Taoum Aline, Carrault Guy, Tesson Caroline, Esvan Maxime, Laviolle Bruno, Lassel Linda
LTSI, Université de Rennes, INSERM, Rennes, France.
CHU Rennes, Rennes, France.
PLoS One. 2025 Jan 2;20(1):e0305875. doi: 10.1371/journal.pone.0305875. eCollection 2025.
Chorioamnionitis is recognized as a major consequence of preterm premature rupture of membranes (PPROM), and a frequent cause of neonatal morbidity and mortality. The association between fetal heart rate (FHR) and chorioamnionitis remains unclear.
The aim of this study was to evaluate the dynamics of FHR in a PPROM population at the approach of delivery according to the presence or absence of chorioamnionitis.
MATERIALS & METHODS: 120 pregnant women with PPROM between 26 and 34 weeks' gestation were enrolled in this multicenter prospective unblinded study. All participants were fully informed of the study's objectives. 39 of the 120 patients were included in the analysis of FHR recordings. The analysis consisted of extracting features from computerized FHR analysis (cFHR) and fetal heart rate variability analysis (FHRV) in the temporal, frequency and nonlinear domains. Then, each set of features was analyzed separately using the multiple factor analysis, where three groups were defined as the feature set for days 0, -1 and -2 prior to birth. The distances between the global projection and the projections for each day were computed and used in the ROC analysis to distinguish chorioamnionitis from non-chorioamnionitis group.
The results showed that there were significant differences in certain features between populations with and without chorioamnionitis. The distinction between the two populations reached an area under the curve (AUC) of only 37% [34-40] for cFHR features and 63% [59-66] for time-domain FHRV features when comparing all stages of chorioamnionitis to non-chorioamnionitis subjects. When only stage 3 chorioamnionitis was compared to non-chorioamnionitis patients, the AUC reached 90% [88-93] for nonlinear-domain and 84% [82-87] for time-domain FHRV features, whereas it was limited to 71% [68-74] using cFHR features.
The present study suggests that the HRV features are more reliable for diagnosing chorioamnionitis than cFHR, and that the assessment of features dynamics over several days is an interesting tool for detecting chorioamnionitis. Further study should be carried out on a larger sample to confirm these findings, improve the diagnostic performance of chorioamnionitis and help clinicians decide on delivery criteria.
绒毛膜羊膜炎被认为是胎膜早破（PPROM）的主要后果，也是新生儿发病和死亡的常见原因。胎儿心率（FHR）与绒毛膜羊膜炎之间的关联尚不清楚。
本研究的目的是根据绒毛膜羊膜炎的有无，评估PPROM人群在分娩临近时FHR的动态变化。
120例孕26至34周的PPROM孕妇纳入了这项多中心前瞻性非盲研究。所有参与者都充分了解了研究目的。120例患者中的39例被纳入FHR记录分析。分析包括从计算机化FHR分析（cFHR）和胎儿心率变异性分析（FHRV）的时间、频率和非线性域中提取特征。然后，每组特征分别使用多因素分析进行分析，其中三组被定义为出生前0、-1和-2天的特征集。计算全局投影与每天投影之间的距离，并用于ROC分析，以区分绒毛膜羊膜炎组和非绒毛膜羊膜炎组。
结果表明，有绒毛膜羊膜炎和无绒毛膜羊膜炎人群在某些特征上存在显著差异。将绒毛膜羊膜炎各阶段与非绒毛膜羊膜炎受试者进行比较时，cFHR特征的两组人群之间曲线下面积（AUC）仅为37%[34-40]，时域FHRV特征为63%[59-66]。当仅将3期绒毛膜羊膜炎与非绒毛膜羊膜炎患者进行比较时，非线性域的AUC达到90%[88-93]，时域FHRV特征为84%[82-87]，而使用cFHR特征时AUC限于71%[68-74]。
本研究表明，HRV特征在诊断绒毛膜羊膜炎方面比cFHR更可靠，并且对几天内特征动态的评估是检测绒毛膜羊膜炎的一个有趣工具。应在更大样本上进行进一步研究以证实这些发现，提高绒毛膜羊膜炎的诊断性能，并帮助临床医生确定分娩标准。
