Abnormal Placental Findings Associated with Non-Reassuring Fetal Monitoring and Excellent Neonatal Outcomes

Objective: Obstetricians, Neonatologists, and Pathologists have studied gross histological analysis of human placentas in search of specific alterations in placental functions that can be correlated with neonatal outcomes. Our study assessed the prevalence of abnormal placental findings associated with non-reassuring fetal monitoring in labor requiring emergent instrumental or cesarean delivery, followed by an excellent neonatal outcome. Study Design: One hundred consecutive emergency deliveries, instrumental or cesarean, performed due to non-reassuring fetal monitoring while in labor were retrospectively evaluated. All patients were low-risk for obstetric complications, and had a singleton, term pregnancy. They had a normal antenatal routine testing and a normal anatomy ultrasound scan at 20 to 22 weeks gestation. Results: There were 35 placentas (35%) with gross placental anomalies at the delivery triage. Additionally 7 placentas (7%) were reported to be abnormal at the pathology examination. Conclusion: The prevalence of abnormal placental findings in our studied population was 42%.

Community Hospital Experience of Surgical Times and Outcomes in Patients Undergoing Cesarean Deliveries for Non-Reassuring Fetal Tracing: A Retrospective Cohort

Background: Current guidelines recommend regional anesthesia versus general as a method of choice for women undergoing cesarean deliveries (CS). However, little is known about the surgical times in the operating room and a choice of anesthesia for cesarean deliveries. Objective: This study was designed to compare times from the arrival to the OR to the delivery of the fetus between regional and general anesthesia along with maternal and fetal outcomes, for patients undergoing cesarean sections for non-reassuring fetal tracing. Study Design: Records were reviewed for patients who underwent cesarean delivery for non-reassuring fetal heart rate tracing from February 2012 to May 2018. A total of 190 charts were selected. Seven patients who received epidural or spinal anesthesia and then converted to general anesthesia (GA) were excluded. The primary outcomes were: 1) entering the operating room to skin incision (min);2) the time from entering the operating room to delivery of the fetus (min). These times were compared among the patients who underwent epidural, spinal and general anesthesia. The secondary criteria included time from skin incision to delivery of the fetus (min), estimated blood loss (ml), Apgars scores, Arterial/venous cord pH, NICU admissions and fetal complications. ANOVA or Kruskal-Wallis Test was used for the continuous variable and Fisher’s exact test was used for the categorical variable to test the differences between groups. Logistic regression model was used for the binary outcomes after adjusting for age, BMI and number of prior laparotomies. Results: Infants in the GA group were delivered significantly faster when compared to epidural and spinal group separately with a P-value of 0.001. The mean time from arrival to OR to delivery of the newborn in GA group was 12.7 minutes, compared to 27 minutes in epidural group and 32.7 minutes in the spinal group. Time intervals from time in the OR to incision and time from incision to delivery of the fetus were also calculated and were significantly shorter in the GA group when compared to spinal and epidural groups, P Conclusion: The induction of general anesthesia for emergency cesarean section resulted in shorter times to delivery compared to spinal and epidural. General anesthesia was associated with lower, albeit not statistically significant Apgar scores and higher NICU admissions, and had similar cord gases compared to neuraxial anesthesia group.

Development of Portable Monitoring System for Real-Time Detection of Fetal Movement

Effective fetal monitoring is an important guarantee for fetal health and early treatment. Fetal movement is one of critical indicators of fetal monitoring, which plays an important role in fetal health. Counting the number of fetal movement by pregnant women is a traditional method for long-term monitoring. However, there are many defects in pregnant women’s feeling count, which cannot meet the accurate requirements of modern perinatal medicine. With the rapid development of biological and electronic technology, various sensors are used to probe the fetal dynamic monitoring, but not on fetal movement. This research proposes a monitoring method for fetal movement via three electrodes. Briefly: first, three electrodes are used to extract electrical signals in the abdomen of pregnant women;second, these signals are amplified and filtered;third, A/D converter with microprocessor is used to make analog digital conversion, which can be stored in the SD card under the control of the microprocessor;finally, the SD card data are processed by computer software and the fetal movement information is analyzed.

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.

