Devane D, Lalor J, Bonnar J
School of Nursing and Midwifery, Trinity College Dublin.
Ir Med J. 2007 Feb;100(2):360-2.
This study describes the use of intrapartum electronic fetal monitoring in Ireland. Electronic fetal monitoring (EFM) has become routine in the assessment of fetal wellbeing during labour. Current evidence indicates that the routine use of EFM leads to an increased caesarean section and operative vaginal delivery rate and a reduction in the rate of neonatal seizures. Practices and service provision related to the use and interpretation of and educational provision for electronic fetal monitoring have not been investigated in Ireland. A national survey of all (n = 22) maternity units in Ireland was undertaken using a self-reported questionnaire amended, with permission, from that used in the 8th CESDI report. The questionnaire sought information on unit birth rate in 2002, number of cardiotocograph (CTG) monitors available in delivery units, use of the admission CTG, use of continuous EFM for women with various risk factors for pregnancy and/or labour, availability of fetal blood sampling facilities, use of umbilical cord blood sampling and availability of guidelines on the use of EFM. All units responded to the survey giving a national picture of the use of EFM during labour. All units had cardiotocograph (CTG) monitors available in the delivery area (median 6, range 3-14). An admission CTG was performed on all women by 96% (n=21) of units. Thirty six per cent of units (n=8) used continuous EFM routinely during labour in women who did not have risk factors for labour. Fetal blood sampling (FBS) was used in 36% (n=8) of units in cases of suspicious CTG tracings. Umbilical cord blood gases were sampled routinely following emergency caesarean section in 46% (n= 10) of units while 64% (n= 14) did so if the baby's condition was poor at birth. A departmental guideline on the use of EFM was available in 73% (n= 16) units. The findings of this survey indicate wide variations in the use of intrapartum EFM in Ireland. The use of continuous EFM for specific high-risk indications was variable and EFM was used by a third of units for women who did not have risk factors for labour. The admission CTG was used by 21 of the 22 units despite evidence of no benefit. The absence of FBS in the majority of units surveyed and the low rate of umbilical cord blood sampling is of concern.
本研究描述了爱尔兰产时电子胎儿监护的使用情况。电子胎儿监护（EFM）已成为分娩期间评估胎儿健康状况的常规手段。目前的证据表明，常规使用EFM会导致剖宫产率和阴道助产率上升，新生儿惊厥率降低。爱尔兰尚未对与电子胎儿监护的使用、解读及相关教育提供有关的实践和服务提供情况进行调查。我们使用一份经许可修改自第八次综合产科、围产儿及新生儿调查（CESDI）报告中所使用的自填式问卷，对爱尔兰所有22家 maternity unit进行了全国性调查。该问卷旨在获取2002年各单位的出生率、产房中心电图（CTG）监护仪数量、入院CTG的使用情况、对具有各种妊娠和/或分娩风险因素的女性使用连续EFM的情况、胎儿血样采集设施是否可用、脐血采样的使用情况以及EFM使用指南是否可用等信息。所有单位都对调查做出了回应，呈现出爱尔兰分娩期间EFM使用情况的全国概况。所有单位产房均配备有心电图（CTG）监护仪（中位数为6台，范围为3 - 14台）。96%（n = 21）的单位对所有产妇均进行入院CTG检查。36%（n = 8）的单位在分娩过程中对无分娩风险因素的女性常规使用连续EFM。在CTG描记可疑的情况下，36%（n = 8）的单位会进行胎儿血样采集（FBS）。46%（n = 10）的单位在急诊剖宫产后常规采集脐血气，而64%（n = 14）的单位在婴儿出生时状况不佳时会这样做。73%（n = 16）的单位有关于EFM使用的部门指南。本次调查结果表明，爱尔兰产时EFM的使用存在很大差异。针对特定高危指征使用连续EFM的情况各不相同，三分之一的单位对无分娩风险因素女性使用EFM。尽管没有证据表明有益，但22个单位中有21个使用了入院CTG。大多数被调查单位未进行胎儿血样采集以及脐血采样率较低令人担忧。
