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SUMMARY OBJECTIVE: This study aimed to determine whether maternal cortisol levels affect fetal heart rate patterns in primiparous pregnant women in the third trimester. METHODS: This cross-sectional descriptive study included 400 primiparous pregnant women with uncomplicated pregnancies between November and December 2022. The study included primiparous pregnant women over 18 years old in the third trimester who had not exercised for at least 2 h before the fetal heart rate monitoring and had a healthy pregnancy without consuming any food or drink. Fetuses with decelerating heartbeats and pregnant women who showed uterine contraction and cervical dilation during the fetal heart rate monitoring were excluded from the study. Research data were collected with the data collection form. The fetal heart rate data were collected using a cardiotocograph. At least two accelerations during the 20-min nonstress test period were the basis for diagnosing a reactive nonstress test. About 5 mL of maternal saliva for cortisol measurements was collected before fetal heart rate monitoring. Research data were analyzed with IBM SPSS Statistics for Macintosh, Version 28.0. A p-value of <0.05 was considered significant. RESULTS: There were no significant differences in the comparison of the groups in terms of education and income status, family type, fetal gender, pregnancy planning status, BMI and age averages, or gestational week averages (p>0.05). The number of at least two accelerations required for the diagnosis of reactive NST was also higher in Group 1 (maternal salivary cortisol level ≤24.20). A moderately positive relationship between fetal heart rate and maternal salivary cortisol was observed (r=0.448, p=0.000). In total, 11.9% of the total change in fetal heart rate level is explained by maternal cortisol (R2=0.119). Maternal cortisol increases fetal heart rate level (ß=0.349). CONCLUSION: These findings suggest that stress in primiparous pregnant women with high cortisol levels may influence fetal heart rate patterns. It was revealed that the increase in cortisol level, considered a stress hormone, may be a harbinger of fetal tachycardia.
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Objective To investigate the diurnal rhythms of fetal heart rate in third trimester of pregnancy. Methods From June 2014 and October 2017,97 cases of low-risk pregnancy women who received antenatal care and deliveried in Peking University Third Hospital were collected. Totally 130 cases of fetal heart rate and maternal holter monitoring data were analyzed. All cases were singleton pregnancy, cephalic position and had normal perinatal outcome. They were divided into three groups based on gestational age, 29 cases(22.3%,29/130)in pregnancy 28-33+6weeks, 37 cases(28.5%,37/130)in 34-36+6weeks, and 64 cases (49.2%, 64/130)in 37-40+6weeks. Fetal heart baseline (FHB), fetal heart baseline variation (FHBV), fetal heart rate acceleration area and maternal heart rate were acquired by computer, their diurnal rhythms and the differences among three groups were analyzed. Results FHB、FHBV、fetal heart rate acceleration area and maternal heart rate all presented diurnal rhythms.(1)FHB rose in daytime and decreased at night with the minimum value at 2:00-5:00, and didn′t decline further at night with the advancing of gestational age(P=0.548).(2)FHBV was similar to FHB, which rose in daytime and decreased at night, but declined smaller at night with the advancing of gestational age, especially after 37 weeks (P<0.01).(3)Fetal heart rate acceleration area reduced in daytime and enlarged at night, and enlarged more with the advancing of gestational age.(4)The diurnal rhythm of maternal heart rate was consistent with fetal heart rate. FHB lagged behind maternal heart rate for 1-2 hours when declining to the nocturnal nadir but been basically in sync with maternal heart rate when recovered. Conclusion The basic characteristics of fetal heart rate in normal pregnancy exist obviously diurnal rhythms, and change in different trends with the advancing of gestational age.
