Ingemarsson I, Arulkumaran S, Ingemarsson E, Tambyraja R L, Ratnam S S
Obstet Gynecol. 1986 Dec;68(6):800-6.
The usefulness of a short electronic fetal heart rate recording at admission of patients in labor (admission test) was investigated in low-risk patients in two prospective studies. The admission test was done in a concealed manner, and the result of the test was evaluated after delivery so as not to influence the clinical management. In part I of the investigation, the test was performed in 130 patients monitored during labor with pH determinations in scalp blood and in cord blood at birth. Patients with reactive admission tests had a low rate of intrauterine asphyxia in labor (0.9%), whereas half of the patients with ominous traces had intrauterine fetal asphyxia with a low scalp blood pH and neonatal depression. Similar results were obtained in part II, when the admission test was used as a screening procedure involving 1041 patients. The test was reactive in 94.3%, and in this group fetal distress (cesarean section, or forceps on that indication, or an Apgar score less than 7 at five minutes) occurred in 1.3%. Ten patients (1.0%) had ominous tests; four of these had fetal distress, and one of these fetuses died in utero three hours after admission, during which time stethoscopic auscultation failed to detect the fetal compromise. It is concluded that the admission test can detect fetal distress already present at admission and unnecessary delay in intervention can be avoided in such a case. The test seems also to have some predictive value for the fetal well-being for the next few hours of labor. The test is simple and convenient for screening purposes.
在两项前瞻性研究中，对低风险产妇入院时进行简短电子胎心监护（入院检查）的效用进行了调查。入院检查以隐蔽方式进行，检查结果在分娩后评估，以免影响临床管理。在调查的第一部分，对130名产妇进行了检查，这些产妇在分娩期间接受监护，并在出生时测定头皮血和脐血的pH值。入院检查呈反应型的产妇，分娩时发生宫内窒息的比例较低（0.9%），而有不祥迹象的产妇中有一半发生了宫内胎儿窒息，头皮血pH值较低且有新生儿抑制。在第二部分研究中也得到了类似结果，当时入院检查被用作对1041名产妇的筛查程序。检查呈反应型的比例为94.3%，在这组产妇中，胎儿窘迫（剖宫产、因该指征行产钳助产或5分钟时阿氏评分低于7分）的发生率为1.3%。10名产妇（1.0%）检查结果不祥；其中4名有胎儿窘迫，其中1名胎儿在入院3小时后死于宫内，在此期间听诊未能发现胎儿窘迫。结论是，入院检查能够检测出入院时已存在的胎儿窘迫，在这种情况下可避免不必要的干预延迟。该检查似乎对接下来几个小时的分娩过程中胎儿的健康状况也有一定的预测价值。该检查用于筛查目的简单方便。
