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1.
Brain Behav ; 9(8): e01345, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31254448

RESUMO

INTRODUCTION: Some studies suggest that maternal touch of the abdomen produces an increase in the number of movements of the fetus. However, the influence of maternal touch of the abdomen on fetal cardiotocography patterns has not been studied. METHODS: This nonrandomized, before-after clinical trial that assessed fetal cardiotocography patterns during maternal touch of the abdomen in 28 low-risk pregnant women. RESULTS: Baseline fetal heart rate, accelerations, decelerations, and variability did not change with maternal touch of the abdomen, but fetal movements increased (p = 0.044). CONCLUSION: Fetal movements increases during maternal touch of the abdomen.


Assuntos
Cardiotocografia/métodos , Movimento Fetal/fisiologia , Frequência Cardíaca Fetal/fisiologia , Abdome , Adulto , Família , Feminino , Humanos , Gravidez , Tato/fisiologia , Percepção do Tato/fisiologia
2.
Acta Obstet Gynecol Scand ; 98(11): 1450-1454, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31148156

RESUMO

INTRODUCTION: The objective of this study was to examine the outcomes and interventions in pregnant women presenting with a perception of reduced fetal movements (RFM), and to determine if repeated episodes of RFM increase the risk of adverse outcomes. MATERIAL AND METHODS: This was a retrospective cohort study conducted in six NHS hospitals within the Thames Valley network region, UK and one neighboring hospital, an area with approximately 31 000 births annually. All women with a primary presentation of perceived RFM after 24 completed weeks of gestation during the month of October 2016 were included in the study. Prospective records in all units were examined and individual case-notes were reviewed. Pregnancy and neonatal outcomes and their relation with recurrent presentations with RFM were examined using relative risks with 95% CI. The main outcome measures are described. Neonatal outcomes measured were perinatal mortality, neonatal unit admission, abnormal cardiotocography at presentation, a composite severe morbidity outcome of Apgar <7 at 5 minutes or arterial pH <7.0 or encephalopathy, and birthweight. Pregnancy outcomes measured were induction of labor, cesarean section, admission and ultrasound usage rates. RESULTS: In all, 591 women presented with RFM during the month; using annual hospital birth figures, the incidence of RFM was estimated at 22.6% (range 14.9%-32.5%). More than 1 presentation of RFM occurred in 273 (46.2%). All 3 deaths (0.5%) were at the first presentation. More than 1 presentation was associated with higher induction rates (56.0% vs 31.9%), but no increase in any adverse outcomes including small-for-gestational-age. CONCLUSIONS: Reduced fetal movements, and recurrent episodes, are common, and lead to considerable resource usage and obstetric intervention. We found no evidence to suggest that recurrent episodes increase pregnancy risk.


Assuntos
Retardo do Crescimento Fetal/diagnóstico por imagem , Movimento Fetal/fisiologia , Recém-Nascido Pequeno para a Idade Gestacional , Resultado da Gravidez , Natimorto , Ultrassonografia Pré-Natal , Adulto , Cardiotocografia/métodos , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Gravidez , Estudos Retrospectivos , Medição de Risco , Reino Unido
3.
PLoS One ; 14(6): e0217583, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31188847

