Schulten Phillip Sebastian, Suppelna Jan Philip, Dagres Timoleon, Noè Günter, Anapolski Michael, Reinhard Joscha, Krentel Harald, Tempfer Clemens, Schiermeier Sven
Department für Humanmedizin, Lehrstuhl für Frauenheilkunde und Geburtshilfe, Universitat Witten/Herdecke, Witten.
Marien-Hospital Witten, Frauenklinik der Universität Witten/Herdecke, Witten.
Z Geburtshilfe Neonatol. 2018 Apr;222(2):66-71. doi: 10.1055/s-0043-122945. Epub 2018 Feb 23.
This study examines the recommendations of international guidelines on the use of antepartum and intrapartum cardiotocography.
The guidelines of Germany, Canada, UK, USA, Sri Lanka, Australia as well as FIGO have been compared. The recommendations on the use of cardiotocography were separately evaluated for antepartum and intrapartum use.
Antepartum: In risk-free pregnancies the use of cardiotocography is not recommended in all countries. On the other hand the use of cardiotocography is indicated in the presence of a defined maternal and fetal risk factors. While the NICE guidelines recommend cardiotocography in the case of maternal hypertension, as well as preeclampsia, the German guidelines as well as SOGC list considerably more risk factors. Intrapartually, the recommendations vary greatly from country to country. While German guidelines suggest the use of cardiotocography from late 1st stage of labor, the other countries strongly recommend the auscultation of the fetal heart rate of non-risk pregnancies. This is due to the current study situation, which does not show any advantage of cardiotocography as opposed to intermittent auscultation. Furthermore studies have indicated that the use of cardiotocography caused an increase in iatrogenic induced cesarean sections. In high risk pregnancies the use of cardiotocography is strongly recommended in the compared countries, however there are major differences in the definition of high risk pregnancy and therefore the indication for cardiotocographic monitoring.
Intermittent auscultation is a more cost-effective alternative compared to cardiotocography. However, in the case of legal litigation intermittent auscultation is harder to reconstruct the well-being of the newborn during birth. On the other hand cardiotocography might result in a higher cesarean section rate, but can be more helpful to prove fetal well-being during birth for a legal litigation process. Despite the lack of evidence only German guidelines recommend cardiotocographic monitoring from the late 1st stage of labor for risk-free pregnancies.
本研究探讨国际指南中关于产前和产时胎心监护使用的建议。
比较了德国、加拿大、英国、美国、斯里兰卡、澳大利亚以及国际妇产科联合会（FIGO）的指南。分别对产前和产时胎心监护的使用建议进行评估。
产前：在所有国家，对于无风险妊娠均不建议使用胎心监护。另一方面，在存在明确的母体和胎儿风险因素时则建议使用胎心监护。英国国家卫生与临床优化研究所（NICE）指南建议在母体高血压以及子痫前期的情况下使用胎心监护，而德国指南以及加拿大妇产科医师协会（SOGC）列出的风险因素更多。在产时，各国的建议差异很大。德国指南建议从第一产程后期开始使用胎心监护，而其他国家强烈推荐对无风险妊娠进行胎儿心率听诊。这是由于当前的研究情况表明，与间歇性听诊相比，胎心监护没有任何优势。此外，研究表明使用胎心监护会导致医源性剖宫产率增加。在高危妊娠中，所比较的国家均强烈建议使用胎心监护，然而在高危妊娠的定义以及因此胎心监护监测的指征方面存在重大差异。
与胎心监护相比，间歇性听诊是一种更具成本效益的替代方法。然而，在法律诉讼的情况下，间歇性听诊更难重现出生时新生儿的健康状况。另一方面，胎心监护可能会导致更高的剖宫产率，但在法律诉讼过程中可能更有助于证明出生时胎儿的健康状况。尽管缺乏证据，但只有德国指南建议对无风险妊娠从第一产程后期开始进行胎心监护监测。
