產(chǎn)時(shí)電子胎兒監(jiān)護(hù)

產(chǎn)時(shí)電子胎兒監(jiān)護(hù)主要內(nèi)容胎監(jiān)應(yīng)用的歷史應(yīng)用胎監(jiān)來篩查產(chǎn)時(shí)胎兒缺氧的發(fā)展現(xiàn)狀產(chǎn)時(shí)缺氧對胎兒及新生兒預(yù)后的關(guān)系

胎心率與胎兒的生物物理活動的關(guān)系產(chǎn)時(shí)缺氧的EFM（ElectronicFetalMonitoring）主要內(nèi)容胎監(jiān)應(yīng)用的歷史胎兒監(jiān)護(hù)的發(fā)展fetalmonitorstodayhavethefollowingfeatures:Reliable,providedtheyareregularlymaintainedandservicedUserfriendlywithoperatingmanualandvideo/DVDFHRrecording:byexternalDopplerultrasound(US)withautocorrelationbyfetalelectrode(ECG)TwinmonitoringMaternalheartrateEventmarkerExternaltocographyMode,dateandtimeprintoutAutomaticmaternalbloodpressurepulseandSaO2facility

胎兒監(jiān)護(hù)的發(fā)展fetalmonitorstodayha胎兒心率的發(fā)育ThefetalheartisdetectablebytransvaginalUSasearlyas4weeksafterconceptionAtthisstagethemeanFHRisabout100bpm.Thereafteritprogressivelyrises,reachingameanofabout140-150by10weeksmenstrualage(8weekspostconception),andlevelsoffatthatratebythestartofthesecondtrimester.From14weekstotermthereisaprogressivefallinthemeanbaselineFHRwhichisunaffectedbywhetherthefetusisActiveorQuiescentThisloweringofthebaselineratewithgestationisareflectionofthefactthatthesympatheticautonomic胎兒心率的發(fā)育Thefetalheartisdete胎心率變異胎心率變異胎兒氧供的來源Fetaloxygenationisthereforedependentuponmanyfactorsinthisprocess.AnythingthatdisturbsthischainofoxygentransferwillpotentiallyaffectfetaloxygenationandtheFHR.Thekeycomponentsofthechainare:MaternalbloodpressureandoxygenationTheintegrityoftheplacenta,specificallytheamountofsurfaceareaforoxygentransferThepatencyoftheumbilicalcord胎兒氧供的來源Fetaloxygenationisth胎心減速From26weeksonwardsdecelerationsofthefetalheartshouldberegardedasabnormal.However,fetaldecelerationsareanormalfeaturebefore26weeks胎心減速From26weeksonwardsdece胎兒產(chǎn)時(shí)缺氧IPfetalhypoxiaoccursinabout1%oflabours.Itcanleadtooneofthreeadverseoutcomes:Perinataldeath(stillbirthsandneonataldeaths)CerebralpalsyHypoxicischemicencephalopathy(HIE)胎兒產(chǎn)時(shí)缺氧IPfetalhypoxiaoccurs胎兒缺氧的機(jī)制與結(jié)局Hypoxiamaypresentchronicallyoracutely.Chronichypoxiaevolvesthroughaseriesofsequentialchanges.Acutehypoxiaalsoevolvesthroughadifferentseriesofsequentialchanges.However,bothrouteseventuallycanleadtothecommonoutcome胎兒缺氧的機(jī)制與結(jié)局Hypoxiamaypresent判讀胎兒電子監(jiān)護(hù)圖形的基本要點(diǎn)

基線變異加速減速宮縮無宮縮---NST有規(guī)律宮縮---CST---OCT判讀胎兒電子監(jiān)護(hù)圖形的基本要點(diǎn)

基線變異加速減速宮縮胎兒電子監(jiān)護(hù)的判讀胎監(jiān)圖形的各個(gè)基本指標(biāo)的概念、客觀評價(jià)標(biāo)準(zhǔn)、臨床意義胎監(jiān)圖形的結(jié)果評價(jià)結(jié)果如何指導(dǎo)臨床的處理胎兒電子監(jiān)護(hù)的判讀胎監(jiān)圖形的各個(gè)基本指標(biāo)的概念、客觀評價(jià)標(biāo)準(zhǔn)胎監(jiān)的臨床意義圖形判讀評價(jià)如何處理胎監(jiān)的臨床意義圖形評價(jià)如何各個(gè)指標(biāo)的臨床意義胎心加速胎兒不存在宮內(nèi)缺氧早期減速胎頭受壓胎兒缺氧：第一產(chǎn)程早期的早減晚期減速胎兒缺氧無腦兒等變異減速臍帶受壓胎兒缺氧：非典型變異減速正弦曲線胎兒缺氧各個(gè)指標(biāo)的臨床意義胎心加速胎兒不存在宮內(nèi)缺氧早期減速胎頭受壓

胎監(jiān)的三級診斷分級定義評價(jià)處理Ⅰ同時(shí)滿足以下條件：

基線：110-~160bpm

基線變異：中度

晚期或變異減速：無

早期減速：有或無

加速：有或無正常定期監(jiān)護(hù)胎監(jiān)的三級診斷分級定義評價(jià)處理Ⅰ同時(shí)滿足以下

胎監(jiān)的三級診斷分級定義評價(jià)處理Ⅱ

胎心監(jiān)護(hù)未達(dá)Ⅰ和Ⅲ級標(biāo)準(zhǔn)，如基線：胎心過緩但不伴變異缺失

胎心過速基線變異：微小變異

變異缺失不伴反復(fù)出現(xiàn)的晚期減速

顯著變異加速：刺激胎兒后仍缺失周期性減速：反復(fù)出現(xiàn)的變異減速伴微小變異或中度變異延長減速（>2min但<10min）反復(fù)出現(xiàn)的晚期減速伴基線中度變異

非特異性的變異減速

可疑

需進(jìn)行評估，持續(xù)監(jiān)護(hù)和再評估，必要時(shí)行其它輔助檢查以確定胎兒情況及實(shí)施宮內(nèi)復(fù)蘇

胎監(jiān)的三級診斷分級定義評價(jià)處理Ⅱ胎心監(jiān)護(hù)未達(dá)

胎監(jiān)的三級診斷分級定義評價(jià)處理Ⅲ

滿足以下條件之一：胎心基線變異缺失伴下列情況之一：反復(fù)出現(xiàn)的晚期減速反復(fù)出現(xiàn)的變異減速

胎心過緩正弦曲線

異常

立即評估，迅速采取措施如吸氧、側(cè)臥、停止刺激、處理孕婦低血壓以及宮縮過頻引起的胎心改變；如上述措施均無效，應(yīng)立即終止