产时胎儿监护的指南.ppt

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,ObjectivesofFetalMonitoring,Ischemia(tissueperfusion)缺血Hypoxemia(O2inblood)血氧不足Hypoxia组织缺氧(O2intissue)acidosis酸血症Asphyxia窒息(hypoxiaandmetabolicacidemia,代谢性酸中毒)Organinjury器官损伤Cerebralinsufficiency脑功能不全Cerebralpalsy脑瘫Fetaldeath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DavidA.Intrapartumfetalheartratedefinitionsandinterpretation:evolvingconsensus.ClinObstetGynecol,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,ObstetGynecol2013;121:92733,First,between1990and2004,therewasprogressiveincrementalincreaseintheEFMusealthoughitmayhaveplateaued,Second,thetemporalincreaseinEFMwasassociatedwithimprovementinneonatalmortality.,Third,useofEFMwasassociatedwithincreasedcesareanandoperativevaginaldeliveryforfetaldistress.,Fourth,wenotedthatApgarscorelessthan4at5minuteswasdecreasedbutnotneonatalseizures.,EFM的标准化,定义StandardizedDefinitions解释StandardizedInterpretation管理Standardizedmanagement,指南回顾,1997，theNationalInstituteofChildhealthandHumanDevelopmentResearchPlanningWorkshoppublishedaconsensusreportproposingstandardizeddefinitionsforFHRtracings.2005and2006：thesedefinitionswereendorsedbyAmericanCollegeofObstetriciansandGynecologists,theAssociationofWomensHealth,ObstetricandNeonatalNurses,andtheAmericanCollegeofNurseMidwives.2008,asecondNICHDResearchPlanningWorkshoppartneredwithACOG,SocietyforMaternalFetalMedicine)publishedrecommendationsforFHRdefinitionsandinterpretation.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,ACOGPracticeBulletin106endorsedthe2008NICHDrecommendations.2010,ACOGPracticeBulletin116:“ManagementofIntrapartumFetalHeartRateTracings”,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,ElectronicFetalMonitoringDefinitions(ACOG指南2009年),对任何FHR图形进行判读,必须结合临床状况,3tierfetalheart-rateclassificationsystem,The2008NationalInstituteofChildHealthandHumanDevelopmentworkshopreportonelectronicfetalmoni-toring.ObstetGynecol.