Monitoring the Fetal Environment

In addition to various biochemical tests, outlined in part 1 of this paper, endocrine studies and biophysical measurements give important information about the status of the fetus in utero. An ultrasonic technic makes possible an accurate assessment of fetal size, and this measurement can be correlated with the biochemical and endocrine values.     

Fetal Heart Monitoring in Labor

Auscultation of the fetal heart rate is no longer considered an accurate indication of change in fetal well-being since it misses many subtle changes. Electronic fetal monitoring, when judiciously used, can be an invaluable aid in early recognition of fetal distress. This article lists indications for monitoring and describes some causes of heart rate change.     

Fetal Monitoring in the Prehospital Setting

Background: Prehospital emergency care providers have very little information regarding fetal perfusion adequacy in the field. Objective: This study was conducted to evaluate the feasability of the use of fetal monitoring in the prehospital setting. Methods: A mobile cardiotocometer was used for all consecutive pregnant women managed by our physician-staffed Emergency Medical Services unit. The visualization of interpretable tracings (both fetal heart rate and tocography) at the different stages of prehospital management was evaluated. Any change in a patient's management was also recorded. Results: There were 145 patients enrolled during 119 inter-hospital transfers and 26 primary prehospital interventions. Interpretable tracings were obtained for 81% of the patients during the initial examination. This rate decreased to 66% during handling and transfer procedures. For 17 patients (12%), the monitoring led to a change in the patient's management. Conclusion: This study shows that cardiotocography can be easily performed in the prehospital setting, and is usually feasible. Moreover, the study demonstrates a positive impact of fetal heart rate monitoring on prehospital management.     

胎心监护在产科中的临床应用

目的探讨胎心监护在产科中的临床应用价值。方法对胎心监护结果异常的产妇174例和同期入院分娩的胎心监护正常的220例进行比较分析。结果异常组中,脐带因素发生率明显高于对照组,提示胎心监护中出现频繁变异减速、基线变异加大型;基线平直多考虑胎儿宫内慢性缺氧;基线平直伴无反应型则提示胎儿宫内情况较差;基线平直伴无反应型且出现变异减速则胎儿危险性很大。结论胎心监护在产科中有较好的应用价值,可以作为产前胎儿监护的常用方法。     

胎心监护在晚期妊娠中的作用

3258例妊娠晚期妇女进行胎心监护,分析胎儿宫内窘迫、脐带异常及新生儿窒息等因素与胎心监护的关系。胎心监护是临床监测胎儿宫内缺氧及其程度、了解胎儿耐受力的主要方法之一。特别是孕37周以上者进行胎心监护,当出现异常图型时,应严密监护,根据胎心率异常的程度结合B超生物物理评分、S/D比值综合评判,准确分析胎儿宫内情况,估测胎儿能够娩出的时间选择恰当的分娩方式,可减少围产儿病死率。     

开展数码远程胎儿监护的体会

数码远程胎儿监护是利用数据传输、通讯、计算机数据处理等技术手段来实现远程异地胎儿的监护工作。它对孕妇进行无损伤、有效、简便快捷的监测。我院于 2 0 0 0年 10月建立了数码远程胎儿监护中心 ,对 3 13例孕妇进行了远程胎儿监护及咨询 ,现报道如下。1　临床资料　　本组进行远程胎儿监护 3 13例 ,其中直接租用远程监护仪的孕妇 76例 ,其余基层医院或社区医疗点孕妇 2 3 7例。在 76例直接租用远程监护仪孕妇中 ,有 2 2例存在高危因素 ,其中妊娠肝内胆汁淤积征 (ＩＣＰ) 7例 ,妊娠合并糖尿病 1例 ,脐带绕颈6例 ,妊娠高血压综合征 1例 ,心…     

