Alfirevic Z, Walkinshaw S A
Department of Obstetrics and Gynaecology, University of Liverpool, UK.
Br J Obstet Gynaecol. 1995 Aug;102(8):638-43. doi: 10.1111/j.1471-0528.1995.tb11402.x.
To compare the impact on perinatal outcome of two different protocols for antenatal fetal monitoring after 42 weeks gestation.
A prospective randomised controlled trial.
Liverpool Maternity Hospital.
One hundred and forty-five women with singleton, uncomplicated pregnancies after 42 weeks of gestation.
Random allocation to fetal monitoring by either: 1. a modified biophysical profile comprising of computerised cardiotocography, amniotic fluid index, and assessment of fetal breathing, tone and gross body movements; or 2. standard cardiotocography and maximum pool depth.
Cord pH at delivery, number of abnormal monitoring tests, intrapartum management, mode of delivery and neonatal outcome.
There were significantly more abnormal antenatal monitoring results in the modified biophysical profile group (47.2% vs 20.5%; odds ratio = 3.5, 99% CI = 1.3-9.1). There were no differences in cord blood gases, neonatal outcome, or in outcomes related to labour and delivery between the two groups, but a trend towards more obstetric interventions in the modified biophysical profile group was noted. Amniotic fluid volume after 42 weeks was more likely to be labelled as abnormal with amniotic fluid index than with maximum pool depth (44.4% vs 15.1%; odds ratio = 4.5, 99% CI = 1.6-12.8).
The results suggest that after 42 weeks fetal monitoring with the modified biophysical profile does not improve pregnancy outcome as measured by umbilical cord pH, but is more likely to yield an abnormal result. The higher incidence of abnormal monitoring results in the modified biophysical profile group was likely to be caused by different methods of amniotic fluid assessment in the modified biophysical profile group (amniotic fluid index) and simple monitoring group (maximum pool depth). The use of amniotic fluid index as a test of fetal wellbeing in prolonged pregnancy may lead to more obstetric interventions with, as yet, unclear impact on the perinatal outcome.
比较妊娠42周后两种不同的产前胎儿监测方案对围产期结局的影响。
一项前瞻性随机对照试验。
利物浦妇产医院。
145名单胎、妊娠42周后无并发症的孕妇。
随机分配进行以下胎儿监测：1. 改良生物物理评分，包括电脑化胎心监护、羊水指数以及胎儿呼吸、肌张力和大体运动评估；或2. 标准胎心监护和最大羊水深度。
分娩时脐动脉血pH值、异常监测检查次数、产时管理、分娩方式及新生儿结局。
改良生物物理评分组产前监测异常结果显著更多（47.2%对20.5%；优势比=3.5，99%可信区间=1.3-9.1）。两组间脐血气、新生儿结局或与分娩相关的结局无差异，但改良生物物理评分组有更多产科干预的趋势。42周后，用羊水指数评估羊水过少比用最大羊水深度更易被判定为异常（44.4%对15.1%；优势比=4.5，99%可信区间=1.6-12.8）。
结果表明，妊娠42周后，用改良生物物理评分进行胎儿监测并不能改善以脐动脉血pH值衡量的妊娠结局，但更可能得出异常结果。改良生物物理评分组监测异常结果发生率较高可能是由于该组（羊水指数）和单纯监测组（最大羊水深度）羊水评估方法不同。在过期妊娠中使用羊水指数作为胎儿健康状况的检测指标可能导致更多产科干预，但其对围产期结局的影响尚不清楚。
