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1.
Afr J Reprod Health ; 25(1): 81-89, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34077114

RESUMO

Maternal position is one of the most important factors to be considered during Non-Stress Test (NST). It should be a part of practice guidelines, where the appropriate maternal position reduces test-related errors and false-positive results. This study aimed to investigate the effect of different maternal positions during NST on maternal hemodynamic parameters, satisfaction, and fetal Cardiotocographic (CTG) pattern. A quasi-experimental research design was conducted at NST clinic, outpatient department/ Maternal and Children hospital at Najran city, Saudi Arabia. The study comprised a convenience sample of 118 low-risk pregnant women in their third trimester of pregnancy. Data was collected from January to June 2020. All women were assessed in the three different positions; supine, left lateral, and semi-fowler position concerning CTG pattern, maternal hemodynamic parameters, and satisfaction. The study results indicated a higher Fetal Heart Rate (FHR), increased accelerations, and fetal movement in the left lateral position, followed by a semi-fowler position compared to the supine position with statistically significant differences. No statistically significant differences (P>0.05) were observed regarding FHR variability and NST reactivity in the three positions. In addition, there were statistically significant differences (P <0.05) between the different maternal positions regarding maternal heart rate, systolic Blood pressure (BP), diastolic BP, and maternal satisfaction. The current study concluded that left lateral and semi- fowler positions were associated with a more favorable CTG pattern, maternal hemodynamic parameters, and satisfaction than the supine position. Left lateral and semi-fowler positions during the NST test should be standardized to reduce practical variations among health care providers, which, in turn, may reduce the need for unnecessary, expensive, and even hazardous interventions.


Assuntos
Cardiotocografia/métodos , Monitorização Fetal/métodos , Frequência Cardíaca Fetal/fisiologia , Satisfação Pessoal , Postura/fisiologia , Adulto , Feminino , Coração Fetal/fisiologia , Movimento Fetal/fisiologia , Hemodinâmica/fisiologia , Humanos , Gravidez , Gestantes , Cuidado Pré-Natal
2.
Comput Intell Neurosci ; 2021: 6656770, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33628217

RESUMO

Cardiotocography data uncertainty is a critical task for the classification in biomedical field. Constructing good and efficient classifier via machine learning algorithms is necessary to help doctors in diagnosing the state of fetus heart rate. The proposed neutrosophic diagnostic system is an Interval Neutrosophic Rough Neural Network framework based on the backpropagation algorithm. It benefits from the advantages of neutrosophic set theory not only to improve the performance of rough neural networks but also to achieve a better performance than the other algorithms. The experimental results visualize the data using the boxplot for better understanding of attribute distribution. The performance measurement of the confusion matrix for the proposed framework is 95.1, 94.95, 95.2, and 95.1 concerning accuracy rate, precision, recall, and F1-score, respectively. WEKA application is used to analyse cardiotocography data performance measurement of different algorithms, e.g., neural network, decision table, the nearest neighbor, and rough neural network. The comparison with other algorithms shows that the proposed framework is both feasible and efficient classifier. Additionally, the receiver operation characteristic curve displays the proposed framework classifications of the pathologic, normal, and suspicious states by 0.93, 0.90, and 0.85 areas that are considered high and acceptable under the curve, respectively. Improving the performance measurements of the proposed framework by removing ineffective attributes via feature selection would be suitable advancement in the future. Moreover, the proposed framework can also be used in various real-life problems such as classification of coronavirus, social media, and satellite image.


Assuntos
Inteligência Artificial , Cardiotocografia/métodos , Aprendizado de Máquina , Algoritmos , COVID-19/diagnóstico , Árvores de Decisões , Humanos , Redes Neurais de Computação , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Máquina de Vetores de Suporte
4.
Am J Obstet Gynecol ; 223(5): B16-B20, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32861686

RESUMO

Approximately 20% of twin pregnancies are monochorionic. The management of monochorionic twin pregnancy involves several additional interventions beyond the routine management of singletons or dichorionic twins. In 2015, the Society for Maternal-Fetal Medicine posted checklists for monochorionic/diamniotic twins and monochorionic/monoamniotic twins. The Society presents updated versions of these 2 checklists reflecting recent changes in practice recommendations. Suggestions for implementing the use of the checklists into antenatal care practices are also included.


Assuntos
Lista de Checagem , Parto Obstétrico/métodos , Gravidez de Gêmeos , Cuidado Pré-Natal/métodos , Corticosteroides/uso terapêutico , Âmnio , Cardiotocografia/métodos , Córion , Feminino , Retardo do Crescimento Fetal/diagnóstico por imagem , Transfusão Feto-Fetal/diagnóstico por imagem , Transfusão Feto-Fetal/terapia , Humanos , Educação de Pacientes como Assunto , Gravidez , Ultrassonografia Pré-Natal
5.
Am J Obstet Gynecol ; 223(5): B6-B11, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32861690

RESUMO

Optimal management of HIV-positive pregnant individuals involves many specific interventions made by many healthcare professionals at specific time-points before, during, and after pregnancy. Errors of omission are likely unless those professionals use a cognitive aid such as a checklist as a reminder of critical steps. In this document, SMFM presents updated and expanded checklists to help ensure that all relevant elements are considered for every person with HIV during prepregnancy, antepartum, intrapartum, and postpartum periods. The checklists are intended to be used as tools to facilitate the care of individuals with HIV during all phases of pregnancy care. Their use should improve the safety of HIV-positive patients by ensuring that appropriate treatment is given and relevant information is shared with consultative services. Routine use should also facilitate improved documentation, communication, and continuity of care before, during, and after pregnancy.


Assuntos
Lista de Checagem , Infecções por HIV/terapia , Cuidado Pós-Natal , Cuidado Pré-Concepcional , Complicações Infecciosas na Gravidez/terapia , Cuidado Pré-Natal , Terapia Antirretroviral de Alta Atividade/métodos , Cardiotocografia/métodos , Parto Obstétrico/métodos , Feminino , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Gravidez , Carga Viral
6.
PLoS One ; 15(7): e0236123, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32649719

RESUMO

INTRODUCTION: The fetal cardio-electrohysterographic coupling (FCEC) is defined as the influence of the uterine electrical activity on fetal heart rate. FCEC has been mainly evaluated by visual analysis of cardiotocographic data during labor; however, this physiological phenomenon is poorly explored during the antenatal period. Here we propose an approach known as Bivariate Phase-Rectified Signal Averaging analysis (BPRSA) to assess such FCEC in the late third trimester of low-risk pregnancies. We hypothesized that BPRSA is a more reliable measure of FCEC than visual analysis and conventional measures such as cross-correlation, coherence, and cross-sample entropy. Additionally, by using BPRSA it is possible to detect FCEC even from the third trimester of pregnancy. MATERIAL AND METHODS: Healthy pregnant women in the last third trimester of pregnancy (36.6 ± 1.8 gestational weeks) without any clinical manifestation of labor were enrolled in the Maternal and Childhood Research Center (CIMIGen), Mexico City (n = 37). Ten minutes of maternal electrohysterogram (EHG) and fetal heart rate (FHR) data were collected by a transabdominal non-invasive device. The FCEC was quantified by the coefficient of coherence, the maximum normalized cross-correlation, and the cross-sample entropy obtained either from the EHG and FHR raw signals or from the corresponding BPRSA graphs. RESULTS: We found that by using BPRSA, the FCEC was detected in 92% cases (34/37) compared to 48% cases (18/37) using the coefficient of coherence between the EHG and FHR raw signals. Also, BPRSA indicated FCEC in 82% cases (30/37) compared to 30% cases (11/37) using the maximum normalized cross-correlation. By comparing the analyses, the BPRSA evidenced higher FCEC in comparison to the coupling estimated from the raw EHG and FHR signals. CONCLUSIONS: Our results support the consideration that in the third trimester of pregnancy, the fetal heart rate is also influenced by uterine activity despite the emerging manifestation of this activity before labor. To quantify FCEC, the BPRSA can be applied to FHR and EHG transabdominal signals acquired in the third trimester of pregnancy.


Assuntos
Cardiotocografia/métodos , Coração Fetal/fisiologia , Frequência Cardíaca Fetal , Terceiro Trimestre da Gravidez , Útero/fisiologia , Adolescente , Adulto , Eletrocardiografia , Feminino , Idade Gestacional , Humanos , Gravidez , Adulto Jovem
7.
PLoS One ; 15(4): e0231461, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298307

