Hasegawa Junichi, Ikeda Tomoaki, Toyokawa Satoshi, Jojima Emi, Satoh Shoji, Ichizuka Kiyotake, Tamiya Nanako, Nakai Akihito, Fujimori Keiya, Maeda Tsugio, Masuzaki Hideaki, Takeda Satoru, Suzuki Hideaki, Ueda Shigeru, Ikenoue Tsuyomu
Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan.
Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Japan.
J Obstet Gynaecol Res. 2018 Apr;44(4):647-654. doi: 10.1111/jog.13555. Epub 2018 Jan 23.
The study identifies the relevant obstetric factors associated with fetal heart rate (FHR) monitoring for cerebral palsy (CP) in pregnant women with hypertensive disorders of pregnancy (HDP).
The subjects were neonates with CP (birth weight ≥ 2000 g, gestational age ≥ 33 weeks) who were approved for compensation for CP by the Operating Organization of the Japan Obstetric Compensation System between 2009 and 2012. After selection of women with antepartum HDP, obstetric characteristics associated with FHR monitoring were analyzed.
The subjects included 33 neonates with CP whose mothers suffered from HDP during pregnancy and 450 neonates whose mothers did not develop HDP. The rates of placental abruption (48.5% vs. 20%; P < 0.001) and light-for-gestational age (12.1% vs. 2.2%; P = 0.011) were significantly higher in women with HDP than in those without HDP. Regarding FHR pattern analysis, fetal bradycardia was observed on admission to hospital in 94% of women with placental abruption. In women without placental abruption, FHR was likely to indicate a favorable pattern on admission, but became worse with the progression of labor.
This is first study to clinically demonstrate FHR patterns in CP cases in association with HDP. Although antepartum CP is undetectable, pregnant women with HDP should be placed under strict observation and management to minimize fetal hypoxic conditions during labor.
本研究确定妊娠高血压疾病（HDP）孕妇中与脑瘫（CP）胎儿心率（FHR）监测相关的产科因素。
研究对象为2009年至2012年间经日本产科赔偿系统运营机构批准获得CP赔偿的CP新生儿（出生体重≥2000g，胎龄≥33周）。在选择产前患有HDP的孕妇后，分析与FHR监测相关的产科特征。
研究对象包括33例母亲孕期患有HDP的CP新生儿和450例母亲未患HDP的新生儿。HDP孕妇的胎盘早剥发生率（48.5%对20%；P<0.001）和小于胎龄儿发生率（12.1%对2.2%；P = 0.011）显著高于未患HDP的孕妇。关于FHR模式分析，94%的胎盘早剥孕妇入院时观察到胎儿心动过缓。在无胎盘早剥的孕妇中，FHR在入院时可能显示为良好模式，但随着产程进展会变差。
这是第一项临床证明与HDP相关的CP病例中FHR模式的研究。尽管产前无法检测出CP，但HDP孕妇应接受严格观察和管理，以尽量减少分娩期间胎儿缺氧情况。
