Mahomed K, Nyoni R, Mlambo T, Jacobus E, Kasule J
University of Zimbabwe, Department of Obstetrics, Avondale, Harare.
Cent Afr J Med. 1992 Dec;38(12):458-62.
To compare different methods of intrapartum foetal heart rate monitoring in high risk pregnancies in detecting foetal heart rate abnormalities, need for operative delivery for foetal distress, and neonatal mortality and short term neonatal morbidity.
A prospective randomised controlled trial.
Women in labour at a referral maternity hospital.
Women who were 37 weeks or more pregnant with singleton cephalic presentation and normal foetal heart rate prior to entry into the study.
Women were randomly allocated using sealed opaque envelopes to either continuous electronic foetal heart rate monitoring or intermittent monitoring using hand held doppler foetal heart rate detector.
These include abnormal foetal heart rate patterns, need for operative delivery for foetal distress, neonatal mortality, Apgar scores, admission to NNU, neonatal seizures, and hypoxic encephalopathy.
Randomisation achieved good comparability between the two groups. Abnormal FHR patterns were more frequent in the electronic group (54 pc versus 32 pc). Caesarean section rate was not significantly different in the two groups (28 pc versus 24 pc) although slightly higher compared to overall for the unit (18pc). Foetal outcome was also comparable between the two groups.
Asphyxia can be detected with a hand held doppler just as reliably as by the use of electronic monitors and their use should be further evaluated and promoted in obstetric units caring for high risk pregnancies in developing countries with scarce resources.
比较高危妊娠中不同的产时胎儿心率监测方法在检测胎儿心率异常、因胎儿窘迫而行手术分娩的必要性以及新生儿死亡率和短期新生儿发病率方面的差异。
一项前瞻性随机对照试验。
一家转诊妇产医院中正在分娩的妇女。
孕周37周或以上、单胎头先露且在进入研究前胎儿心率正常的妇女。
使用密封不透明信封将妇女随机分配至连续电子胎儿心率监测组或使用手持式多普勒胎儿心率检测仪进行间歇监测组。
这些指标包括异常胎儿心率模式、因胎儿窘迫而行手术分娩的必要性、新生儿死亡率、阿氏评分、入住新生儿重症监护病房、新生儿惊厥和缺氧性脑病。
随机分组使两组具有良好的可比性。电子监测组中异常胎心率模式更为常见（54%对32%）。两组的剖宫产率无显著差异（28%对24%），尽管与该科室总体剖宫产率（18%）相比略高。两组的胎儿结局也具有可比性。
在资源稀缺的发展中国家，在照顾高危妊娠的产科病房中，使用手持式多普勒检测窒息与使用电子监测仪同样可靠，其应用应进一步评估并推广。
