Gilstrap L C, Hauth J C, Hankins G D, Beck A W
Obstet Gynecol. 1987 Aug;70(2):191-5.
The type of acidemia (umbilical arterial pH less than 7.2) occurring in newborns with second-stage baseline fetal heart rate (FHR) abnormalities was evaluated in 277 term gestations. Umbilical arterial acidemia occurred in 40% of the neonates with moderate to severe bradycardia (25 of 63), in 30% with mild bradycardia (16 of 53), and in 22% with tachycardia (seven of 32), compared with only 6% (eight of 129) of those with a normal FHR (P less than .05 in each of the three comparisons). The majority (31 of 56, 55%) of the acidemic neonates had a mixed respiratory-metabolic pattern, whereas 13 of 56 (23%) had a respiratory pattern and 12 of 56 (21%) had a metabolic pattern. The mean umbilical arterial buffer deficit (mEq/L) was significantly greater (P less than .0005) in newborns with metabolic acidemia (-15.9 +/- 2.8) than in those with either mixed (-9.6 +/- 2.5) or respiratory (-6.4 +/- 1.9) acidemia. We conclude that baseline second-stage FHR abnormalities can predict which newborns are at increased risk of having umbilical arterial pH below 7.2 at birth. Selective determination of umbilical arterial pH and blood gas analysis may be useful in assessing intrapartum management retrospectively.
在277例足月妊娠中，对出现第二产程基线胎心率（FHR）异常的新生儿发生的酸血症类型（脐动脉pH值小于7.2）进行了评估。中度至重度心动过缓的新生儿中40%（63例中的25例）发生脐动脉酸血症，轻度心动过缓的新生儿中30%（53例中的16例）发生，心动过速的新生儿中22%（32例中的7例）发生，而胎心率正常的新生儿中只有6%（129例中的8例）发生（三项比较中的每一项P均小于0.05）。大多数（56例中的31例，55%）酸血症新生儿具有呼吸 - 代谢混合模式，而56例中的13例（23%）具有呼吸模式，56例中的12例（21%）具有代谢模式。代谢性酸血症新生儿的平均脐动脉缓冲碱缺乏（mEq/L）（-15.9±2.8）显著高于混合性（-9.6±2.5）或呼吸性（-6.4±1.9）酸血症新生儿（P小于0.0005）。我们得出结论，第二产程基线FHR异常可预测哪些新生儿出生时脐动脉pH值低于7.2的风险增加。选择性测定脐动脉pH值和血气分析可能有助于回顾性评估产时管理。
