Ashwal Eran, Shinar Shiri, Aviram Amir, Orbach Sharon, Yogev Yariv, Hiersch Liran
a Department of Obstetrics and Gynecology , Lis Maternity Hospital, Sourasky Medical Center , Tel Aviv , Israel.
b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.
J Matern Fetal Neonatal Med. 2019 Mar;32(6):889-895. doi: 10.1080/14767058.2017.1395010. Epub 2017 Nov 2.
Intrapartum fetal heart rate (FHR) monitoring is well recommended during labor to assess fetal wellbeing. Though commonly used, the external Doppler and fetal scalp electrode monitor have significant shortcomings. Lately, non-invasive technologies were developed as possible alternatives.
The objective of this study is to compare the accuracy of FHR trace using novel Electronic Uterine Monitoring (EUM) to that of external Doppler and fetal scalp electrode monitor.
A comparative study conducted in a single tertiary medical center. Intrapartum FHR trace was recorded simultaneously using three different methods: internal fetal scalp electrode, external Doppler, and EUM. The latter, a multichannel electromyogram (EMG) device acquires a uterine signal and maternal and fetal electrocardiograms. FHR traces obtained from all devices during the first and second stages of labor were analyzed. Positive percent of agreement (PPA) and accuracy (by measuring root means square error between observed and predicted values) of EUM and external Doppler were both compared to internal scalp electrode monitoring. A Bland-Altman agreement plot was used to compare the differences in FHR trace between all modalities. For momentary recordings of fetal heart rate <110 bpm or >160 bpm level of agreement, sensitivity, and specificity were also evaluated.
Overall, 712,800 FHR momentary recordings were obtained from 33 parturients. Although both EUM and external Doppler highly correlated with internal scalp electrode monitoring (r = 0.98, p < .001 for both methods), the accuracy of EUM was significantly higher than external Doppler (99.0% versus 96.6%, p < .001). In addition, for fetal heart rate <110 bpm or >160 bpm, the PPA, sensitivity, and specificity of EUM as compared with internal fetal scalp electrode, were significantly greater than those of external Doppler (p < .001).
Intrapartum FHR using EUM is both valid and accurate, yielding higher correlations with internal scalp electrode monitoring than external Doppler. As such, it may provide a good framework for non-invasive evaluation of intrapartum FHR.
分娩期间推荐进行产时胎儿心率（FHR）监测以评估胎儿健康状况。尽管外部多普勒和胎儿头皮电极监测常用，但存在显著缺点。最近，开发了非侵入性技术作为可能的替代方法。
本研究的目的是比较新型电子子宫监测（EUM）的FHR描记图与外部多普勒和胎儿头皮电极监测的准确性。
在一家单一的三级医疗中心进行了一项比较研究。使用三种不同方法同时记录产时FHR描记图：内部胎儿头皮电极、外部多普勒和EUM。后者是一种多通道肌电图（EMG）设备，可获取子宫信号以及母体和胎儿心电图。分析了分娩第一和第二阶段从所有设备获得的FHR描记图。将EUM和外部多普勒的阳性一致性百分比（PPA）和准确性（通过测量观察值与预测值之间的均方根误差）与内部头皮电极监测进行比较。使用Bland-Altman一致性图比较所有模式之间FHR描记图的差异。对于胎儿心率<110次/分钟或>160次/分钟的瞬时记录，还评估了一致性水平、敏感性和特异性。
总体而言，从33名产妇获得了712,800次FHR瞬时记录。尽管EUM和外部多普勒与内部头皮电极监测均高度相关（两种方法的r = 0.98，p <.001），但EUM的准确性显著高于外部多普勒（99.0%对96.6%，p <.001）。此外，对于胎儿心率<110次/分钟或>160次/分钟，与内部胎儿头皮电极相比，EUM的PPA、敏感性和特异性显著高于外部多普勒（p <.001）。
使用EUM进行产时FHR监测既有效又准确，与内部头皮电极监测的相关性高于外部多普勒。因此，它可为产时FHR的非侵入性评估提供良好框架。