RESUMO

Although being the golden standard for intrapartum fetal surveillance, cardiotocography (CTG) has been shown to have poor specificity for detecting fetal acidosis. Non-invasive near-infrared-spectroscopy (NIRS) monitoring of placental oxygenation during labour has not been studied yet. The objective of the study was to determine whether changes in placental NIRS values during labour could identify intrapartum fetal hypoxia and resulting acidosis. We included 43 healthy women in active stage of labour at term. CTG and NIRS parameters in groups with vs. without neonatal umbilical artery pH ≤ 7.20 were compared using Mann-Whitney-U. Receiver-operating-characteristics (ROC) curves were used to estimate predictive value of CTG and NIRS parameters for neonatal pH ≤ 7.20. A computer-based statistical classification was also performed to further evaluate predictive values of CTG and NIRS for neonatal acidosis. Ten (23%) neonates were born with umbilical artery pH ≤ 7.20. Compared to group with pH > 7.20, fetal acidosis was associated with more episodes of placental NIRS deoxygenation (9 (range 2-37) vs. 2 (range 0-65); p<0.001), higher velocity of placental NIRS deoxygenation (2.31 (range 0-22) vs. 1 (range 0-49) %/s; p = 0.03), more decelerations on CTG (25 (range 3-91) vs. 10 (range 10-60); p = 0.02), and more prolonged decelerations on CTG (2 (range 0-4) vs. 1 (range 0-3); p = 0.04). Number of placental deoxygenations had the highest prognostic value for fetal/neonatal acidosis (area under the ROC curve 0.85 (95% confidence interval 0.70-0.99). Computer-based classification also identified number of placental deoxygenations as the most accurate classifier, with 25% false positive and 93% true positive rate in the training dataset, with 100% accuracy when applied to the testing dataset. Placental deoxygenations during labour measured by NIRS are associated with fetal/neonatal acidosis. Predictive value of placental NIRS for neonatal acidosis was superior to that of CTG.


Assuntos
Cardiotocografia/métodos , Feto/irrigação sanguínea , Trabalho de Parto , Placenta/fisiologia , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Adolescente , Adulto , Feminino , Humanos , Trabalho de Parto/fisiologia , Pessoa de Meia-Idade , Oxigênio/metabolismo , Placenta/metabolismo , Gravidez , Adulto Jovem
8.
Acta Obstet Gynecol Scand ; 99(10): 1387-1395, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32306380

RESUMO

INTRODUCTION: Doppler ultrasound cardiotocography is a non-invasive alternative that, despite its poor specificity, is often first choice for intrapartum monitoring. Doppler ultrasound suffers from signal loss due to fetal movements and is negatively correlated with maternal body mass index (BMI). Reported accuracy of fetal heart rate monitoring by Doppler ultrasound varies between 10.6 and 14.3 bpm and reliability between 62.4% and 73%. The fetal scalp electrode (FSE) is considered the reference standard for fetal monitoring but can only be applied after membranes have ruptured with sufficient cervical dilatation and is sometimes contra-indicated. A non-invasive alternative that overcomes the shortcomings of Doppler ultrasound, providing reliable information on fetal heart rate, could be the answer. Non-invasive fetal electrocardiography (NI-fECG) uses a wireless electrode patch on the maternal abdomen to obtain both fetal and maternal heart rate signals as well as an electrohysterogram. We aimed to validate a wireless NI-fECG device for intrapartum monitoring in term singleton pregnancies, by comparison with the FSE. MATERIAL AND METHODS: We performed a multicenter cross-sectional observational study at labor wards of 6 hospitals located in the Netherlands, Belgium, and Spain. Laboring women with a healthy singleton fetus in cephalic presentation and gestational age between 36 and 42 weeks were included. Participants received an abdominal electrode patch and FSE after written informed consent. Accuracy, reliability, and success rate of fetal heart rate readings were determined, using FSE as reference standard. Analysis was performed for the total population and measurement period as well as separated by labor stage and BMI class (≤30 and >30 kg/m2 ). RESULTS: We included a total of 125 women. Simultaneous registrations with NI-fECG and FSE were available in 103 women. Overall accuracy is -1.46 bpm and overall reliability 86.84%. Overall success rate of the NI-fECG is around 90% for the total population as well as for both BMI subgroups. Success rate dropped to 63% during second stage of labor, similar results are found when looking at the separate BMI groups. CONCLUSIONS: Performance measures of the NI-fECG device are good in the overall group and the separate BMI groups. Compared with Doppler ultrasound performance measures from the literature, NI-fECG is a more accurate alternative. Especially, when women have a higher BMI, NI-fECG performs well, resembling FSE performance measures.


