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Fetal Heart Tracing

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21. An evaluation of fetal heart rate characteristics associated with neonatal encephalopathy: A case-control study. Full Text available with Trip Pro

An evaluation of fetal heart rate characteristics associated with neonatal encephalopathy: A case-control study. We sought to identify fetal heart rate (FHR) characteristics that are associated with neonatal encephalopathy (NE).Retrospective case-control study.A single medical centre in Shanghai, China, 2006-2015.Women delivering a singleton, non-anomalous infant at ≥36 weeks' gestation diagnosed with NE (cases, n = 109) were compared with a group of women with unaffected infants (controls, n (...) = 233).Two physicians blinded to the outcome independently reviewed FHR tracings during the last 30 minutes of tracing prior to delivery. FHR characteristics were compared in the two groups and multivariable logistic regression was used to adjust for confounding.Adjusted odds ratio (aOR) and 95% confidence interval (CI) for the presence of specific FHR categories and characteristics.Category II FHR tracings were observed in 89% of women prior to delivery and were not independently associated with NE

2018 BJOG

22. Automated analysis of fetal cardiac function using color tissue Doppler imaging in the second half of normal pregnancy. Full Text available with Trip Pro

an automated method to analyze cTDI recordings from a cardiac four-chamber view.This was a cross-sectional study including 201 normal singleton pregnancies between 18 and 42 weeks of gestation. During fetal echocardiography, a four-chamber view of the heart was visualized and cTDI was performed. Regions of interest were positioned at the level of the atrioventricular plane in the left ventricular (LV), right ventricular (RV) and septal walls of the fetal heart, to obtain myocardial velocity traces (...) Automated analysis of fetal cardiac function using color tissue Doppler imaging in the second half of normal pregnancy. Color tissue Doppler imaging (cTDI) is a promising tool for the assessment of fetal cardiac function. However, the analysis of myocardial velocity traces is cumbersome and time-consuming, limiting its application in clinical practice. The aim of this study was to evaluate fetal cardiac function during the second half of pregnancy and to develop reference ranges using

2018 Ultrasound in Obstetrics and Gynecology

23. The electrical heart axis and ST events in fetal monitoring: A post-hoc analysis following a multicentre randomised controlled trial. Full Text available with Trip Pro

analysis, and congenital heart disease were excluded. The orientation of the fetal electrical heart axis affects the height of the initial T/QRS baseline, and therefore the incidence of ST events. We grouped tracings with the same initial baseline T/QRS value. We depicted the number of ST events as a function of the initial baseline T/QRS value with a linear regression model.A significant increment of ST events was observed with increasing height of the initial T/QRS baseline, irrespective of the fetal (...) The electrical heart axis and ST events in fetal monitoring: A post-hoc analysis following a multicentre randomised controlled trial. Reducing perinatal morbidity and mortality is one of the major challenges in modern health care. Analysing the ST segment of the fetal electrocardiogram was thought to be the breakthrough in fetal monitoring during labour. However, its implementation in clinical practice yields many false alarms and ST monitoring is highly dependent on cardiotocogram assessment

2017 PLoS ONE Controlled trial quality: uncertain

24. Diagnosis and Treatment of Fetal Cardiac Disease Full Text available with Trip Pro

the goal has become to understand the fetus as a patient, knowing that the fetal circulation is different from the postnatal circulation, that structural disease may progress in utero, and that cardiac function and stability of the cardiovascular system play an important role in fetal wellness. Given the expanded roles of the pediatric cardiologist specializing in fetal medicine and the maternal fetal specialist as collaborative caregivers for fetuses with structural heart disease, arrhythmias (...) of fetus (maternal, paternal or sibling with CHD) First or second degree relative with disorder with Mendelian inheritance with CHD association Fetal cardiac abnormality suspected on obstetrical ultrasound Fetal extracardiac abnormality suspected on obstetrical ultrasound Fetal karyotype abnormality Fetal tachycardia or bradycardia, or frequent or persistent irregular heart rhythm Fetal increased NT >95% (≥3 mm) Monochorionic twinning Fetal hydrops or effusions Indications with lower risk profile

2014 American Heart Association

25. Fetal Health Surveillance: Intrapartum Consensus Guideline

) (III-B). Recommendation 4: Admission Fetal Heart Test 1. Admission fetal heart tracings are not recommended for healthy women at term in labour in the absence of risk factors for adverse perinatal outcome, as there is no evident benefit (I-A). 2. Admission fetal heart tracings are recommended for women with risk factors for adverse perinatal outcome (III-B). Recommendation 5: Intrapartum Fetal Surveillance for Women With Risk Factors for Adverse Perinatal Outcome 1. Electronic fetal monitoring (...) ). Recommendation 6: Digital Fetal Scalp Stimulation 1. Digital fetal scalp stimulation is recommended in response to atypical electronic fetal heart tracings (II-B). 2. In the absence of a positive acceleratory response with digital fetal scalp stimulation, • Fetal scalp blood sampling is recommended when available (II-B). • If fetal scalp blood sampling is not available, consideration should be given to prompt delivery, depending upon the overall clinical situation (III-C). Recommendation 7: Fetal Scalp Blood

