Der Gynäkologe

, Volume 42, Issue 5, pp 350–360

Perspektiven der CTG-Anwendung während der Geburt

Leitthema
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Zusammenfassung

Die Kardiotokographie (CTG) ist weltweit die am häufigsten genutzte Methode der Fetalüberwachung während der Geburt. Während das normale CTG zuverlässig fetales Wohlbefinden anzeigt, entsprechen als pathologisch eingestufte Muster der fetalen Herzfrequenz (FHF) häufig noch physiologischen Veränderungen. Spezifität und positiv prädiktiver Wert des CTG für eine fetale Hypoxie und/oder fetale Azidose sind niedrig, während Sensitivität und negativ prädiktiver Wert hoch sind. Die Falsch-positiv-Rate der CTG-Interpretation führt zu vielen vermeidbaren Entbindungsoperationen. In Kombination mit dem indizierten Einsatz von Fetalblutanalysen (FBA) werden hypoxiebedingte Mortalität, Auftreten neonataler Krampfanfälle und ungerechtfertigte operative Entbindungen reduziert. Online-Analysen des CTG mit der Quantifizierung von FHF-Parametern durch elektronische Verfahren ermöglichen eine höhere Reproduzierbarkeit der CTG-Interpretation und verbessern so die diagnostische Sicherheit. Die gute Korrelation von pathologischen Befunden der ergänzenden Überwachungsverfahren fetale Pulsoxymetrie und ST-Analyse des fetalen EKG (STAN) zur fetalen Azidose wird eine Reduzierung von FBA bei suspekter und pathologischer FHF ermöglichen.

Schlüsselwörter

Kardiotokographie Kombinierte Geburtsüberwachung Fetale Pulsoxymetrie STAN Computerisierte FHF-Analyse 

Perspectives of electronic fetal heart rate monitoring during labor

Abstract

Cardiotocography (CTG) is the most frequently used method for fetal surveillance during labor. While a normal CTG usually indicates a reassuring fetal status, a non-reassuring or abnormal fetal heart rate (FHR) does not necessarily equate with fetal hypoxia and/or acidosis. The positive predictive value of CTG for adverse outcome is low and the negative predictive value is high. These features, combined with marked interobserver variation in CTG interpretation, result in inappropriately high operative delivery rates for non-reassuring fetal status. Using fetal blood sampling (FBS) in labor with non-reassuring CTG can reduce the high false positive rate of FHR patterns. The use of CTG in combination with FBS permits a reduction of neonatal seizures and also a reduction of avoidable operative deliveries. The development of online analysis of FHR patterns with a quantification of important parameters by computerized expert systems leads to more reproducible interpretation and more diagnostic reliability. Pathologic findings of the supplementary methods for fetal monitoring during labor, fetal pulse oxymetry and ST-waveform analysis of fetal ECG have a good correlation with fetal acidosis making a reduction of FBS possible.

Keywords

Electronic fetal monitoring Combined fetal surveillance Fetal pulse oximetry STAN Computerized FHR analysis 

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Klinik für GeburtsmedizinCharité-Universitätsmedizin Berlin, Campus Benjamin FranklinBerlinDeutschland

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