Assuntos
Cardiotocografia/instrumentação , Frequência Cardíaca Fetal , Tecnologia sem Fio , Adulto , Índice de Massa Corporal , Cardiotocografia/métodos , Estudos Transversais , Eletrodos , Feminino , Humanos , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes
9.
J Pregnancy ; 2020: 7801039, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32089884

RESUMO

Every year, about 85 percent of the approximately 5 million births in North America are evaluated with the electronic fetal monitoring (EFM). Clinicians use the EFM as a proxy to assess fetal oxygenation status, fetal well-being, and potential compromise. Despite the widespread use of this technology, neonatal hypoxia and acidosis continue to make up a high proportion of neonatal morbidity at term. Indeed, though the fetal heart rhythm is inextricably linked to fetal acid-base status, EFM has not been shown to reliably predict neonatal pH status nor has it reduced adverse maternal or neonatal outcomes. As a consequence, the high false-positive rate of EFM for predicting adverse neonatal outcomes has led to an increase in the rate of operative vaginal and cesarean delivery, with elevated rates of associated maternal and neonatal morbidity. This fact invariably leads to a paradox we have henceforth defined as the "obstetrical paradox." Herein, we explore the potential solutions to this paradox and introduce a novel noninvasive technique to assess fetal acid-base status in utero known as the "FETAL technique" (Fourier Evaluation of Tracings and Acidosis in Labour). The FETAL technique, currently under investigation, applies the discrete Fourier transformation to EFM tracings to determine the spectral frequency distribution of the fetal heart rate. These specific frequency distributions correlate with specific umbilical pH values and may provide the missing link between fetal heat rate patterns and acid-base status at birth. As we work toward realizing the full potential benefits of EFM, finding the best assessment strategies to evaluate fetal pH in real time remains a key goal in obstetrics.


Assuntos
Cardiotocografia/métodos , Concentração de Íons de Hidrogênio , Feminino , Sangue Fetal , Frequência Cardíaca Fetal , Humanos , Obstetrícia , Gravidez
10.
Am J Obstet Gynecol ; 223(2): 244.e1-244.e12, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32087146

RESUMO

OBJECTIVE: The objective of the study was to compare interpretability of 2 intrapartum abdominal fetal heart rate-monitoring strategies. We hypothesized that an external fetal electrocardiography monitoring system, a newer technology using wireless abdominal pads, would generate more interpretable fetal heart rate data compared with standard external Doppler fetal heart rate monitoring (standard external monitoring). STUDY DESIGN: We conducted a randomized controlled trial at 4 Utah hospitals. Patients were enrolled at labor admission and randomized in blocks based on body mass index to fetal electrocardiography or standard external monitoring. Two reviewers, blinded to study allocation, reviewed each fetal heart rate tracing. The primary outcome was the percentage of interpretable minutes of fetal heart rate tracing. An interpretable minute was defined as >25% fetal heart rate data present and no more than 25% continuous missing fetal heart rate data or artifact present. Secondary outcomes included the percentage of interpretable minutes of fetal heart rate tracing obtained while on study device only, the number of device adjustments required intrapartum, clinical outcomes, and patient/provider device satisfaction. We determined that 100 patients per arm (200 total) would be needed to detect a 5% difference in interpretability with 95% power. RESULTS: A total of 218 women were randomized, 108 to fetal electrocardiography and 110 to standard external monitoring. Device setup failure occurred more often in the fetal electrocardiography group (7.5% [8 of 107] vs 0% [0 of 109] for standard external monitoring). There were no differences in the percentage of interpretable tracing between the 2 groups. However, fetal electrocardiography produced more interpretable fetal heart rate tracing in subjects with a body mass index ≥30 kg/m2. When considering the percentage of interpretable minutes of fetal heart rate tracing while on study device only, fetal electrocardiography outperformed standard external monitoring for all subjects, regardless of maternal body mass index. Maternal demographics and clinical outcomes were similar between arms. In the fetal electrocardiography group, more device changes occurred compared with standard external monitoring (51% vs 39%), but there were fewer nursing device adjustments (2.9 vs 6.2 mean adjustments intrapartum, P < .01). There were no differences in physician device satisfaction scores between groups, but fetal electrocardiography generated higher patient satisfaction scores. CONCLUSION: Fetal electrocardiography performed similarly to standard external monitoring when considering percentage of interpretable tracing generated in labor. Furthermore, patients reported overall greater satisfaction with fetal electrocardiography in labor. Fetal electrocardiography may be particularly useful in patients with a body mass index ≥30 kg/m2.


