妊娠胆汁瘀积症的围产儿监测

Perinatal Monitoring in Intrahepatic Cholestasis of Pregnancy

以胎儿脐带血ｐＨ值为指标评价羊水胎粪污染，预测妊娠胆汁瘀积症（ＩＣＰ）患者围产儿结局的敏感性。结果：ＩＣＰ组ｐＨ＜７．２者１０例，８例羊水胎粪污染，阳性预测值为８０．０％，ｐＨ≥７．２者２０例，羊水胎粪污染４例，阴性预测值为８０．０％；对照组ｐＨ＜７．２者５例，羊水胎粪污染３例，阳性预测值６０．０％，ｐＨ≥７．２者２５例，羊水胎粪污染２例，阴性预测值９８．０％。两组间阳性预测值和阴性预测值均无统计学差异（Ｐ＞０．０５），但两组的阳性预测值和阴性预测值都比较高，表明羊水胎粪污染与胎儿宫内缺氧密切相关。而且，ＩＣＰ组羊水胎粪污染的发生率（４０．０％）明显高于对照组（１６．７％，Ｐ＜０．０５）。因此，我们主张对于ＩＣＰ患者，在妊娠期和分娩期应特别注意观察羊水有无胎粪污染。

The sensitivity of meconium stain in amniotic fluid for prediction of fetal well being in intrahepatic cholestasis of pregnancy(ICP) was evaluated.The study consisted of an ICP group( n=30) ,and a control group ( n =30) and the umbilical arterial pH value(<7.2) was used as a standard.The positive and negative predicttive valus of meconium stained amniotic fluid in ICP group were 80.0%;the positive and negative predictive values in control group were 60.0% and 92.0% respectively.There was no significant difference ( P >0.05) between the two groups in positive and negative predictive values.However,the positive and negative predictive values of the two groups were high,which indicated that meconium stained amniotic fluid related to fetal hypoxia.Moreover,the incidence of meconium stained amniotic fluid in ICP was higher than that in control (40.0%∶ 16.70%, P <0 05).Therefore,we suggest that the amniotic fluid of patients with ICP should be observed very closely.When meconium stained amniotic fluid is discovered,delivery by cesarean section is imminent.