Fetal heart rate patterns in term labor vary with sex, gestational age, epidural analgesia, and fetal weight
Fetal heart rate patterns in term labor vary with sex, gestational age, epidural analgesia, and fetal weight
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DOI：
10.1016/s0002-9378(99)70172-9
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发表时间：
1999-01-01
影响因子：
9.8
通讯作者：
Redman, CWG
中科院分区：
文献类型：
--
作者：
Dawes, NW;Dawes, GS;Redman, CWG
目的：我们的目的是分析以前未报道的胎儿性别对胎儿心率在劳动力的影响，并测量其幅度的影响，其他独立的临床variables.Study DESIGN：在常规临床监测超过19个月，在英国牛津收集的1884长期单胎胎儿分娩时的心脏率的最后一个小时，通过计算机技术进行了分析。选择记录的目的是为了确保完整性和连续性，直到交付后至少30分钟内。一个子集的记录，从早期的劳动力和一个单独的档案产前正常足月records.Results：女性胎儿的心率明显快于男性胎儿（P <0.0001）。硬膜外镇痛、体重百分位数（根据年龄和性别调整）、产次、第一产程和第二产程的持续时间以及出生时脐动脉血pH值的下降也独立调节胎心率（均P < .0001）。这些独立变量对心率的影响是累加的，最重要的是硬膜外镇痛作为心动过速的原因。胎儿性别的影响在分娩前6 ~ 7小时的第一阶段较小，在分娩开始前不存在（另外552例妊娠37 ~ 38周）。结论：女性胎儿对正常分娩的胎心反应不同于男性胎儿。产时胎心率模式的计算机数值分析需要考虑影响胎心率的多种因素，以准确识别哪些模式预测临床结局。
OBJECTIVES: Our purpose was to analyze the previously unreported effect of fetal sex on the fetal heart rate in labor and to measure its magnitude in relation to the effects of other independent clinical variables.STUDY DESIGN: The last hour of the intrapartum heart rates of 1884 term singleton fetuses collected during routine clinical monitoring over 19 months in Oxford, United Kingdom, was analyzed by computerized techniques. The records were selected for completeness and continuity until within at least 30 minutes of delivery. A subset of records from earlier in labor and a separate archive of antepartum normal term records were also examined.RESULTS: Female fetuses had significantly faster heart rates than male fetuses (P < .0001). Epidural analgesia, weight percentile (adjusted for age and sex), parity, the duration of first and second stages of labor, and a fall in umbilical arterial blood pH at birth also independently modulated the fetal heart rate (all P < .0001). The effects of these independent variables on heart rate were additive, the most important being epidural analgesia as a cause of tachycardia. The effect of fetal sex was less in the first stage, 6 to 7 hours before delivery, and was not present before the onset of labor (in another 552 pregnancies at 37 to 38 weeks).CONCLUSIONS: The fetal heart rate response of female fetuses to normal labor differs from that of male fetuses. Computerized numeric analysis of intrapartum fetal heart rate patterns will need to take into account the multiple factors that influence the fetal heart rate to identify precisely which patterns predict clinical outcome.