Kyozuka Hyo, Yasuda Syun, Hiraiwa Tsuyoshi, Nomura Yasuhisa, Fujimori Keiya
Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan.
Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan.
Eur J Obstet Gynecol Reprod Biol. 2018 Sep;228:32-37. doi: 10.1016/j.ejogrb.2018.06.015. Epub 2018 Jun 11.
Histological chorioamnionitis (CAM) is related to neonatal mortality and morbidity. However, identifying intrauterine inflammation before delivery is challenging. The aim of this study was to investigate the changes in fetal heart rate (FHR) short-term variability (STV) during the course of histological CAM.
Changes in STV were measured in 7 chronically instrumented fetal sheep at 111-120 days of gestation. Lipopolysaccharide (LPS) was infused into the amniotic cavity for 2 days following the 4th postoperative day to develop histological CAM. STV was determined based on the R to R interval of the fetal electrocardiogram. We continued to observe the changes in STV until the time of intrauterine fetal death (IUFD). The umbilical cord and fetal membranes were evaluated histologically after IUFD. The experiment was divided into two phases: 1) the acute phase, defined as the 24-hour period between the first and second injections of LPS and 2) the perimortem phase, defined as the period between the second injection of LPS and IUFD. Changes in STV in both the acute and perimortem phases were evaluated using Friedman's test. A probability of <0.05 was accepted as statistically significant.
The fetuses died, on average, at 23.7 ± 4.9 h after the second injection of LPS. Both the umbilical cord and fetal membranes showed histological evidence of severe inflammation. During the perimortem phase, there were statistically significant differences in STV at each time point. STV increased significantly at 6, 4, and 3 h before intrauterine fetal death compared to the baseline.
Our study suggests that STV increased as the fetal condition deteriorated during the course of histological CAM.
组织学绒毛膜羊膜炎（CAM）与新生儿死亡率和发病率相关。然而，在分娩前识别宫内炎症具有挑战性。本研究的目的是调查组织学CAM病程中胎儿心率（FHR）短期变异性（STV）的变化。
在7只妊娠111 - 120天的慢性仪器监测胎羊中测量STV变化。术后第4天之后，将脂多糖（LPS）注入羊膜腔2天以诱发组织学CAM。基于胎儿心电图的R - R间期确定STV。我们持续观察STV的变化直至宫内胎儿死亡（IUFD）。IUFD后对脐带和胎膜进行组织学评估。实验分为两个阶段：1）急性期，定义为首次和第二次注射LPS之间的24小时时间段；2）濒死期，定义为第二次注射LPS至IUFD之间的时间段。使用Friedman检验评估急性期和濒死期STV的变化。P < 0.05被认为具有统计学意义。
胎儿在第二次注射LPS后平均23.7±4.9小时死亡。脐带和胎膜均显示出严重炎症的组织学证据。在濒死期，每个时间点的STV均有统计学显著差异。与基线相比，在宫内胎儿死亡前6、4和3小时STV显著增加。
我们的研究表明，在组织学CAM病程中，随着胎儿状况恶化，STV增加。
