Pregledni rad
CARDIOTOCOGRAPHY AND pH-MEASUREMENTS IN PROGNOSIS OF PERINATAL OUTCOME
Oleg Petrović
; Klinika za ginekologiju i porodništvo Kliničkog bolničkog centra Rijeka, Cambierieva 17, 51 000 Rijeka, Hrvatska
Nebojša Sindik
; Klinika za ginekologiju i porodništvo Kliničkog bolničkog centra Rijeka, Cambierieva 17, 51 000 Rijeka, Hrvatska
Marinko Marić
; Klinika za ginekologiju i porodništvo Kliničkog bolničkog centra Rijeka, Cambierieva 17, 51 000 Rijeka, Hrvatska
Vesna Mahulja-Stamenković
; Klinika za ginekologiju i porodništvo Kliničkog bolničkog centra Rijeka, Cambierieva 17, 51 000 Rijeka, Hrvatska
Sažetak
Objective. The aim of this study was to examine the effectiveness of cardiotocography and pH-measurements as intrapartal methods of fetal monitoring in predicting the perinatal outcome and later psychomotor development in children, as well as to establish the number and frequency of surgical interventions at the end of deliveries. Study Design and Methods. Retrospectively we present our long-standing practical experience with the use of cardiotocography and pH-measurements as fetal monitoring methods during the birthing process. The lot of study included 14301 deliveries during a five years period, between January 1, 2003 and December 31, 2007 in The Department of Gynecology and Obstetrics of the Clinical Hospital Centre in Rijeka. A special part within this study was dedicated to analysis of 880 deliveries with determined acid-base fetal status, that was initiated by CTG records, to the appearance rates of meconium stained amniotic fluid and to the mode of delivery, in relation to the pH-measurement results. The analysis also included data on perinatal outcome and late results in children ( 1 year of age), data based on the newborns, Apgar score at 5 minutes after birth, on admission to and length of stay in the intensive neonatal care unit, and monitoring results regarding psychomotor development in especially endangered children. Results: In the delivery group in which the pH-measurement was performed, the fetal acidosis (pH < 7.20) was detected in 164 (18.6%) cases, and the fetal preacidosis (pH 7.20 – 7.24) in 160 cases, whereas in 556 cases the pH-measurement results were within normal limits. In cases with normal pH-measurements surgically assisted were 32.7% of deliveries, in cases of fetal preacidosis surgically assisted were 56.9% of deliveries, and in cases of fetal acidosis the percentage of surgically assisted deliveries was 76.2%. In the delivery group with the fetal acidosis the most frequent alterations in CTG records were type DIP II decelerations (55.5%), and variable decelerations (28.7%), whereas in the group with the fetal preacidosis the variable decelerations appeared more often (37.5%) and decelerations type DIP II less often (26.9%). The average base deficit (BE) in the group with the fetal preacidosis was –5, and in the group with fetal acidosis –8. In the group with severe fetal acidosis (pH < 7.00) the average BE was –16, and 60% of newborns had an Apgar score at 5 minutes 7. In six of ten children between 1 and 5 years of age was established a regular psychomotor development, while there were no relevant evaluation data for the rest four children. From the total number of the newborns with a detected fetal acidosis at birth, 155 (94.5%) had an Apgar score at 5 minutes 7. Four (2.5%) newborns with the preacidosis, which was detected using the pH-measurements during the delivery procedure, had an Apgar score at 5 minutes of 7. Cardiotocography (CTG) is widely used and the most frequent method in modern obstetrics, »the golden standard« in monitoring of the fetus during pregnancy and birth, that provides information on fetal oxygenation or the respiratory function of the placenta. It is a known that during the interpretation of the CTG records more then 25% of false positive and up to 40% of non-reactive results can appear, which can generally lead to higher percentage of unnecessary surgical interventions at the end of the delivery procedure. Therefore the CTG records during the delivery procedure must be verified, according to the clinical judgement, using the pH-measurement or evaluating the acid-base status of fetal blood sample. This, in addition to data about actual fetal condition, can further provide information about compensatory reserves of fetoplacental unit, which can be of a great help when choosing the best possible model of obstetrical procedure and deciding about the speed and the mode of ending the delivery. The assessment of perinatal outcome does not highly correlate with single method, but could be more accurate when both complementary methods are used in specific clinical situations. Conclusion. The combination of both methods during the intrapartal fetal monitoring directly influences the reduction in perinatal morbidity and mortality and decreases the rate of unnecessary surgical interventions in obstetrics. The study results suggest that in addition to the intrapartal cardiotocographic surveillance of fetal status, the pH-measurement should be used as the complementary method in all secondary and tertiary care obstetric units.
Ključne riječi
caesarean section; cardiotocography; fetal acid-base status; perinatal outcome; pH-measurements
Hrčak ID:
68420
URI
Datum izdavanja:
1.6.2010.
Posjeta: 5.549 *