RESUMO

BACKGROUND AND OBJECTIVES: Encouraging awareness of fetal movements is a common strategy used to prevent stillbirths. Information provided to pregnant women about fetal movements is inconsistent perhaps due to limited knowledge about normal fetal movement patterns in healthy pregnancies. We aimed to describe maternally perceived fetal movement strength, frequency, and pattern in late pregnancy in women with subsequent normal outcomes. METHODS: Participants were ≥28 weeks' gestation, with a non-anomalous, singleton pregnancy who had been randomly selected from hospital booking lists and had consented to participate. Fetal movement data was gathered during pregnancy via a questionnaire administered face-to-face by research midwives. Participants remained eligible for the study if they subsequently gave birth to a live, appropriate-for-gestational-age baby at ≥37 weeks. RESULTS: Participants were 274 women, with normal pregnancy outcomes. The majority (59.3%, n = 162) of women reported during antenatal interview that the strength of fetal movements had increased in the preceding two weeks. Strong fetal movements were felt by most women in the evening (72.8%, n = 195) and at night-time including bedtime (74.5%, n = 199). The perception of fetal hiccups was also reported by most women (78.8%). Women were more likely to perceive moderate or strong fetal movements when sitting quietly compared with other activities such as having a cold drink or eating. CONCLUSIONS: Our data support informing women in the third trimester that as pregnancy advances it is normal to perceive increasingly strong movement, episodes of movements that are more vigorous than usual, fetal hiccups, and a diurnal pattern involving strong fetal movement in the evening. This information may help pregnant women to better characterise normal fetal movement and appropriately seek review when concerned about fetal movements. Care providers should be responsive to concerns about decreased fetal movements in the evening, as this is unusual.


Assuntos
Ritmo Circadiano/fisiologia , Movimento Fetal/fisiologia , Feto/fisiologia , Reconhecimento Fisiológico de Modelo , Adulto , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Modelos Logísticos , Gravidez , Terceiro Trimestre da Gravidez , Inquéritos e Questionários
4.
PLoS One ; 14(5): e0216216, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31048896

RESUMO

INTRODUCTION: Women's awareness of fetal movements is important as perception of decreased fetal movements can be a sign of a compromised fetus. We aimed to study rate of labor induction in relation to number of times women seek care due to decreased or altered fetal movements during their pregnancy compared to women not seeking such care. Further, we investigated the indication of induction. MATERIAL AND METHODS: A prospective population-based cohort study including all obstetric clinics in Stockholm, Sweden. Questionnaires were distributed to women who sought care due to decreased or altered fetal movements ≥ 28 week's gestation in 2014, women for whom an examination did not indicate a compromised fetus that required induction of labor or cesarean section when they sought care. Women who gave birth at ≥ 28 weeks' gestation in 2014 in Stockholm comprises the reference group. RESULTS: Labor was induced more often among the 2683 women who had sought care due to decreased or altered fetal movements (RR 1.4, 95% CI 1.3-1.5). In women who presented with decreased or altered fetal movements induction of labor occurred more frequently for fetal indication than those with induction of labor and no prior fetal movement presentation (RR 1.6, 95% CI 1.4-1.8). The rate of induction increased with number of times a woman sought care, RR 1.3 for single presentation to 3.2 for five or more. CONCLUSIONS: We studied women seeking care for decreased or altered fetal movements and for whom pregnancy was not terminated with induction or caesarean section. Subsequent (median 20 days), induction of labor and induction for fetal indications were more frequent in this group compared to the group of women with no fetal movement presentations. Among women seeking care for altered or decreased fetal movements, the likelihood of induction of labor increased with frequency of presentation.


Assuntos
Movimento Fetal/fisiologia , Trabalho de Parto Induzido/tendências , Adulto , Cesárea , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Trabalho de Parto Induzido/métodos , Trabalho de Parto/fisiologia , Gravidez , Complicações na Gravidez/epidemiologia , Cuidado Pré-Natal , Estudos Prospectivos , Inquéritos e Questionários , Suécia
5.
Dev Psychobiol ; 61(4): 626-633, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30942503

RESUMO

This study examined the developmental trajectories of general and breathing movements in fetal twins. Fetal movement patterns were assessed from real-time ultrasound recordings performed at 12-15, 20-23, and 28-32 weeks of gestation in 42 twin pairs. Results indicated that both general movements and breathing movements followed a curvilinear, inverted U-shaped curve. Developmental trajectories were unrelated within pairs of twins and were not associated with gestational age at birth and birth weight. However, sex differences were found for general movements with males displaying more time making general movements at 21 weeks and a steeper decline in time spent making general movements during the second half of pregnancy than females. These age-related changes in fetal movements may reflect CNS development. These findings also suggest that twins' behavioral development is largely independent of co-twin development, gestational age at birth, and birth weight, but not of fetal sex.


