[脐动脉舒张末期血流速度消失或倒置的妊娠中的胎心监护：围产期结局分析]

Nomura Roseli Mieko Yamamoto, Francisco Rossana Pulcineli Vieira, Miyadahira Seizo, Zugaib Marcelo

Setor de Vitalidade Fetal, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Porto Alegre, RS, Brasil.

Rev Assoc Med Bras (1992). 2003 Jan-Mar;49(1):79-85. doi: 10.1590/s0104-42302003000100038. Epub 2003 Apr 28.

OBJECTIVES

To study the correlation between cardiotocography parameters and perinatal outcome in pregnancies with absent or reversed end-diastolic velocity (AERDV) in the umbilical arteries.

METHODS

One hundred and twenty-seven cases presenting with AREDV followed between 1993 and 2000 were selected for analysis. The last cardiotocographic tracing performed on the day of delivery was reviewed and the following parameters were considered: magnitude of long-term variability, presence or absence of acceleration, late deceleration, variable deceleration, prolonged deceleration, pseudo sinusoidal pattern and the classification in normal, suspected and abnormal tracing.

RESULTS

A significant (p<0.05) association was found between abnormal tracing and acidemia at birth (pH inferior to 7.20) with 71.9%, first minute Apgar score inferior to seven (73.4%), newborn intubation at delivery (64.1%), and early neonatal death (20.3%). The absence of acceleration was associated (p<0.05) to acidemia at birth (58.8%), first minute Apgar score inferior to seven (67.7%), newborn intubation at delivery (51%) and neonatal death (29.4%). Low FHR variability (<5bpm) was associated to (p<0.05): acidemia at birth (88.5%), newborn intubation at delivery (69.2%), early neonatal death (34.6%) and neonatal death (42.3%). Late decelerations were significantly (p<0,05) related to acidemia at birth.(78.2%). The severe variable deceleration was associated to (p<0.05): acidemia at birth (79.3%), newborn intubation at delivery (69%) and early neonatal death (17.2%). Prolonged deceleration was associated to (p<0.05) newborn intubation at delivery (70.6%). Pseudo sinusoidal pattern was associated to (p<0.05) early neonatal death (60%).

CONCLUSION

The AREDV represents a severe fetal compromise with high risk to neonatal morbidity and mortality, and correlation between cardiotocography abnormalities and adverse perinatal outcome was demonstrated.

目的

研究脐动脉舒张末期血流缺失或倒置（AERDV）妊娠中胎心监护参数与围产期结局之间的相关性。

方法

选取1993年至2000年间随访的127例出现AREDV的病例进行分析。回顾分娩当天进行的最后一次胎心监护记录，并考虑以下参数：长期变异性的大小、是否存在加速、晚期减速、变异减速、延长减速、伪正弦波型以及正常、可疑和异常记录的分类。

结果

发现异常记录与出生时酸血症（pH低于7.20）之间存在显著（p<0.05）关联，其中酸血症发生率为71.9%，出生后1分钟阿氏评分低于7分的比例为73.4%，分娩时新生儿插管率为64.1%，早期新生儿死亡率为20.3%。无加速与出生时酸血症（58.8%）、出生后1分钟阿氏评分低于7分（67.7%）、分娩时新生儿插管（51%）和新生儿死亡（29.4%）相关（p<0.05）。低胎心率变异性（<5bpm）与以下情况相关（p<0.05）：出生时酸血症（88.5%）、分娩时新生儿插管（69.2%）、早期新生儿死亡（34.6%）和新生儿死亡（42.3%）。晚期减速与出生时酸血症显著相关（p<0.05）（78.2%）。重度变异减速与以下情况相关（p<0.05）：出生时酸血症（79.3%）、分娩时新生儿插管（69%）和早期新生儿死亡（17.2%）。延长减速与分娩时新生儿插管相关（p<0.05）（70.6%）。伪正弦波型与早期新生儿死亡相关（p<0.05）（60%）。