第一产程异常胎心监护图形的分析

目的:探讨第一产程异常胎心监护图形的临床意义。方法:选自第一产程胎心监护图形异常的患者348例为观察组,367例第一产程胎心监护正常者为对照组。观察并比较两组间孕妇并发症及胎儿合并症的情况。结果:①电子胎心监护显示早期减速(ED)所占比例最高,为55.2%,然后依次为变异减速(VD)、晚期减速(LD)、心动过速、心动过缓、基线变异减弱及延长减速(PD)。②观察组中,伴有脐带绕颈及羊水量异常的患者分别占28.4%和10.3%,其比例均明显高于对照组,两组之间均有统计学差异(P<0.05)。③观察组中羊水粪染(Ⅱ-Ⅲ度),Apgar评分≤7分(出生1min),胎儿窘迫及剖宫产的比例均明显高于对照组,两组之间均有统计学差异(P<0.05)。结论:不同电子胎心监护异常图形有不同的临床意义,应该结合临床资料综合分析。     

第一产程异常胎心监护图形与新生儿结局的关系

目的　探讨第一产程异常胎心监护图形与新生儿结局的关系。方法　回顾分析 2 0 0 2年 8月至 2 0 0 3年 6月在我院足月单胎头位分娩产妇 ,第一产程中胎心率 (FHR)异常图形 2 1 7例 (观察组 )和FHR正常图形的2 6 9例 (对照组 )的临床资料。结果　第一产程异常FHR图形的发生率为 4 4 7% ,常见类型为轻度变异减速(6 4 5 % )、基线变异减弱 (2 1 6 % )和轻度心动过速 (1 2 0 % )。晚期减速、基线变异减弱和重度变异减速是导致新生儿窒息的危险因素。观察组羊水过少 (5 1 % )、脐带缠绕 (2 2 6 % )、羊水粪染 (1 0 6 % )、新生儿窒息 (6 5 % )、新生儿转入NICU(1 0 1 % )的发生率和剖宫产率 (31 8% )明显高于对照组 (P <0 0 5 )。结论　第一产程异常FHR图形的发生率较高 ,其中晚期减速、基线变异减弱、重度变异减速与新生儿窒息的发生相关 ,其他图形可在严密监护下继续试产     

第二产程胎心宫缩图与胎儿预后的关系

105例第二产程电子胎心宫缩图(CTG)可归纳为基线变异增大,轻VD(可变减速)、重VD、晚期减速、心动过缓 宫缩时加速、轻VD 晚减成份(LDC)、重VD LDC 及延长减速(PD)等8类.从新生儿出生情况看出,逐渐加重的VD、频发VD 及基线变异增大是胎儿宫内窘迫的警戒图型.7例新生儿窒息中5例CTG 为重VD LDC 及PD,故可视为不祥图型.19例监护到胎头娩出者,5例出现了分娩终末期胎心减速(ESD),及时结束分娩,新生儿情况良好.重复PD 出现应于10分钟内娩出胎儿,重VD LDC 20分钟内娩出胎儿,警戒图型30分钟内娩出胎儿.     

脐血乳酸水平、产时胎心监护不良图形和新生儿结局关系的研究

目的:研究脐动脉血乳酸水平与产时胎心监护不良图形及新生儿结局之间的关系。方法:229例足月妊娠、单胎、头位产妇根据产时胎心宫缩图(cardiotocography,CTG)分为两组,观察组:轻度变异减速(variable deceleration,VD)68例、不良CTG包括中、重度VD、不典型VD、胎心基线变异减弱或消失、延长减速、重度晚期减速及心动过缓84例。对照组:产时CTG无VD及不良图形、新生儿脐动脉血pH≥7.20的产妇77例,检测新生儿脐动脉血乳酸浓度及生后20项行为神经评分(neonatal behavioral neudogioal as-sessment,NBNA)。结果:对照组脐动脉血乳酸99%参考值范围为1.31~4.05mmol/L,不良CTG脐血乳酸水平明显高于对照组(P<0.01);pH、BE值显著低于对照组与轻度VD组(P<0.01,P<0.05),脐血乳酸水平与pH、BE呈显著负相关(P<0.01)。以对照组x-±2.58s为界值,观察组脐血乳酸超过界值者不良CTG占73.33%,其中不良结局儿占68.18%。结论:脐动脉乳酸水平与pH、BE值有较好的相关性。产时重度VD或VD并存其它异常CTG,胎心基线变异减弱,尤其伴发羊水粪染、脐带异常时与围生儿脐血高乳酸水平、不良结局有关。     