Assuntos
Desenvolvimento Fetal/fisiologia , Movimento Fetal/fisiologia , Gravidez de Gêmeos , Mecânica Respiratória/fisiologia , Feminino , Idade Gestacional , Humanos , Masculino , Gravidez , Respiração , Gêmeos , Ultrassonografia Pré-Natal
6.
J Matern Fetal Neonatal Med ; 32(21): 3627-3632, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29685073

RESUMO

Objective: To identify the level of amniotic fluid lactate (AFL), placental growth factor (PLGF), and vascular endothelial growth factor (VEGF) at second trimester amniocentesis, and to compare levels in normal pregnancies with pregnancies ending in a miscarriage, an intrauterine growth restricted fetus (IUGR) or decreased fetal movements. Study design: A prospective cohort study. Amniotic fluid was consecutively collected at amniocentesis in 106 pregnancies. Fetal wellbeing at delivery was evaluated from medical files and compared with the levels of AFL, VEGF, and PLGF at the time of amniocentesis. Results: The median level of AFL was 6.9 mmol/l, VEGF 0.088 pg/ml, and PLGF 0.208 pg/ml. The median levels of AFL in pregnancies ended in miscarriage were significantly higher (10.7 mmol/l) compared to those with a live new-born (6.9 mmol/L, p = .02). The levels of VEGF (p = .2) and PLGF (p = .7) were not affected. In pregnancies with an IUGR, the median level of AFL was higher compared to those with normal fetal growth (p = .003). No differences VEGF (p = .5), but significant lower PLGF were found in IUGR pregnancies (p = .03). Conclusions: Pregnancies ending in a miscarriage or with IUGR had significantly higher median values of AFL but lower values of PLGF in the amniotic fluid at the time of second trimester amniocentesis compared to normal pregnancies.


Assuntos
Líquido Amniótico/metabolismo , Biomarcadores/metabolismo , Feto/fisiologia , Resultado da Gravidez , Segundo Trimestre da Gravidez/metabolismo , Aborto Espontâneo/diagnóstico , Aborto Espontâneo/metabolismo , Adulto , Amniocentese , Líquido Amniótico/química , Biomarcadores/análise , Estudos de Casos e Controles , Feminino , Sofrimento Fetal/diagnóstico , Sofrimento Fetal/metabolismo , Sofrimento Fetal/fisiopatologia , Retardo do Crescimento Fetal/diagnóstico , Retardo do Crescimento Fetal/metabolismo , Movimento Fetal/fisiologia , Viabilidade Fetal , Humanos , Recém-Nascido , Ácido Láctico/análise , Ácido Láctico/metabolismo , Fator de Crescimento Placentário/análise , Fator de Crescimento Placentário/metabolismo , Gravidez , Fator A de Crescimento do Endotélio Vascular/análise , Fator A de Crescimento do Endotélio Vascular/metabolismo
7.
Sociol Health Illn ; 41(1): 95-111, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30171609

RESUMO

A large body of literature engages with personal accounts of pregnancy to illustrate the subjugation of women's embodied experience by practices of biomedicine. This article explores this issue through women's accounts of sensing initial foetal movement, drawn from qualitative interviews with 15 women resident in the UK. Participants depict this aspect of pregnant embodiment as ambiguous and indefinite, in contrast to clinical and popular representations of foetal movement. In highlighting the uncertainties characteristic of this corporeal event, the article adds to literature destabilising understandings of pregnant women's and foetal bodies as bounded and distinct. Ambiguous experiences of foetal movement arise in the context of sociocultural framings of pregnancy as 'at risk', and in turn, may be seen to contribute to these representations, with some participants articulating that uncertain sensations could provoke anxiety. In this article, perceptions of foetal movement are emphasised as valuable to women, and as inextricable from the social settings in which they emerge. This research has implications for sociological and feminist discussions of pregnancy, and work exploring the mutual shaping of corporeality and sociocultural contexts more widely.


