Accuracy and reliability of fetal heart rate monitoring using maternal abdominal surface electrodes.

OBJECTIVE: Compare the accuracy and reliability of fetal heart rate identification from maternal abdominal fetal electrocardiogram signals (ECG) and Doppler ultrasound with a fetal scalp electrode. DESIGN: Prospective open method equivalence study. SETTING: Three urban teaching hospitals in the Northeast United States. SAMPLE: 75 women with normal pregnancies in labor at >37 weeks of gestation. METHODS: Three fetal heart rate detection methods were used simultaneously in 75 parturients. The fetal scalp electrode was the standard against which abdominal fetal ECG and ultrasound were judged. MAIN OUTCOME MEASURES: The positive percent agreement with the fetal scalp electrode indicated reliability. Bland-Altman analysis determined accuracy. The confusion rate indicated how frequently the devices tracked the maternal heart rate. RESULTS: Positive percent agreement was 81.7 and 73% for the abdominal fetal ECG and ultrasound, respectively (p = 0.002). The abdominal fetal ECG had a lower root mean square error than ultrasound (5.2 vs. 10.6 bpm, p < 0.001). The confusion rate for ultrasound was 20-fold higher than for abdominal ECG (8.9 vs. 0.4%, respectively, p < 0.001). CONCLUSION: Compared with the fetal scalp electrode, fetal heart rate detection using abdominal fetal ECG was more reliable and accurate than ultrasound, and abdominal fetal ECG was less likely than ultrasound to display the maternal heart rate in place of the fetal heart rate.

Commissioning of a new SeHCAT detector and comparison with an uncollimated gamma camera.

Measurements of SeHCAT (tauroselcholic [75selenium] acid) retention have been used to diagnose bile acid malabsorption for a number of years. In current UK practice the vast majority of centres calculate uptake using an uncollimated gamma camera. Because of ever-increasing demands on gamma camera time, a new 'probe' detector was designed, assembled and commissioned. To validate the system, nine patients were scanned at day 0 and day 7 with both the new probe detector and an uncollimated gamma camera. Commissioning results were largely in line with expectations. Spatial resolution (full-width 95% of maximum) at 1 m was 36.6 cm, the background count rate was 24.7 cps and sensitivity at 1 m was 720.8 cps/MBq. The patient comparison study showed a mean absolute difference in retention measurements of 0.8% between the probe and uncollimated gamma camera, and SD of ± 1.8%. The study demonstrated that it is possible to create a simple, reproducible SeHCAT measurement system using a commercially available scintillation detector. Retention results from the probe closely agreed with those from the uncollimated gamma camera.