EARLY PERINATAL OUTCOME IN THE DIAGNOSIS OF CARDIOTOCOGRAPHIC INTRAPARTUM FETAL DISTRESS IN LOW RISK PREGNANCY

Yıl 2013, Cilt: 10 Sayı: 40, 1647 - 1650, 01.10.2013

Metin Kaba Elif Gül Yapar Eyi Yaprak Engin Üstün Leyla Mollamahmutoğlu

Öz

Aim: To evaluate outcome of fetuses who were delivered with emergency cesarean section for results fetal distress based on external fetal cardiotocography. Materials and Method: A chort study was designed to evaluate early perinatal outcome of fetuses who were delivered with emergency cesarean seation for fetal dirtress on cardiotocography. The study was performed between January 1, 2010 to December 31, in 2010 at Zekai Tahir Burak Womens’ Health Education and Research Hospital. Inclusion criteria’s were: singleton fetuses in primigravids, no high risk factor, gestational age greater than 37 weeks, vertex presentation and fetal distress necessitating cesarean in labor. Fetal distress criteria were: recurrent or prolonged deceleration of fetal heart rate under 70 beats/ minute lasting 60 seconds or more & continuing at least 30 minutes. Philips fetal cardioticography Series 50A was used for fetal cardiotographic monitoring. Fetal blood sample was analyzed with automatic blood gas analyzer. S1-S2 Fluid Pack Cobass b 221 Roche Omni s. Roche Diagnostics GmbH in Austria . Fetal metabolic acidosis was defined as a pH < 7.0 and base excess of ≤ -12; 3. Results: 114 fetuses developed fetal distress during monitorization. Mean maternal age was 26.3±5.3, mean maternal body mass index was 28± 5 kg/M2, mean gestational age was 39 ± 1 weeks. median gravidity was 1. There were 45 39.4% patients with meconium stained amnion and 19 16.6% patents with. Premature rupture of membranes 51 44.7% women underwent labor induction. Mean fetal birth weight was 3286 ± 371 g. Mean pH was 7.22 ± 0.14, mean PO2 was 31.45 ± 15.64 mmHg, mean PCO2 was 56.84 ± 19.20 mmHg, mean base deficit was -6.05 ± 7.90. Upon the definition of fetal metabolic acidosis, pH < 7.0 and BE ≤ -12; 3 2.3% fetuses were acidemic. 13 11.4% fetuses were admitted to newborn intensive care unit, 8 7% fetuses were intubated, 10 8.7% fetuses underwent continuous positive airway pressure ventilation CPEP , and 38 33.3% fetuses were in need of oxygen support. One fetal death occurred because of meconium aspiration and bilateral pneumothorax.Conclusion: Cardiotocography is a nonspecific tool to identify fetal acidosis due to its low specificity and high false predictive value to detect fetal metabolic acidosis at term primigravid pregnancies without risk factors.

Anahtar Kelimeler

Fetal distress, cardiotocography, hypoxia, fetal acidosis, newborn intensive care unit

DÜŞÜK RİSKLİ GEBELİKLERDE KARDİYOTOKOGRAFİK İNTRAPARTUM FETAL DİSTRESS TANISINDA ERKEN PERİNATAL SONUÇLAR

Öz

Amaç: Düşük riskli term gebelerde intrapartum eksternal kardiyotokografide fetal distress tanısıyla acil sezaryenle doğurtulan fetusların doğum sonrası sonuçlarını değerlendirmektir. Gereçler ve Yöntem: Kohort çalışma 1 Ocak-31 Aralık 2010 tarihleri arasında Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesinde gerçekleştirildi. Çalışmaya alma kriterleri: bilinen riskli gebeliğin olmaması, gebelik haftasının 37 hafta ve üzerinde olması, tekil primigravit gebelikler, baş prezentasyonu; doğum eylemi takibi sırasında fetal distress tanısı ile acil sezaryenle doğum yaptırılması olarak belirlendi. Ortalama maternal yaş 26,3±5,3 yıl, ortalama maternal beden kitle indeksi 28± 5 kg/M2, ortanca gebelik sayısı bir 1 , gebelik haftası 39 ± 1 hafta idi. Fetal monitorizasyon Philips fetal kardiyotokografik series 50A cihazı ile kan gazı analizi otomatik kan gazı analizer S1-S2 Fluid Pack Cobass b 221 Roche Omnis. Roche Diagnostics GmbH, Avusturya cihazı ile yapıldı. Fetal distress kriteri olarak 30 dakika içinde tekrarlayan ve dakikada 70 atımın altına düşüp 60 saniyeden uzun süren deselerasyonlar alındı. Fetal metabolik asidoz tanımı pH

Anahtar Kelimeler

Fetal distress, kardiyotokografi, hipoksi, fetal asidoz, yenidoğan yoğun bakım ünitesi

Kaynakça

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