第二产程延长的原因及第二产程延长后新生儿窒息的高危因素分析

目的:探讨致第二产程延长的原因及导致新生儿窒息的高危因素.方法:对我院2002年1月至2008年1月所发生的第二产程延长病例进行回顾性分析.结果:发生第二产程延长共133例,其发生率为2.07%.导致第二产程延长的原因中胎位异常占35.34%,宫缩乏力占19.55%,脐带异常占15.04%,产道异常占8.27%,分别占本次资料的前4位.第二产程延长后伴随胎儿窘迫、脐带异常产妇的新生儿窒息的发生率明显高于无上述因素者(P<0.05);阴道助产者新生儿窒息率明显高于剖宫产及阴道自娩(P<0.05),而伴随胎位异常、宫缩乏力早产、妊娠合并症的产妇新生儿窒息的发生率与无上述因素者差异无统计学意义(P>0.05);不同性别胎儿窒息发生率差异也无统计学意义(P>0.05).结论:胎位异常、宫缩乏力、脐带异常、产道异常是第二产程延长的主要原因;胎儿窘迫、脐带异常以及阴道助产是第二产程延长后新生儿窒息的高危因素.     

产程中羊水胎粪污染行羊水置换预防新生儿窒息的意义

羊水胎粪污染与胎儿窘迫及新生儿窒息有关,可引起新生儿胎粪吸入综合征（MAS）,影响围产儿预后。我们对产程中羊水Ⅱ度以上胎粪污染者行羊水置换,观察其对围产儿预后及剖宫产率的影响。现报道如下。1资料与方法1．1临床资料产程中前羊水Ⅱ度以上污染共60例,随机分为观察组和对照组,每组30例。观察组平均孕41周,初产妇26例,经产妇4例,羊水过少18例,羊水量正常12例。宫口开大3cm,行人工破膜19例,宫口开大4～scm自然破膜11例。羊水Ⅲ度污染21例,Ⅱ度污染9例。胎心监护有变异减速波（VD）及延年减速波（PD）14例,VD波有晚期减…     

产时异常胎儿宫缩图133例分析

我院自１９９３年１月至１０月，在产时采用胎心率电子外监护４５０例，出现异常胎心宫缩图１３３例，占２９．６％，其中包括基线率异常２８例，基线变异异常３５例，胎心率各类减速７０例。分析表明：潜伏期出现晚期减速（ＬＤ）、重度可变减速（ＶＤ）、频发早期减速（ＥＤ）及基线率异常等都是胎儿缺氧的信号，应引起高度重视；活跃期及第二产程出现重度ＶＤ预示有严重的脐带并发症，出现ＬＤ表示胎盘储备功能不良，如合并基线变     

胎心监护无负荷试验中变化减速波形的临床分析

目的 探讨胎心监护无负荷试验（NST）中变化减速（VD）发生的影响因素及围生儿结局。方法 回顾性分析山东省立医院2001年2月至2005年2月5120例NST中出现VD的283例监护图形,比较不同图形影响因素的发生率和围生儿结局。结果 NST中VD的发生率5.53%（283/5120）。单纯VD中影响因素发生率56.49%（87/154）,不典型VD中影响因素发生率94.57%（122/129）,差异具有显著性意义（χ^2=52.7,P〈0.01）。在分娩的283例新生儿中,1分钟Apgar评分〉7分者252例,≤7分者31例,其中单纯VD组新生儿窒息率2.59%（4/154）,而不典型VD组新生儿窒息率20.92%（27/129）,差异具有显著性意义（χ^2=24.2,P〈0.01）;单纯VD组剖宫产率（21.43%,33/154）低于不典型VD组（55.04%,71/129）,差异具有显著性意义（χ^2=34.1,P〈0.01）。结论 NST中变化减速的发生与多种因素有关,脐带异常最常见,不典型VD较典型者影响因素更明确,新生儿窒息的发生率更高,不典型VD较单纯VD更容易发生胎儿宫内窘迫。     

