Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.
Department of Obstetrics and Gynecology, George Washington University Biostatistics Center, Washington, District of Columbia.
Am J Perinatol. 2021 Dec;38(14):1465-1471. doi: 10.1055/s-0041-1735285. Epub 2021 Aug 31.
This study aimed to evaluate whether intrapartum fetal electrocardiogram (ECG) tracings with ST-elevation or depression occur more frequently in each stage of labor in small-for-gestational age (SGA) or large-for-gestational age (LGA), as compared with appropriate-for-gestational age (AGA) fetuses.
We conducted a secondary analysis of a large, multicenter trial in which laboring patients underwent fetal ECG waveform-analysis. We excluded participants with diabetes mellitus and major fetal anomalies. Birth weight was categorized as SGA (<10th percentile), LGA (>90th percentile), or AGA (10-90th percentile) by using a gender and race/ethnicity specific nomogram. In adjusted analyses, the frequency of ECG tracings with ST-depression or ST-elevation without depression was compared according to birthweight categories and labor stage.
Our study included 4,971 laboring patients in the first stage and 4,074 in the second stage. During the first stage of labor, there were no differences in the frequency of ST-depression in SGA fetuses compared with AGA fetuses (6.7 vs. 5.5%; adjusted odds ratio [aOR]: 1.41, 95% confidence interval [CI]: 0.93-2.13), or in ST-elevation without depression (35.8 vs. 34.1%; aOR: 1.17, 95% CI: 0.94-1.46). During the second stage, there were no differences in the frequency of ST-depression in SGA fetuses compared with AGA fetuses (1.6 vs. 2.0%; aOR: 0.69, 95% CI: 0.27-1.73), or in ST-elevation without depression (16.2 vs. 18.1%; aOR: 0.90, 95% CI: 0.67-1.22). During the first stage of labor, there were no differences in the frequency of ST-depression in LGA fetuses compared with AGA fetuses (6.3 vs. 5.5%; aOR: 0.97, 95% CI: 0.60-1.57), or in ST-elevation without depression (33.1 vs. 34.1%; aOR: 0.80, 95% CI: 0.62-1.03); during the second stage of labor, the frequency of ST-depression in LGA compared with AGA fetuses (2.5 vs. 2.0%, aOR: 1.36, 95% CI: 0.61-3.03), and in ST-elevation without depression (15.5 vs. 18.1%; aOR: 0.83, 95% CI: 0.58-1.18) were similar as well.
The frequency of intrapartum fetal ECG tracings with ST-events is similar among SGA, AGA, and LGA fetuses.
· SGA and LGA neonates are at increased risk of cardiac dysfunction.. · Fetal ECG has been used to evaluate fetal response to hypoxia.. · Fetal ST-elevation and ST-depression occur during hypoxia.. · Frequency of intrapartum ST-events is similar among SGA, AGA and LGA fetuses..
本研究旨在评估与适用于胎龄（AGA）胎儿相比，在小胎龄（SGA）或大胎龄（LGA）中，胎儿心电图（ECG）描记图中的 ST 段抬高或压低是否更常发生于产程的每个阶段。
我们对一项大型多中心试验进行了二次分析，该试验中分娩患者接受了胎儿心电图波形分析。我们排除了患有糖尿病和主要胎儿畸形的参与者。通过使用性别和种族/民族特定的图表，将出生体重分为 SGA（<第 10 百分位数）、LGA（>第 90 百分位数）或 AGA（第 10-90 百分位数）。在调整后的分析中，根据出生体重类别和产程阶段比较 ST 压低或 ST 抬高而无压低的心电图描记图的频率。
我们的研究包括第一产程的 4971 名分娩患者和第二产程的 4074 名分娩患者。在第一产程中，与 AGA 胎儿相比，SGA 胎儿的 ST 压低频率没有差异（6.7%与 5.5%；调整后的优势比[aOR]：1.41，95%置信区间[CI]：0.93-2.13），ST 抬高而无压低也没有差异（35.8%与 34.1%；aOR：1.17，95%CI：0.94-1.46）。在第二产程中，与 AGA 胎儿相比，SGA 胎儿的 ST 压低频率也没有差异（1.6%与 2.0%；aOR：0.69，95%CI：0.27-1.73），ST 抬高而无压低也没有差异（16.2%与 18.1%；aOR：0.90，95%CI：0.67-1.22）。在第一产程中，与 AGA 胎儿相比，LGA 胎儿的 ST 压低频率也没有差异（6.3%与 5.5%；aOR：0.97，95%CI：0.60-1.57），ST 抬高而无压低也没有差异（33.1%与 34.1%；aOR：0.80，95%CI：0.62-1.03）；在第二产程中，LGA 胎儿的 ST 压低频率与 AGA 胎儿相比（2.5%与 2.0%，aOR：1.36，95%CI：0.61-3.03），以及 ST 抬高而无压低（15.5%与 18.1%；aOR：0.83，95%CI：0.58-1.18）也相似。
SGA、AGA 和 LGA 胎儿的产时胎儿心电图 ST 事件的频率相似。
· SGA 和 LGA 新生儿心脏功能障碍的风险增加。· 胎儿心电图已用于评估胎儿对缺氧的反应。· 胎儿 ST 抬高和 ST 压低发生在缺氧时。· SGA、AGA 和 LGA 胎儿的产时 ST 事件频率相似。
