Boog G
Service d'Obstétrique et de Médecine Foetale, Hôpital Mère et Enfant, 7, quai Moncousu, 44093 Nantes Cedex 1, France.
J Gynecol Obstet Biol Reprod (Paris). 2001 Sep;30(5):393-432.
Three different clinical patterns of acute fetal distress may be observed during labor: an ante-partum hypoxia with a persistent nonreactive and "fixed" fetal heart rate (FHR) on admission to the hospital, a progressive intra-partum asphyxia manifested, as the labor continues, by a substantial rise in baseline heart rate, a loss of variability and repetitive severe variable or late decelerations, and finally, as a result of a catastrophic event, a sudden prolonged FHR deceleration to approximately 60 beats per minute lasting until delivery. However the majority of fetuses with nonreassuring tracings of FHR are neurologically intact, as evidenced by the high false-positive rate of electronic fetal monitoring (EFM). Therefore the diagnosis of fetal distress must be corroborated by complementary methods, such as continuous recording of the fetal electrocardiogram or computed-assisted EFM, fetal pulse oximetry or fetal scalp sampling with immediate determination of blood gases or lactates. Defavorable outcome of an acute fetal distress leading to neonatal encephalopathy or death is best predicted by a persisting low Apgar score (<3) for more than 5 minutes and by a severe metabolic acidosis (umbilical artery pH<7,00 and base-excess>-12mmol/l).
入院时存在产前缺氧，伴有持续性无反应且“固定”的胎心率（FHR）；随着产程进展，出现进行性产时窒息，表现为随着产程继续，基线心率大幅上升、变异性丧失以及反复出现严重变异减速或晚期减速；最后，由于灾难性事件，胎心率突然长时间减速至约每分钟60次，持续至分娩。然而，大多数FHR监护结果不令人放心的胎儿神经功能完好，电子胎儿监护（EFM）的高假阳性率证明了这一点。因此，胎儿窘迫的诊断必须通过补充方法加以证实，如连续记录胎儿心电图或计算机辅助EFM、胎儿脉搏血氧饱和度测定或胎儿头皮取样并立即测定血气或乳酸。急性胎儿窘迫导致新生儿脑病或死亡的不良结局，最能通过持续5分钟以上的低Apgar评分（<3）以及严重代谢性酸中毒（脐动脉pH<7.00且碱剩余>-12mmol/L）来预测。
