胎儿宫内窘迫的危险因素分析

沈连梅; 宋明霞; 袁玲

doi:10.16766/j.cnki.issn.1674-4152.004298

胎儿宫内窘迫的危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.004298

西湖大学医学院附属杭州市第一人民医院产科，浙江杭州 310006

基金项目:

浙江省医药卫生科技计划项目 2023KY948

详细信息

通讯作者:
袁玲，E-mail：446832066@qq.com

中图分类号: R714.5 R730.7
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- 文章访问数: 12
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- 被引次数: 0
出版历程
- 收稿日期: 2025-02-19
- 网络出版日期: 2026-03-13

Analysis of risk factors of intrauterine distress in fetus

Obstetrical Department, Affiliated Hangzhou First People' s Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang 310006, China

摘要

摘要: 目的分析胎儿宫内窘迫的危险因素及这些因素对新生儿预后的影响，为临床干预提供依据。方法纳入2022年1月—2024年12月杭州市第一人民医院收治的107例胎儿宫内窘迫产妇(观察组)及107例同期正常妊娠产妇(对照组)，比较2组新生儿的出生结局，并采用logistic回归分析和ROC曲线分析影响宫内窘迫发生的危险因素。结果单因素分析显示，脐血流异常、胎心率异常、胎动异常、羊水过少、脐带异常、胎盘早剥、妊娠期高血压、妊娠期糖尿病是影响胎儿发生宫内窘迫的危险因素(P＜0.05)；多因素logistic回归分析显示，胎心率异常、羊水过少、胎盘早剥、胎动异常及妊娠期糖尿病均是胎儿发生宫内窘迫的独立危险因素(P＜0.05)；ROC曲线分析发现，胎心率异常、羊水过少、胎盘早剥、胎动异常及妊娠期糖尿病预测发生宫内窘迫的AUC均大于0.7，且灵敏度(78.9%、72.6%、70.1%、63.2%、82.4%)和特异度(75.6%、69.3%、71.8%、74.5%、68.7%)较高。观察组中出现5 min Apgar评分＜7分、新生儿窒息、低血糖、高胆红素血症及胎儿生长受限的例数均多于对照组，围产儿死亡率及NICU入住率亦高于对照组(P＜0.05)。结论胎心率异常、羊水过少、胎盘早剥、胎动异常及妊娠期糖尿病是胎儿宫内窘迫的危险因素，上述因素易导致不良出生结局，需加强产前监测和围产期护理，以改善围产儿结局。
- 胎儿 /
- 宫内窘迫 /
- 危险因素 /
- 预后
Abstract: Objective To analyze the risk factors of fetal intrauterine distress and their impact on neonatal prognosis, providing a basis for clinical intervention. Methods A total of 107 cases of intrauterine distress (observation group) and 107 normal pregnant women (control group) admitted to Hangzhou First People' s Hospital from January 2022 to December 2024 were enrolled, and the birth outcomes of neonates in the two groups were compared, and the risk factors affecting the occurrence of intrauterine distress were analyzed by logistic regression analysis and ROC working curve. Results Univariate analysis showed that abnormal umbilical cord blood flow, abnormal fetal heart rate, abnormal fetal movement, oligohydramnios, abnormal umbilical cord, placental abruption, gestational hypertension, and gestational diabetes mellitus were risk factors for fetal intrauterine distress (P < 0.05). Multivariate logistic regression analysis revealed that abnormal fetal heart rate, oligohydramnios, placental abruption, abnormal fetal movement, and gestational diabetes mellitus are independent risk factors for fetal distress (P < 0.05). ROC working curve analysis showed that the AUC of abnormal fetal heart rate, oligohydramnios, placental abruption, abnormal fetal movement and gestational diabetes mellitus was greater than 0.7, and the sensitivity (78.9%, 72.6%, 70.1%, 63.2%, 82.4%) and specificity (75.6%, 69.3%, 71.8%, 74.5%, 68.7%) were high. The 5-minute Apgar score was < 7 in the observation group, and the number of cases of neonatal asphyxia, hypoglycemia, hyperbilirubinemia, and fetal growth restriction were higher than those in the control group, and the perinatal mortality rate and Neonatal Intensive Care Unit (NICU) admission rate were also higher than those in the control group (P < 0.05). Conclusion Abnormal fetal heart rate, oligohydramnios, placental abruption, abnormal fetal movement, and gestational diabetes mellitus are risk factors for fetal intrauterine distress, and the above factors are likely to lead to adverse birth outcomes. Prenatal monitoring and perinatal care should be strengthened to improve perinatal outcomes.
- Fetal /
- Intrauterine distress /
- Risk factors /
- Prognosis

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图 1 各因素预测胎儿宫内窘迫发生的ROC曲线

Figure 1. ROC curves for predicting fetal intrauterine distress based on various factors

