Crawford Alexandra, Hayes Dexter, Johnstone Edward D, Heazell Alexander E P
Maternal and Fetal Health Research Center, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK.
Central Manchester University Hospitals NHS Foundation Trust, St Mary's Hospital, Manchester, UK.
Acta Obstet Gynecol Scand. 2017 Dec;96(12):1404-1413. doi: 10.1111/aogs.13231.
Antepartum stillbirth is often preceded by detectable signs of fetal compromise, including changes in fetal heart rate and movement. It is hypothesized that continuous fetal monitoring could detect these signs more accurately and objectively than current forms of fetal monitoring and allow for timely intervention. This systematic review aimed to explore available evidence on women's experiences of continuous fetal monitoring to investigate its acceptability before clinical implementation and to inform clinical studies.
Systematic searching of four electronic databases (Embase, PsycINFO, MEDLINE and CINAHL), using key terms defined by initial scoping searches, identified a total of 35 studies. Following title and abstract screening by two independent researchers, five studies met the inclusion criteria. Studies were not excluded based on language, methodology or quality assessment. An integrative methodology was used to synthesize qualitative and quantitative data together.
Forms of continuous fetal monitoring used included Monica AN24 monitors (n = 4) and phonocardiography (n = 1). Four main themes were identified: practical limitations of the device, negative emotions, positive perceptions, and device implementation. Continuous fetal monitoring was reported to have high levels of participant satisfaction and was preferred by women to intermittent cardiotocography.
This review suggests that continuous fetal monitoring is accepted by women. However, it has also highlighted both the paucity and heterogeneity of current studies and suggests that further research should be conducted into women's experiences of continuous fetal monitoring before such devices can be used clinically.
产前死胎往往在出现可检测到的胎儿窘迫迹象之前发生，包括胎心率和胎动的变化。据推测，与当前的胎儿监测形式相比，持续胎儿监测能够更准确、客观地检测到这些迹象，并能及时进行干预。本系统评价旨在探索关于女性持续胎儿监测体验的现有证据，以调查其在临床应用前的可接受性，并为临床研究提供参考。
使用初步范围搜索定义的关键词，对四个电子数据库（Embase、PsycINFO、MEDLINE和CINAHL）进行系统检索，共识别出35项研究。经过两名独立研究人员对标题和摘要的筛选，有五项研究符合纳入标准。研究未因语言、方法或质量评估而被排除。采用综合方法将定性和定量数据综合在一起。
使用的持续胎儿监测形式包括莫妮卡AN24监护仪（n = 4）和心音描记法（n = 1）。确定了四个主要主题：设备的实际局限性、负面情绪、积极看法和设备实施。据报告，持续胎儿监测的参与者满意度较高，女性更喜欢持续胎儿监测而非间歇性胎心监护。
本评价表明女性接受持续胎儿监测。然而，它也凸显了当前研究的匮乏和异质性，并建议在这类设备临床应用之前，应进一步研究女性对持续胎儿监测的体验。
