Sameshima Hiroshi, Ikenoue Tsuyomu, Ikeda Tomoaki, Kamitomo Masato, Ibara Satoshi
Perinatal Center and the Department of Obstetrics and Gynecology, Miyazaki Medical College, Kiyotake, Miyazaki, Japan.
Am J Obstet Gynecol. 2004 Jan;190(1):118-23. doi: 10.1016/j.ajog.2003.07.014.
Our purpose was to evaluate the clinical validity of electronic fetal heart rate monitoring to detect fetal acidemia and to evaluate the prevalence of cerebral palsy in unselected low-risk pregnancies.
We selected two secondary and two tertiary level institutions in which 10,030 infants were born. Among them, 5546 of the pregnancies were low-risk pregnancies by antepartum evaluation. The fetal heart rate patterns were interpreted according to the guidelines of the National Institute of Child Health and Human Development. The correlations between the fetal heart rate pattern and umbilical blood gases and the fetal heart rate pattern and cerebral palsy were studied. Spastic cerebral palsy was diagnosed at > or =1 year by pediatric neurologists. Statistics included unpaired t test, contingency table with chi(2) and Fisher tests, and one-way analysis of variance with Bonferroni/Dunn test.
On the basis of the severity of decelerations, frequency of decelerations, and decreased variability, umbilical pH, and Po(2) level were decreased accordingly, and incidence of pH<7.1 was increased. Sensitivity and false-positive rate of nonreassuring fetal heart rate patterns for fetal acidemia were 63% and 89%. There were nine cerebral palsy cases: six of the cases were preexisting asphyxia before monitoring was initiated, two of the cases were cytomegaloviral infections, and one of the cases was a maternal amniotic fluid embolism.
In low-risk pregnancies, intrapartum fetal heart rate monitoring was useful to detect fetal acidemia. Cerebral palsy caused by intrapartum asphyxia was restricted to unavoidable accidents under continuous fetal heart rate monitoring.
我们的目的是评估电子胎儿心率监测检测胎儿酸血症的临床有效性，并评估未选择的低风险妊娠中脑瘫的患病率。
我们选择了两家二级和两家三级医疗机构，共有10,030名婴儿在这些机构出生。其中，5546例妊娠经产前评估为低风险妊娠。胎儿心率模式根据美国国立儿童健康与人类发展研究所的指南进行解读。研究了胎儿心率模式与脐血气以及胎儿心率模式与脑瘫之间的相关性。痉挛性脑瘫由儿科神经科医生在1岁及以上时诊断。统计分析包括非配对t检验、卡方检验和Fisher检验的列联表，以及Bonferroni/Dunn检验的单因素方差分析。
根据减速的严重程度、减速频率和变异性降低情况，脐部pH值和氧分压水平相应降低，pH<7.1的发生率增加。胎儿心率模式异常对胎儿酸血症的敏感性和假阳性率分别为63%和89%。有9例脑瘫病例：其中6例在开始监测前就已存在窒息，2例为巨细胞病毒感染，1例为母体羊水栓塞。
在低风险妊娠中，产时胎儿心率监测有助于检测胎儿酸血症。产时窒息导致的脑瘫仅限于在持续胎儿心率监测下不可避免的意外情况。
