第一产程异常胎心监护图形与新生儿结局的关系

Relationship between abnormal fetal heart rate tracing patterns during the first stage of labor and perinatal outcome

目的 探讨第一产程异常胎心监护图形与新生儿结局的关系。方法 回顾分析 2 0 0 2年 8月至 2 0 0 3年 6月在我院足月单胎头位分娩产妇 ,第一产程中胎心率 (FHR)异常图形 2 1 7例 (观察组 )和FHR正常图形的2 6 9例 (对照组 )的临床资料。结果 第一产程异常FHR图形的发生率为 4 4 7% ,常见类型为轻度变异减速(6 4 5 % )、基线变异减弱 (2 1 6 % )和轻度心动过速 (1 2 0 % )。晚期减速、基线变异减弱和重度变异减速是导致新生儿窒息的危险因素。观察组羊水过少 (5 1 % )、脐带缠绕 (2 2 6 % )、羊水粪染 (1 0 6 % )、新生儿窒息 (6 5 % )、新生儿转入NICU(1 0 1 % )的发生率和剖宫产率 (31 8% )明显高于对照组 (P <0 0 5 )。结论 第一产程异常FHR图形的发生率较高 ,其中晚期减速、基线变异减弱、重度变异减速与新生儿窒息的发生相关 。

Objective To investigate the relationship between abnormal fetal heart rate(FHR) tracing patterns during the first stage of labor and perinatal outcome.Methods The perinatal outcomes of 217 cases at 37 to 42 gestational weeks with abnormal FHR tracing patterns during the first stage of labor were compared with 269 cases with normal ones from August 2002 to June 2003.Results The incidence of abnormal FHR tracing patterns during the first stage of labor was 44 7%(217/486).Common patterns of abnormal FHR tracing during the first stage of labor included mild variable decelerations(VD 64 5%),reduced baseline variability(21 6% ),and mild tachycardia(12 0%).Late decelerations,reduced baseline variability and severe variable decelerations were significant factors associated with birth asphyxia.The occurrences of oligohydramnios,umbilical cord loops,meconium stained amniotic fluid,birth asphyxia,admissions in neonatal intensive care units (NICU) and cesarean section were significantly higher in abnormal FHR tracing group compared with those with normal FHR tracing.Conclusion There is a high incidence of abnormal FHR tracing during the first stage of labor.Late decelerations,reduced baseline variability and severe variable decelerations are significantly related to birth asphyxia.