日常胎动记录图预测和评估脐带绕颈胎儿宫内安危的价值研究

背景 胎动(FM)是唯一依赖孕妇自我评估的主观性指标,却可客观反映胎儿宫内安全情况;如何将FM量化并使其成为一个相对客观的评价指标一直是产科医师研究和关注的焦点.目的 通过应用日常胎动记录图(DFMC)预测和评估脐带绕颈胎儿的宫内安危.方法 回顾性选取2010年1月—2016年1月在浙江衢化医院住院分娩的足月孕妇100...

Predictive Value of Daily Fetal Movement Count Chart for the Fetal Safety of Fetus with Umbilical Cord around Neck

Background　Fetal movement is the only index that is assessed by pregnant women subjectively，but can objectively reflect the safety of fetus.How to quantify fetal movement and make it be a relatively objective evaluation index has been a research focus of obstetricians.Objective　To predict the fetal safety of fetus with umbilical cord around neck by using the daily fetal movement count chart （DFMC）.Methods　A retrospective design was used.Participants were 100 pregnant women who were hospitalized in Zhejiang Quhua Hospital for a full-term delivery from January 2010 to January 2016.Their babies had antepartum B-mode ultrasound suggested umbilical cord around neck，which was confirmed at birth.The DFMC of 24 hours before delivery was collected and used to predict the fetal safety （fetal safety and unsafety were defined as normal fetal movement，and abnormal，decreased or disappeared fetal movement，respectively）.Other clinical data were collected，including maternal age，gestational week，systolic-diastolic（S/D） ratio in the umbilical artery measured by Doppler ultrasound，amniotic fluid index，modified Fischer score of the results of non-stress test performed 24 hours before delivery，neonatal outcome after delivery（44 with safety and 56 without），delivery mode（vaginal，cesarean or forceps）.Stepwise multiple Logistic regression was used to analyze influencing risk factors of fetal safety of fetus with umbilical cord around neck.Results　There were significant differences in the S/D ratio，the gestational week at which umbilical cord to be found around the baby's neck，fetal movement，modified Fischer score and delivery mode between the two groups （P<0.05）.Stepwise multiple Logistic regression analysis showed that fetal movement and mode of delivery were independently associated with fetal safety of fetus with umbilical cord around neck（P<0.05）.The sensitivity，specificity and Youden's index of DFMC were 86.5%，90.0%，and 0.77，respectively in predicting the fetal safety of a baby vaginally born with umbilical cord around neck，and were 66.7%，94.6% and 0.61，respectively in predicting that of a baby cesarean delivered with umbilical cord around neck.Abnormal, decreased or disappeard fetal movement was accounting for 87.5% （35/40） of the cesarean delivered babies.Conclusion　DFMC may effectively predict the fetal satety of fetus with umbilical cord around neck，and may be used as a clinical indicator for the selection of an appropriate delivery mode in pregnant women with a fetus with umbilical cord around neck.