Carbonne B, Nguyen A
Service de Gynécologie-Obstétrique, Hôpital Saint-Antoine, Paris, France.
J Gynecol Obstet Biol Reprod (Paris). 2008 Feb;37 Suppl 1:S65-71. doi: 10.1016/j.jgyn.2007.11.012. Epub 2008 Jan 7.
The wide use of continuous of fetal heart rate monitoring (FHR) since the seventies has been accompanied by an increase in cesarean delivery rates, without any decrease in cerebral palsy rate. Second line methods of fetal monitoring have been developed in order to better identify fetuses truly at risk of intrapartum asphyxia. The use of fetal scalp blood sampling (FBS) for fetal monitoring seems logical since neonatal acidosis is one of the major criteria of birth asphyxia. Studies show that the use of FBS reduces the increase in cesarean deliveries associated with the use of continuous FHR monitoring. However, FBS is invasive, non continuous and technically uneasy, with a rather high rate of failed blood samplings. Fetal scalp lactates measurement by micromethod requires a much smaller volume of blood. Although a wider assessment is required, the predictive value of fetal blood lactates seems to be similar to that of fetal scalp blood pH.
自七十年代以来，连续胎儿心率监测（FHR）的广泛应用伴随着剖宫产率的上升，而脑瘫率却没有任何下降。为了更好地识别真正处于产时窒息风险的胎儿，已经开发了二线胎儿监测方法。由于新生儿酸中毒是出生窒息的主要标准之一，因此使用胎儿头皮血采样（FBS）进行胎儿监测似乎是合理的。研究表明，FBS的使用减少了与连续FHR监测相关的剖宫产增加。然而，FBS具有侵入性、非连续性且技术上不易操作，采血失败率相当高。通过微量法测量胎儿头皮乳酸所需的血量要少得多。尽管需要更广泛的评估，但胎儿血乳酸的预测价值似乎与胎儿头皮血pH值的预测价值相似。
