胎儿头皮刺激试验在评估分娩期间胎儿健康状况中的有效性：一项回顾性队列研究。
Effectiveness of fetal scalp stimulation test in assessing fetal wellbeing during labor, a retrospective cohort study.
机构信息
Department of Gynecology and Obstetrics, Sjælland University Hospital, Roskilde, Denmark.
Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
出版信息
BMC Pregnancy Childbirth. 2020 Jun 5;20(1):347. doi: 10.1186/s12884-020-03030-7.
BACKGROUND
It is discussed whether fetal scalp stimulation (FSS) test is a reliable complimentary tool to cardiotocography (CTG) to assess fetal wellbeing during labor. The test is based on the assumption that a well-oxygenated fetus, in contrast to the depressed fetus, will respond to a certain stimulus. The aim of this study was to investigate the effectiveness of the FSS-test.
METHODS
A retrospective observational study carried out Copenhagen University Hospital, Herlev, Denmark. Laboring women with singleton pregnancies in cephalic presentation after gestation week 33 and indication for fetal blood sampling (FBS) were eligible for inclusion. The FSS-test was classified as positive when an acceleration was absent at the time of FBS and negative when an acceleration was present. Lactate in scalp blood was measured by the point-of-care device LactatePro™ and pH in artery umbilical cord blood by the stationary blood gas analyzer ABL800. Lactate level < 4.2 mmol/L in scalp blood and arterial cord pH > 7.1 were cut-offs for normality.
RESULTS
Three hundred eighty-five women were included. The cohort was divided by the FBS-to-delivery time: Group 1 (n = 128) ≤ 20 min, Group 2 (n = 117) 21-59 min and Group 3 (n = 140) ≥ 60 min. The proportion of FSS-positive tests differed significantly between the groups (p < 0.000). In Group 1 the sensitivity, specificity and likelihoods for scalp lactate ≥4.2 mmol/L were 81.5 (95% CI 67-90.1), 13.3 18.5 (95% CI 5.9-24.6), LHR+ 0.94 (95% CI 0.8-1.1) and LHR - 1.4 (95% CI 0.6-3.2) and for umbilical artery pH ≤ 7.10 the values were 82.6% (95% CI 61.2-95.1), 16% (95% CI 9.4-24.7), 1.0 (95% CI 0.8-1.2) and 1.1 (95% CI 0.4-3) respectively. Regardless of the FBS-to-delivery time the LHR+ for lactate ≥4.2 mmol/L increased to 1.38 (95% CI 1.2-1.6).
CONCLUSION
The effectiveness of scalp stimulation test was poor for both ruling in and out fetal hypoxia during labor. Absence of a provoked acceleration seems to be a normal phenomenon in the second stage of labor.
背景
有人讨论胎儿头皮刺激（FSS）试验是否是评估分娩期间胎儿健康状况的一种可靠的补充手段，其基于胎儿对刺激有反应，而不是胎儿抑郁的假设。本研究的目的是研究 FSS 试验的有效性。
方法
这是在丹麦哥本哈根大学医院进行的一项回顾性观察性研究。孕 33 周后头位单胎妊娠，有胎儿血液取样（FBS）指征的产妇符合纳入标准。当 FBS 时无加速时，FSS 试验被分类为阳性，当有加速时，FSS 试验被分类为阴性。头皮血中的乳酸通过即时检测设备 LactatePro™进行测量，脐动脉血中的 pH 通过固定式血气分析仪 ABL800 进行测量。头皮血中乳酸水平 < 4.2 mmol/L 和动脉脐带 pH > 7.1 为正常的截止值。
结果
共纳入 385 名女性。根据 FBS 至分娩时间将队列分为三组：第 1 组（n = 128） ≤ 20 分钟，第 2 组（n = 117）21-59 分钟，第 3 组（n = 140） ≥ 60 分钟。三组之间 FSS 阳性试验的比例差异有统计学意义（p < 0.000）。第 1 组中，头皮乳酸水平 ≥ 4.2 mmol/L 的灵敏度、特异性和似然比分别为 81.5%（95% CI 67-90.1）、13.3%（95% CI 5.9-24.6）、LHR+0.94（95% CI 0.8-1.1）和 LHR - 1.4（95% CI 0.6-3.2），脐动脉 pH ≤ 7.10 的灵敏度、特异性和似然比分别为 82.6%（95% CI 61.2-95.1）、16%（95% CI 9.4-24.7）、1.0（95% CI 0.8-1.2）和 1.1（95% CI 0.4-3）。无论 FBS 至分娩时间如何，LHR+对于乳酸水平 ≥ 4.2 mmol/L 增加至 1.38（95% CI 1.2-1.6）。
结论
FSS 试验在分娩期间判断胎儿缺氧的有效性均较差。第二产程中无诱发加速似乎是一种正常现象。
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