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Tarvonen M, Markkanen J, Tuppurainen V, Jernman R, Stefanovic V, Andersson S. Intrapartum cardiotocography with simultaneous maternal heart rate registration improves neonatal outcome. Am J Obstet Gynecol 2024; 230:379.e1-379.e12. [PMID: 38272284 DOI: 10.1016/j.ajog.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Intrapartum cardiotocographic monitoring of fetal heart rate by abdominal external ultrasound transducer without simultaneous maternal heart rate recording has been associated with increased risk of early neonatal death and other asphyxia-related neonatal outcomes. It is unclear, however, whether this increase in risk is independently associated with fetal surveillance method or is attributable to other factors. OBJECTIVE This study aimed to compare different fetal surveillance methods and their association with adverse short- and long-term fetal and neonatal outcomes in a large retrospective cohort of spontaneous term deliveries. STUDY DESIGN Fetal heart rate and maternal heart rate patterns were recorded by cardiotocography during labor in spontaneous term singleton cephalic vaginal deliveries in the Hospital District of Helsinki and Uusimaa, Finland between October 1, 2005, and September 30, 2023. According to the method of cardiotocography monitoring at birth, the cohort was divided into the following 3 groups: women with ultrasound transducer, women with both ultrasound transducer and maternal heart rate transducer, and women with internal fetal scalp electrode. Umbilical artery pH and base excess values, low 1- and 5-minute Apgar scores, need for intubation and resuscitation, neonatal intensive care unit admission for asphyxia, neonatal encephalopathy, and early neonatal death were used as outcome variables. RESULTS Among the 213,798 deliveries that met the inclusion criteria, the monitoring type was external ultrasound transducer in 81,559 (38.1%), both external ultrasound transducer and maternal heart rate recording in 62,268 (29.1%), and fetal scalp electrode in 69,971 (32.7%) cases, respectively. The rates of both neonatal encephalopathy (odds ratio, 1.48; 95% confidence interval, 1.08-2.02) and severe acidemia (umbilical artery pH <7.00 and/or umbilical artery base excess ≤-12.0 mmol/L) (odds ratio, 2.03; 95% confidence interval, 1.65-2.50) were higher in fetuses of women with ultrasound transducer alone compared with those of women with concurrent external fetal and maternal heart rate recording. Monitoring with ultrasound transducer alone was also associated with increased risk of neonatal intubation for resuscitation (odds ratio, 1.22; 95% confidence interval, 1.03-1.44). A greater risk of severe neonatal acidemia was observed both in the ultrasound transducer (odds ratio, 2.78; 95% confidence interval, 2.23-3.48) and concurrent ultrasound transducer and maternal heart rate recording (odds ratio, 1.37; 95% confidence interval, 1.05-1.78) groups compared with those monitored with fetal scalp electrodes. No difference in risk of neonatal encephalopathy was found between newborns monitored with concurrent ultrasound transducer and maternal heart rate recording and those monitored with fetal scalp electrodes. CONCLUSION The use of external ultrasound transducer monitoring of fetal heart rate without simultaneous maternal heart rate recording is associated with higher rates of neonatal encephalopathy and severe neonatal acidemia. We suggest that either external fetal heart rate monitoring with concurrent maternal heart rate recording or internal fetal scalp electrode be used routinely as a fetal surveillance tool in term deliveries.