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Objective To explore the pregnancy outcomes in women whose fetal/embryonic heart rate( FHR) were below 120 beats per minute( bpm) before 8 weeks pregnancy and determine the predictive value of FHR in pregnancy outcome . Methods The laboratory examinations ,clinical data and clinical history of the pregnant women whose FHR were below 120 bpm before 8 weeks pregnancy were retrospectively analyzed . Results When gestational age(GA) was less than 8 weeks ,pregnancy loss was observed in 11 .0% ( 110/998 ) cases with an FHR less than or equal to 120 bpm ,and pregnancy loss occurred in all the cases ( 23/23) with an FHR less than or equal to 70 bpm . The proportions of first trimester loss were 86 .4% (19/22) for pregnancies with an FHR of 71 －80 bpm ,75 .7% (28/37) for pregnancies with an FHR of 81－90 bpm ,25 .5% (14/55) for pregnancies with an FHR of 91 －100 bpm , 6 .3% (13/208) for pregnancies with an FHR of 101 －110 bpm ,and 2 .0% (13/653) for pregnancies with an FHR of 111 －120 bpm .ROC analysis showed that the best cut-off value to predict adverse pregnancy outcomes was an FHR of 94 bpm . The area under the ROC curve was 0 .906 ( P ＜ 0 .0001 ) and its sensitivity and specificity values were 97 .86% and 71 .43% respectively . Conclusions Fetal/embryonic heart monitoring before 8-weeks pregnancy can be an effective predictor for early pregnancy outcome . The best cut-off value to predict adverse pregnancy outcomes is an FHR of 94 bpm .
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Objective To analyze the characteristics of long-range monitoring of fetal heart rate in the third trimester fetuses with atypical non-stress test (NST).Methods Long-range monitoring of fetal heart rate was performed in low-risk pregnant women who received antenatal care between April 2014 and October 2015 in Peking University Third Hospital.All subjects underwent NST from the 36th gestational week,and divided into normal NST (30 cases) and atypical NST (36 cases) groups according to the results of NST.The clinical data,including maternal age,gestational age at delivery,termination of pregnancy,neonatal asphyxia,hospitalization rate and umbilical cord blood peak-systolic/diastolic ratio value were collected.The data of long-range monitoring were analyzed by specially designed computer software.T test and Chi-square test were applied for statistical analysis.Results There were no differences in maternal age,gestational age at delivery,mode of delivery and incidence of neonatal asphyxia between the two groups (all P＞0.05).In atypical NST group,fetal heart rate baseline was higher [(138.05±5.65) vs (135.10±5.39) bpm] (t=-2.170,P＜0.05),and fetal heart rate baseline variability was lower than in normal NST group [(5.19±1.07) vs (6.28±1.15) bpm] (t=3.960,P＜0.001).Compared with normal NSTs,the percentage of mild baseline variability was significantly increased in atypical NST group [(40.79±9.97) vs (51.17± 10.84)％],while that of moderate variability was significantly decreased [(56.57±8.86) vs (46.72± 10.24)％] (t=-4.018 and 4.133,both P ＜ 0.001).In atypical NSTs,the average ratio of time of acceleration/the whole time of monitoring [(37.41 ±4.60)％] and acceleration area per unit time[(1.42±0.48) cm2/20 min] were decreased compared with normal NSTs [(40.78±4.23)％ and (2.03±0.67) cm2/20 min] (t=3.079 and 4.359,both P＜0.05).Conclusions Long-range monitoring of fetal heart rate in the third trimester fetuses with atypical NST is characterized by the declined fetal heart rate baseline variability,increased proportion of mild variability and unit time acceleration area;but these are not associated with pregnancy outcomes and short-term prognosis.
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PURPOSE: To determine fetal heart rate (FHR) responses to maternal resistance exercise for the upper and lower body at two different volumes, and after 25 minutes post-exercise. METHODS: Ten pregnant women (22-24 weeks gestation, 25.2±4.4 years of age, 69.8±9.5 kg, 161.6±5.2 cm tall) performed, at 22-24, 28-32 and 34-36 weeks, the following experimental sessions: Session 1 was a familiarization with the equipment and the determination of one estimated maximum repetition. For sessions 2, 3, 4 and 5,FHR was determined during the execution of resistance exercise on bilateral leg extension and pec-deck fly machines, with 1 and 3 sets of 15 repetitions; 50% of the weight load and an estimated repetition maximum. FHR was assessed with a portable digital cardiotocograph. Results were analyzed using Student's t test, ANOVA with repeated measures and Bonferroni (α=0.05; SPSS 17.0). RESULTS: FHR showed no significant differences between the exercises at 22-24 weeks (bilateral leg extension=143.8±9.4 bpm, pec-deck fly=140.2±10.2 bpm, p=0.34), 28-30 weeks (bilateral leg extension=138.4±12.2 bpm, pec-deck fly=137.6±14.0 bpm, p=0.75) and 34-36 weeks (bilateral leg extension=135.7±5.8 bpm, pec-deck fly=139.7±13.3 bpm, p=0.38), between the volumes(bilateral leg extension at 22-24 weeks: p=0.36, at 28-30 weeks: p=0.19 and at 34-36 weeks: p=0.87; pec-deck fly at 22-24 weeks: p=0.43, at 28-30 weeks: p=0.61 and at 34-36 weeks: p=0.49) and after 25 minutes post-exercise. CONCLUSION: Results of this pilot study would suggest that maternal resistance exercise is safe for the fetus. .
