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

doi:10.12114/j.issn.1007-9572.2021.00.007

摘要/Abstract

摘要： 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例，分娩前B超和分娩后临床均证实胎儿脐带绕颈。分析孕妇分娩前24 h DFMC，并根据FM情况预测胎儿宫内是否安全：FM规律定义为宫内安全；FM异常、减少或消失均定义为宫内不安全。收集孕妇一般资料，包括年龄、孕周、超声下脐动脉收缩期与舒张期血流比值（S/D值）、羊水指数（AFI），同时行临产前24 h无应激试验（NST）并予以改良Fischer评分法评分，采集分娩后围生儿结局情况、分娩方式（自然阴道、剖宫产、产钳助产）。根据分娩后围生儿结局分为胎儿宫内安全组（44例）和胎儿宫内不安全组（56例），采用多因素Logistic逐步回归分析探究脐带绕颈胎儿宫内安全的影响因素。结果　两组S/D值、脐带绕颈周数、FM、改良Fischer评分法评分、分娩方式比较，差异均有统计学意义（P<0.05）。多因素Logistic逐步回归分析结果显示，FM和分娩方式是脐带绕颈胎儿宫内安危的影响因素（P<0.05）。DFMC预测自然分娩的脐带绕颈胎儿宫内安全的灵敏度为86.5%，特异度为90.0%，约登指数为0.77；DFMC预测剖宫产的脐带绕颈胎儿宫内安全的灵敏度为66.7%，特异度为94.6%，约登指数为0.61。FM异常、减少或消失者剖宫产比例为87.5%（35/40）。结论　DFMC可以有效预测和评价脐带绕颈胎儿宫内安危，同时亦可为胎儿脐带绕颈的孕妇分娩方式的选择提供有限的临床依据。

关键词: 脐带绕颈, 日常胎动记录图, 无应激试验, 胎儿宫内安全, 预测

Abstract: 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.

Key words: Nuchal cord, Daily fetal movement count chart, Non stress test, Fetal intrauterine safety, Forecasting

叶爱梅,李子军,艾小玉. 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[J]. 中国全科医学, 2021, 24(6): 690-695. DOI: 10.12114/j.issn.1007-9572.2021.00.007.
YE Aimei,LI Zijun,AI Xiaoyu. Predictive Value of Daily Fetal Movement Count Chart for the Fetal Safety of Fetus with Umbilical Cord around Neck　[J]. Chinese General Practice, 2021, 24(6): 690-695. DOI: 10.12114/j.issn.1007-9572.2021.00.007.

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