产时电子胎儿心率监测的胎儿心率模式通知指南及建议处理算法
Fetal heart rate pattern notification guidelines and suggested management algorithm for intrapartum electronic fetal heart rate monitoring.
作者信息
Downs Thomas, Zlomke Evelyn
出版信息
Perm J. 2007 Fall;11(4):22-8. doi: 10.7812/TPP/07-024.
CONTEXT
Numerous randomized controlled trials have demonstrated limited efficacy of intrapartum fetal heart rate monitoring in improving fetal outcome. A potential reason is the wide variability in clinical decision making seen with its use. Standardizing management of variant intrapartum fetal heart rate tracings may reduce this variability and lead to improvement in fetal outcome.
OBJECTIVE
We sought to develop notification guidelines and a management algorithm for variant intrapartum fetal heart rate tracings that improve fetal outcome and do not increase the operative delivery rate.
DESIGN
Outcomes for cases involving the use of our notification guidelines and management algorithm over six months (1181 deliveries) were compared with outcomes for historical control subjects (2247 deliveries).
MAIN OUTCOME MEASURES
The main outcome measures were Apgar scores <7 and the operative delivery rate.
RESULTS
We found no change in fetal outcome or operative delivery rate.
CONCLUSION
Our notification guidelines and management algorithm are safe and do not increase the operative delivery rate. A large multicenter trial is needed to demonstrate improvement in fetal outcome.
背景
众多随机对照试验表明，产时胎儿心率监测在改善胎儿结局方面疗效有限。一个潜在原因是其使用过程中临床决策存在很大差异。规范产时胎儿心率异常图形的管理可能会减少这种差异，并改善胎儿结局。
目的
我们试图制定通知指南和管理算法，用于产时胎儿心率异常图形，以改善胎儿结局且不增加手术分娩率。
设计
将使用我们的通知指南和管理算法的病例在六个月内（1181例分娩）的结局与历史对照对象（2247例分娩）的结局进行比较。
主要结局指标
主要结局指标为阿氏评分<7分和手术分娩率。
结果
我们发现胎儿结局或手术分娩率没有变化。
结论
我们的通知指南和管理算法是安全的，且不会增加手术分娩率。需要进行一项大型多中心试验来证明胎儿结局有所改善。
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