Herbst A, Ingemarsson I
Department of Obstetrics and Gynaecology, University of Lund, Sweden.
Br J Obstet Gynaecol. 1994 Aug;101(8):663-8. doi: 10.1111/j.1471-0528.1994.tb13181.x.
To compare the efficacy in detecting signs of fetal hypoxia in labour of intermittent (I-group) versus continuous (C-group) electronic fetal monitoring in women with low or moderate risk factors for fetal distress.
A prospective, randomised study.
A tertiary referral centre.
Four thousand and forty-four parturients at low risk for obstetric complications with a reactive fetal heart rate admission test at arrival in labour. During the study period (October 5 1989 to May 31 1991), 5647 women were delivered in the labour ward. Of these, 1178 women (20.9%) were excluded because of high risk factors in pregnancy or at admission for labour, including women undergoing elective caesarean section. Of the remaining 4469 women 4044 (90.5%) were randomised to either intermittent (n = 2015) or continuous monitoring (n = 2029) during the first stage of labour.
In the C-group the fetal heart rate was recorded continuously with electronic fetal monitoring during the first stage of labour. In the I-group the fetal heart rate was recorded with electronic fetal monitoring for 10 to 30 min every 2 to 2.5 h during the first stage of labour, and the fetal heart rate was auscultated every 15 to 30 min in between recording periods. If complications occurred, recording was changed to continuous. In the second stage of labour all the women were monitored continuously. Umbilical cord artery acid-base status was assessed at birth.
Duration of electronic fetal monitoring, rates of abnormal fetal heart rate patterns, caesarean section for fetal distress, acidosis in umbilical cord arterial blood at birth, Apgar scores of less than 7 at 1 or 5 min, and referrals to the neonatal intensive care unit.
There were no significant differences between the study groups in the incidence of ominous fetal heart rate recordings: 6.3% (I-group) versus 6.6% (C-group), or the interval from arrival to first detected abnormal fetal heart rate, although the number of suspicious fetal heart rate patterns was higher in the C-group (28.6%) than in the I-group (24.6%). In the I-group electronic fetal monitoring was performed for (median monitoring time) 38.8% of the first stage of labour as compared with 78.6% in the C-group. The incidence of caesarean section for fetal distress was similarly low in both groups: 1.2% versus 1.0%. There were no significant differences in the immediate neonatal outcome in terms of umbilical artery pH, Apgar scores, or admissions to the neonatal care unit.
Intermittent use of electronic fetal monitoring at regular intervals (with stethoscopic auscultation in between) appears to be as safe as continuous electronic fetal monitoring in low risk labours.
比较间歇性（I组）与连续性（C组）电子胎儿监护在检测低或中度胎儿窘迫风险因素孕妇产时胎儿缺氧迹象方面的疗效。
一项前瞻性随机研究。
一家三级转诊中心。
4044名产科并发症低风险且入院时胎儿心率试验反应型的产妇。在研究期间（1989年10月5日至1991年5月31日），有5647名妇女在分娩病房分娩。其中，1178名妇女（20.9%）因孕期或分娩入院时存在高风险因素被排除，包括接受择期剖宫产的妇女。在其余4469名妇女中，4044名（90.5%）在第一产程中被随机分为间歇性监护组（n = 2015）或连续性监护组（n = 2029）。
C组在第一产程中使用电子胎儿监护持续记录胎儿心率。I组在第一产程中每2至2.5小时使用电子胎儿监护记录胎儿心率10至30分钟，在记录时段之间每15至30分钟听诊胎儿心率。若出现并发症，则改为持续记录。在第二产程中，所有妇女均进行持续监护。出生时评估脐动脉酸碱状态。
电子胎儿监护持续时间、异常胎儿心率模式发生率、因胎儿窘迫行剖宫产率、出生时脐动脉血酸中毒情况、1分钟或5分钟时Apgar评分低于7分以及转入新生儿重症监护病房的情况。
研究组之间在不祥胎儿心率记录发生率方面无显著差异：6.3%（I组）对6.6%（C组），或从入院到首次检测到异常胎儿心率的间隔时间，尽管C组可疑胎儿心率模式数量（28.6%）高于I组（24.6%）。I组电子胎儿监护在第一产程中的实施时间（中位监护时间）为38.8%，而C组为78.6%。两组因胎儿窘迫行剖宫产的发生率同样较低：1.2%对1.0%。在脐动脉pH值、Apgar评分或转入新生儿监护病房方面，两组的即时新生儿结局无显著差异。
在低风险分娩中，定期间歇性使用电子胎儿监护（其间进行听诊）似乎与持续电子胎儿监护一样安全。
