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。

Clinical analysis of continuous electronic fetal heart rate monitoring for preterm small for gestational age during labor

OBJECTIVE: To investigate the clinical value of continuous electronic fetal heart rate (FHR) monitoring for preterm small for gestational age (PSGA) during labor. METHODS: Three hundred and three pregnant women who had inevitable preterm labor at 32 - 36 weeks' gestation because of premature rupture of membrane or unknown cause underwent continuous electronic FHR monitoring during labor from Jan 2002 to May 2004. In total, 78 newborns were preterm small for gestational age (PSGA, PSGA group) and 225 newborns were preterm appropriate for gestational age (PAGA, PAGA group). The cardiotocography (CTG), outcome of labor, and cases with combined umbilical cord abnormality of both groups were analysed retrospectively. RESULTS: The number of cases with pure U type variable deceleration of PSGA group and PAGA group was respectively 24 (30.8%) and 10 (4.4%) (P < 0.01). The number of cases of U type variable deceleration accompanied with other abnormal CTG of both groups was respectively 10 (12.8%) and 1 (0.4%) (P < 0.01). Of PSGA group, the rate of cesarean section and forceps among cases of pure U type variable deceleration was lower than that of cases with U type variable deceleration accompanied with other abnormal CTG (20.8% vs 60.0%, P < 0.05. While, the rate of umbilical cord abnormality (44.1%) among 34 cases with U type variable deceleration was higher compared with that (20.5%) among 44 cases without U type variable deceleration (P < 0.05). CONCLUSIONS: U type variable deceleration is the characteristic FHR graph of PSGA during labor and is not the sign of fetal distress when not accompanied with other abnormal CTG.