脐动脉乳酸水平及胎儿心率监测对胎儿窘迫的预测价值

Zhang Hua, Zhang Jianhua, Wu Weixin, Deng Hui

Department of Obstetrics and Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.

Zhonghua Fu Chan Ke Za Zhi. 2002 Nov;37(11):666-8.

OBJECTIVE

Measuring umbilical artery lactate levels to evaluating the predictive value of abnormal fetal heart rate (FHR) monitoring patterns for fetal distress.

METHODS

There were 73 neonates with abnormal fetal heart monitoring patterns in the distress group. The abnormal patterns included abnormal baseline FHR, severe variable decelerations, mild variable decelerations and tachycardia. There were 118 normal neonates (Apgar score > or = 9) in the control group. Twenty min fetal heart monitoring was performed at the time of admitting, laboring and in labor and in active phase. Continuous fetal heart monitoring was performed during the second stage of labor. All neonatal umbilical artery lactate levels were measured at delivery.

RESULTS

The rate of using forceps in distress group was significantly higher than that of the control (P < 0.01), the rate of spontaneous labor was significantly lower than the control group (P < 0.01). In the distress group, severe variable decelerations were generally emerged in the second stage of labor. The incidence of neonatal Apgar score < or = 7 in neonates with abnormal baseline FHR was higher than those with severe variable decelerations, mild variable decelerations and tachycardia (P < 0.05). As for neonatal umbilical artery lactate levels, the neonatatuses with abnormal baseline FHR was (4.55 +/- 0.23) mmol/L, the neonatatuses with severe variable decelerations was (3.84 +/- 0.40) mmol/L, all significantly higher than the control group's (P < 0.01). The neonatatuses with mild variable decelerations was (2.63 +/- 0.32) mmol/L, the neonatatuses with tachycardia was (2.55 +/- 0.46) mmol/L, and there are no significant differences between the neonatatuses with mild variable decelerations and tachycardia and the control group's (P > 0.05).

CONCLUSIONS

Measuring umbilical artery lactate levels is an efficient and accurate technique for fetal distress diagnosis. There was a close correlation between baseline FHR with abnormal changes and severe variable deceleration with fetal distress. There was no certainly correlation between mild variable decelerations and tachycardia with fetal distress. It should be evaluated later.

目的

测量脐动脉乳酸水平，以评估异常胎儿心率（FHR）监测模式对胎儿窘迫的预测价值。

方法

窘迫组有73例胎儿心率监测模式异常的新生儿。异常模式包括FHR基线异常、重度变异减速、轻度变异减速和心动过速。对照组有118例正常新生儿（阿氏评分≥9分）。在入院时、临产时、产程中及活跃期进行20分钟的胎儿心率监测。第二产程进行持续胎儿心率监测。所有新生儿在分娩时测量脐动脉乳酸水平。

结果

窘迫组产钳使用率显著高于对照组（P<0.01），自然分娩率显著低于对照组（P<0.01）。在窘迫组中，重度变异减速一般出现在第二产程。FHR基线异常的新生儿中阿氏评分≤7分的发生率高于重度变异减速、轻度变异减速和心动过速的新生儿（P<0.05）。至于新生儿脐动脉乳酸水平，FHR基线异常的新生儿为（4.55±0.23）mmol/L，重度变异减速的新生儿为（3.84±0.40）mmol/L，均显著高于对照组（P<0.01）。轻度变异减速的新生儿为（2.63±0.32）mmol/L，心动过速的新生儿为（2.55±0.46）mmol/L，轻度变异减速和心动过速的新生儿与对照组之间无显著差异（P>0.05）。