Schifrin Barry S, Koos Brian J, Cohen Wayne R, Soliman Mohamed
Department of Obstetrics and Gynecology, Western University of Health Sciences, Pomona, CA, United States.
Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.
Front Pediatr. 2022 Sep 23;10:915344. doi: 10.3389/fped.2022.915344. eCollection 2022.
Electronic fetal monitoring (EFM) was introduced into obstetric practice in 1970 as a test to identify early deterioration of fetal acid-base balance in the expectation that prompt intervention ("rescue") would reduce neonatal morbidity and mortality. Clinical trials using a variety of visual or computer-based classifications and algorithms for intervention have failed repeatedly to demonstrate improved immediate or long-term outcomes with this technique, which has, however, contributed to an increased rate of operative deliveries (deemed "unnecessary"). In this review, we discuss the limitations of current classifications of FHR patterns and management guidelines based on them. We argue that these clinical and computer-based formulations pay too much attention to the detection of systemic fetal acidosis/hypoxia and too little attention not only to the pathophysiology of FHR patterns but to the provenance of fetal neurological injury and to the relationship of intrapartum injury to the condition of the newborn. Although they do not reliably predict fetal acidosis, FHR patterns, properly interpreted in the context of the clinical circumstances, do reliably identify fetal neurological integrity (behavior) and are a biomarker of fetal neurological injury (separate from asphyxia). They provide insight into the mechanisms and trajectory (evolution) of any hypoxic or ischemic threat to the fetus and have particular promise in signaling preventive measures (1) to enhance the outcome, (2) to reduce the frequency of "abnormal" FHR patterns that require urgent intervention, and (3) to inform the decision to provide neuroprotection to the newborn.
电子胎儿监护（EFM）于1970年被引入产科实践，作为一种识别胎儿酸碱平衡早期恶化的检测方法，期望通过及时干预（“抢救”）降低新生儿发病率和死亡率。使用各种基于视觉或计算机的分类及干预算法的临床试验多次未能证明该技术能改善即时或长期结局，然而，该技术却导致了手术分娩率上升（被认为是“不必要的”）。在本综述中，我们讨论了当前胎心率模式分类以及基于这些分类的管理指南的局限性。我们认为，这些临床和基于计算机的公式过于关注系统性胎儿酸中毒/缺氧的检测，而对胎心率模式的病理生理学、胎儿神经损伤的来源以及产时损伤与新生儿状况的关系关注过少。尽管它们不能可靠地预测胎儿酸中毒，但在临床情况背景下正确解读的胎心率模式确实能可靠地识别胎儿神经完整性（行为），并且是胎儿神经损伤（与窒息分开）的生物标志物。它们能深入了解对胎儿任何缺氧或缺血威胁的机制和轨迹（演变），在提示预防措施方面具有特殊前景：（1）改善结局；（2）减少需要紧急干预的“异常”胎心率模式的频率；（3）为是否对新生儿提供神经保护的决策提供依据。
