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Fetal Heart Tracing

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861. Effect of chronic maternal methadone therapy on intrapartum fetal heart rate patterns. (PubMed)

Effect of chronic maternal methadone therapy on intrapartum fetal heart rate patterns. Treatment of maternal opioid dependence with methadone is associated with a delay in fetal heart rate (FHR) accelerations in nonstress tests. The objective of this investigation was to determine the effect of methadone maintenance therapy on intrapartum FHR patterns.This retrospective cohort study compared intrapartum FHR tracings from 56 methadone-treated patients > or =36 weeks gestation with a control

2006 Journal of the Society for Gynecologic Investigation

862. Maternal position during non-stress test and fetal heart rate patterns. (PubMed)

Maternal position during non-stress test and fetal heart rate patterns. The aim of the study was to determinate whether maternal position during the non-stress test (NST) in different weeks of pregnancy influences fetal heart rate patterns.A total of 1055 NST lasting 30 min were performed in 368 autochthonous mothers with low-risk pregnancies. On the basis of maternal position during the test we divided into three groups: reclining, sitting, and walking. The cardiotocographic parameters (...) considered were: number of minutes of reactive NST with minimum length, number of fetal movements, fetal heart rate baseline, number of large accelerations, number of dubious NST, and number of variable decelerations.Fetal heart rate patterns in low-risk pregnancies were studied using NST in different gestational ages and in different maternal positions. Differences in heart rate were found in relationship to both gestational age and maternal position. The minimum length of NST necessary to record

2005 Acta Obstetricia et Gynecologica Scandinavica

863. Fetal heart rate patterns and neurodevelopmental outcome in very low birth weight infants. (PubMed)

Fetal heart rate patterns and neurodevelopmental outcome in very low birth weight infants. To evaluate the validity of fetal heart rate monitoring during the last hour prior to birth, as a predictor of long term neurodevelopmental outcome of very low birth weight infants.A total of 111 very low birth weight infants were included in the study. Fetal heart rate tracings were obtained during the last hour prior to delivery. A perinatologist, blinded to the neonatal outcome, evaluated the tracings (...) and divided them into three groups: reassuring, nonreassuring, and pathological. Neurodevelopmental status was evaluated at age 2 years. The relationship between fetal heart rate monitoring results and the neurodevelopmental outcome at 2 years of age was assessed with a chi-square test and the Student's t-test.At 2 years of age 97 (87.4%) of the children had normal neurodevelopmental function, while 14 (12.6%) had variable degrees of neurodevelopmental impairment. The fetal heart rate monitoring results

2006 Acta Obstetricia et Gynecologica Scandinavica

864. Intrapartum computerized fetal heart rate parameters and metabolic acidosis at birth. (PubMed)

Intrapartum computerized fetal heart rate parameters and metabolic acidosis at birth. To estimate to what extent computerized fetal heart rate (FHR) parameters are affected by labor and to estimate the relationship between FHR parameters and the degree of fetal metabolic acidosis in laboring patients at term.Fifty-one women between 37 and 42 weeks' gestational age were recruited prospectively in the following groups: 1) nonlaboring women, and 2) laboring women requiring fetal scalp electrode (...) FHR parameters studied. Both umbilical cord venous base excess and pH were inversely related to the number of large FHR decelerations (r = -.46, P <.01 and r = -.56, P <.01, respectively). Labor was associated with a 31% increase in both short- and long-term FHR variation in the reassuring FHR tracing group when compared with nonlaboring women. Although this increase in FHR variation was not seen in the nonreassuring FHR tracing group, there was no relationship to the degree of metabolic acidosis

