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1 АВАВАКдлАмА дла длама АсАядлАмА АВА АсдлАя & MАядлдлАмАК TА 3, T 4, АВ , 2004 АК Ав Ав : fi fi Ая А» Ас Ам apple Ая, Ая Ая: fi Ая, 76, Ая, : , Fax , -mail: nikolasvitoratos@yahoogr АК apple Ав apple АУАв Ав Ав Ав Ав АУ АУ Ая, apple- appleapple Ав Ав АУ appleав fi Apgar score (<7 1 applefi), fi ph (<720) АУ appleappleав (>-12mmol/L) длав apple Ав fi Ав -, appleау АУ apple, Ав, appleав - АвАУ Ав fi apple apple appleав Ав, apple apple- fi appleав Ам fiapple, apple АУ Ав Ав Ав Ав АУ, fi apple Ав Ав АВАУ Ав: Ав, fi, АвАУ, apple applefi fiав Ав АУАв, apple apple Ав 30 fi АК Ав- АУ Ав - appleау АУ Ав Ав-, Ав apple Ав apple АвАУ- applefi fi Авfi, Ав, apple - Ав Ав - apple АУАв -, apple apple fi - apple fi (Boehm, 1999) Асfi apple appleау fi apple- apple АвАв fi 313

2 АК Ав Ав fi Ав apple, apple- apple Ав- (Tucker, 1996; Parer, 1997) fi fi АУ apple- АУ АУ Ав apple АУ apple apple -, АУ apple АУ applefi АУ АвАвАУ apple apple - applefi АУ (Hornbuckle et al, 2000) дл Ав Ас appleау Ав, fi Ав apple apple fi АУАв Ав - Cremer 1906 АУ fi Авfi fi (Ам), apple - apple fiав, apple fi apple Sourthern - АУ Ав - apple А apple appleapple Ам 1958 applefi E Hon apple fi Ав- apple fi Hon fi fi Caldeyro-Barcia applefi А Hammacher applefi Ас appleау Ав АУ Ам Ая fi Ав - АУ АУ АУ АУ Ав- apple АК apple Ам - Ая 1963 applefi - EPSCO Ав Hon - apple Ав applefi Hewlett-Packard, apple apple Авfi Ам АУАв Ав 1964 Calligan apple fiapple apple Doppler appleавfi Ав apple Ая Авfi Авfi Ав- apple applefiав apple, АУ- Ав Ав- АУ Авfi appleapple appleау apple appleapple АУ, АУ apple appleау АвАУ Ав- Аяfi АмАУ -Ас- fi 1975 fi -Асfi (FIGO) 1987 АУАв- appleав applefi fi - Ам АК Ав apple- fi Ав АК fi АК applefi А 2 apple appleау АУ applefi apple: ) applefi applefi apple, ) applefi applefi А 2 ) applefi Ав apple apple- appleау apple А 2 АУ АяАУ apple appleау- : ) applefi, fiapple appleapple- apple, ) applefi АУ, fiapple fi apple Ав,, applefi applefi - (-), apple Ав- fi АУ А 2, ) applefi, fiapple - appleapple applefiapple, apple apple- Ав Ав - АУ АУ, Ав) applefi apple АК apple apple apple apple applefi apple, Ав - apple А 2 АУ, ) applefi АУ АВ- Ав apple - apple apple fi- Ая АУ apple Ав fi fi fi fi apple Rhesus Ав apple - АУ fi, ) applefi apple fi fi - apple fi А 2 fi АУ 85% Ав АУ fi АУ applefi apple apple А 2 АУ, fi apple fi fi fi, apple- АУ appleау fi Авfi, apple Ав applefi Ав fi Ав Ав АК appleав - Ав АУ- apple ph fi АК АУ- Ав АУapple apple apple fi АУ, Ав Ам 314

3 АВАВАКдлАмА дла длама АсАядлАмА АВА АсдлАя & MАядлдлАмАК TА 3, T 4, АВ , 2004 АК Ав АК Ав АУ appleав АУАв АУ Ав - Аяfi applefi fi fi - apple 80% applefi АКАУ Ая Ав - (Thacker et al, 2000) АК apple Ав - Ав appleау АУ Ав fi А - Ав apple АвАУ appleау fiав apple Ав - Ав (Thacker et al, 2000; Kazandi et al, 2003) АК apple Ав АУ fi fi fi fi apple ) fi Авfi fi 110 АУ 160 apple- applefi, )fi >6 <25 apple applefi, ) apple apple Ав) apple appleав Ав apple apple Ав- АУ (Schifrin and Dame, 1972; Paul et al, 1975; Gonik and Bobrowski, 1996) Ая, apple applefiapple Ав, fiapple, Ав АУ apple АУ fi ph (<720), fi Apgar Score (<7 1 applefi) АУ appleappleав (>-12 mmol/l) АУ applefi АУ apple apple Ав АУ Ав- АУ appleау (Hadar et al, 2001) Ая apple Ав АУ apple А 2 АУ Ав apple Ав- Ав АК applefi АУ fi Авfi АУ fi apple- Ав Ав Ав- Ав apple applefi АвАв Ав (<110 apple/applefi) Ав apple - applefi appleав Ав (Parer, 1997) Ав Ав apple АК apple - Ав АУ fi appleapple, Ав Ав Ав- apple applefi apple- fi appleав - Ав АК АУ, apple, apple- fi А 2 applefi АУ fi appleappleав, Ав Ав Ав apple applefi apple apple- Ав Ав (Parer, 1997) АК Ав fi - apple fi АвАв Ав- fi fi fi - fi АвАв applefi apple АК АУ fiapple АУ - Ав, Ав Ав appleау АвАв (Lijoi and Brady, 2003) Ав АУ appleав- fi fi appleау apple Ав 60 apple applefi apple appleapple apple (Marsh et al, 2002) АК - Ав АвАв АУ fi Ав АвАУ apple applefi 30% appleав Ав- Ав apple fi ph (<715) - АУ АУ (>-12mmol/L) (Strachan et al, 2001) appleappleау, АвАв Ав apple Ав applefi applefi- appleapple длав Ав, apple apple- Ав АвАв appleapple applefiapple apple applefi apple Ам, fiapple appleау АУ (Ridgeway et al, 2004) АК Ав- АУ Ав - apple Ав (>160 apple applefi) АК Ав applefi fi Ав АУ fiapple Авfi Ав apple fi Ав АУ fi appleав Ав-, apple Авfi 89% - apple 89%, Авfi АвАУ (Strachan et al, 2001) Ав fi 240 apple applefi АУ appleавapple- fi applefi Ав Авapple (Marsh et al, 2002) apple apple appleав Ав- АУ fi Ав- АУ fi (Stahle et al, 2003) fi Ав Ав fi Ав applefi 6 apple- applefi АК fi- АУ fi fi - fi (>6 АУ <25 apple applefi) appleав- fi АУ АвАУ 315

4 АК Ав Ав fi apple appleау А 2 АУ, apple- АУ apple apple Ая, appleapple АУ apple- apple А 2 АУ Ав apple, appleау apple appleав, apple apple АУ fi- АУ apple fi - fi Ав (Strachan et al, 2001) apple fi АУ applefi Ав- Ав АвАУ fi apple АУ fi Ав- appleау АУ - fi Ав (Boog, 2001; Stahle et al, 2003) АК АУ - Ав applefi - fi fi - apple applefi АУ apple АУ АУ fi - appleappleауав А 2, fiapple fi АУ fi (Leszczynska-Corzelak et al, 2002; Siristatidis et al, 2003) Ав - fi apple apple - appleав apple fi applefi appleав - Ав А appleав apple Ав fi АУ АвАУapple appleау - Ав appleав Ав - А applefi appleав - appleав Ав, Ав Ав applefi apple- Ав АУ АУ, fi Авfi - fi 60 apple applefi apple Ав applefi applefi 60 Ав- fiapple (Turrentine, 2003) АК АУ apple appleав fi applefi, apple АУ fi ph (<720), АУ appleappleав (<-12mmol/L) fi Apgar Score (<7 5 apple) apple Ав apple- АУ АвАУ АУ (Hadar et al, 2001) АК fi apple- Ав Ав applefi АУ fi Apgar Score (5-6 1 applefi) (Malik et al, 2002) АК apple - applefi appleав АУ Argar Score applefi, fiapple applefi 818% - АУ appleappleау, fiapple apple, apple (Malik et al, 2002; Chuang et al, 2004) apple apple applefi АУ Ав fi fi appleав - АУ apple fi fi apple АУ АУ fi apple- Ав, fi АУ (Carles et al, 2003; Sameshima et al, 2004) Ая applefi - applefi appleав apple - fi Ав apple- АУ АУ applefi apple- Ав Ав, apple- Ав apple applefi Ав applefiав Ав fi fi, АвАУ appleав apple fi Ав appleав appleав applefi 34-56% АУ - fi ph (<720), fi Apgar Score (<7 5 apple) Ав - Ав apple apple- fi apple 40% (Kazandi et al, 2003) АК, apple, applefi appleав applefi, appleав apple Ав - Ав АУ fi fi (Holmes et al, 2001) apple Ав- appleау apple- Ав Ав apple appleав fi fi Ав АУ fi АУ Ав fi apple (Lijoi and Brady, 2003) Ht<30% АУ АУ, appleау АУ Ав Ав- Ав АУ fi Ав apple (- fi 1) АУ fi Ав fiapple А» apple АУ - АУ Ав fi 3-6 applefi (Murata et al, 1985; Parer, 1997) АУ, apple fi Ав- Ав - АУ АУ Ав apple - fi АУ fi Ав- Авfi apple apple АУ apple - (Bellver et al, 2004) АК apple apple- Ав ( Ав, - 15 apple apple applefi fi fi Ав 15 Ав- 316

