Manning F A, Menticoglou S, Harman C R, Morrison I, Lange I R
Baillieres Clin Obstet Gynaecol. 1987 Mar;1(1):55-72. doi: 10.1016/s0950-3552(87)80023-8.
In the art of medicine we have always known that establishing an accurate diagnosis of health or disease is essential. An active search for the physical signs, both the time honoured and newly discovered, are a crucial step in achieving diagnostic accuracy, in monitoring disease progression, and in assigning prognosis. In extrauterine medicine it is common practice to gather together sets of biophysical data in order to determine immediate health, to monitor condition, and to estimate prognosis: witness the use of vital signs, and, in the newborn, the Apgar score. The providers of perinatal care have known since biblical days that fetal biophysical activities were a reflection of fetal condition (Luke: Chapter 1, Verses 44-45), yet lacked the ability to categorize these activities in an objective and complete manner. The introduction of dynamic ultrasound imaging methods to perinatal medicine at last create the window through which the principles of extrauterine medicine may now be applied to the intrauterine patient--the fetus. Fetal biophysical profile scoring is a method that utilizes this new wealth of information to differentiate the normal fetus from the fetus at risk for death or damage in utero. The method is based on the concept that the discrimination of fetal health and disease improves as more variables are considered. The now extensive clinical experience with the method, in which both overall (gross) and selected (corrected) perinatal death are reduced, while maintaining a remarkably low false negative predictive error, indicate the validity of the concept. Comparative studies lead us to believe that reliance upon single biophysical variables, such as fetal movement counts, or antepartum fetal heart rate monitoring, is no longer of sufficient accuracy to support its use as a sole measure of fetal condition. Looking forward, we anticipate that while the concept on which fetal biophysical profile scoring is based will remain unchanged, inclusion of additional variables is likely to occur. It seems likely that addition of new variables, as may be now measured using high-resolution dynamic ultrasound methods, both B-mode and Doppler, will improve diagnostic accuracy even more. We believe that the application of the current and future modified methods of composite fetal risk assessment will render the occurrence of the tragedy of perinatal loss even more infrequent. While the goal of complete elimination of perinatal deaths remain elusive, this method may be one step towards this goal.
在医学领域，我们一直都明白，准确诊断健康状况或疾病至关重要。积极寻找各种体征，包括那些由来已久的和新发现的体征，是实现诊断准确性、监测疾病进展以及判断预后的关键步骤。在宫外医学中，为了确定即时健康状况、监测病情并评估预后，通常会收集一系列生物物理数据：例如生命体征的使用，以及新生儿的阿氏评分。自圣经时代起，围产期护理人员就知道胎儿的生物物理活动反映了胎儿的状况（路加福音：第一章，第44 - 45节），但缺乏以客观和完整的方式对这些活动进行分类的能力。动态超声成像方法引入围产期医学，终于创造了一扇窗口，通过它宫外医学的原则现在可以应用于宫内患者——胎儿。胎儿生物物理评分是一种利用这些丰富新信息来区分正常胎儿与宫内有死亡或损伤风险胎儿的方法。该方法基于这样的概念，即考虑的变量越多，对胎儿健康和疾病的辨别能力就越强。目前对该方法广泛的临床经验表明，总体（粗略）和选定（校正）围产期死亡率都有所降低，同时保持了极低的假阴性预测误差，这表明了该概念的有效性。比较研究使我们相信，依赖单一生物物理变量，如胎动计数或产前胎儿心率监测，其准确性已不足以支持将其作为评估胎儿状况的唯一指标。展望未来，我们预计虽然胎儿生物物理评分所基于的概念将保持不变，但可能会纳入更多变量。似乎使用高分辨率动态超声方法（B超和多普勒）测量的新变量的加入，将进一步提高诊断准确性。我们相信，当前和未来改进的综合胎儿风险评估方法的应用，将使围产期损失悲剧的发生更加罕见。虽然完全消除围产期死亡的目标仍然难以实现，但这种方法可能是朝着这个目标迈出的一步。
