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Fetal Heart Tracing

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1021. Intrapartum fetal heart rate patterns in the prediction of neonatal acidemia. (Abstract)

reviewed all 488 tracings using the National Institute of Child Health and Human Development guidelines for fetal heart rate monitoring. All fetal heart rate tracings with bradycardia were removed from further analysis. The patients were placed in six groups, depending on the absence or presence of normal variability (amplitude >5 beats) during the last hour of monitoring combined with the absence of decelerations or the presence of variable or late decelerations. The relationship between changes (...) Intrapartum fetal heart rate patterns in the prediction of neonatal acidemia. This study was undertaken to correlate changes in the intrapartum electronic fetal heart rate patterns with the development of significant neonatal acidemia.We identified 488 fetuses at a gestational age of >37 weeks' gestation who had continuous electronic fetal monitoring during labor for the last 2 hours and umbilical artery cord gas analysis performed at delivery. One investigator blinded to the cord gas outcome

2003 American Journal of Obstetrics and Gynecology

1022. Fetal heart rate parameters predictive of neonatal outcome in the presence of a prolonged deceleration. (Abstract)

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

1023. Fetal heart rate and survival of the very premature newborn. (Abstract)

, 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

1024. Determinants of fetal heart rate response to vibroacoustic stimulation in labor. (Abstract)

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

1025. The effects of epidural opioids on fetal heart rate variability when coadministered with 0.25% bupivacaine for labor analgesia. (Abstract)

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

1026. The effect of maternal position on fetal heart rate during epidural or intrathecal labor analgesia. (Abstract)

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

1027. Accuracy of strategies for monitoring fetal heart rate in labor. (Abstract)

Accuracy of strategies for monitoring fetal heart rate in labor. We investigated whether the accuracy of auscultation could be improved with the use of a heart rate meter. Six fetal heart rate (FHR) traces were presented in a random sequence to 30 subjects using a customized computer program in each of three modalities: auscultation by counting alone, auscultation with the aid of an FHR meter, and visual assessment. The following characteristics were assessed: baseline rate, baseline (...) variability, periodic change, and interpretation of the trace. For baseline rate, counting was associated with consistent underestimation of the FHR, which became more evident as the heart rate increased. The variation observed with each method was greatest with counting. For baseline variability, the proportion of correct responses using a meter was comparable to visual assessment, whereas counting was significantly less effective in 4 of 6 traces. For periodic change, the use of a meter was superior

1999 American journal of perinatology Controlled trial quality: uncertain

1028. The effect of magnesium sulfate on fetal heart rate parameters: A randomized, placebo-controlled trial. (Abstract)

, electrolyte, and glucose levels. One hour of fetal heart rate monitoring was repeated at 1 and 3 hours of infusion. Tracings were interpreted without identifiers (of time or group) by using the National Institute of Child Health and Human Development fetal heart rate monitoring guidelines.Magnesium sulfate administration resulted in decreased fetal heart rate baseline values and variability in the third hour. The fetal heart rate baseline value was 134.4 +/- 6.3 versus 136.6 +/- 6.4 beats/min before (...) The effect of magnesium sulfate on fetal heart rate parameters: A randomized, placebo-controlled trial. We sought to determine the effect of magnesium sulfate on fetal heart rate baseline value, variability, and acceleration-deceleration pattern.Normal, nonlaboring pregnant patients at >30 weeks' gestation were recruited. Baseline fetal heart rate monitoring for 1 hour was performed. After an 800-kcal meal, patients were randomized to receive either an intravenous loading dose of 6 g

1999 American journal of obstetrics and gynecology Controlled trial quality: uncertain

1029. Fetal heart rate after epidural lidocaine and bupivacaine for elective cesarean section. (Abstract)

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

1030. Fetal heart rate variability after epidural fentanyl during labor. (Abstract)

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

1031. 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. (Abstract)

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

1032. The effect of ephedrine on intrapartum fetal heart rate after epidural analgesia. (Abstract)

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

1033. 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. (Abstract)

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

1034. Fetal heart rate response to strenuous maternal exercise: not a predictor of fetal distress. (Abstract)

Fetal heart rate response to strenuous maternal exercise: not a predictor of fetal distress. The purpose of this study was to analyze the effects of maternal exercise on fetal heart rate changes to determine prognostic factors for an abnormal trace in labor.Two hundred fifty-eight primiparous women who were 33 to 38 weeks of gestation with varying levels of activity were recruited. A symptom-limited incremental exercise test was preformed. Cardiotocography was carried out before and after (...) exercise. Data were analyzed with specialized computer software.A strenuous level of exercise was achieved. The most common fetal heart rate response seen was tachycardia. The incidence did not vary with the level of fitness, maternal body mass index, or fetal weight. Male fetuses were more prone to fetal distress. A significantly higher proportion of distressed babies were born to older women (P <.0001). The percentage of abnormal traces was equal in the vaginal and caesarean delivery groups.The

2002 American Journal of Obstetrics and Gynecology

1035. Three-dimensional multiplanar time-motion ultrasound or anatomical M-mode of the fetal heart: a new technique in fetal echocardiography. (Abstract)