5 АВАВАКдлАмА дла длама АсАядлАмА АВА АсдлАя & MАядлдлАмАК TА 3, T 4, АВ , 2004 fi 1: Амapple apple fi Авfi fi АУapple) Ав fiав, - Ав apple - Ав applefi - applefi apple Ав АУ apple apple apple (Elimian et al, 2003) АК Ав applefi Ав АУ apple appleав, Авfi АУАв fi АУ fi АУapple apple - Ав apple apple appleау apple appleав (Levene et al, 1985) АК - apple fi Ав-, fi Ав (Mortimer and Dickinson, 1993) АК - Ав apple fi fi applefi - applefi apple apple fi applefi АУ АУ apple apple- Ав Ав (Smith et al, 2000) АК apple Ав Ав Ав - apple - Ав АУ fi Авfi apple- - apple Ав А»70, fi Ав Авfi apple- apple fi Ав А»90 fi АУ Ав (Thornberg et al, 1995) Ая (Smith et al, 2000) АК Ав Ав Ав, АУ Ав applefi АУ- fiapple appleав applefi -, Ав appleав apple- АУ- (Nelson and Leviton, 1991; Yudkin et al, 1994) appleавfi, fi apple applefi Ав apple Авfi Авfi apple Ав apple Ав- (Pellantova et al, 2000) fi, apple applefi АУ applefi apple АУ (Pellantova et al, 2000) O Ellison et al (1991) АУАв fi 135 applefi АУ 2362 apple- Ав apple apple fi appleав Ав apple Ав Ав Ав apple- fi apple А Yudkin et al (1994) apple fi 6 applefi 7 appleapple apple - apple Ав Ав- Ая АУ Spender et al (1997), fiapple АУАв fi 91 appleapple apple 50% appleapple apple apple Ав- (appleав АУ - fi) 1 89% appleapple apple apple Ав- е«1 apple АУ Ас, Ав, apple АУ, applefi %, Авfi applefi % 317

6 АК Ав Ав fi apple applefi 10 АУ 37% (Rosen and Dickinson, 1993) apple apple apple apple apple Ав applefi 2/3 appleав apple apple- apple Phelan and Ahn (1994) applefi Ав- (apple apple - Ав - ), Ав applefiapple 1/3 apple Ав- АУ (appleау - fi, Ав, appleав - Ав ) Ав apple, Ав АУАв Ав Ав АУ applefi АУ apple- Ав apple- fi АУ (Smith et al, 2000; Sameshima et al, 2004) The cardiotocography during labor The benefit Ая Vitoratos 2nd Department of Obstetrics and Gynaecology, Univercity of Athens, Athens, Greece Correspondence: N A Vitoratos 76, Vas Sofias str Athens, Greece Tel: , Fax: mail: nikolasvitoratos@yahoogr Summary The continuous electronic fetal heart monitoring is a common method for fetal assessment during labor Normal cardiotocographic patterns are associated with good perinatal outcome On the contrary, the appearance of pathological or suspicious patterns are associated with the birth of newborns with low Apgar Score, low ph level and elevated Decf concentrations Reduced or absence of fetal heart variability, a finding observed only with the cardiotocographic investigation, indicates fetal distress Furthermore, the appearance of fetal heart rate decelerations (lates or variables) predicts the presence of fetal acidosis in the most of the cases Catastrophic events effecting fetus during labor such as anemia or infection give characteristic cardiotocographic patterns Finally, the fetal assessment during labor by cardiotocography has contributed to the decreased incidence of neonatal encephalopathy at term Key words: cardiotography, labor, fetal