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1.
PLoS One ; 15(2): e0228630, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32027690

RESUMO

OBJECTIVE: The relevance between time-series fetal heart rate (FHR) pattern changes during labor and outcomes such as arterial blood gas data at delivery has not been studied. Using 3-tier and 5-tier classification systems, we studied the relationship between time-series FHR pattern changes before delivery and umbilical artery blood gas data at delivery. METHODS: The subjects were 1,909 low-risk women with vaginal delivery (age: 29.1 ± 4.4 years, parity: 1.7 ± 0.8). FHR patterns were classified by a skilled obstetrician based on each 10 min-segment of the last 60 min before delivery from continuous CTG records in an obstetric clinic. RESULTS: The relationship between each 10 min-segment FHR pattern classification from 60 minutes before delivery and umbilical artery blood pH and base excess (BE) values at delivery changed with time. In the 3-tier classification, mean pH of Category I group in each 10 min-segment was significantly higher than that of Category II group. For Category I groups in each 10-minute segment, its number decreased and its average pH increased as the delivery time approached. In the 5-tier classification, there was the same tendency. About each level group in 10 min-segment, the higher the level, the lower the blood gas values, and mean pH of higher level groups decreased as the delivery time approached. CONCLUSIONS: The relationship between classifications and outcomes was clear at any time from 60 min before delivery in 3- and 5-tier classifications, and the 5-tier classification was more relevant.


Assuntos
Sangue Fetal , Frequência Cardíaca Fetal , Adulto , Gasometria , Parto Obstétrico , Feminino , Monitorização Fetal/métodos , Humanos , Concentração de Íons de Hidrogênio , Trabalho de Parto , Gravidez , Fatores de Tempo , Artérias Umbilicais
3.
Theriogenology ; 142: 303-309, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31711710

RESUMO

During stage II of parturition, the bovine fetus is at risk of oxygen deficiency caused by insufficient gas exchange between the dam and the fetus. The early detection of this critical condition, followed by assistance at calving, can help to improve the vitality of the newborn calf, or even prevent it from being born dead. By using pulse oximetry, the arterial oxygen saturation, as well as the pulse rate, can be continuously and non-invasively measured. The aim of our study was to identify critical thresholds for the parameters 'arterial oxygen saturation (FSpO2)' and 'pulse rate (PR)' that indicate a severe postnatal risk for calves to suffer from acidosis. FSpO2 and PR from 40 bovine fetuses were recorded during the last 25 min of calving with a commercially available pulse oximeter (Radius-7, Masimo Corporation, Irvine, USA). The calves were tested immediately after birth for acidosis by analyzing their blood with a portable blood gas analyzer (VetScan iStat1, Abaxis Inc., Union City, USA). Retrospectively, the pulsoximetric data were scanned for predefined patterns. The validity of these patterns to predict acidosis in newborn calves was analyzed by using receiver operating characteristics (ROC) curve analyses. In general, PR was a stronger predictive parameter for acidosis than FSpO2, with the greatest area under the curve (AUC) for the PR criteria 'Pulse rate > 120 beats per minute (bpm) for at least 2 min', with an AUC of 0.764, in contrast to an AUC of 0.613 for the best FSpO2 criteria 'FSpO2 < 40% for at least 50% of the measurement'. Further studies should investigate whether vitality after calving can be improved and fetal death rate can be reduced when obstetric assistance is performed as soon as one of these criteria apply to the bovine fetus. For more practical implementation in the field, improvement of the device's hardware would be necessary.


Assuntos
Acidose/diagnóstico , Artérias/química , Doenças Fetais/diagnóstico , Monitorização Fetal , Frequência Cardíaca Fetal , Oximetria , Oxigênio/sangue , Acidose/veterinária , Animais , Animais Recém-Nascidos , Bovinos , Doenças dos Bovinos/diagnóstico , Feminino , Doenças Fetais/veterinária , Monitorização Fetal/métodos , Monitorização Fetal/veterinária , Trabalho de Parto/fisiologia , Masculino , Oximetria/métodos , Oximetria/veterinária , Oxigênio/análise , Valor Preditivo dos Testes , Gravidez , Prognóstico , Troca Gasosa Pulmonar/fisiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos
4.
Glob Health Sci Pract ; 7(4): 521-539, 2019 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-31874937

