sdt gid tri cua trieu chung ldm sdng, sieudm 3D vd Monitoring sdn khoa trong chdn dodn. theo doi vd xir tri ddy rdn qudn cd, Luan an chuyen khoa II, Trudng Dai hpc Y Dupe Can Tha.
4. Phong Thi Thanh Xuan (2014), Nghien ciru ung dgng sieu dm Doppler vd Monitoring sdn khoa trong chdn dodn vd ddnh gid kit qud xir tii ddy ron qudn cd tren thai du thdng chimin dg sanh tgi Bjnh viin Da khoa Tnmg uang Cdn Tha, Luan an chuyen khoa cap II, Trudng Bgi hpc Y Dupe Can Tha.
5. Phan Tmdng Sang (2005), Khdo sdt gia tri siiu dm, ldm sdng, monitoring tiong chdn dodn, theo doi. xir tri ddy rdn qudn cd, Ludn van Thac si, Truang Dai Hpc Y Khoa Hue.
6. Fangui Zhao va cac cpng sir (2015), "Quantitative analysis of tightness of nuchal cord and its relationship with fetal inttauterme disttess", Int J Clin Exp Med 8(10): 17507-17514.
7. Hatice Akkaya va cac cpng sy (2016), "Nuchal cord: is it really the silent risk of pregnancy?", Tlie Journal of Maternal-Fetal <& Neonatal Medicine.
8. Liangcheng Wang va cac cpng su (2016), "Nuchal cord complication in male small for gestational age increases fetal distress risk during labor".
9. Nuriye Buyukkayaci Duman va cac cdng sir (2017), "The effects of umbilical cord entanglement upon labor management and fetal health: retrospective case conttol study".
The Journal of Maternal-Fetal & Neonatal Medicine.
10. Ting-ting X and Xue-mei F (2011), "Comparative analysis of umbilical artery and middle cerebral artery in fetus whh cord around neck", Modern Medical Journal, pp. 2-12.
(Ngdynhdnbdi: 12/11/2017-Ngdy duyjt ddng: 03/01/2018)
