Gonçalves Hernâni, Pinto Paula, Silva Manuela, Ayres-de-Campos Diogo, Bernardes João
Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Rua Dr Plácido Costa, s/n, 4200-319, Porto, Portugal.
Hospital Dr Nélio Mendonça, EPE, Funchal, Portugal.
Med Biol Eng Comput. 2016 Apr;54(4):691-9. doi: 10.1007/s11517-015-1359-7. Epub 2015 Jul 29.
Fetal heart rate (FHR) monitoring is used routinely in labor, but conventional methods have a limited capacity to detect fetal hypoxia/acidosis. An exploratory study was performed on the simultaneous assessment of maternal heart rate (MHR) and FHR variability, to evaluate their evolution during labor and their capacity to detect newborn acidemia. MHR and FHR were simultaneously recorded in 51 singleton term pregnancies during the last two hours of labor and compared with newborn umbilical artery blood (UAB) pH. Linear/nonlinear indices were computed separately for MHR and FHR. Interaction between MHR and FHR was quantified through the same indices on FHR-MHR and through their correlation and cross-entropy. Univariate and bivariate statistical analysis included nonparametric confidence intervals and statistical tests, receiver operating characteristic curves and linear discriminant analysis. Progression of labor was associated with a significant increase in most MHR and FHR linear indices, whereas entropy indices decreased. FHR alone and in combination with MHR as FHR-MHR evidenced the highest auROC values for prediction of fetal acidemia, with 0.76 and 0.88 for the UAB pH thresholds 7.20 and 7.15, respectively. The inclusion of MHR on bivariate analysis achieved sensitivity and specificity values of nearly 100 and 89.1%, respectively. These results suggest that simultaneous analysis of MHR and FHR may improve the identification of fetal acidemia compared with FHR alone, namely during the last hour of labor.
胎儿心率（FHR）监测在分娩过程中被常规使用，但传统方法检测胎儿缺氧/酸中毒的能力有限。本研究进行了一项探索性研究，同时评估母体心率（MHR）和FHR变异性，以评估它们在分娩过程中的变化及其检测新生儿酸血症的能力。在51例单胎足月妊娠的分娩最后两小时同时记录MHR和FHR，并与新生儿脐动脉血（UAB）pH值进行比较。分别计算MHR和FHR的线性/非线性指标。通过FHR-MHR上的相同指标及其相关性和交叉熵来量化MHR和FHR之间的相互作用。单变量和双变量统计分析包括非参数置信区间和统计检验、受试者工作特征曲线和线性判别分析。分娩进展与大多数MHR和FHR线性指标的显著增加相关，而熵指标下降。单独的FHR以及与MHR结合作为FHR-MHR，对于预测胎儿酸血症具有最高的auROC值，UAB pH阈值为7.20和7.15时，分别为0.76和0.88。在双变量分析中纳入MHR，敏感性和特异性值分别达到近100%和89.1%。这些结果表明，与单独的FHR相比，同时分析MHR和FHR可能会改善胎儿酸血症的识别，即在分娩的最后一小时。
