Morin C, Chartier M, Bounan S, Hatem G, Goffinet F, Le Ray C
Maternité Port-Royal, hôpital Cochin, DHU risques et grossesse, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France.
Département d'obstétrique et gynécologie, hôpital Delafontaine, 93200 Saint-Denis, France.
J Gynecol Obstet Hum Reprod. 2017 Feb;46(2):183-187. doi: 10.1016/j.jogoh.2016.12.007. Epub 2017 Jan 30.
In case of abnormal fetal heart rate, there is no consensus on the decision threshold pH scalp leading to a rapid birth. The objective of this study was to compare neonatal issues and cesarean rate in two maternity using different decision thresholds of scalp pH.
A comparative retrospective study conducted in two level III maternity units between January 2013 and May 2014, one maternity unit used a decision threshold of 7.20 (maternity unit 7,20), and the other one a threshold of 7.25 (maternity unit 7,25). An adverse neonatal outcome was defined by a composite endpoint of neonatal morbidity. The risk of cesarean was assessed using a multivariate analysis.
One hundred and four patients were included in the maternity unit 7,20 and 163 patients in the maternity 7,25. Adverse neonatal outcome was similar in both maternities (25% vs. 30,1%; P=0.4). The average pH at birth was similar in both maternities, as well as the Apgar score at 5minutes and neonatal transfer rates. However, BE<-12 was more frequent in maternity using 7,20 scalp pH threshold (7% vs. 0%; P<0.01). The cesarean rate was higher in maternity 7,25 (adjusted OR=2.23 95% CI [1.17-4.25]).
It seems that a decisional threshold fixed to 7,20 could be used reasonably. It could allow to reduce cesarean rate. Other studies are, however, needed to confirm that such threshold of 7,20 does not increase the risk of severe acidosis.
在胎儿心率异常的情况下，对于导致快速分娩的头皮血pH值决策阈值尚无共识。本研究的目的是比较两家产科医院使用不同头皮血pH值决策阈值时的新生儿问题及剖宫产率。
2013年1月至2014年5月在两家三级产科单位进行了一项比较性回顾性研究，一家产科单位使用的决策阈值为7.20（7.20产科单位），另一家使用的阈值为7.25（7.25产科单位）。不良新生儿结局由新生儿发病率的复合终点定义。使用多变量分析评估剖宫产风险。
7.20产科单位纳入了104例患者，7.25产科单位纳入了163例患者。两家产科的不良新生儿结局相似（25%对30.1%；P=0.4）。两家产科出生时的平均pH值相似，5分钟时的阿氏评分及新生儿转运率也相似。然而，在使用7.20头皮血pH阈值的产科中，碱剩余<-12更为常见（7%对0%；P<0.01）。7.25产科的剖宫产率更高（调整后的比值比=2.23，95%可信区间[1.17-4.25]）。
似乎可以合理使用固定为7.20的决策阈值。这可能有助于降低剖宫产率。然而，需要其他研究来证实7.20这样的阈值不会增加严重酸中毒的风险。
