声刺激试验及其在胎儿监测中的应用

声刺激试验及其在胎儿监测中的应用浙江医科大学附属妇产科医院（３１０００６）石一复胎儿活动包括呼吸、心跳及四肢、躯干肌肉活动，胎儿活动监测包括自测法和客观检查两大类，前者由孕妇自数胎动，简便可靠，方法也多，后者也有数种，现介绍声刺激检查胎儿法。声刺激试...     

足月胎儿对声音刺激和声振刺激反应的研究

目的通过观察声音刺激引起胎儿的胎动和胎心率的反应及其特点,探索声音刺激能否替代声振刺激及适宜的声强。方法选择2002年4月至2003年2月在浙江大学医学院附属妇产科医院产前检查的正常足月孕妇94例。将孕妇分为5组,分别接受95、100、105、110、115dB不同强度的声音刺激,观察胎儿的胎动和胎心率反应,同时设置空白对照和声振刺激对照。结果(1)95、100、105、110、115dB声音和声振刺激引起胎动的比例分别为15％、89％、83％、83％、95％、99％,其中100、105、110、115dB声音和声振刺激的结果差异无统计学意义。声振刺激引起的胎动强度显著强于115dB声音。(2)100、105、110、115dB声音引起胎心率上升≥15bpm的比例分别为39％、61％、56％、85％。声振刺激总的引起胎心率上升≥15bpm的比例为92％,显著高于100、105、110dB声音,和115dB声音相比差异无统计学意义。(3)五组中声振刺激总的引起胎心率上升的峰值为23bpm,显著高于100、105、110dB声音,而与115dB声音相比差异无统计学意义。(4)声振刺激较115dB声音刺激引起胎儿更长时间的胎心率过速(42．5s和5s,P=0．011)和更长时间的胎动(270s和100s,P=0．000)。结论115dB声音刺激可以引起胎儿有效的胎动和胎心率上升,并避免出现胎儿过度惊吓、胎心率过速和胎动过多,提示在联合NST时,115dB的声音刺激可以替代声振刺激作为胎儿唤醒仪。     

胎儿声振动刺激反应的研究

目的：了解不同孕龄胎儿对声振动刺激的反应。方法：对４３５例次正常中、晚期妊娠妇女进行声振胎心试验（ＶＡＳ－Ｔ）、声振胎动试验（ＳＰＦＭ），并对声振动刺激前、后胎心率变化规律进行前瞻性研究。结果：（１）从２４周开始，胎儿对声振刺激有反应，但大部分未能达到ＶＡＳ－Ｔ诊断标准，而胎动反应良好。（２）妊娠２８周开始，声振刺激后，９０％以上的胎儿出现显著的胎动、胎心率加速反应，足月胎儿反应率在９８％以上。（３）ＳＰＦＭ阳性率的显著提高早于ＶＡＳ－Ｔ。提示：２８周后胎儿神经系统发育已趋完善。胎儿运动神经的发育成熟早于植物神经。     

胎儿声振刺激

本文目的是复习新生儿和胎儿对外源声、振的反应,概述声刺激与NST结合在评价胎儿健康中的临床意义。一、胎儿对声振刺激的反应许多外部声振刺激可增加胎心率(FHR)的反应性。一种电子人工喉(EAL)的振动声刺激(VAS)目前已广泛应用于评价胎儿健康。这种装置可产生一种87Hz基本频率的宽带噪声,在距声源1.5cm处的空气中可测得高达15 000Hz的多重泛音,平均声压水平(SPL)为110dB。此前曾推测放置在母腹表面的EAL产生的子宫内SPL不会超过子宫内背景噪声的SPL。近来     

胎儿声振刺激

胎儿声振刺激以１０３ｄＢ持续３秒钟为适宜。观察胎儿对声振刺激出现反应的常用指标为胎心率加速和明显胎动。孕２４周后胎儿对声振刺激出现反应，且比例随胎龄而增加，孕３２周后所有胎儿均有反应，且胎心率反应模式随胎龄而改变。产前声振刺激结果与其后ＯＣＴ试验结果相吻合，产时对声振刺激有反应的胎儿通常有正常的结局，但反应不正常不能单独诊断胎儿窘迫，应结合其它指标进行判断。出生后４年多的随访表明，声振刺激对胎儿无     

胎儿宫内行为的研究

对胎儿宫内行为的研究包括研究胎儿自发活动和受外界刺激后活动两大类.一些实验证实高危组胎儿行为状态较之正常胎儿发生改变,可通过观察胎儿宫内行为来评估胎儿安危.通过观察胎儿对不同外界刺激的反应来研究胎儿宫内早期智力发育.     

胎儿宫内行为的

对胎儿宫内行为的研究包括研究胎儿自发活动和受外界刺激后活动两大类。一些实验证实高危组胎儿行为状态较之正常胎儿发生改变，可通过观察胎儿宫内行为来评估胎儿安危。通过观察胎儿对不同外界刺激的反应来研究胎儿宫内早期智力发育。     

胎儿宫内缺氧的物理监测

胎儿宫内缺氧的监测是提高产科质量、搞好围产期优生的重要措施。１胎心率图监护胎心率图可持续监测胎心率的变化,以及胎动和宫缩对胎心率的影响,是胎儿宫内安危状况监测的重要手段。在产前主要观察胎心对胎动的反应称为非应激性试验（ＮＳＴ）。通常监护２０分钟,其结...     