2003 Obstetrics and Gynecology

865. Fetal heart rate changes associated with uterine rupture. (Full text)

or more prior low transverse uterine incisions, and availability of fetal heart tracings. Each case was matched with 3 controls randomly selected from a pool of successful VBAC deliveries at the same institution within 1 year. Three blinded independent examiners then examined fetal heart tracings. Each tracing was rated for the presence of fetal tachycardia, mild or moderate variable decelerations, severe variable decelerations, late decelerations, prolonged decelerations, fetal bradycardia, and loss (...) Fetal heart rate changes associated with uterine rupture. To identify fetal heart rate characteristics of patients with uterine rupture compared with successful vaginal birth after cesarean (VBAC) controls.This is a case-control study. Obstetric records of patients at the University of Washington Medical Center and Swedish Medical Center were reviewed for cases of uterine rupture. Entry criteria included operative confirmation of the diagnosis, gestational age beyond 24 weeks, presence of one

2004 Obstetrics and Gynecology

866. Intrathecal sufentanil and fetal heart rate abnormalities: a double-blind, double placebo-controlled trial comparing two forms of combined spinal epidural analgesia with epidural analgesia in labor. (PubMed)

Intrathecal sufentanil and fetal heart rate abnormalities: a double-blind, double placebo-controlled trial comparing two forms of combined spinal epidural analgesia with epidural analgesia in labor. Combined spinal epidural analgesia (CSE) for labor pain relief has become increasingly popular. However, the effect of intrathecal sufentanil on the incidence of uterine hyperactivity and fetal heart rate (FHR) abnormalities remains controversial. We hypothesized that the use of intrathecal (...) hypotension, requiring IV ephedrine (29% in the BSE group versus 7% and 12% in the EPD and SUF groups, respectively). All these differences reached statistical significance. The present data corroborate previous recommendations of caution when performing CSE using a large dose (7.5 microg or more) of spinal sufentanil because of the risk of uterine hyperactivity and FHR abnormalities.Combined spinal epidural analgesia (CSE) produces pain relief during labor. Fetal heart rate changes after CSE using

2004 Anesthesia and analgesia Controlled trial quality: predicted high

867. The effect of ephedrine on intrapartum fetal heart rate after epidural analgesia. (Full text)

The effect of ephedrine on intrapartum fetal heart rate after epidural analgesia. Adverse fetal heart rate (FHR) changes occur frequently during the first 30 minutes after epidural analgesia. The aim of this study was to estimate whether intravenous administration of ephedrine during induction of epidural analgesia can reduce the frequency of adverse FHR changes.We prospectively studied 145 term singleton deliveries where epidural analgesia was administered. The patients were randomly allocated (...) before the administration of epidural analgesia to receive an intravenous infusion of 10 mg ephedrine, after epidural induction, followed by a continuous infusion for 60 minutes of 20 mg ephedrine (study group) or to receive no ephedrine (control group). The FHR tracing was evaluated for 20 minutes before and 40 minutes after initiating epidural analgesia. Demographic data and clinical and delivery outcome were assessed and compared between the 2 groups.Injection of ephedrine significantly reduced

2004 Obstetrics and Gynecology Controlled trial quality: uncertain

868. Fetal heart rate patterns and ECG ST segment changes preceding metabolic acidaemia at birth. (Full text)

Fetal heart rate patterns and ECG ST segment changes preceding metabolic acidaemia at birth. To compare the rates of abnormal ST segment patterns of the ECG and cardiotocographic (CTG) abnormalities in fetuses with metabolic acidaemia at birth and controls. To evaluate the inter-observer agreement in interpretation of ST analysis and CTG.Case-control study.Three University hospitals in southern Sweden.Cases and controls were selected from the Swedish randomised controlled trial on intrapartum (...) monitoring, including 4966 fetuses monitored with a scalp electrode.Two obstetricians independently assessed the CTG and ST traces of 41 fetuses with metabolic acidaemia at birth and 101 controls, blinded to group, outcome and all clinical data. They classified each CTG trace and ST analysis as abnormal or not abnormal, and whether there was indication to intervene according to the CTG or to the CTG + ST guidelines. If their classification differed, assessment by a third obstetrician determined the final