胎儿先天畸形超声监测结果分析

目的:分析2020-2023年聊城市第二人民医院胎儿先天畸形(CM)监测结果并分析影响因素。方法:收集2020年1月-2023年12月在本院产前检查的孕妇5852例,根据超声筛查结果并分成畸形组和无畸形组。对孕妇相关资料行单因素分析,并通过多因素分析确定胎儿CM的影响因素。结果:5852例孕妇中胎儿存在CM有56例,CM发生率为0.96%;在畸形部位上,以心血管系统为主(30.4%),其次为神经系统畸形(23.2%);畸形组和无畸形组在妊娠年龄≥35岁、异常妊娠史、孕期毒物接触史、孕期用药史、孕期感染病原体、孕期补充叶酸、孕期患糖尿病或高血压、配偶吸烟间存在差异(P<0.05);logistic回归分析显示,胎儿CM的危险因素主要为妊娠年龄≥35岁(OR=2.289)、孕期有毒物接触史(OR=3.152)、孕期有用药史(OR=2.516)、孕期感染病原体(OR=2.449)、孕期患糖尿病或高血压(OR=2.792)、配偶吸烟(OR=2.584),保护因素为孕期补充叶酸(OR=0.478)。结论:本次调查妊娠年龄≥35岁、孕期有毒物接触史、孕期有用药史、孕期感染病原体、孕期患糖尿病或高血压、配偶吸烟与胎儿CM发生有关,补充叶酸可减少胎儿CM发生。提示对上述高危因素予以精准干预,并指导孕妇有效补充叶酸,以降低胎儿CM发生风险。

单胎脐带过度扭转产时胎心监护特征及围产结局

目的 探讨脐带过度扭转的产妇在产时胎心监护图形特点、分娩方式及对围产儿预后的影响。方法 本研究采用回顾性病例对照研究的方法,选取2012年1月—2021年12月于北京某三甲医院产科住院分娩时发现脐带过度扭转的单胎孕妇122例(扭转组),同期住院的无脐带过度扭转136例产妇(对照组),比较两组产妇的一般情况、分娩方式、围产儿结局,及不同程度脐带过度扭转的胎心监护特征对新生儿的影响。结果 扭转组与对照组间产妇的平均孕周差异有统计学意义(P<0.05),在分娩方式(剖宫产或阴道顺产)、新生儿出生体重、身长、脐带长度、胎儿窘迫发生率差异有统计学意义(P<0.05),扭转组的Ⅱ类、Ⅲ类胎心监护图形显著高于对照组(P<0.05),脐带重度扭转与轻度扭转相比,更易发生胎儿窘迫、出现Ⅱ类、Ⅲ类监护,差异均有统计学意义(P<0.05)。结论 脐带过度扭转存在一定的孕期高危因素,增加了剖宫产和阴道助产的机会,胎儿宫内窘迫发生率增加,其大部分监护图形正常,但Ⅱ类,Ⅲ类图形明显增加。

基于5G技术的远程母胎监护体系建设实践

目的/意义探索在妇产科医院建立基于5G技术的远程母胎监护体系,为医疗系统基于5G技术完善远程医疗、智慧医疗提供参考。方法/过程利用5G技术速度快、频谱宽、低时延等优点,结合母胎监护、在线教育、远程问诊、人工智能、健康数据管理、就医绿色通道等服务,构建孕产妇母胎监护数据库与母胎监护人工智能模型,建设远程母胎监护体系,优化胎心监护流程。结果/结论实现母胎监护院内、院外、医联体、互联网医院、救护车转运等的应用结合。

孕中期羊水过少胎儿动脉血流参数对胎儿窘迫的预测价值

目的:通过超声监测大脑中动脉、肾动脉及脐动脉血流,对孕中期羊水过少胎儿发生胎儿窘迫进行预测。方法:回顾性选取2020年1月至2022年5月于某院接受治疗的羊水过少的104例孕中期孕妇的临床资料,依据是否存在胎儿窘迫将其分为窘迫组(n=43)和非窘迫组(n=48)。采用Logistic多因素回归分析胎儿窘迫发生的危险因素,采用ROC曲线评估发生胎儿窘迫的预测效能,构建贝叶斯网络模型并对其进行验证。结果:胎动异常、胎心监护异常、血脂水平异常、血液流变学指标异常以及大脑中动脉、肾动脉、脐动脉参数异常均是发生胎儿窘迫的独立危险因素(P<0.05)。大脑中动脉、肾动脉和脐动脉血流参数三者联合评估发生胎儿窘迫的预测效能优于单一参数。贝叶斯网络模型预测显示,当患者3种动脉参数的异常概率为100%时,胎儿窘迫发生率由49.9%升高为61.50%,且经验证贝叶斯网络模型预测胎儿窘迫的净获益较高。结论:孕中期孕妇羊水过少时,对胎儿进行脐动脉、大脑中动脉和肾动脉血流参数的三者联合监测可以有效预测胎儿窘迫。