胎心监护在产程中的应用

目的减少围产儿的病残率和死亡率，熟练地识别胎心监护图，正确地指导产程中的处理。方法分析我院2002年1月-2004年12月在产程中采用胎心率电子外监护587例，出现异常胎心宫缩图形243例，其中基线率异常89例，胎心率各类减速94例，其中新生儿轻度窒息21例，重度窒息3例。结果产程中出现晚减(ID)、可变减(VD)、频发早减(ED)及基线率异常都是胎儿缺氧的表现。结论产妇产前应常规进行胎心监护，以便及时发现异常胎心变化，减少围产儿的死亡率及病残率。     

脐血乳酸水平及胎心监护图形预测胎儿窘迫的价值

目的　探讨新生儿脐动脉血乳酸水平及胎心监护图形预测胎儿窘迫的价值。方法　测定 73例胎心监护图形为不良图形 (胎心基线异常、重度变异减速、轻度变异减速、心动过速 )的新生儿(病例组 )和 118例产前无胎儿窘迫征象 ,出生后 1分钟Apgar评分≥ 9分的新生儿 (对照组 )出生后脐动脉血乳酸水平。结果　病例组中产钳助产率明显高于对照组 (P <0 0 1) ,顺产率低于对照组 (P<0 0 1)。病例组中 ,胎心重度变异减速多发于第二产程 ;胎心基线异常的新生儿Apgar评分≤ 7分的发生率高于重度变异减速、轻度变异减速、心动过速的新生儿 (P <0 0 5 )。病例组中 ,胎心基线异常者脐动脉血乳酸水平为 (4 5 5± 0 2 3 )mmol/L ;重度变异减速者为 (3 84± 0 40 )mmol/L ,出现以上两种图形的新生儿脐动脉血乳酸水平均明显高于对照组 (P <0 0 1)。轻度变异减速者脐动脉血乳酸水平为 (2 63± 0 3 2 )mmol/L ;心动过速者脐动脉血乳酸水平为 (2 5 5± 0 46)mmol/L。并且轻度变异减速与心动过速者脐动脉血乳酸水平与对照组比较 ,差异无显著性 (P >0 0 5 )。结论　测定新生儿脐动脉血乳酸水平是一种有效、准确的诊断胎儿窘迫的方法。胎心基线异常、重度变异减速与胎儿窘迫的发生密切相关 ;轻度变异减速、心动过速与胎     

临床早期胎心率监测的价值

对１２３例高危产妇临床早期进行胎心监护，按Ｆｉｓｃｈｅｒ评分法分高分、中分与低分３组。结果：１．３组分娩方式、Ａｐｇａｒ评分及脐带情况差异均有显著性，（Ｐ＜０．０１）；２．监测组与未监测组Ａｐｇａｒ评分＜４分者分别为０．６１％与１．４７％，未监测组新生儿死亡率为５．５墸嗖庾槲抟焕劳觯＊３．胎心率监护图象异常组中８２．６１％伴产科临床情况异常，而正常组仅１７．３９％（Ｐ＜０．００１）；４．白天与夜间均行胎心率监护，低分组分别为５．１５％与１９．２３％，（Ｐ＜０．０５）。提示不论有无高危因素，在临床早期常规行胎心率监护，对可疑者连续或反复监测，可减少胎儿重度窒息，避免新生几死亡，对促进优生有很大的价值。     

Evaluation of fetal heart rate patterns during the second stage of labor through fetal oximetry.

The purpose of this study was to assess the feasibility and accuracy of fetal pulse oximetry during the second stage of labor in cases with abnormal fetal heart rate (FHR) patterns with reference to postpartum acid-base status and Apgar scores. Forty-eight parturients with normal and 20 parturients with abnormal FHR tracings during the second stage of labor were monitored by fetal pulse oximetry and postpartum umbilical artery pH, pO(2), pCO(2) values and 1- and 5-min Apgar scores. The mean SpO(2) value was 55. 47 +/- 9.95% in cases with normal and 52.55 +/- 16.42% in cases with abnormal FHR patterns. A significant correlation was noted between fetal SpO(2) and umbilical artery pH in cases with normal (r = 0.76, p < 0.05) as well as in cases with abnormal FHR patterns (r = 0.78, p < 0.05). No significant correlation was found between fetal SpO(2) and Apgar scores at 1 and 5 min in cases with normal FHR patterns. On the contrary a significant correlation was noted in cases with abnormal FHR patterns. A normal FHR pattern alone is reassuring. In cases with abnormal FHR, fetal pulse oximetry is an objective method for distinguishing a hypoxic fetus.     

