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The Clinical Analysis of Continuous Electronic Intrapartum Fetal Heart Rate Monitoring in1011Pregnant Women

Author: BaoMin
Tutor: XiaoXiaoMin
School: Jinan University
Course: Clinical
Keywords: Fetal heart rate monitoring Pattern generation Neonatal outcomes Variable deceleration Intrapartum Fetus Late decelerations Surgery yield Pregnant woman Apgar FHR Umbilical artery Cord blood Early deceleration Predictive value Moderate fetal Mode of delivery Umbilical blood flow The false positive rate
CLC: R714.5
Type: Master's thesis
Year: 2013
Downloads: 15
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Abstract


Objects:1.To investigate the necessary of fetal heart rate monitoring (FHR) in clinical work andfound out which is the best criterion for interpretation.2.To investigate the value of intrapartum continuation fetal heart monitoring in predictingneonatal birth condition.3.To investigate the predictive value of fetal heart monitoring combined with otherclinical physical index.Methods:1011pregnant women who had regular prenatal checkup and gave birth in hospital onJanuary2012-July2012at the first affiliated hospital of Jinan university were included.Clinical dates were collected, blood gas was analyzed. The fetal heart monitoring figurewas interpreted according four interpretation criterions.Results:1. Among the1011cases, the frequency of the occurrence of variation deceleration washighest, it take up to87.5%, the next were prolonged deceleration (31.6%), laterdeceleration (20.1%) and early deceleration (16.5%);2. According to interpretation criterion from ACOG(2009), the number of stage I andstage II was124(12.3%) and887(87.7%) respectively. According to the interpretationcriterion from RCOG(2007),the number of normal patterns,suspicious patterns andpathological patterns was122(12.2%),767(75.8%) and121(12.0%).According to theinterpretation criterion from SOGC(2007), the number of normal CST, atypical CST andabnormal CST was142(14.1%),537(53.1%) and332(32.8%) respectively. According tothe pyatyi(2007) interpretation criterions, the number of green, blue, yellow, orange andred was126(12.5%),407(40.3%),393(39.9%),69(6.8%) and16(1.6%) respectively;3.The differences of maternal age, birth gestational age,the incidence of pregnancycomplications and complications were no significant among various types of fetal heart rate pattern diagnosed by the interpretation criterions fromACOG(2009),RCOG(2007),SOGC(2007) and Pyatyi(2007).And The differences ofparities and pregnancies were significant.The occurrence rate of the second-class fetalheart pattern diagnosed by the four interpretation criterions was highest,and there wassignificant difference of the incidence of the second-class fetal heart pattern among thefour interpretation criterions;4.Choosing the umbilical cord blood PH<7.2as the diagnosis of fetal acidemia,choosingthe type II and type III pattern diagnosed by the interpretation criterions fromACOG(2009),RCOG(2007),SOGC(2007);the blue,yellow,orange and red pattermdiagnosed by the interpretation criterions from Pyatyi(2007) as abnormal pattern,thepositive predictive value was very low and the negative predictive value was high;5.The false positive rate of fetal heart rate was reduced and the positive predict value offetal heart rate was improved by choosing the third type of fetal heart patterns asabnormal fetal heart patterns;6.Comparing the rate of the incidence of the umbilical cord blood PH<7.2,the group ofoperative delivery with abnormal patterns diagnosed by the interpretation criterions fromACOG(2009),RCOG(2007) and SOGC(2007) was significantly higher than naturalbirths,the difference was no significant between the two groups with abnormal patternsdiagnosed by the interpretation criterions from Pyatyi(2007). Comparing the rate of theincidence of the1minute Apgar<7,the difference was no significant between the twogroups with abnormal patterns diagnosed by the four interpretation criterions;7.Comparing the rate of the incidence of the umbilical cord blood PH<7.2, the differencewas significant between normal baseline and bradycardia,there was no significantdifference between normal baseline and tachycardia,bradycardia and tachycardia.The rateof the incidence of the1minute of Apgar<7and the rate of fetuses who were in NICUwere no significantly different among normal baseline,tachycardia andbradycardia.Comparing the group of normal variability with minimal variability,thedifferences of incidence of the umbilical cord blood PH<7.2, the1minute of Apgar<7andthe rate of fetuses who were in NICU were no significant; 8.Comparing the rate of the incidence of the umbilical cord blood PH<7.2, the1minute ofApgar<7and the rate of fetuses who were in NICU,there were no significant differencesamong various degrees of variable deceleration,late deceleration,mild and moderateprolonged deceleration,moderate and severe prolonged deceleration,bradycardia. Thedifference of the rate of the incidence of the1minute of Apgar<7was significant betweenmild and severe prolonged deceleration;9. When the proportion of variable deceleration<50%was compared with those≥50%,theincidence of the1minute of Apgar<7was significantly reduced. When the time of simplevariable deceleration<3was compared with those≥3,The incidence of fetal acidemia andthe1minute of Apgar<7were significantly different.Comparing the time of complexvariable deceleration<3with those≥3,the incidence of fetal acidemia was significantlydifferent.The higher the proportion of complex variable deceleration, the higher the risk ofneonatal adverse birth situation;10. The difference of the rate of operative labor was significant among mild,moderate andsevere prolonged deceleration.And there were no significant differences among variousdegree of variable deceleration,late deceleration and bradycardia.When the group ofoperative delivery with abnormal patterns was compared with natural birth,the incidenceof fetal acidemia was significantly improved,the incidence of the1minute Apgar<7wasno significant difference between the two groups;11.The baseline,variability, deceleration were scored and analyzed by receiver operatingcharacteristic curve, then choosing the score≥5.5as abnormal fetal heart patterns,theaccuracy rate of diagnosis was67.0%,the false positive rate of fetal heart rate was reducedand the positive predict value of fetal heart rate was improved. The higher of the scoresand the value of S/D ratio of umbilical cord blood flow in late pregnancy,the higher therisk of neonatal adverse birth situation.Conclusions:1. The false positive rate of predict fetal acidemia can be reduced by choosing the third setof criterion as abnormal electronic fetal heart rate monitoring,but the positive predictivevalue is low.The Pyatyi(2007) interpretation criterion was superior to the three-level interpretation criterion from ACOG(2009),RCOG(2007) and SOGC(2007).2.The frequentness of variable decelerations and the degree of prolonged decelerationswere closely related with the birth outcome, It recommends that the diagnostic criteriashould consider the degree of variable decelerations,and not only consider the duration ofthe prolonged deceleration,but also the degree of prolonged deceleration should beconsidered.3. We should attach great importance to the significance of complex variable decelerationduring labor, it is closely related with the birth outcome, the higher the proportion, theworse the outcome.4. It is closely related with the scores of fetal heart rate monitoring,the value of S/D ratioof umbilical cord blood flow in late pregnancy and neonatal birth outcomes.The higher ofthe scores and the value of S/D ratio of umbilical cord blood flow in late pregnancy, theworse the outcome.

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CLC: > Medicine, health > Obstetrics and Gynaecology > Obstetrics > Fetus
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