高危妊娠中脐带血气分析对产时胎心监护图形诊断出生时酸中毒的准确性。
Accuracy of intrapartum cardiotocography in identifying acidemia at birth by umbilical cord blood gasometry in high-risk pregnancies.
机构信息
Universidade de Uberaba, Mário Palmério University Hospital, Gynecology and Obstetrics Service - Uberaba (MG), Brazil.
Universidade Federal do Triângulo Mineiro, Department of Gynecology and Obstetrics - Uberaba (MG), Brazil.
出版信息
Rev Assoc Med Bras (1992). 2023 Oct 9;69(11):e20230511. doi: 10.1590/1806-9282.20230511. eCollection 2023.
OBJECTIVE
The aim of this study was to evaluate the accuracy of intrapartum cardiotocography in identifying acidemia at birth by umbilical cord blood gasometry in high-risk pregnancies.
METHODS
This was a retrospective cohort study of singleton high-risk parturients using intrapartum cardiotocography categories I, II, and III. The presence of fetal acidemia at birth was identified by the analysis of umbilical cord arterial blood pH (<7.1). Associations between variables were determined using the chi-square test and Kruskal-Wallis tests.
RESULTS
We included 105 cases of cardiotocography category I, 20 cases of cardiotocography category II, and 10 cases of cardiotocography category III. cardiotocography category III had a higher prevalence of cesarean sections compared to cardiotocography category I (90.0 vs. 42.9%, p<0.006). Venous pH was higher in patients with cardiotocography category I compared to cardiotocography category III (7.32 vs. 7.23, p=0.036). Prevalence of neonatal intensive care unit (NICU) admission was lower in neonates of patients with cardiotocography category I compared to cardiotocography category III (3.8 vs. 30.0%, p=0.014). Prevalence of composite adverse outcomes was lower in neonates of patients with cardiotocography category I compared to cardiotocography category II (9.5 vs. 30.0%, p=0.022) and cardiotocography category III (9.5 vs. 60.0%, p=0.0004). cardiotocography categories II and III had low sensitivity (0.05 and 0.00, respectively) and high negative predictive value (NPV) (0.84 and 0.91, respectively) for identifying fetal acidemia at birth. The three categories of intrapartum cardiotocography showed high specificities (96.0, 99.0, and 99.0%, respectively).
CONCLUSION
All three categories of intrapartum cardiotocography showed low sensitivity and high specificity for identifying acidemia at birth.
目的
本研究旨在评估高危妊娠中产时胎心监护图分类 I、II 和 III 识别脐动脉血气分析中出生时酸中毒的准确性。
方法
这是一项回顾性队列研究，纳入使用产时胎心监护图分类 I、II 和 III 的单胎高危产妇。通过分析脐动脉血 pH（<7.1）来确定出生时胎儿酸中毒的存在。使用卡方检验和 Kruskal-Wallis 检验确定变量之间的关联。
结果
共纳入 105 例胎心监护图分类 I 病例、20 例胎心监护图分类 II 病例和 10 例胎心监护图分类 III 病例。与胎心监护图分类 I 相比，胎心监护图分类 III 的剖宫产率更高（90.0% vs. 42.9%，p<0.006）。与胎心监护图分类 III 相比，胎心监护图分类 I 的静脉 pH 值更高（7.32 vs. 7.23，p=0.036）。与胎心监护图分类 III 相比，胎心监护图分类 I 的新生儿重症监护病房（NICU）入住率更低（3.8% vs. 30.0%，p=0.014）。与胎心监护图分类 II 相比（30.0% vs. 9.5%，p=0.022）和胎心监护图分类 III（30.0% vs. 9.5%，p=0.0004），胎心监护图分类 I 的新生儿复合不良结局发生率更低。胎心监护图分类 II 和 III 对识别出生时酸中毒的敏感性较低（分别为 0.05 和 0.00），阴性预测值（NPV）较高（分别为 0.84 和 0.91）。三种产时胎心监护图分类均具有较高的特异性（分别为 96.0%、99.0%和 99.0%）。
结论
三种产时胎心监护图分类对识别出生时酸中毒的敏感性均较低，特异性均较高。
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