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Fetal Heart Tracing

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21. Interpreting Category II Fetal Heart Rate Tracings: Does Meconium Matter? (Full text)

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

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

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

2019 BMJ open

23. Sex differences in fetal heart rate and variability assessed by antenatal computerized cardiotocography. (PubMed)

Sex differences in fetal heart rate and variability assessed by antenatal computerized cardiotocography. The aim of the current study is to explore the effect of fetal sex on the fetal heart rate and variability.This is a retrospective cross-sectional study. We analyzed fetal heart rate (FHR) traces of pregnant women that were recorded antenatally using a commercially available computerized cardiotocograph (cCTG; Oxford system). Fetal sex was ascertained after birth. Baseline FHR and short-term (...) heart rate variation (STV) were compared between male and female fetuses. Expected mean values for baseline FHR and STV were computed and multiples of the mean (MOMean) of males and females were compared.Information on 9259 cases is reported in this study. Baseline FHR of female fetuses was significantly higher (P < 0.001) and STV lower (P < 0.001) than that of male fetuses. This difference remained even after the effects of gestational age and diurnal variation were eliminated by computation

2018 Acta Obstetricia et Gynecologica Scandinavica

24. Validation of a computerized algorithm to quantify fetal heart rate deceleration area. (PubMed)

Validation of a computerized algorithm to quantify fetal heart rate deceleration area. Reliability in visual cardiotocography interpretation is unsatisfying, which has led to the development of computerized cardiotocography. Computerized analysis is well established for antenatal fetal surveillance but has yet not performed sufficiently during labor. We aimed to investigate the capacity of a new computerized algorithm compared with visual assessment in identifying intrapartum fetal heart rate (...) baseline and decelerations.In all, 312 intrapartum cardiotocography tracings with variable decelerations were analyzed by the computerized algorithm and visually examined by two observers, blinded to each other and the computer analysis. The width, depth and area of each deceleration was measured. Four cases (>100 variable decelerations) were subjected to in-depth detailed analysis. The outcome measures were bias in seconds (width), beats per minute (depth), and beats (area) between computer

2018 Acta Obstetricia et Gynecologica Scandinavica

25. Fetal heart rate short term variation during labor in relation to scalp blood lactate concentration. (PubMed)

Fetal heart rate short term variation during labor in relation to scalp blood lactate concentration. Fetal heart rate short term variation (STV) decreases with severe chronic hypoxia in the antenatal period. However, only limited research has been done on STV during labor. We have tested a novel algorithm for a valid baseline estimation and calculated STV. To explore the value of STV during labor, we compared STV with fetal scalp blood (FBS) lactate concentration, an early marker in the hypoxic (...) process.Software was developed which estimates baseline frequency using a novel algorithm and thereby calculates STV according to Dawes and Redman in up to four 30-minute blocks prior to each FBS. Cardiotocography traces from 1070 women in labor who had had FBS performed on 2134 occasions were analyzed.In acidemic cases (lactate >4.8 mmol/L; Lactate Pro™), median STV 30 minutes prior to FBS was 7.10 milliseconds compared with 6.09 milliseconds in the preacidemic (4.2-4.8 mmol/L) and 5.23 milliseconds

2018 Acta Obstetricia et Gynecologica Scandinavica

26. An evaluation of fetal heart rate characteristics associated with neonatal encephalopathy: A case-control study. (PubMed)

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

27. Acute tocolysis for uterine tachysystole or suspected fetal distress. (Full text)

; 2 studies, 57 women; low-quality evidence). One had gross hydrocephalus and the second occurred with vaginal delivery after waiting 55 minutes for caesarean section. The decision for caesarean section delivery was an inclusion criterion in both studies so we could not assess this as an outcome under this comparison. Abnormal fetal heart trace is probably lower with tocolytic treatment (RR 0.28, 95% CI 0.08 to 0.95; 2 studies, 43 women; moderate-quality evidence). The effects on the number (...) , 95% CI 0.01 to 4.57; 35 women; low-quality evidence).Subcutaneous terbutaline versus IV magnesium sulphate (1 study, 46 women)No data were reported for perinatal death, severe morbidity or fetal or neonatal mortality. The decision for caesarean section was an inclusion criterion, so we could not assess this. The effects on abnormal fetal heart trace are uncertain (very low-quality evidence).Subcutaneous terbutaline with continuation of oxytocic infusion versus cessation of oxytocic infusion

