Amer-Wåhlin I, Hellsten C, Norén H, Hagberg H, Herbst A, Kjellmer I, Lilja H, Lindoff C, Månsson M, Mårtensson L, Olofsson P, Sundström A, Marsál K
Department of Obstetrics and Gynaecology, University Hospital Lund, Lund, Sweden.
Lancet. 2001 Aug 18;358(9281):534-8. doi: 10.1016/s0140-6736(01)05703-8.
Previous studies indicate that analysis of the ST waveform of the fetal electrocardiogram provides information on the fetal response to hypoxia. We did a multicentre randomised controlled trial to test the hypothesis that intrapartum monitoring with cardiotocography combined with automatic ST-waveform analysis results in an improved perinatal outcome compared with cardiotocography alone.
At three Swedish labour wards, 4966 women with term fetuses in the cephalic presentation entered the trial during labour after a clinical decision had been made to apply a fetal scalp electrode for internal cardiotocography. They were randomly assigned monitoring with cardiotocography plus ST analysis (CTG+ST group) or cardiotocography only (CTG group). The main outcome measure was rate of umbilical-artery metabolic acidosis (pH <7.05 and base deficit >12 mmol/L). Secondary outcomes included operative delivery for fetal distress. Results were first analysed according to intention to treat, and secondly after exclusion of cases with severe malformations or with inadequate monitoring.
The CTG+ST group showed significantly lower rates of umbilical-artery metabolic acidosis than the cardiotocography group (15 of 2159 [0.7%] vs 31 of 2079 [2%], relative risk 0.47 [95% CI 0.25-0.86], p=0.02) and of operative delivery for fetal distress (193 of 2519 [8%] vs 227 of 2447 [9%], 0.83 [0.69-0.99], p=0.047) when all cases were included according to intention to treat. The differences were more pronounced after exclusion of 291 in the CTG+ST group and 283 in the CTG group with malformations or inadequate recording.
Intrapartum monitoring with cardiotocography combined with automatic ST-waveform analysis increases the ability of obstetricians to identify fetal hypoxia and to intervene more appropriately, resulting in an improved perinatal outcome.
既往研究表明，分析胎儿心电图的ST段波形可提供胎儿对缺氧反应的信息。我们进行了一项多中心随机对照试验，以检验以下假设：与单纯的产时胎心监护相比，产时胎心监护结合自动ST段波形分析可改善围产期结局。
在瑞典的三个产科病房，4966名头位足月胎儿的孕妇在临床决定应用胎儿头皮电极进行内部胎心监护后进入分娩期并参与试验。她们被随机分配接受胎心监护加ST段分析（CTG+ST组）或仅接受胎心监护（CTG组）。主要结局指标是脐动脉代谢性酸中毒的发生率（pH<7.05且碱缺失>12 mmol/L）。次要结局包括因胎儿窘迫而行的手术分娩。结果首先根据意向性分析进行分析，其次在排除严重畸形或监护不充分的病例后进行分析。
根据意向性分析纳入所有病例时，CTG+ST组脐动脉代谢性酸中毒的发生率显著低于胎心监护组（2159例中有15例[0.7%]，而2079例中有31例[2%]，相对危险度0.47[95%CI 0.25-0.86]，p=0.02），因胎儿窘迫而行手术分娩的发生率也较低（2519例中有193例[8%]，而2447例中有227例[9%]，0.83[0.69-0.99]，p=0.047）。在排除CTG+ST组的291例和CTG组的283例有畸形或记录不充分的病例后，差异更为明显。
产时胎心监护结合自动ST段波形分析可提高产科医生识别胎儿缺氧并更恰当地进行干预的能力，从而改善围产期结局。