RESUMO

BACKGROUND: Timely identification and management of intrapartum complications could significantly reduce maternal deaths, intrapartum stillbirths, and newborn deaths due to hypoxia. The World Health Organization (WHO) identifies monitoring of labor using the paper partograph as a high-priority intervention for identifying abnormities in labor and fetal well-being. This article describes a mixed-method, quasi-experimental study to assess the effectiveness of an Android tablet-based electronic, labor clinical decision-support application (ePartogram) in limited-resource settings. METHODS: The study, conducted in Kenya from October 2016 to May 2017, allocated 12 hospitals and health centers to an intervention (ePartogram) or comparison (paper partograph) group. Skilled birth attendants (SBAs) in both groups received a 2-day refresher training in labor management and partograph use. The intervention group received an additional 1-day orientation on use and care of the Android-based ePartogram app. All outcomes except one compare post-ePartogram intervention versus paper partograph controls. The exception is outcome of early perinatal mortality pre- and post-ePartogram introduction in intervention sites compared to control sites. We used log binomial regression to analyze the primary outcome of the study, suboptimal fetal outcomes. We also analyzed for secondary outcomes (SBAs performing recommended actions), and conducted in-depth interviews with facility in-charges and SBAs to ascertain acceptability and adoptability of the ePartogram. RESULTS: We compared data from 842 clients in active labor using ePartograms with data from 1,042 clients monitored using a paper partograph. SBAs using ePartograms were more likely than those using paper partographs to take action to maintain normal labor, such as ambulation, feeding, and fluid intake, and to address abnormal measurements of fetal well-being (14.7% versus 5.3%, adjusted relative risk=4.00, 95% confidence interval [CI]=1.95-8.19). Use of the ePartogram was associated with a 56% (95% CI=27%-73%) lower likelihood of suboptimal fetal outcomes than the paper partograph. Users of the ePartogram were more likely to be compliant with routine labor observations. SBAs stated that the technology was easy to use but raised concerns about its use at high-volume sites. Further research is needed to evaluate costs and benefit and to incorporate recent WHO guidance on labor management. CONCLUSION: ePartogram use was associated with improvements in adherence to recommendations for routine labor care and a reduction in adverse fetal outcomes, with providers reporting adoptability without undue effort. Continued development of the ePartogram, including incorporating new clinical rules from the 2018 WHO recommendations on intrapartum care, will improve labor monitoring and quality care at all health system levels.


Assuntos
Computadores de Mão , Sistemas de Apoio a Decisões Clínicas , Parto Obstétrico/métodos , Monitorização Fetal/métodos , Trabalho de Parto , Assistência Perinatal/métodos , Adulto , Feminino , Humanos , Hipóxia/prevenção & controle , Recém-Nascido , Quênia , Tocologia/normas , Gravidez , Análise de Regressão , Adulto Jovem
5.
Medicine (Baltimore) ; 98(48): e18170, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31770267

RESUMO

RATIONALE: The umbilical cord is the way to exchange gas, supply nutrients, excrete metabolized. Thrombosis of the umbilical cord leads to fetal hypoxia, which jeopardizes fetal health and can cause fetal death. Umbilical vessel thrombosis, which is rarely reported, is difficult to detect prenatally. PATIENT CONCERNS: Both pregnant women had an unremarkable pregnancy course until a routine ultrasound scan in the third trimester showed a single umbilical artery. However, one umbilical vein and 2 umbilical arteries were seen during an ultrasound examination at 32 weeks. Case 2 had a better pregnancy outcome because of the timely discovery of this complication. DIAGNOSIS: Both cases were diagnosed as umbilical artery thrombosis. INTERVENTIONS: The first patient received no interventions until they reported decreased fetal movements and gradually disappear. The second patient underwent an emergency cesarean section. OUTCOMES: In Case 1, an emergency ultrasound examination showed intrauterine fetal death, and the patient vaginally delivered a stillborn child weighing 3300 g in a day. In Case 2, a female neonate weighing 2860 g was delivered by cesarean section, and exhibited Apgar scores of 10 and 10 at 1 and 5 minutes. CONCLUSION: In the late-term abortions, obstetricians should be vigilant if ultrasound imaging shows suspected umbilical vascular thrombosis or shows 1 umbilical artery when there had previously been 2. The fetus should be closely monitored and interventions implemented as early as possible to improve the prenatal detection rate of umbilical vessel thrombosis and avoid adverse pregnancy outcomes.


