目的 在妊娠晚期孕妇中使用网络远程电子胎心监护（electronic fetal monitoring, EFM）系统,并与传统EFM进行比较,分析其对于妊娠结局的改善效果。方法 研究对象为2019年1月—2020年1月收治的妊娠晚期孕妇298例;依据术后治疗方法分为两组,传统组孕妇采用常规EFM检查（142例）,网络组孕妇采用网络远程EFM检查（156例）。观察指标包括两组孕妇妊娠晚期胎儿管理指标、妊娠期间不良心理状态评分、最终分娩方式及胎儿妊娠结局。结果 网络组孕妇的胎心、胎动、无应激实验（non-stress test, NST）异常检出率均明显优于传统组（P<0.05）。干预后,两组孕妇的焦虑、抑郁等不良心理状态评分均获得明显改善;网络组孕妇的焦虑、抑郁等不良心理状态评分均明显低于传统组（P<0.05）。两组孕妇的顺产、助产及剖宫产等分娩方式的占比差异较小（P>0.05）。网络组孕妇的早产、新生儿窒息、羊水污染及体质量过低等不良妊娠结局发生率均明显低于传统组（P<0.05）。结论 网络远程EFM系统具有简便、安全、高效的应用优势,孕妇接受程度高,存在较高的敏感性、准确性及时效性,有利于突破传统时间与空间的限制、节约医患双方的时间与精力,更大程度地降低诊治压力、优化医疗资源的配置。因此,建议依据实际情况优先选择网络远程EFM以达到规避胎儿缺氧的发生、改善妊娠质量的效果。
Objective To compare the effects of networked remote electronic fetal monitoring （EFM） and traditional EFM in the late stage of pregnancy on the outcome of pregnancy. Methods The study subjects were 298 pregnant women of late pregnancy admitted from January 2019 to January 2020. According to postoperative treatment method, they were divided into two groups： a traditional group who received conventional EFM examination （142 cases） and a network group who received networked remote EFM examination （156 cases）. Fetal management during late pregnancy, adverse psychological status score during pregnancy, final mode of delivery, and pregnancy outcome were compared between the two groups. Results The abnormal rates of fetal heart, fetal movement, and non-stress test （NST） results were significantly lower in the network group than those in the traditional group （P<0.05）. After the intervention, both groups of pregnant women showed significant improvement in anxiety and depression scores; the network group showed significantly lower anxiety and depression scores than the traditional group （P<0.05）. No differences were found in the distribution of normal, assisted, and caesarean deliveries between the two groups of pregnant women （P>0.05）. The incidence rates of adverse pregnancy outcomes such as premature birth, neonatal asphyxia, amniotic fluid contamination, and low body weight were significantly lower in the network group than those in the traditional group （P<0.05）. Conclusion The networked remote EFM system has the advantages of simple, safe, and efficient application, high acceptance by pregnant women, as well as high sensitivity, accuracy and timeliness, which is conducive to breaking the traditional time and space limitation, saving time and energy of both doctors and patients, reducing the pressure of diagnosis and treatment, and optimizing the allocation of medical resources to a greater extent. Therefore, it is recommended to prioritize networked remote EFM in order to avoid fetal hypoxia and improve the quality of pregnancy.
[1] Kilowski KA, Robinson B.Strip of the month: does antenatal steroid administration impact electronic fetal monitoring?[J]. Neo Reviews, 2018,19(4):256-264.
[2] Sartwelle TP, Johnston JC, Arda B.Electronic Fetal monitoring, cerebral palsy litigation and bioethics: the evils in Pandora's Box[J]. J Pediatr Health Care, 2016,2(14):1-7.
[3] Heelan F, Shi L, Zhang Y, et al.Impact of continuous electronic fetal monitoring on birth outcomes in low-risk pregnancies[J]. Birth, 2019, 6(12):326-329.
[4] Mullins E, Lees C, Brocklehurst P.Is continuous electronic fetal monitoring useful for all women in labour?[J]. BMJ, 2017,35(9):5423.
[5] 何茹碧,吴云涛,缪华章,等.基于互联网的移动远程胎心监护的实现和一致性评价[J].中国妇幼卫生杂志,2016,3(1):5-7.
[6] Taylor R, Friedman P, Kim SK, et al.Temporal and quantitative associations of electronic fetal monitoring with outcomes[J]. Obstet Gynecol Surv, 2018,13(1):155.
[7] Evans MI, Eden RD, Britt DW, et al.Re-engineering the interpretation of electronic fetal monitoring to identify reversible risk for cerebral palsy: a case control series[J]. J Matern Fetal Neonatal Med, 2018,7(1):188-191.
[8] Carter EB, Chu CS,Thompson Z,et al.True knot at the time of delivery: electronic fetal monitoring characteristics and neonatal outcomes[J]. J Perinatol, 2018,24(9):665-667.
[9] Yeom GJ, Kim IO.Development and effects of supplementary material about electronic fetal monitoring for nursing students[J]. Eur J Oncol Nurs, 2016,22(1):235-257.
[10] Porter AC, Triebwasser JE, Tuuli M, et al.Fetal sex differences in intrapartum electronic fetal monitoring[J]. Am J Perinatol, 2016,33(8):786-790.
[11] 蒲杰,张刚,蒋庆源,等.互联网+远程胎心监护临床应用的可行性研究[J].实用妇产科杂志, 2018, 34(3):208-212.
[12] Turnbull TL, Mol B WJ, Matthews G, et al.Does ST analysis have a place in electronic fetal monitoring?[J]. J Matern Fetal Neonatal Med, 2016,2(6):167-169.
[13] Carter E, Chu C, Thompson Z, et al.Electronic fetal monitoring and neonatal outcomes when a nuchal cord is present at delivery[J]. Am J Perinatol,2019,2(9):456-459.
[14] Enabudoso E, Ande AA, Enaruna N, et al.Challenges and practical steps to optimizing the utilization of electronic fetal monitoring in low-and medium-income countries: The UBTH experience[J].Trop J Obstet Gynaecol, 2019, 7(6):522-526.
[15] Rosenbloom JI, Stout MJ, Tuuli MG, et al.Elevated umbilical cord arterial lactate at birth and electronic fetal monitoring characteristics on admission and in the active phase[J]. Am J Perinatol, 2019,6(2):356-359.
[16] 贾红知,马玉红,刘欢,等.基于互联网的远程胎儿电子胎心监护在妊娠晚期孕妇中的应用和效果观察[J].中国计划生育和妇产科, 2019, 2(8):106-108.
[17] Sartwelle TP, Johnston JC, Arda B, et al.Cerebral palsy, cesarean sections, and electronic fetal monitoring: All the light we cannot see[J].J Clin Ethics,2019,4(3):1-8.
[18] Daglar G, Demirel G, Guler H, et al.The effect of electronic fetal monitoring (EFM) education program on EFM interpretation skills[J]. J Matern Fetal Neonatal Med,2019,4(7):152-156.
