Saji Shota, Mima Yasuyuski, Yahata Masaki, Ishi Masato, Koike Junki, Hasegawa Junichi
Department of Perinatal Developmental Pathophysiology, St. Marianna University Graduate School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kanagawa, Kawasaki, 216-8511, Kanagawa, Japan.
Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan.
BMC Pregnancy Childbirth. 2025 Jul 24;25(1):788. doi: 10.1186/s12884-025-07901-9.
This study aimed to estimate population-based frequencies of various fetal heart rate (FHR) evolution patterns in cases with umbilical cord abnormalities and to identify particular FHR evolution patterns associated with different types of umbilical cord abnormalities.
We conducted a retrospective cohort study. FHR evolution patterns, evaluating the trend of all FHR tracings from admission to delivery, were retrospectively analyzed and classified into five categories: persistent non-reassuring (p-NR), persistent bradycardia, Hon's pattern, reactive-prolonged deceleration (PD), and persistent reassuring. The study included pregnant women who delivered after 37 weeks of gestation. Frequencies of the five FHR evolution pattern categories were stratified by the type of umbilical cord abnormalities.
Among 1,195 participants, 1,074 had no cord abnormalities, and 122 had abnormalities. Overall, the prevalence of FHR patterns in cases with the cord abnormality was: 2% p-NR, 3% Hon's pattern, 21% reactive-PD, and 74% persistent reassuring. The frequencies of various FHR evolution patterns did not differ significantly between cases with and without umbilical cord abnormalities. However, when analyzing specific cord abnormalities, velamentous cord insertion showed a higher prevalence of p-NR (7% vs. 1%, p = 0.14) and reactive-PD (40% vs. 17%, p < 0.05) compared with cases without cord abnormality, along with a lower prevalence of persistence reassuring patterns (53% vs. 79%, p < 0.05).
Analysis of FHR evolution patterns in a population-based sample demonstrated a higher occurrence of reactive-PD patterns in cases with umbilical cord abnormalities, which result in sudden deterioration of fetal condition during delivery, compared with cases without umbilical cord abnormalities.
本研究旨在估计脐带异常病例中各种胎儿心率（FHR）演变模式的基于人群的频率，并确定与不同类型脐带异常相关的特定FHR演变模式。
我们进行了一项回顾性队列研究。回顾性分析从入院到分娩的所有FHR描记图的趋势，将FHR演变模式分为五类：持续性非令人安心型（p-NR）、持续性心动过缓、洪氏模式、反应性延长减速（PD）和持续性令人安心型。该研究纳入了妊娠37周后分娩的孕妇。根据脐带异常类型对五种FHR演变模式类别的频率进行分层。
在1195名参与者中，1074人无脐带异常，122人有异常。总体而言，脐带异常病例中FHR模式的患病率为：2%为p-NR，3%为洪氏模式，21%为反应性-PD，74%为持续性令人安心型。有和没有脐带异常的病例中各种FHR演变模式的频率没有显著差异。然而，在分析特定的脐带异常时，与无脐带异常的病例相比，帆状脐带插入显示p-NR（7%对1%，p = 0.14）和反应性-PD（40%对17%，p < 0.05）的患病率更高，而持续性令人安心模式的患病率更低（53%对79%，p < 0.05）。
在基于人群的样本中对FHR演变模式的分析表明，与无脐带异常的病例相比，脐带异常病例中反应性-PD模式的发生率更高，这会导致分娩期间胎儿状况突然恶化。
