Grivell Rosalie M, Alfirevic Zarko, Gyte Gillian Ml, Devane Declan
Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, 72 King William Road, Adelaide, Australia, SA 5006.
Cochrane Database Syst Rev. 2010 Jan 20(1):CD007863. doi: 10.1002/14651858.CD007863.pub2.
Cardiotocography (CTG) is a continuous recording of the fetal heart rate obtained via an ultrasound transducer placed on the mother's abdomen. CTG is widely used in pregnancy as a method of assessing fetal well-being, predominantly in pregnancies with increased risk of complications.
To assess the effectiveness of antenatal CTG (both traditional and computerised assessments) in improving outcomes for mothers and babies during and after pregnancy.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2009).
Randomised and quasi-randomised trials that compared traditional antenatal CTG with no CTG or CTG results concealed; computerised CTG with no CTG or CTG results concealed; and computerised CTG with traditional CTG.
Two authors independently assessed eligibility, quality and extracted data.
Six studies (involving 2105 women) are included. Overall, the included studies were not of high quality, and only two had both adequate randomisation sequence generation and allocation concealment. All studies that were able to be included enrolled only women at increased risk of complications.Comparison of traditional CTG versus no CTG showed no significant difference identified in perinatal mortality (risk ratio (RR) 2.05, 95% confidence interval (CI) 0.95 to 4.42, 2.3% versus 1.1%, four studies, N = 1627) or potentially preventable deaths (RR 2.46, 95% CI 0.96 to 6.30, four studies, N = 1627, though the meta-analysis was underpowered to assess this outcome. Similarly, there was no significant difference identified in caesarean sections (RR 1.06, 95% CI 0.88 to 1.28, 19.7% versus 18.5%, three trials, N = 1279) nor in the secondary outcomes that were assessed.There were no eligible studies that compared computerised CTG with no CTG.Comparison of computerised CTG versus traditional CTG showed a significant reduction in perinatal mortality with computerised CTG (RR 0.20, 95% CI 0.04 to 0.88, two studies, 0.9% versus 4.2%, 469 women, graph 3.1.1). However, there was no significant difference identified in potentially preventable deaths (RR 0.23, 95% CI 0.04 to 1.29, two studies, N = 469), though the meta-analysis was underpowered to assess this outcome. There was no significant difference identified in caesarean sections (RR 0.87, 95% CI 0.61 to 1.24, 63% versus 72%, one study, N = 59) or in secondary outcomes.
AUTHORS' CONCLUSIONS: There is no clear evidence that antenatal CTG improves perinatal outcome, but further studies focusing on the use of computerised CTG in specific populations of women with increased risk of complications are warranted.
胎心监护（CTG）是通过放置在母亲腹部的超声换能器对胎儿心率进行的连续记录。CTG在孕期被广泛用作评估胎儿健康状况的方法，主要用于并发症风险增加的妊娠。
评估产前CTG（传统评估和计算机化评估）在改善妊娠期间及产后母婴结局方面的有效性。
我们检索了Cochrane妊娠与分娩组试验注册库（2009年4月）。
比较传统产前CTG与无CTG或CTG结果隐匿的随机和半随机试验；计算机化CTG与无CTG或CTG结果隐匿的试验；以及计算机化CTG与传统CTG的试验。
两位作者独立评估纳入标准、质量并提取数据。
纳入6项研究（涉及2105名女性）。总体而言，纳入的研究质量不高，只有两项研究具备充分的随机序列生成和分配隐匿。所有能够纳入的研究仅纳入了并发症风险增加的女性。传统CTG与无CTG的比较显示，围产期死亡率无显著差异（风险比（RR）2.05，95%置信区间（CI）0.95至4.42，分别为2.3%和1.1%，4项研究，N = 1627）或潜在可预防死亡（RR 2.46，95%CI为0.96至6.30，4项研究，N = 1627，尽管荟萃分析评估该结局的效能不足。同样，剖宫产率（RR 1.06，95%CI为0.88至1.28，分别为19.7%和18.5%，3项试验，N = 1279）以及所评估的次要结局均无显著差异。没有符合条件的研究比较计算机化CTG与无CTG。计算机化CTG与传统CTG的比较显示，计算机化CTG可显著降低围产期死亡率（RR 0.20，95%CI为0.04至0.88，2项研究，分别为0.9%和4.2%，469名女性，图3.1.1）。然而，潜在可预防死亡方面无显著差异（RR 0.23，95%CI为0.04至1.29，2项研究，N = 469），尽管荟萃分析评估该结局的效能不足。剖宫产率（RR 0.87，95%CI为0.61至1.24，分别为63%和72%，1项研究，N = 59）或次要结局方面均无显著差异。
尚无明确证据表明产前CTG能改善围产期结局，但有必要开展进一步研究，聚焦于在并发症风险增加的特定女性群体中使用计算机化CTG。
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