OBJETIVO: O objetivo do presente estudo foi determinar a frequência cardíaca fetal (FCF) enquanto gestantes realizavam exercícios de força para os membros superiores e inferiores, com dois volumes diferentes, e 25 minutos pós-exercício. MÉTODOS: Dez gestantes (22-24 semanas, 25,2±4,4 anos, 69,8±9,5 kg, 161,6±5,2 cm) realizaram as seguintes sessões experimentais com 22-24, 28-32 e 34-36 semanas de gestação: A Sessão 1 foi a familiarização com os equipamentos e determinação de uma repetição máxima estimada. Para as Sessões 2, 3, 4 e 5, foi determinada a FCF durante a execução do exercício de força nos equipamentos extensão de joelhos bilateral e voador, com 1 e 3 séries de 15 repetições e carga de 50% de uma repetição máxima estimada. A FCF foi avaliada com um cardiotocógrafo digital portátil. Os resultados foram analisados com teste t de Student, ANOVA com medidas repetidas e Bonferroni (α=0,05; SPSS 17.0). RESULTADOS: A FCF não demonstrou diferença significativa entre os exercícios com 22-24 semanas (extensão de joelhos bilateral=143,8±9,4 bpm, voador=140,2±10,2 bpm, p=0,34), 28-30 semanas (extensão de joelhos bilateral=138,4±12,2 bpm, voador=137,6±14,0 bpm, p=0,75) e 34-36 semanas (extensão de joelhos bilateral=135,7±5,8 bpm, voador=139,7±13,3 bpm, p=0,38), entre os volumes (extensão de joelhos bilateral com 22-24 semanas: p=0,36, 28-30 semanas: p=0,19 e 34-36 semanas: p=0,87; voador com 22-24 semanas: p=0,43, 28-30 semanas: p=0,61 e 34-36 semanas: p=0,49) e 25 minutos pós-exercícios. CONCLUSÃO: Os resultados deste estudo piloto podem sugerir que o exercício de força materno é seguro para o feto. .
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Humans , Female , Pregnancy , Adult , Heart Rate, Fetal/physiology , Resistance Training , Gestational Age , Pilot ProjectsABSTRACT
Objective To discuss the relationship between repetitive variable deceleration with a short interval (RDSI) in labor and neonatal acidosis.Methods One hundred and seventy-seven electronic fetal heart monitoring (EFM) patterns within one hour preceding delivery in term singleton pregnancies were collected in Peking University Third Hospital between February 2011 to October 2013.Continued EFM were recorded before delivery.Analysis was conducted on general information of both mothers and babies,including pregnant complications,duration of labor,cord and placental factors,nature of amniotic fluid,Apgar score and neonatal cord blood gas.RDSI was defined as that over 50％ intervals between two decelerations (the end of the last deceleration to the beginning of the next one) ≤ 60 s which appeared repetitevly in a period of 20 minutes.Independent sample t test,rank sum test,Chi-square test and Fisher's exact test were applied for statistics and receiver operating characteristic curve was obtained from the information of those with RDSI.Results Twenty-four of the 177 women with RDSI were assigned to the study group (24 cases,13.6％) and the rest 153 cases without RDSI to the control group.Background information of women in the two groups was comparable according to the maternal age,gestational weeks at delivery and duration of labor (all P ＞ 0.05).The occurrence of meconium stained amniotic fluid in the study group was higher than that of the control group [16.7％ (4/24) vs 5.2％ (7/153),x2=5.204,P=0.045],while the pH and base excess value of the neonatal blood gas in the study group were lower [7.20 (7.13-7.28) vs 7.29 (7.25-7.33),Z=-4.490;-6.10 (-4.67 to-9.62) mmol/L vs-3.20 (-4.90 to-1.55) mmol/L,Z=-5.044;P ≤ 0.01] resulting a higher rate of neonatal acidosis [50.0％(12/24) vs 7.8％ (12/153),x2=31.456,P ＜ 0.01].No significant difference was found in the incidence of neonatal asphyxia between the two groups.The area under the curve was 0.774 (95％CI:0.579-0.969).Conclusion RDSI in labor might indicate a high risk of neonatal acidosis.