2005 BJOG Controlled trial quality: uncertain

869. Prophylactic ephedrine and combined spinal epidural: maternal blood pressure and fetal heart rate patterns. (Full text)

ephedrine 25 mg or placebo by random allocation before combined spinal epidural. During the first hour after analgesia, maternal heart rate, blood pressure, and need for treatment of significant hypotension were recorded. Fetal heart rate tracings for 1 hour before and for 1 hour after administration of anesthetic were evaluated. Categorical variables were compared with Fisher exact test. Continuous variables were compared with one way analysis of variance for repeated measures. P < .05 was considered (...) Prophylactic ephedrine and combined spinal epidural: maternal blood pressure and fetal heart rate patterns. Labor analgesia with the combined spinal epidural approach has been associated with maternal hypotension and fetal heart rate (FHR) changes. The purpose of this study was to estimate whether prophylactic intramuscular ephedrine before combined spinal epidural prevents these complications.In a prospective double blind trial, 100 healthy patients with term singletons received intramuscular

2005 Obstetrics and Gynecology Controlled trial quality: uncertain

870. Suitability of fetal scalp electrodes for monitoring the fetal electrocardiogram during labour. (PubMed)

Suitability of fetal scalp electrodes for monitoring the fetal electrocardiogram during labour. As the limitations of heart-rate based intrapartum monitoring have become apparent, there is renewed interest in analysis of the fetal electrocardiographic waveform as obtained from a fetal scalp electrode. A high quality ECG signal is necessary for waveform analysis. This study examined the suitability of five commonly available scalp electrodes for collecting this signal by examining their physical (...) and electrical characteristics, together with a randomised clinical trial in which the ECG trace quality was assessed in 50 patients. The frequency response of Copeland electrodes was such that they attenuate the ECG signal more than the baseline noise. Difficulties were experienced in obtaining optimum attachment and the long, semi-rigid design increased movement artefact resulting in significantly poorer quality ECG signals. Whilst the Hewlett-Packard double spiral electrode had a near ideal frequency

1990 Clinical physics and physiological measurement : an official journal of the Hospital Physicists' Association, Deutsche Gesellschaft für Medizinische Physik and the European Federation of Organisations for Medical Physics Controlled trial quality: uncertain

871. ST segment analysis of the fetal electrocardiogram plus electronic fetal heart rate monitoring in labor and its relationship to umbilical cord arterial blood gases. (PubMed)

ST segment analysis of the fetal electrocardiogram plus electronic fetal heart rate monitoring in labor and its relationship to umbilical cord arterial blood gases. This study was undertaken to determine the ability of intrapartum electronic fetal heart rate monitoring (EFM) plus fetal electrocardiogram (ECG) ST segment automated ANalysis (STAN, Neoventa Medical, Goteborg, Sweden) monitoring to predict metabolic acidemia (defined as an umbilical cord artery pH < 7.15 and base deficit > or = 12 (...) mmol/L) at birth.Women with singleton, term pregnancies who had a clinical indication for internal EFM with a fetal scalp electrode were included in the study. Attending physicians were blinded to the ST analysis information, only using available EFM as per current clinical practice. After delivery, 2 trained observers blinded to neonatal outcome and ST analysis information performed visual classification of the EFM tracing in 10-minute epochs according to FIGO guidelines. ST events automatically

2004 American Journal of Obstetrics and Gynecology

872. Three-dimensional multiplanar time-motion ultrasound or anatomical M-mode of the fetal heart: a new technique in fetal echocardiography. (Full text)

extrasystoles (26 and 31 weeks) were easily diagnosed using this technique.The new technique presented here enables the easy acquisition of optimal M-mode traces from different fetal heart structures. Based on our promising findings we would recommend that, in the future, three-dimensional multiplanar imaging should not be limited to automatic volume acquisition but should include the free-hand technique.Copyright 2003 ISUOG. Published by John Wiley & Sons, Ltd. (...) Three-dimensional multiplanar time-motion ultrasound or anatomical M-mode of the fetal heart: a new technique in fetal echocardiography. To assess the application of a three-dimensional multiplanar rendering technique for examination of the fetal heart.Free-hand acquisition of a three-dimensional volume was performed without moving or tilting the transducer. While the anatomical plane shows the four cardiac chambers, the two other orthogonal planes show vertical and horizontal time-axis planes

