Paladugu Vinya, Sreedhar Sarala, Chitra R, Mannava Sai Tejaswi, Sreekumar Saranya, Mangalakanthi Janu
Amrita Institute of Medical Sciences and Research Centre, Amrita Institute of Medical Sciences, Kochi, India.
J Obstet Gynaecol India. 2023 Feb;73(1):28-35. doi: 10.1007/s13224-022-01702-2. Epub 2022 Sep 17.
Intrapartum fetal hypoxia which is one of the leading causes of neonatal morbidity and mortality is a preventable cause. Over the past years, many methods have been employed to diagnose fetal distress, a sign of fetal hypoxia, among these, cardiotocography (CTG) is the most widely used method. Diagnosis of fetal distress based on CTG can have high inter and intraobserver variation leading to either delayed or inessential intervention henceforth increasing maternal morbidity and mortality. Fetal cord arterial blood pH is an objective method to diagnose intrapartum fetal hypoxia, hence by observing the incidence of acidemia in cord blood pH among those newborns born through cesarean section (CS) in view of non-reassuring CTG can help make a judicious decision.
In this single institutional observational study, patients admitted for safe confinement were subjected to CTG in the latent and active phases of labor. Non-Reassuring traces were further classified based on NICE guideline CG190. The cord blood of these neonates born through CS in view of non-reassuring CTG was drawn and sent for ABG analysis.
Among the 87 neonates delivered through CS in view of fetal distress, 19.5% had acidosis. Among those with pathological traces, 16(28.6%) had acidosis and one (100%) which was categorized as the need for urgent intervention showed acidosis. This result showed a statistically significant association ( value-0.003). No statistically significant association was obtained when variation in baseline characters of CTG when taken independently.
In our study, neonatal acidemia which is the objective evidence of fetal distress was seen in 19.5% of our study population who underwent cesarean in view of non-reassuring CTG. Among these, acidemia was significantly associated with pathological CTG trace compared to suspicious trace. We also observed that abnormal FHR features when taken independently showed no significant association with acidosis. Acidosis among newborns certainly increased the requirement for active resuscitation and additional hospital stay. Hence, we conclude that by recognizing specific fetal heart rate patterns associated with acidosis in a fetus, a more judicious decision can be made, thereby preventing both delayed as well as inessential intervention.
产时胎儿缺氧是新生儿发病和死亡的主要原因之一，是可预防的病因。在过去几年中，已采用多种方法来诊断胎儿窘迫（胎儿缺氧的一种表现），其中，胎心监护（CTG）是应用最广泛的方法。基于CTG诊断胎儿窘迫可能存在较高的观察者间和观察者内差异，从而导致干预延迟或不必要的干预，进而增加孕产妇发病率和死亡率。胎儿脐动脉血pH值是诊断产时胎儿缺氧的客观方法，因此，鉴于CTG结果不令人放心，观察剖宫产出生新生儿脐血pH值中的酸血症发生率有助于做出明智的决策。
在这项单机构观察性研究中，因安全分娩入院的患者在产程的潜伏期和活跃期接受CTG检查。根据英国国家卫生与临床优化研究所（NICE）指南CG190对不令人放心的图形进行进一步分类。鉴于CTG结果不令人放心，抽取这些剖宫产出生新生儿的脐血并送检进行血气分析。
鉴于胎儿窘迫而行剖宫产的87例新生儿中，19.5%存在酸中毒。在有病理图形的新生儿中，16例（28.6%）存在酸中毒，1例（100%）被归类为需要紧急干预的新生儿显示存在酸中毒。这一结果显示出统计学显著相关性（P值=0.003）。单独考虑CTG基线特征的差异时，未获得统计学显著相关性。
在我们的研究中，鉴于CTG结果不令人放心而行剖宫产的研究人群中，19.5%出现了作为胎儿窘迫客观证据的新生儿酸血症。其中，与可疑图形相比，酸血症与病理CTG图形显著相关。我们还观察到，单独考虑异常胎心率特征时，与酸中毒无显著相关性。新生儿酸中毒肯定会增加积极复苏的需求和额外的住院时间。因此，我们得出结论，通过识别与胎儿酸中毒相关的特定胎心率模式，可以做出更明智的决策，从而避免干预延迟和不必要的干预。
