胎心监护图形联合彩色多普勒超声预测胎儿窘迫

Application value of fetal heart rate monitoring combined with color Doppler ultrasonography in predicting fetal distress

目的分析胎心监护图形联合彩色多普勒超声检测胎儿脐动脉(UA)、大脑中动脉(MCA)血流动力学在预测胎儿窘迫中的应用价值。方法回顾性收集2020年1月-12月在我院分娩的晚孕期孕妇84例患者的临床资料,根据临产时是否出现胎儿窘迫将其分为窘迫组(26例)、未窘迫组(58例)。比较2组胎心监护情况、UA、MCA血流动力学、妊娠结局、羊水污染和胎儿窒息情况。结果窘迫组胎心监护异常率(84.62%)高于未窘迫组(12.07%)(P<0.05)。窘迫组胎儿UA的PI、RI高于未窘迫组(P<0.05),MCA、MCA/UA的PI、RI低于未窘迫组(P<0.05)。窘迫组羊水过少、剖宫产、胎膜早破、脐带绕颈孕妇占比分别为53.85%、80.77%、42.31%、65.38%,均高于未窘迫组的8.62%、22.41%、8.62%、6.90%(P<0.05)。窘迫组羊水污染程度Ⅰ度、II度、III度,阿氏评分(Apgar评分)0~3分、4~7分孕妇占比分别为19.23%、23.08%、5.41%、7.69%、7.69%,均高于未窘迫组的5.17%、1.72%、0.00%、0.00%、0.00%(P<0.05),Apgar评分8~10分孕妇占比为84.62%,低于未窘迫组的100.00%(P<0.05)。结论胎儿窘迫的晚孕期孕妇胎心监护图形及UA、MCA血流动力学检查均存在异常,可提示胎儿可能存在缺氧,且能一定程度预测妊娠结局,具有较高的应用价值。

Objective To analyze the application value of the fetal heart rate monitoring combined with the color Doppler ultrasonography in predicting fetal distress by detecting the fetal umbilical artery(UA)and middle cerebral artery(MCA)hemodynamics.Methods The clinical data of 84 pregnant women in the third trimester who delivered in our hospital from January to December 2020 were retrospectively collected,and they were divided into a distress group(26 cases)and a non-distress group(58 cases)according to whether fetal distress occurred during labor.The fetal heart rate monitoring,UA and MCA hemodynamics,pregnancy outcome,amniotic fluid contamination and fetal asphyxia were compared between the two groups.Results The abnormal rate of fetal heart rate monitoring in the distress group(84.62%)was higher than that in the non-distress group(12.07%)(P<0.05).The PI and RI of UA in the distress group were higher than those in the non-distress group(P<0.05),while the PI and RI of MCA and MCA/UA were lower than those in the non-distress group(P<0.05).The proportions of pregnant women with oligohydramnios,cesarean section,premature rupture of membranes,and umbilical cord around the neck in the distress group were 53.85%,80.77%,42.31%,and 65.38%,respectively,which were higher than 8.62%,22.41%,8.62%and 6.90%in the non-distress group(P<0.05).In the distress group,the proportions of pregnant women with amniotic fluid pollution degreeⅠ,ⅡandⅢand the Apgar score 0-3 and 4-7 were 19.23%,23.08%,5.41%,7.69%and 7.69%,respectively,higher than 5.17%,1.72%,0.00%,0.00%,0.00%in the non-distressed group(P<0.05),while the proportion of pregnant women with the Apgar score 8-10 was 84.62%,lower than 100.00%in the non-distress group(P<0.05).Conclusion Abnormalities in the fetal heart rate monitoring graphics,in the UA and MCA hemodynamics in late pregnant women with fetal distress,can indicate that a fetus may have hypoxia,and can predict the pregnancy outcome to a certain extent,having a high application value.