Intrapartum heart rate ambiguity: a comparison of cardiotocogram and abdominal fetal electrocardiogram with maternal electrocardiogram.

OBJECTIVE/AIMS: To investigate the presence of signal ambiguity of intrapartum fetal heart rate (FHR) monitoring during delivery by comparing simultaneous cardiotocogram (CTG), abdominal fetal electrocardiogram (ECG) with continuous maternal ECG. METHODS: A total of 144 simultaneous CTG (Corometrics 250 series), abdominal fetal ECG (Monica -AN24™) and maternal ECG (Monica AN24™) recordings were evaluated. MAIN OUTCOME MEASURES: When the FHR is within 5 bpm of the maternal heart rate (MHR) acquired from the ECG, it is classified as 'MHR/FHR ambiguity'. Statistical analyses were performed with Fisher's exact test and the Wilcoxon signed-rank test. RESULTS: Comparison of abdominal fetal ECG against CTG demonstrates significantly less 'MHR/FHR ambiguity' in both the first stage (mean 0.70 vs. 1.22%, p < 0.001) and second stage of labour (mean 3.30 vs. 6.20%, p < 0.001). CONCLUSION: Intrapartum FHR monitoring in daily practice via the CTG modality provides significantly more 'MHR/FHR ambiguity' than abdominal fetal ECG, which also provides additional information on the MHR.

Comparison of non-invasive fetal electrocardiogram to Doppler cardiotocogram during the 1st stage of labor.

OBJECTIVE: We compared a non-invasive fetal electrocardiogram (fECG) to Doppler cardiotocogram (CTG) during the 1(st) stage of labor. STUDY DESIGN: This was a prospective observational study of non-invasive fECG using five abdominal electrodes and one Doppler ultrasound probe in 27 patients. Data were analyzed for reliability, clinical and statistical equivalence. RESULTS: The fECG was similar to the traditional Doppler method. The fECG characterizes a fetal heart rate (FHR) trace in a similar way with regards to acceleration count, decelerations count and coincidence, variability and baseline. The FHR was overall correlated (Pearson's r=0.91). CONCLUSION: This non-invasive fECG presents an alternative, reliable and accurate assessment for fetal well-being during the 1(st) stage of labor.

Do macromorphological features of the human placenta influence somatic and psychomotor development of the newborn and early infant? A historic question revisited.

OBJECTIVE: We examined the meaning of placental weight, form (massive and thick or extended and flat) and circumference for early somatic and psychomotor childhood development. METHODS: In this prospective study, fresh placentas (n = 265) were measured for weight and circumference and correlated with neonatal data. A subset of placentas statistically defined as 'massive' (circumference <10th percentile) and 'extended' (circumference >90th percentile) was correlated with somatic and basic psychomotor variables during the first 4 years of life. A 'medium' category (circumference 45-55th percentile) served as control. RESULTS: Placental weight correlated with birth weight (r = 0.53, p < 0.0005) and mean infantile weight until month 48 (r = 0.29, p = 0.016). Placental circumference weakly correlated with birth weight (r = 0.17, p = 0.011) but not with mean infantile weight. Placental extremes (massive, medium, extended) demonstrated significant influences only on very early somatic growth (day 1 to month 4): Massive placentas were associated with heavier and taller children (p = 0.02-0.033). Markers of early psychomotor development (first sitting, crawling, running, one- and two-word sentences) were not related with placental weight or circumference nor with extremes of placental morphology. CONCLUSION: Placental weight and circumference seem to influence very early somatic but not psychomotor development.

Fetal short time variation during labor: a non-invasive alternative to fetal scalp pH measurements?

OBJECTIVE: To determine whether short time variation (STV) of fetal heart beat correlates with scalp pH measurements during labor. PATIENTS AND METHODS: From 1279 deliveries, 197 women had at least one fetal scalp pH measurement. Using the CTG-Player, STVs were calculated from the electronically saved cardiotocography (CTG) traces and related to the fetal scalp pH measurements. RESULTS: There was no correlation between STV and fetal scalp pH measurements (r=-0.0592). CONCLUSIONS: Fetal STV is an important parameter with high sensitivity for antenatal fetal acidosis. This study shows that STV calculations do not correlate with fetal scalp pH measurements during labor, hence are not helpful in identifying fetal acidosis.