Association between Fetal Heart Rate Monitoring during Labor and Neonatal Acidosis in Full-Term Newborns: A Retrospective Multicenter Cohort Study

Introduction: Fetal heart rate monitoring during labor is used to study fetal well-being and predict neonatal acidosis of newborn. Fetal heart rate monitoring is analyzed by the obstetrical team and categorized according to the FIGO guidelines. An important limitation of this diagnostic tool is an inter- and intra-observer variability, leading to subjective cardiotocography interpretation and classification. Our objective was to study the association between the categories of fetal heart rate analysis (according to FIGO classification) and neonatal acidosis of full-term newborns. Study design: This is a multicenter retrospective cohort study conducted between 2014 and 2018 in the Grand-Est region. We searched and included retrospectively children hospitalized in a pediatric intensive care unit in one of the participating hospitals with an ICD-10 coding type “P91.6” corresponding to “Hypoxic Ischemic Encephalopathy”. Maternal, pregnancy, delivery, and newborn characteristics were collected and compared by univariate logistic regression with multiple imputation. Odds Ratio and 95% confidence intervals (CI) were calculated using the model and presented. Multiple imputation with m = 100 imputations was tested, using Rubin rules to combine the results. Results: 55 patients were included in the study. Fetal heart rate tracings classified in Category 3 as “pathological” according to FIGO guidelines were significantly associated with an increased risk of severe neonatal acidosis. Late decelerations and bradycardia during labor were associated with severe neonatal acidosis. Conclusion: Severe neonatal acidosis may be suspected by interpretation of fetal heart rate during labor. Fetal bradycardia and late decelerations are predictive of the severity of neonatal acidosis. This study emphasizes the need to screen severe neonatal acidosis and allows the identification of populations most at risk. Repeated team training and upgrading of fetal heart rate study would further reduce the incidence of neonatal acidosis.

Critical evaluation of American categorization of fetal heart rate (FHR) decelerations and three tier classification—Shortcomings, contradictions, remedies and need for debate

Fetal heart rate (FHR) decelerations are the commonest aberrant feature on cardiotocograph (CTG) thus having a major influence on classification ofFHRpatterns into the three tier system. The unexplained paradox of early decelerations (head compression—an invariable phenomenon in labor) being extremely rare [1] should prompt a debate about scientific validity of current categorization. This paper demonstrates that there appear to be major fallacies in the pathophysiological hypothesis (cord compression—baroreceptor mechanism) underpinning of vast majority of (variable?) decelerations. Rapid decelerations during contractions with nadir matching peak of contractions are consistent with “pure” vagal reflex (head compression) rather than result of fetal blood pressure or oxygenation changes from cord compression. Hence, many American authors have reported that the abrupt FHR decelerations attributed to cord compression are actually due to head compression [2-6]. The paper debates if there are major fundamental fallacies in current categorization of FHR decelerations based concomitantly on rate of descent (reflecting putative aetiology?) and time relationship to contractions. Decelerations with consistently early timing (constituting majority) seem to get classed as “variable” because of rapid descent. A distorted unscientific categorization of FHR decelerations could lead to clinically unhelpful three tier classification system. Hence, the current unphysiological classification needs a fresh debate with consideration of alternative models and re-evaluation of clinical studies to test these. Open debate improves patient care and safety. The clue to benign reflex versus hypoxic nature of decelerations seems to be in the timing rather than the rate of descent. Although the likelihood of fetal hypxemia is related to depth and duration ofFHRdecelerations, the cut-offs are likely to be different for early/late/variable decelerations and it seems to be of paramount importance to get this discrimination right for useful visual or computerized system of CTG interpretation.

