Small M L, Phelan J P, Smith C V, Paul R H
Obstet Gynecol. 1987 Oct;70(4):636-40.
Reports have shown that a reactive nonstress test (NST) with decelerations in the postdate patient is associated with an increase in perinatal morbidity. Based on these observations, patients who exhibited this fetal heart rate (FHR) pattern during NST had labor induced. The purpose of this report was to determine what impact, if any, this approach had on subsequent maternal and fetal outcome. The pregnancy outcome of 470 patients who delivered during 1984 within seven days of their last NST was compared with data from this institution in 1980. The last NST was reactive in 420 patients (89.4%) and nonreactive in 50 (10.6%). Fetal heart rate decelerations occurred in 130 patients (27.7%); of these, 96 (73.9%) were reactive and 34 (26.1%) nonreactive. Postdate patients whose last NST was reactive with decelerations had similar outcomes to patients with a nonreactive NST on their last test, but less favorable outcomes than patients with reactive tests alone. Comparison with data from our institution in 1980 shows that prompt induction of labor in the postdate patient with a reactive NST and decelerations resulted in significantly lower perinatal morbidity, with no corresponding increase in maternal morbidity. These results lead us to conclude that a reactive NST without FHR decelerations is a reliable indicator of fetal well-being in the postdate pregnancy. However, in the postdate pregnancy with a reactive NST with FHR decelerations, induction of labor is indicated.
报告显示，过期妊娠患者进行的反应性无应激试验（NST）出现减速与围产期发病率增加有关。基于这些观察结果，在NST期间出现这种胎儿心率（FHR）模式的患者进行了引产。本报告的目的是确定这种方法对随后的母婴结局有何影响（如果有）。将1984年最后一次NST后7天内分娩的470例患者的妊娠结局与该机构1980年的数据进行了比较。420例患者（89.4%）的最后一次NST呈反应性，50例（10.6%）呈无反应性。130例患者（27.7%）出现胎儿心率减速；其中，96例（73.9%）呈反应性，34例（26.1%）呈无反应性。最后一次NST呈反应性且伴有减速的过期妊娠患者的结局与最后一次试验呈无反应性的患者相似，但比仅呈反应性试验的患者结局更差。与我们机构1980年的数据比较表明，对最后一次NST呈反应性且伴有减速的过期妊娠患者及时引产可显著降低围产期发病率，且孕产妇发病率无相应增加。这些结果使我们得出结论，无FHR减速的反应性NST是过期妊娠中胎儿健康的可靠指标。然而，在最后一次NST呈反应性且伴有FHR减速的过期妊娠中，应引产。
