Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
Obstet Gynecol. 2022 Jun 1;139(6):1003-1008. doi: 10.1097/AOG.0000000000004801. Epub 2022 May 2.
The evolution of continuous electronic fetal heart rate (FHR) monitoring has presented the obstetrician with a critical clinical conundrum: basic science observations suggest that such monitoring might be associated with improved long-term neurologic outcomes, yet, after a half century of use and millions of cesarean deliveries based on FHR monitoring, evidence for such improvement remains absent. This dichotomy appears to be related to widespread misconceptions regarding the physiology underlying various FHR patterns and the developmental origins of cerebral palsy. These misconceptions are strengthened by a reliance on anecdotal experience and tradition in lieu of evidence-based medicine, the confusing "category II" FHR designation, medical-legal considerations, and our tendency to view fetal monitoring, as originally conceptualized, as a single, indivisible entity whose concepts must be accepted or rejected en bloc. Ill-defined and largely imaginary conditions such as "depletion of fetal reserve" are particularly harmful and their use in clinical medicine uniquely not evidence based. A solution to this self-inflicted injury to our specialty will require a concerted effort involving teachers, authors, and researchers.
连续电子胎心监护（FHR）的演变给产科医生带来了一个关键的临床难题：基础科学观察表明，这种监测可能与改善长期神经发育结局有关，但在半个世纪的使用和基于 FHR 监测的数百万例剖宫产之后，仍然缺乏这种改善的证据。这种二分法似乎与人们对各种 FHR 模式背后的生理学以及脑瘫的发育起源的广泛误解有关。这些误解因依赖轶事经验和传统而不是循证医学、令人困惑的“类别 II”FHR 标记、医疗法律考虑因素以及我们倾向于将胎儿监测（最初概念化）视为单一、不可分割的实体而得到加强，其概念必须整体接受或拒绝。诸如“胎儿储备耗竭”等定义不明确且主要是想象的情况特别有害，其在临床医学中的应用是完全没有依据的。要解决我们专业领域的这种自伤问题，需要教师、作者和研究人员的共同努力。
