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首页> 外文期刊>Acta Obstetricia et Gynecologica Scandinavica: Official Publication of the Nordisk Forening for Obstetrik och Gynekologi >Identification of cases with adverse neonatal outcome monitored by cardiotocography versus ST analysis: Secondary analysis of a randomized trial
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Identification of cases with adverse neonatal outcome monitored by cardiotocography versus ST analysis: Secondary analysis of a randomized trial

机译：通过心动描记术与ST分析监测确定新生儿不良结局的病例：一项随机试验的二级分析

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Objective. To evaluate whether correct adherence to clinical guidelines might have led to prevention of cases with adverse neonatal outcome. Design. Secondary analysis of cases with adverse outcome in a multicenter randomized clinical trial. Setting. Nine Dutch hospitals. Population. Pregnantwomenwith a termsingleton fetus in cephalic position. Methods. Data were obtained from a randomized trial that compared monitoring by STAN? (index group) with cardiotocography (control group). In both trial arms, three observers independently assessed the fetal surveillance results in all cases with adverse neonatal outcome, to determine whether an indication for intervention was present, based on current clinical guidelines. Main outcome measures. Adverse neonatal outcome cases fulfilled one or more of the following criteria: (i) metabolic acidosis in umbilical cord artery (pH<7.05 and base deficit in extracellular fluid>12 mmol/L); (ii) umbilical cord artery pH<7.00; (iii) perinatal death; and/or (iv) signs of moderate or severe hypoxic ischemic encephalopathy. Results. We studied 5681 women, of whom 61 (1.1%) had an adverse outcome (26 index; 35 control). In these women, the number of performed operative deliveries for fetal distress was 18 (69.2%) and 16 (45.7%), respectively. Reassessment of all 61 cases showed that there was a fetal indication to intervene in 23 (88.5%) and 19 (57.6%) cases, respectively. In 13 (50.0%) vs. 11 (33.3%) cases, respectively, this indication occurred more than 20 min before the time of delivery, meaning that these adverse outcomes could possibly have been prevented. Conclusions. In our trial, more strict adherence to clinical guidelines could have led to additional identification and prevention of adverse outcome.
机译：目的。评估是否正确遵守临床指南可能会预防新生儿不良结局。设计。在多中心随机临床试验中对不良结果病例进行二次分析。设置。九家荷兰医院。人口。孕妇在头位有白母胎儿。方法。数据来自一项随机试验，该试验比较了STAN？ （索引组）和心动描记法（对照组）。在两个试验组中，三名观察员根据当前临床指南独立评估了所有新生儿不良结局病例的胎儿监护结果，以确定是否存在干预指征。主要观察指标。新生儿不良结局病例符合以下一项或多项标准：（i）脐动脉代谢性酸中毒（pH <7.05，细胞外液碱缺乏症> 12 mmol / L）; （ii）脐动脉pH <7.00; （iii）围产期死亡;和/或（iv）中度或重度缺氧缺血性脑病的体征。结果。我们研究了5681名妇女，其中61名（1.1％）的不良结果（26指数; 35名对照）。在这些妇女中，因胎儿窘迫而进行的手术分娩数分别为18（69.2％）和16（45.7％）。对所有61例病例的重新评估显示，有胎儿迹象表明分别有23例（88.5％）和19例（57.6％）干预。分别在13例（50.0％）和11例（33.3％）的病例中，该指征发生在分娩前20分钟以上，这意味着这些不良后果可能可以预防。结论在我们的试验中，更严格地遵守临床指南可能会导致其他识别和预防不良结局。

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