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Fetal Heart Tracing

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1. Vibroacoustic stimulation for fetal assessment in labour in the presence of a nonreassuring fetal heart rate trace. (PubMed)

Vibroacoustic stimulation for fetal assessment in labour in the presence of a nonreassuring fetal heart rate trace. Fetal vibroacoustic stimulation (VAS) is a simple, non-invasive technique where a device is placed on the maternal abdomen over the region of the fetal head and sound is emitted at a predetermined level for several seconds. It is hypothesised that the resultant startle reflex in the fetus and subsequent fetal heart rate (FHR) acceleration or transient tachycardia following VAS (...) provide reassurance of fetal well-being. This technique has been proposed as a tool to assess fetal well-being in the presence of a nonreassuring cardiotocographic (CTG) trace during the first and second stages of labour.To evaluate the clinical effectiveness and safety of VAS in the assessment of fetal well-being during labour, compared with mock or no stimulation for women with a singleton pregnancy exhibiting a nonreassuring FHR pattern.We searched the Cochrane Pregnancy and Childbirth Group's

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2013 Cochrane

2. Intermittent auscultation (IA) of fetal heart rate in labour for fetal well-being. (PubMed)

Intermittent auscultation (IA) of fetal heart rate in labour for fetal well-being. The goal of fetal monitoring in labour is the early detection of a hypoxic baby. There are a variety of tools and methods available for intermittent auscultation (IA) of the fetal heart rate (FHR). Low- and middle-income countries usually have only access to a Pinard/Laënnec or the use of a hand-held Doppler device. Currently, there is no robust evidence to guide clinical practice on the most effective IA tool (...) to use, timing intervals and length of listening to the fetal heart for women during established labour.To evaluate the effectiveness of different tools for IA of the fetal heart rate during labour including frequency and duration of auscultation.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (19 September 2016), contacted experts and searched reference lists of retrieved articles.All published and unpublished randomised controlled trials (RCTs) or cluster-RCTs comparing

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2017 Cochrane

3. Fetal Heart Monitor Tracing in a Pregnancy Complicated by a Ruptured Fetal Vessel on the Placenta: A Case Report. (PubMed)

Fetal Heart Monitor Tracing in a Pregnancy Complicated by a Ruptured Fetal Vessel on the Placenta: A Case Report. This report describes the fetal heart rate (FHR) tracing in a pregnancy complicated by antenatal spontaneous rupture of fetal vessels on the placental surface that resulted in a live birth.36-year-old woman, G2P1001, was being followed with weekly antenatal testing for gestational diabetes type A2 on insulin with possible intrauterine growth restriction. She presented for an office (...) visit at 37.5 weeks' gestation with a complaint of decreased fetal movement. The FHR pattern demonstrated minimal baseline variability with an occasional spontaneous deceleration not associated with a contraction, an absence of recurrent decelerations, and no accelerations. The antenatal evaluation is discussed, and portions of the FHR tracing and the placental findings at delivery are provided.The FHR pattern did not fit with what is usually depicted with uteroplacental insufficiency or umbilical

2017 Journal of Reproductive Medicine

4. The Effect of Combined Spinal-Epidural Versus Epidural Analgesia in Laboring Women on Nonreassuring Fetal Heart Rate Tracings: Systematic Review and Meta-analysis: Erratum.

The Effect of Combined Spinal-Epidural Versus Epidural Analgesia in Laboring Women on Nonreassuring Fetal Heart Rate Tracings: Systematic Review and Meta-analysis: Erratum. 29257775 2018 04 30 1526-7598 126 1 2018 01 Anesthesia and analgesia Anesth. Analg. The Effect of Combined Spinal-Epidural Versus Epidural Analgesia in Laboring Women on Nonreassuring Fetal Heart Rate Tracings: Systematic Review and Meta-analysis: Erratum. 372 10.1213/ANE.0000000000002702 eng Journal Article Published

2018 Anesthesia and Analgesia

5. Uterine, Fetal Cerebral Doppler and Oligohydramnios to Predict Abnormal Heart Rate Tracings in Postterm Pregnancies

Uterine, Fetal Cerebral Doppler and Oligohydramnios to Predict Abnormal Heart Rate Tracings in Postterm Pregnancies Uterine, Fetal Cerebral Doppler and Oligohydramnios to Predict Abnormal Heart Rate Tracings in Postterm Pregnancies - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number (...) of saved studies (100). Please remove one or more studies before adding more. Uterine, Fetal Cerebral Doppler and Oligohydramnios to Predict Abnormal Heart Rate Tracings in Postterm Pregnancies The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details