A randomized controlled trial of a new fetal acoustic stimulation test for fetal well-being

OBJECTIVES: Our purpose was to determine (1) whether a fetal acoustic stimulation test results in more palpable fetal movement compared with a mock test (control) and (2) whether palpated fetal movements after a fetal acoustic stimulation test are accompanied by a reactive nonstress test.STUDY DESIGN: In a randomized controlled trial we studied women seen in the labor and delivery suite for various indications. Women were excluded for multiple gestation, <31 weeks' gestational age, treatment with magnesium sulfate or narcotics, or ruptured membranes. Informed consent was obtained from eligible women, who were then randomized to a test or control group. We placed an acoustic stimulator on the abdomen of each woman, but only the test group was stimulated. We assessed fetal movement by a grading system: 0 = no fetal movement felt by patient or tester, 1 = fetal movement felt by patient only, 2 = fetal movement felt by tester, 3 = visual movement seen by tester. A positive fetal acoustic stimulation test result was defined as one with any fetal movement felt or seen by the tester (grades 2 or 3). We then performed a nonstress test. We compared rates of a positive fetal acoustic stimulation test in the test and control groups with the χ² test. A p value <0.05 was considered significant.RESULTS: We randomized 297 women to the test group and 280 women to the control (mock test) group. Of women tested with the fetal acoustic stimulation test, 81% had fetal movement by palpation or visualization (grades 2 or 3) compared with 19% of the control group (p < 0.0001, odds ratio 19.29, 95% confidence interval 12.42 to 30.07). Of the test group, 283 (95%) had a reactive nonstress test and 14 (5%) had nonreactive tests; the control group had 267 (95%) reactive and 13 (5%) nonreactive nonstress tests. Of 242 patients in the test group with a positive fetal acoustic stimulation test, 236 (98%) had a reactive nonstress test. Of those in the test group with fewer than three contractions per 10 minutes, 164 (89%) had a positive fetal acoustic stimulation test. Of these, 162 (99%) had a reactive nonstress test.CONCLUSION: The fetal acoustic stimulation test evokes significantly more palpated or visualized fetal movement than in controls. Palpated or visualized fetal movement after acoustic stimulation was almost always accompanied by a reactive nonstress test. (Am J Obstet Gynecol 1997;176:1386-8.)     

The assessment of fetal well-being by venous Doppler velocimetry

The assessment of fetal well-being by venous Doppler velocimetry, especially in cases of intrauterine growth restriction, has been growing in importance as a number of researchers have been improving their studies^1 - 5 as well as a consequence of better technologies in ultrasound equipment. Since different authors have studied the fetal blood circulation with color Doppler, initially focusing their attention on the arterial system^6 - 12, many questions and doubts have remained without a reasonable answer, especially concerning the optimal time at which to deliver these fetuses. Among these authors, some have expressed the opinion that all biophysical methods, including the cardiotocogram, should be used before the decision of fetus delivery should be made^13,14. It is possible, nowadays, to study several venous vessels, such as the ductus venosus, inferior vena cava, umbilical vein, portal vein, hepatic veins¹⁵, and, more recently^1,2, the cerebral transverse sinus. The purpose of this review is to describe the fetal circulation, the technique and rationale behind measuring venous Dopplers and to assess the clinical applications of venous Doppler velocimetry.     

振动声音刺激引起胎动胎心率加速对预测胎儿预后的意义

本文对319例单胎足月孕妇进行振动声音刺激试验(VAS—T)及声刺激引起的胎动(SPFM)与传统的无负荷试验(NST)对预测胎儿预后的临床意义进行前瞻性对比研究。结果三者的阴性预测价值及敏感性均很高。VAS—T及SPFM的特异性、阳性预测价值均明显高于NST,而假阳性率显著低于NST,且大大缩短了试验时间,表明VAS—T及SPFM是有效、简便、省时、经济的产前胎儿监护方法。     

Antepartum fetal evaluation by assessment of fetal heart rate and fetal movements

Three antenatal monitoring tests--fetal movement acceleration test (FMAC-test), fetal heart rate-nonstress test (FHR-NST), and daily fetal movement recording (DFMR) were evaluated in 212 high risk pregnant women. While in 196 cases all three tests were normal, in 16 patients one to three tests showed pathological results. In the latter group, there was a significantly higher incidence of perinatal mortality, low Apgar score and growth retardation. Since false positives are known to occur in these tests, at least two should be pathological to warrant delivery in am attempt to prevent fetal death in utero. The sequence in which the pathology appears in the deteriorating fetus is as follows: the first to become non-reactive is the FMAC-test, followed by decreased fetal movements till cessation, and, finally, severe changes in the FHR-NST take place. The importance of this sequence of events is discussed.     

Decreased fetal activity and fetal heart rate changes after amniocentesis complicated by fetal hemorrhage

A case is described in which amniocentesis caused placental injury, abruptic placenta, and fetal hemorrhage which caused fetal distress. This was primarily manifested by reduction of fetal movements and later by fetal heart rate deceleration. Emergency cesarean section was performed of monitoring the fetus after amniocentesis by assessment of fetal movements is stressed.     

Small-volume amnioinfusion: a potential stimulus of intrapartum fetal heart rate accelerations

We describe a recurrent nonreassuring fetal heart rate pattern in which small-volume amnioinfusions apparently evoked fetal heart rate accelerations suggested fetal well-being, allowing that progressive labor that culminated in the vaginal delivery of a healthy infant.