Hendrix N W, Chauhan S P, Scardo J A, Ellings J M, Devoe L D
Department of Obstetrics and Gynecology, Spartanburg Regional Medical Center, Spartanburg, South Carolina, USA.
J Reprod Med. 2000 Dec;45(12):995-9.
To determine the rate of compliance with current American College of Obstetricians and Gynecologists (ACOG) recommendations for management of parturients undergoing cesarean delivery for persistent nonreassuring fetal heart rate (FHR) tracings.
We performed a retrospective chart review (July 1995-June 1998) of all parturients who underwent cesarean delivery for nonreassuring FHR tracings. Outcome measures included maneuvers for fetal assessment (scalp stimulation or scalp blood pH) and therapeutic interventions (tocolytic agents for reducing uterine activity or amnioinfusion). Patients with multiple gestations and cesarean delivery for other indications were excluded. Student's t test, chi 2 and Fisher's exact tests were used; odds ratio and 95% confidence interval were calculated. P < .05 was considered significant.
Cesarean delivery for persistent nonreassuring FHR patterns included 134 (3.6%) of the 3,671 deliveries during three years. Thirty patients produced intrapartum FHR tracings containing persistent variable decelerations; 12 (40%) of these patients received amnioinfusion. In only 37% (50/134) of cases was there a documented attempt at scalp or acoustic stimulation prior to delivery. Scalp pH was obtained in 15% (15/98) of patients whose cervix was at least 3 cm dilated. Tocolytic agents were used for intrauterine resuscitation in 25% (34/134) of cases; their use varied significantly (P = .006) with the type of FHR abnormality.
At our tertiary center, ACOG recommendations for management of nonreassuring intrapartum FHR tracings were used in a limited number of cases.
确定当前美国妇产科医师学会（ACOG）对因胎儿心率（FHR）持续异常而行剖宫产的产妇管理建议的依从率。
我们对1995年7月至1998年6月期间所有因FHR异常而行剖宫产的产妇进行了回顾性病历审查。结局指标包括胎儿评估措施（头皮刺激或头皮血pH值）和治疗干预措施（用于降低子宫活动的宫缩抑制剂或羊膜腔灌注）。排除多胎妊娠及因其他指征行剖宫产的患者。采用学生t检验、卡方检验和Fisher精确检验；计算比值比和95%置信区间。P<0.05被认为具有统计学意义。
在三年的3671例分娩中，因FHR持续异常而行剖宫产的有134例（3.6%）。30例产妇产时FHR监测显示存在持续可变减速；其中12例（40%）接受了羊膜腔灌注。在仅37%（50/134） 的病例中，有记录显示在分娩前尝试进行头皮或声刺激。宫颈扩张至少3cm的患者中，15%（15/98）进行了头皮pH值检测。25%（34/134）的病例使用宫缩抑制剂进行宫内复苏；其使用因FHR异常类型而异（P=0.006）。
在我们的三级医疗中心，ACOG对产时FHR异常管理的建议仅在少数病例中得到应用。
