产前胎心监护异常与围产结局的关系分析

Relationship between prenatal cardiac monitoring anomaly and perinatal outcomes

目的探讨孕产妇产前胎心监护异常与脐带、羊水异常及新生儿结局的关系和对分娩方式的影响。方法选择在三门县人民医院产科门诊行产前胎心监护的孕产妇为研究对象,应用无应激试验(NST)、B超等对胎心、脐带、羊水情况进行评价,根据NST试验结果将孕产妇分为胎心监护异常组(530例)和正常对照组(2 085例),对比分析两组孕产妇脐带、羊水的异常发生率、新生儿结局及分娩方式的差异。结果胎心监护异常组的脐带异常、羊水量异常及羊水粪染的发生率均高于正常对照组,差异均有统计学意义(x^2值分别为112.838、32.220、93.248,P<0.05)。胎心监护异常组的新生儿出生后1min Apgar评分平均值低于正常对照组(u=19.533,P=0.000),且新生儿窒息的发生率高于正常对照组,差异有统计学意义(x^2=37.589,P=0.000)。胎心监护异常组的正常产所占比例低于正常对照组,而阴道助产率、有剖宫产指征的剖宫产率均高于正常对照组,差异均有统计学意义(x^2值分别为416.393、26.277、564.367,PP<0.05)。结论产前胎心监护异常与脐带、羊水情况及新生儿结局密切相关,同时也影响着分娩方式的选择。对缺氧损伤胎儿进行及时有效的诊断和处理,可降低新生儿窒息的发生率,对改善预后具有重要意义。

Objective To investigate the relationship between prenatal cardiac monitoring anomaly and the anomaly of umbilical cord and amniotic fluid, and neonatal outcomes as well as the effects on delivery mode. Methods The pregnant and lying - in woman who received prenatal cardiac monitoring in obstetrics outpatient clinics of People＇ s Hospital of Sanmen were selected as the research objects. The cardiac monitoring, umbilical cord and amniotic fluid were tested with no stress test （NST） , B-ultrasound and so on. According to NST results, the cases were divided into cardiac monitoring anomaly group （n = 530） and normal control group （n = 2 085 ）. The differences in the incidence of umbilical cord anomaly and amniotic fluid anomaly, neonatal outcomes, and delivery mode between two groups were analyzed. Results The incidence of umbilical cord anomaly, amniotic fluid anomaly and amniotic infection in cardiac monitoring anomaly group was signifieantly higher than that of the normal control group, and the differences had statistical significance （χ2 value was 112. 838, 32. 220 and 93. 248, respectively, all P 〈 0.05 ）. The average 1 rain Apgar score of the cardiac monitm＇ing anomaly group was significantly lower than the normal control group （ u = 19. 533 ,P =0. 000） , hut the incidence of neonatal asphyxia was obviously higher than normal control group （χ2 = 37. 589,P = 0. 000）. The proportion of normal delivery in cardiac monitoring anomaly group was lower than the normal control group, while vaginal midwifery rate and cesarean section rate with cesarean section indications were higher than normal control group. The differences between two groups had statistical significance （χ2 value was 416. 393, 26. 277 and 564. 367, respectively, all P 〈 0.05 ）. Conclusion Prenatal cardiac monitoring anomaly is closely related to the umbilical cord, amniotic fluid and neonatal outcomes, and it also affects deliveiverymode. Timely and effective diagnosis and treatment on anoxic damage of the fetus can reduce the incidence of neonatal asphyxia, and can improve prognosis with great significance.