Parisi Silvia, Monzeglio Clara, Attini Rossella, Biolcati Marilisa, Masturzo Bianca, Mensa Manuela, Mischinelli Marina, Pilloni Eleonora, Todros Tullia
Department of Obstetrics and Gynaecology, Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, Turin, Italy.
BMC Pregnancy Childbirth. 2017 Jul 1;17(1):209. doi: 10.1186/s12884-017-1392-7.
The aim of the present study is to test the hypothesis that Growth Restricted foetuses (FGR) have the tendency to develop more pathological cardiotocograpic tracings during labour than do appropriate for gestational age foetuses and that there is a shorter time lapse from the beginning of labour and the advent of a pathological cardiotocograpic tracing.
The study was carried out at the Maternal-Foetal Medicine Unit of the Sant'Anna University Hospital, Turin, Italy. A total of 930 foetuses born at term between January and December 2012 were analysed: 355 small for gestational age (SGA) comprising both constitutional small for gestational age and growth restricted foetuses (cases group) and 575 Appropriate for Gestational Age (AGA) foetuses (control group). Tracings were evaluated independently by two obstetric consultants, according to the International Federation of Gynaecology and Obstetrics (FIGO) classification. The main outcomes considered were the incidence of pathological cardiotocograpic tracings and the time interval between the beginning of labour and the advent of pathological cardiotocograpic tracing. The Student's t-test, chi-square test and ANOVA were used for comparisons between cases and controls and amongst groups. Significance was set at <0.05. Univariate and multivariate odds-ratios were calculated.
Foetuses with birthweight <3rd centile (growth restricted foetuses) more frequently presented pathological cardiotocograpic tracings in labour than did controls (43.8% vs. 21.6%; p < 0.001). Pathological cardiotocograpic tracing developed faster in the foetuses with birthweight <3rd centile group (53', 0'-277') than it did in the control group (170.5', 0'-550'; p < 0.05). A higher induction rate was observed in the cases (29.6%) than in the control group (17%), with statistical significance p < 0.001. To correct for this possible confounding factor a multivariate logistic regression analysis was performed. It confirmed a statistically significant increased risk of pathological cardiotocographic tracings in the FGR group (OR 1.63; CI 1.30-2.05).
The results confirm the hypothesis that Growth Restricted foetuses (FGR) have fewer oxygen reserves to deal with labour. Our results underscore the importance of the prenatal detection of these foetuses and of their continuous cardiotocographic monitoring during labour.
本研究的目的是检验以下假设：与孕周相符的胎儿相比，生长受限胎儿（FGR）在分娩期间出现更多病理性胎心监护图形的倾向，并且从分娩开始到出现病理性胎心监护图形的时间间隔更短。
该研究在意大利都灵圣安娜大学医院的母胎医学科进行。对2012年1月至12月足月出生的930例胎儿进行了分析：355例小于胎龄儿（SGA），包括体质性小于胎龄儿和生长受限胎儿（病例组）以及575例孕周相符胎儿（AGA）（对照组）。由两名产科顾问根据国际妇产科联合会（FIGO）分类独立评估监护图形。所考虑的主要结局是病理性胎心监护图形的发生率以及分娩开始至出现病理性胎心监护图形的时间间隔。采用学生t检验、卡方检验和方差分析对病例组和对照组以及各亚组之间进行比较。显著性设定为<0.05。计算单因素和多因素比值比。
出生体重低于第3百分位数的胎儿（生长受限胎儿）在分娩时出现病理性胎心监护图形的频率高于对照组（43.8%对21.6%；p<0.001）。出生体重低于第3百分位数组的胎儿病理性胎心监护图形出现得更快（53分钟，0 - 277分钟），而对照组为（170.5分钟，0 - 550分钟；p<0.05）。病例组的引产率（29.6%）高于对照组（17%），具有统计学意义p<0.001。为校正这一可能的混杂因素，进行了多因素逻辑回归分析。结果证实FGR组病理性胎心监护图形的风险显著增加（OR 1.63；CI 1.30 - 2.05）。
结果证实了生长受限胎儿（FGR）应对分娩的氧储备较少这一假设。我们的结果强调了产前检测这些胎儿以及分娩期间持续进行胎心监护的重要性。