Assuntos
Cesárea/métodos , Intervenção Médica Precoce/métodos , Morte Fetal , Complicações Cardiovasculares na Gravidez , Trombose , Artérias Umbilicais , Adulto , Serviços Médicos de Emergência/métodos , Feminino , Morte Fetal/etiologia , Morte Fetal/prevenção & controle , Monitorização Fetal/métodos , Humanos , Recém-Nascido , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/fisiopatologia , Resultado da Gravidez , Natimorto , Trombose/complicações , Trombose/diagnóstico , Trombose/fisiopatologia , Ultrassonografia Pré-Natal/métodos , Artérias Umbilicais/diagnóstico por imagem , Artérias Umbilicais/patologia
6.
Medicine (Baltimore) ; 98(48): e18182, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770271

RESUMO

RATIONALE: Rupture of an unscarred uterus after in vitro fertilization-embryo transfer (IVF-ET) in a primiparous woman is rare. Assisted reproductive technology (ART)-induced rupture of an unscarred uterus is usually attributable to increased dizygotic twinning rates. Salpingectomy can result in cornual scarring and increase the risk of uterine rupture as well as the mortality rate in a subsequent ectopic pregnancy. Here, we present the first reported case of a spontaneous, third-trimester, uterine rupture in a primiparous woman after IVF-ET due to a history of bilateral salpingectomy because of bilateral oviduct and ovarian cysts; the patient did not have an ectopic pregnancy or any cornual or other uterine scarring during this pregnancy after IVF-ET. PATIENT CONCERNS: A 24-year-old woman with a history of IVF-ET and bilateral salpingectomy was admitted to our hospital with unexplained acute upper abdominal pain during the third trimester. DIAGNOSIS: The fetal heart rate was abnormal. Abdominal ultrasonography was negative. Computed tomography revealed a small amount of abdominal and pericardial effusion. Laboratory tests revealed increased white blood cells. A diagnosis of pregnancy complicated by acute abdomen was considered. Emergent exploratory laparotomy revealed a uterine rupture at the right fundus adjacent to the right cornual area. INTERVENTIONS: The patient was successfully managed with simultaneous exploratory laparotomy and lower-segment cesarean section. The rupture site was repaired. OUTCOMES: Two live infants were uneventfully delivered. Follow-up assessments of the mother and the female baby on the 42nd postpartum day yielded normal results. The male infant was diagnosed with left hydronephrosis and required an operation. LESSONS: We conclude that the ART-associated increase in dizygotic twinning rates may be a neglected risk factor for spontaneous rupture of the unscarred uterus, especially in patients who have undergone salpingectomy. Uterine rupture should be considered in a patient with multiple pregnancy following IVF-ET who presents with acute abdominal pain and abnormal fetal heart rate. Timely exploratory laparotomy is the key to a good prognosis.


Assuntos
Dor Abdominal , Cesárea/métodos , Transferência Embrionária , Fertilização In Vitro , Frequência Cardíaca Fetal , Ruptura Espontânea , Ruptura Uterina , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Transferência Embrionária/efeitos adversos , Transferência Embrionária/métodos , Feminino , Fertilização In Vitro/efeitos adversos , Fertilização In Vitro/métodos , Monitorização Fetal/métodos , Humanos , Gravidez , Resultado da Gravidez , Terceiro Trimestre da Gravidez , Gravidez de Gêmeos , Fatores de Risco , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/etiologia , Ruptura Espontânea/cirurgia , Salpingectomia/efeitos adversos , Ruptura Uterina/diagnóstico , Ruptura Uterina/etiologia , Ruptura Uterina/cirurgia , Adulto Jovem
7.
Br Med Bull ; 131(1): 97-108, 2019 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-31504226

