胎儿监护的解读分析VIP免费

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（ElectronicFetalMonitoring）胎儿监护的发展fetalmonitorstodayhavethefollowingfeatures:Reliable,providedtheyareregularlymaintainedandservicedUserfriendlywithoperatingmanualandvideo/DVDFHRrecording:byexternalDopplerultrasound(US)withautocorrelationbyfetalelectrode(ECG)TwinmonitoringMaternalheartrateEventmarkerExternaltocographyMode,dateandtimeprintoutAutomaticmaternalbloodpressurepulseandSaO2facility胎儿心率的发育ThefetalheartisdetectablebytransvaginalUSasearlyas4weeksafterconceptionAtthisstagethemeanFHRisabout100bpm.Thereafteritprogressivelyrises,reachingameanofabout140-150by10weeksmenstrualage(8weekspostconception),andlevelsoffatthatratebythestartofthesecondtrimester.From14weekstotermthereisaprogressivefallinthemeanbaselineFHRwhichisunaffectedbywhetherthefetusisActiveorQuiescentThisloweringofthebaselineratewithgestationisareflectionofthefactthatthesympatheticautonomic胎心率变异胎儿氧供的来源Fetaloxygenationisthereforedependentuponmanyfactorsinthisprocess.AnythingthatdisturbsthischainofoxygentransferwillpotentiallyaffectfetaloxygenationandtheFHR.Thekeycomponentsofthechainare:MaternalbloodpressureandoxygenationTheintegrityoftheplacenta,specificallytheamountofsurfaceareaforoxygentransferThepatencyoftheumbilicalcord胎心减速From26weeksonwardsdecelerationsofthefetalheartshouldberegardedasabnormal.However,fetaldecelerationsareanormalfeaturebefore26weeks胎儿产时缺氧IPfetalhypoxiaoccursinabout1%oflabours.Itcanleadtooneofthreeadverseoutcomes:Perinataldeath(stillbirthsandneonataldeaths)CerebralpalsyHypoxicischemicencephalopathy(HIE)胎儿缺氧的机制与结局Hypoxiamaypresentchronicallyoracutely.Chronichypoxiaevolvesthroughaseriesofsequentialchanges.Acutehypoxiaalsoevolvesthroughadifferentseriesofsequentialchanges.However,bothrouteseventuallycanleadtothecommonoutcome判读胎儿电子监护图形的基本要点基线变异加速减速宫缩无宫缩---NST有规律宫缩---CST---OCT胎儿电子监护的判读胎监的临床意义各个指标的临床意义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处理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可疑需进行评估，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胎监的三级诊断分级定义评价处理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Ⅱ级和Ⅲ级胎心监护的宫内复苏方法