胎儿监护的解读分析课件

产时电子胎儿监护

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）主要内容胎监应用的历史胎儿监护的发展fetalmonitorstodayhavethefollowingfeatures:Reliable,providedtheyareregularlymaintainedandservicedUserfriendlywithoperatingmanualandvideo/DVDFHRrecording:byexternalDopplerultrasound(US)withautocorrelationbyfetalelectrode(ECG)TwinmonitoringMaternalheartrateEventmarkerExternaltocographyMode,dateandtimeprintoutAutomaticmaternalbloodpressurepulseandSaO2facility

胎儿监护的发展fetalmonitorstodayha胎儿心率的发育ThefetalheartisdetectablebytransvaginalUSasearlyas4weeksafterconceptionAtthisstagethemeanFHRisabout100bpm.Thereafteritprogressivelyrises,reachingameanofabout140-150by10weeksmenstrualage(8weekspostconception),andlevelsoffatthatratebythestartofthesecondtrimester.From14weekstotermthereisaprogressivefallinthemeanbaselineFHRwhichisunaffectedbywhetherthefetusisActiveorQuiescentThisloweringofthebaselineratewithgestationisareflectionofthefactthatthesympatheticautonomic胎儿心率的发育Thefetalheartisdete胎心率变异胎心率变异胎儿氧供的来源Fetaloxygenationisthereforedependentuponmanyfactorsinthisprocess.AnythingthatdisturbsthischainofoxygentransferwillpotentiallyaffectfetaloxygenationandtheFHR.Thekeycomponentsofthechainare:MaternalbloodpressureandoxygenationTheintegrityoftheplacenta,specificallytheamountofsurfaceareaforoxygentransferThepatencyoftheumbilicalcord胎儿氧供的来源Fetaloxygenationisth胎心减速From26weeksonwardsdecelerationsofthefetalheartshouldberegardedasabnormal.However,fetaldecelerationsareanormalfeaturebefore26weeks胎心减速From26weeksonwardsdece胎儿产时缺氧IPfetalhypoxiaoccursinabout1%oflabours.Itcanleadtooneofthreeadverseoutcomes:Perinataldeath(stillbirthsandneonataldeaths)CerebralpalsyHypoxicischemicencephalopathy(HIE)胎儿产时缺氧IPfetalhypoxiaoccurs胎儿缺氧的机制与结局Hypoxiamaypresentchronicallyoracutely.Chronichypoxiaevolvesthroughaseriesofsequentialchanges.Acutehypoxiaalsoevolvesthroughadifferentseriesofsequentialchanges.However,bothrouteseventuallycanleadtothecommonoutcome胎儿缺氧的机制与结局Hypoxiamaypresent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、客观评价标准胎监的临床意义图形判读评价如何处理胎监的临床意义图形评价如何各个指标的临床意义胎心加速胎儿不存在宫内缺氧早期减速胎头受压胎儿缺氧：第一产程早期的早减晚期减速胎儿缺氧无脑儿等变异减速脐带受压胎儿缺氧：非典型变异减速正弦曲线胎儿缺氧各个指标的临床意义胎心加速胎儿不存在宫内缺氧早期减速胎头受压

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Ⅰ同时满足以下

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Ⅱ胎心监护未达

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

胎监的三级诊断分级定义评价处理Ⅲ满足以下条Ⅱ级和Ⅲ级胎心监护的宫内复苏方法宫缩过频或过强停用催产素脐带、胎头受压阴道检查脐带受压改变体位母亲因素血压监测、血氧吸氧常用、但安全性及有效性待证实宫缩频密宫缩抑制剂的应用脐带受压羊膜腔灌注Ⅱ级和Ⅲ级胎心监护的宫内复苏方法宫缩过频或过强停用催产素脐产时电子胎儿监护

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）主要内容胎监应用的历史胎儿监护的发展fetalmonitorstodayhavethefollowingfeatures:Reliable,providedtheyareregularlymaintainedandservicedUserfriendlywithoperatingmanualandvideo/DVDFHRrecording:byexternalDopplerultrasound(US)withautocorrelationbyfetalelectrode(ECG)TwinmonitoringMaternalheartrateEventmarkerExternaltocographyMode,dateandtimeprintoutAutomaticmaternalbloodpressurepulseandSaO2facility

胎儿监护的发展fetalmonitorstodayha胎儿心率的发育ThefetalheartisdetectablebytransvaginalUSasearlyas4weeksafterconceptionAtthisstagethemeanFHRisabout100bpm.Thereafteritprogressivelyrises,reachingameanofabout140-150by10weeksmenstrualage(8weekspostconception),andlevelsoffatthatratebythestartofthesecondtrimester.From14weekstotermthereisaprogressivefallinthemeanbaselineFHRwhichisunaffectedbywhetherthefetusisActiveorQuiescentThisloweringofthebaselineratewithgestationisareflectionofthefactthatthesympatheticautonomic胎儿心率的发育Thefetalheartisdete胎心率变异胎心率变异胎儿氧供的来源Fetaloxygenationisthereforedependentuponmanyfactorsinthisprocess.AnythingthatdisturbsthischainofoxygentransferwillpotentiallyaffectfetaloxygenationandtheFHR.Thekeycomponentsofthechainare:MaternalbloodpressureandoxygenationTheintegrityoftheplacenta,specificallytheamountofsurfaceareaforoxygentransferThepatencyoftheumbilicalcord胎儿氧供的来源Fetaloxygenationisth胎心减速From26weeksonwardsdecelerationsofthefetalheartshouldberegardedasabnormal.However,fetaldecelerationsareanormalfeaturebefore26weeks胎心减速From26weeksonwardsdece胎儿产时缺氧IPfetalhypoxiaoccursinabout1%oflabours.Itcanleadtooneofthreeadverseoutcomes:Perinataldeath(stillbirthsandneonataldeaths)CerebralpalsyHypoxicischemicencephalopathy(HIE)胎儿产时缺氧IPfetalhypoxiaoccurs胎儿缺氧的机制与结局Hypoxiamaypresentchronicallyoracutely.Chronichypoxiaevolvesthroughaseriesofsequentialchanges.Acutehypoxiaalsoevolvesthroughadifferentseriesofsequentialchanges.However,bothrouteseventuallycanleadtothecommonoutcome胎儿缺氧的机制与结局Hypoxiamaypresent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、客观评价标准胎监的临床意义图形判读评价如何处理胎监的临床意义图形评价如何各个指标的临床意义胎心加速胎儿不存在宫内缺氧早期减速胎头受压胎儿缺氧：第一产程早期的早减晚期减速胎儿缺氧无脑儿等变异减速脐带受压胎儿缺氧：非典型变异减速正弦曲线胎儿缺氧各个指标的临床意义胎心加速胎儿不存在宫内缺氧早期减速胎头受压

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Ⅰ同时满足以下

胎监的三级诊