Interpretation of British experts’ illustrations of fetal heart rate (FHR) decelerations by Consultant Obstetricians, registrars and midwives: A prospective study—Reasons for major disagreement with experts and implications for clinical practice

Objective: To test the reproducibility of British experts’ (eFM, K2MS, Gibb and Arulkumaran) [1-3] illustrations of fetal heart rate (FHR) decelerations by trained British Obstetricians and midwives. To analyze reasons for any discrepancies by examining factors relating to the participants, British experts’ descriptions and NICE guidelines [4]. Design: Prospective observational study. Setting: National Health Service (NHS) Hospitals. Participants: 38 Obstetric Consultants, 49 registrars and 45 midwives. Methods: Printed questionnaire. Statistical Analysis: Fisher’s Exact test. Results: This largest study of its kind showed almost unbelievably high disconnect between CTG interpretation by experts and participants. 98% - 100% midwives, 80% - 100% Registrars and 74% - 100% Consultants categorized FHR decelerations differently from the five experts’ illustrations/interpretations (p < 0.0001). Remarkably, the three experts’ illustrations of early (supposedly most benign) decelerations were classed as atypical variable by 56% Consultants, 78% Registrars and 99% midwives and the CTGs as pathological by 85% of the participants. Conclusions: The high degree of disagreement with the experts’ illustrations (p < 0.0001) did not appear to be due to participant factors. The immediate reasons seemed to be the conflicting illustrations and heterogeneity of experts’ descriptions. But most importantly, these appeared to stem from non-standardized ambiguous definitions of FHR decelerations and many intrinsic systemic flaws in the current NICE guidelines [4]. The NICE concept of “true uniform” (identical) early and late decelerations seems biologically implausible (a myth) and no examples can be found. Another myth seems to be that early and late decelerations should be gradual. Only very shallow decelerations will look “gradual” on the British CTG. These systemic flaws lead to dysfunctional CTG interpretation increasing intervention as well as impairing diagnosis of fetal hypoxemia. This is because the vast majority of FHR decelerations fall in a single heterogeneous “variable” group with many further classed as “atypical” (pathological) based on disproven and discredited criteria [5-7]. There is increasing evidence in USA that a system with variable decelerations as the majority is clinically unhelpful because of loss of information [5-9]. In the interest of patient care and safety, open debate is necessary regarding a better way forward. Classification of FHR decelerations based primarily and solely on time relationship to contractions appears more scientific and clinically useful.

The Signal Extraction of Fetal Heart Rate Based on Wavelet Transform and BP Neural Network

This paper briefly introduces the collection and recognition of bio-medical sig nals, designs the method to collect FM signals. A detailed discussion on the sys tem hardware, structure and functions is also given. Under LabWindows/CVI,the ha rdware and the driver do compatible, the hardware equipment work properly active ly. The paper adopts multi threading technology for real-time analysis and make s use of latency time of CPU effectively, expedites program reflect speed, impro ve s the program to perform efficiency. One threading is collecting data; the other threading is analyzing data. Using the method, it is broaden to analyze the sig nal in real-time. Wavelet transform to remove the main interference in the FM a nd by adding time-window to recognize with BP network; Finally the results of c ollecting signals and BP networks are discussed.8 pregnant women’s signals of F M were collected successfully by using the sensor. The correct of BP network rec ognition is about 83.3% by using the above measure.

Unexplained fetal tachycardia:A case report

BACKGROUND This study aimed to explore the possible etiology and treatment of severe fetal tachycardia in the absence of organic disease and provide a reference for clinical management of severe fetal tachycardia.CASE SUMMARY A 29-year-old pregnant woman,with a gravidity 1 parity 0,presented with a fetal heart rate(FHR)of 243 beats per minute during a routine antenatal examination at 31+2 wk of gestation.Before termination of pregnancy at 38 wk of gestation,the FHR repeatedly showed serious abnormalities,lasting more than 30 min.However,the pregnant woman and the fetus had no clinical symptoms,and repeated examination revealed no organic lesions.The mother and the baby were regularly followed up.CONCLUSION This was a case of severe fetal tachycardia with no organic lesions and management based on clinical experience.

