作为早产胎膜早破孕妇羊膜腔内感染标志物的胎心率短期变化:一项历史性队列研究。

IF 1.7 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Brynhildur Tinna Birgisdottir, Ingela Hulthén Varli, Sissel Saltvedt, Ke Lu, Farhad Abtahi, Ulrika Åden, Malin Holzmann
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引用次数: 0

摘要

导言:羊膜腔内感染(IAI)和随后的早发性新生儿败血症(EONS)是与早产胎膜早破(PPROM)相关的主要并发症之一。目前使用的诊断工具对 IAI 的诊断效果不佳。本研究旨在探讨产前胎膜早破是否与胎膜早破孕妇的胎心率短期变化有关:2012年至2019年期间,瑞典斯德哥尔摩县的五个产科对678名孕周24+0至33+6的PPROM孕妇进行了观察性队列研究。我们检查了电子病历,以获得背景和暴露数据。对于暴露的 IAI,我们使用后代后来诊断出的 EONS 作为替代。EONS与IAI密切相关,与急性绒毛膜羊膜炎的组织学诊断相比,EONS被认为是更好的IAI替代物,因为急性绒毛膜羊膜炎可以在微生物学和炎症生化指标均呈阳性的情况下观察到。通过计算机算法分析了胎儿心率的短期变化,这也是主要的结果测量指标:结果:根据出生后EONS的代理诊断,27名孕妇被归类为IAI孕妇。暴露于IAI的胎儿在出生前最后一次心动图描记中的短期变异值明显低于未暴露于IAI的胎儿(5.25 vs 6.62 ms;未调整差异:-1.37,p = 0.009)。在对吸烟和糖尿病进行调整后,这一差异仍然显著。后来新生儿血培养呈阳性的 IAI(n = 12)显示 STV 的绝对差异更大(-1.65;p = 0.034),相对下降 23.5%:结论:在患有早产儿窒息综合征的孕妇中,暴露于以EONS为代表的IAI的胎儿的胎心率短期变化低于未暴露于IAI的胎儿。短期变化可能有助于对患有先兆流产的孕妇进行辅助监测。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Short-term variation of the fetal heart rate as a marker of intraamniotic infection in pregnancies with preterm prelabor rupture of membranes: a historical cohort study.

Introduction: Intraamniotic infection (IAI) and subsequent early-onset neonatal sepsis (EONS) are among the main complications associated with preterm prelabor rupture of membranes (PPROM). Currently used diagnostic tools have been shown to have poor diagnostic performance for IAI. This study aimed to investigate whether the exposure to IAI before delivery is associated with short-term variation of the fetal heart rate in pregnancies with PPROM.

Methods: Observational cohort study of 678 pregnancies with PPROM, delivering between 24 + 0 and 33 + 6 gestational weeks from 2012 to 2019 in five labor units in Stockholm County, Sweden. Electronic medical records were examined to obtain background and exposure data. For the exposure IAI, we used the later diagnosis of EONS in the offspring as a proxy. EONS is strongly associated to IAI and was considered a better proxy for IAI than the histological diagnosis of acute chorioamnionitis, since acute chorioamnionitis can be observed in the absence of both positive microbiology and biochemical markers for inflammation. Cardiotocography traces were analyzed by a computerized algorithm for short-term variation of the fetal heart rate, which was the main outcome measure.

Results: Twenty-seven pregnancies were categorized as having an IAI, based on the proxy diagnosis of EONS after birth. Fetuses exposed to IAI had significantly lower short-term variation values in the last cardiotocography trace before birth than fetuses who were not exposed (5.25 vs 6.62 ms; unadjusted difference: -1.37, p = 0.009). After adjustment for smoking and diabetes, this difference remained significant. IAI with a later positive blood culture in the neonate (n = 12) showed an even larger absolute difference in STV (-1.65; p = 0.034), with a relative decrease of 23.5%.

Conclusion: In pregnancies with PPROM, fetuses exposed to IAI with EONS as a proxy have lower short-term variation of the fetal heart rate than fetuses who are not exposed. Short-term variation might be useful as adjunct surveillance in pregnancies with PPROM.

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来源期刊
CiteScore
4.40
自引率
0.00%
发文量
217
审稿时长
2-3 weeks
期刊介绍: The official journal of The European Association of Perinatal Medicine, The Federation of Asia and Oceania Perinatal Societies and The International Society of Perinatal Obstetricians. The journal publishes a wide range of peer-reviewed research on the obstetric, medical, genetic, mental health and surgical complications of pregnancy and their effects on the mother, fetus and neonate. Research on audit, evaluation and clinical care in maternal-fetal and perinatal medicine is also featured.
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