INTERPRETATION OF THE CARDIOTOCOGRAPHY IN LABOR THROUGH THE UNDERSTANDING OF PATHOPHYSIOLOGICAL MECHANISMS OF INTRAUTERINE HYPOXIA

UDC 61

 

INTERPRETATION OF THE CARDIOTOCOGRAPHY IN LABOR THROUGH

THE UNDERSTANDING OF PATHOPHYSIOLOGICAL MECHANISMS

OF INTRAUTERINE HYPOXIA

 

H. Capros, PhD, Associate Professor, Obstetrics, Gynecology Department

State Medical University of Medicine and Pharmacy “Nicolae Testemitanu”

(Republic of Moldova, bd. Ştefan cel Mare, 165, Chişinău, MD 2001)

Е-mail: hristiana.capros@usmf.md

 

N. Codreanu, PhD, Associate Professor, Obstetrics, Gynecology Department

State Medical University of Medicine and Pharmacy “Nicolae Testemitanu”

(Republic of Moldova, bd. Ştefan cel Mare, 165, Chişinău, MD 2001)

Е-mail: hristiana.capros@usmf.md

 

M. Surguci, PhD, Associate Professor, Obstetrics, Gynecology Department

State Medical University of Medicine and Pharmacy “Nicolae Testemitanu”

(Republic of Moldova, bd. Ştefan cel Mare, 165, Chişinău, MD 2001)

Е-mail: hristiana.capros@usmf.md

 

D. Mitriuc, Assistant Professor Obstetrics, Gynecology Department

State Medical University of Medicine and Pharmacy “Nicolae Testemitanu”

(Republic of Moldova, bd. Ştefan cel Mare, 165, Chişinău, MD 2001)

Е-mail: hristiana.capros@usmf.md

 

V. Voloceai, Assistant Professor Obstetrics, Gynecology Department

State Medical University of Medicine and Pharmacy “Nicolae Testemitanu”

(Republic of Moldova, bd. Ştefan cel Mare, 165, Chişinău, MD 2001)

Е-mail: hristiana.capros@usmf.md

 

V. Cotelea, Assistant Professor Obstetrics, Gynecology Department

State Medical University of Medicine and Pharmacy “Nicolae Testemitanu”

(Republic of Moldova, bd. Ştefan cel Mare, 165, Chişinău, MD 2001)

Е-mail: hristiana.capros@usmf.md

 

Abstract. During labor, the development of regular uterine contractions causes the constriction of myometrial vessels and the decrease of utero-placental blood flow. As a result a fetus is exposed to repetitive conditions of short duration hypoxia. Intranatal fetal assessment methods are used to assess the tolerance of the fetus to oxygen deficiency during labor. Cardiotocography is the first-line method of fetal assessment during birth, it is harmless and affordable.

Keywords:  Fetal hypoxia, cardiotocography, labor.

 

Introduction.

Childbirth, through the development of regular uterine contractions and the decrease in utero-placental flow, represents a stressful event for the fetus. Due to the presence of physiological compensation mechanisms: fetal hemoglobin, fetal heart rate, the particularities of the fetal vascular system, most girls tolerate the lack of oxygenation well during labor. In order to assess the fetal tolerance to the decrease in oxygenation during labor, methods have been developed by means of which we could determine potential fetal decompensation and prevent subsequent fetal damage and fetal death [8, 18]. The purpose of intrapartum fetal surveillance is to detect cases of fetal distress during fetal birth to ensure optimal obstetric management (most frequently by fetal extraction).

 

Pathophysiology of fetal oxygenation during labor.

Fetal tissue oxygenation depends on several factors, namely: gas exchange in the maternal lung, adequate blood circulation and diffusion of oxygen through uterine vessels and placenta, distribution and assimilation of gasses by fetal tissues. Any disruption of this circuit will reduce the availability of oxygen for the fetus, and therefore the activation of compensatory mechanisms to centralize the circulation [9]. During labor, the development of regular uterine contractions causes the constriction of myometrial vessels and the decrease of utero-placental blood flow. As a result a fetus is exposed to repetitive conditions of short duration hypoxia. During labor, in the fetus with normal utero-placental function, a moderate and gradual increase in PCO2 and a decrease in PO2 and pH are observed. During normal labor, there is a gradual rise in PCO2 and a slight fall in PO2 and pH. These values are not within normal limits, and the fetus does not show changes in heart rate. If uteroplacental function is impaired, the decrease in blood flow during contractions results in a significant increase in pCO2 and a decrease in pO2 and pH that exceed critical thresholds, which induces the activation of compensatory mechanisms [12]. Intrauterine hypoxia leads to a series of progressive changes in the cardiovascular system, the fetal nervous system, the purpose of which is the priority of oxygenation of the vital organs: brain, heart and adrenals.