Assuntos
Movimento Fetal/fisiologia , Percepção , Saúde da Mulher , Adulto , Feminino , Humanos , Gravidez , Pesquisa Qualitativa , Sociologia Médica , Incerteza , Reino Unido
8.
Women Birth ; 32(2): 131-136, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30007853

RESUMO

BACKGROUND: Perinatal audits in the Netherlands showed that stillbirth was nearly always preceded by a period of reduced fetal movements. Patient or caregiver delay was identified as a substandard care factor. AIM: To determine whether the use of a new information brochure for pregnant women on fetal movements results in less patient delay in contacting their maternity caregiver. METHODS: A pre- and post-survey cohort study in the Netherlands, including 140 women in maternity care with a singleton pregnancy, expecting their first child. All participating women filled out a baseline questionnaire, Cambridge Worry Scale and pre-test questionnaire at the gestational age of 22-24 weeks. Subsequently, the intervention group received a newly developed information brochure on fetal movements. At a gestational age of 28 weeks, all women received the post-test questionnaire. Multiple regression analyses were used. FINDINGS: Per-protocol analysis showed less patient delay in the intervention group compared to the control group (Odds Ratio 0.43; 95% Confidence Interval 0.17-0.86, p=0.02). A significant linear relation was observed between reading the information brochure and an increase of knowledge about fetal movements (B=1.2, 95% Confidence Interval 1.0-1.4, p<0.001). Maternal concerns did not affect patient delay to report reduced fetal movements. CONCLUSION: Use of an information brochure regarding fetal movements has the potential to reduce patient delay and increase knowledge about reduced fetal movements. A national survey to determine the effect of an information brochure about reduced fetal movements on patient delay and stillbirth rates is needed.


Assuntos
Movimento Fetal/fisiologia , Folhetos , Natimorto , Adulto , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Países Baixos , Razão de Chances , Gravidez , Gestantes , Inquéritos e Questionários , Adulto Jovem
9.
Conf Proc IEEE Eng Med Biol Soc ; 2018: 1-4, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30440290

RESUMO

Recent studies have shown that occasional short term coupling between fetal and maternal cardiac systems occurs. Fetal magnetocardiography (fMCG) is a non-invasive technique that records the magnetic fields associated with the electrical activity of the fetal heart through sensors placed over the maternal abdomen. The fMCG allows accurate estimation of fetal heart rates (fHR) due to its high signal-to-noise ratio (SNR) and temporal resolution. In this study, we analyzed couplingbetween fHR and maternal heart rates (mHR) using Transfer Entropy (TE). TE determines coupling between two variables by quantifying the information transferred between them in both directions. In this work, we used 74 fMCG recordings to compute TE in both directions over 1-minute disjoint time windows (TW). We examined the effect of fetal movement (FM) as a factor of influence on the TE analysis. We identified 21 subjects with FM during the recording and separated them into two gestational age (GA) groups (GA1<32 and GA2≥32 weeks). Next, TE values were compared between TWs containing non- FM with TWs containing FM using Wilcoxon Signed-Rank test. In addition, we compared TE calculations for non-FM segments obtained from the 74 subjects using Rank-Sum test in the two GA groups. Our results showed that TE values from TWs containing FM are not significantly different than those computed for TWs of non-FM. In both directions, we found that TE values obtained from the 74 subjects did not show any significant difference between GA1 and GA2 which is consistent with previous studies. Our study suggests that FM does not affect the TE computations.