2018 Society of Obstetricians and Gynaecologists of Canada

26. Detection and management of women with Fetal Growth Restriction in singleton pregnancies

to women (e.g. smoking cessation). 1 ? For low risk women, measure symphyseal fundal height (SFH) using a standardised technique. Plotting serial SFH measures on a growth chart may help to identify FGR. 2 ? Where the SFH measures 30 centiles 23 ) of EFW or AC Amniotic fluid volume (AFV) Measured by the single deepest vertical pocket (DVP) of amniotic fluid DVP 95th centile, absent or reverse end diastolic flow (AREDF) Cardiotocography (CTG) Recording of fetal heart rate and uterine activity Abnormal (...) outcomes. Cochrane Database Syst Rev 2012; (6). 6. Royal College of Obstetricians and Gynaecologists. The investigation and management of the small-for-gestational-age fetus, 2013. 7. New Zealand Maternal Fetal Medicine Network. Guideline for the mangment of suspected small for gestational age singleton pregnancies and infants after 34 weeks' gestation, 2014. 8. Lausman A, Kingdom J. Intrauterine Growth Restriction: Screening, Diagnosis, and Management. Journal of Obstetrics and Gynaecology Canada 2013

2019 Centre of Research Excellence in Stillbirth

27. Preterm fetal monitoring

to reduced fetal heart rate variability or lack of accelerations, the possible effects of glucocorticoids on these parameters should be considered. B To rule out fetal compromise, it is recommended to consider serial doppler assessment of fetal flow indices and amniotic fluid quantification, if suspicious changes in the CTG trace are noted following administration of glucocorticoids. B Drug induced CTG changes When preterm delivery is considered due to reduced fetal heart rate variability or lack (...) of accelerations, the possible effects of atosiban on these parameters should be considered. B When preterm delivery is considered due to reduced fetal heart rate variability or lack of accelerations, the possible effects of magnesium sulphate on these parameters should be considered. BTo rule out fetal compromise, it is recommended to consider serial doppler assessment of fetal flow indices and amniotic fluid quantification, if suspicious changes in the CTG trace are noted during tocolysis or treatment

2019 Nordic Federation of Societies of Obstetrics and Gynecology

28. Intrapartum fetal surveillance

aim of intrapartum fetal surveillance is to prevent adverse perinatal outcomes arising from fetal metabolic acidosis related to labour. 2 As the fetal brain modulates the fetal heart rate (FHR) through an interplay of sympathetic and parasympathetic forces, fetal heart rate monitoring can be used as an indicator of whether or not a fetus is well oxygenated. 3 In the absence of risk factors FHR surveillance by continuous electronic fetal monitoring (CEFM) does not provide proven benefit and may (...) during labour 2 · Uses external Doppler US to monitor FHR and pressure transducers strapped to the abdomen to monitor uterine contractions 17 · Requires physical attachment to CTG machine if telemetry not available · Associated with high false positive results and inconsistent FHR tracing interpretations 5 Internal CTG- Fetal scalp electrode (FSE) · Recommended when: o Concerns with baseline variability o Difficulty: ? Auscultating the fetal heart ? Obtaining an adequate fetal heart rate tracing

2019 Queensland Health

29. Interpreting Category II Fetal Heart Rate Tracings: Does Meconium Matter? Full Text available with Trip Pro

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

2014 American Journal of Obstetrics and Gynecology

31. Doppler-based fetal heart rate analysis markers for the detection of early intrauterine growth restriction. Full Text available with Trip Pro

and gender. We assessed the discriminative power of short-term variability and long-term variability of the fetal heart rate, computed over episodes of high and low variation aiming to separate growth-restricted fetuses from controls. Metrics characterizing the sleep state distribution within a trace were also considered for inclusion into an IUGR detection model.Significant differences in the risk markers comparing growth-restricted with healthy fetuses were found. When used in a logistic regression (...) Doppler-based fetal heart rate analysis markers for the detection of early intrauterine growth restriction. One indicator for fetal risk of mortality is intrauterine growth restriction (IUGR). Whether markers reflecting the impact of growth restriction on the cardiovascular system, computed from a Doppler-derived heart rate signal, would be suitable for its detection antenatally was studied.We used a cardiotocography archive of 1163 IUGR cases and 1163 healthy controls, matched for gestation

