Mwansa Joseph Chola, Tambwe Albert Mwembo, Thaba Jules Ngwe, Ndoudule Arthur Munkana, Museba Baudouin Yumba, Thabu Thérèse Mowa, Muenze Prosper Kalenga
Département de Gynécologie-Obstétrique de la Faculté de Médecine de l'Université de Lubumbashi, Republique Démocratique du Congo.
Service de Gynécologie-Obstétrique de l'Hôpital Général du Cinquantenaire Karavia, Lubumbashi, Republique Démocratique du Congo.
Pan Afr Med J. 2018 Aug 17;30:278. doi: 10.11604/pamj.2018.30.278.13365. eCollection 2018.
Cardiotocography (CTG) has recently come into use in Lubumbashi but no thorough study has yet been conducted to identify its impact on perinatal morbi-mortality. This study aims to determine the frequency of fetal heart rate abnormalities (FHR)in order to identify the associated factors and to propose a suitable management. We conducted a cross-sectional, descriptive study of 411 women in labour over a period of 19 months (March 2015-December 2016). In patients with pathologic FHR abnormalities, sensitivity and positive predictive value of cardiotocography in the screening test for acute fetal distress were 82.95% and 45.35% respectively. FHR abnormalities were found in two women in labour out of five. Decelerations were the most frequent FHR abnormalities observed (50.8%) with a remarkable predominance of late decelerations (22.1% of all abnormalities). The factors associated with pathological FHR abnormalities were prolonged labor (OR = 14.64, CI = 3.91-54.81), chorioamnionitis (OR = 14.56, CI = 3.83-55.34), chronic maternal anemia (OR = 4.99, CI = 1.48-16.85), primiparity (OR = 2.69, CI = 1.49-4.85), prematurity (OR = 2.90, CI = 1.51-5.54) and prolonged pregnancy (OR = 3.22, CI = 1.38-7.52). Intrauterine growth retardation and arterial hypertension were mainly associated with flat lines and late decelerations (OR = 7.79, CI = 2.50-24.30 and OR=2.74, CI = 1.31-5.72). CTG is a screening tool for the identification of acute fetal distress but with high false-positive rate (55%); it should be associated with other second-line screening tests for acute fetal distress in order to reduce this rate. Factors associated with pathologic FHR abnormalities often cause acute fetal distress thus requiring a rigorous analysis of CTG traces.
胎心监护（CTG）最近在卢本巴希开始应用，但尚未进行全面研究以确定其对围产期发病率和死亡率的影响。本研究旨在确定胎儿心率异常（FHR）的频率，以识别相关因素并提出合适的管理措施。我们对19个月（2015年3月至2016年12月）期间411名分娩妇女进行了一项横断面描述性研究。在病理性FHR异常患者中，胎心监护在急性胎儿窘迫筛查试验中的敏感性和阳性预测值分别为82.95%和45.35%。每五名分娩妇女中有两名出现FHR异常。减速是观察到的最常见的FHR异常（50.8%），其中晚期减速显著占优势（占所有异常的22.1%）。与病理性FHR异常相关的因素有产程延长（OR = 14.64，CI = 3.91 - 54.81）、绒毛膜羊膜炎（OR = 14.56，CI = 3.83 - 55.34）、慢性母体贫血（OR = 4.99，CI = 1.48 - 16.85）、初产（OR = 2.69，CI = 1.49 - 4.85）、早产（OR = 2.90，CI = 1.51 - 5.54）和过期妊娠（OR = 3.22，CI = 1.38 - 7.52）。胎儿宫内生长受限和动脉高血压主要与基线平直和晚期减速相关（OR = 7.79，CI = 2.50 - 24.30和OR = 2.74，CI = 1.31 - 5.72）。胎心监护是识别急性胎儿窘迫的一种筛查工具，但假阳性率较高（55%）；应将其与其他急性胎儿窘迫二线筛查试验联合使用以降低该比率。与病理性FHR异常相关的因素常导致急性胎儿窘迫，因此需要对胎心监护图形进行严格分析。
