Kastendieck E, Yilmar G, Jensen A, Horner G
Z Geburtshilfe Perinatol. 1986 Feb-Mar;190(1):14-23.
Clinical and animal experiments suggest that fetal metabolic acidosis is influenced by placental transfer of lactate and bicarbonate. It was the aim of this study to answer the following questions: What kind of relationship does exist between fetal metabolic acidosis and maternal metabolic acidosis? Does fetal metabolic acidosis coincide with alterations of fetal heart rate and fetal oxygenation? Does the maternofetal difference of base deficit reflect fetal oxygen deprivation more accurately than the measurement of fetal base deficit alone? What is the maternofetal difference of base deficit in normoxia and mild hypoxia? In 100 pregnant women (gestational age greater than 37 weeks, fetal weight greater than 3 rd percentile) a fetomaternal blood analysis (FMBA) was performed during labour and immediately after delivery. The metabolic acidosis was measured as base deficit of extracellular fluid (BDECF).
The fetal metabolic acidosis depends mainly on the buffer base concentration in the maternal blood. Moderate repetitive hypoxemia with no severe pathological FHR-alterations do not show a significant relationship to fetal metabolic acidosis. Moderate hypoxia (defined as the combination of oxygen saturation below 30%, periodical decelerations and basal fetal heart rate above 160 b/min) can be recognized most accurately by determining the maternofetal differences of BDECF. In fetal normoxia BDECF in the maternal blood is 4 mmol/l higher than in the fetal blood, in moderate hypoxia the maternofetal difference of BDECF is reduced to 1 mmol/l. These findings are in accordance with the results of Roversi et al. (1975). Conclusions for the intensive surveillance of the fetus during labour by fetal blood analysis: Within the range of pH 7.10-7.30 the maternal BDECF should be determined in addition to the fetal BDECF to calculate the maternal fetal difference of BDECF. If BDECF in the fetus exceeds the maternal BDECF, the risk of fetal hypoxia is increasing. In these cases, delivery should be performed as soon as possible avoiding additional hypoxic or mechanical birth injuries. The technical procedure of fetal maternal blood analysis is described and the difficulties of routine use are discussed.
临床和动物实验表明，胎儿代谢性酸中毒受乳酸和碳酸氢盐的胎盘转运影响。本研究旨在回答以下问题：胎儿代谢性酸中毒与母体代谢性酸中毒之间存在何种关系？胎儿代谢性酸中毒是否与胎儿心率和胎儿氧合的改变同时出现？母体-胎儿碱缺失差异比单独测量胎儿碱缺失更能准确反映胎儿缺氧吗？正常氧合和轻度缺氧时母体-胎儿碱缺失差异是多少？对100名孕妇（孕周大于37周，胎儿体重高于第3百分位数）在分娩期间及分娩后立即进行母胎血液分析（FMBA）。代谢性酸中毒以细胞外液碱缺失（BDECF）来衡量。
胎儿代谢性酸中毒主要取决于母体血液中的缓冲碱浓度。伴有无严重病理性胎心率改变的中度重复性低氧血症与胎儿代谢性酸中毒无显著关系。中度缺氧（定义为血氧饱和度低于30%、周期性减速且胎儿基础心率高于160次/分钟的组合）通过测定BDECF的母体-胎儿差异能最准确地识别。在胎儿正常氧合时，母体血液中的BDECF比胎儿血液中的高4 mmol/L，在中度缺氧时，BDECF的母体-胎儿差异降至1 mmol/L。这些发现与罗韦尔西等人（1975年）的结果一致。关于分娩期间通过胎儿血液分析对胎儿进行强化监测的结论：在pH值7.10 - 至7.30范围内，除了测定胎儿BDECF外，还应测定母体BDECF以计算BDECF的母体-胎儿差异。如果胎儿的BDECF超过母体BDECF，胎儿缺氧风险增加。在这些情况下，应尽快分娩，避免额外的缺氧或机械性产伤。描述了母胎血液分析的技术操作过程，并讨论了常规使用中的困难。
