第二产程胎心监护异常的处理及临床意义

目的 探讨第二产程胎心监护异常者的分娩方式,及其与产妇并发症和围产儿结局的关系。方法 回顾性分析我院足月单胎头位分娩产妇第二产程中胎心率（FHR）正常的111例（对照组）和胎心率异常的121例（观察组）的资料。结果 FHR异常的发生率为52.2%（121／232）,异常胎心率类型包知中、重度变异减速（VD）81例,占66.9%;晚期减速（LD）27例,占22.3%,其中仅1例发生连续LD;延长减速（PD）4例,占3.3%;VD合并LD2例,占1.7%;VD合并PD3例,占2.5%;基线变异减弱4例,占3.3%。对照组中,阴道助产13例（11.7%）,顺产98例（88.3%）;观察组中,顺产86例（71.1%）,阴道助产35例（28.9%）,其中29例（82.9%）为FHR异常而施术者,两组间比较,差异有显著性（P＜0.05）。观察组、对照组新生儿窒息的发生率（分别为5.0%、1.8%）及产伤的发生率（14.3%、15.4%）比较,差异均无显著性（P＞0.05）;观察组中有1例产妇会阴Ⅲ度撕伤。结论 第二产程中FHR异常的发生率高,多为产程中胎头受压或脐带受压而引起的迷走神经反射或暂时性子宫胎盘血流减少,并非缺氧所致,不必急于干预,以免造成母、儿损伤。

Management of abnormal fetal heart rate in the second stage of labor

Objective We investigated the correlations between abnormal fetal heart rate (FHR) during the second stage of labor and delivery types and intrapartum maternal complications and fetal outcome Methods The data of 232 nulliparas with single vertex in the second stage of labor (111 cases with normal FHR, 121 cases with abnormal FHR) were analyzed retrospectively Results The incidence of abnormal FHR in the second stage of labor was 52 2%(121/232) The patterns of abnormal FHR included: 81 (66 9%) cases with moderate and/or severe variable deceleration (VD), 27 (22 3%) cases with scattered late deceleration (LD), only one with continuous LD, 4 (3 3%) cases prolonged deceleration (PD), 2 (1 7%) cases with VD and LD, 3 (2 5%) cases with VD and PD, 4 (3 3%) cases with diminished baseline variability There were 13 (11 7%) among the cases with normal FHR and 35 (28 9%) among the cases with abnormal FHR underwent assistant delivery operations (forceps or/and vaccum), respectively ( P <0 05) Furthermore 29 of 35 (82 9%) cases underwent assistant operations for vagina delivery due to abnormal FHR, the others underwent assistant operations for vagina delivery due to weak expulsive force or malpositioning of fetal head There was one case of complicated vaginal laceration in the group with abnormal FHR There was no difference of newborns with low Apgar score between two groups Conclusions There was a very high incidence of abnormal FHR during the second stage of labor, however, the most cases were response to parasympathetic stimulation due to umbilical cord or fetal head compression by mothers over push and descent of fetal head, or temporal diminishing of uterine placenta blood flow It suggests that it is unnecessary to interfere immediately, unless truly fetal distress