Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.
Neonatology. 2012;102(3):235-42. doi: 10.1159/000339481. Epub 2012 Aug 15.
Intermittent fetal heart rate (FHR) monitoring during labor using an acoustic stethoscope is the most frequent method for fetal assessment of well-being in low- and middle-income countries. Evidence concerning reliability and efficacy of this technique is almost nonexistent.
To determine the value of routine intermittent FHR monitoring during labor in the detection of FHR abnormalities, and the relationship of abnormalities to the subsequent fresh stillbirths (FSB), birth asphyxia (BA), need for neonatal face mask ventilation (FMV), and neonatal deaths within 24 h.
This is a descriptive observational study in a delivery room from November 2009 through December 2011. Research assistants/observers (n = 14) prospectively observed every delivery and recorded labor information including FHR and interventions, neonatal information including responses in the delivery room, and fetal/neonatal outcomes (FSB, death within 24 h, admission neonatal area, or normal).
10,271 infants were born. FHR was abnormal (i.e. <120 or >160 beats/min) in 279 fetuses (2.7%) and absent in 200 (1.9%). Postnatal outcomes included FSB in 159 (1.5%), need for FMV in 695 (6.8%), BA (i.e. 5-min Apgar score <7) in 69 (0.7%), and deaths in 89 (0.9%). Abnormal FHR was associated with labor complications (OR = 31.4; 95% CI: 23.1-42.8), increased need for FMV (OR = 7.8; 95% CI: 5.9-10.1), BA (OR = 21.7; 95% CI: 12.7-37.0), deaths (OR = 9.9; 95% CI: 5.6-17.5), and FSB (OR = 35; 95% CI: 20.3-60.4). An undetected FHR predicted FSB (OR = 1,983; 95% CI: 922-4,264).
Intermittent detection of an absent or abnormal FHR using a fetal stethoscope is associated with FSB, increased need for neonatal resuscitation, BA, and neonatal death in a limited-resource setting. The likelihood of an abnormal FHR is magnified with labor complications.
在中低收入国家，使用听诊器进行间歇性胎儿心率（FHR）监测是评估胎儿健康状况的最常用方法。几乎没有关于该技术可靠性和有效性的证据。
确定常规间歇性 FHR 监测在检测 FHR 异常中的价值，以及异常与随后的新鲜围产儿死亡（FSB）、出生窒息（BA）、新生儿面罩通气（FMV）需求以及 24 小时内新生儿死亡之间的关系。
这是 2009 年 11 月至 2011 年 12 月在产房进行的描述性观察性研究。研究助理/观察员（n=14）前瞻性地观察每一次分娩，并记录包括 FHR 和干预措施在内的分娩信息、包括在分娩室中的反应在内的新生儿信息以及胎儿/新生儿结局（FSB、24 小时内死亡、新生儿区入院或正常）。
共有 10271 名婴儿出生。10271 名婴儿中，有 279 名（2.7%）胎儿 FHR 异常（即<120 或>160 次/分钟），200 名（1.9%）胎儿 FHR 消失。围产儿结局包括 159 例（1.5%）FSB、695 例（6.8%）需要 FMV、69 例（0.7%）BA（即 5 分钟 Apgar 评分<7）和 89 例（0.9%）死亡。异常 FHR 与分娩并发症相关（OR=31.4；95%CI：23.1-42.8），需要 FMV 的可能性增加（OR=7.8；95%CI：5.9-10.1），BA（OR=21.7；95%CI：12.7-37.0），死亡（OR=9.9；95%CI：5.6-17.5）和 FSB（OR=35；95%CI：20.3-60.4）。未检测到 FHR 可预测 FSB（OR=1983；95%CI：922-4264）。
在资源有限的情况下，使用胎儿听诊器间歇性检测无 FHR 或异常 FHR 与 FSB、新生儿复苏需求增加、BA 和新生儿死亡有关。与分娩并发症相关时，异常 FHR 的可能性会增加。