Assuntos
Entropia , Frequência Cardíaca/fisiologia , Magnetocardiografia/métodos , Feminino , Coração Fetal , Movimento Fetal/fisiologia , Idade Gestacional , Frequência Cardíaca Fetal/fisiologia , Humanos , Mães , Gravidez
10.
PLoS One ; 13(11): e0206533, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30395584

RESUMO

OBJECTIVE: To assess the value of in utero placental assessment in predicting adverse pregnancy outcome after reported reduced fetal movements (RFM). METHOD: A non-interventional prospective cohort study of women (N = 300) with subjective RFM at ≥28 weeks' gestation in singleton non-anomalous pregnancies at a UK tertiary maternity hospital. Clinical, sonographic (fetal weight, placental size and maternal, fetal and placental arterial Doppler) and biochemical (maternal serum hCG, hPL, progesterone, PlGF and sFlt-1) assessment was conducted. Multiple logistic regression identified combinations of measurements (models) most predictive of adverse pregnancy outcome (perinatal mortality, birth weight <10th centile, five minute Apgar score <7, umbilical arterial pH <7.1 or base excess <-10, neonatal intensive care admission). Models were compared by test performance characteristics (ROC curve, sensitivity, specificity, positive/negative predictive value, positive/negative likelihood ratios) against baseline care (estimated fetal weight centile, amniotic fluid index and gestation at presentation). RESULTS: 61 (20.6%) pregnancies ended in adverse outcome. Models incorporating PlGF/sFlt-1 ratio and umbilical artery free loop Doppler impedance demonstrated modest improvement in ROC area for adverse outcome (baseline care 0.69 vs. proposed models 0.73-0.76, p<0.05). However, there was little improvement in other test characteristics (baseline vs. best proposed model: sensitivity 21.7% [95% confidence interval 13.1-33.6] vs. 35.8%% [24.4-49.3], specificity 96.6% [93.4-98.3] vs. 94.7% [90.7-97.0], PPV 61.9% [40.9-79.3] vs. 63.3% [45.5-78.1], NPV 82.8% [77.9-86.8] vs. 85.2% [80.0-89.2], positive LR 6.3 [2.8-14.6] vs. 6.7 [3.4-3.3], negative LR 0.81 [0.71-0.93] vs. 0.68 [0.55-0.83]) and wide confidence intervals. Negative post-test probability remained high (16.7% vs. 14.0%). CONCLUSION: Antenatal placental assessment may improve identification of RFM pregnancies at highest risk of adverse pregnancy outcome but further work is required to understand and refine currently available outcome definitions and diagnostic techniques to improve clinical utility.


Assuntos
Movimento Fetal/fisiologia , Placenta/diagnóstico por imagem , Resultado da Gravidez , Adulto , Índice de Apgar , Estudos de Coortes , Cordocentese , Feminino , Humanos , Concentração de Íons de Hidrogênio , Recém-Nascido de Baixo Peso , Recém-Nascido , Terapia Intensiva Neonatal , Modelos Logísticos , Estudos Longitudinais , Modelos Biológicos , Morte Perinatal , Placenta/irrigação sanguínea , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Natimorto , Ultrassonografia Pré-Natal
11.
Med Ultrason ; 1(1): 88-94, 2018 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-29400374

RESUMO

The introduction of four-dimensional (4D) ultrasonography (US) allows the study of fetal movements and facial expressions in real time. The possibility of evaluating fetal movements has led to the study of fetal neurobehaviour, which has been for a long period of time a mystery for physicians. The study of fetal activity in utero could differentiate between normal and abnormal behavioural patterns, thus making possible the early recognition of fetal brain impairment. Facial expressions observed with 4D US represent a marker for neurobehaviour and at the same time could enhance fetal-maternal bonding. The present review represents an update of the literature on fetal movements, facial expressions, and their relationship with fetal neurobehaviour.