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Affiliation(s)
- Mikko Tarvonen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
| | - Janne Markkanen
- Department of Industrial Engineering and Management, LUT University of Technology, Lappeenranta, Finland; Intensive and Intermediate Care Unit, Helsinki University Hospital, Helsinki, Finland
| | - Ville Tuppurainen
- Department of Industrial Engineering and Management, LUT University of Technology, Lappeenranta, Finland; Helsinki University Hospital Area Administration, Helsinki, Finland
| | - Riina Jernman
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Sture Andersson
- Children's Hospital, Pediatric Research Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
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Application of probability theory to neonatal cardiac evaluation. Cardiol Young 2023; 33:415-419. [PMID: 35514093 DOI: 10.1017/s104795112200097x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Based on probability theory, a methodology that allows diagnosing neonatal cardiac dynamics was previously developed; however, diagnostic applications of this method are required to validate it to the neonatal cardiac dynamics was conducted, allowing to differentiate normal from pathological dynamics. The hourly maximum and minimum heart rate values from 39 continuous and ambulatory electrocardiographic records with a minimum length of 21 hours were taken, from newborns between 0 and 10 days of life, 9 clinically within normality limits and 30 with cardiac pathologies. The probability of occurrence of heart rates in ranges of 5 beats/minute was calculated. The distributions of probability were analysed, and finally the diagnosis was determined by the physical-mathematical methodology. Then, a statistical validation of sensitivity, specificity, and diagnostic agreement was performed. Normal registries showed probability distributions with absent or minimal presence of heart rates of the ranges between 125 and 135 beats/minute, while the abnormal ones had values within these ranges, as well as absence or minimal presence of heart rates from 75 beats/minute to 85 beats/minute. The sensitivity and specificity were 100%, and the Kappa coefficient had a value of 1. Hereby, it is concluded that through an application of a physical-mathematical methodology of neonatal cardiac diagnosis, it is possible to differentiate normality from disease.
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Bernardes J. Computerized analysis of cardiotocograms in clinical practice and the SisPorto ® system thirty-two years after: technological, physiopathological and clinical studies. J Perinat Med 2023; 51:145-160. [PMID: 36064191 DOI: 10.1515/jpm-2022-0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 08/21/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The objective of this study is to present the why, what and how about computerized analysis of cardiotocograms (cCTG) and the SisPorto system for cCTG. CONTENT A narrative review about cCTG and the SisPorto system for cCTG is presented. The meta-analysis of randomized controlled trials (RCT) performed so far have evidenced that cCGT compared to traditional CTG analysis may save time spent in hospital for women, in the antepartum period, and is objective with at least equivalent results in maternal and perinatal outcomes, both in the ante and intrapartum periods. The SisPorto system for cCTG closely follows the FIGO guidelines for fetal monitoring. It may be used both in the ante and intrapartum periods, alone or connected to a central monitoring station, with simultaneous monitoring of fetal and maternal signals, not only in singletons but also in twins. It has been assessed in technical, physiopathological and clinical studies, namely in one large multicentric international RCT during labor and two meta-analysis. SUMMARY AND OUTLOOK There is evidence that cCTG may be useful in clinical practice with advantages compared to traditional CTG analysis, although without clear impact on the decrease of preventable maternal and perinatal mortality and morbidity. More studies are warranted, namely on technical improvements and assessment in larger studies in a wider range of clinical settings.
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Affiliation(s)
- João Bernardes
- Head of the Department of Gynecology Obstetrics and Pediatrics, Faculdade de Medicina da Universidade do Porto, Portugal
- Senior Consultant of Centro Hospitalar Universitário de São João, Porto, Portugal
- Senior Researcher of Centro de Investigação em Tecnologias e Sistemas de Saúde (CINTESIS), Porto, Portugal
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Widatalla N, Khandoker A, Alkhodari M, Koide K, Yoshida C, Kasahara Y, Kimura Y, Saito M. Similarities between maternal and fetal RR interval tachograms and their association with fetal development. Front Physiol 2022; 13:964755. [PMID: 36479345 PMCID: PMC9721082 DOI: 10.3389/fphys.2022.964755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/02/2022] [Indexed: 12/26/2023] Open
Abstract