Assuntos
Atitude do Pessoal de Saúde , Cardiotocografia/instrumentação , Eletrocardiografia/instrumentação , Sofrimento Fetal/diagnóstico , Trabalho de Parto , Obesidade Materna , Satisfação do Paciente , Adulto , Analgesia Epidural , Índice de Apgar , Gasometria , Índice de Massa Corporal , Cardiotocografia/métodos , Cesárea , Eletrocardiografia/métodos , Feminino , Sangue Fetal , Humanos , Recém-Nascido , Trabalho de Parto Induzido , Masculino , Gravidez , Fatores de Tempo , Adulto Jovem
11.
Midwifery ; 83: 102655, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32036193

RESUMO

BACKGROUND: The STan Australian Randomised controlled Trial (START), the first of its kind in Australia, compares two techniques of intrapartum fetal surveillance (cardiotocographic electronic fetal monitoring (CTG) plus analysis of the ST segment of the fetal electrocardiogram (STan+CTG) with CTG alone) with the aim of reducing unnecessary obstetric intervention. It is also the first comprehensive intrapartum fetal surveillance (IFS) trial worldwide, including qualitative examination of psychosocial outcomes and cost-effectiveness. In evaluating and implementing healthcare interventions, the perspectives and experiences of individuals directly receiving them is an integral part of a comprehensive assessment. Furthermore, the added value of using qualitative research alongside randomised controlled trials (RCTs) is becoming widely acknowledged. OBJECTIVE: This study aimed to examine women's experiences with the type of IFS they received in the START trial. METHODS: Using a qualitative research design, a sample of thirty-two women were interviewed about their experiences with the fetal monitoring they received. Data were analysed using thematic analysis. FINDINGS: Six themes emerged from analysis: reassurance, mobility, discomfort, perception of the fetal Scalp Electrode (FSE), and overall positive experience. CONCLUSION: Interestingly, it was found that women who had an FSE in the CTG alone arm of the trial reported very similar experiences to women in the STan+CTG arm of the trial. Despite STan and CTG differing clinically, from women's perspectives, the primary difference between the two techniques was the utilisation (or not) of the FSE. Women were very accepting of STan+CTG as it was perceived and experienced as a more accurate form of monitoring than CTG alone. Findings from this study have significant implications for health professionals including midwives and obstetricians and implications for standard practice and care. The study has demonstrated the importance and significance of incorporating qualitative enquiry within RCTs.


Assuntos
Cardiotocografia/normas , Eletrocardiografia/normas , Gestantes/psicologia , Adulto , Austrália , Cardiotocografia/métodos , Cardiotocografia/psicologia , Eletrocardiografia/métodos , Eletrocardiografia/psicologia , Feminino , Humanos , Entrevistas como Assunto/métodos , Gravidez , Pesquisa Qualitativa
12.
J Perinat Neonatal Nurs ; 34(1): 46-55, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31996644

RESUMO

There are 2 approaches to fetal assessment during labor: continuous electronic fetal monitoring (EFM) and intermittent auscultation (IA). The vast majority of healthy labors in the United States use EFM, despite professional organization recommendations against its use for low-risk pregnancies. This qualitative investigation explores maternity care team members' perspectives on why EFM is the dominant approach to fetal assessment instead of IA. Focus groups comprised of nurses, midwives, and physicians were conducted using a semistructured interview guide. Transcripts were analyzed using directed content analysis to identify themes related to clinical and nonclinical factors influencing the type of fetal assessment employed during labor. Seven focus groups with a total of 41 participants were completed. Seven themes were identified: clinical environment; technology; policies, procedures, and evidence-based protocols; patient-centered influences; fear of liability; providers as members of healthcare team; and deflection of responsibility. All maternity care team members had knowledge of the evidence base supporting IA use for low-risk care. Nurses identified unique challenges in having agency over monitoring decision making and executing best practices. Improved communication among team members can facilitate evidence-based approaches to IA use, facilitating increased utilization for low-risk labor care.


Assuntos
Cardiotocografia/métodos , Barreiras de Comunicação , Parto Obstétrico , Auscultação Cardíaca/métodos , Utilização de Procedimentos e Técnicas , Atitude do Pessoal de Saúde , Parto Obstétrico/métodos , Parto Obstétrico/psicologia , Prática Clínica Baseada em Evidências/normas , Feminino , Monitorização Fetal/métodos , Grupos Focais , Humanos , Comunicação Interdisciplinar , Gravidez , Utilização de Procedimentos e Técnicas/normas , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Pesquisa Qualitativa , Melhoria de Qualidade , Estados Unidos
13.
Obstet Gynecol ; 135(2): 453-462, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31923063