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表 1 2组研究对象基线资料与临床特征比较

Table 1. Comparison of baseline data and clinical characteristics between the two groups of study subjects

组别	例数	年龄(x±s，岁)	孕周 (x±s，周)	BMI (x±s)	初产妇 [例(%)]	妊娠期高血压 [例(%)]	妊娠期糖尿病 [例(%)]
观察组	107	30.5±4.2	37.8±2.1	26.5±3.4	73(68.2)	16(15.0)	18(16.8)
对照组	107	29.8±3.8	38.2±1.9	25.8±3.1	70(65.4)	9(8.4)	4(3.7)
统计量		1.192^a	1.457^a	1.354^a	0.378^b	4.067^b	8.354^b
P值		0.234	0.145	0.178	0.542	0.043	0.004

组别	例数	羊水过少 [例(%)]	脐带异常 [例(%)]	胎盘早剥 [例(%)]	脐血流异常 [例(%)]	胎心率异常 [例(%)]	胎动异常 [例(%)]
观察组	107	24(22.4)	21(19.6)	10(9.3)	27(25.2)	32(29.9)	35(32.7)
对照组	107	10(9.3)	10(9.3)	1(0.9)	11(10.3)	13(12.1)	8(7.5)
统计量		7.982^b	4.572^b	7.762^b	6.890^b	8.571^b	13.943^b
P值		0.005	0.032	0.005	0.009	0.003	＜0.001
注：^a为t值，^b为χ²值。

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表 2 胎儿发生宫内窘迫影响因素的单因素分析

Table 2. Univariate analysis of influencing factors of intrauterine distress in fetuses

变量	B	SE	Waldχ²	P值	OR值	95% CI
脐血流异常	1.032	0.402	6.632	0.010	2.807	1.284~6.138
胎心率异常	1.204	0.398	9.158	0.002	3.332	1.529~7.257
胎动异常	1.463	0.385	14.453	＜0.001	4.318	2.031~9.182
羊水过少	1.138	0.362	9.867	0.002	3.120	1.533~6.349
脐带异常	0.832	0.385	4.685	0.030	2.298	1.079~4.909
胎盘早剥	1.506	0.521	8.353	0.004	4.510	1.625~12.532
妊娠期高血压	0.767	0.378	4.093	0.043	2.152	1.025~4.516
妊娠期糖尿病	1.325	0.432	9.321	0.002	3.762	1.613~8.772
注：各变量赋值如下，脐血流异常(有=1，无=0)、胎心率异常(有=1，无=0)、胎动异常(有=1，无=0)、羊水过少(有=1，无=0)、脐带异常(有=1，无=0)、胎盘早剥(有=1，无=0)、妊娠期高血压(有=1，无=0)、妊娠期糖尿病(有=1，无=0)。

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表 3 胎儿发生宫内窘迫影响因素的多因素logistic回归分析

Table 3. Logistic regression analysis of factors influencing fetal intrauterine distress

变量	B	SE	Waldχ²	P值	OR值	95% CI
胎心率异常	1.125	0.415	7.341	0.006	3.077	1.363~6.939
羊水过少	1.043	0.375	7.789	0.005	2.837	1.353~5.944
胎盘早剥	1.523	0.545	7.798	0.005	4.583	1.570~13.398
胎动异常	0.986	0.402	6.085	0.014	2.679	1.217~5.902
妊娠期糖尿病	0.863	0.421	4.223	0.039	2.371	1.037~5.423

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表 4 2组研究对象预后结局比较[例(%)]

Table 4. Comparison of prognostic outcomes between two groups of study subjects [cases (%)]

组别	例数	5 min Apgar评分＜7分	NICU入住	新生儿窒息	新生儿低血糖	新生儿高胆红素血症	胎儿生长受限	围产儿死亡
观察组	107	20(18.7)	27(25.2)	14(13.1)	12(11.2)	15(14.0)	19(17.8)	6(5.6)
对照组	107	6(5.6)	10(9.3)	4(3.7)	3(2.8)	5(4.7)	8(7.5)	0
χ²值		8.354	8.571	6.890	5.274	5.135	4.762	6.171
P值		0.004	0.003	0.009	0.021	0.023	0.029	0.013

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表 5 各因素对胎儿宫内窘迫的预测价值分析

Table 5. Analysis of the predictive value of various factors for intrauterine distress in the fetus

项目	AUC(95% CI)	灵敏度(%)	特异度(%)	约登指数
胎心率异常	0.780(0.715~0.845)	78.9	75.6	0.545
羊水过少	0.732(0.665~0.799)	72.6	69.3	0.419
胎盘早剥	0.728(0.661~0.795)	70.1	71.8	0.419
胎动异常	0.741(0.674~0.808)	63.2	74.5	0.377
妊娠期糖尿病(分层)	0.765(0.698~0.832)	82.4	68.7	0.511

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