Assuntos
Encéfalo/embriologia , Encéfalo/fisiologia , Expressão Facial , Movimento Fetal/fisiologia , Imageamento Tridimensional/métodos , Ultrassonografia Pré-Natal/métodos , Feminino , Desenvolvimento Fetal/fisiologia , Humanos , Gravidez
12.
Dev Psychobiol ; 60(3): 265-277, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29442370

RESUMO

Previous research has revealed that fetuses detect and respond to extrauterine stimuli such as maternal movement and speech, but little attention has been cast on how fetuses may directly influence and respond to each other in the womb. This study investigated whether motor activity of E20 rat fetuses influenced the behavior of siblings in utero. Three experiments showed that; (a) contiguous siblings expressed a higher frequency of synchronized movement than noncontiguous siblings; (b) fetuses that lay between two siblings immobilized with curare showed less movement relative to fetuses between saline or uninjected controls; and (c) fetuses between two siblings behaviorally activated by the opioid agonist U50,488 also showed less activity and specific behavioral changes compared to controls. Our findings suggest that rat fetuses are directly impacted by sibling motor activity, and thus that a rudimentary form of communication between siblings may influence the development of fetuses in utero.


Assuntos
Comunicação Animal , Movimento Fetal/fisiologia , Relações entre Irmãos , Irmãos , (trans)-Isômero de 3,4-dicloro-N-metil-N-(2-(1-pirrolidinil)-ciclo-hexil)-benzenoacetamida/farmacologia , Analgésicos não Entorpecentes/farmacologia , Animais , Feminino , Gravidez , Ratos , Ratos Sprague-Dawley
14.
Women Birth ; 31(5): e287-e293, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29287635

RESUMO

PROBLEM: Decreased fetal movements is a common reason for unscheduled antenatal assessment and is associated with adverse pregnancy outcome. BACKGROUND: Fetal movement counting has not been proven to reduce stillbirths in high-quality studies. AIMS: The aim was to explore a qualitative account of fetal movements in the third trimester as perceived by pregnant women themselves. METHODS: Using qualitative descriptive methodology, interviews were conducted with 19 women experiencing an uncomplicated first pregnancy, at two timepoints in their third trimester. Interview transcripts were later analysed using qualitative content analysis. FINDINGS: Pregnant women described a sustained increase in strength, frequency and variation in types of fetal movements from quickening until 28-32 weeks. Patterns of fetal movement were consistently described as involving increased movement later in the day and as having an inverse relationship to the women's own activity and rest. At term, the most notable feature was increased strength. Kicking and jolting movements decreased whilst pushing and rolling movements increased. DISCUSSION: Maternal descriptions of fetal activity in this study were consistent with other qualitative studies and with ultrasound studies of fetal development. CONCLUSION: Pregnant women observe a complex range of fetal movement patterns, actions and responses that are likely to be consistent with normal development. Maternal perception of a qualitative change in fetal movements may be clinically important and should take precedence over any numeric definition of decreased fetal movement. Midwives may inform women that it is normal to perceive more fetal movement in the evening and increasingly strong movements as pregnancy advances.


Assuntos
Monitorização Fetal , Movimento Fetal , Percepção , Gravidez/fisiologia , Gestantes/psicologia , Natimorto , Adulto , Feminino , Monitorização Fetal/métodos , Movimento Fetal/fisiologia , Humanos , Entrevistas como Assunto , Resultado da Gravidez , Terceiro Trimestre da Gravidez , Cuidado Pré-Natal/métodos , Pesquisa Qualitativa
15.
Acta Obstet Gynecol Scand ; 97(1): 13-24, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29068467

