A multicenter controlled trial of fetal pulse oximetry in the intrapartum management of nonreassuring fetal heart rate patterns
A multicenter controlled trial of fetal pulse oximetry in the intrapartum management of nonreassuring fetal heart rate patterns
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DOI：
10.1067/mob.2000.110632
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发表时间：
2000-11-01
影响因子：
9.8
通讯作者：
Swedlow, DB
中科院分区：
文献类型：
--
作者：
Garite, TJ;Dildy, GA;Swedlow, DB
目的：最近的发展允许使用脉搏血氧饱和度来评估分娩中的胎儿氧合。我们测试的假设，除了胎儿脉搏血氧饱和度在分娩中的异常胎儿心率模式的评价，提高胎儿评估的准确性，并允许安全减少剖宫产分娩进行，因为nonreasonable胎儿status.Study设计：一个随机，对照试验同时进行了9个中心。这些患者均为足月妊娠，当出现异常胎心率模式时，他们正处于活跃分娩期。患者被随机分配到单独的电子胎心监护（对照组）或电子胎心监护和连续胎儿脉搏血氧饱和度的组合（研究组）。主要结果是减少剖腹产的胎儿不放心的状态作为衡量胎儿oxygenation.Results评估的准确性提高的措施：共1010例患者被随机分组，502对照组和508研究组。在研究组中，由于胎儿状况不安全而进行的剖宫产数量减少了50%以上（研究组为4.5%，对照组为10.2%; P= 0.007）。然而，由于研究组中因难产而进行的剖宫产增加，因此总体剖宫产率没有净差异（研究组，n = 147 [29%];对照组，130 [26%]; P = 0.49）。在盲法产程图分析中，89%的研究患者和91%的对照患者因难产而进行剖宫产，符合实际难产的定义标准。两组之间在不良母体或新生儿结局方面无差异。在非放心胎儿状态的手术干预方面，有一个改善的敏感性和特异性的研究组相比，对照组的终点代谢性酸中毒和需要复苏CONCLUSION. The研究证实了其主要假设的安全减少剖宫产分娩，因为非放心胎儿状态。然而，增加胎儿脉搏血氧饱和度并没有导致剖腹产的总体减少。研究组中因难产而进行剖腹产的增加似乎是由于有充分记录的分娩停止。胎儿脉搏血氧仪提高了产科医生的能力，更适当地干预剖宫产或手术阴道分娩的胎儿谁是真正的抑郁症和酸中毒。研究组中难产的手术分娩意外增加值得关注，仍有待解释。
OBJECTIVE: Recent developments permit the use of pulse oximetry to evaluate fetal oxygenation in labor. We tested the hypothesis that the addition of fetal pulse oximetry in the evaluation of abnormal fetal heart rate patterns in labor improves the accuracy of fetal assessment and allows safe reduction of cesarean deliveries performed because of nonreassuring fetal status.STUDY DESIGN: A randomized, controlled trial was conducted concurrently in 9 centers. The patients had term pregnancies and were in active labor when abnormal fetal heart rate patterns developed. The patients were randomized to electronic fetal heart rate monitoring alone (control group) or to the combination of electronic fetal monitoring and continuous fetal pulse oximetry (study group). The primary outcome was a reduction in cesarean deliveries for nonreassuring fetal status as a measure of improved accuracy of assessment of fetal oxygenation.RESULTS: A total of 1010 patients were randomized, 502 to the control group and 508 to the study group. There was a reduction of >50% in the number of cesarean deliveries performed because of nonreassuring fetal status in the study group (study, 4.5%; vs control, 10.2%; P=.007). However, there was no net difference in overall cesarean delivery rates (study, n = 147 [29%]; vs control, 130 [26%]; P = .49) because of an increase in cesarean deliveries performed because of dystocia in the study group. In a blinded partogram analysis 89% of the study patients and 91% of the control patients who had a cesarean delivery because of dystocia met defined criteria for actual dystocia. There was no difference between the 2 groups in adverse maternal or neonatal outcomes. In terms of the operative intervention for nonreassuring fetal status, there was an improvement in both the sensitivity and the specificity for the study group compared with the control group for the end points of metabolic acidosis and need for resuscitation.CONCLUSION: The study confirmed its primary hypothesis of a safe reduction in cesarean deliveries performed because of nonreassuring fetal status. However, the addition of fetal pulse oximetry did not result in an overall reduction in cesarean deliveries. The increase in cesarean deliveries because of dystocia in the study group did appear to result from a well-documented arrest of labor. Fetal pulse oximetry improved the obstetrician's ability to more appropriately intervene by cesarean or operative vaginal delivery for fetuses who were actually depressed and acidotic. The unexpected increase in operative delivery for dystocia in the study group is of concern and remains to be explained.