Pello L C, Dawes G S, Smith J, Redman C W
Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford.
Br J Obstet Gynaecol. 1988 Nov;95(11):1128-36. doi: 10.1111/j.1471-0528.1988.tb06790.x.
The fetal heart rates (FHR) of 588 women admitted in labour, or in early labour after induction, were screened for up to 60 min (average 17 min) using computerized numerical analysis. Decelerative records with normal FHR variation occurred in eight (1.4%) and were not associated with acidaemia or depression at birth. Forty women (6.8%) had fetuses with a reduced FHR variation. They were more likely to be in spontaneous labour, to be at an earlier gestational age, and to be delivered operatively for fetal distress of babies that were more hypoxaemic and acidaemic. However, none of the fetuses with the least variable FHR patterns required resuscitation at birth or special care. The results of the screening procedure were not fully concealed and could have influenced clinical management. This is unlikely to have caused the associations that were observed, but could have reduced an association between low FHR variation and poor outcome. We conclude that there is a basis for a randomized controlled trial of FHR screening in early labour, but that this would need to be large (more than 10,000 patients) to test the benefit of detecting the most sinister pattern (decelerations with reduced variation) of which only one example was found in this study.
对588名临产或引产早期入院的孕妇的胎儿心率（FHR）进行了长达60分钟（平均17分钟）的计算机数值分析筛查。8名（1.4%）出现了FHR变异正常的减速记录，且与出生时的酸血症或新生儿抑制无关。40名（6.8%）孕妇的胎儿FHR变异减少。她们更有可能是自然分娩，孕周较早，并且由于胎儿窘迫而进行手术分娩，其婴儿的低氧血症和酸血症更为严重。然而，FHR模式变化最小的胎儿在出生时均无需复苏或特殊护理。筛查程序的结果并未完全保密，可能影响了临床管理。这不太可能导致所观察到的关联，但可能减少了低FHR变异与不良结局之间的关联。我们得出结论，有理由对产程早期的FHR筛查进行随机对照试验，但这需要大量样本（超过10000名患者）才能检验检测到最严重模式（变异减少的减速）的益处，而本研究中仅发现了1例这种模式。
