胎心率基线变异在分娩方式选择及新生儿结局中的临床意义

Clinical significance of fetal heart rate baseline variability in the abnormal mode of delivery options and neonatal outcomes

目的：探讨胎心率基线变异在分娩方式选择及新生儿结局中的临床意义。方法回顾性分析2013年10月~2014年5月浙江省临安人民医院收治的150例单胎孕妇临床资料，根据孕妇的电子胎心监护中胎心率基线情况，将其分为观察组与对照组，每组各75例。观察组孕妇的电子胎心监护中胎心率基线变异减弱或消失，对照组孕妇电子胎心监护提示胎心率基线变异正常。比较两组产妇分娩方式、新生儿结局、脐带绕颈、羊水粪染等情况。并分析两组不同NST类型与新生儿Apgar评分的关系。结果观察组分娩方式以剖宫产为主，且剖宫产率明显高于对照组。分娩后，两组均无一例新生儿死亡，且对照组未见新生儿重度窒息与足月小样儿，而观察组新生儿重度窒息6例与足月小样儿6例，明显多于对照组，差异有统计学意义（P〈0.05）。观察组产妇出现羊水过少、羊水粪染、脐带绕颈的发生率均明显高于对照组，差异均有统计学意义（P〈0.05）。观察组NST可疑型Apgar评分≥8分新生儿例数明显少于对照组，而观察组NST可疑型Apgar评分≤7分的新生儿例数明显多于对照组，差异有统计学意义（P〈0.05）。结论胎心率基线变异减少或消失可以预测羊水胎粪污染、胎儿窘迫、分娩方式。胎心监护胎心率基线变异减弱或消失结合NST诊断有无胎儿窘迫，积极的处理，改善围生儿结局，提高产科质量，有效地避免胎死宫内的发生。

Objective To investigate the clinical relevance of fetal heart rate baseline variability in the abnormal mode of delivery options and neonatal outcomes. Methods Clinical data of 150 cases of singleton pregnant women from Octo-ber 2013 to May 2014 in the People＆#39;s Hospital of Lin＆#39;an City in Zhejiang Province were retrospectively analyzed and divided into observation group and control group, according to the baseline maternal electronic fetal heart rate monitor-ing of fetal heart rate, 75 cases in each group. The observation group was electronic fetal heart rate monitoring baseline fetal heart rate variability decreased or disappeared. The electronic monitoring of fetal heart rate baseline fetal heart rate variability of control group was normal. The mode of delivery, umbilical cord around the neck, meconium-stained amniotic fluid, and neonatal asphyxia of two groups were compared. Results Cesarean section was the main mode of de-livery in the observation group. The cesarean section rate of observation group was significantly higher than that of the control group. After delivery, there were no cases of neonatal death in two groups, and the control group had no severe asphyxia in neonates and infants. 6 cases of severe asphyxia and 6 cases of full-term infants in observation group, was significantly more than the control group, the difference was statistically significant （P〈 0.05）. The incidences of de-livery mode, amniotic fluid, and cord around neck of the observation group were significantly higher than those of con-trol group, the differences were statistically significant （P〈0.05）. In suspicious type NST, the newborn number of the observation group, whose Apgar score were more than 8 points, was significantly less than the control group. In suspi-cious type NST, the newborn number of the observation group whose Apgar score were less than 7 points, was more than the control group, the difference was statistics significance （P〈0.05）. Conclusion The reduction or disappearance of baseline fetal heart rate variability can predict meconium stained amniotic fluid, fetal distress, mode of delivery. Fetal heart rate baseline variability decreased or disappeared in combination with NST can diagnose fetal distress. Ac-tive treatment can improve the perinatal outcome, improve the quality of obstetrics, effectively avoid the occurrence of intrauterine fetal death.