An association between maternal and fetal heart rate (HR) has been reported but, so far, little is known about its physiological implication and importance relative to fetal development. Associations between both HRs were investigated previously by performing beat-by-beat coupling analysis and correlation analysis between average maternal and fetal HRs. However, studies reporting on the presence of similarities between maternal and fetal HRs or RR intervals (RRIs) over the short term (e.g., 5-min) at different gestational ages (GAs) are scarce. Here, we demonstrate the presence of similarities in the variations exhibited by maternal and fetal RRl tachograms (RRITs). To quantify the same similarities, a cross-correlation (CC) analysis between resampled maternal and fetal RRITs was conducted; RRITs were obtained from non-invasive electrocardiogram (ECG). The degree of similarity between maternal and fetal RRITs (bmfRRITs) was quantified by calculating four CC coefficients. CC analysis was performed for a total of 330 segments (two 5-min segments from 158 subjects and one 5-min from 14 subjects). To investigate the association of the similarity bmfRRITs with fetal development, the linear correlation between the calculated CC coefficients and GA was calculated. The results from the latter analysis showed that similarities bmfRRITs are common occurrences, they can be negative or positive, and they increase with GA suggesting the presence of a regulation that is associated with proper fetal development. To get an insight into the physiological mechanisms involved in the similarity bmfRRITs, the association of the same similarity with maternal and fetal HR variability (HRV) was investigated by comparing the means of two groups in which one of them had higher CC values compared to the other. The two groups were created by using the data from the 158 subjects where fetal RRI (fRRI) calculation from two 5-min ECG segments was feasible. The results of the comparison showed that the maternal very low frequency (VLF) HRV parameter is potentially associated with the similarity bmfRRITs implying that maternal hormones could be linked to the regulations involved in the similarity bmfRRITs. Our findings in this study reinforce the role of the maternal intrauterine environment on fetal development.
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Affiliation(s)
- Namareq Widatalla
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
| | - Ahsan Khandoker
- Healthcare Engineering Innovation Center, Department of Biomedical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Mohanad Alkhodari
- Healthcare Engineering Innovation Center, Department of Biomedical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
- Cardiovascular Clinical Research Facility, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Kunihiro Koide
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chihiro Yoshida
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiyuki Kasahara
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshitaka Kimura
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masatoshi Saito
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
- Tohoku University Graduate School of Medicine, Sendai, Japan
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Ribeiro M, Monteiro-Santos J, Castro L, Antunes L, Costa-Santos C, Teixeira A, Henriques TS. Non-linear Methods Predominant in Fetal Heart Rate Analysis: A Systematic Review. Front Med (Lausanne) 2021; 8:661226. [PMID: 34917624 PMCID: PMC8669823 DOI: 10.3389/fmed.2021.661226] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 11/04/2021] [Indexed: 12/19/2022] Open
Abstract
The analysis of fetal heart rate variability has served as a scientific and diagnostic tool to quantify cardiac activity fluctuations, being good indicators of fetal well-being. Many mathematical analyses were proposed to evaluate fetal heart rate variability. We focused on non-linear analysis based on concepts of chaos, fractality, and complexity: entropies, compression, fractal analysis, and wavelets. These methods have been successfully applied in the signal processing phase and increase knowledge about cardiovascular dynamics in healthy and pathological fetuses. This review summarizes those methods and investigates how non-linear measures are related to each paper's research objectives. Of the 388 articles obtained in the PubMed/Medline database and of the 421 articles in the Web of Science database, 270 articles were included in the review after all exclusion criteria were applied. While approximate entropy is the most used method in classification papers, in signal processing, the most used non-linear method was Daubechies wavelets. The top five primary research objectives covered by the selected papers were detection of signal processing, hypoxia, maturation or gestational age, intrauterine growth restriction, and fetal distress. This review shows that non-linear indices can be used to assess numerous prenatal conditions. However, they are not yet applied in clinical practice due to some critical concerns. Some studies show that the combination of several linear and non-linear indices would be ideal for improving the analysis of the fetus's well-being. Future studies should narrow the research question so a meta-analysis could be performed, probing the indices' performance.
