Dubiel M, Gudmundsson S, Thuring-Jönsson A, Maesel A, Marsal K
University of Lund, Department of Obstetrics and Gynecology, University Hospital Malmö, Sweden.
Am J Perinatol. 1997 Mar;14(3):139-44. doi: 10.1055/s-2007-994114.
Because fetal motor activity reflects the fetal condition in utero, maternal counting of fetal movements has been suggested as a useful method for monitoring fetal well-being, based on empirical evidence that a decrease in or absence of fetal movements often presages fetal death. The aim of this study was to compare the predictive capacity of umbilical artery (UA) Doppler velocimetry with that of nonstress test (NST) cardiotocography in 599 women with low-risk pregnancies, reporting decreased fetal movements. In 19 cases the fetus was dead on maternal admission. Umbilical artery Doppler velocimetry and NST were performed in the remaining 580. In 541 the NST and UA velocimetry findings were reassuring, and the women were discharged. There was one perinatal death in this group, due to extreme prematurity and placental abruption 1 week later. Thirty-nine women who gave birth on the day of admission or next day were especially given closer attention. Umbilical artery velocimetry was abnormal in only one fetus. In 6 cases, the NST trace on admission indicated fetal distress, and emergency cesarean section was performed, resulting in 3 infant deaths and 3 infants with sequelae. The umbilical cord pH was normal in 3, suggesting an earlier temporary intrauterine hypoxic event. Overall perinatal mortality was thus 23 (3.8%). Decreased fetal movement perception by mothers should therefore be taken seriously, even though an irreversible insult to the fetus might already have occurred.
由于胎儿运动反映了子宫内胎儿的状况，基于胎动减少或消失往往预示着胎儿死亡这一经验证据，建议孕妇计数胎动作为监测胎儿健康的一种有用方法。本研究的目的是比较599例低风险妊娠且报告胎动减少的孕妇中，脐动脉（UA）多普勒测速与无应激试验（NST）胎心监护的预测能力。19例孕妇入院时胎儿已死亡。对其余580例孕妇进行了脐动脉多普勒测速和NST检查。541例孕妇的NST和UA测速结果令人放心，这些孕妇随后出院。该组中有1例围产期死亡，原因是极度早产和1周后胎盘早剥。对39例在入院当天或次日分娩的孕妇给予了特别密切的关注。仅1例胎儿的脐动脉测速异常。6例孕妇入院时NST监护显示胎儿窘迫，遂行急诊剖宫产，导致3例婴儿死亡，3例婴儿有后遗症。其中3例脐带血pH值正常，提示早期有一过性宫内缺氧事件。因此，总体围产期死亡率为23例（3.8%）。所以，即使胎儿可能已经受到了不可逆转的损害，母亲感觉到的胎动减少也应予以重视。