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 (...) as M-mode traces. Because off-line plane positioning is possible on three-dimensional multiplanar reconstruction, M-mode traces can be obtained from different stored cardiac structures independently of the fetal position. Fifty-two women with normal singleton pregnancies at 22-40 weeks underwent transabdominal ultrasound examination and five women with singleton fetuses between 13 and 15 weeks were assessed transvaginally. Clinical application of the echocardiographic technique was tested

2003 Ultrasound in Obstetrics and Gynecology

1036. Intrapartum nonreassuring fetal heart rate tracing and prediction of adverse outcomes: interobserver variability. (Abstract)

Intrapartum nonreassuring fetal heart rate tracing and prediction of adverse outcomes: interobserver variability. We determined interobserver variability in the classification of fetal heart rate (FHR) tracing with periodic deceleration as being reassuring or nonreassuring and in the ability to predict emergency cesarean delivery (ECD) or umbilical arterial pH < 7.00.Five clinicians reviewed 100 FHR tracings 1 hour before abnormalities and, if applicable, the hour before delivery. We calculated (...) weighted Kappa coefficients (WKC) to assess interobserver variability and likelihood ratio of FHR tracing to identify ECD and low pH.Among 100 parturients, 46% of the women had ECD, and 2% of the women had low pH. The WKC for the classification of the FHR tracing as reassuring or nonreassuring in early labor was -0.12 and before delivery was 0.15. The WKC for ECD was 0.26 and for low pH was 0.21. The likelihood ratio for these 2 outcomes was < 2.0.There was poor agreement among the clinicians who

2008 American Journal of Obstetrics and Gynecology

1037. Effect of betamethasone administration on fetal heart rate tracing: a blinded longitudinal study. (Abstract)

Effect of betamethasone administration on fetal heart rate tracing: a blinded longitudinal study. Computerized fetal heart rate (FHR) analysis revealed that antenatal corticosteroids transiently suppress multiple parameters of fetal well-being, potentially leading to the erroneous diagnosis of fetal distress and to unnecessary iatrogenic delivery of premature infants. Our aim was to determine whether clinicians who visually analyze FHR tracings detect these suppressive effects, thereby (...) potentially affecting their clinical management decisions.Singleton pregnancies admitted for preterm labor between 26 and 34 weeks' gestation received two doses of betamethasone, 24 h apart, and were monitored daily between 16:00 and 19:00 h for 5 days. FHR tracings were randomly coded and presented in a non-consecutive order to four clinicians, who were unaware of the time of steroid administration. FHR baseline, FHR variability, number of accelerations and amplitude of maximal FHR acceleration were

2005 Fetal diagnosis and therapy Controlled trial quality: uncertain

1038. Graded classification of fetal heart rate tracings: association with neonatal metabolic acidosis and neurologic morbidity. (Abstract)

Graded classification of fetal heart rate tracings: association with neonatal metabolic acidosis and neurologic morbidity. The objective of the study was to measure the performance of a 5-tier, color-coded graded classification of electronic fetal monitoring (EFM).We used specialized software to analyze and categorize 7416 hours of EFM from term pregnancies. We measured how often and for how long each of the color-coded levels appeared in 3 groups of babies: (A) 60 babies with neonatal (...) abnormalities.Both degree and duration of tracing abnormality are related to outcome. We present empirical data quantifying that relationship in a systematic fashion.Copyright 2010 Mosby, Inc. All rights reserved.

2009 American Journal of Obstetrics and Gynecology

1039. Influence of carbon monoxide poisoning on the fetal heart monitor tracing: a report of 3 cases. (Abstract)

Influence of carbon monoxide poisoning on the fetal heart monitor tracing: a report of 3 cases. The diagnosis of carbon monoxide poisoning in the third trimester of pregnancy requires an index of suspicion, and the appearance of the fetal heart monitor tracing may help in this regard.Three cases of third-trimester acute carbon monoxide poisoning occurred. In each pregnancy, the fetal heart monitor tracing on admission was correlated with the maternal carboxyhemoglobin level, and how the pattern (...) changed following the institution of therapy was analyzed.In all 3 cases, the initial fetal heart rate pattern demonstrated decreased variability with an elevated baseline and an absence of accelerations and decelerations. Within 45-90 minutes of treatment onset, the baseline fetal heart rate dropped by 20-40 beats per minute, the variability became moderate, and accelerations occurred. Absent accelerations with minimal variability, if caused by uteroplacental insufficiency, are usually preceded

2009 Journal of Reproductive Medicine

1040. Fetal heart rate tracing patterns associated with congenital hypothyroidism. (Abstract)

Fetal heart rate tracing patterns associated with congenital hypothyroidism. This study was undertaken to determine fetal heart rate (FHR) tracing patterns associated with congenital hypothyroidism.FHR patterns of 59 women whose babies were diagnosed with congenital hypothyroidism were retrospectively compared with tracings of 78 of their siblings. Tracings were interpreted during the first stage of labor. Multivariable analysis was used to control for confounders.Neonates with congenital (...) hypothyroidism had significantly higher rates of reduced variability in FHR tracing patterns as compared with those without congenital hypothyroidism (49.2% vs 3.8%; odds ratio, 24.1; 95% confidence interval, 6.8-85.3; P < .001). No significant differences were noted between the groups regarding decelerations or baseline abnormalities. The significant association between congenital hypothyroidism and reduced variability persisted after controlling for confounders such as treatment with pethidine, MgSO4

2009 American Journal of Obstetrics and Gynecology

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