2018 Clinical Trials

6. Intrapartum Fetal Heart Rate Tracing Among Small-for-Gestational Age Compared With Appropriate-for-Gestational-Age Neonates. (PubMed)

Intrapartum Fetal Heart Rate Tracing Among Small-for-Gestational Age Compared With Appropriate-for-Gestational-Age Neonates. To compare fetal heart rate (FHR) patterns during the last hour of labor between small-for-gestational-age (SGA; birth weight less than the 10th percentile for gestational age) and appropriate-for-gestational-age (AGA; birth weight at the 10-90th percentile) neonates at 36 weeks of gestation or greater. We also compared the rate of cesarean delivery and composite neonatal (...) morbidity among SGA and AGA newborns.This is a secondary analysis of a randomized trial of intrapartum fetal electrocardiographic ST-segment analysis. We excluded women with chorioamnionitis, insufficient duration of FHR tracing in the hour before delivery, and anomalous newborns. Fetal heart rate patterns were categorized by computerized pattern recognition software (PeriCALM Patterns). Composite neonatal morbidity was defined as any of the following: intrapartum fetal death, Apgar score 3 or less at 5

2018 Obstetrics and Gynecology

7. Risk factors for nonreassuring fetal heart rate tracings after artificial rupture of membranes in spontaneous labor. (PubMed)

Risk factors for nonreassuring fetal heart rate tracings after artificial rupture of membranes in spontaneous labor. We aimed to characterize factors associated with nonreassuring fetal heart (FHR) tracings after artificial rupture of membranes (AROM), during the active phase of labor.Delivery charts of patients who presented in spontaneous labor, at term, between 2015 and 2016 were reviewed. We identified cases in which AROM was performed during the active stage of labor. We compared (...) deliveries with a normal FHR and those who developed nonreassuring FHR. Nonreassuring FHR was defined as fetal tracing that necessitated intrauterine resuscitation, which included: oxytocin withheld, amnioinfusion, or immediate instrumental or cesarean birth.Of 664 deliveries, nonreassuring FHR occurred in 141 (21.2%) and normal FHR in 523 (78.7%). Both groups were notable for similar maternal characteristics and a similar gestational age. Epidural block was significantly more common in the nonreassuring

2018 Birth

8. Standard External Doppler Fetal Heart Tracings versus External Fetal Electrocardiogram in Very Preterm Gestation: A Pilot Study (PubMed)

Standard External Doppler Fetal Heart Tracings versus External Fetal Electrocardiogram in Very Preterm Gestation: A Pilot Study Introduction Very preterm babies can be difficult to monitor using standard external Doppler fetal heart tracings (eFHR). External fetal electrocardiogram (fECG) is a potential alternative. Methods This was a prospective observational pilot study of hospitalized patients at 24 to 28 weeks' gestation. A total of 30 women were traced for up to 2 hours using eFHR followed (...) by up to 2 hours using fECG. The percentage of time the fetal heart rate was traced during the 2-hour window for each modality was calculated. Differences of ≥ 60, ≥ 80, and ≥ 90% total time traced were compared between modalities using McNemar's test. Differences were also assessed for each method between nonobese (body mass index [BMI] < 30 kg/m2) and obese (BMI ≥ 30 kg/m2) women using chi-square and Fisher's exact tests. Results Superior performance was found with eFHR at ≥ 60% (93.3 vs. 46.7%, p

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2016 AJP Reports

9. Oxygen for Intrauterine Resuscitation of Category II Fetal Heart Tracings

Oxygen for Intrauterine Resuscitation of Category II Fetal Heart Tracings Oxygen for Intrauterine Resuscitation of Category II Fetal Heart Tracings - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Oxygen (...) for Intrauterine Resuscitation of Category II Fetal Heart Tracings (O2C2) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT02741284 Recruitment Status : Active, not recruiting First Posted : April 18, 2016 Results First Posted : November 2, 2018 Last Update Posted : November 2, 2018 Sponsor: Washington

2016 Clinical Trials

10. Fetal Heart Tracing

Fetal Heart Tracing Fetal Heart Tracing Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Fetal Heart Tracing Fetal Heart Tracing Aka (...) : Fetal Heart Tracing , Fetal Heart Tones , Fetal Heart Rate , FHR , FHT , Continuous Electronic Fetal Monitoring , CEFM , Structured Intermittent Auscultation , SIA , Reassuring Fetal Heart Tracing , Non-reassuring Fetal Heart Tracing , Ominous Fetal Heart Tracing From Related Chapters II. Monitoring Options Continuous Electronic Fetal Monitoring (CEFM) Indicated in high risk pregnancy (see efficacy below) See Structured Intermittent Auscultation (SIA) Contraindications High risk maternal or fetal