distress, neonatal encephalopathy American College of Obstetricians and Gynecologists (1975) Technical Bulletin Bellver, J, Perales, A, Maiques, V and Serra, V (2004) Can antepartum computerized cardiotocography predict the evolution of intrapartum acid-base status in normal fetuses? Acta Obstet Gynecol Scand 83, Boehm, FH (1999) Intrapartum fetal heart rate monitoring Obstet Gynecol Clin North Am 26, Boog, G (2001) Acute fetal distress Eur J Obstet Gynecol Reprod Biol 30, Carles, G, Tobal, N, Marret, H and Arbeille, P (2003) Acute reversible placental dysfunction and abnormal fetal heart rate at delivery Eur J Obstet Gynecol Report Biol 110, Chuang, J, Chou, CT, Cheng, WC et al (2004) Spontaneous fetal heart rate deceleration: an ominous sign for fetal outcome Arch Gynecol Obstet 269, Cremer, M (1906) Mе nch Med Wochenschr 53,811 Elimian, A, Lawlor, P, Pigueroa, R et al (2003) Intrapartum assessment of fetal well-being: any role for a fetal admission test? J Matern Fetal Neonatal Med 13, Ellison, P H, Foster, M, Sheridan-Pereira, M, and Mac- Donald, D (1991) Electronic fetal heart monitoring, auscultation and neonatal outcome Am J Obstet Gynecol 164, FIGO 1987 News Guidelines for the use of fetal monitoring Int J Gynecol Obstet 25, Gonik, B and Bobrowski, R (1996) Medical complications in Labor Blackwell science, Detroit Michigan, p Hadar, A, Sheiner, E, Hallak, M et al (2001) Abnormal fetal heart rate tracing patterns during the first stage of labor: effect on perinatal outcome Obstet Gynecol 185: Holmes, P, Oppenheimer, LW, Gravelle, A et al (2001) The effect of variable heart rate decelerations on intraventicular haemorrhage and other perinatal outcomes in preterm infants J Matern Fetal Med 10, Hon, EH (1958) The electronic evaluation of the fetal heart rate Am J Obstet Gynecol 75, Hon, EH (1963) Instrumentation of fetal heart rate and electrocardiography II A vaginal electrode Am J Ob- 318

7 АВАВАКдлАмА дла длама АсАядлАмА АВА АсдлАя & MАядлдлАмАК TА 3, T 4, АВ , 2004 stet Gynecol 86, Hornbuckle, J, Vail, A and Abrams, K (2000) Bayesian interpretation of trials: the example of intrapartum electronic fetal heart rate monitoring Br J Obstet Gynaecol 107,3-14 Kazandi, M, Sendag, F, Akercan, F et al (2003) Different types of variable decelerations and their effects to neonatal outcome Singapore Med J 44, Leszczynska-Gorzelak, B, Poniedzialek-Crajkowska, E and Oleszczuk, J (2002) Intrapartum cardiography and fetal pulse oximetry in as fetal hypoxia Int J Gynaecol Obstet 76,9-14 Levene, MI, Kornberg, J and Williams, THC (1985) The incidence and severity of post-asphyxial encephalopathy in full term infants Earl Hum Dev 11,21-26 Lijoi, AF and Brady, J (2003) Vasa previa diagnosis and management J Am Board Famil Pract 16, Malik, N, Raghunanda, C and Madan, N (2002) Foetal heart rate patterns in early labour in low and high risk pregnancies and its correlation with perinatal outcome J Indian Med Assoc 100, Marsh, M, Rennie, JM and Groves, PA (2002) In: Clinical protocols in Labour Parthenon Publ, London, p 83, p 147 Mortimer, G and Dickinson, JC (1993) The paradox of electronic fetal monitoring: more data