Compensatory responses of the fetus developing hypoxia include the following progressive changes:

1. Modification of fetal cardiac activity to increase fetal cardiac output.

Fetal cardiac activity is regulated by a complex mechanism of interaction between baro- and chemoreceptors, the sympathetic and parasympathetic systems.

The decrease in the level of oxygenation stimulates the activation of chemoreceptors at the level of the carotid sinus, with the predominant stimulation of the parasympathetic system, but also of the sympathetic system. Activation of the parasympathetic system results in a reduction in heart rate, which prolongs filling time, increases end-diastolic volume, and therefore contributes to the maintenance of cardiac output and tissue perfusion pressure [15]. Clinically, this change corresponds to the appearance of cardiac decelerations.

2. Decrease in oxygen consumption by decreasing active movements and breathing frequency. It is the next stage in the chain of pathophysiological changes in response to tissue hypoxia. Clinically, it translates into the disappearance of cardiac accelerations.

3. Blood redistribution with central vasodilatation and peripheral vasoconstriction.

The significant decrease in pO2 during labor and the activation of the sympathetic system causes the secretion of a series of vasoconstrictive substances: plasma catecholamines, vasopressin, angiotensin II and neuropeptide Y. The activation of the sympathetic system increases the fetal heart rate (tachycardia), activates anaerobic glycogenolysis with the production of lactic acid. The production of lactic acid and the decrease in fetal blood pH define metabolic acidosis and tissue alteration [13].

At the cerebral level, acidosis manifests itself through the alteration of the brain stem, the loss of the fine balance between sympathetic and parasympathetic cardiac control, and as a clinical manifestation, the resulting decrease in the variability of the fetal cardiac activity takes place. Thus, persistence or aggravation of hypoxia conditions, especially in a compromised fetus before the onset of contractions, leads to severe metabolic acidosis and cardio-vascular decompensation with systemic arterial hypotension, ischemia and brain damage. The type of brain injury caused depends on the duration and intensity of hypoxia, the vascularity and maturity of the brain. The type of brain injury caused depends on the duration and intensity of hypoxia, the vascularity and maturity of the brain. The most frequently affected areas are the subcortical areas of white matter located between the cerebral vessels. Often these lesions involve the motor cortex responsible for motility in the lower and upper extremities. The most common consequence of this injury is spastic tetraplegia. An even deeper lesion of the cerebral white matter occurs when the nervous system is immature (premature birth, fetal growth restriction) can occur in the case of severe hypotension. An example of profound hypoxic damage during preterm labor would be periventricular leukomalacia. Manifestations of periventricular leukomalacia following intrapartum hypoxia are spastic diplegia or spastic tetraplegia, which are associated with visual and cognitive deficit [5]. As can be seen from the above, the cardiovascular changes precede the changes in the central nervous system, which is why monitoring the fetal heart rate is the basic method for evaluating the fetal state at birth. It should be mentioned that cardiotocography is a screening method, and not a diagnostic method of fetal acidosis [14].

 

Methods of fetal assessment.

Depending on the presence of fetal and maternal risk factors during labor, fetal cardiac activity can be determined by:

• Intermittent auscultation of the fetal heart (without cardiotocographic recording),
• Cardiotocographic recording on admission (for example, 20 minutes) followed by intermittent auscultation during labor,
• Intermittent cardiotocographic monitoring,
• Continuous cardiotocographic monitoring [10].

The type of intrapartum fetal monitoring depends on the clinical circumstances and is decided in each individual situation. As a rule, in full-term, uncomplicated single-fetal pregnancies, which are properly and regularly monitored, intermittent auscultation of the fetal heart is performed. In pregnancies with fetal and maternal risk factors, in which the development or worsening of fetal distress during labor is possible, depending on the clinical situation, either intermittent cardiotocographic monitoring or continuous cardiotocographic monitoring is preferred. If, in low-risk pregnancies, the cardiotocographic path recorded at admission is suspicious, continuous fetal recording during labor is recommended [1].

