以胎儿窘迫为剖宫产指征的胎心监护图形分析

Graphic analysis of fetal heart rate monitoring with fetal distress as the indication of cesarean section

目的分析以胎儿窘迫为剖宫产手术指征的胎心监护图形,以提高产前胎儿窘迫诊断准确率,降低胎儿窘迫为指征的剖宫产率。方法回顾性分析2011年1月至2018年12月于本院分娩的以胎儿窘迫为剖宫产指征的723例产妇的临床资料,采用胎心监护三类评价系统分析患者的胎心监护图形、胎儿窘迫符合率、新生儿窒息胎心监护图形特征及胎心监护Ⅱ类图形不同特征胎儿窘迫的诊断符合率。结果723例中新生儿窒息共176例,其中Ⅰ类图形0例;Ⅱ类图形145例,胎心基线微小变异所致的新生儿窒息占比最高为31.3%(55/176);Ⅲ类图形31例。Ⅰ类图形40例,胎儿窘迫诊断符合率为5.0%;Ⅱ类图形585例,胎儿窘迫诊断符合率为60.2%;Ⅲ类图形98例,胎儿窘迫诊断符合率为88.8%。Ⅱ类图形和Ⅲ类图形胎儿窘迫诊断符合率均高于Ⅰ类图形(P<0.05)。Ⅱ类图形中,胎儿心动过速和显著变异的胎儿窘迫诊断符合率显著低于其他Ⅱ类图形(P<0.05)。结论胎心监护三级分类法有助于临床医生对胎心监护图形的正确解读,从而减少胎儿窘迫的过度诊断,减少不必要的剖宫产。

Objective Analyze the fetal heart rate monitoring with fetal distress as the indication of cesarean section,so as to improve the diagnostic accuracy of prenatal fetal distress and reduce the cesarean section rate with fetal distress as the indication.Methods The clinical data of 723puerpera with fetal distress as indication of cesarean section delivered in our hospital from January 2011 to December 2018 in our hospital were analyzed retrospectively,three types of evaluation system for fetal heart rate monitoring were used to analyze the fetal heart rate monitoring graphics,the coincidence rate of fetal distress,the characteristics of fetal heart monitoring graphics of neonatal asphyxia and the diagnostic coincidence rate of fetal distress with different characteristics of fetal heart monitoring class Ⅱ graphics.Results There were 176 cases of neonatal asphyxia in 723 cases,including 0 cases of class Ⅰ graphics;there were 145 cases of class Ⅱ graphics;the highest proportion of neonatal asphyxia caused by small variation of fetal heart rate at baseline was 31.3%(55/176);there were 31 cases of class Ⅲ graphics.There were 40 cases of type Ⅰ graphics,and the coincidence rate of fetal distress diagnosis was 5.0%;there were 585 cases of type Ⅱ graphics,and the coincidence rate of fetal distress diagnosis was60.2%;there were 98 cases of type Ⅲ graphics,and the coincidence rate of fetal distress diagnosis was 88.8%.The coincidence rate of diagnosis of fetal distress in type Ⅱ and type Ⅲ graphics was higher than that in type Ⅰ graphics(P<0.05).The coincidence rate of the diagnosis of fetal distress with tachycardia and significant variation is significantly lower than that of other class Ⅱ graphics(P<0.05).Conclusion The three-level classification method of fetal heart monitoring helps clinicians to correctly interpret the graphics of fetal heart rate monitoring,thereby reducing the excessive diagnosis of fetal distress and reducing unnecessary cesarean section.