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Affiliation(s)
- Maria Ribeiro
- Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Computer Science Department, Faculty of Sciences, University of Porto, Porto, Portugal
| | - João Monteiro-Santos
- Centre for Health Technology and Services Research, Faculty of Medicine University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luísa Castro
- Centre for Health Technology and Services Research, Faculty of Medicine University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,School of Health of Polytechnic of Porto, Porto, Portugal
| | - Luís Antunes
- Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Computer Science Department, Faculty of Sciences, University of Porto, Porto, Portugal
| | - Cristina Costa-Santos
- Centre for Health Technology and Services Research, Faculty of Medicine University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Andreia Teixeira
- Centre for Health Technology and Services Research, Faculty of Medicine University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
| | - Teresa S Henriques
- Centre for Health Technology and Services Research, Faculty of Medicine University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
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Signal Ambiguity and Misinterpretation of Fetal Heart Rate: A Report of Two Cases and an Overview of Suspicious Patterns. JOURNAL OF FETAL MEDICINE 2020. [DOI: 10.1007/s40556-020-00260-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kiely DJ, Oppenheimer LW, Dornan JC. Unrecognized maternal heart rate artefact in cases of perinatal mortality reported to the United States Food and Drug Administration from 2009 to 2019: a critical patient safety issue. BMC Pregnancy Childbirth 2019; 19:501. [PMID: 31842798 PMCID: PMC6915916 DOI: 10.1186/s12884-019-2660-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 12/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal heart rate artefact is a signal processing error whereby the fetal heart rate is masked by the maternal pulse, potentially leading to danger by failure to recognize an abnormal fetal heart rate or a pre-existing fetal death. Maternal heart rate artefact may be exacerbated by autocorrelation algorithms in modern fetal monitors due to smooth transitions between maternal and fetal heart rates rather than breaks in the tracing. In response, manufacturers of cardiotocography monitors recommend verifying fetal life prior to monitoring and have developed safeguards including signal ambiguity detection technologies to simultaneously and continuously monitor the maternal and fetal heart rates. However, these safeguards are not emphasized in current cardiotocography clinical practice guidelines, potentially leading to a patient safety gap. METHODS The United States Food and Drug Administration Manufacturer and User Facility Device Experience database was reviewed for records with event type "Death" for the time period March 31, 2009 to March 31, 2019, in combination with search terms selected to capture all cases reported involving cardiotocography devices. Records were reviewed to determine whether maternal heart rate artefact was probable and/or whether the report contained a recommendation from the device manufacturer regarding maternal heart rate artefact. RESULTS Forty-seven cases of perinatal mortality were identified with probable maternal heart rate artefact including 14 with antepartum fetal death prior to initiation of cardiotocography, 14 with intrapartum fetal death or neonatal death after initiation of cardiotocography, and 19 where the temporal relationship between initiation of cardiotocography and death cannot be definitively established from the report. In 29 cases, there was a recommendation from the manufacturer regarding diagnosis and/or management of maternal heart rate artefact. CONCLUSIONS This case series indicates a recurring problem with undetected maternal heart rate artefact leading to perinatal mortality and, in cases of pre-existing fetal death, healthcare provider confusion. In response, manufacturers frequently recommend safeguards which are found in their device's instructions for use but not in major intrapartum cardiotocography guidelines. Cardiotocography guidelines should be updated to include the latest safeguards against the risks of maternal heart rate artefact. An additional file summarizing key points for clinicians is included.
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Affiliation(s)
- Daniel J Kiely
- Department of Obstetrics and Gynecology, Hôpital de Thetford Mines, 1717 rue Notre Dame Est, Thetford Mines, Québec, G6G 2V4, Canada.
