진통시 태아심박형과 태아혈액 pH 및 태아예후와의 관계에 대한 연구

Abstract

최근 산과학의 급속한 발달은 태아의 상태를 감시 및 평가함으로써 신생아의 육체적, 신경학적 손상에 기인하는 불구아 및 저능아를 방지하고 건강한 우리의 2세를 분만하는데 기여하게 되었다. 지금까지 자궁내 태아의 상태를 조사하기 위해 다양한 방법이 시도되어 왔으나, 귀중한 인간의 생명을 다루는데 있어서 여러가지 제약이 있어 주산기 태아사망율은 뚜렷한 호전을 보이지 못하고 있었다. 그러나 1958년 이후 Caldeyro-Barcia와 Hon등이 시도한 태아두피혈액 pH측정으로 태아의 상태를 비교적 정확하게 예측할 수 있게 되어, 불의에 발생할 수 있는 태아곤란증을 예방하는데 이용하게 되었다. 그러나 이 두 방법은 각기 태아상태를 예측하는데 있어서 학자들의 의견이 상이하여, 그 해석에 난점이 많았으나 근래 여러저자들의 통계보고에 의하여 차츰 그 신빙성을 획득하게 되었지만 국내의 보고는 회유하므로 이에 저자는 태아혈액 pH와 태아심박형 및 신생아예후와의 상관관계에 대한 임상적 통계 고찰을 통하여 주산기 사망을 감소시키는 노력의 일환으로 이번 본 연구를 실시하였다.;An assessment of fetal condition during labor consists one of the major problems of modern obstetrics. For practical purposes, two methods are offered as promising approaches to this problem, such as continuous fetal heart rate monitoring and micro blood sampling from fetal scaip for the check of pH. This study was performed in an attempt to evaluate the correlation between fetal heart rate patterns and fetal scalp blood pH during the labor with neonatal outcome among 9 cases of control group and 41 cases of high risk pregnancy group admitted to National Medical Center, Seoul, Korea from March 1 to August 31, 1983. The results were as follows : The indications of fetal monitoring, the most frequent cases were postdate (>42 weeks), 11 cases (22 %) and the next, premature rupture of membrane in 10 cases (20 %). 2. In the incidence of fetal heart rate patterns, variable deceleration was the most frequent (42 %), especially in their subdivisions, mild pattern 24.0 %, moderate pattern 12.0 % and severe pattern 60 % were revealed. The next was no periodic change (18.0 %), and late deceleration (14.0 %), early deceleration (12.0 %), acceleration (10.0 %) and prolonged deceleration (4.0 %), respectively. 3. The mean scalp pH of all 9 cases of no periodic change was 7.341, among which 8 cases (88.9%) were pH>7.25, and the mean Apgar score was 8.8 ranging in 7-10 score. 4. The mean pH of 5 cases of accelerate patterns was 7.422 and all cases (100%) belonged to pH>7.25. Also the Apgar score was 10 in all cases. 5. The menu pH of cases of determinations associated with early deceleration was 7.359 with pH>7.25 in all cases and their mean Apgar score was 9.5. 6. The mean pH of 21 cases in variable deceleration was 7.292 and there were significant differences among the mild (pH=7.342), moderate (pH=7.271) and severe pattern (pH=7.171). In these groups, 71.4% of all cases was pH 7.25 and the other 28.6% was pH<7.25. Mean Apgar score was 7.1 with 71.4% of cases were distributed in the range of 7-10 and 28.6% was in lower than 6 score. 7. The mean pH of 7 Late deceleration was 7.222 among which 6 cases (85.7%) were included In the range of pH≤ 7.25 >7.2. The average Apgar score was 4.7 with less than 6 score in 85.7%. 8. In 2 cases of prolonged deceleration, the average pH was 7.231 with the one was PH> 7.25 and the other PH≤7.25 >7.2. The mean Aogar score was 4.0 each other. 9. In the feta1 blood pH> 7.25, mean Apgar score was 8.8 with 88.6% in the range of 7-10. In the fetal blood pH>7.21≤7.25, mean Apgar score was 5.2 with 72.7% of cases in the range of 4-6. In the fetal blood pH≤7.2, mean Apgar score was 2.3 with 100% in the range of 1-3. 10. Fetal acidosis (pH≤7.20) was appeared when the difference between the mother and fetal blood pH was over 0.20. 11. There were no correlation between the baseline fetal heart rates and the fetal blood pH. 12. The most frequent delivery method was vaginal in the innocuous fetal heart rate patterns and the higher tendency of C-section in the ominous patterns. There was neither fetal nor maternal complications in the respect of fetal scalp blood sampling in this study.