Alfirevic Zarko, Devane Declan, Gyte Gillian M L
Department of Women’s and Children’s Health, The University of Liverpool, Liverpool, UK.
Cochrane Database Syst Rev. 2013 May 31(5):CD006066. doi: 10.1002/14651858.CD006066.pub2.
Cardiotocography (known also as electronic fetal monitoring), records changes in the fetal heart rate and their temporal relationship to uterine contractions. The aim is to identify babies who may be short of oxygen (hypoxic), so additional assessments of fetal well-being may be used, or the baby delivered by caesarean section or instrumental vaginal birth.
To evaluate the effectiveness of continuous cardiotocography during labour.
We searched the Cochrane Pregnancy and Childbirth Group Trials Register (31 December 2012) and reference lists of retrieved studies.
Randomised and quasi-randomised controlled trials involving a comparison of continuous cardiotocography (with and without fetal blood sampling) with (a) no fetal monitoring, (b) intermittent auscultation (c) intermittent cardiotocography.
Two review authors independently assessed study eligibility, quality and extracted data from included studies.
Thirteen trials were included with over 37,000 women; only two were judged to be of high quality.Compared with intermittent auscultation, continuous cardiotocography showed no significant improvement in overall perinatal death rate (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.59 to 1.23, n = 33,513, 11 trials), but was associated with a halving of neonatal seizures (RR 0.50, 95% CI 0.31 to 0.80, n = 32,386, nine trials). There was no significant difference in cerebral palsy rates (RR 1.75, 95% CI 0.84 to 3.63, n = 13,252, two trials). There was a significant increase in caesarean sections associated with continuous cardiotocography (RR 1.63, 95% CI 1.29 to 2.07, n = 18,861, 11 trials). Women were also more likely to have an instrumental vaginal birth (RR 1.15, 95% CI 1.01 to 1.33, n = 18,615, 10 trials).Data for subgroups of low-risk, high-risk, preterm pregnancies and high-quality trials were consistent with overall results. Access to fetal blood sampling did not appear to influence the difference in neonatal seizures nor any other prespecified outcome.
AUTHORS' CONCLUSIONS: Continuous cardiotocography during labour is associated with a reduction in neonatal seizures, but no significant differences in cerebral palsy, infant mortality or other standard measures of neonatal well-being. However, continuous cardiotocography was associated with an increase in caesarean sections and instrumental vaginal births. The challenge is how best to convey these results to women to enable them to make an informed choice without compromising the normality of labour.
胎心监护（也称为电子胎儿监护）记录胎儿心率的变化及其与子宫收缩的时间关系。目的是识别可能缺氧（缺氧）的婴儿，以便进行额外的胎儿健康评估，或通过剖宫产或器械辅助阴道分娩。
评估分娩期间连续胎心监护的有效性。
我们检索了Cochrane妊娠和分娩组试验注册库（2012年12月31日）以及检索到的研究的参考文献列表。
随机和半随机对照试验，比较连续胎心监护（有或无胎儿血样采集）与（a）无胎儿监护，（b）间歇听诊，（c）间歇胎心监护。
两位综述作者独立评估研究的合格性、质量，并从纳入研究中提取数据。
纳入了13项试验，涉及超过37000名妇女；只有两项被判定为高质量。与间歇听诊相比，连续胎心监护在总体围产期死亡率方面没有显著改善（风险比（RR）0.86，95%置信区间（CI）0.59至1.23，n = 33513，11项试验），但与新生儿惊厥发生率减半相关（RR 0.50，95%CI 0.31至0.80，n = 32386，9项试验）。脑瘫发生率没有显著差异（RR 1.75，95%CI 0.84至3.63，n = 13252，2项试验）。与连续胎心监护相关的剖宫产显著增加（RR 1.63，95%CI 1.29至2.07，n = 18861，11项试验）。妇女也更有可能进行器械辅助阴道分娩（RR 1.15，95%CI 1.01至1.33，n = 18615，10项试验）。低风险、高风险、早产妊娠亚组和高质量试验的数据与总体结果一致。进行胎儿血样采集似乎并未影响新生儿惊厥差异或任何其他预先指定的结果。
分娩期间的连续胎心监护与新生儿惊厥减少相关，但在脑瘫、婴儿死亡率或其他新生儿健康标准指标方面没有显著差异。然而，连续胎心监护与剖宫产和器械辅助阴道分娩的增加相关。挑战在于如何最好地将这些结果传达给妇女，使她们能够在不影响分娩正常性的情况下做出明智的选择。