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Objective To explore the potential risk of category Ⅱ fetal heart rate(FHR) tracing according to the latest electron-ic fetal monitoring tracings .Methods The prenatal fetal heart rate tracings in 400 parturients with hospitalized delivery in this hos-pital from November 2011 to October 2012 were classified by category .Among them ,the pregnancy outcomes were compared be-tween the category Ⅰ FHR tracings(control group) and category Ⅱ FHR tracings(observation group) .Results The case number of meconium-staining amniotic fluid ,cesarean rate ,hypamniony and umbilical cord abnormality was significantly higher than that of the control group with statistical difference between the two groups (P0 .05);among the groups with various fetal heart monitoring abnormalities ,the rate of meconium-staining amniotic fluid in the decreased variation group was significantly higher than that in the fetal tachycardia group ,the difference showing statistical significance (P<0 .05);the rate of meconium-staining amniotic fluid in the fetal tachycardia group was significantly higher than that in the prolonged acceleration and ineffective acceleration group with statistical difference (P< 0 .05);the pregnant outcomes had no statistical differences among the other groups .Conclusion Compared with the category Ⅰ FHR tracings ,the category Ⅱ FHR tracings indicate a potential risk to the fetus ,which need to strengthen the prenatal and intrapartum fetal monitoring .
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Objective To explore the relationship between mathematical characteristics of cardiotocograph in electronic fetal monitoring (EFM) and umbilical blood acidosis,and help to evaluate the clinical significance of indeterminate EFM.Methods A total of 85 vaginal delivery cases (or transfer to caesarean section during labor) hospitalized in Peking University Third Hospital during February 4 to December 5,2011 was enrolled in this retrospective study.EFM monitored 0.5-1 hour before delivery was recorded and the mathematical characteristics as the baseline,deceleration area per unit time (cm2/min),deceleration duration ratio and some other variables of EFM were analyzed.All cases were divided into acidosis (n=12) and non-acidosis group (n=73) based on the umbilical blood gas results.Rank sum test or t-test were used to compare the difference on mathematical characteristics between these two groups.Results The deceleration duration ratio and deceleration area per unit time in acidosis group were 0.56±0.17 and 0.45 cm2/min (0.38-0.79 cm2/min),which were higher than those in non acidosis group [0.42±0.14 and 0.30 cm2/min (0.19-0.40 cm2/min)],the differences were statistically significant (t=2.889,Z=2.587,both P＜0.05).There were no statistically significant differences in the number of mild variable deceleration and severe deceleration per unit time between acidosis group and non acidosis group [(0.44± 0.14)/min vs (0.41±0.13)/min,t=1.318,P＞0.05; 0.033/min (0.016-0.062/min) vs 0.016/min (0.008-0.033/min),Z=-1.596,P＞0.05].Conclusions The deceleration duration ratio and deceleration area per unit time can be used to assist the interpretation of indeterminate EFM.
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Objective To investigate the value of fetal heart monitoring combined with umbilical blood flow for the prediction of perinatal outcome.Methods 2200 women with pregnancy for 26 to 42 weeks were given the detection of S/D value of fetal umbilical artery blood flow and Non Stress Test(NST) of fetal heart monitoring,and the relationship between the NST,S/D and prediction of perinatal outcome.Results When the S/D value ＜3,perinatal anmiotic fluid shortage,amniotic fluid pollution,newborn children hypoxia asphyxia,newborn child deformity and the probability of death were significantly less than S/D ≥ 3(x2 =15.61,6.2.4,12.38,9.73,5.77,all P ＜ 0.05);when the NST ＞7,the probability of adverse perinatal outcome was significantly less than the NST≤7(x2 =4.54,4.12,5.89,5.94,8.10,all P ＜ 0.05).Conclusion The fetal umbilical artery blood flow monitoring and fetal heart monitor could improve the accuracy of prediction of perinatal outcome,avoid the defects of a single method of monitoring,early and timely diagnose the fetal distress,and give reasonable treatment to reduce neonatal mortality.
