Analysis Of Intrapartum Cardiotocography And Umbilical Arterial Blood Gas

ObjectiveThis study aim to explore maternal-fetal and labor factors affecting neonatal umbilical arterial blood gas results,analyzed the correlation between fetal heart rate monitoring and neonatal blood gas during labor,provides theoretical basis for early intervention in the labor process and further reduce the incidence of neonatal asphyxia,reduce poor prognosis,and improve maternal-fetal safety.MethodsSelect June 2018-October 2018 in Tianjin central hospital ward childbirth meet the inclusion criteria of full-term and vaginal delivery 895 cases,and the umbilical arterial blood gas pH 7.2 was used as a threshold according to the consensus of experts in China.The case was divided into the normal group(pH ? 7.2)and the acidemia group(pH < 7.2).Record general information of the population,maternal-fetal factors,factors in labor,continuous CTG information during labor,analysis of maternal-fetal and labor factors of neonatal acidemia,and according to CTG graph(2015 China expert consensus),classification(2015FIGO)and physiological mechanism of hypoxia interpret CTG,compare the accuracy of different interpretation aspects for neonatal acidemia.The acidemia newborns were followed up for a general follow-up of growth and development after 3 months.Using two-variable logistic regression to combined analyze the high-risk factors for neonatal acidemia.Results1.Time of labor and neonatal acidemia: the incubation period of the neonatal umbilical artery blood gas normal group is 5.5h,the active period is 1.33 h,the active period is 4.67cm/h,and the first stage is 6.83 h.The second stage time is 0.43 h.The time of labor in the normal blood gas group was shorter than that in the acidemia group.The active uterine cervix expansion rate was faster than that in the acidemia group,which was statistically significant.Logistic regression results showed that for every 1 hour increase in the first stage of labor,the risk of acidemia increased by9.3%.2.Obstetric risk factors for neonatal acidemia:(1)Logistic regression results showed that PROM was an independent risk factor for neonatal acidemia.The incidence of PROM in normal blood group and acidemia group was 24.00% and30.50%,the difference was statistically significant;(2)CTG classification: 277 cases of type I CTG,382 cases of type II CTG,and 0 cases of type III CTG under the China classification criteria.Under the FIGO classification standard,there were 253 normal CTG cases,346 suspected CTG cases,and 60 cases of pathological CTG.More than80% of neonates with normal blood gas in normal CTG group.And more than 85% of neonates in pathological CTG group had acidemia.For suspected CTG,the incidence of normal and acidemia was similar.Compared with China's classification criteria,FIGO standard is more appropriate with the umbilical arterial blood gas;(3)Univariate analysis of amniotic fluid staining indicates a decrease in neonatal umbilical arterial blood gas pH.Amniotic fluid II°and above was significantly lower than that of the amniotic fluid clearing group(7.23 vs 7.25).3.CTG and neonatal acidemia:(1)CTG baseline and variation: baseline abnormality,repeated variable deceleration,repeated late deceleration and prolonged deceleration are indicators of predicting acidemia,and the predicted value of prolonged deceleration is more obvious(adjustment standardized residuals is 6.3);(2)CTG classification: Our classification standards have led to an increase in type II CTG and a decrease in type III CTG.Compared with China's classification standards,the 2015 FIGO consensus is closer to clinical practice,the incidence of normal CTG,suspected CTG and pathological CTG in the labor process were 39.39%,52.50% and8.11%.More than 80% of neonates in normal CTG group had normal blood gas,and more than 85% of neonates in pathological CTG group had acidemia.For suspected CTG,the incidence of neonatal neonates with acidemia was similar;(3)Oxygen compensatory mechanism: For suspicious CTG,the most common type of compensatory mechanism is progressive hypoxia.If CTG shows progressive hypoxia but the baseline is normal,62.8% of neonates have normal pH(adjusted standardized residual is 3.8).In the presence of progressive hypoxia and elevated baseline,69.0% of neonates have acidosis(adjusted standardized residuals is 3.1).4.Neonatal follow-up: In this study,390 neonates with acidemia,including 360 patients were followed up,30 patients were lost to follow-up,and the follow-up rate was 92.31%.The follow-up content was the growth and development of 3 months after birth.The follow-up results showed that there were no serious adverse outcomes.5.Comprehensive analysis of obstetric factors and CTG : The risk of acidemia in PROM was 1.545 times than that of no PROM.The risk of acidosis in epidural analgesia combined with oxytocin was 1.464 times than that of neither epidural analgesia nor oxytocin;Suspicious CTG occurred acidemia is 3.239 times that of normal CTG;the risk of acidosis in pathological CTG is 25.449 times than that of normal CTG.The logistic model sensitivity is 51.60% and specificity is 85.40%.Conclusions1.The fetus in the uterus from hypoxia to organ damage or even death is a gradual progress,continuous CTG can dynamically monitor the process of intrauterine hypoxia.2.CTG determines the occurrence of acidemia during labor in combination with maternal risk factors and interventions.When pregnant women have PROM,epidural analgesia and oxytocin,continuous monitoring should be given regardless of whether the labor progress is normal.3.It is recommended to use the FIGO classification interpretation to improve the accuracy of the judgment of acidemia.4.At present,China has pH<7.2 as the standard for diagnosis of neonatal acidemia.From our data,we can properly lower the diagnostic threshold to the international standard of 7.0,but in order to support the 7.0 standard better,we'll still need multi-center,large sample research.