VIBROACOUSTIC AND SCALP STIMULATION - 07/09/11
Résumé |
Continuous fetal heart rate (FHR) monitoring was developed in the 1960s for the purpose of identifying fetal compromise through the observation of abnormal FHR patterns. Used initially for intrapartum evaluation, FHR monitoring was gradually extended into antepartum assessment with the development of the contraction stress test (CST), the nonstress test (NST), and, eventually, the biophysical profile (BPP) and modified biophysical profile. Unfortunately, abnormalities identified on electronic FHR monitoring are nonspecific. Relying solely on these results as a means of predicting poor neonatal outcome may lead to unnecessary intervention and potentially to worsened neonatal morbidity. Many FHR patterns that are identified as abnormal may, in fact, depict the normal state of fetal behavioral activity.
Fetal stimulation has been used in an effort to change the fetal behavioral state, thereby inducing normal FHR monitoring patterns in noncompromised fetuses. Reactive FHR patterns induced by stimulation have been shown to be reliable indicators of fetal well-being. FHR accelerations and movement induced by vibroacoustic stimulation (VAS) were first reported in 1936 by Sontag and Wallace.46 In subsequent studies, VAS was found to decrease the number of falsely abnormal interpretations of FHR patterns and to shorten the time necessary for testing without adversely affecting perinatal outcome.37, 39, 44, 45, 51
Although fetal scalp pH determination remains a valid method of intrapartum evaluation,53 this technique is cumbersome and sometimes technically impossible to perform (e.g., via an undilated cervix). Fetal scalp stimulation was developed to improve the specificity and efficiency of interpretation of FHR monitoring patterns. Several studies have confirmed that scalp stimulation is a reasonable and effective alternative to fetal scalp blood sampling and may decrease unnecessary operative interventions compared with the rate of intervention for fetal monitor interpretation alone.7, 8, 22 Because of the availability of VAS and scalp stimulation, fetal scalp blood sampling has been eliminated in most large centers without any adverse effect on perinatal outcome.22
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| Address reprint requests to T. Flint Porter, MD, MPH, LDS Hospital Perinatal Center, 8th Avenue and C Street, Salt Lake City, UT 84143, e-mail: ldtporte@ihc.com |
Vol 26 - N° 4
P. 657-669 - décembre 1999 Retour au numéro
Article précédent
- SCALP BLOOD GAS ANALYSIS
- Keith R. Greene
- CONTINUOUS INTRAPARTUM pH, pO2, pCO2, and SpO2 MONITORING
- Helen M. Mc Namara, Gary A. Dildy
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