Continuous objective recording of fetal heart rate and fetal movements could reliably identify fetal compromise, which could reduce stillbirth rates by facilitating timely management
Continuous objective recording of fetal heart rate and fetal movements could reliably identify fetal compromise, which could reduce stillbirth rates by facilitating timely management
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DOI：
10.1016/j.mehy.2014.07.009
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发表时间：
2014-09-01
影响因子：
4.7
通讯作者：
Heazell, Alexander E. P.
中科院分区：
文献类型：
--
作者：
Brown, Rebecca;Wijekoon, Jayawan H. B.;Heazell, Alexander E. P.
目前，在联合王国，每200例妊娠中约有1例死产。胎儿可能会表现出妥协的迹象，作为死产前应激反应的一部分，包括胎动减少（RFM）和胎心率（FHR）改变。目前，尽管广泛使用，目前的胎儿监护与围产期死亡率（PMR）的降低无关，因为胎儿妥协的迹象没有充分检测。这可能是由于人工判读结果或主观评估胎儿活动导致的不准确性。此外，妥协的迹象往往只发生在胎儿死亡前几个小时或几天，所以可能会错过目前的监测方法，这是间歇性进行。一个重要的考虑因素是，正确识别这些迹象和随后的干预可以导致健康婴儿的分娩，从而防止死产。提出了一个假设，建议及时检测胎儿妥协与使用24小时连续客观胎儿监护。由于重点放在获得长期的FHR和胎动数据上，因此已发现开发用于此目的的设备的优先兴趣。然而，尚未将其引入临床实践。假设研究将从设计记录上述参数的器械开始开始，然后进行适当的确认过程。如果开发和测试成功，使用连续胎儿监测与当前监测的PMR的最终比较将解决这一假设。这表明，通过长期监测获得的胎儿健康的及时而可靠的指示将允许及时和适当的产科干预，从而减少PMR。(C)2014爱思唯尔有限公司版权所有。
Stillbirth currently affects approximately I in every 200 pregnancies in the United Kingdom. Fetuses may exhibit signs of compromise as part of a stress response before stillbirth, including reduced fetal movements (RFM) and fetal heart rate (FHR) alterations. At present, and despite widespread use, current fetal monitoring is not associated with a reduction in perinatal mortality rate (PMR) as signs of fetal compromise are not adequately detected. This may be attributed to inaccuracies resulting from manual interpretation of results or subjective assessment of fetal activity. In addition, signs of compromise often occur only hours or days before fetal death, so may be missed by current monitoring methods, which are performed intermittently. A significant consideration is that correct identification of these signs and consequent intervention can result in the delivery of a healthy baby, thus preventing stillbirth. A hypothesis is presented, proposing prompt detection of fetal compromise with the use of 24-hour continuous objective fetal monitoring. With focus placed on obtaining long-term FHR and fetal movement data, prior interest has been found in developing devices for this purpose. However, introduction into clinical practice has not been achieved. Investigation of the hypothesis will begin with the design of a device to record the mentioned parameters, followed by an appropriate validation process. Should development and testing be successful, an eventual comparison in PMR with the use of continuous fetal monitoring vs current monitoring would address the hypothesis. It is suggested that a timely yet reliable indication of fetal wellbeing obtained via long-term monitoring would allow prompt and appropriate obstetric intervention and consequently reduce PMR. (C) 2014 Elsevier Ltd. All rights reserved.