Ugwumadu A
St George's Hospital, London, UK.
BJOG. 2014 Aug;121(9):1063-70. doi: 10.1111/1471-0528.12900. Epub 2014 Jun 12.
Original interpretations of fetal heart rate (FHR) patterns equated FHR decelerations with 'fetal distress', requiring expeditious delivery. This simplistic interpretation is still implied in our clinical guidelines despite 40 years of increasing understanding of the behaviour and regulation of the fetal cardiovascular system during labour. The physiological basis of FHR responses and adaptations to oxygen deprivation is de-emphasised, whilst generations of obstetricians and midwives are trained to focus on, and classify, the morphological appearances of decelerations into descriptive categories, with no attempt to understand how the fetus defends itself and compensates for intrapartum hypoxic ischaemic insults, or the patterns that suggest progressive loss of compensation. Consequently, there is a lack of confidence, marked variation in FHR interpretation, defensive practices, unnecessary operative interventions, and a failure to recognise abnormal FHR patterns, resulting in adverse outcomes and expensive litigation.
对胎儿心率（FHR）模式的最初解读将FHR减速等同于“胎儿窘迫”，需要迅速分娩。尽管在过去40年里，我们对分娩期间胎儿心血管系统的行为和调节有了越来越多的了解，但这种简单化的解读在我们的临床指南中仍然有所暗示。FHR对缺氧的反应和适应的生理基础被淡化了，而一代又一代的产科医生和助产士被训练去关注减速的形态外观并将其分类为描述性类别，却没有人试图去了解胎儿如何保护自己并补偿产时缺氧缺血性损伤，或者那些表明代偿逐渐丧失的模式。因此，存在信心不足、FHR解读存在显著差异、防御性医疗行为、不必要的手术干预，以及未能识别异常FHR模式的情况，从而导致不良后果和昂贵的诉讼。