CTGNet: Automatic Analysis of Fetal Heart Rate from Cardiotocograph Using Artificial Intelligence

Objective:This study investigates the efficacy of analyzing fetal heart rate(FHR)signals based on Artificial Intelligence to obtain a baseline calculation and identify accelerations/decelerations in the FHR through electronic fetal monitoring during labor.Methods:A total of 43,888 cardiotocograph(CTG)records of female patients in labor from January 2012 to December 2020 were collected from the NanFang Hospital of Southern Medical University.After filtering the data,2341 FHR records were used for the study.The ObVue fetal monitoring system,manufactured by Lian-Med Technology Co.Ltd.,was used to monitor the FHR signals for these pregnant women from the beginning of the first stage of labor to the end of delivery.Two obstetric experts together annotated the FHR signals in the system to determine the baseline as well as accelerations/decelerations of the FHR.Our cardiotocograph network(CTGNet)as well as traditional methods were then used to automatically analyze the baseline and acceleration/deceleration of the FHR signals.The results of calculations were compared with the annotations provided by the obstetric experts,and ten-fold cross-validation was applied to evaluate them.The root-mean-square difference(RMSD)between the baselines,acceleration F-measure(Acc.F-measure),deceleration F-measure(Dec.F-measure),coefficient of synthetic inconsistency(SI)and the morphological analysis discordance index(MADI)were used as evaluation metrics.The data were analyzed by using a pairedt-test.Results:The proposed CTGNet was superior to the best traditional method,proposed by Mantel,in terms of the RMSD.BL(1.7935±0.8099vs.2.0293±0.9267,t=-3.55,P=0.004),Acc.F-measure(86.8562±10.9422vs.72.2367±14.2096,t=12.43,P<0.001),Dec.F-measure(72.1038±33.2592vs.58.5040±38.0276,t=4.10,P<0.001),SI(34.8277±20.9595vs.54.8049±25.0265,t=-9.39,P<0.001),and MADI(3.1741±1.9901vs.3.7289±2.7253,t=-2.74,P=0.012).The proposed CTGNet thus had significant advantages over the best traditional method on all evaluation metrics.Conclusion:The proposed Artificial Intelligence-based method CTGNet delivers good performance in terms of the automatic analysis of FHR based on cardiotocograph data.It promises to be a key component of smart obstetrics systems of the future.

The Efficacy of In-Phase and Quadrature Demodulation in Electronic Fetal Heart Rate Monitoring During Labor

Objective:To investigate the efficacy of in-phase and quadrature(IQ)demodulation in electronic fetal heart rate monitoring(EFM)to reduce false reports of fetal heart rate(FHR)doubling or halving.Methods:This is a prospective cohort study.A total of 263 full-term pregnant women who delivered at Peking University Shenzhen Hospital between August 2019 and July 2020 were prospectively enrolled in the study.FHR monitoring began when the cervix was dilated to 2-3 cm and continued until delivery.Raw fetal Doppler audio signals and internal and external cardiotocography curves from internal electrode monitoring,EFM with conventional demodulation(external),and EFM with IQ demodulation(external)were acquired to compare FHR doubling and halving time.In cohort 1,FHR was compared between IQ demodulation and conventional demodulation.In cohort 2,FHR was compared between IQ demodulation,conventional demodulation,and internal FHR monitoring.Count data were statistically analyzed using the Chi-squared test,and measurement data were statistically analyzed usingt-test for correlation coefficients,and Bland-Altman analysis for concordance ranges.Results:To compare IQ demodulation and conventional demodulation,225 pregnant women were monitored for a total of 835,870 seconds.The beat-to-beat interval of FHRs in raw fetal Doppler audio signals was used as the reference.The results showed a doubling time of 3401 seconds(0.407%,3401/835,870)and a halving time of 2918 seconds(0.349%,2918/835,870)with conventional demodulation,compared to 241 seconds(0.029%,241/835,870)and 589 seconds(0.070%,589/835,870),respectively,with IQ demodulation.IQ demodulation reduced FHR doubling by approximately 93%(3160/3401)and FHR halving by approximately 80%(2329/2918)compared to conventional demodulation(P<0.01).Conclusion:EFM with IQ demodulation significantly reduces false FHR doubling and halving,with an efficacy similar to that of internal FHR monitoring.