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OBJETIVO: estudar o efeito da estimulação sônica na resposta cardíaca fetal de acordo com os parâmetros fornecidos pela cardiotocografia computadorizada em gestações de baixo risco. MÉTODOS: foram incluídas 20 gestantes de baixo risco com os seguintes critérios de inclusão: idade materna superior a 18 anos; gestação única, feto vivo; idade gestacional entre 36 e 40 semanas; índice de líquido amniótico superior a 8,0 cm e ausência de malformações fetais. Foram excluídos os casos com diagnóstico pós-natal de anomalia fetal. A cardiotocografia computadorizada foi realizada por 20 minutos antes e depois da estimulação sônica fetal. Os resultados foram analisados pelo teste t para amostras dependentes, adotando-se o nível de significância de p<0,05. RESULTADOS: a estimulação sônica foi efetuada com sucesso em todos os casos analisados. Pela análise dos parâmetros cardiotocográficos, não foi constatada diferença significativa quando se comparou os parâmetros pré e pós-estimulação, respectivamente: número médio de movimentos fetais por hora (55,6 versus 71,9, p=0,1); frequência cardíaca fetal (FCF) basal média (135,2 versus 137,5 bpm, p=0,3); média de acelerações da FCF>10 bpm (6,5 versus 6,8, p=0,7); média de acelerações da FCF>15 bpm (3,8 versus 4,3, p=0,5); média da duração dos episódios de alta variação da FCF (11,4 versus 10,9 minutos, p=0,7); média da duração dos episódios de baixa variação da FCF (2,5 versus 1,1 minutos, p=0,2) e média da variação de curto prazo (10,6 versus 10,9 ms, p=0,6). CONCLUSÕES: em gestação de baixo risco, no termo, a cardiotocografia computadorizada não evidenciou diferenças nos parâmetros da FCF após a estimulação sônica fetal.
PURPOSE: to study the effect of acoustic stimulation in the fetal cardiac response, according to parameters from computerized cardiotocography in low risk pregnancies. METHODS: twenty low risk pregnant women were included in the study, according to the following criteria: age over 18; single gestation, living fetus; gestational age between 36 and 40 weeks; amniotic liquid index over 8.0 cm and absence of fetal malformation. Cases with post-natal diagnosis of fetal anomaly were excluded. Computerized cardiotocography was performed for 20 minutes, before and after fetal acoustic stimulation. Results were analyzed by the t test for dependent samples, with significance level at p<0.05. RESULTS: acoustic stimulation was successfully performed in all cases analyzed. By the analysis of the cardiotocographic parameters, there was no significant difference when the pre and post-stimulation parameters were compared: average number of fetal movements per hour (55.6 versus 71.9, p=0.1); mean basal fetal heart rate (FHR) (135.2 versus 137.5 bpm, p=0.3); mean FHR increases>10 bpm (6.5 versus 6.8, p=0.7); mean FHR increases>15 bpm (3.8 versus 4.3, p=0.5); mean duration of high FHR variation episodes (11.4 versus 10.9 min, p=0.7); mean duration of low FHR variation episodes (2.5 versus 1.1 min, p=0.2), and mean short-term variation (10.6 versus 10.9 ms, p=0.6). CONCLUSIONS: in low risk gestations at term, computerized cardiotocography has not evidenced differences in the FHR parameters after the fetal sonic stimulation.
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Adult , Female , Humans , Pregnancy , Acoustic Stimulation , Cardiotocography , Diagnosis, Computer-Assisted , Cross-Sectional Studies , Prospective StudiesABSTRACT
O contexto atual da atividade médica exige do obstetra e ginecologista ampla compreensão dos avanços científicos e tecnológicos de sua área. O objetivo primordial da avaliação fetal antenatal é identificar fetos de risco para eventos adversos ou para o óbito e, assim, atuar preventivamente para evitar o insucesso. O perfil biofísico fetal atinge sua máxima eficiência quando aplicado dentro do contexto clínico de cada caso. Em gestações de alto risco, a doplervelocimetria da artéria umbilical mostrou-se útil para melhorar os resultados perinatais. Na restrição de crescimento fetal por insuficiência placentária grave, antes da 34ª semana de gestação, a doplervelocimetria do ducto venoso tem sido importante instrumento na condução dos casos. Nenhum teste isoladamente é considerado o melhor na avaliação da vitalidade fetal anteparto, entretanto, a análise conjunta de todos os métodos irá propiciar melhor compreensão da resposta fetal à hipóxia.