 

Intermittent auscultation.

Fetal heart rate and rhythm are assessed using a Pinard stethoscope, or the cardio monitor based on the Doppler principle. The fetal heartbeat is heard "at the maximum auscultation point" from the back, which adheres more intimately to the uterine wall. The maximum point of auscultation is determined by the Leopold maneuvers. The heart rate is determined immediately after a contraction for at least one minute, at the same time the maternal pulse is palpated to differentiate the maternal and fetal heartbeats. The normal frequency of the fetal heartbeat is 110-150 beats/minute. If, during the intermittent auscultation, it is determined that there is an increase or decrease in the fetal heart rate compared to the normal basic rhythm, the fetal cardiotocographic monitoring is performed [4].

 

Cardiotocography.

The method of assessing the intrauterine condition of the fetus by simultaneously recording the fetal heartbeat and maternal uterine contractions is called cardiotocography. The advantages of this noninvasive investigation are numerous: ease of use, excellent sensitivity, and negative predictive value of neonatal asphyxia. Its main disadvantage is the low specificity, resulting in more cesarean operations and unsubstantiated instrumental extractions [11]. The frequency of fetal heart contractions and uterine activity are assessed using simple equipment in operation. Ultrasonic wave emitting sensors are placed on the anterior abdominal wall. The fetal heart rate is obtained through a transducer placed at the level of the maximum point of auscultation, assessed by Leopold palpation, and the uterine contractions are recorded through another pressure transducer, fixed externally at the level of the uterine fundus. Fetal heart rate and uterine activity are recorded on thermal paper (cardiotocogram). Cardiotocographic recording during labor can be performed continuously (throughout the birth) or at regular intervals [17]. Interpretation of the cardiotocogram is done according to a standardized procedure. In the assessment of the cardiotocographic route, the particular clinical situation and the presence of risk factors are taken into account.

A correct and complete description of cardiotocography contains :

Characteristics of uterine activity:

frequency,

duration,

intensity of contractions

the basic tone.

 

Features of fetal cardiac activity:

1. Basal rhythm. By basal rate is the average heart rate of the fetus. It is appreciated over a segment of at least 10 minutes or more. The base rate is normally between 110 and 160 beats per minute (bpm). Tachycardia is defined as a fetal heart rate greater than 160 bpm for more than 10 minutes. Bradycardia is defined as a fetal heart rate below 110 bpm for more than 10 minutes.

2. Variability - represents the degree to which the basal rhythm oscillates or varies. Variability is considered normal if it is between 6 and 25 bpm, minimal if it is less than or equal to 5 bpm, and marked above 25 bpm.

3. The presence of accelerations. A sudden increase in fetal heart rate of more than 15 bpm lasting 15 seconds or more (but less than 2 minutes) is called an acceleration. The presence of accelerations indicates that the fetus is reacting correctly to the lack of oxygen during the contraction and does not show signs of hypoxia/acidosis.

4. The presence of decelerations - is the decrease in heart rate by at least 15 bpm for at least 15 seconds. They are mediated through the parasympathetic system. Decelerations are analyzed only in relation to uterine contractions. Decelerations are repetitive when associated with every second uterine contraction.

5. Early decelerations - represent a progressive and slow decrease in the frequency of heart contractions. These decelerations begin and end with uterine contraction (early). Early decelerations are thought to be secondary to fetal head compression and are benign.

6. Late decelerations - the progressive decrease in heart rate, start at least 20 sec after the beginning of the uterine contraction (late) and persist after the contraction.

Variable decelerations consist of a rapid, steep drop in heart rate followed by a rapid return to the original baseline rate. These can have different duration and morphology in relation to the contraction (they are variable). In the analysis of the decelerations, the pathological criteria are taken into account, which are the following: duration more than 60 seconds; reducing base rate variability during deceleration; slow recovery, no return to baseline; biphasic appearance (in W); lack of acceleration before and after deceleration. Prolonged decelerations last from 3 to 10 min [2, 7].