RESUMO

INTRODUCTION: Presentation with decreased fetal movement (DFM) is associated with fetal growth restriction and stillbirth. Some studies report that DFM is frequent among overweight or obese mothers. We aimed to determine the significance and associations of fetal movements in women of increased body size. MATERIAL AND METHODS: This systematic review was conducted in accordance with the PRISMA statement and the protocol was registered with PROSPERO (CRD42016046352). Major databases were explored from inception to September 2017, using a predefined search strategy. We restricted inclusion to studies published in English and considered studies of any design that compared fetal movements in women of increased and normal body size. Two authors independently extracted data and assessed quality. RESULTS: We included 23 publications from 19 observational studies; data were extracted from 10 studies. Increased maternal body size was not associated with altered perception of fetal movement (four studies, 95 women, very low-quality evidence), but was associated with increased presentation for DFM (two cohort studies, 20 588 women, OR 1.56, 95% CI 1.27-1.92: three case-control studies, 3445 women, OR 1.32, 95% CI 1.12-1.54; low-quality evidence). Among women with DFM, increased maternal body size was associated with increased risk of stillbirth and fetal growth restriction (one study, 2168 women, very low-quality evidence). CONCLUSIONS: This systematic review identified limited evidence that women with increased body size are more likely to present with DFM but do not have impaired perception of fetal movements. In women with DFM, increased body size is associated with worse pregnancy outcome, including stillbirth.


Assuntos
Movimento Fetal/fisiologia , Obesidade , Sobrepeso , Complicações na Gravidez , Tamanho Corporal , Feminino , Humanos , Obesidade/diagnóstico , Obesidade/fisiopatologia , Sobrepeso/diagnóstico , Sobrepeso/fisiopatologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/fisiopatologia , Estatística como Assunto
16.
IEEE J Biomed Health Inform ; 22(3): 758-765, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-28391212

RESUMO

Due to its high spatial and temporal resolution, fetal magnetocardiography (fMCG) measurements have been used for fetal movement (FM) detection in several studies, which considered the changes in the amplitude and/or morphology of measured fMCG signals. Using source localization for fMCG measurements, we propose a novel method to fit a magnetic dipole moment to fetal heart signals and investigate the positional changes of magnetic dipole in order to detect FMs. We first split each fMCG recording into 6-s time windows. Then, the magnetic dipole location and orientation for each time window are estimated using our inverse solution model. Finally, the distance between magnetic dipole positions in adjacent time windows is computed. Also, we calculate the dot products of the normalized magnetic dipoles to monitor the orientational changes. We analyzed 28 fMCG measurements from 23 subjects to investigate accuracy of the dipole fitting results. For each dipole fit, our model described the measured data with a goodness-of-fit value over 97% and with a fitting error of less than 2%. We observed that magnetic dipole positions significantly moved for some time windows. The time points at which the significant movement was observed were correlated with the heart rate acceleration as well. In addition to identifying the time points of the movement, our method is capable of observing rotational movement checking orientation of the dipoles.


Assuntos
Movimento Fetal/fisiologia , Magnetocardiografia/métodos , Processamento de Sinais Assistido por Computador , Algoritmos , Desenho de Equipamento , Feminino , Feto/fisiologia , Humanos , Gravidez
17.
Dev Psychobiol ; 59(7): 822-831, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28888054

RESUMO

Testosterone exposure during pregnancy has been hypothesized as a mechanism for sex differences in brain and behavioral development observed in the postnatal period. The current study documents the natural history of maternal salivary testosterone from 18 weeks gestation of pregnancy to 6 months postpartum, and investigates associations with fetal heart rate, motor activity, and their integration. Findings indicate maternal salivary testosterone increases with advancing gestation though no differences by fetal sex were detected. High intra-individual stability in prenatal testosterone levels extend into the postnatal period, particularly for pregnancies with male fetuses. With respect to fetal development, by 36 weeks gestation higher maternal prenatal salivary testosterone was significantly associated with faster fetal heart rate and less optimal somatic-cardiac integration. Measurement of testosterone in saliva is a useful tool for repeated-measures studies of hormonal concomitants of pregnancy. Moreover, higher maternal testosterone levels are associated with modest interference to fetal neurobehavioral development.


