Jonsson Maria, Ågren Johan, Nordén-Lindeberg Solveig, Ohlin Andreas, Hanson Ulf
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Am J Obstet Gynecol. 2014 Dec;211(6):667.e1-8. doi: 10.1016/j.ajog.2014.06.027. Epub 2014 Jun 17.
In cases with moderate and severe neonatal encephalopathy, we aimed to determine the proportion that was attributable to asphyxia during labor and to investigate the association between cardiotocographic (CTG) patterns and neonatal outcome.
In a study population of 71,189 births from 2 Swedish university hospitals, 80 cases of neonatal encephalopathy were identified. Cases were categorized by admission CTG patterns (normal or abnormal) and by the presence of asphyxia (cord pH, <7.00; base deficit, ≥12 mmol/L). Cases with normal admission CTG patterns and asphyxia at birth were considered to experience asphyxia related to labor. CTG patterns were assessed for the 2 hours preceding delivery.
Admission CTG patterns were normal in 51 cases (64%) and abnormal in 29 cases (36%). The rate of cases attributable to asphyxia (ie, hypoxic ischemic encephalopathy) was 48 of 80 cases (60%), most of which evolved during labor (43/80 cases; 54%). Both severe neonatal encephalopathy and neonatal death were more frequent with an abnormal, rather than with a normal, admission CTG pattern (13 [45%] vs 11 [22%]; P = .03), and 6 [21%] vs 3 [6%]; P = .04), respectively. Comparison of cases with an abnormal and a normal admission CTG pattern also revealed more frequently observed decreased variability (12 [60%] and 8 [22%], respectively) and more late decelerations (8 [40%] and 1 [3%], respectively).
Moderate and severe encephalopathy is attributable to asphyxia in 60% of cases, most of which evolve during labor. An abnormal admission CTG pattern indicates a poorer neonatal outcome and more often is associated with pathologic CTG patterns preceding delivery.
在中重度新生儿脑病病例中，我们旨在确定分娩期间因窒息导致的病例比例，并研究胎心监护（CTG）模式与新生儿结局之间的关联。
在瑞典两家大学医院的71189例出生病例的研究人群中，识别出80例新生儿脑病病例。病例按入院时CTG模式（正常或异常）以及是否存在窒息（脐动脉血pH值<7.00；碱缺失≥12 mmol/L）进行分类。入院时CTG模式正常但出生时存在窒息的病例被视为与分娩相关的窒息。对分娩前2小时的CTG模式进行评估。
51例（64%）入院时CTG模式正常，29例（36%）异常。80例病例中因窒息（即缺氧缺血性脑病）导致的病例率为48例（60%），其中大多数在分娩期间发生（43/80例；54%）。入院时CTG模式异常而非正常的病例中，重度新生儿脑病和新生儿死亡更为常见（分别为13例[45%]对11例[22%]；P = 0.03），以及6例[21%]对3例[6%]；P = 0.04）。入院时CTG模式异常与正常的病例比较还显示，更常观察到变异减少（分别为12例[60%]和8例[22%]）以及更多晚期减速（分别为8例[40%]和1例[3%]）。
60%的中重度脑病病例归因于窒息，其中大多数在分娩期间发生。入院时CTG模式异常表明新生儿结局较差，且更常与分娩前的病理性CTG模式相关。