RESUMO

BACKGROUND: Gestational diabetes mellitus (GDM) is highly prevalent and has both short- and long-term implications for mother and infant. SOURCES OF DATA: Literature search using PubMed with keywords 'Gestational diabetes' and 'diabetes in pregnancy' together with published papers known to the authors. AREAS OF AGREEMENT: The cornerstone of management is medical nutrition therapy with regular self-monitoring of capillary blood glucose levels and intensification of therapy if glycaemic goals are not achieved. Post-partum, annual assessment for type 2 diabetes is recommended. AREAS OF CONTROVERSY: Diagnostic criteria and new biomarkers for GDM and the clinical and economic benefits of treating women with milder levels of glucose intolerance during pregnancy. GROWING POINTS: Women with GDM are a heterogeneous group with varying degrees of insulin resistance and beta cell dysfunction. AREAS TIMELY FOR DEVELOPING RESEARCH: Development of alternative diagnostic markers and application of novel technologies for GDM management.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Diabetes Gestacional/terapia , Automonitorização da Glicemia , Parto Obstétrico/métodos , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Gestacional/diagnóstico , Dietoterapia , Terapia por Exercício/métodos , Feminino , Monitorização Fetal/métodos , Humanos , Hipoglicemiantes/uso terapêutico , Cuidado Pós-Natal/métodos , Gravidez , Cuidado Pré-Natal/métodos , Ganho de Peso/fisiologia
10.
Medicina (Kaunas) ; 55(8)2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31357513

RESUMO

Background and objectives: Doppler ultrasound of umbilical and fetal vessels is useful for monitoring fetal well-being, fetal anemia, intrauterine growth retardation, and other perinatal outcomes. The adverse perinatal outcome and circulatory changes can be reflected in fetal Doppler studies. The aim of this study was to evaluate the effect of increased pressure exerted on the maternal abdominal wall during routine ultrasound on the middle cerebral artery (MCA), resistance index (RI), pulsatility index (PI), and peak systolic velocity (PSV). Materials and Methods: A prospective study was conducted, in which we included 40 pregnant women between 24 + 0 and 41 + 3 gestational weeks (GW), with singleton pregnancies, without any associated pathologies, undergoing routine US examination. We recorded the flow velocity waveforms in the MCA, and we measured the RI, PI, PSV, and the applied pressure on to the maternal abdominal wall-needed for a proper evaluation of MCA. We then repeated the same measurements at two different higher pressure levels, at the same time having a proper image of the targeted vessel. Results: We found significant differences for the PI and RI levels with an increase in abdominal pressure (median PI 1.46, 1.58, and 1.92, respectively; median RI 0.74, 0.78, and 0.85, respectively; p < 0.05), for both PI and RI. At the same time, we found no significant differences for PSV in the studied group in relationship with increase in abdominal pressure (median PSV 39.56, 40.10, and 39.70, respectively; p > 0.05). Conclusions: The applied abdominal pressure by the examiner's hand, during routine US scan in pregnancy, can modify the MCA parameters of blood flow resistance (PI and RI) when measured by Doppler US, thus influencing the diagnostic accuracy in a series of pregnancy associated pathologies, such as chronic fetal distress (CFD) or intrauterine growth restriction (IUGR).


Assuntos
Parede Abdominal/fisiologia , Indicadores Básicos de Saúde , Artéria Cerebral Média/fisiologia , Pressão/efeitos adversos , Ultrassonografia Pré-Natal/efeitos adversos , Parede Abdominal/diagnóstico por imagem , Adulto , Análise de Variância , Velocidade do Fluxo Sanguíneo/fisiologia , Feminino , Monitorização Fetal/efeitos adversos , Monitorização Fetal/métodos , Idade Gestacional , Humanos , Gravidez , Estudos Prospectivos , Romênia , Ultrassonografia Pré-Natal/métodos
11.
PLoS One ; 14(7): e0219573, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291375