RESUMO

OBJECTIVE: To assess the association of fetal movement counting with perinatal mortality. DATA SOURCES: Electronic databases (ie, MEDLINE, ClinicalTrials.gov, ScienceDirect, the Cochrane Library at the CENTRAL Register of Controlled Trials) were searched from inception until May 2019. Search terms used were: "fetal movement," "fetal movement counting," "fetal kick counting," "stillbirth," "fetal demise," "fetal mortality," and "perinatal death." METHODS OF STUDY SELECTION: We included all randomized controlled trials comparing perinatal mortality in those women randomized to receive instructions for fetal movement counting compared with a control group of women without such instruction. TABULATION, INTEGRATION AND RESULTS: The primary outcome was perinatal mortality. Five of 1,290 identified articles were included, with 468,601 fetuses. Definitions of decreased fetal movement varied. In four of five studies, women in the intervention group were asked to contact their health care providers if they perceived decreased fetal movement; the fifth study did not provide details. Reported reduction in fetal movement usually resulted in electronic fetal monitoring and ultrasound assessment of fetal well-being. There was no difference in the incidence of perinatal outcome between groups. The incidence of perinatal death was 0.54% (1,252/229,943) in the fetal movement counting group and 0.59% (944/159,755) in the control group (relative risk [RR] 0.92, 95% CI 0.85-1.00). There were no statistical differences for other perinatal outcomes as stillbirths, neonatal deaths, birth weight less than 10th percentile, reported decreased fetal movement, 5-minute Apgar score less than 7, neonatal intensive care unit admission or perinatal morbidity. There were weak but significant increases in preterm delivery (7.6% vs 7.1%; RR 1.07, 95% CI 1.05-1.10), induction of labor (36.6% vs 31.6%; RR 1.15, 95% CI 1.09-1.22), and cesarean delivery (28.2% vs 25.3%; RR 1.11, 95% CI 1.10-1.12). CONCLUSION: Instructing pregnant women on fetal movement counting compared with no instruction is not associated with a clear improvement in pregnancy outcomes. There are weak associations with some secondary outcomes such as preterm delivery, induction of labor, and cesarean delivery. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42019123264.


Assuntos
Cardiotocografia/métodos , Movimento Fetal , Trabalho de Parto , Mortalidade Perinatal , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
14.
Neonatology ; 117(1): 111-117, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31846958

RESUMO

BACKGROUND: While late decelerations and major bradycardia episodes in intrapartum cardiotocography (CTG) recordings are known to correlate with fetal distress,little is known of the importance of the saltatory pattern. OBJECTIVE: The aim of the study was to examine whether the fetal heart rate (FHR) saltatory pattern in intrapartum CTG registration is associated with fetal hypoxia during the last 2 h of labor. DESIGN: The study group consisted of CTG recordings from 194 births with a 1-min Apgar score of <8 (birth weight 3,614 ± 512 g; gestational age 40.6 ± 0.7 weeks). The comparison group included 51 infants with a 1-min Apgar score of ≥9 (birth weight 3,624 ± 400 g; gestational age 40.5 ± 0.4 weeks). FHR patterns were evaluated blindly by 2 experienced perinatologists. The pH, base excess (BE), pO2 and erythropoietin (EPO) were measured from umbilical cord blood at birth as outcome variables. RESULTS: Saltatory pattern occurred in 31/194 (16.0%) of the study group and in 1/51 (2.0%) of the comparison group. Umbilical artery pH, BE, and pO2 were lower and umbilical vein (UV) EPO higher in the study group than in the comparison group. In the study group, UV EPO level was significantly higher in cases where the saltatory pattern was present (median 241 mU/mL, 95% CI 39.4-16,484), than in those without the saltatory pattern (median 39.4 mU/mL, 95% CI 11-282) (p < 0.0001, for difference). In the study group, no differences in EPO levels were found in cases where episodes of bradycardia, tachycardia, reduced variability, or uterine tachysystole were present or absent. In the study group, saltatory pattern preceded late decelerations in 82.8%. CONCLUSION: Saltatory pattern in an intrapartum FHR recording is an early sign of fetal hypoxia.


