对妊娠肝内胆汁淤积症孕妇进行胎儿监护的临床意义

Clinical Value of Fetal Monitoring in Intrahepatic Cholestasis of Pregnancy

目的 探讨对妊娠肝内胆汁淤积症 (ICP)孕妇进行胎儿监护的临床价值。方法 对 2 0 6例ICP孕妇进行无负荷试验 (NST)和声振刺激试验 (VAS T) ,对其中 5 1例进行宫缩应力试验 (CST)或催产素激惹试验 (OCT) ,15 7例进行超声脐动脉血流分析、12 7例进行胎儿心电图检查。结果 OCT和超声脐血流分析结果异常者的围产儿预后不良的发生率分别为 73 .3 %和 5 0 .0 % ,明显高于正常者的 2 7.8%和 3 3 .0 % ,差异有显著性 (P <0 .0 0 5和P <0 .0 5 )。NST、VAS T和胎儿心电图正常者和异常者的围产儿预后不良发生率无明显差异。结论 OCT和超声脐动脉血流分析对了解ICP孕妇胎盘功能和预测围产儿预后具有较高的临床价值 ;NST和VAS T具有操作简便、价格低廉、对母婴无任何创伤、重复性强等优点 ,可作为了解ICP孕妇胎儿宫内安危的首选监护项目 ;胎儿心电图检查在ICP孕妇伴有其他妊娠合并症时 。

Objective To study the clinical value of fetal monitoring in intrahepatic cholestasis of pregnancy (ICP). Methods Two hundred and six cases of ICP, deliving in our hospital from Dec.1993 to Sept.1998 were investigated. In these cases, 206 cases were examined by the fetal monitoring and vibtratory acoustic stimulation test (VAS T), 157 cases by ultrasonic umbilical artery flow analysis, and 127 cases by fetal electrocardiograph (FECG). Results There is a significant difference between normal and abnormal groups of the poor perinatal prognosis in constraction stress test (CST) and oxytocin challenge test (OCT) and ultrasonic umbilical artery flow anaalysis ( P <0.005, P <0.05). There is no difference between normal and abnormal groups of the poor perinatal prognosis in NST, VAS T and FECG. Conclusion CST,OCT and ultrasonic umbilical artery flow analysis have the higher clinical value to detect the poor placental function and to foretell the perinatal prognosis in ICP.