Influences of delivery termination time on neonatal outcomes in patients with type Ⅱ graphical repetitive variation deceleration of electronic fetal monitoring

doi:10.3877/cma.j.issn.1673-5250.2021.01.013

Objective

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).

Methods

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.

Results

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).

Conclusions

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.

Key words: Heart rate, fetal, Custodial care, Labor stage, second, Parturition, Asphyxia neonatorum, Puerperae

表1 本研究纳入829例EFM Ⅱ类图形反复性VD产妇的一般临床资料[例数(%)]

项目		构成比或发生率
孕次(次)
	1	340(41.0)
	2	383(46.2)
	3	73(8.8)
	≥4	33(4.0)
反复性VD发生时间
	潜伏期	83(10.0)
	活跃期	290(35.0)
	第二产程	456(55.0)
羊水粪染		125(15.1)
脐带异常
	脐带过短	2(0.2)
	脐带绕颈、绕身	576(69.5)
反复性VD严重程度
	轻度	392(47.3)
	中度	246(29.7)
	重度	191(23.0)
产妇类型
	初产妇	466(56.2)
	经产妇	363(43.8)

表1 本研究纳入829例EFM Ⅱ类图形反复性VD产妇的一般临床资料[例数(%)]

项目		构成比或发生率
孕次(次)
	1	340(41.0)
	2	383(46.2)
	3	73(8.8)
	≥4	33(4.0)
反复性VD发生时间
	潜伏期	83(10.0)
	活跃期	290(35.0)
	第二产程	456(55.0)
羊水粪染		125(15.1)
脐带异常
	脐带过短	2(0.2)
	脐带绕颈、绕身	576(69.5)
反复性VD严重程度
	轻度	392(47.3)
	中度	246(29.7)
	重度	191(23.0)
产妇类型
	初产妇	466(56.2)
	经产妇	363(43.8)

表2 3组不同分娩终止时限的EFM Ⅱ类图形出现反复性VD产妇分娩新生儿不良结局比较[例数(%)]

组别	例数	新生儿窒息	新生儿酸血症	新生儿窒息+新生儿酸血症	合计
A组	380	3(0.8)	5(1.3)	2(0.5)	10(2.6)
B组	251	10(4.0)	5(2.0)	7(2.8)	22(8.8)
C组	198	10(5.1)	8(4.0)	22(11.1)	40(20.2)
χ²值		—	—	—	50.675
P值		—	—	—	<0.001

表2 3组不同分娩终止时限的EFM Ⅱ类图形出现反复性VD产妇分娩新生儿不良结局比较[例数(%)]

组别	例数	新生儿窒息	新生儿酸血症	新生儿窒息+新生儿酸血症	合计
A组	380	3(0.8)	5(1.3)	2(0.5)	10(2.6)
B组	251	10(4.0)	5(2.0)	7(2.8)	22(8.8)
C组	198	10(5.1)	8(4.0)	22(11.1)	40(20.2)
χ²值		—	—	—	50.675
P值		—	—	—	<0.001

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