2003 Ultrasound in Obstetrics and Gynecology

873. Fetal heart rate and survival of the very premature newborn. (PubMed)

, birth weight, the administration of corticosteroids, multiple pregnancies, and fetal heart rate. Fetal heart rate had the greatest effect on the mortality rate. Children with a reactive rate were 4 times more likely to survive than children with a flat tracing (P =.003; odd ratio, 4; 95% CI, 12.1; 39.8).The results in our study lead us to think that recording the fetal heart rate before and during labor may be useful in the prediction of perinatal death and may help obstetric decision-making. (...) Fetal heart rate and survival of the very premature newborn. Our purpose was to study the likelihood of survival of infants who are born before 28 weeks of gestation and to examine the influence of fetal heart rate findings on neonatal death.In this retrospective study, we analyzed the mortality rate of infants at 2 months of age as a function of various obstetric and prenatal indicators.At 2 months, 207 of 325 children were still alive. The survival rate was also a function of gestational age

2002 American Journal of Obstetrics and Gynecology

874. Fetal heart rate parameters predictive of neonatal outcome in the presence of a prolonged deceleration. (PubMed)

Fetal heart rate parameters predictive of neonatal outcome in the presence of a prolonged deceleration. To correlate the presence of baseline variability and the duration of a prolonged deceleration/bradycardia in intrapartum fetal heart rate (FHR) tracings with the development of neonatal acidemia.We identified 186 patients with term gestations who had continuous electronic fetal monitoring for at least 2 hours before delivery, with an identified bradycardia during that period. Each patient (...) had umbilical artery cord analysis done and delivery within 30 minutes of that bradycardia. One investigator blinded to the cord gas outcome reviewed the last 2 hours of the tracing using the National Institute of Child Health and Human Development guidelines for FHR monitoring. We assessed the presence or absence of variability before the bradycardia and recovery or no recovery of the bradycardia and placed the patients into four groups. Group 1 (128 patients) with normal variability and recovery

2002 Obstetrics and Gynecology

875. Determinants of fetal heart rate response to vibroacoustic stimulation in labor. (PubMed)

correlations between the acceleration response and other maternal and fetal variables. There was a statistically significant negative correlation between the heart rate response to stimulation and three maternal variables: the degree of cervical dilation, the presence of ruptured membranes, and use of epidural anesthesia. The degree of fetal response did not correlate significantly with fetal distress at delivery or abnormal FHR tracings at the time of stimulation. Fewer than one-fifth of the fetuses (...) Determinants of fetal heart rate response to vibroacoustic stimulation in labor. To determine whether the fetal heart accelerates in response to a sound stimulus in labor, 40 women at various stages of labor were chosen at random to receive either a vibroacoustic stimulus or sham stimulus over the fetal head. Subsequent fetal heart rate (FHR) accelerations occurred to a significantly greater extent in study patients. One hundred thirty-two high- and low-risk patients were studied to determine

1988 Obstetrics and Gynecology Controlled trial quality: uncertain

876. Fetal heart rate variability after epidural fentanyl during labor. (PubMed)

Fetal heart rate variability after epidural fentanyl during labor. The effects of epidural fentanyl on fetal heart rate (FHR) were examined in 39 parturients, 19 given 75 micrograms epidural fentanyl and 20 given normal saline in 5-mL volumes administered randomly after establishment of adequate epidural lidocaine analgesia. Fetal heart rate was measured 15 min before and 15 min after lidocaine epidural analgesia, and for 60 min at 5-min intervals after administration of epidural fentanyl (...) /placebo. A perinatologist blinded to the injected epidural solution analyzed FHR tracings. Epidural injections of fentanyl and saline, when given during established epidural lidocaine analgesia, were associated with equal reductions in FHR variability and the frequency of FHR accelerations (P less than 0.003). Neonatal outcome was also similar in both groups. The clinical significance, if any, of these moderate reductions in FHR during epidural lidocaine analgesia is unclear.

