Weiner Z, Farmakides G, Schulman H, Kellner L, Plancher S, Maulik D
Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Lab, Winthrop-University Hospital, Mineola, NY 11501.
Am J Obstet Gynecol. 1994 Oct;171(4):1132-8. doi: 10.1016/0002-9378(94)90051-5.
Our purpose was to evaluate whether computerized analysis of fetal heart rate variation may improve fetal surveillance in postterm pregnancy.
Three hundred thirty-seven pregnant women who were delivered after 41 weeks' gestation and who had 610 antenatal tests were included in this study. Fetal tests included a nonstress test with a computerized analysis of the fetal heart rate, Doppler examination of the umbilical artery, and a biophysical profile, performed every 2 to 4 days. Induction of labor was performed when the fetal heart rate variation was reduced (< 30 msec), when fetal heart rate decelerations appeared, or when the amniotic fluid index was < or = 5. The results of the fetal surveillance tests were compared with the results of the intrapartum fetal heart rate monitoring and with the metabolic status of the babies at delivery. Sensitivity and specificity of the various tests in predicting intrapartum fetal distress and acidosis at delivery were described by means of the receiver-operator characteristic curve.
Ten of 12 fetuses with reduced fetal heart rate variation had a trial of labor. Nine of these 10 fetuses had fetal distress during labor. Seven of the 12 fetuses with reduced fetal heart rate variation were acidotic at delivery (umbilical artery pH < 7.2). Overall, there were 10 acidotic fetuses at delivery in the study group. Only two of them had an umbilical systolic/diastolic ratio > 95th percentile, three had an amniotic fluid index < or = 5, and five had fetal heart rate decelerations before labor. Fetuses who demonstrated an abnormal intrapartum fetal heart rate tracing or who were acidotic at delivery had a significantly higher rate of reduced fetal heart rate variation or decelerations before labor. The largest area under the receiver-operator curve curve for predicting fetal acidosis at delivery or fetal distress during labor was achieved by means of computerized analysis of fetal heart rate variation.
A computerized numeric analysis of fetal heart rate variation may improve fetal surveillance in postterm pregnancy.
我们的目的是评估胎儿心率变异的计算机化分析是否可改善过期妊娠的胎儿监测。
本研究纳入了337名妊娠41周后分娩且进行了610次产前检查的孕妇。胎儿检查包括对胎儿心率进行计算机化分析的无应激试验、脐动脉多普勒检查以及生物物理评分，每2至4天进行一次。当胎儿心率变异降低（<30毫秒）、出现胎儿心率减速或羊水指数≤5时，进行引产。将胎儿监测试验的结果与产时胎儿心率监测结果以及分娩时婴儿的代谢状况进行比较。通过受试者操作特征曲线描述各种试验在预测产时胎儿窘迫和酸中毒方面的敏感性和特异性。
12名胎儿心率变异降低的胎儿中有10名进行了引产试验。这10名胎儿中有9名在分娩过程中出现胎儿窘迫。12名胎儿心率变异降低的胎儿中有7名在分娩时酸中毒（脐动脉pH<7.2）。总体而言，研究组中有10名胎儿在分娩时酸中毒。其中只有2名胎儿的脐动脉收缩压/舒张压比值>第95百分位数，3名胎儿的羊水指数≤5，5名胎儿在分娩前出现胎儿心率减速。在产时胎儿心率描记异常或在分娩时酸中毒的胎儿中，分娩前胎儿心率变异降低或减速的发生率显著更高。通过对胎儿心率变异进行计算机化分析，在预测分娩时胎儿酸中毒或产时胎儿窘迫方面获得了受试者操作特征曲线下最大的面积。
对胎儿心率变异进行计算机化数值分析可改善过期妊娠的胎儿监测。