2018 FP Notebook

11. The Effect of Combined Spinal-Epidural Versus Epidural Analgesia in Laboring Women on Nonreassuring Fetal Heart Rate Tracings: Systematic Review and Meta-analysis. (PubMed)

The Effect of Combined Spinal-Epidural Versus Epidural Analgesia in Laboring Women on Nonreassuring Fetal Heart Rate Tracings: Systematic Review and Meta-analysis. Combined spinal-epidural labor analgesia has gained popularity, but it is unclear whether this technique is associated with a higher incidence of nonreassuring fetal heart rate (FHR) tracings compared with epidural analgesia. Our meta-analysis aimed at comparing the incidence of nonreassuring FHR tracings between the 2 neuraxial (...) techniques.Databases were searched to identify randomized controlled trials that compared the incidence of nonreassuring FHR tracings, as defined in the individual studies, after combined spinal-epidural versus epidural analgesia in laboring women. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using the random-effects model. We performed a subgroup analysis for studies using low-dose epidural bupivacaine concentrations (≤0.125%) for epidural analgesia.Seventeen trials including 3947

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2016 Anesthesia and Analgesia

12. Computerised interpretation of fetal heart rate during labour does not improve outcomes

Computerised interpretation of fetal heart rate during labour does not improve outcomes Computerised interpretation of fetal heart rate during labour does not improve outcomes Discover Portal Discover Portal Computerised interpretation of fetal heart rate during labour does not improve outcomes Published on 27 June 2017 doi: Using a computerised decision-support system to interpret the outputs of continuous electronic fetal monitoring during labour does not show any advantages over clinicians (...) interpreting the outputs themselves. This is the first trial to assess decision support of this kind. In this large NIHR-funded trial, rates of poor neonatal outcomes, caesarean sections and assisted deliveries were not affected by whether clinicians were alerted to potential problems by the decision-support system or by their own interpretation of the data. Developmental outcomes at two years of age were not affected either. The system used in the trial only looked at fetal heart rate patterns, and didn’t

2019 NIHR Dissemination Centre

13. Computerised interpretation of fetal heart rate during labour does not improve outcomes

Computerised interpretation of fetal heart rate during labour does not improve outcomes Computerised interpretation of fetal heart rate during labour does not improve outcomes Discover Portal Discover Portal Computerised interpretation of fetal heart rate during labour does not improve outcomes Published on 27 June 2017 doi: Using a computerised decision-support system to interpret the outputs of continuous electronic fetal monitoring during labour does not show any advantages over clinicians (...) interpreting the outputs themselves. This is the first trial to assess decision support of this kind. In this large NIHR-funded trial, rates of poor neonatal outcomes, caesarean sections and assisted deliveries were not affected by whether clinicians were alerted to potential problems by the decision-support system or by their own interpretation of the data. Developmental outcomes at two years of age were not affected either. The system used in the trial only looked at fetal heart rate patterns, and didn’t

2018 NIHR Dissemination Centre

14. Flowchart: Intrapartum fetal surveillance , Mode of fetal heart rate monitoring

Flowchart: Intrapartum fetal surveillance , Mode of fetal heart rate monitoring Department of Health Queensland Clinical Guidelines State of Queensland (Queensland Health) 2015 http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en Queensland Clinical Guidelines, Guidelines@health.qld.gov.au Mode of fetal heart rate monitoring Abbreviations: APH Antepartum Haemorrhage; BMI Body Mass Index; CTG Cardiotocograph; FBS Fetal blood sample; FGR Fetal Growth Restriction; GDM Gestational Diabetes (...) ; IOL Induction of labour; MoM Multiples of Median; PaPP-A Pregnancy associated plasma protein-A; PROM Premature Rupture of Membranes; PTL Preterm labour; PV Per Vaginal; T Temperature; = greater than or equal to; < Less than; = Equal to; o C Degrees Celsius Intrapartum • IOL with Prostaglandin • Abnormal auscultation or CTG • Oxytocin induction/augmentation • Post PV Prostaglandins at onset of contractions • Regional analgesia/paracervical block (obtain baseline trace prior to insertion) • Abnormal

2015 Queensland Health

15. A Comprehensive Feature Analysis of the Fetal Heart Rate Signal for the Intelligent Assessment of Fetal State (PubMed)

