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Gebelerde anormal kardiotokogram, arterial kord kanı pH'sı, baz açığı ve düşük apgar skorları arasındaki ilişki

Year 2005, Volume: 36 Issue: 1, 1 - 5, 01.02.2005

Abstract

Objective: Our purpose was to evaluate the clinical validity of electronic heart rate monitoring in pregnancies and to predict fetal acidosis. Materials and Methods: Fifty-five women between 38 and 40 weeks''gestational age who had electronic fetal monitoring were recruited prospectively and umbilical artery cord gas analysis was performed at delivery. One investigator, blinded to the cord blood gases outcome and using the standard guidelines for fetal heart rate monitoring reviewed all tracings with decreased variability (amplitude < 5 beats). Variable or late decelerations were considered as abnormal fetal heart rate patterns. The occurrences of an umbilical arterial pH of < 7.1, 1- and 5-minute Apgar scores of < 7 and an umbilical artery base deficit of>-14 mmol/L were interpreted as fetal acidosis. Results: The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of abnormal tracings for predicting low Apgar scores were 100 %, 90.2 %, 44.4 %, and 100 °/o for 1-minute, and 100 %, 88.9 %, 14.3 %, and 100 %, for 5-minute, respectively. The sensitivity, specificity, PPV and NPV of abnormal tracings for predicting umbilical arterial pH of 7.1 were 88.8 %, 97.8 %, 88.9 %, and 97.8 %, respectively. The sensitivity, specificity, PPV and NPV of abnormal tracings for predicting base deficit were 75.0 %, 93.6 %, 66.7 %, and 95.6 %, respectively. Conclusion: Intrapartum fetal heart rate monitoring is useful to detect fetal acidemia, nevertheless, the operative delivery rate is higher among patients with abnormal fetal heart rate patterns. The obstetrician should therefore, be aware of the high false positivity rate of abnormal tracings in order to avoid unnecessary cesarean delivery.

References

  • 1.Walker DS, Shunkwiler S, SupanichJ, Williamsen J, Yensch A. Labor and delivery nurses' attitudes toward intermittent fetal monitoring. J Midwifery Womens Health 2001;46:374-380
  • 2.Odent M. Preparing for the post-electronic birthing age. Midwifery Today Int Midwife 1997;43:19-20
  • 3.Symonds EM. Fetal monitoring: medical and legal implications for the practitioner
  • Curr Opin Obstet Gynecol 1994;6:430-433
  • 4.Low JA, Victory R, Derrick EJ. Predictive value of electronic fetal monitoring for intrapartum fetal asphyxia with metabolic acidosis.1999;93:285-291
  • 5.National Institute of Child Health and Human Development Research Planning Workshop
  • Electronic fetal heart rate monitoring: research guidelines for interpretation. Am J Obstet Gynecol 1997;177:1385-1390
  • 6.ACOG: Umbilical Artery Blood Acid Base Analysis Technical Bulletin No: 216, November 1995
  • 7.Lauener PA, Calame A, Janeçek P, Bossart H, Monod JF. Systematic pH-mçasurements in the umbilical artery: causes and predictive value of neonatal acidosis. J Perinat Med 1983;11:278-285
  • 8.Handley-Derry M, Low JA, Burke S, Waurick M, Killen H, Derrick EJ. Intrapartum fetal asphyxia and the occurrence of minor deficits in 4 to 8 year old children Dev Med Child Neurol 1997;39:508-514
  • 9.Porreco RP. Meeting the challenge of the rising caesarean birth rate. Obstet Gynecol 1990;75:133-136
  • 10.Hughey MJ, LaPata RE, McElin TW Lussky R
  • The effect of fetal monitoring on the incidence of caesarean section. Obstet Gynecol 1977;49:513-518
  • 11.Hawkins JL, Gibbs CP, Orleans M, Martin-Salvage G, Beaty B. Obstetric anasthesia workforce survey, 1981 versus 1992. Anaesthesiology 1997 ;87:135-143
  • 12.Herczeg f. High-risk obstetrics, medicolegal problems. Eur J Obstet Gynecol Reprod Biol
  • 1997;87:181-185
  • 13.Haggerty LA. Continuous electronic fetal monitoring: contradictions between practice and research. J Obstet Gynecol Neonatal Nurs 1999;28:409-416
  • 14.Hanley ML, Vintzileos AM. Antepartum and intrapartum surveillance of fetal well-being. In: Reece EA, Hobbins fC, eds. Medicine of the fetus and mother. 2n ed. Philadelphia: Lippincott-Raven, 1999:793-826
  • 15.Seelbach-Gobel B, Heupel M, Kuhnert M, Butterwegge M. The prediction of fetal acidosis by means of intrapartum fetal pulse oximetry. Am J Obstet Gynecol 1999;180:73-81
  • 16.Steer PJ, Eigbe F, Lissauer TJ, Beard RW
  • Interrelationships among abnormal cardio- tocograms in labor, meconium staining of the amniotic fluid, arterial cord blood pH, and Apgar scores. Obstet Gynecol 1989;74:715-721
  • 17.Şanhalp Ç, Çağlar GS, Alkan RN, Avşar AF
  • Correlation of neonatal acid-base status and abnormal fetal heart rate patterns. Gynecol Obstet Reprod Med 2003;9:172-175
  • 18.ÇorakcıA, Hüseyinoğlu N, Gümüştaş G, Özeren S, Yücesoy G, Vural B, et al. The value of intrapartum fetal monitorization in predicting fetal acidosis. T Klin jinekol Obstet 2003;13:14-18

