Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.
Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway.
Acta Obstet Gynecol Scand. 2019 Mar;98(3):390-395. doi: 10.1111/aogs.13500. Epub 2018 Nov 21.
This study describes clinical routines for intrapartum fetal monitoring in Norway and compliance with national clinical recommendations.
A national survey of all (n = 48) birth units in Norway, using a self-reporting questionnaire about fetal monitoring methods and devices available in the birth units, admission cardiotocography (CTG) use, intrapartum fetal monitoring methods for women with and without risk factors, the availability of fetal scalp blood sampling facilities, and umbilical cord blood sampling routines.
All birth units responded. They all had access to Pinard stethoscopes, hand-held Doppler devices, and CTG. Half of the units used ST waveform analysis (STAN) as an adjunct to CTG. Furthermore, 23 of 48 units analyzed fetal blood samples and 43 of 48 umbilical cord blood gas samples. In 11 units, admission CTG was routinely offered to all women. No units used continuous CTG during labor in low-risk women. However, three units routinely used intermittent CTG during the first stage of labor. Three units used CTG without having access to fetal blood samples or STAN.
Our findings indicate some deviations from clinical recommendations in the use of intrapartum fetal monitoring in Norway. Three units used intermittent CTG for women without risk factors. Almost one in four units routinely used admission CTG, despite national clinical recommendations. The lack of access to fetal blood samples or STAN in units using CTG is of concern.
本研究描述了挪威产时胎儿监测的临床常规及对国家临床建议的遵循情况。
对挪威所有（n=48）分娩单位进行了一项全国性调查，使用自我报告问卷了解分娩单位中可用的胎儿监测方法和设备、入院胎心监护（CTG）使用情况、有或无危险因素的产妇产时胎儿监测方法、胎儿头皮采血设施的可用性以及脐带血采样常规。
所有分娩单位均做出回应。它们均能使用 Pinard 听诊器、手持式多普勒设备和 CTG。半数单位将 ST 波分析（STAN）作为 CTG 的辅助手段。此外，48 个单位中有 23 个分析了胎儿血样，48 个中有 43 个分析了脐带血血气样本。在 11 个单位中，所有妇女常规入院时行 CTG。无单位在低危产妇中常规行产时连续 CTG。然而，有 3 个单位在第一产程中常规间歇性使用 CTG。有 3 个单位使用 CTG，但无法获得胎儿血样或 STAN。
我们的发现表明，挪威在产时胎儿监测的使用方面存在一些与临床建议的偏差。有 3 个单位对无危险因素的妇女使用间歇性 CTG。近四分之一的单位常规入院时行 CTG，尽管有国家临床建议。在使用 CTG 的单位中无法获得胎儿血样或 STAN 令人担忧。