2017 Acta Obstetricia et Gynecologica Scandinavica

32. Automated analysis of fetal cardiac function using color tissue Doppler imaging. Full Text available with Trip Pro

Automated analysis of fetal cardiac function using color tissue Doppler imaging. To evaluate the feasibility of automated analysis of fetal myocardial velocity recordings obtained by color tissue Doppler imaging (cTDI).This was a prospective cross-sectional observational study of 107 singleton pregnancies ≥ 41 weeks of gestation. Myocardial velocity recordings were obtained by cTDI in a long-axis four-chamber view of the fetal heart. Regions of interest were placed in the septum and the right (...) (RV) and left (LV) ventricular walls at the level of the atrioventricular plane. Peak myocardial velocities and mechanical cardiac time intervals were measured both manually and by an automated algorithm and agreement between the two methods was evaluated.In total, 321 myocardial velocity traces were analyzed using each method. It was possible to analyze all velocity traces obtained from the LV, RV and septal walls with the automated algorithm, and myocardial velocities and cardiac mechanical time

2017 Ultrasound in Obstetrics and Gynecology

33. Classification of caesarean section and normal vaginal deliveries using foetal heart rate signals and advanced machine learning algorithms Full Text available with Trip Pro

Classification of caesarean section and normal vaginal deliveries using foetal heart rate signals and advanced machine learning algorithms Visual inspection of cardiotocography traces by obstetricians and midwives is the gold standard for monitoring the wellbeing of the foetus during antenatal care. However, inter- and intra-observer variability is high with only a 30% positive predictive value for the classification of pathological outcomes. This has a significant negative impact (...) on the perinatal foetus and often results in cardio-pulmonary arrest, brain and vital organ damage, cerebral palsy, hearing, visual and cognitive defects and in severe cases, death. This paper shows that using machine learning and foetal heart rate signals provides direct information about the foetal state and helps to filter the subjective opinions of medical practitioners when used as a decision support tool. The primary aim is to provide a proof-of-concept that demonstrates how machine learning can be used

2017 Biomedical engineering online

34. Oxytocin and Fetal Heart Rate Changes

Details Study Description Go to Brief Summary: The reported risk of nonreassuring fetal heart trace following neuraxial analgesia is 3-23%. This variability may be due to fluid and oxytocin management prior to and during the initiation of neuraxial analgesia. The study hypothesis is that decreasing the oxytocin infusion rate by 50 % prior to initiation of combined spinal epidural analgesia will cause a reduction in the incidence of adverse fetal heart rate changes. Condition or disease Intervention (...) /treatment Phase Fetal Bradycardia Complicating Labor and Delivery Fetal Bradycardia During Labor Fetal Heart Rate or Rhythm Abnormality Affecting Fetus Drug: Half dose Oxytocin Phase 4 Detailed Description: Oxytocin is used in labor and delivery to increase the frequency of contractions and augment uterine contractile strength, thereby establishing a regular pattern of labor. However, the administration of exogenous oxytocin in the presence of an uncoordinated labor pattern confers a risk

2017 Clinical Trials

35. Prediction of fetal base excess values at birth using an algorithm to interpret fetal heart rate tracings: a retrospective validation. (Abstract)

Prediction of fetal base excess values at birth using an algorithm to interpret fetal heart rate tracings: a retrospective validation. To evaluate whether a standardised algorithm to interpret fetal heart rate (FHR) tracings during the entire length of labour can predict umbilical artery base excess at birth, and to investigate its inter- and intra-observer reproducibility.Retrospective study.Obstetrics and gynaecology department at a tertiary referral centre in a university hospital.Group 1 (...) : 152 consecutive, generally low-risk, labouring women. Group 2: mixed group of 30 women who delivered a fetus with pH < 7.00 and 30 women who delivered a fetus with pH ≥ 7.00.Intrapartum FHR tracings were retrospectively and blindly evaluated by two independent assessors using an algorithm proposed by Ross and Gala to predict fetal base excess at birth.The accuracy in predicting the base excess values of newborns was expressed as the proportion of FHR tracings in which the operator was able

2012 BJOG

36. Improvements in fetal heart rate analysis by the removal of maternal-fetal heart rate ambiguities. Full Text available with Trip Pro

