胎儿腹裂合并症孕妇除了进行系列超声检查外，每日进行胎儿心率家庭监测的价值。

The value of daily fetal heart rate home monitoring in addition to serial ultrasound examinations in pregnancies complicated by fetal gastroschisis.

机构信息

Department of Obstetrics and Gynecology, Hôpital Necker Enfants Malades, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France.

出版信息

Prenat Diagn. 2012 Aug;32(8):789-96. doi: 10.1002/pd.3903. Epub 2012 Jun 1.

DOI:10.1002/pd.3903

PMID:22653694

Abstract

OBJECTIVES

To audit the practice of daily fetal heart rate home monitoring (FHM) in pregnancies complicated by fetal gastroschisis (GS).

METHODS

Prenatal records and pregnancy outcome were reviewed of all cases with fetal GS between 1999 and 2010, managed with a consistent protocol, which included weekly fetal cardiotocography and ultrasound examinations after 30 weeks, and option of daily FHM. Data were collected including gestational age (GA) at FHM and the presence of fetal heart rate anomaly. Follow-up included fetal growth, amniotic fluid volume, gastrointestinal appearance and cardiotocography findings.

RESULTS

One hundred five cases of GS were identified. Stillbirth rate was 1.9% (2/105). FHM was performed in 97/105 (92.4%) cases. Abnormal FHM was recorded in 24 cases. Fetuses with abnormal versus normal FHM were more likely to have C-section for fetal heart rate anomaly (50% vs 24%, p=0.025) at an earlier gestational age (34.9 ± 1.7 vs 35.8 ± 1.4 weeks, p=0.016). There was no difference in Apgar score or umbilical artery pH at birth.

CONCLUSION

Fetal heart rate abnormalities are frequent in fetuses with GS. FHM appears useful in detecting fetal distress necessitating expedited delivery. However, the impact of a daily FHM policy on neonatal outcome should be evaluated in a randomized study.

摘要

目的

对胎儿脐膨出（GS）合并妊娠患者的每日胎儿心率家庭监测（FHM）实践进行审核。

方法

对 1999 年至 2010 年间所有 GS 病例的产前记录和妊娠结局进行回顾，所有病例均采用一致的治疗方案进行管理，包括每周进行胎儿胎心监护和 30 周后进行超声检查，以及选择每日进行 FHM。收集的数据包括 FHM 时的胎龄（GA）和胎心异常的存在情况。随访包括胎儿生长情况、羊水体积、胃肠道外观和胎心监护结果。

结果

共发现 105 例 GS 病例。死胎率为 1.9%（2/105）。97/105（92.4%）例患者进行了 FHM。24 例记录到异常的 FHM。与正常 FHM 相比，异常 FHM 的胎儿更有可能因胎心异常（50%对 24%，p=0.025）而更早进行剖宫产（34.9±1.7 对 35.8±1.4 周，p=0.016）。出生时的 Apgar 评分或脐动脉 pH 无差异。