Optimal choice of fetal hypoxia diagnosis during childbirth

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OBJECTIVE

To find an optimal method for diagnosing fetal hypoxia during childbirth in order to select the correct tactics for their management.

MATERIAL AND METHODS

The 320 pregnant women and their newborns with signs of compensated and sub-compensated chronic fetal hypoxia starting from 36 weeks of pregnancy and during childbirth were retrospectively examined. The average age of the patients was 28±1.5 years. The 1^st group included 160 pregnant women. In order to determine the indications for cesarean section they were monitored for the biophysical profile of the fetus, the presence of an umbilical cord entanglement and indicators of dynamic registration of fetal Cardiotocography were taken into account. Group 2 included 160 pregnant women. In order to improve fetal monitoring, they underwent the cardiotocography in combination with direct fetal electrocardiography — an invasive method for assessing the ST segment on the fetal electrocardiogram and determining the T/QRS ratio using a spiral electrode installed on the head of the fetus during childbirth. To confirm the degree of fetal hypoxia, the acid-base state and the lactate content in the umbilical blood of newborns were determined. Before the childbirth onset of and in the first stage of delivery, ultrasound examination, Doppler study of blood flow in the vessels of the umbilical cord and middle cerebral artery of the fetus, as well as in the uterine arteries were used.

RESULTS

It was found that in the 2^nd group the number of spontaneous births was higher than in the 1^st group (81.2 and 64.4%, respectively). When using complex diagnostics of the fetus state (cardiotocography and direct electrocardiography), a 2-fold decrease in the number of cesarean sections was noted (13.7 and 28.1%, respectively). With the combined diagnostic method, cases of confirmation of hypoxia were more often observed in newborns than in first group with the use of cardiotocography (86.6 and 63.2%, respectively). When using the combined method for diagnosing fetal hypoxia, acute fetal hypoxia was diagnosed reliably less often (p<0.05) — respectively in 21.0 and 35.2% in the 2^nd and 1^st groups. Moreover, in 20% of cases in the 2^nd group a violation of the fetal-placental complex of the I degree was recorded that made it possible to complete the birth naturally.

CONCLUSION

Comparing the method of combined use of cardiotocography and direct electrocardiography and only cardiotocography it was proved that the invasive method for evaluating the fetal electrocardiogram in combination with cardiotocography leads to a more reliable and high-quality diagnosis of intrapartum fetal hypoxia. In addition, it decreases the frequency of surgical delivery that allows reducing the risk of severe complications and material costs.

Keywords:

fetal hypoxia

diagnostic optimization

childbirth

cardiotocography

direct fetal electrocardiography

ST segment registration

cesarean section

fetal vacuum extraction

Authors:

Medvedeva I.N.

Kursk State Medical University

Davydova A.V.

Kursk State Medical University

Received:

31.12.2020

Accepted:

02.03.2021

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