Evolving Frameworks for the Foundation and Practice of Electronic Fetal Monitoring

作     者：Mark I.Evans David W.Britt Shara M.Evans Lawrence D.Devoe 

作者机构：Fetal Medicine Foundation of AmericaNew YorkNY 10065USA Comprehensive GeneticsPLLCNew YorkNY 10065USA Department of Obstetrics&GynecologyIcahn School of Medicine at Mt.SinaiNew YorkNY10029USA Department of Maternal Child HealthGillings School of Public Health University of North Carolina at Chapel HillChapel HillNY 27599USA Department of Obstetrics and GynecologyMedical College of GeorgiaAugusta UniversityAugustaGA 30907USA. 

出 版 物：《Maternal-Fetal Medicine》 (母胎医学杂志（英文）)

年 卷 期：2022年第4卷第2期

页      面：141-151页

学科分类：1002[医学-临床医学] 100211[医学-妇产科学] 10[医学] 

主　　题：Fetal monitoring Cardiotocography Fetal reserve index 

摘      要：Since the 1970s,electronic fetal monitoring(EFM)also known as cardiotocography(CTG)has been used extensively in labor around the world,despite its known failure to help prevent many babies from developing neonatal encephalopathy and cerebral *** of EFM’s poor performance with respect to these outcomes arises from a fundamental misunderstanding of the differences between screening and diagnostic tests,subjective classifications of fetal heart rate(FHR)patterns that lead to large inter-observer variability in its interpretation,failure to appreciate early stages of fetal compromise,and poor statistical modeling for its use as a screening *** have developed a new approach to the practice and interpretation of EFM called the fetal reserve index(FRI)which does the following:(1)breaking FHR components down into 4 components,(heart rate,variability,accelerations,and decelerations);(2)contextualizing the metrics by adding increased uterine activity;(3)adding specific maternal,fetal,and obstetric risk *** result is an eight-point scoring metric that,when directly compared with current American College of Obstetricians and Gynecologists EFM categories,even in version 1.0 with equal weighting of variables,shows that the FRI has performed much better for identifying cases at risk before damage had occurred,reducing the need for emergency deliveries,and lowering overall Cesarean delivery *** increased data,we expect further refinements in the specifics of scoring that will allow even earlier detection of compromise in labor.