Royal College of Surgeons in Ireland, Dublin, Ireland.
New Mexico, United States.
Eur J Obstet Gynecol Reprod Biol. 2022 Jun;273:69-74. doi: 10.1016/j.ejogrb.2022.04.021. Epub 2022 Apr 23.
To describe the accuracy of intrapartum fetal heart rate abnormalities as defined by National Institute of Health and Care Excellence guidelines to predict moderate-severe neonatal encephalopathy of apparent hypoxic-ischemic etiology.
A case-control study of HIE risk factors was conducted. Eligible babies were born in a single maternity hospital in Dublin, Ireland between September 2006, and November 2017 at ≥35 + 0 weeks' gestational age. Cases were eligible babies with moderate-severe neonatal encephalopathy of definite or apparent hypoxic-ischemic etiology. Controls were eligible babies born before and after each case with normal Apgar scores. The included subjects who had intrapartum fetal heart rate recordings were identified. Pattern features (baseline rate, variability, accelerations, decelerations [early, late, variable, prolonged], bradycardia, sinusoidal pattern) were manually identified blind to all clinical details by one of the authors. Each 15-minute segment was then algorithmically categorized (uninterpretable, normal, suspicious, pathological).
Of 88 cases and 176 controls, 71 cases (81%) and 146 controls (83%) were admitted to the delivery suite in labor. From that group, intrapartum FHR traces longer than 15 min were available for 52 (73%) cases and 118 (83%) controls. The FHR pattern feature with the largest area under the receiver operating characteristic curve was the maximum number of consecutive segments in which the baseline was >160 bpm (0.71 [95% confidence interval: 0.62-0.80]). The category variable with the highest area under the curve was the number of suspicious segments (0.76 [95% confidence interval: 0.67-0.84]). A tri-variate logistic regression model incorporating the total number of segments, the number of "suspicious" segments classed, and the number of "pathological" segments achieved an area under the curve of 0.78 (95% confidence interval: 0.70-0.86). With 95% specificity, this model correctly identified 17 cases (33%) at a median time before delivery of 2 h and 18 min (interquartile range: 01:19-04:40).
The power of fetal heart rate analysis to predict neonatal encephalopathy is hampered by poor specificity given the rarity of the outcome. When analyzing a suspicious trace, it is beneficial to consider the overall duration of the suspicious pattern.
描述国家卫生与保健卓越研究所指南定义的产时胎儿心率异常，以预测明显由缺氧缺血引起的中重度新生儿脑病。
进行了一项 HIE 危险因素的病例对照研究。合格的婴儿在爱尔兰都柏林的一家产科医院出生，胎龄均大于等于 35+0 周，出生于 2006 年 9 月至 2017 年 11 月。病例为具有明确或明显缺氧缺血性病因的中重度新生儿脑病的婴儿。对照组为每个病例前和后出生的、阿普加评分正常的婴儿。确定了有产时胎儿心率记录的纳入对象。一位作者对基线率、变异性、加速、减速（早期、晚期、可变、延长）、心动过缓、正弦模式等特征进行了盲法手动识别。然后，将每个 15 分钟的片段按算法分类（无法解释、正常、可疑、病理性）。
在 88 例病例和 176 例对照中，71 例（81%）和 146 例（83%）病例在分娩室进入产程。在该组中，52 例（73%）和 118 例（83%）对照组的产时 FHR 记录时间长于 15 分钟。ROC 曲线下面积最大的 FHR 特征是连续基线超过 160 bpm 的片段数（0.71 [95%置信区间：0.62-0.80]）。曲线下面积最高的类别变量是可疑片段数（0.76 [95%置信区间：0.67-0.84]）。纳入总片段数、“可疑”片段数和“病理性”片段数的三变量逻辑回归模型，获得的曲线下面积为 0.78（95%置信区间：0.70-0.86）。在 95%特异性的情况下，该模型在中位分娩前 2 小时 18 分钟（四分位距：01:19-04:40）时正确识别出 17 例（33%）病例。
由于结局罕见，胎儿心率分析预测新生儿脑病的特异性较差，因此其预测新生儿脑病的能力有限。在分析可疑迹线时，考虑可疑迹线的整体持续时间是有益的。
