A prospective cohort study of fetal heart rate monitoring: deceleration area is predictive of fetal acidemia.
A prospective cohort study of fetal heart rate monitoring: deceleration area is predictive of fetal acidemia.
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胎儿心率监测的前瞻性队列研究：减速区预测胎儿酸血症。
DOI：
10.1016/j.ajog.2018.01.026
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发表时间：
2018-05
影响因子：
9.8
通讯作者：
Macones GA
中科院分区：
文献类型：
--
作者：
Cahill AG;Tuuli MG;Stout MJ;López JD;Macones GA
在美国，产时电子胎儿监护（EFM）是产科最常用的工具，然而，哪种EFM模式预测酸血症仍不清楚。本研究旨在描述使用现代命名法在分娩中看到的模式的频率，并验证视觉解释模式与足月婴儿酸血症和发病率相关的假设。我们进一步确定了分娩前的模式，单独或联合，预测酸血症和新生儿发病率。这是一项前瞻性队列研究，研究对象为2010年至2015年的8580名女性。患者均为连续妊娠≥37周且单胎头位胎儿的妇女。分娩前120分钟的EFM模式以10分钟为周期进行解释。解释包括根据尤尼斯肯尼迪施莱弗国家儿童健康和人类发展研究所（NICHD）标准的分类系统和个人EFM模式以及新模式。主要结局为胎儿酸血症（脐动脉pH≤7.10）；新生儿发病率也进行了评估。最终回归模型的酸血症调整为无产，妊娠糖尿病和高龄产妇。采用受试者工作特征曲线下面积（AUC）来评估酸血症和新生儿发病率的个体模型的测试特征。在8,580名妇女中，有149名（1.7%）分娩了患有白血病的婴儿。在整个队列中，有757例（8.8%）新生儿被诊断出复合新生儿发病率。持续的第I类和10分钟的第III类分别与正常pH值和酸血症显著相关。总减速区对酸血症的鉴别能力最强（AUC=0.76, 95% CI: 0.72-0.80），而任何10分钟心动过速的减速区对新生儿发病率的鉴别能力最强（AUC=0.77, 95% CI: 0.75-0.79）。一旦达到减速区阈值，需要进行的剖宫产手术数量分别为5例和6例，以潜在地预防一例酸血症和发病率。从所研究的EFM模式来看，减速区是最能预测酸血症的EFM模式，并与心动过速相结合，具有显著的发病风险。重要的是要承认，这项研究是在37周或37周以上分娩的患者中进行的，这可能限制了早产儿人群的普遍性。我们也没有使用计算机分析EFM的模式，因为人类的视觉解释是NICHD分类的基础，重要的是，它是如何在临床上使用EFM的。
Intrapartum electronic fetal monitoring (EFM) is the most commonly used tool in obstetrics in the United States, however, which EFM patterns predict acidemia remains unclear. This study was designed to describe the frequency of patterns seen in labor using modern nomenclature, and to test the hypothesis that visually interpreted patterns are associated with acidemia and morbidities in term infants. We further identified patterns prior to delivery, alone or in combination, predictive of acidemia and neonatal morbidity. This was a prospective cohort study of 8,580 women from 2010 to 2015. Patients were all consecutive women laboring at ≥ 37 weeks gestation with a singleton cephalic fetus. EFM patterns during the 120 minutes prior to delivery were interpreted in 10-minute epochs. Interpretation included the Category system and individual EFM patterns per the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) criteria as well as novel patterns. The primary outcome was fetal acidemia (umbilical artery pH ≤ 7.10); neonatal morbidities were also assessed. Final regression models for acidemia adjusted for nulliparity, pregestational diabetes, and advanced maternal age. Area under the receiver-operating characteristic curves (AUC) were used to assess the test characteristics of individual models for acidemia and neonatal morbidity. Of 8,580 women, 149 (1.7%) delivered acidemic infants. Composite neonatal morbidity was diagnosed in 757 (8.8%) neonates within the total cohort. Persistent Category I, and 10-minute period of Category III, were significantly associated with normal pH and acidemia, respectively. Total deceleration area was most discriminative of acidemia (AUC=0.76; 95% CI: 0.72–0.80), and deceleration area with any 10 minutes of tachycardia had the greatest discriminative ability for neonatal morbidity (AUC=0.77; 95% CI: 0.75–0.79). Once the threshold of deceleration area is reached the number of cesareans needed-to-be performed to potentially prevent one case of acidemia and morbidity is 5 and 6, respectively. Deceleration area is the most predictive EFM pattern for acidemia, and combined with tachycardia for significant risk of morbidity, from the EFM patterns studied. It is important to acknowledge that this study was performed in patients delivering at or beyond 37 weeks which may limit the generalizability to preterm populations. We also did not use computerized analysis of the EFM patterns because human visual interpretation was the basis for the NICHD categories, and importantly, it is how EFM is used clinically.
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DOI：
10.1016/s0002-9378(99)70316-9
发表时间：
1999-10-01
影响因子：
9.8
作者：
Andres, RL;Saade, G;Hankins, GV
通讯作者：
Hankins, GV
DOI：
10.1016/0002-9378(79)90705-1
发表时间：
1979-01-01
影响因子：
9.8
作者：
GAZIANO, EP
通讯作者：
GAZIANO, EP
DOI：
10.1016/0002-9378(83)90714-7
发表时间：
1983-01-01
影响因子：
9.8
作者：
KREBS, HB;PETRES, RE;DUNN, LJ
通讯作者：
DUNN, LJ
影响因子：
1.8
作者：
Giannubilo, Stefano Raffaele;Buscicchio, Giorgia;Tranquilli, Andrea Luigi
通讯作者：
Tranquilli, Andrea Luigi
DOI：
10.1016/s0002-9378(16)34294-6
发表时间：
1969-01-01
影响因子：
9.8
作者：
KUBLI, FW;HON, EH;TAKEMURA, H
通讯作者：
TAKEMURA, H