RESUMO

BACKGROUND: Intermittent auscultation (IA) is the technique of listening to and counting the fetal heart rate (FHR) for short periods during active labour and continuous cardiotocography (CTC) implies FHR monitoring for longer periods. Although the evidence suggests that IA is the best way to monitor healthy women at low risk of complications, there is no scientific evidence for the ideal device, timing, frequency and duration for IA. We aimed to give an overview of the field, identify and describe methods and practices for performing IA, map the evidence and accuracy for different methods of IA, and identify research gaps. METHODS: We conducted a systematic scoping review following the Joanna Briggs methodology. Medline, EMBASE, Cinahl, Maternity & Infant Care, Cochrane Library, SveMed+, Web of Science, Scopus, Lilacs and African Journals Online were searched for publications up to January 2019. We did hand searches in relevant articles and databases. Studies from all countries, international guidelines and national guidelines from Denmark, United Kingdom, United States, New Zealand, Australia, The Netherlands, Sweden, Denmark, and Norway were included. We did quality assessment of the guidelines according to the AGREEMENT tool. We performed a meta-analysis assessing the effects of IA with a Doppler device vs. Pinard device using methods described in The Cochrane Handbook, and we performed an overall assessment of the summary of evidence using the GRADE approach. RESULTS: The searches generated 6408 hits of which 26 studies and 11 guidelines were included in the review. The studies described slightly different techniques for performing IA, and some did not provide detailed descriptions. Few of the studies provided details of normal and abnormal IA findings. All 11 guidelines recommended IA for low risk women, although they had slightly different recommendations on the frequency, timing, and duration for IA, and the FHR characteristics that should be observed. Four of the included studies, comprising 8436 women and their babies, were randomised controlled trials that evaluated the effect of IA with a Doppler device vs. a Pinard device. Abnormal FHRs were detected more often using the Doppler device than in those using the Pinard device (risk ratio 1.77; 95% confidence interval 1.29-2.43). There were no significant differences in any of the other maternal or neonatal outcomes. Four studies assessed the accuracy of IA findings. Normal FHR was easiest to identify correctly, whereas identifying periodic FHR patterns such as decelerations and saltatory patterns were more difficult. CONCLUSION: Although IA is the recommended method, no trials have been published that evaluate protocols on how to perform it. Nor has any study assessed interrater agreements regarding interpretations of IA findings, and few have assessed to what degree clinicians can describe FHR patterns detected by IA. We found no evidence to recommend Doppler device instead of the Pinard for IA, or vice versa.


Assuntos
Auscultação/métodos , Monitorização Fetal/métodos , Frequência Cardíaca Fetal/fisiologia , Trabalho de Parto/fisiologia , Auscultação/instrumentação , Feminino , Monitorização Fetal/instrumentação , Humanos , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Estetoscópios , Ultrassonografia Doppler/instrumentação , Ultrassonografia Doppler/métodos
12.
Am J Emerg Med ; 37(8): 1604.e1-1604.e2, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31155170

RESUMO

Supraventricular Tachycardias are the most common cardiac rhythm disturbances in pregnant patients. Adenosine is the recommended medication to treat these arrhythmias in part because the medication is projected to be metabolized prior to crossing the placenta and producing any fetal effects. Reported here is a case of a pregnant patient treated with adenosine in which the fetal heart activity was monitored through point of care ultrasonography with documentation of no fetal impact from this medication. This is the first documentation of a lack of fetal effect from adenosine.


Assuntos
Adenosina/administração & dosagem , Antiarrítmicos/administração & dosagem , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Taquicardia Supraventricular/tratamento farmacológico , Administração Intravenosa , Adulto , Eletrocardiografia , Feminino , Monitorização Fetal/métodos , Frequência Cardíaca Fetal , Humanos , Testes Imediatos , Gravidez , Ultrassonografia Pré-Natal
14.
Comput Methods Programs Biomed ; 175: 193-204, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31104707

RESUMO

BACKGROUND AND OBJECTIVE: This paper proposes a simple yet effective method for the extraction of foetal ECG from abdominal ECG which is necessary due to similar spatial and temporal content of mother and foetal ECG. METHODS: The proposed algorithm for extraction of foetal ECG (fECG) from abdominal signal uses single channel. Pre-processing of abdominal ECG (abdECG) has been done to eliminate noise and condition the signal. The maternal ECG R-peaks have been detected based on thresholding, first order Gaussian differentiation and zero cross detection on pre-processed signal. Having identified R-peaks and pre-processed signal as base, using Maximum Likelihood Estimation, one beat including QRS complex morphology of maternal ECG (mECG) has been constructed. Extraction of maternal ECG from abdECG is done based on the constructed beat, R-peak locations and its corresponding QRS complex of abdECG. Extracted mECG has been cancelled from abdECG. This results in foetal ECG with residual noise. The noise has been reduced by Polynomial Approximation and Total Variation (PATV) to improve SNR. This approach ensures no loss of partially or completely overlapped fECG signals due to mECG removal. The algorithm is tested on three database namely daISy (DBI), Physiobank challenge 2013 (DBII) and abdominal and direct foetal ECG database (adfecgdb) of Physiobank (DBIII). RESULTS: The algorithm detected no false positives or false negatives with certain channel for DBI, DBII and DBIII which shows that the proposed algorithm can achieve good performance. Overall accuracy and sensitivity of the system is 98.53% and 100% for DBI. Best accuracy and sensitivity of 97.77% and 98.63% are obtained for DBII. Best accuracy of 92.41% and sensitivity of 93.8% are obtained for DBIII. Correlation coefficient between actual foetal heart rate (fHR) and estimated fHR of 0.66 for DBII and 0.59 for DBIII is obtained. The method has obtained overall F1 score of 99.25% for DBI, 96.04% for DBII and 94.25% for DBIII. It has obtained a best MSE of fHR and overall MSE of R-R interval which is 10.8bpm2 and 2.2 ms for DBII, 12bpm2 and 2.14 ms for DBIII. CONCLUSION: The results for different public databases show that the proposed method is capable of providing good results. The foetal QRS, R-peaks and R-R intervals have also been obtained in this method. Thus, it gives a significant contribution in the required area of research.