Assuntos
Movimento Fetal/fisiologia , Frequência Cardíaca Fetal/fisiologia , Gravidez/metabolismo , Testosterona/metabolismo , Adulto , Feminino , Humanos , Estudos Longitudinais , Saliva/química
18.
BMJ Open ; 7(8): e014813, 2017 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-28801392

RESUMO

BACKGROUND: In 2013, the stillbirth rate in the UK was 4.2 per 1000 live births, ranking 24th out of 49 high-income countries, with an annual rate of reduction of only 1.4% per year. The majority of stillbirths occur in normally formed infants, with (retrospective) evidence of placental insufficiency the most common clinical finding. Maternal perception of reduced fetal movements (RFM) is associated with placental insufficiency and increased risk of subsequent stillbirth.This study will test the hypothesis that the introduction of a package of care to increase women's awareness of the need for prompt reporting of RFM and standardised management to identify fetal compromise with timely delivery in confirmed cases, will reduce the rate of stillbirth. Following the introduction of a similar intervention in Norway the odds of stillbirth fell by 30%, but the efficacy of this intervention (and possible adverse effects and implications for service delivery) has not been tested in a randomised trial. METHODS: We describe a stepped-wedge cluster trial design, in which participating hospitals in the UK and Ireland will be randomised to the timing of introduction of the care package. Outcomes (including the primary outcome of stillbirth) will be derived from detailed routinely collected maternity data, allowing us to robustly test our hypothesis. The degree of implementation of the intervention will be assessed in each site. A nested qualitative study will examine the acceptability of the intervention to women and healthcare providers and identify process issues including barriers to implementation. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Scotland A Research Ethics Committee (Ref 13/SS/0001) and from Research and Development offices in participating maternity units. The study started in February 2014 and delivery of the intervention completed in December 2016. Results of the study will be submitted for publication in peer-reviewed journals and disseminated to local investigating sites to inform education and care of women presenting with RFM. TRIAL REGISTRATION NUMBER: www.clinicaltrials.gov NCT01777022. VERSION: Protocol Version 4.2, 3 February 2017.


Assuntos
Sofrimento Fetal/diagnóstico , Monitorização Fetal/métodos , Movimento Fetal/fisiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Gestantes , Cuidado Pré-Natal/métodos , Conscientização , Medicina Baseada em Evidências , Feminino , Idade Gestacional , Promoção da Saúde , Humanos , Recém-Nascido , Irlanda , Masculino , Análise Multinível , Gravidez , Natimorto , Reino Unido
19.
Women Birth ; 30(6): 468-471, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28506686

RESUMO

BACKGROUND: Fetal movement is the most common method to evaluate fetal well-being. Furthermore, maternal perception of decreased fetal movements is associated with perinatal demise. Previously, we showed that perception of decreased fetal movements was the most common reason for mothers visiting the outpatient department among those who had stillbirths in our region. Further investigation of stillbirths with decreased fetal movements is essential to find a possible way of preventing stillbirth. AIM: To investigate maternal reaction time after their perceiving decreased fetal movements among stillbirths in our region of Japan. METHODS: This is a population-based study of stillbirths in Shiga Prefecture, Japan conducted from 2007 to 2011. We sent a questionnaire to each obstetrician who had submitted the stillbirth certificate. We reviewed and evaluated the questionnaires returned from the obstetricians. FINDINGS: There were 66 cases (35%) with decreased fetal movements among 188 stillbirths in Shiga during the study period. The number of maternal visits to outpatient department after perception of decreased fetal movements within 24h was only seven (11%) among 64 stillbirths diagnosed at outpatient department. CONCLUSION: We conclude that delayed maternal visit after perceiving decreased fetal movements is frequently observed in stillbirths. Promoting more thorough maternal education on fetal movements, including emphasizing earlier visitation after perceiving decreased fetal movements, may prevent stillbirths.


Assuntos
Movimento Fetal/fisiologia , Percepção , Gravidez/fisiologia , Gestantes/psicologia , Natimorto , Adulto , Feminino , Idade Gestacional , Humanos , Japão , Cuidado Pré-Natal , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
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