足月新生儿酸血症相关的子宫收缩活动阈值：随机对照试验队列的二次分析
Uterine contractile activity thresholds associated with neonatal acidemia at term: A secondary analysis of a randomized controlled trial cohort.
摘要(中文译文)
本研究旨在确定与脐动脉(UmA)pH相关的正常及过度子宫活动(UA)的临床相关阈值。本盲法二次分析纳入了一项随机对照试验(NCT02941393, ClinicalTrials.gov)队列中的625例足月单胎妊娠,均接受宫内压(IUP)监测、头位分娩并于出生时采集脐带血。测量指标包括以Montevideo单位(MVUs)表示的IUP、每10分钟宫缩频率及子宫基线张力。采用线性回归和逻辑回归及Student t检验评估UA与UmA pH(≤7.15)或碱剩余(线性)之间的关联。以IUP截断值>250 MVUs时,pH≤7.15的新生儿比例从16.8%升至25.6%(OR 1.68,95% CI 1.10-2.59;P = 0.017)。在缩宫素刺激分娩者中(n = 579),IUP截断值>200 MVUs与pH≤7.15比例从14.7%升至21.4%相关(OR 1.58,95% CI 1.02-2.44;P = 0.038)。基线张力升高显示类似关联,阈值>20 mmHg时pH≤7.15的发生率从16.6%升至23.6%(OR 1.59,95% CI 1.06-2.39;P = 0.025)。宫缩频率>5/10 min时观察到UmA pH分布显著下移(7.23 [0.09] vs. 7.22 [0.09];P = 0.042),而在缩宫素刺激分娩者中,该下移已在>4/10 min时出现(7.24 [0.08] vs. 7.23 [0.09];P = 0.016)。与新生儿酸血症相关的建议阈值为IUP≤250 MVUs、宫缩频率≤5/10 min及基线张力≤20 mmHg。对于缩宫素刺激分娩,较低的阈值(IUP≤200 MVUs及宫缩频率≤4/10 min)似乎更安全。
Abstract
This study identifies clinically relevant thresholds for normal and excessive uterine activity (UA) in relation to umbilical artery (UmA) pH. This blinded secondary analysis included 625 term singleton pregnancies from a randomized controlled trial (NCT02941393, ClinicalTrials.gov) cohort with intrauterine pressure (IUP) monitoring, cephalic presentation, and umbilical cord blood sampling at birth. Measures included IUP expressed as Montevideo units (MVUs), contraction frequency per 10 min, and uterine baseline tone. Associations between UA and UmA pH (≤7.15) or base excess (linear) were assessed using linear and logistic regression and Student's t-test. With an IUP cutoff >250 MVUs, the proportion of neonates with pH ≤7.15 increased from 16.8% to 25.6% (OR 1.68, 95% CI 1.10-2.59; P = 0.017). Among oxytocin-stimulated labors (n = 579), an IUP cutoff >200 MVUs was associated with an increase in pH ≤7.15 from 14.7% to 21.4% (OR 1.58, 95% CI 1.02-2.44; P = 0.038). Elevated baseline tone showed a similar association, with the incidence of pH ≤7.15 increasing from 16.6% to 23.6% at a threshold >20 mmHg (OR 1.59, 95% CI 1.06-2.39; P = 0.025). A significant downward shift in UmA pH distribution was observed at a contraction frequency >5/10 min (7.23 [0.09] vs. 7.22 [0.09]; P = 0.042), and among oxytocin-stimulated labors, this shift occurred already at >4/10 min (7.24 [0.08] vs. 7.23 [0.09]; P = 0.016). Suggested thresholds associated with neonatal acidemia are IUP ≤250 MVUs, contraction frequency ≤5/10 min, and baseline tone ≤20 mmHg. For oxytocin-stimulated labors, lower thresholds (IUP ≤200 MVUs and contraction frequency ≤4/10 min) appear safer.
如何引用
AMA
Milla Juhantalo, Tuija Hautakangas, Outi Palomäki, Jukka Uotila. Uterine contractile activity thresholds associated with neonatal acidemia at term: A secondary analysis of a randomized controlled trial cohort.. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2026; doi:10.1002/ijgo.71151.
APA
Milla Juhantalo, Tuija Hautakangas, Outi Palomäki, Jukka Uotila (2026). Uterine contractile activity thresholds associated with neonatal acidemia at term: A secondary analysis of a randomized controlled trial cohort.. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. https://doi.org/10.1002/ijgo.71151
GB/T 7714
Milla Juhantalo, Tuija Hautakangas, Outi Palomäki, Jukka Uotila. Uterine contractile activity thresholds associated with neonatal acidemia at term: A secondary analysis of a randomized controlled trial cohort.[J]. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2026 doi:10.1002/ijgo.71151.
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