Schwartz D B, Sherman S J, Goyert G L, Fields P, Simkins S, Daoud Y
Department of Obstetrics and Gynecology, Sinai Hospital, Detroit, MI 48235.
Eur J Obstet Gynecol Reprod Biol. 1991 Jul 1;40(2):97-103. doi: 10.1016/0028-2243(91)90099-7.
Fetal heart rate reactivity was evaluated following acoustic stimulation testing (AST). The AST and NST (non-stress test) were compared with regards to certain adverse perinatal outcome criteria, and in a selected sample of cases, to other surveillance tests. These tests were the oxytocin challenge test (OCT) and biophysical profile (BPP). 479 tests were performed on 240 high-risk patients. The AST significantly increased fetal heart rate reactivity. With regards adverse perinatal outcome criteria, there was no significant difference between the AST and NST in relation to sensitivity, specificity or predictive values. In the 38 patients with both non-reactive NSTs and reactive ASTs, 5 (13.5%) had immediate follow-up surveillance tests (OCTs and/or BPPs) that were non-reassuring and necessitated delivery. In four of the five cases, there was evidence of potential fetal compromise. These preliminary observations suggest that the AST may have evoked reactivity in fetuses with early compromise, and raise concerns about replacing the NST with the AST as a primary screening test of fetal well-being.
在进行声刺激试验（AST）后评估胎儿心率反应性。将AST与无应激试验（NST）就某些围产期不良结局标准进行比较，并在部分选定病例样本中与其他监测试验进行比较。这些试验包括催产素激惹试验（OCT）和生物物理评分（BPP）。对240名高危患者进行了479次试验。AST显著提高了胎儿心率反应性。就围产期不良结局标准而言，AST与NST在敏感性、特异性或预测值方面无显著差异。在38例NST无反应但AST有反应的患者中，5例（13.5%）随后立即进行的监测试验（OCT和/或BPP）结果不令人放心，需要进行分娩。在这5例中的4例中，有潜在胎儿窘迫的证据。这些初步观察结果表明，AST可能在早期有窘迫的胎儿中诱发了反应性，并引发了对用AST取代NST作为胎儿健康主要筛查试验的担忧。
