Feasibility of a mobile cardiotocogram device for fetal heart rate self-monitoring in low-risk singleton pregnant women.

AIM: This study aimed to clarify the feasibility of a mobile cardiotocogram (CTG) device for self-monitoring fetal heart rate (FHR) in low-risk singleton pregnant women. METHODS: This study was conducted at six university hospitals and seven maternity clinics in Japan. Using a mobile cardiotocogram device (iCTG, Melody International Ltd., Kagawa, Japan), participants of more than 34 gestational weeks measured the FHR by themselves at least once a week until hospitalization for delivery. We evaluated the acquisition rate of evaluable FHR recordings and the frequency of abnormal FHR patterns according to the CTG classification system of the Japan Society of Obstetrics and Gynecology (JSOG). The participants also underwent a questionnaire survey after delivery to evaluate their satisfaction level of self-monitoring FHR using the mobile CTG device. RESULTS: A total of 1278 FHR recordings from 101 women were analyzed. Among them, 1276 (99.8%) were readable for more than 10 min continuously, and the median percentage of the total readable period in each recording was 98.9% (range, 51.4-100). According to the JSOG classification system, 1245 (97.6%), 9 (0.7%), 18 (1.4%), and four (0.3%) FHR patterns were classified as levels 1, 2, 3, and 4, respectively. The questionnaire survey revealed high participant satisfaction with FHR self-monitoring using the iCTG. CONCLUSION: The mobile CTG device is a feasible tool for self-monitoring FHR, with a high participant satisfaction level.

A case report: change in fetal heart rate pattern on spontaneous uterine rupture at 35 weeks gestation after laparoscopically assisted myomectomy.

A 31-year-old nulligravid woman who underwent laparoscopically assisted myomectomy 5 months before becoming pregnant suffered uterine rupture at 35 weeks gestation. A 50 g intramuscular myomatous node had been removed laparoscopically. Early signs of rupture included sudden onset of severe abdominal tenderness and frequent uterine contractions despite reassuring FHR tracing. Variable deceleration was observed as late as 7.5 hours after onset. Emergency cesarean section was performed due to increasing severity of tenderness, revealing complete uterine rupture at the fundus site without extrusion of the fetus or placenta. A male neonate (2,860 g) was delivered without asphyxia and an Apgar score of 8. Total volume of hemorrhage was approximately 50 ml. The ruptured uterine wall was repaired by suturing in 2 layers. The present case indicates that sudden onset of abdominal tenderness in pregnant women with a history of laparoscopic myomectomy may suggest uterine rupture even in the presence of reassuring FHR. This is a rare case, as non-reassuring FHR patterns generally appear in the late stages of uterine rupture.