胎心仪产品服务体验优化设计策略与实践研究

随着人民对美好生活需求的日益增长,医疗康养产品设计成为设计研究的热点之一。本文以孕期胎心仪为例,对其开展体验优化的应用性设计研究。首先基于对孕妇群体的深度访谈,总结出两类典型用户画像;其后以服务可视化分析,寻找设计机会点,制订设计策略;最后完成胎心仪设计实践。实践表明,采用服务设计理念对胎心仪产品进行创新设计,能够形成具有深层特征的形态语言,完成体验结构的升级,能为相关产品的开发提供有益参考。

胎儿脐血流监测及胎心监护监测在高危妊娠中的预测价值

目的探讨高危妊娠应用胎儿脐血流监测及胎心监护监测的预测价值。方法回顾性分析2021年3月—2023年3月中国人民解放军空军特色医学中心妇产科收治的180例高危妊娠孕妇的临床资料,均开展胎儿脐血流监测和胎心监护监测。根据产前脐血流和胎心的监测结果,将研究对象分为甲组、乙组、丙组、丁组4组。对比4组的分娩指标(剖宫产、胎儿窘迫、脐带缠绕、羊水过少、胎粪污染、新生儿出生1 min内阿氏评分)、脐血流指标[脐动脉血流比值(systolic to diastolic velocity ratio,S/D)、脐动脉阻力指数(resistance index,RI)、脐动脉搏动指数(pulsatility index,PI)]。结果丁组剖宫产(79.17%)、胎儿窘迫(50.00%)、脐带缠绕(50.00%)、羊水过少(70.83%)、胎粪污染(100.00%)的不良分娩情况发生率最高,显著高于甲组、乙组,差异有统计学意义(P<0.05)。甲组新生儿出生1 min内阿氏评分8~10分比例显著高于乙组、丙组、丁组(P<0.05)。乙组和丙组新生儿出生1 min内阿氏评分8~10分比例均高于丁组(P<0.05)。丁组脐动脉血流指标(S/D值、RI、PI)高于甲组、乙组、丙组,差异有统计学意义(P<0.05)。结论对高危妊娠孕妇应用胎儿脐血流监测及胎心监护监测,可对不良妊娠结局提高预测准确性,有助于围产期的治疗与管理,减少不良分娩结局的产生,提高分娩质量。

基于物联网的胎心监护系统在孕晚期羊水量过少孕妇胎儿监测中的应用研究

目的:探讨基于物联网的胎心监护系统在孕晚期羊水量过少孕妇胎儿监测中的应用。方法:将2019年6月—2020年6月商丘市妇幼保健院产科收治的68例孕晚期羊水量过少孕妇设为对照组,将2020年7月—2021年7月收治的70例孕晚期羊水量过少孕妇设为观察组。对照组孕妇采用传统产前监护,观察组孕妇采用基于物联网的胎心监护系统实施监护。比较两组孕妇胎动异常发生率、新生儿无刺激性胎心监护(NST)异常检出率、孕妇不良妊娠结局及孕妇胎心监护满意度。结果:观察组新生儿NST异常检出率高于对照组,差异有统计学意义(U=9.992,P<0.05)。观察组胎动异常发生率比较,差异无统计学意义(χ^(2)=0.032,P>0.05)。观察组新生儿窒息发生率、早产发生率低于对照组,差异有统计学意义(χ^(2)=6.356、2.630,P<0.05);两组产妇不良妊娠结局中中转剖宫产率、新生儿吸入羊水发生率、产后出血发生率、术后感染发生率、新生儿缺血缺氧性脑病发生率比较,差异无统计学意义(χ^(2)=0.708、0.239、0.759、0.183、0.371,P>0.05)。观察组孕妇胎心监护满意度高于对照组,差异有统计学意义(χ^(2)=8.742,P<0.05)。结论:基于物联网的胎心监护系统可有效提高孕晚期羊水量过少孕妇胎儿的监测效果,有效降低孕妇不良妊娠结局发生率,提高孕妇胎心监护满意度。