Assuntos
Cardiotocografia/métodos , Hipóxia Fetal/diagnóstico , Frequência Cardíaca Fetal , Adulto , Índice de Apgar , Peso ao Nascer , Feminino , Sangue Fetal/metabolismo , Sofrimento Fetal/diagnóstico , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos
15.
Arch Gynecol Obstet ; 301(1): 137-142, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31883047

RESUMO

PURPOSE: Phase-rectified signal averaging method (PRSA) represents an analysis method which applied on fetal cardiotocography (CTG) allows the quantification of the speed of fetal heart rate changes. By calculating the average deceleration capacity (ADC) an assessment of the fetal autonomic nervous system (ANS) is possible. The objective of this study was to test its ability to predict perinatal acidosis. METHODS: A case-control study was performed at a University Hospital in Munich. All intrapartum CTG heart rate tracings saved during a 7-year period were considered for analysis. All neonates born with an umbilical arterial blood pH ≤ 7.10 were considered as cases. Controls were defined as healthy fetuses born with a pH ≥ 7.25. The main matching criteria were gestational age at delivery, parity, birth mode, and birth weight percentile. Exclusion criteria were a planned caesarean section, fetal malformations, and multiple pregnancies. ADC and STV were then calculated during the last 60, the last 45, and the last 30 min intervals prior to delivery. RESULTS: Of all stored birth CTG recordings, 227 cases met the inclusion criteria and were studied. ADC was significantly higher in fetuses born with acidemia (4.85 bpm ± 3.0) compared to controls (3.36 bpm ± 2.2). The area under ROC curve was 0.659 (95% CI 0.608-0.710) for ADC and 0.566 (0.512-0.620) for STV (p = 0.013). CONCLUSIONS: This study confirms that the assessment of ADC using PRSA represents a good additional tool for the prediction of acute fetal acidosis during delivery.


Assuntos
Acidose/sangue , Cardiotocografia/métodos , Sangue Fetal/química , Doenças Fetais/diagnóstico , Estudos de Casos e Controles , Feminino , Sangue Fetal/citologia , Doenças Fetais/sangue , Frequência Cardíaca Fetal/fisiologia , Humanos , Masculino , Gravidez
16.
Int J Gynaecol Obstet ; 148(2): 145-156, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31646629

RESUMO

BACKGROUND: Using Doppler to improve detection of intrapartum fetal heart rate (FHR) abnormalities coupled with appropriate, timely intrapartum care in low- and middle-income countries (LMIC) can save lives. OBJECTIVE: To review studies using Doppler to improve detection of intrapartum FHR abnormalities and intrapartum care quality in LMIC health facilities. SEARCH STRATEGY: PubMed, Web of Science, Embase, Global Health, and Scopus were searched from inception to October 2018 by combining terms for Doppler, perinatal outcomes, and FHR monitoring. SELECTION CRITERIA: Selected studies compared Doppler and Pinard stethoscope for detecting/monitoring intrapartum FHR, or described provider and maternal preferences for FHR monitoring in LMIC settings. DATA COLLECTION AND ANALYSIS: Two team members independently screened and collected data. Risk of bias was assessed by Cochrane EPOC criteria. RESULTS: Eleven studies from eight countries were included. Doppler was superior at detecting abnormal intrapartum FHR as compared with Pinard stethoscope, but was not associated with improved perinatal outcomes. Using Doppler on admission helped to accurately measure perinatal deaths occurring after facility admission. CONCLUSION: Studies and program learning are needed to translate improved detection of FHR abnormalities to improved case management in LMICs. Doppler should be used to calculate a facility indicator of intrapartum care quality. PROSPERO registration: CRD42019121924.


Assuntos
Cardiotocografia/métodos , Cardiopatias Congênitas/diagnóstico por imagem , Frequência Cardíaca Fetal/fisiologia , Ultrassonografia Doppler , Países em Desenvolvimento , Feminino , Saúde Global , Humanos , Recém-Nascido , Mortalidade Perinatal , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Ultrassonografia Pré-Natal
17.
Women Birth ; 33(5): 411-418, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31668871

RESUMO

PROBLEM: Caesarean section rates have risen in high-income countries. One of the potential drivers for this is the widespread use of CTG monitoring. BACKGROUND: Intrapartum cardiotocograph monitoring is considered to be indicated for women at risk for poor perinatal outcome. AIM: This systematic literature review with meta-analysis examined randomised controlled trials and non-experimental research to determine whether cardiotocograph monitoring rather than intermittent auscultation during labour was associated with changes in perinatal mortality or cerebral palsy rates for high-risk women. METHODS: A systematic search for research published up to 2019 was conducted using PubMed, CINAHL, Cochrane, and Web of Science databases. Non-experimental and randomised controlled trial research in populations of women at risk which compared intrapartum cardiotocography with intermittent auscultation and reported on stillbirth, neonatal mortality, perinatal mortality and/or cerebral palsy were included. Relative risks were calculated from extracted data, and meta-analysis of randomised controlled trials was undertaken. FINDINGS: Nine randomised controlled trials and 26 non-experimental studies were included. Meta-analysis of pooled data from RCTs in mixed- and high-risk populations found no statistically significant differences in perinatal mortality rates. The majority of non-experimental research was at critical risk of bias and should not be relied on to inform practice. Cardiotocograph monitoring during preterm labour was associated with a higher incidence of cerebral palsy. DISCUSSION: Research evidence failed to demonstrate perinatal benefits from intrapartum cardiotocograph monitoring for women at risk for poor perinatal outcome. CONCLUSION: There is an urgent need for well-designed research to consider whether intrapartum cardiotocograph monitoring provides benefits.


