Larma Joel D, Silva Anadir M, Holcroft Cynthia J, Thompson Richard E, Donohue Pamela K, Graham Ernest M
Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Am J Obstet Gynecol. 2007 Sep;197(3):301.e1-8. doi: 10.1016/j.ajog.2007.06.053.
The purpose of this study was to determine whether electronic fetal monitoring can identify fetuses with metabolic acidosis and hypoxic-ischemic encephalopathy.
The cases were 107 nonanomalous chromosomally normal fetuses with an umbilical arterial pH < 7.0 and base excess < or = 12 mmol/L. Controls were the subsequent delivery that was matched by gestational age and mode of delivery. The last hour of electronic fetal monitoring before delivery was evaluated by 3 obstetricians who were blinded to outcome.
Cases had a significant increase in late and prolonged decelerations/hour and late decelerations/contractions. Those fetuses with hypoxic-ischemic encephalopathy had significant increases in bradycardia, decreased variability, and nonreactivity but no difference in late or variable decelerations/hour. For the identification of hypoxic-ischemic encephalopathy, the sensitivity, specificity, and positive and negative predictive values were 15.4%, 98.9%, 66.7%, and 89.4%, respectively, for bradycardia; 53.8%, 79.8%, 26.9%, and 92.6%, respectively, for decreased variability; 92.3%, 61.7%, 2.7%, and 82.9%, respectively, for nonreactivity; and 7.7%, 98.9%, 50.0%, and 88.6%, respectively, for all 3 abnormalities combined.
Fetal metabolic acidosis and hypoxic-ischemic encephalopathy are associated with significant increases in electronic fetal monitoring abnormalities, but their predictive ability to identify these conditions is low.
本研究旨在确定电子胎儿监护能否识别患有代谢性酸中毒和缺氧缺血性脑病的胎儿。
研究对象为107例染色体正常且无异常的胎儿，其脐动脉pH<7.0且碱剩余≤12 mmol/L。对照组为随后按孕周和分娩方式匹配的分娩病例。3名对结果不知情的产科医生对分娩前最后一小时的电子胎儿监护进行评估。
病例组晚期减速和延长减速/小时数以及晚期减速/宫缩数显著增加。患有缺氧缺血性脑病的胎儿心动过缓、变异性降低和无反应性显著增加，但晚期或变异减速/小时数无差异。对于缺氧缺血性脑病的识别，心动过缓的敏感度、特异度、阳性预测值和阴性预测值分别为15.4%、98.9%、66.7%和89.4%；变异性降低分别为53.8%、79.8%、26.9%和92.6%；无反应性分别为92.3%、61.7%、2.7%和82.9%；三项异常合并存在时分别为7.7%、98.9%、50.0%和88.6%。
胎儿代谢性酸中毒和缺氧缺血性脑病与电子胎儿监护异常显著增加相关，但其识别这些情况的预测能力较低。
