胎儿监护的解读分析

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 The patency of the umbilical cord
正常
定期监护
胎监的三级诊断
分级 定义 评 价
Cerebral palsy Hypoxic ischemic encephalopathy (HIE)
胎儿缺氧的机制与结局

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


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


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
• 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
sequential 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
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
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
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:
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)