Department of Obstetrics and Gynecology, University of Porto School of Medicine, and Centro Hospitalar, S. João, Portugal.
Department of Obstetrics and Gynecology, University of Porto School of Medicine, and Centro Hospitalar, S. João, Portugal; Institute of Biomedical Engineering, University of Porto School of Medicine, Porto, Portugal.
Am J Obstet Gynecol. 2019 Mar;220(3):269.e1-269.e8. doi: 10.1016/j.ajog.2018.12.037. Epub 2018 Dec 27.
Intrapartum cardiotocography is widely used in high-resource countries and remains at the center of fetal monitoring and the decision to intervene, but there is ample evidence of poor reliability in visual interpretation as well as limited accuracy in identifying fetal hypoxia. Combined monitoring of intrapartum cardiotocography and ST segment signals was developed to increase specificity, but analysis relies heavily on intrapartum cardiotocography interpretation and is therefore also affected by the previously referred problems. Computerized analysis was developed to overcome these limitations, aiding in the quantification of parameters that are difficult to evaluate visually, such as variability, integrating the complex guidelines of combined intrapartum cardiotocography and ST analysis, and using visual and sound alerts to prompt health care professionals to reevaluate features associated with fetal hypoxia.
The objective of the study was to evaluate the effect of introducing a central fetal monitoring system with computerized analysis of intrapartum cardiotocography and ST signals into the labor ward of a tertiary care university hospital in which all women are continuously monitored with intrapartum cardiotocography. The incidence of adverse perinatal outcomes and intervention rates was evaluated over time.
In this retrospective cohort study, yearly rates of hypoxic-ischemic encephalopathy, instrumental vaginal delivery, overall cesarean delivery, and urgent cesarean delivery were obtained from the hospital's clinical databases. The rates occurring in the period from January 2001 to December 2003, before the introduction of the central monitoring system with computerized analysis of intrapartum cardiotocography and ST signals (Omniview-SisPorto), were compared with those occurring from January 2004 to December 2014, after the introduction of the system. All rates were calculated with 95% confidence intervals.
A total of 38,466 deliveries occurred during this period. After introduction of the system, there was a significant decrease in the number of hypoxic-ischemic encephalopathy cases per 1000 births (5.3%, 95% confidence interval [4.0-7.0] vs 2.2%, 95% confidence interval [1.7-2.8]; relative risk, 0.42, 95% confidence interval [0.29-0.61]), overall cesarean delivery rates (29.9%, 95% confidence interval [28.9-30.8] vs 28.3%, 95% confidence interval [27.8-28.8]; relative risk, 0.96, 95% confidence interval [0.92-0.99]), and urgent cesarean deliveries (21.6%, 95% confidence interval [20.7-22.4] vs 19.2%, 95% confidence interval [18.8-19.7]; relative risk, 0.91, 95% confidence interval [0.87-0.95]). The instrumental vaginal delivery rate increased (19.5%, 95% confidence interval [18.7-20.3] vs 21.4%, 95% confidence interval [21.0-21.9; relative risk, 1.07, 95% confidence interval 1.02-1.13].
Introduction of computerized analysis of intrapartum cardiotocography and ST signals in a tertiary care hospital was associated with a significant reduction in the incidence of hypoxic-ischemic encephalopathy and a modest reduction in cesarean deliveries.
产时胎心监护图在高资源国家广泛应用，仍然是胎儿监测和干预决策的核心，但视觉解释的可靠性差以及识别胎儿缺氧的准确性有限的证据充足。为了提高特异性，联合产时胎心监护图和 ST 段信号监测得到了发展，但分析严重依赖于产时胎心监护图的解释，因此也受到前面提到的问题的影响。计算机化分析的发展克服了这些局限性，有助于量化难以通过视觉评估的参数，如变异性，整合联合产时胎心监护图和 ST 分析的复杂指南，并使用视觉和声音警报来提示医护人员重新评估与胎儿缺氧相关的特征。
本研究旨在评估在一所三级保健大学附属医院的产房引入具有产时胎心监护图和 ST 信号计算机化分析的中央胎儿监测系统对围产期不良结局发生率和干预率的影响。
在这项回顾性队列研究中，从医院的临床数据库中获得了缺氧缺血性脑病、器械性阴道分娩、总剖宫产率和紧急剖宫产率的年度发生率。比较了 2001 年 1 月至 2003 年 12 月在引入产时胎心监护图和 ST 信号的中央监测系统（Omniview-SisPorto）之前的发生率，以及 2004 年 1 月至 2014 年 12 月引入系统后的发生率。所有比率均以 95%置信区间计算。
在此期间，共发生了 38466 例分娩。系统引入后，每 1000 例新生儿中缺氧缺血性脑病的发生率显著下降（5.3%，95%置信区间[4.0-7.0] vs 2.2%，95%置信区间[1.7-2.8]；相对风险，0.42，95%置信区间[0.29-0.61]），总剖宫产率（29.9%，95%置信区间[28.9-30.8] vs 28.3%，95%置信区间[27.8-28.8]；相对风险，0.96，95%置信区间[0.92-0.99]）和紧急剖宫产率（21.6%，95%置信区间[20.7-22.4] vs 19.2%，95%置信区间[18.8-19.7]；相对风险，0.91，95%置信区间[0.87-0.95]）。器械性阴道分娩率增加（19.5%，95%置信区间[18.7-20.3] vs 21.4%，95%置信区间[21.0-21.9]；相对风险，1.07，95%置信区间 1.02-1.13]）。
在三级保健医院引入产时胎心监护图和 ST 信号的计算机化分析与缺氧缺血性脑病发生率的显著降低和剖宫产率的适度降低相关。
