Tommaso Mariarosaria Di, Pinzauti Serena, Bandinelli Silvia, Poli Chiara, Ragusa Antonio
Department of Health Sciences, University of Florence, Italy.
San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy.
Adv Clin Exp Med. 2019 Sep;28(9):1193-1198. doi: 10.17219/acem/103843.
All guidelines regarding electronic fetal heart monitoring (EFM) before 2008 were designed to avoid more hypoxia than acidosis. In addition, the results of the Cochrane meta-analysis of 2013 do not show a significant improvement in neonatal outcomes using EFM or intermittent auscultation (IA).
We retrospectively evaluated the results on delivery outcomes arising from a comparison between EFM and IA during labor of 2 specific and high-quality trials. We hypothesized that revisiting the delivery outcomes through the adoption of the recent National Institute of Child Health and Human Development (NICHHD) guidelines, the reported delivery outcomes would be different.
The study retrospectively evaluated the results on delivery outcomes arising from the comparison between EFM and IA during labor of the "Dublin trial" and "Vintzileos trial" published, respectively, in 1985 and 1993. A translational model was constructed to recalculate these results, applying a correction factor to estimate the number of pathological patterns using the NICHHD guidelines for EFM.
After the reevaluation of the 2 trials using the proposed correction factor, the comparison of the recalculated cesarean section and operative delivery rates for fetal distress between EFM and IA group were no longer statistically significant, both in the Dublin trial and Vintzileos trial. Even the comparison of the recalculated incidence of the rate of non-reassuring fetal heart rate (FHR) patterns in the EFM and IA groups has not given any indication of significance for the Vintzileos trial.
Our results lead to reconsidering the results of the Dublin trial and Vintzileos trial in terms of operational rates of births, hypothesizing that these results would have been significantly lower if FHR traces were interpreted using the current NICHHD guidelines, which aim to identify potential acidotic fetuses rather than hypoxic ones.
2008年以前所有关于电子胎儿监护（EFM）的指南旨在避免比酸中毒更多的缺氧情况。此外，2013年Cochrane荟萃分析的结果并未显示使用EFM或间歇性听诊（IA）在新生儿结局方面有显著改善。
我们回顾性评估了两项特定高质量试验中分娩期间EFM与IA比较所产生的分娩结局结果。我们假设通过采用美国国立儿童健康与人类发展研究所（NICHHD）的最新指南重新审视分娩结局，报告的分娩结局会有所不同。
该研究回顾性评估了分别于1985年和1993年发表的“都柏林试验”和“温齐莱奥斯试验”中分娩期间EFM与IA比较所产生的分娩结局结果。构建了一个转换模型来重新计算这些结果，应用校正因子根据NICHHD的EFM指南估计病理模式的数量。
在使用提议的校正因子对两项试验进行重新评估后，在都柏林试验和温齐莱奥斯试验中，EFM组与IA组之间重新计算的因胎儿窘迫而行剖宫产和手术分娩率的比较不再具有统计学意义。即使对EFM组和IA组重新计算的胎心监护（FHR）图形异常率的发生率进行比较，温齐莱奥斯试验也未显示出任何显著性。
我们的结果致使我们重新考虑都柏林试验和温齐莱奥斯试验在分娩手术率方面的结果，推测如果使用当前旨在识别潜在酸中毒胎儿而非缺氧胎儿的NICHHD指南来解读FHR图形，这些结果会显著更低。