Improvements in fetal heart rate analysis by the removal of maternal-fetal heart rate ambiguities. Misinterpretation of the maternal heart rate (MHR) as fetal may lead to significant errors in fetal heart rate (FHR) interpretation. In this study we hypothesized that the removal of these MHR-FHR ambiguities would improve FHR analysis during the final hour of labor.Sixty-one MHR and FHR recordings were simultaneously acquired in the final hour of labor. Removal of MHR-FHR ambiguities (...) was performed by subtracting MHR signals from their FHR counterparts when the absolute difference between the two was less or equal to 5 beats per minute. Major MHR-FHR ambiguities were defined when they exceeded 1% of the tracing. Maternal, fetal and neonatal characteristics were evaluated in cases where major MHR-FHR ambiguities occurred and computer analysis of FHR recordings was compared, before and after removal of the ambiguities.Seventy-two percent of tracings (44/61) exhibited episodes of major MHR

2015 BMC Pregnancy and Childbirth

37. Tachysystole in Term Labor: Incidence, Risk Factors, Outcomes, and Effect on Fetal Heart Tracings. (Abstract)

Tachysystole in Term Labor: Incidence, Risk Factors, Outcomes, and Effect on Fetal Heart Tracings. Recent recommendations called for obstetricians to abandon the terms of "hyperstimulation" and "hypercontractility" in favor of the more rigidly defined term, "tachysystole" (TS). The aim of the current study is to describe incidence of and risk factors for TS, describe fetal heart rate (FHR) changes associated with TS, and investigate maternal and neonatal outcomes associated with TS.For (...) this retrospective cohort study, we reviewed and analyzed the intrapartum FHR and tocometric characteristics of all patients with a singleton, nonanomalous fetus in term labor in a single hospital system over a 28-month period. Univariate association testing was done using χ(2) and t tests, comparing demographics, pregnancy characteristics, outcomes, and TS events. Multivariable association testing between risk factors and TS events were tested using generalized estimating equations, adjusting for multiple

2013 American Journal of Obstetrics and Gynecology

38. Intrapartum Management of Category II Fetal Heart Rate Tracings- Towards Standardization of Care. (Abstract)

Intrapartum Management of Category II Fetal Heart Rate Tracings- Towards Standardization of Care. There is currently no standard national approach to the management of category II fetal heart rate (FHR) patterns, yet such patterns occur in the majority of fetuses in labor. Under such circumstances, it would be difficult to demonstrate the clinical efficacy of FHR monitoring even if this technique had immense intrinsic value, since there has never been a standard hypothesis to test dealing

2013 American Journal of Obstetrics and Gynecology

39. Heart Disease and Stroke Statistics 2017 Update: A Report From the American Heart Association Full Text available with Trip Pro

Cardiac Arrest . . . . . . . . . . . . . . e468 19. Subclinical Atherosclerosis . . . . . . . . . . . . e487 20. Coronary Heart Disease, Acute Coronary Syndrome, and Angina Pectoris. . . . . . . . . . e505 21. Cardiomyopathy and Heart Failure . . . . . . . . e523 22. Valvular Diseases . . . . . . . . . . . . . . . . e539 23. Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism), Chronic Venous Insufficiency, Pulmonary Hypertension. . . e548 24. Peripheral Artery Disease and Aortic (...) , clini- cians, healthcare administrators, researchers, health advo- cates, and others seeking the best available data on these factors and conditions. Cardiovascular disease (CVD) and stroke produce immense health and economic burdens in the United States and globally. The Update also presents the latest data on a range of major clinical heart and circula- tory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart

2017 American Heart Association

40. Intrapartum fetal surveillance – Indications

evidensgrad III, styrke C: Studie Population Studie design Fund Philip Reif: Short-term neonatal outcome in diabetic versus non-diabetic pregnancies complicated by non- reassuring foetal heart rate traces (2) 57 kvinder med gestationel diabetes type 1 eller type 2 diabetes, 114 ikke- diabetiske matchede controller. 7 kvinder havde prægestationel diabetes, 13 kunne klassificeres som White gruppe A/B ud fra målinger af C- peptid og insulin i navlesnorsblod. 27 kvinder havde diætbehandlet GDM, de øvrige (...) Thyreoideasygdomme o Vægtestimat -15% - -22% 6 7 9 14 16 20 22 25 28 31 33 33 352 o Igangsættelse o Igangsættelse, medikamentel o Igangsættelse, mekanisk (Ballonkateter og HSP) o Pressefase over 1 time o Vandafgang mere end 24 timer 38 39 41 43 47 Hvornår skal overvågningen opstartes 49 Intrapartum fetal surveillance – Indications. English summery 51 Referencer 61 Forkortelser CTG: Cadiotocografi FIGO: International Federation of Gynecology and Obstetrics FHR: Fetal Heart Rate FV: Foster vægt BPM: Beats per

2017 Nordic Federation of Societies of Obstetrics and Gynecology

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