may not enable us to predict or prevent infant neurologic morbidity Am J Obstet Gynecol 168, Murata, Y, Miyake, Y and Yamamoto, T (1985) Experimentally produced sinusoidal fetal heart rate patterns in the chronically-instrumental fetal lamb Am J Obstet Gynecol 153, Nelson, KB and Leviton, A (1991) How much of neonatal encephalopathy is due to birth asphyxia Am J Dis Child 145, Parer, JT (1997) Handbook of fetal heart rate monitoring 2nd ed, WB Saunders Company, London, p Paul, RH, Suidan, AK and Yeh, S (1975) Clinical fetal monitoring VII The evaluation and significance of intrapartum baseline FHR variability Am J Obstet Gynecol 123, Pellantova, S, Roztcocil, A and Miklica, J (2000) Validity of cardiography in acute fetal hypoxia-neonatal status after caesarean section Ceska Gynecol 65,34-38 Phelan, JP and Ahn, MO (1994) Perinatal observations in forty-eight neurologically impaired term infants Am J Obstet Gynecol 171, Ridgeway, JJ, Weyrich, DL and Benedetti, TJ (2004) Fetal heart rate changes associated with uterine rupture Obstet Gynecol 103, Rosen, MG and Dickinson, JC (1993) The paradox of electronic fetal monitoring: more data may not enable us to predict or prevent infant neurologic morbidity Am J Obstet Gynecol 168, Sameshima, H, Ikenous, T, Ikeda, T et al (2004) Unselected low-risk pregnancies and the effect of continuous intrapartum fetal heart rate monitoring on umbilical blood gases and cerebral palsy Am J Obstet Gynecol 190, Schifrin, BS and Dame, L (1972) Fetal heart rate patterns: prediction of Apgar score JAMA 219, Siristatidis, C, Salamalekis, E, Vitoratos, N et al (2003) Intrapartum surveillance of IUGR fetuses with cardiotocography and fetal pulse oximetry Biol Neonate 43, Smith, J, Wells, L and Dodd, K (2000) The continuing fall in incidence of hypoxic-ischaemic encephalopathy in term infants Br J Obstet Gynaecol 107, Sourherm, EM (1957) Fetal anoxia and cts possible relation to changes in the prenatal fetal electrocardiogram Am J Obstet Gynecol 73,233 Spencer, J AD, Badawi, N, Burton, P et al (1997) The intrapartum CTG prior to neonatal encephalopathy at term: a case-control study Br J Obstet Gynaecol 104,25-28 Stahle, C, Melehert, F and Weigel, M (2003) Investigation of a fetal heart-rate pattern that shows reduced oscillation amplitude Z Geburtshilfe Neonatal 207, Strachan, BK, Sahota, DS, Van Wijugaarden, A et al (2001) Computerised analysis of the fetal heart rate and relation to acidemia at delivery Br J Obstet Gynaecol 108, Thacker, SB, Stoup, D and Chang, M (2000) Continuous electronic heart rate monitoring for fetal assessment during labor Cochrane Database Syst Pen 2:CD Thornberg, E, Thiringer, K and Odeback, A (1995) Birth asphyxia: incidence, clinical course and outcome in a Swedish population Acta Paediatr 84, Tucker, SM (1996) Fetal Monitoring and Assessement 3rd ed, NL Coon, Baltimore Turrentine, JE (2003) Clinical protocols in Obstetrics and Gynecology 2nd ed, Parthenon Publ, London, p152, p184 Yudkin, PL, Johnson, A and Clover, IM (1994) Clustering of perinatal markers of birth asphyxia and outcome at age five years Br J Obstet Gynaecol 101, АмАяАяАКАм 10/10/2004 Асдл АяА АмАК 25/10/