产时胎儿监护的指南(漆洪波).pptVIP

产时胎儿监护指南解读 重庆医科大学附属第一医院 漆洪波 Objectives of Fetal Monitoring ? Ischemia (▼tissue perfusion ) 缺血 ? Hypoxemia (▼O2 in blood) 血氧不足 ? Hypoxia 组织缺氧 (▼ O2 in tissue) → acidosis 酸血症 ? Asphyxia 窒息 (hypoxia and metabolic acidemia,代谢性酸中毒) ? Organ injury 器官损伤 ? Cerebral insufficiency 脑功能不全 ? Cerebral palsy 脑瘫 ? Fetal death 胎儿死亡 争议不断、依旧广泛使用 唯一的方法 阴性预测值高 David A.Intrapartum fetal heart rate definitions and interpretation: evolving consensus. Clin Obstet Gynecol, 2011,54(1):16 与间歇性听诊，能降低3倍以上的死产率 产时不采用电子胎心监护，风险更大。如果没有产时胎心监护的信息，难以提供客观证据说明：不良结局并不是由宫内缺氧所导致 Obstet Gynecol 2013;121:927–33 First, between 1990 and 2004, there was progressive incremental increase in the EFM use although it may have plateaued Second, the temporal increase in EFM was associated with improvement in neonatal mortality. Third, use of EFM was associated with increased cesarean and operative vaginal delivery for fetal distress. Fourth, we note d that Apgar score less than 4 at 5 minutes was decreased but not neonatal seizures. EFM的标准化 定义 Standardized Definitions 解释 Standardized Interpretation 管理 Standardized management 指南回顾 1997，the National Institute of Child health and Human Development Research Planning Workshop published a consensus report proposing standardized definitions for FHR tracings. 2005 and 2006：these definitions were endorsed by American College of Obstetricians and Gynecologists, the Association of Women’s Health, Obstetric and Neonatal Nurses, and the American College of Nurse Midwives. 2008, a second NICHD Research Planning Workshop partnered with ACOG, Society for Maternal–Fetal Medicine) published recommendations for FHR definitions and interpretation. 更新胎心监护相关定义; 目前应用的FHR分析解释的分类系统, 并推荐美国适用的分析系统 指明今后该领域相关研究 2009, ACOG Practice Bulletin 106 endorsed the 2008 NICHD recommendations. 2010, ACOG Practice Bulletin 116: “Management of Intrapartum Fetal Heart Rate Tracings ” 完整的EFM描述 子宫收缩 FHR基线 FHR基线的变异 FHR加速情况 FHR周期性或间断性的减速 FHR的变化趋势 Electronic F