万古霉素治疗药物监测中不同牛血清替代人血清可行性分析

目的分析万古霉素治疗药物监测(TDM)中不同牛血清替代人血清作为空白基质的可行性。方法建立测定万古霉素血药浓度的高效液相色谱(HPLC)法。收集医院2022年1月至2023年1月接受万古霉素治疗患者的血清样本105份(已检测血药浓度),关联人血清和不同厂家(厂家1和厂家2)的不同牛血清(小牛血清、新生牛血清、胎牛血清)作为空白基质的标准曲线,得到相应的血药浓度。采用Passing-Bablok回归分析法和Bland-Altman法考察测定结果的相关性和一致性。结果以人血清和不同牛血清作为空白基质时,万古霉素质量浓度在1~100 mg/L范围内与峰面积线性关系均良好(R^(2)>0.999);日内精密度、日间精密度的RSD均小于15%,相对回收率均在85%~115%范围内。人血清与不同牛血清作为空白基质均有良好的相关性(r>0.999),但均有系统误差和比例误差。厂家1的3种牛血清(小牛血清1、新生牛血清1、胎牛血清1)对比人血清作为空白基质检测值的相对平均偏差和95%一致性界限均小于50%允许总误差(±15%),厂家2的3种牛血清(小牛血清2、新生牛血清2、胎牛血清2)对比人血清作为空白基质检测值的相对平均偏差或95%一致性界限超出±15%。结论使用HPLC法进行万古霉素TDM时,部分厂家生产的牛血清能替代人血清作为空白基质进行检测。

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。

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。

母亲胎儿监护仪相关专用标准的研究

安全和性能可靠的母亲胎儿监护仪(简称母胎监护仪)可为孕产妇和胎儿提供全方面的生理监护,有效降低母婴死亡率。现阶段我国除母胎监护仪设备适用医用电气设备通用标准要求外,并无针对母胎监护仪的专用标准,行业普遍做法是参照和借鉴多参数监护仪和超声多普勒胎儿监护仪的专用标准。基于此,研究母胎监护仪适用的专用标准,针对母胎监护仪基本安全和基本性能要求,提出制定专用标准的设想,以期有效保障产品的安全有效性。

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。

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。

优质护理联合胎心监护在分娩产妇中的应用效果

目的探讨优质护理联合胎心监护在分娩产妇中的应用效果。方法选取本院380例临产妇为研究对象,按照随机数字表法分为两组,各190例。对照组开展常规护理,观察组开展优质护理联合胎心监护,比较两组的产程时间、母婴结局、护理满意度。结果观察组第一产程、第二产程、第三产程、总产程用时短于对照组(P<0.05);观察组产妇不良妊娠结局发生率、新生儿不良结局发生率均低于对照组(P<0.05);观察组健康教育、心理护理、环境护理、监测护理、体位护理评分高于对照组(P<0.05)。结论优质护理联合胎心监护在分娩产妇中的应用效果确切,能够缩短产程,保障良好的妊娠结局,提升护理满意度评分,值得应用。

远程超声多普勒胎心监护仪的发展趋势及其应用研究

远程超声多普勒胎心监护仪是一种新型的医疗设备,其发展趋势主要体现在技术的不断创新和应用范围的扩大。随着无线通信技术和互联网的发展,远程超声多普勒胎心监护仪可以实现远程监测胎心信号,为孕妇提供更加便捷和及时的医疗服务。未来,随着医疗技术的不断进步,其在医疗行业的应用也将得到进一步推广。

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。

超声监测胎儿脑脐血流对子痫前期孕妇胎儿生长受限的诊断价值

目的 分析超声监测胎儿脑脐血流对子痫前期孕妇胎儿生长受限的诊断价值。方法 选取2021年1月至2023年1月在遵义市第一人民医院产科建档的120例子痫前期孕妇,采用彩色多普勒超声诊断仪监测胎儿大脑中动脉、脐动脉的血流参数,以妊娠结局为金标准,采用Kappa检验分析超声诊断与金标准的一致性,并分析不同动脉血流参数的诊断效能。结果 胎儿脑脐动脉血流参数联合诊断结果与金标准的一致性(Kappa=0.832)高于单独胎儿大脑中动脉血流参数(Kappa=0.587)、胎儿脐动脉血流参数诊断结果(Kappa=0.561);胎儿脑脐动脉血流参数联合监测的灵敏度、特异度、准确性、阳性预测值、阴性预测值高于胎儿大脑中动脉血流参数监测、胎儿脐动脉血流参数监测(P <0.05)。结论 胎儿大脑中动脉和脐动脉血流参数联合诊断子痫前期孕妇胎儿生长受限的价值较高。

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。

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.