胎盘早剥胎心监护的图形分析

Fetal heart rate patterns in placenta abruption

目的分析胎盘早剥异常胎心监护图形特征,总结图像规律,以提高早期诊治胎盘早剥的能力。方法选取2015年1月至2019年11月中山大学附属第一医院产科收治的胎盘早剥且胎心监护异常的56例病例,按出现胎心监护异常时临产情况分为已临产组(25例)和未临产组(31例),并对其胎心监护图形等资料进行分析;按胎盘早剥产前诊断与漏诊分为产前诊断组(30例)和产前漏诊组(26例),对其胎心监护异常的类型进行比较。结果胎盘早剥常见的胎心监护异常类型为无加速、微小变异、变异减速及宫缩波异常。微小变异在胎盘早剥未临产组胎监异常类型所占比例(51.6%)明显高于临产组(8%),两组差异有统计学意义(χ2=12.07,P<0.01);延长减速在未临产组胎监异常类型所占比例(6.5%)明显低于临产组(48%),两组差异有统计学意义(χ2=12.74,P<0.01)。宫缩波异常在产前诊断组胎监异常类型所占比例(50%)明显高于产前漏诊组(3.8%),两组差异有统计学意义(χ2=14.54,P<0.01);变异减速在产前漏诊组胎监异常类型所占比例(46.2%)明显高于产前诊断组(16.7%),两组差异有统计学意义(χ2=5.73,P=0.02)。结论准确判读胎心监护图形,有助于早期发现胎盘早剥。当胎心监护出现微小变异、延长减速或宫缩波异常时,需警惕胎盘早剥的发生。

Objective To explore the abnormal fetal heart rate(FHR)monitoring in cases of placenta abruption.Methods A retrospective analysis was conducted in 56 pregnant women with placental abruption in The First Affiliated Hospital of Sun Yat-sen University from January 2015 to November 2019.Results Undetectable acceleration,minimal variability,variable deceleration and abnormal uterine contraction appeared more common in abnormal FHR tracings cases of placental abruption.The incidence of minimal variability was higher in no-labor group than labor group,and the differences were significant(χ2=12.07,P<0.01).Prolonged deceleration appeared significantly more frequently in labor group than in no-labor group(χ2=12.74,P<0.01).The incidence of abnormal uterine contraction was significantly higher in diagnosis-before group than in diagnosis-after group(χ2=14.54,P<0.01),whereas the pattern of variable deceleration was more frequent in diagnosis-after group(χ2=5.73,P=0.02).Conclusions Accurate interpretation of fetal heart rate monitoring is helpful to early detection of placental abruption.When minimal variability,prolonged deceleration or abnormal uterine contraction appear,we should be alert to the occurrence of placental abruption.