彩色多普勒血流成像联合胎心监护无负荷试验在孕晚期高危产妇胎儿宫内窘迫诊断中的效能

目的:探讨彩色多普勒血流成像(CDFI)联合胎心监护无负荷试验(NST)在孕晚期高危产妇胎儿宫内窘迫诊断中的效能。方法:回顾性分析2020年8月至2022年8月该院收治的108名孕晚期高危产妇的临床资料,入院后均行CDFI、NST检查,以产后结果为“金标准”,统计CDFI、NST单项及联合检查诊断孕晚期高危产妇发生胎儿宫内窘迫的结果,比较CDFI、NST单项及联合检查诊断孕晚期高危产妇发生胎儿宫内窘迫的效能。结果:产后结果显示,108名孕晚期高危产妇中,39名发生产前胎儿宫内窘迫;CDFI检查结果显示,25名发生产前胎儿宫内窘迫;NST检查结果显示,24名发生产前胎儿宫内窘迫;CDFI联合NST检查结果显示,38名发生产前胎儿宫内窘迫;CDFI、NST检查诊断孕晚期高危产妇发生胎儿宫内窘迫的灵敏度、特异度、准确度、漏诊率、误诊率、阳性预测值、阴性预测值比较,差异均无统计学意义(P>0.05);CDFI联合NST检查诊断孕晚期高危产妇发生胎儿宫内窘迫的灵敏度、准确度均高于二者单项检查,漏诊率低于二者单项检查,差异有统计学意义(P<0.05)。结论:CDFI联合NST检查诊断孕晚期高危产妇发生胎儿宫内窘迫的效能高于二者单项检查。

胎儿心率采集信号噪声滤波电路设计及仿真

胎心仪使用硅晶传感器对孕妇孕期体内胎儿心率进行无创监测,胎儿心率是一种微弱信号,信噪比低且母体干扰信号强,包含大量与胎儿心率相似的低频信号,都使胎心信号解析十分困难。本文提出了一种应用于单晶片收发模式胎心仪的多级MFB(Multiple Feedback,无限增益多路反馈电路)滤波电路,此电路对微弱的胎心音进行放大和滤波预处理,并使用软件仿真的方法合理选择滤波电路参数,经过滤波预处理的心率信号进入CPU进行自相关算法得到心率数值。最终实验结果表明:经过此多级MFB滤波电路的胎心音信号信噪比高,滤除高频干扰和大部分低频信号的同时有效保留胎儿心脏搏动波形,从而使胎心计探头在胎心30mm范围内能准确的得到胎儿心率,且扬声器播放音频无杂音。

产时胎心监护联合针对性护理干预在分娩中的应用效果

目的:分析产时胎心监护联合针对性护理干预在分娩中的应用效果。方法:选取2021年3月—2023年3月于梧州市妇幼保健院分娩的产妇200例作为研究对象,随机分为观察组与对照组,各100例。对照组采用传统产时护理模式干预,观察组实施产时胎心监护联合针对性护理干预。比较两组新生儿窒息发生情况、阿普加(Apgar)评分及产妇护理满意度。结果:观察组新生儿窒息率低于对照组,差异有统计学意义(P=0.043);观察组新生儿出生1、5、10 min时Apgar评分高于对照组,差异有统计学意义(P<0.05);观察组产妇护理满意度高于对照组,差异有统计学意义(P=0.030)。结论:产时胎心监护联合针对性护理干预可降低新生儿窒息发生率,改善新生儿出生后身体情况,提高产妇护理满意度。