Assuntos
Abdome/diagnóstico por imagem , Abdome/embriologia , Eletrocardiografia , Monitorização Fetal/métodos , Processamento de Sinais Assistido por Computador , Algoritmos , Bases de Dados Factuais , Eletrodos , Feminino , Feto/fisiologia , Frequência Cardíaca Fetal , Humanos , Processamento de Imagem Assistida por Computador , Funções Verossimilhança , Modelos Teóricos , Mães , Distribuição Normal , Gravidez , Sensibilidade e Especificidade
15.
J Health Popul Nutr ; 38(1): 12, 2019 05 16.
Artigo em Inglês | MEDLINE | ID: mdl-31097031

RESUMO

BACKGROUND: Morbidity of birth asphyxia has been estimated to be 42 million disability-adjusted life years. The study sought to assess the impact of the use and completion of partograph during labour on reducing birth asphyxia at the St Anthony's Hospital, Dzodze, in the Volta Region of Ghana. METHODS: A retrospective study design using a quantitative approach was adopted for the study. A simple random sampling technique was used to select a total of 200 folders of labouring women who were admitted and delivered at St Anthony's Hospital, Dzodze, between 1st May 2015 and 30th April 2016. A structured checklist, which was developed by using labour and foetal monitoring parameters based on the standards of the World Health Organization partograph usage, was used to review all the 200 existing maternal records. RESULTS: The findings revealed that partographs were used by midwives at St Anthony's Hospital with the majority of the maternal folders fully completed. The use and completion of partograph were found to be associated with less non-asphyxiated birth outcomes. Labours which were monitored with partograph were 4.29 times less likely to result in birth asphyxia [AOR (95% CI) 4.29 (1.35-14.81)], and those that were monitored with a completed partograph were 5.3 times less likely to result in birth asphyxia [AOR (95% CI) 5.31 (2.011-16.04)]. CONCLUSION: Midwives used partographs during labour at St Anthony's Hospital. The use and completion of partograph were significantly associated with a reduced incidence of birth asphyxia at the hospital. Birth asphyxia could be reduced if partographs are used and completed by midwives during labour in all cases.


Assuntos
Asfixia Neonatal/epidemiologia , Asfixia Neonatal/prevenção & controle , Monitorização Fetal/métodos , Tocologia/métodos , Adulto , Lista de Checagem , Feminino , Gana/epidemiologia , Humanos , Incidência , Recém-Nascido , Trabalho de Parto , Masculino , Gravidez , Estudos Retrospectivos , Serviços Urbanos de Saúde , População Urbana , Adulto Jovem
16.
Acta Obstet Gynecol Scand ; 98(9): 1207-1217, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31081113

RESUMO

The second Signal Processing and Monitoring in Labor workshop gathered researchers who utilize promising new research strategies and initiatives to tackle the challenges of intrapartum fetal monitoring. The workshop included a series of lectures and discussions focusing on: new algorithms and techniques for cardiotocogoraphy (CTG) and electrocardiogram acquisition and analyses; the results of a CTG evaluation challenge comparing state-of-the-art computerized methods and visual interpretation for the detection of arterial cord pH <7.05 at birth; the lack of consensus about the role of intrapartum acidemia in the etiology of fetal brain injury; the differences between methods for CTG analysis "mimicking" expert clinicians and those derived from "data-driven" analyses; a critical review of the results from two randomized controlled trials testing the former in clinical practice; and relevant insights from modern physiology-based studies. We concluded that the automated algorithms performed comparably to each other and to clinical assessment of the CTG. However, the sensitivity and specificity urgently need to be improved (both computerized and visual assessment). Data-driven CTG evaluation requires further work with large multicenter datasets based on well-defined labor outcomes. And before first tests in the clinic, there are important lessons to be learnt from clinical trials that tested automated algorithms mimicking expert CTG interpretation. In addition, transabdominal fetal electrocardiogram monitoring provides reliable CTG traces and variability estimates; and fetal electrocardiogram waveform analysis is subject to promising new research. There is a clear need for close collaboration between computing and clinical experts. We believe that progress will be possible with multidisciplinary collaborative research.


