第二产程胎心监护图形与新生儿结局的关系

Clinical Impacts of Nonstress Test during Second Stage of Labor on Perinatal Outcomes

目的探讨第二产程胎心监护图形与新生儿结局的关系,分析各类异常图形的临床意义。方法对2011年10月—2012年3月待产的2 848例产妇的临床资料进行回顾性分析,选择第二产程胎心监护出现Ⅱ类、Ⅲ类图形的423例产妇为观察组,随机选择同时期200例第二产程为Ⅰ类图形的产妇为对照组,观察组根据胎心监护图形不同分为7个亚组,分别与对照组脐动脉血pH值、第二产程时间、低Apgar评分(≤7分)、新生儿窒息的情况比较。结果观察组除早期减速和延长减速亚组外,其余各亚组脐动脉血pH值均不同程度地低于对照组(P<0.01);观察组除延长减速亚组外,其余各亚组第二产程时间均较对照组缩短(P<0.01);观察组除早期减速和延长减速亚组外,其余各亚组低Apgar评分患儿比例均高于对照组(P<0.01);观察组中基线异常、正弦型、晚期减速亚组新生儿窒息率高于对照组(P<0.01)。结论第二产程连续胎心监护中出现Ⅱ类、Ⅲ类图形能早期提示胎儿宫内窘迫,医务人员需及时准确处理,从而降低新生儿窒息率。

Objective To explore the clinical impacts of nonstress test （NST） during the second stage of labor on perinatal outcomes. Methods A retrospective analysis based on 2 848 expectant mothers from October 2011 to March 2012 was carried out. Of the total, 423 patients, whose NST results on the second stage of labor were found to be type Ⅱ or Ⅲ, were taken as case group, in which there were 7 sub-groups based on different NST results, while those with NST results of type I （n=200） during the same time period as control group. Clinical data, mainly the perinatal outcomes of two groups were collected for comparison. Results There were significant differences of umbilical arterial blood pH values, delivery time as well as low Apgar score among sub-case groups and control group （P〈0.01）. The neonatal asphyxia rate in sub-groups of abnormal baseline, sinusoidally and late deceleration significantly differed from that of control group （P〈0.01）. Conclusion Consecutive monitoring the type Ⅱ or Ⅲ NST results during the second stage of labor would be helpful for early identification of fetal distress.Timely and accurate managements could reduce the rate of neonatal asphyxia.