Ganer Herman Hadas, Tamayev Liliya, Houli Rotem, Miremberg Hadas, Bar Jacob, Kovo Michal
Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.
Birth. 2018 Dec;45(4):393-398. doi: 10.1111/birt.12350. Epub 2018 Apr 24.
We aimed to characterize factors associated with nonreassuring fetal heart (FHR) tracings after artificial rupture of membranes (AROM), during the active phase of labor.
Delivery charts of patients who presented in spontaneous labor, at term, between 2015 and 2016 were reviewed. We identified cases in which AROM was performed during the active stage of labor. We compared deliveries with a normal FHR and those who developed nonreassuring FHR. Nonreassuring FHR was defined as fetal tracing that necessitated intrauterine resuscitation, which included: oxytocin withheld, amnioinfusion, or immediate instrumental or cesarean birth.
Of 664 deliveries, nonreassuring FHR occurred in 141 (21.2%) and normal FHR in 523 (78.7%). Both groups were notable for similar maternal characteristics and a similar gestational age. Epidural block was significantly more common in the nonreassuring FHR group (P < .001), as was meconium during delivery (P = .01). Deliveries in the nonreassuring FHR group were characterized by significantly lower Bishop scores at AROM. Mean birthweight was significantly lower in the nonreassuring FHR group (3201 ± 418 vs 3342 ± 376 g, P < .001), yet, neonatal outcome did not differ between the groups. In a multivariate logistic regression model, nulliparity, AROM at a station lower than -2, and increased birthweight were all significantly associated with a decreased rate of nonreassuring FHR, while prolonged duration from AROM to delivery and oxytocin augmentation significantly increased the risk for nonreassuring FHR.
Nonreassuring FHR after AROM during delivery is associated with parity, fetal station at AROM, birthweight, and oxytocin augmentation.
我们旨在确定在分娩活跃期人工破膜（AROM）后与胎儿心率（FHR）异常相关的因素。
回顾了2015年至2016年足月自然分娩患者的分娩记录。我们确定了在分娩活跃期进行AROM的病例。我们比较了FHR正常的分娩和出现FHR异常的分娩。FHR异常被定义为需要进行宫内复苏的胎儿监护情况，包括：停用缩宫素、羊膜腔灌注或立即器械助产或剖宫产。
在664例分娩中，141例（21.2%）出现FHR异常，523例（78.7%）FHR正常。两组产妇特征和孕周相似。硬膜外阻滞在FHR异常组明显更常见（P <.001），分娩时胎粪污染也是如此（P =.01）。FHR异常组分娩时的Bishop评分明显更低。FHR异常组的平均出生体重明显更低（3201±418 vs 3342±376 g，P <.001），然而，两组新生儿结局无差异。在多因素逻辑回归模型中，初产、AROM时胎头位置低于-2以及出生体重增加均与FHR异常发生率降低显著相关，而从AROM到分娩的时间延长和缩宫素加强显著增加了FHR异常的风险。
分娩时AROM后FHR异常与产次、AROM时胎儿位置、出生体重和缩宫素加强有关。
