第二产程胎心监护图形分析

目的 探讨第二产程胎心监护图形特点及第二产程的不良CTG图形。方法 对237例足月、单胎、头位，无阴道分娩禁忌症者，在第二产程行胎心内监护，用多因素LogisLic回归分析，分析与新生儿不良结局相关的胎心率图形。结果 16种第二产程胎心率图形中，轻度可变减速的发生率最高，为53．24％。以是否新生儿结局不良为应变量，引入Logistic回归方程的变量有晚期减速、延长减速、重度可变减速、基线变异减弱或消失、重度心动过缓及融合减速，OR值分别为2．88、2．84、4.49、6．76、7．00及3．46。结论 第二产程最常见的胎心率图形是轻度可变减速。晚期减速、延长减速、重度可变减速、基线变异消失、重度心动过缓及融合减速是第二产程的不良图形。终末减速是第二产程所特有的图形，多发生在胎儿娩出后期，如能很快娩出胎儿，则对胎儿无不良影响。

Analysis of the fetal heart rate(FHR)Patterns of the second stage

Objective To investigate the characteristics of the FHR tracings of the second stage.To recog-nize the pathological patterns of the second stage.Methods 237primiparas with singleton term pregnancy,and without contraindications for vaginal delivery were investigated.Internal FHR monitoring were carried out simul-taneously during the second stage of labor.Logistic regression analysis was performed respectively to select those FHR patterns associated with adverse neonatal outcome.Results The incidence of mild variable decelera-tion (VD)was53.24%,which was the highest in the16FHR patterns of second stage.when adverse neonatal outcome as dependent variable,variables entered equation were LD,PD,severe VD,absent baseline variability,severe bradycardia and merging of deceleration(OR=2.88,2.84,4.49,6.76,7.00,3.46).Conclusions Mild VD was the most frequent FHR pattern in the second stage.The FHR patterns associated with adverse neonatal outcome in the second stage included absent or minimal baseline variability,late and prolonged decelerations,merging of decelerations,severe bradycardia and severe VD.End stage deceleration(ESD)was a peculiar FHR pat-tern in the second stage and mainly occured in the end stage of delivery.If rapid delivery was possible,neonatal outcome was optimal.