胎儿监护的解读

胎监的三级诊断
分级 定义 评 价 处理
立即评估，迅 速采取措施如 吸氧、侧卧、 停止刺激、处 理孕妇低血压 以及宫缩过频 引起的胎心改 变；如上述措 施均无效，应 立即终止妊娠
Ⅲ
满足以下条件之一： 胎心基线变异缺失伴下列情况之一： 反复出现的晚期减速 反复出现的变异减速 胎心过缓 正弦曲线
异 常
Ⅱ级和Ⅲ级胎心监护的宫内复苏方法
胎心率变异
胎儿氧供的来源

Fetal oxygenation is therefore dependent upon many factors in this process. Anything that disturbs this chain of oxygen transfer will potentially affect fetal oxygenation and the FHR. The key components of the chain are: Maternal blood pressure and oxygenation The integrity of the placenta, specifically the amount of surface area for oxygen transfer
胎儿产时缺氧

IP fetal hypoxia occurs in about 1% of labours. It can lead to one of three adverse outcomes:


Perinatal death (stillbirths and neonatal deaths)
宫缩过频或过强 脐带、胎头受压 • 停用催产素 • 阴道检查
脐带受压
母亲因素 吸氧 宫缩频密
• 改变体位
• 血压监测、血氧 • 常用、但安全性及有效性待证实 • 宫缩抑制剂的应用
脐带受压
• 羊膜腔灌注
胎儿心率的发育



The fetal heart is detectable by transvaginal US as early as 4 weeks after conception At this stage the mean FHR is about 100 bpm. Thereafter it progressively rises, reaching a mean of about 140-150 by 10 weeks menstrual age (8 weeks post conception), and levels off at that rate by the start of the second trimester. From 14 weeks to term there is a progressive fall in the mean baseline FHR which is unaffected by whether the fetus is Active or Quiescent This lowering of the baseline rate with gestation is a reflection of the fact that the sympathetic autonomic
Cerebral palsy Hypoxic ischemic encephalopathy (HIE)
胎儿缺氧的机制与结局

Hypoxia may present chronically or acutely.
Chronic hypoxia evolves through a series of sequential

The patency of the umbilical cord
胎心减速

From 26 weeks onwards decelerations of the fetal heart should be regarded as abnormal. However, fetal decelerations are a normal feature before 26 weeks
• 胎儿不存在宫内缺氧
• 胎头受压 • 胎儿缺氧：第一产程早期的早减 • 胎儿缺氧
• 无脑儿等
• 脐带受压
• 胎儿缺氧：非典型变异减速 • 胎儿缺氧
胎监的三级诊断
分级 定义 评价 处理
Ⅰ
同时满足以下条件： 基线：110-~160bpm 基线变异：中度 晚期或变异减速：无 早期减速：有或无 加速：有或无
正常
定期监护
胎监的三级诊断
分级 定义 评 价
可疑
处理
需进行评估， 持续监护和再 评估，必要时 行其它辅助检 查以确定胎儿 情况及实施宫 内复苏
Ⅱ
胎心监护未达Ⅰ和Ⅲ级标准，如 基线：胎心过缓但不伴变异缺失 胎心过速 基线变异：微小变异 变异缺失不伴反复出现的晚期 减速 显著变异 加速：刺激胎儿后仍缺失 周期性减速： 反复出现的变异减速伴微小变异或中度 变异 延长减速（ >2min但<10min） 反复出现的晚期减速伴基线中度变异 非特异性的变异减速
changes. Acute hypoxia also evolves through a
different series of sequential changes. However, both
routes eventually can lead to the common outcome
判读胎儿电子监护图形的基本 要点
产时电子胎儿监护
主要内容

胎监应用的历史
应用胎监来筛查产时胎儿缺氧的发展现状
产时缺氧对胎儿及新生儿预后的关系
胎心率与胎儿的生物物理活动的关系
产时缺氧的EFM（Electronic Fetal Monitoring）
胎儿监护的发展
fetal monitors today have the following features: Reliable, provided they are regularly maintained and serviced User friendly with operating manual and video/DVD FHR recording:


by external Doppler ultrasound (US) with autocorrelation by fetal electrode (ECG)
Twin monitoring Maternal heart rate Event marker External tocography Mode, date and time printout Automatic maternal blood pressure pulse and SaO2 facility
基线
无宫缩---NST
变异
有规律宫缩 ---CST ---OCT
宫缩 加速 减速
胎儿电子监护的判读
• 胎监图形的各个基本指标的概念、
• 客观评价标准、临床意义
• 胎监图形的结果评价
• 结果如何指导临床的处理
胎监的临床意义
图形பைடு நூலகம்
判读
评价
如何
处理
各个指标的临床意义 胎心加速
早期减速 晚期减速 变异减速 正弦曲线