Evaluation of fetal heart monitoring in the first stage of labor

Objective : To evaluate the usefulness of continuous electronic fetal heart rate (FHR) monitoring in the first stage of labor. Methods : A total of 814 pregnant women in labor without identifiable risk factors was divided into two groups. In group A (468 cases), continuous FHR monitoring began in the earliest phase of the first stage of labor (cervical dilatation &#104 4 cm), while in group B (346 cases) it began when the cervical dilatation was > 4 cm. Initial FHR tracings were normal in all 814 cases. The fetal monitoring findings were analyzed at 10-min intervals, and comparisons were made between the two groups concerning FHR findings and their correlation with the state of the newborns. Results : No significant difference was found between the two groups in the incidence of repetitive variable decelerations (1.9% and 1.7%, respectively); sporadic variable decelerations (9.2% and 8.7%, respectively); persistent repetitive late decelerations that resulted in Cesarean section (1.1% and 1.4%, respectively); or sporadic late decelerations (8.3% and 8.1%, respectively). One newborn from each group required intensive neonatal care. Conclusions : The same tracing sufficiency of fetal stress was observed in the two groups. However, the manner of labor supervision in group B seemed to be more beneficial, because of greater maternal comfort, a lower necessity for personnel, lower consumption of cardiotocographic materials and the possibility of labor induction for more women. Since fetal monitoring is widely used, it is preferable to start continuous FHR monitoring when the dilatation of the cervix approximates 4-5 cm (second phase of the first stage of labor) without risk of fetal loss.     

小于胎龄早产儿产时胎心电子监护图形特征及其临床意义

目的探讨小于胎龄早产儿胎心电子监护图形(CTG)特征及其临床意义。方法回顾性分析303例32~36孕周、无妊娠合并症的单纯胎膜早破和原因不明早产孕妇的全产程CTG。其中,小于胎龄早产儿78例(PSGA组),适于胎龄早产儿225例(PAGA组)。比较宫缩时两组CTG特征,合并症情况及分娩结局。结果PSGA组及PAGA组出现单纯U型变异减速的胎儿分别为24例(308%)和10例(44%),两组比较,差异有统计学意义(P<001);U型变异减速合并其他异常CTG的胎儿分别为10例(128%)和1例(04%),两组比较,差异也有统计学意义(P<001)。PSGA组,出现单纯U型变异减速者的难产率(208%)与胎心电子监护无异常者的难产率(227%)比较,差异无统计学意义(P>005),但与U型变异减速合并其他异常CTG者的难产率(600%)比较,差异有统计学意义(P<005)。PSGA组中,34例出现U形变异减速,其中合并脐带异常15例(绕颈、绕身14例、脐带过短1例),PSGA组44例无U形变异减速者中,合并脐带异常9例(绕颈、绕身),两组比较,差异有统计学意义(P<005)。结论U形变异减速是小于胎龄早产儿分娩过程中的特征性胎儿监护图形,但不是胎儿缺氧的征象,如不合并其他异常CTG,不需特殊处理。     

Occurrence of ST-changes recorded with the STAN S21-monitor during normal and abnormal fetal heart rate patterns during labour

OBJECTIVE: To determine the frequency of ST-changes in the fetal electrocardiogram (ECG) both during normal and abnormal fetal heart (FHR) traces and to study relations with characteristics of pregnancy and delivery. STUDY DESIGN: Retrospective analysis of 563 FHR+ECG-recordings. ST-changes were counted for all recordings with respect to their FHR pattern. Relationships between the occurrence of ST-events and characteristics of pregnancy and delivery were determined for the recordings with a completely normal FHR tracing during the first stage. RESULTS: ST-events were present during 51.7% of recordings in the first stage of labour and during 24.3% of the recordings in the second stage. Surprisingly, events occurred during the first stage at a similar incidence during normal and abnormal FHR-patterns. During the second stage of labour events also occurred in a similar percentage of normal, intermediary and abnormal recordings, but - if present - events were more numerous during the abnormal FHR traces. In the subgroup of cases with a normal FHR pattern more events per hour occurred in babies born at 36-37 weeks of gestation and in boys. CONCLUSION: ST-events are a frequent finding during normal FHR tracings.     

