背景:iPREFACE评分可能有助于预测紧急剖宫产和阴道分娩中的胎儿酸血症和新生儿窒息,这可能会提高未来的劳动力管理精度。
目的:本研究旨在评估使用iPREFACE评分作为在重复异常波形的情况下需要快速分娩的客观指标,而在分娩期间没有立即医疗干预的同时指征。
方法:这项回顾性队列研究是在足月(37+0天至41+6天)单胎孕妇中进行的,这些孕妇由于胎儿状况不可靠而接受了紧急剖宫产。产后胎心率监测综合评分指标预测胎儿酸血症-急诊剖宫产评分决策,在决定进行紧急剖宫产之前,根据30分钟的心电图波形计算,和综合评分指标,通过产时胎心率监测-去除心脏造影传感器评分来预测胎儿酸血症,从心脏造影换能器移除前30分钟的心脏造影波形计算,被雇用。主要结果是评估这些评分对胎儿酸血症的预测能力,而次要结局是两组之间的脐动脉血气结果和产后结局的差异,除以综合评分指数的临界值,以通过产时胎心率监测-去除心电图评分来预测胎儿酸血症。
结果:通过产时胎心率监测-紧急剖宫产的决定来预测胎儿酸血症的综合评分指数和通过产时胎心率监测-去除心肌造影传感器评分来预测胎儿酸血症的综合评分指数证明了预测脐动脉血pH<7.2的能力。产后胎心率监测预测胎儿酸血症的综合评分指标——急诊剖宫产的决定和心脏造影传感器评分的移除,截止值为37点和46点,分别,接收器工作特性曲线下的面积分别为0.82和0.87。通过产时胎心率监测-摘除≥46分的心电图传感器组预测胎儿酸血症的综合评分指标,脐带动脉血pH<7.2,<7.1和<7.0和新生儿重症监护病房入院的发生率更高。新生儿窒息。
结论:通过产时胎心率监测预测胎儿酸血症的综合评分指标,来自紧急剖宫产期间的心脏造影,可能使临床医生能够在胎儿状况不稳定的情况下预测胎儿酸血症。改善胎儿酸血症的预测和促进及时干预有望改善分娩期间母亲和新生儿的结局。有必要进行前瞻性研究以建立精确的临界值并验证这些评分的临床应用。
BACKGROUND: The iPREFACE score may aid in predicting fetal acidemia and neonatal asphyxia in emergency cesarean and vaginal deliveries, which may improve labor management precision in the future.
OBJECTIVE: This study aimed to assess the score use of the iPREFACE as an objective indicator of the need for rapid delivery in cases of repeated abnormal waveforms without concurrent indications for immediate medical intervention during labor.
METHODS: This retrospective cohort study was conducted among term (37+ 0 days to 41+6 days) singleton pregnant women who underwent emergency cesarean delivery owing to a nonreassuring fetal status. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery score, calculated from a 30-minute
cardiotocography waveform before the decision to perform emergency cesarean delivery, and the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of
cardiotocography transducer score, calculated from a 30-minute
cardiotocography waveform before
cardiotocography transducer removal, were employed. The primary outcome was the assessment of the predictive ability of these scores for fetal acidemia, whereas the secondary outcomes were differences in umbilical artery blood gas findings and postnatal outcomes between the 2 groups, divided by the cutoff values of the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of
cardiotocography score.
RESULTS: The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery and integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of
cardiotocography transducer scores demonstrated the capability to predict an umbilical artery blood pH of <7.2. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery and -removal of
cardiotocography transducer score, with cutoff values of 37 and 46 points, respectively, exhibited an area under the receiver operating characteristic curve of 0.82 and 0.87, respectively. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of
cardiotocography transducer group with ≥46 points had higher incidence rates of an umbilical cord artery blood pH of <7.2, <7.1, and <7.0 and neonatal intensive care unit admissions for neonatal asphyxia.
CONCLUSIONS: The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring, derived from cardiotocography during an emergency cesarean delivery, may enable clinicians to predict fetal acidemia in cases of nonreassuring fetal status. Improved prediction of fetal acidemia and facilitation of timely intervention hold promise for enhancing the outcomes of mothers and newborns during childbirth. Prospective studies are warranted to establish precise cutoff values and to validate the clinical application of these scores.