超声监测胎儿血流动力学变化预测胎儿生长发育的价值

【目的]探讨超声检测胎儿动静脉的血流动力学参数和径线对预测胎儿生长发育的价值。【方法】回顾性分析产前二维超声及彩色多普勒血流显像对170例胎儿进行各项参数测定,根据测定结果,将其分为正常对照组和宫内生长迟缓（IUGR）组,测量脐动脉、大脑中动脉、颈内动脉和腹主动脉的搏动指数（PI）、阻力指数（RI）及脐动脉收缩期最大流速与舒张末期流速的比值（S／D）,测量胎儿静脉导管血流量（QDV）和脐静脉的血流量（QuV）,计算静脉导管（DV）分流率,测定胎儿升主动脉和肺动脉收缩期峰值速度（PFV）,测量一般径线包括胎儿的双顶径、头围、腹围、股骨长度,测量产后胎儿体重并进行Apgar评分。【结果]IUGR组脐动脉和腹主动脉的PI、RI及S／D测值明显比对照组增高,IUGR组大脑中动脉和颈内动脉的PI、RI及S／D测值比对照组低,IUGR组升主动脉和肺动脉的PFV明显低于对照组胎儿,差异具有统计学意义（P〈0．05）。两组胎儿的QDV无明显差异,但IUGR组的QuV显著下降且DV分流率显著升高,差异均有统计学意义（P〈0．05）。36周IUGR组的胎头双顶径（BPD）、胎儿头围（HC）、胎儿腹围（AC）和胎儿股骨长（FL）明显比对照组低,差异有统计学意义（P〈0．05）。【结论】超声通过综合监测胎儿血流动力学和一般径线的变化,可以全面、客观地评价胎儿生长发育情况。     

远程胎儿监护在产科的应用价值

目的探讨远程胎儿监护作为产前胎儿健康评估手段在临床的应用价值。方法选择2005年2月至2006年2月在我院产检至分娩的正常孕妇725例,随机分为实验组和对照组,分别采用远程胎儿监护和常规胎儿监护方法对胎儿进行监测,分析两组胎儿监护结果和围生儿结局。结果实验组检出无负荷试验（non-stress test,NST）异常62例,对照组检出NST异常36例,两组比较差异具有统计学意义（P〈0．05）。实验组新生儿预后不良低于对照组（P〈0．05）。结论应用远程胎儿监护作为产前胎儿健康评估手段,可早期发现胎儿潜在的危险,有利于获得良好妊娠结局,是提高产科服务质量的可行方法。     

Multidimensional Ultrasound Doppler Signal Analysis for Fetal Activity Monitoring

Fetal activity parameters such as movements, heart rate and the related parameters are essential indicators of fetal wellbeing, and no device provides simultaneous access to and sufficient estimation of all of these parameters to evaluate fetal health. This work was aimed at collecting these parameters to automatically separate healthy from compromised fetuses. To achieve this goal, we first developed a multi-sensor–multi-gate Doppler system. Then we recorded multidimensional Doppler signals and estimated the fetal activity parameters via dedicated signal processing techniques. Finally, we combined these parameters into four sets of parameters (or four hyper-parameters) to determine the set of parameters that is able to separate healthy from other fetuses. To validate our system, a data set consisting of two groups of fetal signals (normal and compromised) was established and provided by physicians. From the estimated parameters, an instantaneous Manning-like score, referred to as the ultrasonic score, was calculated and was used together with movements, heart rate and the associated parameters in a classification process employing the support vector machine method. We investigated the influence of the sets of parameters and evaluated the performance of the support vector machine using the computation of sensibility, specificity, percentage of support vectors and total classification error. The sensitivity of the four sets ranged from 79% to 100%. Specificity was 100% for all sets. The total classification error ranged from 0% to 20%. The percentage of support vectors ranged from 33% to 49%. Overall, the best results were obtained with the set of parameters consisting of fetal movement, short-term variability, long-term variability, deceleration and ultrasound score. The sensitivity, specificity, percentage of support vectors and total classification error of this set were respectively 100%, 100%, 35% and 0%. This indicated our ability to separate the data into two sets (normal fetuses and pathologic fetuses), and the results highlight the excellent match with the clinical classification performed by the physicians. This work indicates the feasibility of detecting compromised fetuses and also represents an interesting method of close fetal monitoring during the entire pregnancy.     