The present context of medical practice demands from the obstetrician and gynecologist broad understanding of the scientific and technological advances of the area. The main purpose of prenatal evaluation is to identify fetuses at risk for adverse events or death, for preventive action to avoid mishappenings. The determination of fetal biophysical profile reaches its maximum efficiency when applied within the clinical context of each case. In high risk gestations, the Doppler velocimetry of the umbilical artery has shown to be useful to improve perinatal outcome. In the fetal growth deficit, due to severe placentary insufficiency, Doppler velocimetry of the venous duct has been showing to be an important tool in handling of the cases before the 34th week of gestation. Although no test itself is considered the best to evaluate the fetus's prenatal vitality, the joint analysis of all methods may lead to a better understanding of the fetal response to hypoxia.
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Female , Humans , Pregnancy , Fetal Monitoring , Blood Vessels , Cardiotocography/methods , Fetal Monitoring/methods , Ultrasonography, Doppler , Ultrasonography, Prenatal/methodsABSTRACT
Objective To analyse the clinical significance of variable deceleration and extended deceleration in non-stress test. Methods Studied the clinical characteristics of variable deceleration and extended deceleration of 200 cases who underwent non-stress test from January 2005 to December 2007, and compared corresponding clinical significance and newborn prognosis. Results Variable deceleration and extended deceleration in non-stress test dued to cord entanglement, polyhydramnios and fetal growth restriction. The occurrence of fetal distress and severe asphyxia in nowbom were less in low-grade variable deceleration (8.3%, 1.0%) than those in high-grade variable deceleration (17.7%, 4.8%)and extended deceleration (23.8%, 7.1%). Condusion Variable deceleration and extended deceleration in non-stress test due to cord entanglement mostly, low-grade variable deceleration is not always clue to fetal distress and high-grade variable deceleration and extended deceleration is often clue to fetal distress.
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Objective To explore the characteristics of fetal movement and FHR variation elicited by acoustic stimulation and whether acoustic stimulation can replace vibroacoustic stimulation. Methods Ninety-four and seventy-six normal pregnant women for antenatal visit were recruited from the Woman's Hospital, School of Medicine, Zhejiang University from April 2002 to February 2003. All subjects were divided into 5 groups to be exposed to five different intensities of acoustic stimulations at 95,100,105,110,115 dB respectively and self-control of blank and vibroacoustic stimulation were designed. The fetal movements and FHR were recorded during the study. Results (1) The percentage of fetal movement evoked by 95,100,105,110,115 dB airborne sound was 15% , 89%, 83% , 83% , 95% respectively. The total percentage of fetal movement evoked by vibroacoustic stimulation was 99% for all subjects. The percentages of evoked fetal movement by 100,105,110,115 dB airborne sound were not significantly different from those by vibroacoustic stimulation. (2)The percentages of FHR acceleration ≥15 bpm in 100,105,110 and 115 dB airborne sound groups were 39%, 61%, 56% and 85%, respectively, while 92% for all cases evoked by vibroacoustic stimulation was significantly higher than those evoked by 100,105 and 110 dB airborne sound group but with no significant difference to 115 dB airborne sound group. (3)The peak value in FHR evoked by 95,100,105, 110 and 115 dB airborne sound were -4. 5 bpm, 12 bpm, 17 bpm, 14 bpm and 20. 5 bpm, respectively. The peak FHR acceleration evoked by vibroacoustic stimulation was 23 bpm which was significantly higher than those by 100,105,110 dB airborne sound and no significant difference was detected between 115 dB airborne sound and vibroacoustic stimulation group. (4)Compared with 115 dB airborne sound, vibroacoustic stimulation evoked significantly longer duration of FHR tachycardia (42. 5 s vs 5 s, P = 0. 011) and fetal movement (270 s vs 100 s, P = 0. 000). Conclusions Acoustic stimulation at 115 dB is able to elicit efficient fetal movement and FHR acceleration without prolonged tachycardia, fetal behavioral disorganization or excessive fetal movement and is reasonable to replace vibroacoustic stimulation for awaking fetuses combined with NST.
