第二产程中胎儿头皮刺激实验预测胎儿宫内安危的价值  

作　　者：叶爱梅 李子军[1] 艾小玉 刘敏[1] 

机构地区：[1]浙江衢化医院,324004

出　　处：《浙江临床医学》2021年第9期1315-1318,共4页Zhejiang Clinical Medical Journal

摘　　要：目的评价胎儿头皮刺激实验(FSST)在足月单胎初产妇第二产程中预测胎儿宫内安危的价值。方法回顾性分析2016年1月至2020年1月符合纳入标准的孕妇225例,依据分娩后新生儿结局情况,结局良好为胎儿宫内安全组(n=160),结局不良为胎儿宫内不安全组(n=65)。结合PSST至胎儿娩出时间(PSS-BT)分为3个不同亚组,分别是≤35 min(n=89),36~-59 min(n=71)和≥60 min(n=65)。分别收集其年龄、分娩时妊姬天数、PSST评价结果、前羊水清洁度、FSST-BT、新生儿出生后1分钟、5分钟Apgar评分情况、后羊水清洁度和新生儿窒息。采用Logistic逐步回归方法分析影响胎儿宫内安危的产前高凤险因素,结合分娩后临床回颐性结局评价FSST对胎儿宫内安危的预测价值。结果除年龄和妊娘天数外,两组在FSST评价结局、前羊水清洁度、FSST-BT、新生儿出生后1分钟、5分钟Apgar评分情况和后羊水清洁度比较差异有统计学意义(P<0.05),Logistic逐步回归分析显示FSST,FSST-BT和后羊水清洁度是影响第二产程中胎儿宫内安危的风险因素。FSST在3个亚組的预测结局与临床回颐性评价结局比较,除≤30 min外,其余均显示差异有统计学意义(P<0.05);其中FSST在36~59 min预测评价效能最高(PPV=50.00%、NPV=88.24%,敏感性=73.33%、特异性=73.17%,YI=0.96)。结论FSST预测第二产程中的胎儿宫内安全具有一定的局限性,FSST阴性预测价值高于阳性预测价值;同时FSST预测结果明显受到FSST-BT的影响,尤其在FSST预测阳性且FSST-BT≥60 min时需引起助产士和产科医师的高度关注和警惕。Objective To evaluate the clinical value of Fetal Scalp Stimulation Test(FSST)in predicting fetal safety in term singleton primiparas during the second stage of labor.Methods 225 pregnant women who met the inclusion criteria between January 2016 and January 2020 in Zhejiang Quhua hospital were retrospectively analyzed.According to the perinatal outcomes,160 pregnant women with good outcomes were grouped into intrauterine fetal safety group,and 65 cases with poor outcomes were set as intrauterine fetal insecurity group.To combine with FSST to Birth Time(FSST-BT),they were divided into three subgroups,which were≤35 minutes(n=89),36~59 minutes(n=71)and ≥60 minutes(n=65).Nine items of data were collected,including age,gestational days,FSST evaluation results,anterior amniotic fluid turbidity,FSST-BT,Apgar score at 1 and 5 minutes,posterior amniotic fluid and neonatal asphyxia.Logistic stepwise regression analysis was used to analyze the high risk factors affecting fetal intrauterine safety.The clinical predictive value of FSST on fetal intrauterine safety was evaluated combined with the clinical retrospective outcome after delivery.Results Except for age and gestational days,there were significant difierences between the two groups in FSST,anterior/posterior amniotic fluid turbidity,FSST-BT,Apgar score at 1 minute and 5 minutes after birth(all P<0.05),but in binary multivariate logistic regression analysis,FSST,FSST-BT and posterior amniotic fluid turbidity were high risk factors for fetal intrauterine safety in the second stage of labor.After the comparison of FSS prediction and clinical retrospective evaluation of fetal intrauterine safety under different FSST-BT,it was concluded that the predicted outcomes of FSST in three subgroups were significantly different from the Enical retrospective evaluation(all P values<0.05),except for ≤30 minutes(P>0.05).Among them,FSST had the highest predictive evaluation efficiency in[36-59]minutes group PPV=50.0%,NPV=88.2%,sensitivity=73.3%,specificity=73.2%,Yi=0.96).Conclus

关 键 词：胎儿头皮刺激实验 胎儿头皮刺激实验至胎儿娩出的时间 胎儿宫内安全 第二产程 羊水浑浊度 

分 类 号：R71[医药卫生—妇产科学]