Spencer M K, Khong T Y, Matthews B L, MacLennan A H
Department of Obstetrics and Gynaecology, Adelaide University, South Australia.
Aust N Z J Obstet Gynaecol. 2000 Aug;40(3):286-9. doi: 10.1111/j.1479-828x.2000.tb03336.x.
We aimed to study the haematopoietic response in normal and acidotic deliveries following vaginal and abdominal delivery and to compare this to the surrogate markers of perinatal acidosis. Blood gas analyses, complete blood pictures and erythropoietin assays were performed on umbilical or early neonatal blood samples. Placental sections were examined for the presence of nucleated red blood cells. Perinatal clinical risk factors and major neonatal outcomes were collected. The control population was 78 deliveries where the cord arterial pH was > 7.10. Controls born after labour were compared to those born prior to the onset of labour and to 14 acidotic infants born after labour. Nucleated red blood cells did not increase with labour in the control groups but were significantly higher (p < 0.05) in the acidotic group. Erythropoietin did not significantly change with either labour or acidosis. The predictive values from nucleated red blood cell counts were higher than those from low Apgar scores, atypical cardiotocograph traces, meconium-stained amniotic fluid, erythropoietin and the presence of nucleated red blood cells in placental sections. Nucleated red blood cell counts may be a useful surrogate marker of acidosis where blood gas analysis is unavailable. Further studies are required to examine the timing of the increase of erythropoiesis to help define the onset of the stimulus.
我们旨在研究顺产和剖宫产正常分娩及酸中毒分娩后的造血反应，并将其与围产期酸中毒的替代标志物进行比较。对脐血或早期新生儿血样进行血气分析、全血细胞计数和促红细胞生成素检测。检查胎盘切片中是否存在有核红细胞。收集围产期临床危险因素和主要新生儿结局。对照组为78例脐动脉pH值>7.10的分娩。将分娩后出生的对照组与分娩发动前出生的对照组以及14例分娩后出生的酸中毒婴儿进行比较。对照组中有核红细胞数量在分娩过程中未增加，但在酸中毒组中显著更高（p<0.05）。促红细胞生成素在分娩或酸中毒过程中均无显著变化。有核红细胞计数的预测价值高于低Apgar评分、异常胎心监护图、羊水胎粪污染、促红细胞生成素以及胎盘切片中有核红细胞的存在。在无法进行血气分析的情况下，有核红细胞计数可能是酸中毒的有用替代标志物。需要进一步研究以检查红细胞生成增加的时间，以帮助确定刺激的开始时间。
