心动图与 APGAR 综合评分的相关性以及脐带参数在预测 APGAR 综合评分低值方面的诊断性能 - 一项前瞻性队列研究

IF 1.5 Q3 OBSTETRICS & GYNECOLOGY
Soumyashree Paikaray , Saubhagya Kumar Jena , Deepthy Balakrishnan , Pankaj Kumar Mohanty
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引用次数: 0

摘要

目的综合阿普加评分包括持续气道正压、氧气、面罩和呼吸袋通气、插管和通气、新生儿胸外按压、药物和新生儿评估等干预措施的使用情况。传统阿普加评分是评估新生儿出生后情况的黄金标准,但受到医疗干预和早产的影响。为了满足对更准确的新生儿评估工具的需求,并将其用于医疗法律目的,研究人员对阿普加综合评分进行了检查,以检查其与 CTG 追踪和脐带血参数的相关性,从而对胎儿缺氧情况进行客观评估。该研究的目标是:(1) 确定综合 Apgar 评分与可疑和病理 CTG 的相关性;(2) 脐带参数与低综合 Apgar 评分的相关性,以及这些参数在预测低综合 Apgar 评分方面的诊断性能。2350 名连续妊娠满 34 周的产妇按照机构规程接受了心脏排畸检查,其中有可疑和病理 CTG 的产妇在 CTG 异常后 1 小时内分娩。结果 在 2350 名产妇中,分别有 50.7% 和 49.3% 的产妇表现出可疑和异常 CTG 曲线。据报道,CTG 的诊断准确性和特异性较低,在检测 1 分钟和 5 分钟的综合 Apgar 分数方面的灵敏度分别为 66.7% 和 88.9%。5 分钟综合 Apgar 评分与酸中毒密切相关。低综合 Apgar 分值与 1 分钟和 5 分钟的乳酸和碱过量之间存在统计学意义上的显著相关性。结论发现脐带血参数与低综合 Apgar 评分相关。综合 Apgar 评分可能是新生儿评估和新生儿长期发病率的更有用的工具。要确定它是否能在临床实践中取代传统 Apgar 评分的作用,还需要进一步的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Correlation of cardiotocography with combined APGAR scores and diagnostic performance of umbilical cord parameters in predicting low combined APGAR scores – A prospective Cohort study

Objectives

Combined Apgar score includes utilization of interventions such as Continuous positive airway pressure, Oxygen, Mask and Bag ventilation, I ntubation and ventilation, Ne onatal chest compression, Drugs, and newborn assessment. It has been proposed as a substitute for conventional Apgar score which is the gold standard for evaluating newborns right after birth but is impacted by medical interventions and preterm. Combined Apgar scores were examined to check for correlation with CTG tracing and umbilical cord blood parameters which gives an objective assessment of fetal hypoxia, in response to the demand for a more accurate tool for evaluating the neonate and to be used for medico-legal purposes. The study's objectives were to (1) determine the association of combined Apgar scores with suspicious and pathological CTG (2) the association of umbilical cord parameters with low combined Apgar scores and the diagnostic performance of these parameters in predicting low combined Apgar scores.

Study design

A prospective observational cohort study was conducted in a tertiary care center in East India. 2350 consecutive laboring mothers who had completed 34 weeks of gestation underwent cardiotocography according to institutional protocol and those with suspicious and pathological CTG who delivered within 1 h of abnormal CTG were recruited. Arterial blood was analyzed and the newborn was evaluated immediately after delivery with a combined Apgar scoring system

Results

Of the 2350 women, 50.7 % and 49.3 %, respectively, exhibited suspicious and abnormal CTG tracings. CTG was reported to have low diagnostic accuracy and specificity, with a sensitivity of 66.7 % and 88.9 %, respectively, in detecting combined Apgar at 1 and 5 min. The combined Apgar score at five minutes showed a strong association with acidosis. There was a statistically significant correlation between low combined Apgar and excess lactate and base at one and five minutes. With 100 % sensitivity and 95 % specificity, high lactate levels > 4.1 mM/L were found to predict newborn encephalopathy.

Conclusion

Umbilical cord blood parameters were found to be correlated with low combined Apgar scores. Combined Apgar scores may be a more useful tool for neonatal assessment and long-term morbidity of newborns. Additional research is required to determine whether it can take the role of conventional Apgar scores in clinical practice.

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