护理干预对胎儿监护无应激试验结果的影响

目的探讨提高胎儿电子监护无应激试验准确性的方法，对无应激试验假无反应型予以正确筛查。方法应用美国惠普公司生产HP-8041A胎儿电子监护仪进行测试，将2007年10月x-11月在本院产科门诊做胎儿监护的240名孕妇分为2组，对照组120名孕妇按照操作常规进行测试；实验组120名孕妇，在测试前和测试中采用干预措施，观察2组孕妇的测试结果。结果实验组孕妇的无应激试验结果为反应型例数明显高于对照组，p〈0．05。结论通过护理干预措施能提高无应激试验的准确性，降低假无反应型，减轻孕妇的心理负担和避免医务人员的重复劳动，提高工作效率。     

彩色多谱勒血流显像与生物物理评分以及胎心监护对胎儿宫内缺氧的诊断价值

目的:探讨彩色多谱勒血流显像(CDFI),生物物理评分以及胎心监护对胎儿宫内缺氧的诊断价值。方法:605例孕38~40周,年龄19~40岁的孕妇,同一时期利用CDFI,10 min生物物理评分以及胎心监护综合分析胎儿宫内有否缺氧,并对这三者的优缺点、共性进行对比。结果:生物物理评分7~8 分502 例,胎心监护8~10 分491例,脐动脉血流S/D≤2.5有536例;生物物理评分5~6分82例,胎心监护5~7分89 例,脐动脉血流S/D为2.6~3.0有50例;生物物理评分≤4分21例,胎心监护≤4分25例,脐动脉血流S/D> 3.0为19例。结论:3种方法综合检测,可降低单项检查的漏诊率和误诊率,提高胎儿宫内缺氧的确诊率     

护理干预对胎儿监护无应激试验结果的影响

目的探讨提高胎儿电子监护无应激试验准确性的方法，对无应激试验假无反应型予以正确筛查。方法应用美国惠普公司生产HP-8041A胎儿电子监护仪进行测试，将2007年10月x-11月在本院产科门诊做胎儿监护的240名孕妇分为2组，对照组120名孕妇按照操作常规进行测试；实验组120名孕妇，在测试前和测试中采用干预措施，观察2组孕妇的测试结果。结果实验组孕妇的无应激试验结果为反应型例数明显高于对照组，p〈0．05。结论通过护理干预措施能提高无应激试验的准确性，降低假无反应型，减轻孕妇的心理负担和避免医务人员的重复劳动，提高工作效率。     

妊娠期肝内胆汁淤积症胎儿监护与围生儿预后关系分析

目的探讨对妊娠期肝内胆汁淤积症（ICP）孕妇进行胎儿监护的临床价值。方法对102例ICP孕妇进行无负荷试验（NST）,其中36例进行缩宫素激惹试验（OCT）,所有孕妇均进行超声脐动脉血流分析及肝功能检测。结果OCT和超声脐血流分析结果异常者的围生儿预后不良发生率分别为66．67％和25．00％,明显高于正常者的19．05％和11．43％（P〈0．01,P〈0．05）。NST正常者和异常者的围生儿预后不良发生率无明显差异。ICP患者的胎儿窘迫、新生儿窒息、早产、胎儿电子监测异常及脐血流异常高于正常组。ICP组中总胆汁酸大于50μ mol／L的胎儿电子监护异常及脐血流S／D值异常的发生率．均高于其他两组。结论OCT和超声脐动脉血流分析对了解ICP孕妇胎盘功能和预测围生儿预后具有较高的临床价值。     

足月妊娠胎心监护结合激活素A对胎儿窘迫的预测价值

目的:通过胎心监护结合孕妇血血清激活素A水平对足月妊娠胎儿窘迫进行预测,以寻求更为准确可靠的诊断方法.方法:将研究对象分成联合组(NST无反应型且母血血清激活素A>25 ng/mL)70例,NST组(NST无反应型)270例,激活素A组(激活素A>25 ng/mL)210例,比较三组间胎儿窘迫率、羊水污染率和新生儿窒息率.结果:联合组的胎儿窘迫率、羊水污染率、新生儿窒息率均明显高于NST组及激活素A组.结论:胎心监护结合激活素A可提高胎儿窘迫诊断率,为及时采取适当的干预措施提供依据,改善胎儿预后.     

