比较产时宫缩内监测和外监测：一项随机对照临床试验
【目的】
产时比较宫缩内监测（intrauterinetocodynamometry，IT）和宫缩外监测（external tocodynamometry，ET）能否降低手术助产和改善新生儿结局。鉴于IT能够提供更准确的宫缩信息，故假设IT可能比ET更适用于指导缩宫素的使用。
【设计】
随机对照试验。
【处所】
一家大学附属三级医院和一家中心医院的两家产房。
【人群】
共有1504名临产的单胎孕妇，孕周≥37周，头位胎儿，其中269名为疤痕子宫，889名初产妇，346名缩宫素加速产程的经产妇。
【方法】
在第一产程活跃期，736名孕妇受试者使用IT，768名孕妇使用ET。
【主要测量结局】
主要结局：手术助产率。次要结局：产程时间，缩宫素给药量，不良新生儿结局。
【结果】
使用IT的手术助产率为26.9%，使用ET者未25.9%（OR 1.05,95%CI 0.84-1.32P=0.663）。从ET转换成IT的发生率为31%。在次要结局中IT和ET比较没有发现差异。IT降低产时胎儿窘迫征象时和剖宫产后阴道试产时的缩宫素的使用。
【结论】
IT并不降低手术助产率、缩宫素使用或不良新生儿结局，且不缩短产程。
Intrauterine versus external tocodynamometry in monitoring labour: arandomised controlled clinical trial
THautakangas JUotila HHuhtala OPalomäki
First published: 03 June 2020
https://doi.org/10.1111/1471-0528.16343
Trialregistration:Clinicaltrials.gov,identifier:NCT02941393,https://clinicaltrials.gov/ct2/results?cond=&term=NCT02941393&cntry=&state=&city=&dist=
【Objective】
To investigate whether the use ofintrauterine tocodynamometry versus external tocodynamometry (IT versus ET)during labour reduces operative deliveries and improves newborn outcome. As ITprovides more accurate information on labour contractions, the hypothesis wasthat it may more appropriately guide oxytocin use than ET.
【Design】
Randomised controlled trial.
【Setting】
Two labour wards, in a university tertiaryhospital and a central hospital.
【Population】
A total of 1504 parturients with singletonpregnancies, gestational age ≥37 weeks and fetus in cephalic position: 269women with uterine scars, 889 nulliparas and 346 parous women with oxytocinaugmentation.
【Methods】
Participants underwent IT (n = 736)or ET (n = 768) during the active first stage of labour.
【Main outcome measures】
Primary outcome: rate of operativedeliveries. Secondary outcomes: duration of labour, amount of oxytocin given,adverse neonatal outcomes.
【Results】
Operative delivery rates were 26.9% (IT)and 25.9% (ET) (odds ratio 1.05, 95% CI 0.84–1.32, P = 0.663).The ET to IT conversion rate was 31%. We found no differences in secondaryoutcomes (IT versus ET). IT reduced oxytocin use during labours with signs offetal distress, and trial of labour after caesarean section.
【Conclusions】
IT did not reduce the rate of operativedeliveries, use of oxytocin, or adverse neonatal outcomes, and it did notshorten labour duration.
（编译 王伟琳）
