新生儿在分娩期间死亡的风险最大，包括人工和交付，生命的第一天。胎儿心率监测（FHRM）和产程图用于跟踪产程进展是基于证据的技术，可以帮助识别母体和胎儿的危险因素，以便可以及早解决这些问题。这项研究的目的是评估卫生工作者在产时期间对FHRM和模式使用协议的依从性，并评估尼泊尔一家三级医院的依从性与产时死胎之间的关系。
在15个月的时间内进行了一项病例参考研究。病例包括所有产期死胎，而20％的活产妇女在入院时被随机选择以构成参考人群。测量FHRM的频率和产程图的使用，并使用逻辑回归分析评估其与产时死产的关联。
在研究期间，4,476名活产妇女被登记为参考对象，136名产期死产为病例。每30分钟的FHRM仅在四分之一的交付中完成，并且在超过一半的时间内使用句型图监测分娩进度。随着FHRM频率的降低，产时死产风险增加;FHRM间隔超过30分钟导致产时死产风险增加4倍(aOR4.17,95%CI2.0-8.7),如果FHRM每小时执行时间少于或根本不执行，则产时死产的可能性增加7倍（aOR7.38，95％CI3.5-15.4）。此外,如果不使用产程图,产时死产风险增加3倍(aOR3.31,95%CI2.0~5.4).
在尼泊尔一家三级医院中，FHRM的坚持和断代图的使用不足以监测产时进展。当胎儿心率未得到充分监测并且未使用产程图监测产程进展时，产时死产的风险增加。需要进一步探索，以确定和了解遵守的障碍；开发工具，预防产时死产的技术和干预措施。
ISRCTN97846009。
Newborns are at the greatest risk for dying during the intrapartum period, including labor and delivery, and the first day of life. Fetal heart rate monitoring (FHRM) and
partogram use to track labor progress are evidence-based techniques that can help to identify maternal and fetal risk factors so that these can be addressed early. The objective of this study was to assess health worker adherence to protocols for FHRM and
partogram use during the intrapartum period, and to assess the association between adherence and intrapartum stillbirth in a tertiary hospital of Nepal.
A
case-referent study was conducted over a 15-month period. Cases included all intrapartum stillbirths, while 20 % of women with live births were randomly selected on admission to make up the referent population. The frequency of FHRM and the use of
partogram were measured and their association to intrapartum stillbirth was assessed using logistic regression analysis.
During the study period, 4,476 women with live births were enrolled as referents and 136 with intrapartum stillbirths as cases. FHRM every 30 min was only completed in one-fourth of the deliveries, and labor progress was monitored using a partogram in just over half. With decreasing frequency of FHRM, there was an increased risk of intrapartum stillbirth; FHRM at intervals of more than 30 min resulted in a four-fold risk increase for intrapartum stillbirth (aOR 4.17, 95 % CI 2.0-8.7), and the likelihood of intrapartum stillbirth increased seven times if FHRM was performed less than every hour or not at all (aOR 7.38, 95 % CI 3.5-15.4). Additionally, there was a three-fold increased risk of intrapartum stillbirth if the
partogram was not used (aOR 3.31, 95 % CI 2.0-5.4).
The adherence to FHRM and partogram use was inadequate for monitoring intrapartum progress in a tertiary hospital of Nepal. There was an increased risk of intrapartum stillbirth when fetal heart rate was inadequately monitored and when the progress of labor was not monitored using a partogram. Further exploration is required in order to determine and understand the barriers to adherence; and further, to develop tools, techniques and interventions to prevent intrapartum stillbirth.
ISRCTN97846009 .
