探讨电子胎心监护(EFM)Ⅱ类图形反复性变异减速(VD)产妇的分娩终止时限对新生儿结局的影响。

选择2015年1月1日至2018年12月31日在北京市通州区妇幼保健院住院分娩，并且胎儿心率出现EFM Ⅱ类图形反复性VD的829例产妇为研究对象。其中，胎儿心率发生轻、中、重度反复性VD的产妇分别为392、246及191例。按照分娩终止时限不同，将其分为3组，A组(n＝380，分娩终止时限≤30 min)，B组(n＝251，分娩终止时限为30～60 min)和C组(n＝198，分娩终止时限≥60 min)。392例轻度反复性VD产妇中，分娩终止时限≤30 min、30～60 min和≥60 min者分别为98、163、131例；246例中度VD产妇中，分娩终止时限≤30 min、30～60 min和≥60 min者分别为152、62和32例；191例重度VD产妇中，分娩终止时限≤30 min、30～60 min和≥60 min者分别为96、62和33例。采用χ²检验，对3组不同分娩终止时限产妇的新生儿不良结局进行统计学分析，进一步对轻、中、重度反复性VD产妇不同分娩终止时限所致新生儿不良结局发生率分别进行统计学比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

①829例EFM Ⅱ类图形反复性VD产妇的年龄为(29.3±3.7)岁，人体质量指数(BMI)为(22.6±3.5) kg/m²；存在脐带异常为578例(69.7%)。②A、B、C组新生儿不良结局发生率分别为2.6%(10/380)、8.8%(22/251)和20.2%(40/198)，3者比较，差异有统计学意义(χ²＝50.675，P<0.001)。③392例轻度反复性VD产妇中，分娩终止时限≤30 min、30～60 min和≥60 min者分娩新生儿不良结局发生率分别为1.0%(1/98)、0.6%(1/162)和1.5%(2/129)，3者比较，差异无统计学意义(χ²＝0.600，P＝0.741)。④246例中度反复性VD产妇中，分娩终止时限≤30 min、30～60 min和≥60 min者分娩新生儿不良结局发生率分别为2.0%(3/152)、9.7%(6/56)和50.0%(16/32), 3者比较，差异有统计学意义(χ²＝66.805，P<0.001)。⑤191例重度反复性VD产妇中，分娩终止时限≤30 min、30～60 min和≥60 min者分娩新生儿不良结局发生率分别为6.2%(6/96)、24.2%(15/62)和66.7%(22/33)，3者比较，差异有统计学意义(χ²＝51.535，P<0.001)。

EFM Ⅱ类图形中反复性VD产妇，随着分娩终止时限延长，可增加新生儿不良结局发生率。EFM Ⅱ类图形为中至重度反复性VD产妇，应分别在60 min和30 min内及时娩出新生儿。

To investigate the influences of delivery termination time on neonatal outcomes in patients with type Ⅱ graphical repetitive variation deceleration of electronic fetal monitoring (EFU).

A total of 829 pregnant women who were hospitalized in Tongzhou Maternal and Child Health Hospital of Beijing from January 1, 2015 to December 31, 2018 and had repetitive VD of EFM type Ⅱ were selected into this study. According to different delivery termination time, 829 patients were divided into 3 groups, group A (n=380, delivery termination time ≤ 30 min), group B (n=251, delivery termination time was 30-60 min ) and group C (n=198, delivery termination time ≥ 60 min ). In 392 cases of mild VD patients, 98, 163, and 131 patients had delivery termination time ≤30 min, 30-60 min, and ≥60 min, respectively. Among 246 moderate VD patients, 152, 62 and 32 cases had delivery termination time ≤30 min, 30-60 min and ≥60 min, respectively. In 191 severe VD patients, 96, 62 and 33 cases had delivery termination time ≤30 min, 30-60 min and ≥60 min, respectively. Chi-square test was used to statistically compare the incidence of adverse neonatal outcomes caused by different delivery termination time among 3 groups. This study met requirements of World Medical Association Declaration of Helsinki revised in 2013.

① Among 829 pregnant women with EFM type Ⅱ repetitive VD, the age was (29.3±3.7) years old, body mass index (BMI) was (22.6±3.5) kg/m², and 578 cases (69.7%) had umbilical cord abnormalities. ②The incidence of adverse outcomes in group A, B and C was 2.6% (10/380), 8.8% (22/251) and 20.2% (40/198), respectively, and the difference was statistically significant (χ²=50.675, P<0.001). ③Among 392 patients with mild repetitive VD, the incidence of adverse neonatal outcomes were 1.0% (1/98), 0.6% (1/162) and 1.5% (2/129) for the delivery termination time ≤30 min, 30-60 min and ≥60 min, respectively. There was no significant difference among them (χ²=0.600, P=0.741). ④ In 246 patients with moderate repetitive VD, the incidence of adverse neonatal outcomes in patients with termination time ≤30 min, 30-60 min and ≥60 min were 2.0% (3/152 ), 9.7% (6/56) and 50.0% (16/32), respectively, and the difference was statistically significant (χ²=66.805, P<0.001). ⑤ In 191 patients with severe repetitive VD, the incidence of adverse neonatal outcomes in patients with termination time ≤30 min, 30-60 min and ≥60 min were 6.2% (6/96 ), 24.2% (15/62) and 66.7% (22/33), respectively, and the difference was statistically significant (χ²=51.535, P<0.001).

Patients with repetitive VD in EFM type Ⅱ graphical repetitive VD can increase the incidence of adverse neonatal outcomes with prolonged delivery termination time. Neonates with moderate to severe repetitive VD should be delivered within 60 minutes and 30 minutes, respectively.