음향자극검사를 이용한 진통중 태아 안녕 평가의 효용성 = A Critical Appraisal of Fetal Acoustic Stimulation as an Intrapartal Test for Fetal Well-being

다국어 초록 (Multilingual Abstract)

This study was undertaken at the department of Obstetrics and Gynecology, Yonsei University College of Medicine from March through August at 1988. In order to evaluate the fetal well-being during intrapartum, 125 patients with 48 cases of high risk pregnancy, 77 cases with normal pregnancy were assessed with Acoustic stimulation test(AST) immediately followed by Admission test(AT) of intrapartal fetal monitoring and the following data were observed. 1. According to the indications, PROM was most frequent with 21 cases, post-term pregnancy 4 cases, preterm labor 3 cases as decreasing in order and the 77 cases for the control group. 2. The incidence of reactivity on each tests were 86.4% for the acoustic stimulation test, 52.8% for the admission test. 3. Perinatal morbidity was assessed with use of low Apgar score. The 1 minute low Apgar score was 25.9% for the AST reactive and the 24.2% for the AT reactive group. For the nonreactive groups its were 41.2% and 32.2% respectively. The 5 minute low Apgar score, the both reactive groups revealed 1.9% and 1.5% respectively, but in the AST nonreactive group showed three times high perinatal morbidity than AT nonreactive group as 23.5% to 8.5%(p<0.01). 4. The incidence of fetal distress during labor, in AST reactive group is 25.9% and nonreactive group is 76.5% and the difference is statistically significant(p<0.01). For the AT reactive group 21.2% and for the nonreactive group 45.8% were observed and the difference is statistically significant(p<0.01). 5. Diagnostic accuracy of AST and AT in the prediction of intrapartal fetal distress were, sensitivity for the AST and AT were 31.7% and 65.8% respectively. The specificity for the AST and AT were 95.2% and 61.9% respectively. The positive predictive value for the AST and AT were 76.5 and 45.8% respectively. The negative predictive value for the AST and AT were 74.1% and 78.8% respectively. 6. Cesarean section rate, fetal distress and the perinatal morbidity were compared to the different result of AT in relation to reacive and nonreactive AST. Both reactive in AT and AST group and the AT nonreactive and AST reactive group showed low incidence of cesarean section rate compared to the both AT and AST nonreactive group as 3.0%, 2.4% and 11.8% respectively and the difference was not significant. The incidence of the fetal distress was high in the both AT and AST nonreactive group comared to the AT reactive group as 52.9%, 31.0% and 15.1% respectively(p<0.05). 5 minute low Apgar score was highly noted in both AT and AST nonreactive group compared to the AT nonreactive and AST reactive group and the both AT and AST reactive group as 23.5%, 2.4% and 1.5% respectively(p<0.01).