2018 Cochrane

28. 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

29. 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

30. Intrapartum fetal surveillance

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 (...) of meconium if membranes ruptured · Correct hypotension Additional measures 8 · Consider: o Transition to CEFM o Expediting birth 8 3.5 Mode of continuous monitoring Table 7. Modes of Cardiotocography Aspect Recommendations External · Uses external Doppler US to monitor fetal heart rate and pressure transducers strapped to the abdomen to monitor uterine contractions 17 · Requires physical attachment to CTG machine · Associated with high false positive results and inconsistent FHR tracing interpretations 5

2019 Queensland Health

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

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

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

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

2013 American Journal of Obstetrics and Gynecology

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

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

34. Doppler-based fetal heart rate analysis markers for the detection of early intrauterine growth restriction. (Full text)

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

35. 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 (...) was not standardized. The combination of low-dose combined spinal epidural analgesia and the high/low dose oxytocin have not been evaluated. One of the proposed mechanisms for nonreassuring fetal heart a tracing after initiation of analgesia is that the pain relief from neuraxial analgesia causes a decrease in catecholamine release by the sympathetic nervous system. The subsequent decrease in the circulating epinephrine concentration contributes to an increase in uterine tone, as epinephrine is a potent tocolytic

2017 Clinical Trials

36. Fetal hemodynamics and cardiac streaming assessed by 4D flow cardiovascular magnetic resonance in fetal sheep. (Full text)

was measured in the heart and major vessels, and particle traces were used to visualize circulatory patterns in fetal cardiovascular shunts. Conservation of mass was used to test internal 4D flow consistency, and comparison to standard 2D phase contrast (PC) CMR was performed for validation.Streaming of blood from the ductus venosus through the foramen ovale was visualized. Flow waveforms in the major thoracic vessels and shunts displayed normal arterial and venous patterns. Combined ventricular output (...) -sensitive cardiovascular magnetic resonance imaging ("4D flow" CMR) and a specialized animal preparation (catheters to monitor fetal heart rate, anesthesia to immobilize mother and fetus) to examine fetal sheep cardiac hemodynamics in utero.Ten pregnant Merino sheep underwent surgery to implant arterial catheters in the target fetuses. Anesthetized ewes underwent 4D flow CMR with acquisition at 3 T for fetal whole-heart coverage with 1.2-1.5 mm spatial resolution and 45-62 ms temporal resolution. Flow

2019 Journal of Cardiovascular Magnetic Resonance

37. Improvements in fetal heart rate analysis by the removal of maternal-fetal heart rate ambiguities. (Full text)

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

38. Human factors affecting the interpretation of fetal heart rate tracings: an update. (PubMed)

Human factors affecting the interpretation of fetal heart rate tracings: an update. Human factors can have an important impact on cardiotocography (CTG) interpretation and management decisions, and therefore may directly affect obstetrical outcomes.It has been well demonstrated that there is wide observer disagreement over CTG interpretation, particularly in the evaluation of variability, decelerations, and overall tracing classification. The reasons behind this are still incompletely

2012 Current Opinion in Obstetrics and Gynecology

39. Intrapartum fetal surveillance – Indications

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 (...) 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

2017 Nordic Federation of Societies of Obstetrics and Gynecology

40. Phase-rectified signal averaging for intrapartum electronic fetal heart rate monitoring is related to acidaemia at birth (Full text)

Phase-rectified signal averaging for intrapartum electronic fetal heart rate monitoring is related to acidaemia at birth Recent studies suggest that phase-rectified signal averaging (PRSA), measured in antepartum fetal heart rate (FHR) traces, may sensitively indicate fetal status; however, its value has not been assessed during labour. We determined whether PRSA relates to acidaemia in labour, and compare its performance to short-term variation (STV), a related computerised FHR

2014 EvidenceUpdates

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