분만중 태아심전수도 및 pH와 자궁수축곡선과의 상호관계에 관한 연구
A Study on the Fetal Heart Rate Patterns, pH and Uterine Contractions during Labor

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서울대학교 의과대학
Seoul J Med 1977;18(2):87-94
Accurate assessment of fetal condition during labor
constitutes one of the major problems of modern obstetrics.
For practical purposes, two methods are offered
as promising approaches to this problem. viz .• continuous
monitoring of the fetal heart rate and microblood
sampling from the fetal scalp.
This study was performed in an attempt to evaluate
the correlation between fetal heart rate-uterine contraction
(FHR-UC) patterns and fetal scalp blood pH
(FSB-pH) in the terminal part of labor with neonatal
outcome among 15 cases of normal term and 24 cases
of high risk pregnancy admitted to Seoul National
University Hospital from June 1 to December 31, 1976.
The FHR was monitored with external cardiotocography
and the FHR-UC record was analyzed for baseline
FHR and periodic changes that were classified qualitatively
according to Hon. Fetal scalp blood sampling
was performed by the technique of Saling and the
acid-base determinations were carried out on an IL-113
pH-blood gas system. The significance of FHR-UC
monitoring as a means of predicting the condition of
the fetus during labor was studied by correlating
FSB-pH determinations with the analysis of the 20minute
FHR-UC record preceding the fetal scalp blood
The obtained results are as follow:
1. There were 14 instances in the absence of any
periodic change. The mean pH of this group was
7.318. Of the pH deteriminations, 12 (85.7%) were
greater than 7.250 and only two values was s7.250
2. The mean pH of 6 determinations associated
with periodic accelerations was 7.325 with all(100%)
>7.250. The mean pH of 10 determinations associated
with early decelerations was 7. 312 with 9 (90%)
3. The mean pH of the group of 5 variable decelerations
was 7. 289, which was much Icwer than the group
without periodic changes. Of the 5, 3 (60%) were
associated with a pH >7.250, and 2 (40%) with a
pH ~7. 250.
4. The mean pH of the group of 4 late decelerations
was 7.254, which was significantly lower than the
group without periodic change. Only one (25%) of
the pH values was >7.250, and three (75%) s7.250
5. There is a less than 15% chance of fetal pH
~7. 250 with a normal baseline FHR and no periodic
changes or with the so-called "innocuous" changes of
periodic accelerations, early decelerations, and uncomplicated
baseline bradycardia or tachycardia.
6. The analysis of the so-called "ominous" patterns
indicated that 40% of all variable decelerations and
75% of all late deceleration patterns were associated
with a pH ~7. 250.
7. In correlating FHR-UC patterns with Apgar
scores at 1 minute, it was found that the mean Apgar
score, associated with ominous patterns, was much
lower than that seen with no significant FHR-UC
changes. However, in the presence of late decelerations
50% of neonates had an Apgar score of greater than
6 at 1 minnte, and with variable decelerations, 60%
of neonates had an Apgar score at one minute of more
than 6.
8. However, where the FSB-pH was ~7. 2, neonatal
depression (Apgar score ~6) occurred in all (100%)
of two cases. FSB-PH, therefore, provided a more
reliable means of diagnosing fetal distress.
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College of Medicine/School of Medicine (의과대학/대학원)Dept. of Medicine (의학과)The Seoul Journal of MedicineThe Seoul Journal of Medicine Vol. 18 No.2 (1977)
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