Vintzileos A M, Nochimson D J, Guzman E R, Knuppel R A, Lake M, Schifrin B S
Department of Obstetrics, Gynecology, and Reproductive Sciences, Robert Wood Johnson Medical School/St. Peter's Medical Center, University of Medicine and Dentistry of New Jersey, New Brunswick.
Obstet Gynecol. 1995 Jan;85(1):149-55. doi: 10.1016/0029-7844(94)00320-d.
To use a meta-analysis of all published randomized trials to determine whether the use of continuous electronic fetal heart rate monitoring (EFM) as the main method of intrapartum fetal surveillance is associated with improved pregnancy outcome compared to intermittent auscultation.
We used the MEDLINE data base and reference lists of articles to identify all published randomized trials of EFM versus intermittent auscultation.
A total of nine randomized trials published in peer-review journals were identified. The selection criterion was the use of EFM or intermittent auscultation as the main intrapartum fetal surveillance technique.
A total of 18,561 patients were included in the nine published randomized trials, 9398 in the EFM group and 9163 in the auscultation group. Measures of pregnancy outcome included cesarean delivery, cesarean for suspected fetal distress, overall use of forceps or vacuum, use of forceps or vacuum for suspected fetal distress, overall perinatal mortality, and perinatal mortality due to fetal hypoxia (intrapartum or early neonatal death) attributable to the method of intrapartum monitoring. The meta-analysis showed that the patients monitored electronically had a significantly higher overall cesarean rate (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.17-2.01), higher cesarean rate for fetal distress (OR 2.55, 95% CI 1.81-3.53), overall increased use of forceps or vacuum (OR 1.23, 95% CI 1.02-1.49), increased use of forceps or vacuum for suspected fetal distress (OR 2.50, 95% CI 1.97-3.18), and decreased perinatal mortality due to fetal hypoxia (OR 0.41, 95% CI 0.17-0.98).
Electronic fetal monitoring is associated with increased rates of surgical intervention and decreased perinatal mortality due to fetal hypoxia.
通过对所有已发表的随机试验进行荟萃分析，以确定与间歇性听诊相比，采用连续电子胎儿心率监测（EFM）作为产时胎儿监护的主要方法是否能改善妊娠结局。
我们使用MEDLINE数据库及文章的参考文献列表来识别所有已发表的EFM与间歇性听诊的随机试验。
共识别出9项发表于同行评审期刊的随机试验。选择标准为采用EFM或间歇性听诊作为主要的产时胎儿监护技术。
9项已发表的随机试验共纳入18561例患者，EFM组9398例，听诊组9163例。妊娠结局指标包括剖宫产、因可疑胎儿窘迫行剖宫产、产钳或真空吸引器的总体使用情况、因可疑胎儿窘迫使用产钳或真空吸引器、总体围产儿死亡率以及因产时监护方法导致的胎儿缺氧（产时或早期新生儿死亡）所致的围产儿死亡率。荟萃分析显示，接受电子监护的患者总体剖宫产率显著更高（优势比[OR]1.53，95%置信区间[CI]1.17 - 2.01），因胎儿窘迫行剖宫产的比例更高（OR 2.55，95% CI 1.81 - 3.53），产钳或真空吸引器的总体使用增加（OR 1.23，95% CI 1.02 - 1.49），因可疑胎儿窘迫使用产钳或真空吸引器的情况增加（OR 2.50，95% CI 1.97 - 3.18），且因胎儿缺氧导致的围产儿死亡率降低（OR 0.41，95% CI 0.17 - 0.98）。
电子胎儿监护与手术干预率增加及因胎儿缺氧导致的围产儿死亡率降低相关。