Non-invasive continuous fetal transcutaneous pO2 and pCO2 monitoring during labor

Continuous measurements of fetal scalp transcutaneous pO2 (tcpO2) and pCO2 (tcpCO2) monitoring were performed for 49 patients for the purpose of the evaluation of the fetal well-being. The equipment used was transcutaneous pO2/pCO2 monitor Micro Gas 7640 (KONTRON, Switzerland), which was inserted through the vagina and attached to the fetal head with a suction ring. Blood was taken from the umbilical vessels and pO2 and pCO2 values were analyzed. The correlation coefficient between pO2 in the umbilical artery and tcpO2 was 0.78 (p less than 0.01), and that between pCO2 in the umbilical artery and tcPCO2 was 0.79 (p less than 0.01). Relationships between the transcutaneous blood gas analysis and FHR patterns were discussed. Increase of pCO2 and decrease of tcpO2 was observed in the cases of variable deceleration, not observed in the case of early deceleration. FHR patterns don't always indicate fetal condition, for example in the case of fetal arrhythmia, especially fetal bradycardia. But tcpO2 monitoring of the fetus affected fetal arrhythmia during labor aids diagnosis of fetal distress by FHR patterns, especially in the case of fetuses affected by fetal bradycardia.     

早期常规人工破膜对产程及胎儿与新生儿影响的Meta分析

目的探讨产程中早期常规人工破膜对产程及胎儿或新生儿的影响。方法对“早期人工破膜可增加胎儿心率异常的发生、早期人工破膜的随机化对照试验、早期人工破膜对初产妇发生难产危险的影响、选择性人工破膜对胎心率及产程影响的随机研究、比较早期人工破膜与选择性人工破膜对正常产程影响的临床随机研究和关于产程中主动管理的临床随机研究和Meta分析等6篇文献中的临床随机对照试验结果,使用固定效应模型方法进行Meta分析。结果（1）早期常规人工破膜能够缩短第一产程95min,95％可信区间（CI）为-119．17～-70．52。（2）没有足够证据表明早期常规人工破膜能够对分娩方式产生影响：剖宫产率OR=1．25,95％CI为0．99～1．57,器械阴道助产率OR=1．05,95％CI为0．90～1．24。（3）早期常规人工破膜对第一产程胎心率异常的发生没有影响（OR=0．95,95％CI为0．75～1．21）,但增加第二产程胎心率异常的发生（OR=1．28,95％CI为1．02～1．61）。（4）没有足够证据表明早期常规人工破膜能够对羊水胎粪污染的发生产生影响（OR=1．17,95％CI为0．78～1．73）,但可能降低新生儿1分钟Apgar评分〈7分的发生率（OR=0．71,95％CI为0．49～1．03）。结论常规早期人工破膜可缩短产程,并可能减少新生儿1分钟Apgar评分〈7分的发生;但增加第二产程胎心率异常的发生以及有可能会增加剖宫产率。     

产程中持续内监护下行羊膜腔输液及羊水置换治疗胎儿窘迫

目的 探讨产程中持续内监护下行羊膜腔输及羊水置换,对治疗胎儿窘迫的意义。方法 对产程中出现频发可变减速合并羊水胎粪污染者１３６例,随机分为观察组与对照组各６８例,观察组在持续内监护下行羊膜腔输液或羊水置换。对照组给予吸氧、改变体位、静脉输液等治疗。结果观察组经羊膜腔输液５００￣１０００ｍｌ,ＶＤ波消失或明显改善者占９１．２％,同时对观察组中４８例羊水Ⅱ度以上粪染者行羊水置换,其中３９例羊水国 清亮