Yoon B H, Romero R, Roh C R, Kim S H, Ager J W, Syn H C, Cotton D, Kim S W
Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Korea.
Am J Obstet Gynecol. 1993 Dec;169(6):1586-94. doi: 10.1016/0002-9378(93)90441-k.
Fetal hypoxia-acidosis is part of the terminal pathway leading to intrauterine fetal death. A central premise of antepartum surveillance is that identification and timely delivery of the hypoxic or acidotic fetus will prevent intrauterine death and decrease long-term neurologic damage. The optimal method to identify fetal hypoxia-acidosis has not been determined. We attempted to compare the performance of the biophysical profile score and umbilical artery Doppler velocimetry in the identification of fetal acidemia, hypoxemia, and hypercarbia as determined by pH and gas analysis of fetal blood obtained by cordocentesis.
Fetal biophysical profile and umbilical artery Doppler velocimetry studies were performed before cordocentesis in 24 patients (26 to 40 weeks). Umbilical vein pH and blood gas values were determined in all cases. The pulsatility index of the umbilical artery was obtained with pulsed Doppler equipment. Receiver-operator characteristic curve analysis and stepwise multiple logistic regression were performed to examine the relationship between biophysical profile score, umbilical artery Doppler velocimetry, and acid-base status.
The prevalence of fetal acidemia (pH 2 SD below the mean for gestational age) was 41.7% (10/24). There was a significant relationship between the change in umbilical artery pulsatility index and fetal acidemia (chi 2 = 26.6, p < 0.001) and hypercarbia (chi 2 = 22.9, p < 0.001), but not hypoxemia (chi 2 = 1.0, p > 0.1), and between the biophysical profile score and fetal acidemia (chi 2 = 11.1, p < 0.001) and hypercarbia (chi 2 = 9.0, p < 0.005), but not hypoxemia (chi 2 = 2.3, p > 0.1). Stepwise multiple logistic regression demonstrated that umbilical artery Doppler velocimetry was a better explanatory variable for acidemia and hypercarbia than the biophysical profile score.
A strong relationship between the degree of fetal acidemia and hypercarbia and the results of umbilical artery Doppler velocimetry and biophysical profile was found. However, umbilical artery Doppler velocimetry was a better explanatory variable for these outcome than the biophysical profile score.
胎儿缺氧酸中毒是导致宫内胎儿死亡的终末途径的一部分。产前监护的一个核心前提是，识别并及时娩出缺氧或酸中毒胎儿可预防宫内死亡并减少长期神经损伤。尚未确定识别胎儿缺氧酸中毒的最佳方法。我们试图比较生物物理评分和脐动脉多普勒血流速度测定法在识别胎儿酸血症、低氧血症和高碳酸血症方面的性能，这些情况通过经皮脐血穿刺获取的胎儿血液的pH值和气体分析来确定。
对24例患者（孕周26至40周）在经皮脐血穿刺前进行胎儿生物物理评分和脐动脉多普勒血流速度测定研究。所有病例均测定脐静脉pH值和血气值。用脉冲多普勒设备获取脐动脉搏动指数。进行受试者操作特征曲线分析和逐步多元逻辑回归，以研究生物物理评分、脐动脉多普勒血流速度测定与酸碱状态之间的关系。
胎儿酸血症（pH值比孕周均值低2个标准差）的发生率为41.7%（10/24）。脐动脉搏动指数变化与胎儿酸血症（χ² = 26.6，p < 0.001）和高碳酸血症（χ² = 22.9，p < 0.001）之间存在显著关系，但与低氧血症（χ² = 1.0，p > 0.1）无关；生物物理评分与胎儿酸血症（χ² = 11.1，p < 0.001）和高碳酸血症（χ² = 9.0，p < 0.005）之间存在显著关系，但与低氧血症（χ² = 2.3，p > 0.1）无关。逐步多元逻辑回归表明，对于酸血症和高碳酸血症，脐动脉多普勒血流速度测定法比生物物理评分是更好的解释变量。
发现胎儿酸血症和高碳酸血症程度与脐动脉多普勒血流速度测定及生物物理评分结果之间存在密切关系。然而，对于这些结果，脐动脉多普勒血流速度测定法比生物物理评分是更好的解释变量。
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