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Objective To analyze the effects of routine early amniotomy on labor and health status of foetus and neonate. Methods The results of “Early amniotomy increases the frequency of fetal heart rate abnormalities, A randomized controlled trial of early amniotomy, Effect of early amniotomy on the risk of dystocia in nulliparous women, The influence of elective amniotomy on fetal heart rate patterns and the course of labor in term patients: A randomized study, Randomised trial comparing a policy of early with selective amniotomy in uncomplicated labour at term and A randomized controlled trial and meta-analysis of active management of labour were analyzed using Mantel-Haenszel method (fixed effect model) in meta-analysis. Results (1) The routine early amniotomy can shorten 94.90 min of the first stage of labor, 95% CI (-119.17,-70.52). (2) The OR for cesarean section was 1.25,95%CI (0.99-1.57),for instrumental vaginal delivery was 1.05, 95% CI (0.90-1.24). (3) There was no difference in abnormal fetal heart rate at first stage (OR=0.95, 95% CI: 0.75-1.21), but there was increased abnormal fetal heart rate at second stage(OR=1.28, 95% CI: 1.02-1.61). (4) The frequency of stained amniotic fluid and abnormal Apgar scores at 1 minute was not different significantly [ OR=1.17,95% CI (0.78-1.73);OR=0.71,95%CI: (0.49-1.03)]. Conclusions Routine early amniotomy appears to be associated with both benefits and risks. Beneficial effects include reductions in labor duration and possible decrease in frequency of abnormal Apgar score at one minute. Risks include increase in abnormal fetal heart rate at second stage and possible rise in cesarean section rate.
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Objective To investigate the clinical value of the expert type terminal of long distance electronic fetal heart rate home monitoring system in the application to self monitoring of pregnant woman at home in peripartum Methods All the pregnant women ( n =284) were divided into two groups Research group ( n = 134) contained 73 high risk gravida There were 78 high risk gravida in control group ( n =150) In the research group, self monitoring at home in 134 women was taken by the expert type terminal of long distance electronic fetal heart rate monitoring system through telephone and fetal movement counting The women were requested to auscultate and transfer fetal heart rate (FHR) to electronic FHR monitoring center in hospital Non stress test(NST) was made 1～2 times every week when fetal movement was active When women felt any abnormality of baby, she should immediately test NST and then the photograph of NST was send to FHR monitoring center by telephone Doctor would make a diagnosis and management in time according to the photograph of NST In the control group, the way of fetal monitoring was fetal movement counting and regular NST test in the outpatient clinic Results The incidence of abnormal NST was significantly higher in the research group than that in the control group (respectively 22 0% vs 13 5%, P 0 05) Conclusions The expert type terminal of long distance electronic FHR monitoring system through telephone is a new way of the FHR self monitoring at home The application of this method could ease mental press of the women, decrease significantly perinatal mortality, decrease incidence of neonatal asphyxia, and improve quality of obstetrics Whatever there are high risk factors in any pregnant women, the system should be appied to all late pregnant women
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Objective We investigated the correlations between abnormal fetal heart rate (FHR) during the second stage of labor and delivery types and intrapartum maternal complications and fetal outcome Methods The data of 232 nulliparas with single vertex in the second stage of labor (111 cases with normal FHR, 121 cases with abnormal FHR) were analyzed retrospectively Results The incidence of abnormal FHR in the second stage of labor was 52 2%(121/232) The patterns of abnormal FHR included: 81 (66 9%) cases with moderate and/or severe variable deceleration (VD), 27 (22 3%) cases with scattered late deceleration (LD), only one with continuous LD, 4 (3 3%) cases prolonged deceleration (PD), 2 (1 7%) cases with VD and LD, 3 (2 5%) cases with VD and PD, 4 (3 3%) cases with diminished baseline variability There were 13 (11 7%) among the cases with normal FHR and 35 (28 9%) among the cases with abnormal FHR underwent assistant delivery operations (forceps or/and vaccum), respectively ( P