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Intrapartum fetal heart rate between 150 and 160 bpm at or after 40 weeks and labor outcome.

在40周或之后的产时胎心率在150和160 bpm之间和分娩结果。

  • 影响因子:2.21
  • DOI:10.1111/aogs.14024
  • 作者列表:"Ghi T","Di Pasquo E","Dall'Asta A","Commare A","Melandri E","Casciaro A","Fieni S","Frusca T
  • 发表时间:2021-03-01
Abstract

INTRODUCTION:A baseline fetal heart rate between 110 and 160 bpm is considered normal. However, among normal fetuses the average baseline heart rate has been shown to diminish progressively and the 90th centile of the fetal heart rate at 40 weeks of gestation has been consistently found at around 150 bpm. The aim of our study was to assess the labor and neonatal outcome of fetuses at 40 gestational weeks or beyond, whose intrapartum baseline fetal heart rate was between 150 and 160 bpm. MATERIAL AND METHODS:Retrospective cohort study including singleton pregnancies with spontaneous onset of labor, gestational age between 40+0 and 42+0 weeks, category I CTG trace according to the FIGO guidelines 2015 with baseline fetal heart rate between 110 and 160 bpm during the first 60 minutes of active labor. Exclusion criteria were maternal hyperpyrexia at admission, fetal arrhythmias, maternal tachycardia (>110 bpm) and uterine tachysystole (>5 contractions/10 minutes). The following outcomes were compared between fetuses with a baseline ranging between 110 and 149 bpm and those with a baseline ranging between 150 and 160 bpm: incidence of meconium-stained amniotic fluid, intrapartum hyperpyrexia, mode of delivery, Apgar at 5 minutes <7, arterial pH <7.1 and Neonatal Intensive Care Unit admission, incidence of a composite adverse neonatal outcome. RESULTS:In all, 1004 CTG traces were included in the analysis, 860 in Group 110-149 bpm and 144 in Group 150-160 bpm. Group 150-160 bpm had a significantly higher incidence of meconium-stained amniotic fluid (odds ratio [OR] 2.6; 95% CI 1.8-3.8), maternal intrapartum hyperpyrexia (OR 4.7; 95% CI 1.1-14.6), urgent/emergent cesarean section for suspected fetal distress (OR 13.4; 95% CI 3.3-54.3), Apgar <7 at 5th min (OR 9.13; 95% CI 1.5-55.1) and neonatal acidemia (OR 3.5; 95% CI 1.5-55.1). Logistic regression including adjustiing for potential confounders showed that fetal heart rate between 150 and 160 bpm is an independent predictor of meconium-stained amniotic fluid (adjusted odds ratio [aOR] 2.2; 95% CI 1.5-3.3), cesarean section during labor for fetal distress (aOR 10.7; 95% CI 2.9-44.6), neonatal acidemia (aOR 2.6; 95% CI 1.1-6.7) and adverse composite neonatal outcome (aOR 2.6; 95% CI 1.2-5.6). CONCLUSIONS:In fetuses at 40 weeks or beyond, an intrapartum fetal heart rate baseline ranging between 150 and 160 bpm seems associated with a higher incidence of labor complications.

摘要

介绍: 基线胎心率在110和160 bpm之间被认为是正常的。然而,在正常胎儿中,已显示平均基线心率逐渐减小,并且在妊娠40周时的胎儿心率的150厘泊一直被发现在约bpm。我们研究的目的是评估40孕周或更长时间的胎儿的分娩和新生儿结局,其产时基线胎心率在150至160 bpm之间。 材料和方法: 回顾性队列研究,包括自发分娩的单胎妊娠,胎龄在40 + 0和42 + 0周之间,根据FIGO指南2015的I类CTG描记,在活期分娩的前60分钟,基线胎心率在110和160 bpm之间。排除标准为入院时母体高热、胎儿心律失常、母体心动过速 (>110 bpm) 和子宫收缩过快 (>5次收缩/10分钟)。比较了基线介于110和149 bpm之间的胎儿和基线介于150和160 bpm之间的胎儿之间的以下结果: 羊水胎粪污染的发生率,产时高热,分娩方式,5分钟时的Apgar <7,动脉pH <7.1和新生儿重症监护病房入院,复合不良新生儿结局的发生率。 结果: 总共有1004条CTG迹线被纳入分析,860-110 bpm组149条,144-150 bpm组160条。150-160 bpm组羊水胎粪污染的发生率显著升高 (比值比 [OR] 2.6; 95% CI 1.8-3.8),产妇产时高热 (OR 4.7; 95% CI 1.1-14.6),疑似胎儿窘迫的紧急/紧急剖宫产 (OR 13.4; 95% CI 3.3-54.3),5 min时Apgar <7 (OR 9.13;95% CI 1.5-55.1) 和新生儿酸血症 (OR 3.5; 95% CI 1.5-55.1)。包括潜在混杂因素的Logistic回归分析显示,胎心率在150和160 bpm之间是羊水胎粪污染的独立预测因素 (校正比值比 [aOR] 2.2; 95% CI 1.5-3.3),分娩期间因胎儿窘迫而行剖宫产术 (aOR 10.7; 95% CI 2.9-44.6),新生儿酸血症 (aOR 2.6;95% CI 1.1-6.7) 和不良复合新生儿结局 (aOR 2.6; 95% CI 1.2-5.6)。 结论: 在40周或超过40周的胎儿中,产时胎儿心率基线在150和160 bpm之间似乎与更高的分娩并发症发生率相关。

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