Assuntos
Algoritmos , Monitorização Fetal/métodos , Acidose/diagnóstico , Cardiotocografia/métodos , Eletrocardiografia/métodos , Feminino , Humanos , Gravidez , Diagnóstico Pré-Natal , Processamento de Sinais Assistido por Computador , Reino Unido
17.
Acta Obstet Gynecol Scand ; 98(11): 1386-1397, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31070780

RESUMO

Normal pregnancy leads to a state of chronically increased intra-abdominal pressure. Obstetric and non-obstetric conditions may increase intra-abdominal pressure further, causing intra-abdominal hypertension and abdominal compartment syndrome, which leads to maternal organ dysfunction and a compromised fetal state. Limited medical literature exists to guide treatment of pregnant women with these conditions. In this state-of-the-art review, we propose a diagnostic and treatment algorithm for the management of peripartum intra-abdominal hypertension and abdominal compartment syndrome, informed by newly available studies.


Assuntos
Cavidade Abdominal/fisiopatologia , Síndromes Compartimentais/terapia , Monitorização Fetal/métodos , Hipertensão Intra-Abdominal/terapia , Período Periparto , Resultado da Gravidez , Adulto , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/epidemiologia , Estado Terminal/mortalidade , Estado Terminal/terapia , Feminino , Humanos , Incidência , Hipertensão Intra-Abdominal/diagnóstico , Hipertensão Intra-Abdominal/epidemiologia , Mortalidade Materna , Determinação de Necessidades de Cuidados de Saúde , Gravidez , Complicações na Gravidez/fisiopatologia , Complicações na Gravidez/terapia , Prognóstico , Medição de Risco , Resultado do Tratamento
19.
Women Birth ; 32(2): 127-130, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31007206

RESUMO

BACKGROUND: Decreased fetal movements are associated with adverse perinatal outcomes, including stillbirth. Delayed maternal visits to a health care provider after perceiving decreased fetal movements are frequently observed in stillbirths. Informing pregnant women of the normal range of fetal movement frequency is essential in their earlier visits in order to prevent stillbirth. AIM: To investigate the fetal movement frequency in late pregnancy and the effects of associated perinatal factors. METHODS: This prospective multicenter study was conducted in 20 obstetric facilities in our region of Japan. A total of 2337 pregnant women were asked to record the time it took to perceive 10 fetal movements by the modified 'count to 10' method every day from 34weeks of gestation until delivery. FINDINGS: The 90th percentile of the time for the maternal perception of 10 fetal movements was 18-29min, with a gradually increasing trend toward the end of pregnancy. The numbers of both pregnant women giving birth after 39weeks' gestation and infants with a birth weight exceeding 3000g were significantly higher in mothers who took ≥30min to count 10 fetal movements than in those who took <30min. CONCLUSION: The maternal perception time of fetal movements shows a gradually increasing trend within 30min for 10 fetal movements by the modified 'count to 10' method. Informing pregnant women of the normal range of the fetal movement count time will help improve the maternal recognition of decreased fetal movements, which might prevent fetal death in late pregnancy.


Assuntos
Monitorização Fetal/estatística & dados numéricos , Movimento Fetal , Complicações na Gravidez/etiologia , Terceiro Trimestre da Gravidez/fisiologia , Adulto , Peso ao Nascer , Feminino , Monitorização Fetal/métodos , Humanos , Recém-Nascido , Japão , Percepção , Gravidez , Complicações na Gravidez/fisiopatologia , Resultado da Gravidez/epidemiologia , Estudos Prospectivos , Fatores de Risco , Natimorto , Inquéritos e Questionários , Adulto Jovem
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