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产时胎心率评估

Author
David A Miller, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG
Translators
王以新, 主任医师

引言

人类正常临产的特点是：子宫规律收缩且重复出现胎儿氧合暂时中断。多数胎儿可很好地耐受这个过程，但有些胎儿不能。由于胎心率(fetal heart rate, FHR)图形可间接反映胎儿心脏和中枢神经系统对血压、血气和酸碱状态改变的反应，故有助于区分上述两类胎儿。 (参见“产前胎心率评估”，关于‘胎儿心脏发育及生理学’一节)

产时FHR监测的理论依据是，识别可能与胎儿氧合不足有关的FHR变化可能有助于及时采取干预措施，降低缺氧性损害和死亡的可能性。虽然几乎所有产科学会均建议产时进行FHR监测，但目前尚未明确证实该干预的益处，该做法很大程度上基于的是专家意见和法医学先例。

本文将讨论产时胎儿监护。产前FHR监测(无应激试验、宫缩应激试验)见其他专题。 (参见“产前胎心率评估”)

产时FHR监护可改善新生儿结局吗？

虽有一些证据提示，产时胎儿监测可使产时胎儿死亡减少[1]，但目前尚未证实其可减少长期神经系统损害。现有数据来自于对持续电子监测和间歇胎心听诊进行比较的试验。目前没有对进行与不进行产时胎儿监测进行比较的随机试验。

对于低危和高危妊娠，与间歇胎心听诊相比，持续电子FHR监测在预防胎儿死亡和神经功能远期不良结局方面无明确优势，且假阳性率高[2-4]。2013年的一项系统评价纳入了13项随机试验，共37,000多例低危及高危妊娠，对持续电子FHR监测与间歇胎心听诊进行了比较，结果发现，这两种监测方法在如下新生儿/儿童期结局方面的差异没有统计学意义[2]：

                                  

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-24.
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