Vintzileos A M, Nochimson D J, Antsaklis A, Varvarigos I, Guzman E R, Knuppel R A
Department of Obstetrics, Gynecology and Reproductive Sciences, Robert Wood Johnson Medical School/St. Peter's Medical Center, University of Medicine and Dentistry of New Jersey 08903, USA.
J Matern Fetal Med. 1996 Jan-Feb;5(1):11-7. doi: 10.1002/(SICI)1520-6661(199601/02)5:1<11::AID-MFM3>3.0.CO;2-W.
The objective of this study was to determine whether vacuum extraction is associated with umbilical cord blood acid-base changes when used electively or in the presence of suspected fetal distress. Data from 1,428 patients from a previously published randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation were analyzed to identify differences in umbilical cord blood acid-base measurements associated with the elective use of vacuum extraction (patients with duration of second stage of labor 60 min or less) and also in the presence of suspected fetal distress during the second stage of labor. When used electively, vacuum extraction was associated with lower pH (in both umbilical cord artery and vein), lower venous base excess, and higher venous carbon dioxide tension (PCO2), as compared to normal spontaneous vaginal delivery. After correcting for duration of second stage of labor, elective vacuum delivery was significantly associated only with a decrease in cord venous pH and increase in venous PCO2. However, these cord blood acid-base changes were not accompanied by any differences in perinatal morbidity and mortality or in the number of neonates born with acidemia (cord arterial pH < 7.15 or < 7.10). In cases of suspected fetal distress, the use of vacuum extraction was not associated with any detectable cord blood acid-base changes as compared to normal spontaneous vaginal delivery. These data support the continued use of vacuum extraction, especially in cases of suspected fetal distress during the second stage of labor.
本研究的目的是确定在选择性使用或存在疑似胎儿窘迫的情况下，真空吸引术是否与脐血酸碱变化相关。对先前发表的一项关于产时电子胎心监护与间歇听诊的随机试验中1428例患者的数据进行分析，以确定与选择性使用真空吸引术（第二产程持续时间60分钟或更短的患者）以及第二产程中存在疑似胎儿窘迫相关的脐血酸碱测量差异。与正常自然阴道分娩相比，选择性使用真空吸引术时，脐动脉和脐静脉的pH值较低，静脉碱剩余较低，静脉二氧化碳分压（PCO2）较高。校正第二产程持续时间后，选择性真空分娩仅与脐静脉pH值降低和静脉PCO2升高显著相关。然而，这些脐血酸碱变化并未伴有围产期发病率和死亡率或酸血症新生儿数量（脐动脉pH<7.15或<7.10）的任何差异。在疑似胎儿窘迫的病例中，与正常自然阴道分娩相比，使用真空吸引术未发现任何脐血酸碱变化。这些数据支持继续使用真空吸引术，尤其是在第二产程中存在疑似胎儿窘迫的情况下。