Interrelations among abnormal cardiotocograms in labor, arterial cord blood pH, base deficit and apgar scores in pregnancies

Year 2005, Volume: 36 Issue: 1, 1 - 5, 01.02.2005

Abstract

Amaç: Gebelerde fetal asidozu belirlemek için fetal kalp hızının klinik doğruluğunu değerlendirmek. Gereç ve yöntem: Doğum eylemindeki 38-40 gebelik haftaları arasındaki 55 gebe kardio-tokogram ile monitorize edildi ve doğumda umbilikal kordon gaz analizleri çalışıldı. Umbilikal kordon kan gazlan sonuçlarını ve neonatal bebeklerin durumlarını bilmeyen bir araştırmacı, fetal kalp atım traselerini değerlendirdi. Variabilite kaybı (amplitüd < 5 atım), variabilya da geç deselerasyon anormal kalp atım paterni olarak değerlendirildi. Umbilikal arter PH < 7.1,1. ve 5. dakika Apgar skorları < 7 ve umbilikal arter baz açığı > -14 değerleri fetal asidoz olarak değerlendirildi. Fetal kalp atım paternleri, umbilikal kan gazı, baz açığı ve Apgar skorları fetal asidozun prediksiyonu için çalışıldı. İstatistiksel değerlendirmede Ki-kare (Fisher's exact) test kullanıldı. P < 0.05 değeri istatistiksel olarak anlamlı kabul edildi. Bulgular: Anormal, fetal kalp traselerinin düşük Apgar skorun düşüklüğünü belirlemedeki sensitivite, spesifisite, pozitif ve negatif prediktif değerleri 1. dakika için sırasıyla, % 100, % 90.2, % 44.4, % 100 ve 5. dakika için % 100, % 88.9, % 14.3 ve %100 bulundu. Anormal fetal kalp hızı paterninin umbilikal aıterpH'smm < 7.1 olmasını belirlemedeki sensitivite, spesifisite, pozitif ve negatif prediktif değerleri sırasıyla % 88.8, % 97.8,'% 88.9 ve % 97.8 bulundu. Anormal fetal kalp hızı paternlerinin umbilikal arter baz açığını belirlemedeki sensitivite, spesifisite, pozitif ve negatif prediktif değerleri sırasıyla, % 75.0, % 93.6, % 66.7 ve % 95.6 bulundu. Sontiç: Fetal kalp hızı monutörizasyonu fetal asideminin saptanmasında faydalı olsa bile, anormal trase varlığında operatif doğum oranlarında artışa . neden olmaktadır. Bu nedenle, obstetrisyen anormal trase yarlığında yüksek yalancı pozitiflik nedeniyle gereksiz sezaryen doğumlardan kaçınmalıdır.

References

  • 1.Walker DS, Shunkwiler S, SupanichJ, Williamsen J, Yensch A. Labor and delivery nurses' attitudes toward intermittent fetal monitoring. J Midwifery Womens Health 2001;46:374-380
  • 2.Odent M. Preparing for the post-electronic birthing age. Midwifery Today Int Midwife 1997;43:19-20
  • 3.Symonds EM. Fetal monitoring: medical and legal implications for the practitioner
  • Curr Opin Obstet Gynecol 1994;6:430-433
  • 4.Low JA, Victory R, Derrick EJ. Predictive value of electronic fetal monitoring for intrapartum fetal asphyxia with metabolic acidosis.1999;93:285-291
  • 5.National Institute of Child Health and Human Development Research Planning Workshop
  • Electronic fetal heart rate monitoring: research guidelines for interpretation. Am J Obstet Gynecol 1997;177:1385-1390
  • 6.ACOG: Umbilical Artery Blood Acid Base Analysis Technical Bulletin No: 216, November 1995
  • 7.Lauener PA, Calame A, Janeçek P, Bossart H, Monod JF. Systematic pH-mçasurements in the umbilical artery: causes and predictive value of neonatal acidosis. J Perinat Med 1983;11:278-285
  • 8.Handley-Derry M, Low JA, Burke S, Waurick M, Killen H, Derrick EJ. Intrapartum fetal asphyxia and the occurrence of minor deficits in 4 to 8 year old children Dev Med Child Neurol 1997;39:508-514
  • 9.Porreco RP. Meeting the challenge of the rising caesarean birth rate. Obstet Gynecol 1990;75:133-136
  • 10.Hughey MJ, LaPata RE, McElin TW Lussky R
  • The effect of fetal monitoring on the incidence of caesarean section. Obstet Gynecol 1977;49:513-518
  • 11.Hawkins JL, Gibbs CP, Orleans M, Martin-Salvage G, Beaty B. Obstetric anasthesia workforce survey, 1981 versus 1992. Anaesthesiology 1997 ;87:135-143
  • 12.Herczeg f. High-risk obstetrics, medicolegal problems. Eur J Obstet Gynecol Reprod Biol
  • 1997;87:181-185
  • 13.Haggerty LA. Continuous electronic fetal monitoring: contradictions between practice and research. J Obstet Gynecol Neonatal Nurs 1999;28:409-416
  • 14.Hanley ML, Vintzileos AM. Antepartum and intrapartum surveillance of fetal well-being. In: Reece EA, Hobbins fC, eds. Medicine of the fetus and mother. 2n ed. Philadelphia: Lippincott-Raven, 1999:793-826
  • 15.Seelbach-Gobel B, Heupel M, Kuhnert M, Butterwegge M. The prediction of fetal acidosis by means of intrapartum fetal pulse oximetry. Am J Obstet Gynecol 1999;180:73-81
  • 16.Steer PJ, Eigbe F, Lissauer TJ, Beard RW
  • Interrelationships among abnormal cardio- tocograms in labor, meconium staining of the amniotic fluid, arterial cord blood pH, and Apgar scores. Obstet Gynecol 1989;74:715-721
  • 17.Şanhalp Ç, Çağlar GS, Alkan RN, Avşar AF
  • Correlation of neonatal acid-base status and abnormal fetal heart rate patterns. Gynecol Obstet Reprod Med 2003;9:172-175
  • 18.ÇorakcıA, Hüseyinoğlu N, Gümüştaş G, Özeren S, Yücesoy G, Vural B, et al. The value of intrapartum fetal monitorization in predicting fetal acidosis. T Klin jinekol Obstet 2003;13:14-18
There are 24 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