A Comprehensive Feature Analysis of the Fetal Heart Rate Signal for the Intelligent Assessment of Fetal State Continuous monitoring of the fetal heart rate (FHR) signal has been widely used to allow obstetricians to obtain detailed physiological information about newborns. However, visual interpretation of FHR traces causes inter-observer and intra-observer variability. Therefore, this study proposed a novel computerized analysis software of the FHR signal (CAS-FHR), aimed at providing medical (...) decision support. First, to the best of our knowledge, the software extracted the most comprehensive features (47) from different domains, including morphological, time, and frequency and nonlinear domains. Then, for the intelligent assessment of fetal state, three representative machine learning algorithms (decision tree (DT), support vector machine (SVM), and adaptive boosting (AdaBoost)) were chosen to execute the classification stage. To improve the performance, feature selection/dimensionality

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2018 Journal of clinical medicine

16. The 5-tier system of assessing fetal heart rate tracings is superior to the 3-tier system in identifying fetal acidemia (PubMed)

The 5-tier system of assessing fetal heart rate tracings is superior to the 3-tier system in identifying fetal acidemia Electronic fetal heart rate monitoring was developed to identify fetuses at risk of acidemia for intervention before adverse outcomes. Our objective was to compare the 3-tier system with a 5-tier system in evaluation of fetal acidemia.Retrospective case-control study of patients with a fetal arterial pH <7 matched to the next birth that resulted in a pH >7.2. Tracings were (...) categorized into 3- and 5-tier systems by a single reviewer. Sensitivities and specificities were calculated for each.Twenty-four cases and 24 controls were identified. The sensitivity for an orange or red tracing was higher than for category III, with more of these in the pH <7 group compared with controls (P ≤ .001). There were significantly more green, blue, and yellow tracings in the normal pH group compared with the pH <7 group (P = .033, P = .008, P = .023), respectively.The 5-tier system had

2012 EvidenceUpdates

17. IMproving the practice of intrapartum electronic fetal heart rate MOnitoring with cardiotocography for safer childbirth (the IMMO programme): protocol for a qualitative study. (PubMed)

IMproving the practice of intrapartum electronic fetal heart rate MOnitoring with cardiotocography for safer childbirth (the IMMO programme): protocol for a qualitative study. Suboptimal electronic fetal heart rate monitoring (EFM) in labour using cardiotocography (CTG) has been identified as one of the most common causes of avoidable harm in maternity care. Training staff is a frequently proposed solution to reduce harm. However, current approaches to training are heterogeneous in content (...) and format, making it difficult to assess effectiveness. Technological solutions, such as digital decision support, have not yet demonstrated improved outcomes. Effective improvement strategies require in-depth understanding of the technical and social mechanisms underpinning the EFM process. The aim of this study is to advance current knowledge of the types of errors, hazards and failure modes in the process of classifying, interpreting and responding to CTG traces. This study is part of a broader

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2019 BMJ open

18. Intra- And Interobserver Agreement Among Obstetric Experts in Court Regarding the Review of Abnormal Fetal Heart-Rate Tracings and Obstetrical Management. (PubMed)

Intra- And Interobserver Agreement Among Obstetric Experts in Court Regarding the Review of Abnormal Fetal Heart-Rate Tracings and Obstetrical Management. The objective of the study was to evaluate the intra- and interobserver agreement among obstetric experts in court regarding the retrospective review of abnormal fetal heart rate tracings and obstetrical management of patients with abnormal fetal heart rate during labor.A total of 22 French obstetric experts in court reviewed 30 cases of term (...) deliveries of singleton pregnancies diagnosed with at least 1 hour of abnormal fetal heart rate, including 10 cases with adverse neonatal outcome. The experts reviewed all cases twice within a 3-month interval, with the first review being blinded to neonatal outcome. For each case reviewed, the experts were provided with the obstetric data and copies of the complete fetal heart rate recording and the partogram. The experts were asked to classify the abnormal fetal heart rate tracing and to express

2015 American Journal of Obstetrics and Gynecology

20. Interpreting Category II Fetal Heart Rate Tracings: Does Meconium Matter? (PubMed)

Interpreting Category II Fetal Heart Rate Tracings: Does Meconium Matter? Category II fetal heart rate (FHR) tracings are considered indeterminate; thus, improved risk stratification of category II FHR tracings is needed. We estimated whether the presence of meconium increased the risk of adverse neonatal outcomes.This study was conducted within a prospective cohort of 5000 women with singleton pregnancies who were admitted in labor at term. Pregnancies with category II FHR in the 60 minutes (...) for confounders.Of the 3257 women with category II FHR tracings, 693 women (21.3%) had meconium, and 2564 women (78.7%) did not. Meconium was associated with higher risk of the composite morbidity (adjusted odds ratio, 2.49; 95% confidence interval, 1.78-3.48) and increased risks of the secondary outcomes. The associations remained significant when infants with meconium aspiration syndrome were excluded. Thick meconium was associated significantly with the composite morbidity.The presence of meconium

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2014 American Journal of Obstetrics and Gynecology

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