Department of Obstetrics and Gynecology, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA.
Am J Obstet Gynecol. 2013 Oct;209(4):382.e1-8. doi: 10.1016/j.ajog.2013.05.049. Epub 2013 Jun 13.
To examine low maternal admission pulse pressure (PP) as a risk factor for new onset postepidural fetal heart rate (FHR) abnormalities.
Retrospective cohort study of nulliparous, singleton, vertex-presenting women admitted to labor and delivery after 37 0/7 weeks that received an epidural during labor. Women with a low admission PP were compared with those with a normal admission PP. The primary outcome was new onset FHR abnormalities defined as recurrent late or prolonged FHR decelerations in the first hour after initial dosing of a labor epidural.
New onset FHR abnormalities, defined as recurrent late decelerations and/or prolonged decelerations, occurred in 6% of subjects in the normal PP cohort compared with 27% in the low PP cohort (odds ratio, 5.6; 95% confidence interval, 2.1-14.3; P < .001). A multivariate logistic regression analysis generated an adjusted odds ratio of 28.9 (95% confidence interval, 3.7-221.4; P < .001).
New onset FHR abnormalities after initial labor epidural dosing occur more frequently in women with a low admission PP than those with a normal admission pulse. Admission PP appears to be a novel predictor of new onset postepidural FHR abnormalities.
探讨产妇入院时的低脉搏压（PP）是否是硬膜外后新出现胎心率（FHR）异常的危险因素。
回顾性队列研究，纳入 37 周+0/7 周后入院分娩且分娩时接受硬膜外麻醉的初产妇。将入院时低 PP 的产妇与正常入院时 PP 的产妇进行比较。主要结局为新出现的 FHR 异常，定义为硬膜外初始剂量后 1 小时内反复出现晚期或延长性 FHR 减速。
正常 PP 组中，有 6%的受试者出现新的 FHR 异常，定义为反复出现晚期减速和/或延长减速，而低 PP 组中这一比例为 27%（比值比，5.6；95%置信区间，2.1-14.3；P<.001）。多变量逻辑回归分析得出调整后的比值比为 28.9（95%置信区间，3.7-221.4；P<.001）。
与正常入院时的脉搏相比，初始硬膜外给药后新出现 FHR 异常的产妇入院时的 PP 较低。入院时的 PP 似乎是新出现的硬膜外后 FHR 异常的一个新的预测因素。
