胎心率基线变异减弱或消失与产妇分娩方式及新生儿结局的临床研究

目的探讨胎心率基线变异减弱或消失与分娩方式及新生儿结局的关系。方法选择2011年10月-2013年5月在浙江大学医学院附属第二医院建德分院单胎孕妇电子胎心监护中胎心率基线变异减弱或消失者40例（观察组），随机选取同期行电子胎心监护提示胎心率基线变异正常40例（对照组），比较两组产妇脐带异常及胎盘异常、NST类型、刮宫产、死胎、重度窒息、足月小样儿的情况，及两组不同NST类型与新生儿Apgar评分的关系。结果观察组产妇出现帆状胎盘、胎盘早剥、球拍状胎盘、脐带绕颈伴细长、脐带绕颈伴螺旋型、脐带先露、合并羊水污染Ⅱ度以上均高于对照组，差异有统计学意义（P〈0．05）。观察组产妇NST可疑型、NST无反应型均高于对照组，差异有统计学意义（P〈0．05）。观察组产妇剖宫产34例（85．0％）]高于对照组9例（22．5％）]，而新生儿出现重度窒息3例（7．5％）]、死亡2例（5．0％）]、足月小样儿3例（7．5％）]明显高于对照组0例（0．0％），0例（0．0％），0例（0．0％）]，差异有统计学意义（P〈0．05）。观察组NST可疑型新生儿Apgar评分≥7分者低于对照组（55．56％比100．00％），差异有统计学意义（P〈0．05），而新生儿Apgar评分〈7分者高于对照组（44．44％比0．00％），差异有统计学意义（P〈0．05）。结论胎心监护胎心率基线变异减弱或消失提示发生胎儿宫内发生窘迫及缺氧，同时结合NST进行积极的处理，如及时终止妊娠，才能进一步降低新生儿病死率、病残率。

Clinical research of Baseline fetal heart rate variability decreased or dis- appeared for delivery and pregnancy outcomes

Objective To investigate the relationship between baseline fetal heart rate variability decreased or disap- peared and the delivery mode and neonatal outcomes. Methods From October 2011 to May 2013 in Jiande Branch Hospital of the Second Hospital Affiliated to Zhejiang University School of Medicine, 40 pregnancies with single preg- nancies and electronic fetal monitoring showed that the baseline fetal heart rate variability decreased or disappeared were selected as observation group, and at the same time 40 patients of electronic fetal monitoring showed fetal tips normal baseline heart rate variability were randomly selected as control group. The maternal umbilical cord and placen- ta abnormalities, NST type, cesarean section, stillbirth, severe asphyxia, the ratio of full-term age small gestational,and the relationship of two different types NST and neonatal Apgar score were compared. Results The puerperae appeared sail-shaped placenta, placental abruption, placenta racket-shaped, slender cord around the neck, spiral cord around the neck, umbilical cord first exposed, the ratios of combing Ⅱ degrees amniotie of the observation group were higher than those of the control group, the differences were statistically significant （P 〈 0.05）. The ratios of suspicious type NST, non -reactive NST of the observation group were higher than those of the control group, the differences were sta- tistically significant （P 〈 0.05）. The cesarean section rate （34 cases, 85.0%） of the observation group was higher than that of the control group （9 eases, 22.5%）, and the ratios of newborn asphyxia （3 cases, 7.5%）, death （2 cases 5.0%）, full-term age small gestational （2 cases, 5.0%） of the observation group were lower than those of the control group （no case, 0.0%; no case, 0.0%; no case, 0.0%）, the differences were statistically significant （P 〈 0.05）. The ratios of suspi- cious type NST and Apgar score ≥7 points of the observation group were lower than those of the control group （55.56% vs 100.00%）, and the ratios of Apgar score 〈 7 points of the observation group were higher than those of the control group （44.44% vs 0.00%）, the differences were statistically significant （P 〈 0.05）. Conclusion The fetal heart rate variability decreased or disappeared tips by the baseline fetal heart rate monitoring can indicate occurrence of fetal distress and hypoxia,so take active processing at the same time combine with NST, such as timely terminate pregnancy , so can luther reduce neonatal mortality and morbidity.