Maternal heart rate patterns in the first and second stages of labor.
Maternal heart rate patterns in the first and second stages of labor.
复制标题
第一产程和第二产程的产妇心率模式。
DOI：
10.1111/j.1600-0412.2012.01371.x
复制
发表时间：
2012
影响因子：
4.3
通讯作者：
Kofford,Shalece
中科院分区：
文献类型：
--
作者：
VANVeen,TeelkienR;Belfort,MichaelA;Kofford,Shalece
目标。分析产程第一、二阶段产妇的典型心率（MHR）模式。观测study.Setting。三级保健社区医院。人口。正常足月产妇硬膜外麻醉。同时记录确认的MHR和子宫活动。在每次收缩和/或推力的前10秒以及高峰时，分析平均MHR。每位女性在每个时间点为分析贡献了一个数据点。主要结果测量。宫缩期间MHR的变化。第一阶段：每名妇女（n=18）有7.6±2.1次宫缩。平均MHR在宫缩期间下降：从83±13 bpm降至74±10bpm；p<0.001)。在56%（10/18）的女性中，至少50%的宫缩出现“早期”型减速。第二阶段：每位女性宫缩3.5±1.5次。所有女性（n=15）在每次推压时均表现出MHR加速（ΔMHR: +35±13bpm； 88±14至123±17bpm；p<0.001）。在第一阶段，3名女性（17%）的MHR持续低于100bpm，在第二阶段，4名女性（27%）的MHR持续低于100bpm。推入时MHR峰值bb0 140bpm占20%。分娩第一阶段宫缩期间MHR的减少可以模拟胎儿心率（FHR）加速以及早期型减速。因此，低基线和早期型减速的第一阶段追踪可能是母系起源，FHR应在此类追踪中独立确认。由于第二阶段的MHR加速通常比FHR加速显示更大的振幅，因此在宫缩期间（特别是Δ >20bpm）出现重复加速的追踪应该被认为是MHR，直到证明不是这样。
Objective. To analyze typical maternal heart rate (MHR) patterns in the first and second stages of labor.Design. Observational study.Setting. Tertiary care community hospital.Population. Normal term parturients with epidural anesthesia.Methods. Confirmed MHR and uterine activity were simultaneously recorded. The average MHR was analyzed 10 seconds before, as well as at the peak of, each contraction and/or pushing effort. Each woman contributed one datapoint at each time point to the analysis.Main outcome measure. Change in MHR during contractions.Results. First stage: 7.6±2.1 contractions per woman (n=18) were analyzed. Average MHR decreased during contractions: from 83±13 to 74±10bpm;p<0.001). In 56% (10/18) of the women, ‘early’ type decelerations were seen in at least 50% of contractions. Second stage: 3.5±1.5 contractions per woman. All women (n=15) showed MHR accelerations during every pushing effort (ΔMHR: +35±13bpm; 88±14 to 123±17bpm;p<0.001). MHR was persistently >100bpm in three women (17%) in the first stage, and in four women (27%) in the second stage. Peak MHR >140bpm occurred during pushing in 20%.Conclusion. Decreases in MHR during contractions in the first stage of labor can mimic fetal heart rate (FHR) accelerations as well as early type decelerations. Thus, first stage tracings with a low baseline and early type decelerations may be maternal in origin and FHR should be independently confirmed in such tracings. Because second stage MHR accelerations generally show greater amplitude than FHR accelerations, tracings with repetitive accelerations during contractions (especially when Δ >20bpm) should be considered MHR until proven otherwise.