第一产程异常胎心监护图形的分析

目的:探讨第一产程异常胎心监护图形的临床意义。方法:选自第一产程胎心监护图形异常的患者348例为观察组,367例第一产程胎心监护正常者为对照组。观察并比较两组间孕妇并发症及胎儿合并症的情况。结果:①电子胎心监护显示早期减速(ED)所占比例最高,为55.2%,然后依次为变异减速(VD)、晚期减速(LD)、心动过速、心动过缓、基线变异减弱及延长减速(PD)。②观察组中,伴有脐带绕颈及羊水量异常的患者分别占28.4%和10.3%,其比例均明显高于对照组,两组之间均有统计学差异(P<0.05)。③观察组中羊水粪染(Ⅱ-Ⅲ度),Apgar评分≤7分(出生1min),胎儿窘迫及剖宫产的比例均明显高于对照组,两组之间均有统计学差异(P<0.05)。结论:不同电子胎心监护异常图形有不同的临床意义,应该结合临床资料综合分析。     

第一产程异常胎心监护图形与新生儿结局的关系

目的　探讨第一产程异常胎心监护图形与新生儿结局的关系。方法　回顾分析 2 0 0 2年 8月至 2 0 0 3年 6月在我院足月单胎头位分娩产妇 ,第一产程中胎心率 (FHR)异常图形 2 1 7例 (观察组 )和FHR正常图形的2 6 9例 (对照组 )的临床资料。结果　第一产程异常FHR图形的发生率为 4 4 7% ,常见类型为轻度变异减速(6 4 5 % )、基线变异减弱 (2 1 6 % )和轻度心动过速 (1 2 0 % )。晚期减速、基线变异减弱和重度变异减速是导致新生儿窒息的危险因素。观察组羊水过少 (5 1 % )、脐带缠绕 (2 2 6 % )、羊水粪染 (1 0 6 % )、新生儿窒息 (6 5 % )、新生儿转入NICU(1 0 1 % )的发生率和剖宫产率 (31 8% )明显高于对照组 (P <0 0 5 )。结论　第一产程异常FHR图形的发生率较高 ,其中晚期减速、基线变异减弱、重度变异减速与新生儿窒息的发生相关 ,其他图形可在严密监护下继续试产     

第二产程胎心监护异常的处理及临床意义

目的 探讨第二产程胎心监护异常者的分娩方式,及其与产妇并发症和围产儿结局的关系。方法 回顾性分析我院足月单胎头位分娩产妇第二产程中胎心率（FHR）正常的111例（对照组）和胎心率异常的121例（观察组）的资料。结果 FHR异常的发生率为52.2%（121／232）,异常胎心率类型包知中、重度变异减速（VD）81例,占66.9%;晚期减速（LD）27例,占22.3%,其中仅1例发生连续LD;延长减速（PD）4例,占3.3%;VD合并LD2例,占1.7%;VD合并PD3例,占2.5%;基线变异减弱4例,占3.3%。对照组中,阴道助产13例（11.7%）,顺产98例（88.3%）;观察组中,顺产86例（71.1%）,阴道助产35例（28.9%）,其中29例（82.9%）为FHR异常而施术者,两组间比较,差异有显著性（P＜0.05）。观察组、对照组新生儿窒息的发生率（分别为5.0%、1.8%）及产伤的发生率（14.3%、15.4%）比较,差异均无显著性（P＞0.05）;观察组中有1例产妇会阴Ⅲ度撕伤。结论 第二产程中FHR异常的发生率高,多为产程中胎头受压或脐带受压而引起的迷走神经反射或暂时性子宫胎盘血流减少,并非缺氧所致,不必急于干预,以免造成母、儿损伤。     

全产程连续胎心监护1174例临床分析

产时胎儿窘迫是引起围生儿死亡及新生儿智力低下、脑瘫、癫痫等后遗症的主要原因。因此 ,加强分娩期胎儿监护 ,及时诊治胎儿窘迫 ,是降低围生儿病死率 ,提高出生人口质量的重要措施。国外在 80年代初提出并常规使用了胎儿入室监护 ,以判断胎儿胎盘的储备能力[1] ,并于临产后进行全产程的胎心监护 ,及时发现胎儿窘迫。近年来 ,国内部分医院已逐步开展了入室监护。我院应用ＭＦＭ产科中央监护系统 ,对住院分娩的孕妇进行入室监护及全产程监护 ,取得良好效果 ,现报告如下。1　资料与方法1 1　研究对象　　随机选择 1998年 9月至 1999年 4月在我…     

产程中持续胎心监护的现在与将来

        人类正常产程中，节律性的、强有力的宫缩会导致间断性的胎儿供氧中断。绝大多数胎儿可以耐受分娩这一过程，但仍有一小部分胎儿会在产程中因这种间断性供氧中断发生严重缺氧，出现缺氧性损伤甚至死亡。产程中应用持续胎心监护（cardiotocography，CTG）可评估胎儿氧合情况，可能有助于判断氧供中断的频率、持续时间以及严重程度。当持续CTG提示胎儿处于危险状况时，通过宫内复苏或立即分娩，也许可以预防胎儿严重损伤或死亡。     

第二产程胎心监护异常标准化评判和处理

电子胎心监护由于操作简便、无创、结果实时确切,已成为产科临床应用最广泛的胎儿监护手段。但目前在对电子胎心监护图形的解读上尚存在许多争议,如何根据监护结果做出正确的临床决策也未达成一致意见。文章介绍了最新的电子胎心监护图形标准化定义,解读其原理及标准化的处理方法。     

