Department of Obstetrics & Gynaecology, St George's Hospital and University of London, Blackshaw Road, London SW17 0QT, UK.
Best Pract Res Clin Obstet Gynaecol. 2013 Aug;27(4):509-36. doi: 10.1016/j.bpobgyn.2013.04.002. Epub 2013 May 20.
Widespread use of fetal heart rate monitoring for intrapartum fetal surveillance preceded our detailed understanding of the behaviour and regulation of the fetal cardiovascular system during labour. The fetal heart rate is sensitive to fetal hypoxaemia and hypoxia, but lacks specificity for fetal acidosis, the end point of unmitigated hypoxaemia and hypoxia. Original interpretations of fetal heart rate patterns equated decelerations to 'fetal distress' and mandated operative intervention. Since then, obstetricians have been trained to focus on the morphological appearances of fetal heart rate decelerations rather than to understand the underlying physiological mechanisms, how the fetus compensates and defends itself, and those patterns that suggest progressive loss of compensation. Consequently, operative interventions are commonly undertaken to 'rescue' fetuses that display benign signs of fetal heart rate adaption to events in labour. Failure to recognise abnormal fetal heart rate patterns remains the leading cause of avoidable brain injury and litigation. In this chapter the general characteristics of the fetal heart rate, the changes in fetal heart rate pattern that may occur during labour, and the patterns that suggest failure of the fetal compensatory mechanisms leading to injury are discussed.
胎儿心率监测在产时胎儿监测中的广泛应用先于我们对分娩期间胎儿心血管系统行为和调节的详细了解。胎儿心率对胎儿缺氧和低氧血症敏感，但对胎儿酸中毒（未缓解的缺氧和低氧血症的终点）缺乏特异性。胎儿心率模式的原始解释将减速等同于“胎儿窘迫”，并要求进行手术干预。从那时起，产科医生就接受了专注于胎儿心率减速的形态学表现的培训，而不是理解潜在的生理机制、胎儿如何补偿和保护自己，以及那些表明逐渐丧失补偿的模式。因此，通常会进行手术干预以“抢救”显示出对分娩中事件的良性胎儿心率适应迹象的胎儿。未能识别异常的胎儿心率模式仍然是可避免的脑损伤和诉讼的主要原因。在这一章中，讨论了胎儿心率的一般特征、分娩期间可能发生的胎儿心率模式变化，以及提示胎儿补偿机制失效导致损伤的模式。
