新生儿即刻结局与分娩方式：标准化胎儿心率模式管理的应用
Immediate newborn outcome and mode of delivery: use of standardized fetal heart rate pattern management.
作者信息
Katsuragi Shinji, Ikeda Tomoaki, Noda Shunichi, Onishi Junji, Ikenoue Tsuyomu, Parer Julian T
机构信息
Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Osaka, Japan.
出版信息
J Matern Fetal Neonatal Med. 2013 Jan;26(1):71-4. doi: 10.3109/14767058.2012.728645. Epub 2012 Oct 3.
OBJECTIVE
To determine whether a rule-based system for fetal heart rate interpretation can result in reduced metabolic acidemia without increasing obstetrical intervention.
METHODS
Rates of vacuum-assisted delivery and Cesarean sections, and umbilical artery pH and base excess values were determined over a 5-year period in a single hospital with 3907 deliveries in Japan. Results were compared for 2 years before and 2 years after a 6-month training period in rule-based fetal heart rate interpretation.
RESULTS
The pre- and post-training rates of unscheduled Cesarean deliveries (4.8% vs. 6.0%) and vacuum deliveries (21.2% vs. 18.1%) did not differ significantly. The rates of umbilical arterial pH <7.15 (1.51% vs. 0.18%, p < 0.05) and base excess <-12 mEq/L (1.76% vs. 0.25%, p < 0.05) were significantly lower after training.
CONCLUSION
A standardized fetal heart rate pattern management system was associated with a 7-fold reduction of newborn metabolic acidemia with no change in operative intervention.
目的
确定基于规则的胎儿心率解读系统是否能在不增加产科干预的情况下降低代谢性酸中毒的发生率。
方法
在日本一家有3907例分娩的医院，对5年期间的真空辅助分娩率和剖宫产率以及脐动脉pH值和碱剩余值进行测定。将在基于规则的胎儿心率解读方面进行6个月培训前后各2年的结果进行比较。
结果
计划外剖宫产率（4.8%对6.0%）和真空分娩率（21.2%对18.1%）在培训前后无显著差异。培训后脐动脉pH<7.15的发生率（1.51%对0.18%，p<0.05）和碱剩余<-12 mEq/L的发生率（1.76%对0.25%，p<0.05）显著降低。
结论
标准化的胎儿心率模式管理系统与新生儿代谢性酸中毒发生率降低7倍相关，且手术干预无变化。
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