 

Management  of labor depending on the cardiotocographic record.

Depending on the presence and duration of the above characteristics, the cardiotocographic tracks are classified into one of 3 types:

– normal,

– suspect

– pathological.

Decision-making regarding obstetric management will be carried out considering the type of route recorded, but also the individual clinical context of the case. The normal cardiotocographic track confirms the fetal well-being, indicates the minimal probability of acidemia and fetal hypoxic damage at the time of performance. Fetal cardiac activity may remain stable over time or may change resulting in a suspicious or pathological cardiotocographic pattern [6].

Suspicious cardiotocographic pattern. In case the birth is complicated with a suspicious cardiotocographic pattern, the entire clinical picture is reviewed, the diagnosis and correction of reversible underlying causes is attempted. The management of the patient consists in the diagnosis and correction of all possible causes that may underlie these changes. The oxytocin infusion is stopped, a complete maternal examination is performed, the pregnant woman is mobilized and an alternative position is adopted, hypotension is corrected by fluid infusion, tocolytics are administered in case of uterine hyperstimulation (subcutaneous terbutaline 0.25 mg), digital stimulation of the fetal scalp etc. If there are clinical fetal risk factors or 2-3 pathological criteria and the remedial actions do not correct the cardiotocographic path, it is necessary to determine the pH from the fetal scalp or to complete the delivery. The presence of acute bradycardia or prolonged deceleration > 8 minutes is an indication for emergency termination of labor [3].

 

REFERENCES

1. Alfirevic Z, Devane D, Gyte GM, Cuthbert A. conținuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev 2017; 2:CD006066
2. Al Wattar BH, Honess E, Bunnewell S, et al. Effectiveness of intrapartum fetal surveillance to improve maternal and neonatal outcomes: a systematic review and network meta-analysis. CMAJ 2021; 193:E468.
3. Al Wattar BH, Lakhiani A, Sacco A, et al. Evaluating the value of intrapartum fetal scalp blood sampling to predict adverse neonatal outcomes: A UK multicentre observational study. Eur J Obstet Gynecol Reprod Biol 2019; 240:62.
4. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol 2009; 114:192. Reaffirmed 2021.
5. Blix E, Maude R, Hals E, Kisa S, Karlsen E, et al. Intermittent auscultation fetal monitoring during labour: A systematic scoping review to identify methods, effects, and accuracy. PLoS One. 2019 Jul 10;14(7):e0219573. doi: 10.1371/journal.pone.0219573. PMID: 31291375; PMCID: PMC6619817.
6. Carbonne B, Pons K, Maisonneuve E. Foetal scalp blood sampling during labour for pH and lactate measurements. Best Pract Res Clin Obstet Gynaecol 2016; 30:62.
7. Clark SL, Meyers JA, Frye DK, et al. Recognition and response to electronic fetal heart rate patterns: impact on newborn outcomes and primary cesarean delivery rate in women undergoing induction of labor. Am J Obstet Gynecol 2015; 212:494.e1.
8. Cunningham, F.G.; Leveno, K.; Bloom, S.; et al. Williams obstetrics. 24th ed. New York (NY): McGraw-Hill Medical, 2014.
9. Danforth's Obstetrics and Gynecology. 9th ed. Edit.: James R. Scott, Ronald S. Gibbs, Beth Y. Karlan, Arthur F. Haney, David N. Danforth By Lippincott Williams & Wilkins Publishers, 2003.
10. Devane D, Lalor JG, Daly S, McGuire W, Cuthbert A, Smith V. Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing. Cochrane Database Syst Rev. 2017 Jan 26;1(1):CD005122. doi: 10.1002/14651858.CD005122.pub5. PMID: 28125772; PMCID: PMC6464914.
11. Gibb D, Arulkumaran S. Fetal monitoring in practice. 3rd ed. London (UK): Churchill Livingstone; 2008.
12. Giussani DA. The fetal brain sparing response to hypoxia: physiological mechanisms. J Physiol. 2016 Mar 1;594(5):1215-30. doi: 10.1113/JP271099. Epub 2016 Jan 6. PMID: 26496004; PMCID: PMC4721497.
13. Housseine N, Punt MC, Browne JL, Meguid T, Klipstein-Grobusch K, Kwast BE, et al.. Strategies for intrapartum foetal surveillance in low- and middle-income countries: A systematic review. PLoS One. 2018 Oct 26;13(10):e0206295. doi: 10.1371/journal.pone.0206295. PMID: 30365564; PMCID: PMC6203373.
14. Intermittent Auscultation for Intrapartum Fetal Heart Rate Surveillance: American College of Nurse-Midwives. J Midwifery Womens Health. 2015 Sep-Oct;60(5):626-32. doi: 10.1111/jmwh.12372. Erratum in: J Midwifery Womens Health. 2016 Jan-Feb;61(1):134. PMID: 26461195.
15. Kurinczuk JJ, White-Koning M, Badawi N. Epidemiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy. Early Hum Dev. 2010 Jun;86(6):329-38. doi: 10.1016/j.earlhumdev.2010.05.010. Epub 2010 Jun 16. PMID: 20554402.
16. Liston R, Sawchuck D, Young D, Brassard N, Campbell K, Davies G, et al. Fetal health surveillance: intrapartum consensus guideline. SOGC clinical practice guideline no. 197b. J Obstet Gynaecol Can. 2018; 40(4):e298-e322.
17. National Institute for Health and Care Excellence. Intrapartum care for healthy women and babies. London (UK): NICE; Published December 2014, Last updated: February 2017.
18. Royal Australian and New Zealand College of Obstetricians and Gynaecologists (2014). Intrapartum Fetal Surveillance, 3rd ed. East Melbourne: The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

