Lovers Aimée A K, Ugwumadu Austin, Georgieva Antoniya
Nuffield Department of Women's and Reproductive Health, Big Data Institute, University of Oxford, Oxford, United Kingdom.
Department of Obstetrics and Gynaecology, St George's, University of London, London, United Kingdom.
Front Pediatr. 2022 Mar 16;10:784439. doi: 10.3389/fped.2022.784439. eCollection 2022.
The role of cardiotocography (CTG) in fetal risk assessment around the beginning of term labor is controversial. We used routinely collected clinical data in a large tertiary hospital to investigate whether infants with "severe compromise" at birth exhibited fetal heart rate abnormalities in their first-hour CTGs and/or other clinical risks, recorded as per routine care.
Retrospective data from 27,927 parturitions (single UK tertiary site, 2001-2010) were analyzed. Cases were included if the pregnancy was singleton, ≥36 weeks' gestation, cephalic presentation, and if they had routine intrapartum CTG as per clinical care. Cases with congenital abnormalities, planned cesarean section (CS), or CS for reasons other than "presumed fetal compromise" were excluded. We analyzed first-hour intrapartum CTG recordings, using intrapartum Oxford System (OxSys) computer-based algorithms. To reflect the effect of routine clinical care, the data was stratified into three exclusive groups: infants delivered by CS for "presumed fetal compromise" within 2 h of starting the CTG ( = 113); between 2 and 5 h of starting the CTG ( = 203); and the rest of deliveries ( = 27,611). First-hour CTG and clinical characteristics were compared between the groups, sub-divided to those with and without severe compromise: a composite outcome of stillbirth, neonatal death, neonatal seizures, encephalopathy, resuscitation followed by ≥48 h in neonatal intensive care unit. Two-sample -test, X test, and Fisher's exact test were used for analysis.
Compared to babies without severe compromise, those with compromise had significantly higher proportion of cases with baseline fetal heart rate ≥150 bpm; non-reactive trace; reduced long-term and short-term variability; decelerative capacity; and no accelerations in the first-hour CTG across all groups. Prolonged decelerations(≥3 min) were also more common. Thick meconium and small for gestational age were consistently more common in compromised infants across all groups. There was more often thick meconium, maternal fever ≥38 C, sentinel events, and other clinical risk factors in the and compared to the group.
A proportion of infants born with severe compromise had significantly different first-hour CTG features and clinical risk factors.
分娩开始时胎心监护（CTG）在评估胎儿风险中的作用存在争议。我们利用一家大型三级医院常规收集的临床数据，调查出生时出现“严重不良情况”的婴儿在其首小时CTG中是否表现出胎儿心率异常和/或其他按照常规护理记录的临床风险。
分析了来自27927例分娩（英国单一三级医疗机构，2001 - 2010年）的回顾性数据。纳入标准为单胎妊娠、妊娠≥36周、头先露且按照临床护理进行了常规产时CTG检查。排除患有先天性异常、计划剖宫产或因“假定胎儿窘迫”以外原因进行剖宫产的病例。我们使用基于牛津系统（OxSys）计算机算法分析首小时产时CTG记录。为反映常规临床护理的影响，数据被分为三个互斥组：在开始CTG后2小时内因“假定胎儿窘迫”行剖宫产分娩的婴儿（n = 113）；开始CTG后2至5小时内行剖宫产分娩的婴儿（n = 203）；以及其余分娩的婴儿（n = 27611）。比较了三组之间首小时CTG和临床特征，并将其细分为有和没有严重不良情况的两组：复合结局包括死产、新生儿死亡、新生儿惊厥、脑病、复苏后在新生儿重症监护病房住院≥48小时。采用两样本t检验、X检验和Fisher精确检验进行分析。
与无严重不良情况的婴儿相比，有严重不良情况的婴儿在所有组的首小时CTG中，基线胎儿心率≥150次/分钟、无反应型图形、长期和短期变异性降低、减速能力以及无加速的病例比例显著更高。延长减速（≥3分钟）也更常见。所有组中，胎粪黏稠和小于胎龄儿在有严重不良情况的婴儿中始终更为常见。与第3组相比，第1组和第2组中胎粪黏稠、产妇发热≥38℃、哨兵事件及其他临床风险因素更常见。
一部分出生时出现严重不良情况的婴儿在首小时CTG特征和临床风险因素方面存在显著差异。