基于场景交互理论的家用胎心仪功能设计研究

通过“场景交互理论”分析家用胎心仪居家使用的环境适应性问题,对家用胎心仪的功能进行设计优化,提升双人监测的操作体验。基于场景交互理论内涵,将居家胎心监测语境下的角色识别细分为核心用户、辅助用户和周边用户,通过角色行为描述,发掘交互摩擦点,得出初级需求指标,通过AHP层级分析法计算,获取重要设计要求,最终从软硬件交互场景中系统性构建家用胎心仪的产品设计方案,为类似家用医疗产品的设计与开发提供借鉴。

Imperative for improvements and international convergence of intrapartum fetal monitoring: A bird's eye view

Intrapartum fetal monitoring has been criticized for the lack of evidence of improvement in fetal outcome despite causing increased operative intervention. Paradoxically, cardiotocography(CTG) has been a major driver for litigation for neonatal neurological injury. This analytical review tries to explore why extensive clinical studies and trials over 50 years have failed to demonstrate or bring about significant improvement in intrapartum fetal monitoring. There seems a need for significant reform. International congruence on most aspects of CTG interpretation [definitions of fetal heart rate(FHR) parameters, CTG recording speed, 3-tier systems, etc.] is highly desirable to facilitate future meaningful clinical studies, evaluation and progress in this field. The FHR changes are non-specific and poor surrogate for fetal well-being. As a compromise for maintaining low false-negative results for fetal acidemia, a high false-positive value may have to be accepted. The need for redefining the place of adjuvant tests of fetal well-being like fetal blood sampling or fetal electrocardiography(ECG) is discussed. The FHR decelerations are often deterministic(center-stage) in CTG interpretation and 3-tier categorization. It is discussed if their scientific and physiological classification(avoiding framing and confirmation biases) may be best based on time relationship to uterine contractions alone. This may provide a more sound foundation which could improve the reliability and further evolution of 3-tier systems. Results of several trials of fetal ECG(STAN) have been inconclusive and a need for a fresh approach or strategy is considered. It is hoped that the long anticipated Computer-aided analysis of CTG will be more objective and reliable(overcome human factors) and will offer valuable support or may eventually replace visual CTG interpretation. In any case, the recording and archiving all CTGs digitally and testing cord blood gases routinely in every delivery would be highly desirable for future research. This would facilitate well designed retrospective studies which can be very informative especially when prospective randomised controlled trials are often difficult and resource-intensive.

胎儿心脏定量分析技术在中孕晚期正常胎儿心脏结构及功能的研究

目的:用定量分析技术(fetal heart quantification,Fetal HQ),对中孕晚期正常胎儿心脏结构及功能等参数进行初步分析。方法:收集2019年9月至2020年1月,在北京安贞医院母胎医学中心就诊的,妊娠22~27周间的153例正常单胎妊娠胎儿,进行系统超声心动图检查,存储胎儿标准四腔心切面,通过Fetal HQ软件后处理操作计算出心脏整体及左、右心室不同节段的球形指数(sphericity index,SI),左、右心室24节段舒张末期内径及短轴缩短分数(fractional shortening,FS)、左、右心室面积变化率(left and right ventricular area change rate, FAC)及整体纵向应变(global left and right ventricular longitudinal strain,GLS)和LVEF并探讨各参数数据分布情况及与孕周之间的相关性。并进行检查者间和检查者自身的重复性检验。结果:除左心室1~24节段LVEDD及右心室第4~13节段舒张末期内径(right ventricular diastolic diameter, RVED)与孕周(gestational age, GA)呈正相关,且符合正态分布外,其他参数均与GA无相关性,其中右心室面积变化率(the right ventricular area change rate,RVFAC)、左心室短轴缩短分数(the left fractional shortening, LVFS)、右心室短轴缩短分数(the right fractional shortening,RVFS)及第10~17节段LVSI呈正态分布,整体球形指数(the sphericity index,GSI)、左心室面积变化率(the left ventricular area change rate,LVFAC)、LVEF、左心室纵向应变(left ventricular longitudinal strain,LVGS)、右心室纵向应变(right ventricular longitudinal strain,RVGS)、1~24节段右心室球形指数(right ventricular sphericity index,RVSI)、第1~9节段、18~24节段左心室球形指数(left ventricular sphericity index,LVSI)符合非正态分布。各参数观察者自身ICC为GSI:0.89,LVEF:0.79,LVGS:0.83, LVFAC:0.82, RVFAC:0.75, RVGS:0.74;观察者间ICC为GSI:0.83, LVEF:0.75, LVGS:0.78, LVFAC:0.74, RVFAC:0.70, RVGS:0.62。结论:Fetal HQ技术可以分析胎儿心脏整体及左、右心室24节段结构及功能,对了解胎儿心脏发育过程中不同节段的大小、形态、功能随孕周的差异性变化,提供了新的方法。