 

REFERENCES

1.   Alfirevic Z, Devane D, Gyte GM, Cuthbert A. conținuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev 2017; 2:CD006066

2.   Al Wattar BH, Honess E, Bunnewell S, et al. Effectiveness of intrapartum fetal surveillance to improve maternal and neonatal outcomes: a systematic review and network meta-analysis. CMAJ 2021; 193:E468.

3.   Al Wattar BH, Lakhiani A, Sacco A, et al. Evaluating the value of intrapartum fetal scalp blood sampling to predict adverse neonatal outcomes: A UK multicentre observational study. Eur J Obstet Gynecol Reprod Biol 2019; 240:62.

4.   American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol 2009; 114:192. Reaffirmed 2021.

5.   Blix E, Maude R, Hals E, Kisa S, Karlsen E, et al. Intermittent auscultation fetal monitoring during labour: A systematic scoping review to identify methods, effects, and accuracy. PLoS One. 2019 Jul 10;14(7):e0219573. doi: 10.1371/journal.pone.0219573. PMID: 31291375; PMCID: PMC6619817.

6.   Carbonne B, Pons K, Maisonneuve E. Foetal scalp blood sampling during labour for pH and lactate measurements. Best Pract Res Clin Obstet Gynaecol 2016; 30:62.

7.   Clark SL, Meyers JA, Frye DK, et al. Recognition and response to electronic fetal heart rate patterns: impact on newborn outcomes and primary cesarean delivery rate in women undergoing induction of labor. Am J Obstet Gynecol 2015; 212:494.e1.

8.   Cunningham, F.G.; Leveno, K.; Bloom, S.; et al. Williams obstetrics. 24th ed. New York (NY): McGraw-Hill Medical, 2014.

9.   Danforth's Obstetrics and Gynecology. 9th ed. Edit.: James R. Scott, Ronald S. Gibbs, Beth Y. Karlan, Arthur F. Haney, David N. Danforth By Lippincott Williams & Wilkins Publishers, 2003.

10. Devane D, Lalor JG, Daly S, McGuire W, Cuthbert A, Smith V. Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing. Cochrane Database Syst Rev. 2017 Jan 26;1(1):CD005122. doi: 10.1002/14651858.CD005122.pub5. PMID: 28125772; PMCID: PMC6464914.

11. Gibb D, Arulkumaran S. Fetal monitoring in practice. 3rd ed. London (UK): Churchill Livingstone; 2008.

12. Giussani DA. The fetal brain sparing response to hypoxia: physiological mechanisms. J Physiol. 2016 Mar 1;594(5):1215-30. doi: 10.1113/JP271099. Epub 2016 Jan 6. PMID: 26496004; PMCID: PMC4721497.