胎心监护在产程中的应用

目的减少围产儿的病残率和死亡率，熟练地识别胎心监护图，正确地指导产程中的处理。方法分析我院2002年1月-2004年12月在产程中采用胎心率电子外监护587例，出现异常胎心宫缩图形243例，其中基线率异常89例，胎心率各类减速94例，其中新生儿轻度窒息21例，重度窒息3例。结果产程中出现晚减(ID)、可变减(VD)、频发早减(ED)及基线率异常都是胎儿缺氧的表现。结论产妇产前应常规进行胎心监护，以便及时发现异常胎心变化，减少围产儿的死亡率及病残率。     

产时联合应用胎心内外监护56例临床分析

目的：探讨胎心内外监护图形满意率的差异及胎心内监护在产时的应用价值。方法：对56例孕妇在第一产程活跃期和第二产程同时行胎心外监护和内监护,对胎心监护图形进行分类,比较胎心监护图形的满意率。,结果：第一产程胎心外和胎心内监护的图形满意率分别为94．6％和98．2％,两者无显著差异（X2=0．259,P=0．611）;第二产程胎心外和胎心内监护的图形满意率分别为42．3％和86．5％,两者差异显著（X2=22．193,P=0．000）。外监护中10例（17．9％）出现假性图形。、56例产妇的剖宫产率为7．14％,无1例出现新生儿窒息、胎儿头皮损伤血肿及产褥感染。结论：胎心内监护是胎心外监护的一项安全有效的补充。。     

产程胎心监护的方法及必要性探讨

产程监护是采用人工及生物物理、生物化学方法对胎儿宫内安全和产程进展进行监测,以便及早发现胎儿宫内缺氧、识别难产,并积极加以处理。胎儿宫内状况的监护方法包括间断胎心听诊、持续胎心监护、胎儿头皮刺激试验、胎儿头皮血样检查、胎儿脉冲血氧测定法等。持续胎心监护仍是产时一个有效而必要的胎心监护手段。     

计算机辅助产程监护

计算机辅助产程监护潘俊峰，余玉琳，柴靖华，杨芳影响产妇最终分娩方式的因素较多，而且这些因素在产程中相互影响。及时准确的判断和处理影响产程进展的因素，是降低难产率的关键。判断正确率的提高，依赖于对众多影响产程进展因素动态的综合分析。以往国内外学者的研究...     

胎心中央监护及远程监护的评价

胎心中央监护及远程监护是胎儿电子监护和计算机网络技术相结合的结晶,通过网络将医院监护仪与家庭监护仪连接到产科中央监护站,经电脑处理后进行信息贮存和分析,以便更方便、更完善地评价胎儿状况,有效改善胎儿预后。     

Intrapartum fetal heart rate monitoring in cases of cytomegalovirus infection

OBJECTIVE: Several studies have shown that abnormal intrapartum fetal heart rate patterns are the results from pre-existing fetal brain damage. We evaluated intrapartum fetal heart rate pattern of cytomegalovirus-infected fetuses and correlated the patterns with neurologic outcomes. STUDY DESIGN: Between 1991 and 2001, there were 20 cytomegalovirus-infected fetuses. We selected 40 fetuses as control subjects that were matched for gestational age and birth weight. Fetal heart rate was interpreted according to the guidelines of the National Institute for Child and Human Development. The incidence of abnormal fetal heart rate pattern and umbilical blood gases were compared between both groups. We also investigated the factors that contributed to abnormal fetal heart rate pattern in the cytomegalovirus group. RESULTS: Nonreassuring fetal heart rate patterns (prolonged deceleration and recurrent late deceleration) were observed in 8 of 20 fetuses (prolonged deceleration, 7 fetuses; recurrent late deceleration, 1 fetus) in the cytomegalovirus group and in 3 of 41 fetuses (prolonged deceleration, 1 fetus; recurrent late deceleration, 2 fetuses) in the control group (P<.05, Fisher test). Baseline fetal heart rate variability was minimal in 4 of the 7 prolonged deceleration cases in the cytomegalovirus group. Umbilical pH <7.1 was found for 1 fetus in the cytomegalovirus group. The average umbilical arterial pH values were similar in both the groups. In the cytomegalovirus group, there were no differences in the incidence of contributing factors between 8 fetuses with abnormal fetal heart rate pattern (prolonged deceleration and recurrent late deceleration) and 8 fetuses with no change. There were 3 fetuses with cerebral palsy: 2 fetuses in the no change group and 1 fetus in the prolonged deceleration group. Antigenemia was positive exclusively in 4 cases with abnormal fetal heart rate pattern (P<.05). CONCLUSION: Cytomegalovirus-infected fetuses are more likely to show abnormal intrapartum fetal heart rate patterns than low-risk control fetuses, which suggests that the perinatal detection of cytomegalovirus is necessary to distinguish hypoxic-ischemic encephalopathy.     

Limitations of autocorrelation in fetal heart rate monitoring

Fetal heart rate monitors that use autocorrelation of the ultrasonic fetal signal usually produce a cleaner fetal heart rate record than that obtainable with conventional ultrasonic fetal monitors. However, since the autocorrelation function will emphasize any periodic signal originating from the fetus or the mother, in clinical situations the resultant fetal heart rate tracing may contain spurious data. To illustrate the limitations of the autocorrelation technique in fetal monitoring, we compared the autocorrelated ultrasound fetal heart rate records from 23 patients in active labor with the simultaneously recorded direct scalp fetal electrocardiogram tracings. The results indicate that every hour of recording contained, on the average, five instances in which data were missing (range, 0 to 13), four in which data were added (range, 0 to 23), and seven instances in which data were absent for greater than 1 minute (range, 0 to 26). The potential problem of misinterpretation of autocorrelated fetal heart rate data is discussed.