Fetal heart rate pattern in term or near-term cerebral palsy: a nationwide cohort study
Fetal heart rate pattern in term or near-term cerebral palsy: a nationwide cohort study
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DOI：
10.1016/j.ajog.2020.05.059
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发表时间：
2020-12-01
影响因子：
9.8
通讯作者：
Ikeda, Tomoaki
中科院分区：
文献类型：
--
作者：
Nakao, Masahiro;Okumura, Asumi;Ikeda, Tomoaki
背景：解释胎心率模式，重点研究分娩过程中胎心率模式的演变，对于评估脑性瘫痪与分娩之间的关系至关重要。目的：本研究的目的是揭示脑瘫患儿分娩时胎心模式演变的特点，判断产程中胎儿脑损伤的发生时间。研究设计：在这项纵向研究中，对1069例妊娠34周及以上重度脑瘫患儿的产中胎儿心率条进行分析。其分类如下：(1)持续性心动过缓，(2)持续不安心，(3)安心-延长减速，(4)韩氏模式，(5)持续安心。结果：产中缺氧性脑损伤占重度脑性瘫痪病例的31.5%，占产前发生的30%以上。1069例患者中，持续性心动过缓84例(7.86%)，持续性不稳定232例(21.7%)，安慰性延长减速(167例)15.6%，韩氏型(170例)15.9%，持续性安慰性(212例)19.8%，未分类(204例)19.1%。观察员之间的总体协议是温和的(kappa 0.59)。胎盘早剥是脑性瘫痪最常见的原因(31.9%)，在持续性心动过缓组中几乎占90%(，73岁)。在韩氏模式组(n=67)中，脐带异常是脑性瘫痪最常见的临床因素(29.9%)，其次是胎盘早剥(20.9%)和手术阴道分娩不当(13.4%)。结论：产中缺氧性脑损伤约占重型脑瘫病例的30%，但相当大比例的病例被怀疑为产前或产后发病。高达16%的脑瘫病例可以通过更多地关注韩氏胎儿心率进展中看到的早期变化来预防。
BACKGROUND: It is crucial to interpret fetal heart rate patterns with a focus on the pattern evolution during labor to estimate the relationship between cerebral palsy and delivery. However, nationwide data are not available.OBJECTIVE: The aim of our study was to demonstrate the features of fetal heart rate pattern evolution and estimate the timing of fetal brain injury during labor in cerebral palsy cases.STUDY DESIGN: In this longitudinal study, 1069 consecutive intrapartum fetal heart rate strips from infants with severe cerebral palsy at or beyond 34 weeks of gestation, were analyzed. They were categorized as follows: (1) continuous bradycardia (Bradycardia), (2) persistently non-reassuring, (3) reassuring-prolonged deceleration, (4) Hon's pattern, and (5) persistently reassuring. The clinical factors underlying cerebral palsy in each group were assessed.RESULTS: Hypoxic brain injury during labor (those in the reassuring-prolonged deceleration and Hon's pattern groups) accounted for 31.5% of severe cerebral palsy cases and at least 30% of those developed during the antenatal period. Of the 1069 cases, 7.86% were classified as continuous bradycardia (n=84), 21.7% as persistently nonreassuring (n=232), 15.6% as reassuring-prolonged deceleration (n=167), 15.9% as Hon's pattern (n=170), 19.8% as persistently reassuring (n=212), and 19.1% were unclassified (n=204). The overall interobserver agreement was moderate (kappa 0.59). Placental abruption was the most common cause (31.9%) of cerebral palsy, accounting for almost 90% of cases in the continuous bradycardia group (64 of 73). Among the cases in the Hon's pattern group (n=67), umbilical cord abnormalities were the most common clinical factor for cerebral palsy development (29.9%), followed by placental abruption (20.9%), and inappropriate operative vaginal delivery (13.4%).CONCLUSION: Intrapartum hypoxic brain injury accounted for approximately 30% of severe cerebral palsy cases, whereas a substantial proportion of the cases were suspected to have either a prenatal or postnatal onset. Up to 16% of cerebral palsy cases may be preventable by placing a greater focus on the earlier changes seen in the Hon's fetal heart rate progression.