Maeda Mariane de Fátima Y, Nomura Roseli M Y, Niigaki Juliana I, Francisco Rossana P V, Zugaib Marcelo
Department of Obstetrics and Gynecology, São Paulo University Medical School, University of Sao Paulo , São Paulo , Brazil.
J Matern Fetal Neonatal Med. 2013 Dec;26(18):1820-4. doi: 10.3109/14767058.2013.802304. Epub 2013 Jun 10.
To determine the influence of fetal acidemia on fetal heart rate (FHR) parameters analyzed by computerized cardiotocography (cCTG) in pregnancies with placental insufficiency.
This was a cross-sectional study of 46 pregnancies with placental insufficiency between 26 and 34 weeks gestation by abnormal umbilical artery Doppler [pulsatility index (PI) > 95th percentile].
Twenty fetuses had acidemia at birth, pH < 7.20 (43.5%) and 26 had normal pH (56.5%). In the analysis of FHR parameters, fetal movements (FM) per hour was significantly lower in the group with acidemia (median = 2) when compared with the group with normal pH (median = 15, p = 0.019). The values of pH correlated positively with FM (ρ = 0.35; p = 0.019, 95% CI: 0.061 to 0.577) and basal FHR (ρ = 0.37, p = 0,011, 95% CI: 0.090 to 0.597) and negatively with the ductus venosus (DV) PI for veins (PIV) z-score (ρ = -0.31, p = 0,036, 95% CI: -0.550 to -0.021). Logistic regression showed that the DV PIV z-score (p = 0.0232) and basal FHR (p = 0.0401) were independent variables associated with acidemia at birth.
The present results suggest that cCTG parameters may be useful in the management of cases with early onset placental insufficiency in association with Doppler velocimetry assessment, and that basal FHR and DV-PIV are most clearly in association with acidemia at birth.
确定胎儿酸血症对胎盘功能不全妊娠中通过计算机化心动图（cCTG）分析的胎儿心率（FHR）参数的影响。
这是一项横断面研究，对46例妊娠26至34周、脐动脉多普勒异常[搏动指数（PI）>第95百分位数]的胎盘功能不全妊娠进行研究。
20例胎儿出生时存在酸血症，pH<7.20（43.5%），26例pH正常（56.5%）。在FHR参数分析中，酸血症组每小时的胎儿运动（FM）明显低于pH正常组（中位数=2），而pH正常组中位数=15，p=0.019）。pH值与FM呈正相关（ρ=0.35；p=0.019，95%CI：0.061至0.577），与基础FHR呈正相关（ρ=0.37，p=0.011，95%CI：0.090至0.597），与静脉导管（DV）静脉搏动指数（PIV）z评分呈负相关（ρ=-0.31，p=0.036，95%CI：-0.550至-0.021）。逻辑回归显示，DV PIV z评分（p=0.0232）和基础FHR（p=0.0401）是与出生时酸血症相关的独立变量。
目前的结果表明，cCTG参数可能有助于结合多普勒测速评估来管理早发性胎盘功能不全病例，并且基础FHR和DV-PIV与出生时的酸血症关联最为明显。
