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.
Department of Obstetrics and Gynecology, São Paulo University Medical School, University of Sao Paulo, São Paulo, Brazil.
Eur J Obstet Gynecol Reprod Biol. 2015 Jul;190:7-10. doi: 10.1016/j.ejogrb.2015.03.031. Epub 2015 Apr 15.
To evaluate the reliability of fetal heart rate (FHR) parameters analyzed by computerized cardiotocography (cCTG) in predicting myocardial damage in pregnancies with placental insufficiency.
We evaluated 38 patients with placental insufficiency detected before 34 weeks of gestation. All patients underwent 30 min of cCTG (Sonicaid Fetal Care, version 2.2) and Doppler of umbilical artery, middle cerebral artery, and ductus venosus. Umbilical vein blood samples were collected at birth to determine fetal cardiac Troponin T, and a ≥0.09ng/ml value was deemed a sign of myocardial damage.
The fetuses with myocardial damage (39%) showed significantly increased values of umbilical artery pulsatility index z-score (P=0.003), ductus venosus pulsatility index z-score (P=0.007), basal FHR (P=0.033) and periods of low episodes (P=0.038). The number of small accelerations and the short-term variation (STV) were significantly reduced in the group with myocardial damage (P=0.013 and P=0.003, respectively). Logistic regression analysis identified STV and gestational age at delivery as independent predictors for fetal myocardial damage, with area under ROC curve of 0.91.
Computerized cardiotocography parameters may be useful in the management of early onset placental insufficiency, and the association of STV with gestational age could play a role in detecting myocardial injury in pregnancies with placental insufficiency.
评估计算机化心动图（cCTG）分析的胎儿心率（FHR）参数在预测胎盘功能不全妊娠心肌损伤中的可靠性。
我们评估了34周前检测出胎盘功能不全的38例患者。所有患者均接受了30分钟的cCTG（Sonicaid Fetal Care，版本2.2）以及脐动脉、大脑中动脉和静脉导管的多普勒检查。出生时采集脐静脉血样本以测定胎儿心肌肌钙蛋白T，≥0.09ng/ml的值被视为心肌损伤的标志。
有心肌损伤的胎儿（39%）脐动脉搏动指数z评分（P=0.003）、静脉导管搏动指数z评分（P=0.007）、基础FHR（P=0.033）和低心率发作期（P=0.038）的值显著升高。心肌损伤组的小加速次数和短期变异（STV）显著减少（分别为P=0.013和P=0.003）。逻辑回归分析确定STV和分娩时的孕周是胎儿心肌损伤的独立预测因素，ROC曲线下面积为0.91。
计算机化心动图参数可能有助于早期胎盘功能不全的管理，STV与孕周的关联可能在检测胎盘功能不全妊娠的心肌损伤中发挥作用。