孕晚期基于胎心监护的临床护理对胎儿窘迫及新生儿窒息发生情况的影响

目的探讨孕晚期基于胎心监护的临床护理对胎儿窘迫及新生儿窒息发生情况的影响。方法选取2020年2月至2021年8月我院收治的80例孕晚期孕妇作为研究对象,按照护理方法将其分为对照组与研究组,各40例。对照组实施常规护理+胎心监护,研究组在常规护理的基础上实施基于胎心监护的临床护理。比较两组的羊水污染、胎儿窘迫、新生儿窒息发生情况以及不良分娩结局。结果研究组的羊水污染总发生率、胎儿窘迫发生率及新生儿窒息总发生率、不良分娩结局总发生率低于对照组(P<0.05)。结论基于胎心监护的临床护理用于孕晚期孕妇的效果良好,可有效减少羊水污染、胎儿窘迫及新生儿窒息的发生,改善分娩结局,值得推广及应用。

超声检测脐动脉血流指标联合胎心监护评估重度先兆子痫围生儿预后的价值

目的探讨超声检测脐动脉血流指标联合胎心监护评估重度先兆子痫围生儿预后的价值。方法选择2018年5月至2022年3月我院收治的重度先兆子痫孕妇80例作为研究组,同期健康孕妇80例作为对照组,两组均行脐动脉血流超声检查及胎心监护,比较两组的脐动脉血流指标及围生儿预后。结果研究组的收缩期峰值流速/舒张末期血流速度(S/D)、搏动指数(PI)、阻力指数(RI)水平均高于对照组,早产、新生儿窒息、低体重儿发生率均高于对照组(P<0.05)。结论超声检测脐动脉血流指标联合胎心监护在重度先兆子痫中应用价值较高,有助于提高重度先兆子痫检出率,在评估围生儿预后中具有重要作用。

产时超声监测胎心及胎方位结合新产程时限管理对高龄产妇产程及妊娠结局的影响

目的:分析产时超声监测胎心及胎方位结合新产程时限管理后高龄产妇的产程与妊娠结局。方法:回顾性选取2020年10月—2022年12月上饶市妇幼保健院高龄产妇60例,依据产时监测方法不同分组为对照组(予以胎心电子监护仪监测结合Friedman产程管理,n=30)、观察组(予以彩色多普勒超声监测结合新产程时限管理,n=30),比较两组的各产程时间、各产程时疼痛度、母婴结局、产后6周盆底功能。结果:观察组经阴道自然分娩率为73.33%,高于对照组的46.67%,而剖宫产率为26.67%,低于对照组的53.33%(P<0.05),观察组产后出血率低于对照组(P<0.05),两组会阴撕裂、产时发热、胎儿宫内窘迫,以及新生儿窒息、新生儿低体重、新生儿入住重症监护室发生率差异均无统计学意义(P>0.05);观察组产妇第一产程、第二产程、总产程时间均较对照组长(P<0.05);观察组第一产程、第二产程、第三产程中疼痛视觉模拟评分法(VAS)评分均低于对照组(P<0.05);产后6周,观察组盆底肌活力值、功值及峰值均大于对照组(P<0.05)。结论:产时超声监测胎心、胎方位结合新产程时限管理应用于高龄产妇中可促使产程延长,引导产妇经阴道分娩,减少剖宫产风险,改善母婴结局,促进盆底肌功能恢复。