1990 Anesthesia and analgesia Controlled trial quality: uncertain

877. Fetal heart rate after epidural lidocaine and bupivacaine for elective cesarean section. (PubMed)

Fetal heart rate after epidural lidocaine and bupivacaine for elective cesarean section. This prospective double-blind study was designed to determine whether the fetal heart rate (FHR) changes that have been reported after epidural administration of bupivacaine and lidocaine during labor are present when larger doses of these drugs are given during elective cesarean section. Prior to inserting an epidural catheter, FHR and maternal vital signs were monitored during a control period in 60 (...) or ephedrine requirements. Analysis of FHR tracings by a perinatologist blinded to the study group revealed no changes after anesthesia and no significant differences between the groups at any time in basal FHR, short- or long-term variability, or the incidence of accelerations or decelerations.(ABSTRACT TRUNCATED AT 250 WORDS)

1991 Anesthesiology Controlled trial quality: uncertain

878. Plasma concentration profile of epidural alfentanil. Bolus followed by continuous infusion technique in the parturient: effect of epidural alfentanil and fentanyl on fetal heart rate. (PubMed)

using repeated measures analysis of covariance.Fetal heart rate tracings were recorded throughout the study and were retrospectively analyzed by a "blinded" perinatologist. Data from fetal heart rate tracings were examined by repeated measures analysis of variance. Mean infusion rates were 9.3 +/- 2.1 mL/hour and 9.6 +/- 1.7 mL/hour for groups A and B, respectively. Mean study duration was 3.7 hours in group A, and 3.0 hours in group B. Low plasma levels precluded analysis of fentanyl data. Group (...) A subjects exhibited stability of drug levels over time. Fetal heart rate tracings in 21 patients demonstrated no changes associated with epidural opioid infusion in either group.With the dosage regimen used in this study, an initial epidural bolus with continuous infusion technique generates a steady state plasma concentration of alfentanil that is below levels associated with direct respiratory depression.

1995 Regional anesthesia Controlled trial quality: uncertain

879. The effects of epidural opioids on fetal heart rate variability when coadministered with 0.25% bupivacaine for labor analgesia. (Full text)

The effects of epidural opioids on fetal heart rate variability when coadministered with 0.25% bupivacaine for labor analgesia. Assessment of fetal heart rate (FHR) variability provides important information regarding fetal well-being. Normal FHR variability is generally associated with fetal normoxia. Opioids are frequently co-administered with local anesthetics to provide epidural analgesia for labor. Epidural opioid effects on FHR variability have not been extensively studied. In a double (...) -blind, randomized study, 109 parturients had their epidural catheter injected with either butorphanol (2 mg), fentanyl (50 microg), sufentanil (15 microg) or saline and bupivacaine (0.25%). FHR tracings of 30 min duration were obtained both before and after epidural analgesia. Each of the 218 tracings was randomly numbered and later graded by the same individual for short- and long-term variability. The two 30-min tracings for each patient were then paired but not ordered as to which tracing

1998 American journal of perinatology Controlled trial quality: uncertain

880. The effect of maternal position on fetal heart rate during epidural or intrathecal labor analgesia. (PubMed)

The effect of maternal position on fetal heart rate during epidural or intrathecal labor analgesia. This study was designed to determine the relationship between maternal position and the incidence of prolonged decelerations after epidural bupivacaine or intrathecal sufentanil analgesia for labor.Laboring, healthy, term parturient women, with reassuring fetal heart rate tracings, requesting either epidural (n = 145) or intrathecal (n = 160) analgesia were randomly assigned to lie either supine (...) with measured 30-degree left uterine displacement (n = 136) or in the left lateral decubitus position (n = 145). Patients received either intrathecal sufentanil, 10 microg, or epidural 0.25% bupivacaine, 13 mL. An obstetrician, unaware of patient position or type of anesthesia, examined the fetal heart rate tracings.No demographic differences were noted among the groups. Prolonged decelerations occurred with equal frequency after epidural bupivacaine and intrathecal sufentanil (3.9%). Prolonged

1998 American journal of obstetrics and gynecology Controlled trial quality: uncertain

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