İsmail Özdemir This is me

Taner Yavuz This is me

Özlem Yavuz This is me

Furat Demirci This is me

Aslı Somunkıran This is me

Publication Date February 1, 2005
Published in Issue Year 2005 Volume: 36 Issue: 1

Cite

APA Özdemir, İ., Yavuz, T., Yavuz, Ö., Demirci, F., et al. (2005). Interrelations among abnormal cardiotocograms in labor, arterial cord blood pH, base deficit and apgar scores in pregnancies. Zeynep Kamil Tıp Bülteni, 36(1), 1-5. https://doi.org/10.16948/zktb.34732
AMA Özdemir İ, Yavuz T, Yavuz Ö, Demirci F, Somunkıran A. Interrelations among abnormal cardiotocograms in labor, arterial cord blood pH, base deficit and apgar scores in pregnancies. Zeynep Kamil Tıp Bülteni. February 2005;36(1):1-5. doi:10.16948/zktb.34732
Chicago Özdemir, İsmail, Taner Yavuz, Özlem Yavuz, Furat Demirci, and Aslı Somunkıran. “Interrelations Among Abnormal Cardiotocograms in Labor, Arterial Cord Blood PH, Base Deficit and Apgar Scores in Pregnancies”. Zeynep Kamil Tıp Bülteni 36, no. 1 (February 2005): 1-5. https://doi.org/10.16948/zktb.34732.
EndNote Özdemir İ, Yavuz T, Yavuz Ö, Demirci F, Somunkıran A (February 1, 2005) Interrelations among abnormal cardiotocograms in labor, arterial cord blood pH, base deficit and apgar scores in pregnancies. Zeynep Kamil Tıp Bülteni 36 1 1–5.
IEEE İ. Özdemir, T. Yavuz, Ö. Yavuz, F. Demirci, and A. Somunkıran, “Interrelations among abnormal cardiotocograms in labor, arterial cord blood pH, base deficit and apgar scores in pregnancies”, Zeynep Kamil Tıp Bülteni, vol. 36, no. 1, pp. 1–5, 2005, doi: 10.16948/zktb.34732.
ISNAD Özdemir, İsmail et al. “Interrelations Among Abnormal Cardiotocograms in Labor, Arterial Cord Blood PH, Base Deficit and Apgar Scores in Pregnancies”. Zeynep Kamil Tıp Bülteni 36/1 (February 2005), 1-5. https://doi.org/10.16948/zktb.34732.
JAMA Özdemir İ, Yavuz T, Yavuz Ö, Demirci F, Somunkıran A. Interrelations among abnormal cardiotocograms in labor, arterial cord blood pH, base deficit and apgar scores in pregnancies. Zeynep Kamil Tıp Bülteni. 2005;36:1–5.
MLA Özdemir, İsmail et al. “Interrelations Among Abnormal Cardiotocograms in Labor, Arterial Cord Blood PH, Base Deficit and Apgar Scores in Pregnancies”. Zeynep Kamil Tıp Bülteni, vol. 36, no. 1, 2005, pp. 1-5, doi:10.16948/zktb.34732.
Vancouver Özdemir İ, Yavuz T, Yavuz Ö, Demirci F, Somunkıran A. Interrelations among abnormal cardiotocograms in labor, arterial cord blood pH, base deficit and apgar scores in pregnancies. Zeynep Kamil Tıp Bülteni. 2005;36(1):1-5.