胎儿静脉导管血流在电子胎心监护诊治中的应用

目的探讨胎儿静脉导管血流、电子胎心监护与胎儿窘迫及剖宫产率之间的关系。方法将280例孕妇分为两组：电子胎心监护组（电子监护组）150例,电子胎心监护联合胎儿静脉导管血流监测组（联合组）130例。观察新生儿阿氏评分及羊水情况。结果电子监护组产后发现异常因素112例,有38例未发现异常因素。联合组130例产后均发现异常因素。结论联合组能更准确的判断胎儿宫内缺氧状况,假阳性率低,可降低剖宫产率。     

脐动脉血流速率检测在胎儿监护中的作用

目的评价脐动脉收缩期最大血流速度（Ｓ）与舒张末期血流速度（Ｄ）的比值（Ｓ／Ｄ值）在胎儿监护中的作用。方法对１２７例高危孕妇及１４５例低危孕妇进行脐动脉Ｓ／Ｄ值测定，并追踪观察胎儿妊娠结局。结果高危妊娠组Ｓ／Ｄ值异常阳性率及胎儿窘迫、新生儿窒息的发生率（分别为３１．５０％、４７．９２％、１４．５８％）明显高于低危妊娠组（分别为５．５２％、１２．５９％、１．３４％））（Ｐ＜０．０１）。该项检测对胎儿生长迟缓（ＩＵＧＲ）及妊高征有较高的敏感性（分别为８０％和５０％）。结论脐动脉Ｓ／Ｄ值异常提示子宫胎盘血流灌注下降，血管阻力增加，可作为胎儿监护的一项有效指标，但需与Ｂ超等检测手段联合应用，使诊断结果更完善。     

Accuracy and Utility of a New Reflectance Pulse Oximeter for Fetal Monitoring during Labor

Objective. To evaluate the accuracy of a new pulse oximeter inestimating the oxyhemoglobin (O₂Hb) concentration in fetalarterial blood (SaO₂) with either a high concentration ofhemoglobin F (HbF) or a low concentration of O₂Hb duringlabor. Patients and Methods. Fetal forehead arterial oxygenation wasdetermined in 44 fetuses by reflectance pulse oximeter (SpO₂)during labor and was compared with SaO₂ determined immediatelyafter birth. Because HbF has little or no known effect on pulse oximetry, butdoes affect the laboratory multiwavelength CO-oximeter typereading, the SaO₂ was corrected by HbF concentration.SpO₂ and SaO₂ were simultaneously measured infive hypoxic adult volunteers achieved by inhaling 11% oxygen. Results.A gradual decline in HbF concentration was seen during weeks 37 to 40 ofgestation. HbF concentration varied near term, ranging between 53 and 88% ofthe fetal hemoglobin concentration (mean ± SD = 74.6 ± 6.3%).This alteration produced a lower %O₂Hb percentby 4% at the most. The corrected SaO₂ in cord blood correlatedwith fetal SpO₂ (y = 0.974, x –7.279, r = 0.90). In five adults, SpO₂ reflected wellSaO₂ with a mean ± SD of bias of –1.1 ± 2.9%. Conclusions.SpO₂ determined by a new reflectance pulse oximeter at theend of labor correlated with an immediate post-natal cord arterial bloodsample before the first breath, with a mean and SD of bias of 8.5 ±6.2%. Reflectance pulse oximetry is a useful tool for continuousnoninvasive monitoring of the fetal oxygen status during labor.