Pello L C, Rosevear S K, Dawes G S, Moulden M, Redman C W
Nuffield Department of Obstetrics and Gynecology, Oxford, United Kingdom.
Obstet Gynecol. 1991 Oct;78(4):602-10.
Observer variation in visual analysis of fetal heart rate (FHR) records is reportedly high, but can be avoided by computerized numerical analysis. The FHRs of 394 women in labor at 37 or more weeks' gestation were recorded on-line and analyzed to examine how different patterns related to outcome, as judged by umbilical arterial base deficit or Apgar score on delivery. The range of normality and the diversity of patterns of those delivered without acidemia were great. Late decelerations were of poor prognostic value. There was an increase in FHR variation during labor averaging 40%. In this preliminary study, conventional attributes of the FHR, alone or in combination, did not predict metabolic acidemia. Epidural analgesia in 240 women was identified as a confounding variable that significantly affected FHR patterns without influencing the condition of the infant at birth. It was associated with a higher FHR, less FHR variation and fewer decelerations, primiparity, longer labors, more operative deliveries, and a threefold greater cesarean rate. The rise in basal FHR, perhaps due to a rise in maternal temperature, may partly explain the high intervention rate in those without fetal acidemia.
据报道，胎儿心率（FHR）记录的视觉分析中观察者间差异很大，但可通过计算机数值分析避免。对394名妊娠37周及以上的分娩妇女的FHR进行在线记录和分析，以研究不同模式与分娩结局的关系，结局通过分娩时脐动脉碱缺失或阿氏评分判断。无酸血症分娩者的正常范围和模式多样性很大。晚期减速的预后价值较差。分娩期间FHR变异增加，平均增加40%。在这项初步研究中，FHR的传统特征单独或联合使用均不能预测代谢性酸血症。240名妇女的硬膜外镇痛被确定为一个混杂变量，它显著影响FHR模式，但不影响婴儿出生时的状况。它与较高的FHR、较少的FHR变异和较少的减速、初产、产程延长、更多的手术分娩以及三倍的剖宫产率相关。基础FHR升高，可能由于母体体温升高，这可能部分解释了无胎儿酸血症者的高干预率。
