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Abstract

Evidenz based fetal assessment

Cardiotocography (CTG) is the most frequently used method for fetal surveillance during labour. There is no clear evidence that antepartum fetal heart rate assessment can predict fetal compromise. However, the false positive rate might be as high as 60% due to various factors. A higher sensitivity might be achieved either by a longer registration (fetal deep sleep phase) or by adding Ultrasound Doppler studies. Another method would be the quantification of the single parameters in a score. Premise for a correct interpretation of fetal heart patterns is extensive knowledge of physiology and pathophysiology of the fetal cardiovascular regulation. Warning signs of fetal compromise in the CTG can only be seen between 0 to 3 days beforehand, therefore additive methods (Doppler ultrasound, amniotic fluid volume rate, Kineto-CTG) should be used for high-risk pregnancies. There is no evidence that electronic fetal heart rate monitoring can predict a bad neonatal outcome. However, continuous fetal heart rate monitoring is also associated with an increase in operative deliveries. Errors of judgement can be reduced by teaching programs for intrapartum fetal monitoring and standardisation of the classification criteria and the defined intervention endpoints in case of a nonreassuring CTG. Using fetal blood sampling (FBS) in labour for nonreassuring CTG can reduce the high false positiv rate of fetal heart rate patterns. The use of CTG in combination with FBS leads to a reduction of neonatal seizures and also to a reduction of avoidable operative deliveries. The development of onlineanalysis of fetal heartrate patterns with a quantification of the parameters by electronical systems leads to more reproducible interpretation. Their implementation can be recommended. Effectiveness of additive methods for fetal monitoring during labour, such as fetal pulsoxymetry with continuous information about oxygen saturation, and ST-waveform analysis of fetal ECG with automatic warning in case of suspected fetal hypoxia and metabolic acidosis, are being evaluated in clinical trials.

CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol 2014; 10(2): 144–160

Keywords
Antepartum fetal assessment, electronic fetal monitoring, fetal puls oximetry, STAN, quantitative cardiotocography

Andreas Nonnenmacher, Hartmut Hopp
Klinik für Geburtsmedizin, Campus Virchow Klinikum,
Charité – Universitätsmedizin Berlin
Reviewer: Werner Diehl, Hamburg,
und Wiebke Woltmann, Bremen

Nonnenmacher A. Evidenz ... Gynakol Geburtsmed Gynakol Endokrinol 2014; 10(2): 144–160 publiziert 31.07.2014 www.akademos.de/gyn ©akademos Wissenschaftsverlag 2014 ISSN 1614-8533