13. Housseine N, Punt MC, Browne JL, Meguid T, Klipstein-Grobusch K, Kwast BE, et al.. Strategies for intrapartum foetal surveillance in low- and middle-income countries: A systematic review. PLoS One. 2018 Oct 26;13(10):e0206295. doi: 10.1371/journal.pone.0206295. PMID: 30365564; PMCID: PMC6203373.

14. Intermittent Auscultation for Intrapartum Fetal Heart Rate Surveillance: American College of Nurse-Midwives. J Midwifery Womens Health. 2015 Sep-Oct;60(5):626-32. doi: 10.1111/jmwh.12372. Erratum in: J Midwifery Womens Health. 2016 Jan-Feb;61(1):134. PMID: 26461195.

15. Kurinczuk JJ, White-Koning M, Badawi N. Epidemiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy. Early Hum Dev. 2010 Jun;86(6):329-38. doi: 10.1016/j.earlhumdev.2010.05.010. Epub 2010 Jun 16. PMID: 20554402.

16. Liston R, Sawchuck D, Young D, Brassard N, Campbell K, Davies G, et al. Fetal health surveillance: intrapartum consensus guideline. SOGC clinical practice guideline no. 197b. J Obstet Gynaecol Can. 2018; 40(4):e298-e322.

17. National Institute for Health and Care Excellence. Intrapartum care for healthy women and babies. London (UK): NICE; Published December 2014, Last updated: February 2017.

18. Royal Australian and New Zealand College of Obstetricians and Gynaecologists (2014). Intrapartum Fetal Surveillance, 3rd ed. East Melbourne: The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

 

Материал поступил в редакцию 09.11.23

 

 

ИНТЕРПРЕТАЦИЯ КАРДИОТОКОГРАФИИ В РОДАХ  ЧЕРЕЗ ПОНИМАНИЕ ПАТОФИЗИОЛОГИЧЕСКИХ МЕХАНИЗМОВ ПРИ ВНУТРИУТРОБНОЙ ГИПОКСИИ

 

Х.Н. Капрош, кандидат медицинских наук, доцент кафедры акушерства, гинекологии

Государственный медицинский медико-фармацевтический университет им. Николае Тестемицану

(Республика Молдова, бд. Штефан чел Маре, 165, г. Кишинев, MD 2001)

Е-mail: hristiana.capros@usmf.md

 

Н. Кодряну, доцент кафедры акушерства и гинекологии

Государственный медицинский медико-фармацевтический университет им. Николае Тестемицану

(Республика Молдова, бд. Штефан чел Маре, 165, г. Кишинев, MD 2001)

Е-mail: hristiana.capros@usmf.md

 

М. Сургуч, доцент кафедры акушерства и гинекологии

Государственный медицинский медико-фармацевтический университет им. Николае Тестемицану

(Республика Молдова, бд. Штефан чел Маре, 165, г. Кишинев, MD 2001)

Е-mail: hristiana.capros@usmf.md

 

Д. Митриук, ассистент кафедры акушерства и гинекологии

Государственный медицинский медико-фармацевтический университет им. Николае Тестемицану

(Республика Молдова, бд. Штефан чел Маре, 165, г. Кишинев, MD 2001)

Е-mail: hristiana.capros@usmf.md

 

В. Волочаи, ассистент кафедры акушерства и гинекологии

Государственный медицинский медико-фармацевтический университет им. Николае Тестемицану

(Республика Молдова, бд. Штефан чел Маре, 165, г. Кишинев, MD 2001)

Е-mail: hristiana.capros@usmf.md

 

В. Котелеа, ассистент кафедры акушерства и гинекологии

Государственный медицинский медико-фармацевтический университет им. Николае Тестемицану

(Республика Молдова, бд. Штефан чел Маре, 165, г. Кишинев, MD 2001)

Е-mail: hristiana.capros@usmf.md

 

Аннотация. В родах, развитие регулярных сокращений матки вызывает сужение сосудов миометрия и уменьшение маточно-плацентарного кровотока. В результате плод подвергается повторяющимся условиям кратковременной гипоксии. Интранатальные методы оценки плода используются для оценки толерантности плода к дефициту кислорода во время родов. Кардиотокография является методом первой линии оценки плода в родах, онa безвреденa и доступнa.

Ключевые слова: гипоксия плода, кардиотокография, роды.