Skupski D W, Chervenak F A, McCullough L B, Horowitz S
Department of Obstetrics & Gynecology, New York Hospital-Cornell University Medical Center, New York, USA.
Obstet Gynecol. 1996 Jul;88(1):60-4. doi: 10.1016/0029-7844(96)00078-6.
To identify the descriptive clinical practice of maternal-fetal medicine specialists when faced with severe intrapartum fetal heart rate (FHR) abnormalities (as determined by continuous electronic fetal monitoring).
All regular members of the Society of Perinatal Obstetricians (maternal-fetal medicine specialists) were sent a survey questionnaire on the topic of cesarean delivery for intrapartum FHR abnormalities. The time from observation of FHR abnormalities to making the decision to proceed to cesarean delivery was the main outcome measure. Time was allowed for intrauterine resuscitative maneuvers to alleviate the abnormal pattern. Legislative definitions of consensus and strong consensus were applied to the data. Analysis of covariance was performed to determine the effect of physician demographic factors on the times reported.
Four hundred thirty-one of 704 (61.2%) questionnaires were returned. Consensus was identified for deciding on cesarean delivery (after intrauterine resuscitation) 1) after 30 minutes for cases of repetitive late and severe variable decelerations, 2) after 10 minutes in cases of fetal bradycardia, and 3) in all scenarios with decreased beat-to-beat variability of the FHR. Consensus was identified for deciding on cesarean delivery in five of eight intrapartum FHR pattern abnormalities.
The descriptive clinical practice of maternal-fetal medicine specialists demonstrated in this study should be considered in prudential clinical judgment.
确定母胎医学专家在面对严重产时胎儿心率（FHR）异常（通过连续电子胎儿监护确定）时的描述性临床实践。
向围产期产科医师协会的所有正式成员（母胎医学专家）发送了一份关于产时FHR异常剖宫产的调查问卷。从观察到FHR异常到决定进行剖宫产的时间是主要结局指标。允许进行宫内复苏操作以缓解异常模式。对数据应用了共识和强烈共识的立法定义。进行协方差分析以确定医生人口统计学因素对报告时间的影响。
704份问卷中有431份（61.2%）被退回。对于决定剖宫产（宫内复苏后）达成了以下共识：1）对于反复出现的晚期和严重变异减速病例，30分钟后；2）对于胎儿心动过缓病例，10分钟后；3）在所有FHR逐搏变异减少的情况下。在八种产时FHR模式异常中的五种中达成了决定剖宫产的共识。
本研究中展示的母胎医学专家的描述性临床实践应在审慎的临床判断中予以考虑。