Assuntos
Auscultação , Cardiotocografia/métodos , Monitorização Fetal/métodos , Mortalidade Perinatal , Natimorto/epidemiologia , Paralisia Cerebral/epidemiologia , Cesárea , Feminino , Humanos , Recém-Nascido , Trabalho de Parto , Parto , Gravidez
18.
MCN Am J Matern Child Nurs ; 45(2): 82-91, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31714283

RESUMO

Understanding the physiology of fetal oxygenation and various influences on fetal heart rate control supports nurses, midwives, and physicians in interpreting and managing electronic fetal heart rate tracings during labor and birth. Maternal oxygenation, placental circulation and exchange, umbilical blood flow and fetal circulation affect fetal oxygenation, which is reflected in observed fetal heart rate patterns. Fetal heart control is further influenced by the central and autonomic nervous systems, baroreceptors, chemoreceptors, humoral factors, sleep-wake patterns, breathing movements, medications, painful stimuli, sound and vibrations, and temperature. Knowledge of the physiologic basis for fetal heart rate pattern characteristics guides interventions to improve fetal oxygenation when indicated. A review and update on clinical implications of fetal heart rate pattern interpretation based on underlying physiology is presented.


Assuntos
Frequência Cardíaca Fetal/fisiologia , Trabalho de Parto/fisiologia , Adulto , Débito Cardíaco/fisiologia , Cardiotocografia/instrumentação , Cardiotocografia/métodos , Feminino , Humanos , Oxigênio/análise , Oxigênio/sangue , Gravidez
19.
BMC Pregnancy Childbirth ; 19(1): 501, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842798

RESUMO

BACKGROUND: Maternal heart rate artefact is a signal processing error whereby the fetal heart rate is masked by the maternal pulse, potentially leading to danger by failure to recognize an abnormal fetal heart rate or a pre-existing fetal death. Maternal heart rate artefact may be exacerbated by autocorrelation algorithms in modern fetal monitors due to smooth transitions between maternal and fetal heart rates rather than breaks in the tracing. In response, manufacturers of cardiotocography monitors recommend verifying fetal life prior to monitoring and have developed safeguards including signal ambiguity detection technologies to simultaneously and continuously monitor the maternal and fetal heart rates. However, these safeguards are not emphasized in current cardiotocography clinical practice guidelines, potentially leading to a patient safety gap. METHODS: The United States Food and Drug Administration Manufacturer and User Facility Device Experience database was reviewed for records with event type "Death" for the time period March 31, 2009 to March 31, 2019, in combination with search terms selected to capture all cases reported involving cardiotocography devices. Records were reviewed to determine whether maternal heart rate artefact was probable and/or whether the report contained a recommendation from the device manufacturer regarding maternal heart rate artefact. RESULTS: Forty-seven cases of perinatal mortality were identified with probable maternal heart rate artefact including 14 with antepartum fetal death prior to initiation of cardiotocography, 14 with intrapartum fetal death or neonatal death after initiation of cardiotocography, and 19 where the temporal relationship between initiation of cardiotocography and death cannot be definitively established from the report. In 29 cases, there was a recommendation from the manufacturer regarding diagnosis and/or management of maternal heart rate artefact. CONCLUSIONS: This case series indicates a recurring problem with undetected maternal heart rate artefact leading to perinatal mortality and, in cases of pre-existing fetal death, healthcare provider confusion. In response, manufacturers frequently recommend safeguards which are found in their device's instructions for use but not in major intrapartum cardiotocography guidelines. Cardiotocography guidelines should be updated to include the latest safeguards against the risks of maternal heart rate artefact. An additional file summarizing key points for clinicians is included.


Assuntos
Artefatos , Cardiotocografia/mortalidade , Morte Perinatal/etiologia , Mortalidade Perinatal , Cardiotocografia/métodos , Feminino , Frequência Cardíaca Fetal , Humanos , Recém-Nascido , Gravidez , Processamento de Sinais Assistido por Computador , Estados Unidos/epidemiologia , United States Food and Drug Administration
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