| | - Lawrence W Oppenheimer
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, 501 Smyth Road, Box 804, Ottawa, Ontario, K1H 8L6, Canada
| | - James C Dornan
- Department of Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Queens University Belfast (rtrd) and Chair Health and Life Sciences, Ulster University, York Street, Belfast, County Antrim, Belfast, Northern Ireland, BT15 1ED
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8
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Bernardes J. Foetal circadian rhythms, interpretation of foetal heart rate recordings and clues about foetal preparedness for stressful situations. Acta Physiol (Oxf) 2018; 224:e13174. [PMID: 30133146 DOI: 10.1111/apha.13174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/16/2018] [Indexed: 11/26/2022]
Affiliation(s)
- João Bernardes
- Departamento de Ginecologia Obstetrícia e Pediatria; Faculdade de Medicina da Universidade do Porto; Porto Portugal
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9
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Fernández-Morales JC, Morad M. Regulation of Ca 2+ signaling by acute hypoxia and acidosis in rat neonatal cardiomyocytes. J Mol Cell Cardiol 2017; 114:58-71. [PMID: 29032102 DOI: 10.1016/j.yjmcc.2017.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/20/2017] [Accepted: 10/08/2017] [Indexed: 11/25/2022]
Abstract
Ischemic heart disease is an arrhythmogenic condition, accompanied by hypoxia, acidosis, and impaired Ca2+ signaling. Here we report on effects of acute hypoxia and acidification in rat neonatal cardiomyocytes cultures. RESULTS Two populations of neonatal cardiomyocyte were identified based on inactivation kinetics of L-type ICa: rapidly-inactivating ICa (τ~20ms) myocytes (prevalent in 3-4-day cultures), and slow-inactivating ICa (τ≥40ms) myocytes (dominant in 7-day cultures). Acute hypoxia (pO2<5mmHg for 50-100s) suppressed ICa reversibly in both cell-types to different extent and with different kinetics. This disparity disappeared when Ba2+ was the channel charge carrier, or when the intracellular Ca2+ buffering capacity was increased by dialysis of high concentrations of EGTA and BAPTA, suggesting critical role for calcium-dependent inactivation. Suppressive effect of acute acidosis on ICa (~40%, pH6.7), on the other hand, was not cell-type dependent. Isoproterenol enhanced ICa in both cell-types, but protected only against suppressive effects of acidosis and not hypoxia. Hypoxia and acidosis suppressed global Ca2+ transients by ~20%, but suppression was larger, ~35%, at the RyR2 microdomains, using GCaMP6-FKBP targeted probe. Hypoxia and acidosis also suppressed mitochondrial Ca2+ uptake by 40% and 10%, respectively, using mitochondrial targeted Ca2+ biosensor (mito-GCaMP6). CONCLUSION Our studies suggest that acute hypoxia suppresses ICa in rapidly inactivating cell population by a mechanism involving Ca2+-dependent inactivation, while compromised mitochondrial Ca2+ uptake seems also to contribute to ICa suppression in slowly inactivating cell population. Proximity of cellular Ca2+ pools to sarcolemmal Ca2+ channels may contribute to the variability of inactivation kinetics of ICa in the two cell populations, while acidosis suppression of ICa appears mediated by proton-induced block of the calcium channel.
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Affiliation(s)
| | - Martin Morad
- Cardiac Signaling Center of MUSC, USC and Clemson, Charleston, SC, USA; Department of Pharmacology, Georgetown University Medical Center, Washington, DC, USA.
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Gonçalves H, Fernandes D, Pinto P, Ayres-de-Campos D, Bernardes J. Simultaneous monitoring of maternal and fetal heart rate variability during labor in relation with fetal gender. Dev Psychobiol 2017; 59:832-839. [PMID: 28833043 DOI: 10.1002/dev.21554] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/17/2017] [Indexed: 11/07/2022]
Abstract
Male gender is considered a risk factor for several adverse perinatal outcomes. Fetal gender effect on fetal heart rate (FHR) has been subject of several studies with contradictory results. The importance of maternal heart rate (MHR) monitoring during labor has also been investigated, but less is known about the effect of fetal gender on MHR. The aim of this study is to simultaneously assess maternal and FHR variability during labor in relation with fetal gender. Simultaneous MHR and FHR recordings were obtained from 44 singleton term pregnancies during the last 2 hr of labor (H1, H2 ). Heart rate tracings were analyzed using linear (time- and frequency-domain) and nonlinear indices. Both linear and nonlinear components were considered in assessing FHR and MHR interaction, including cross-sample entropy (cross-SampEn). Mothers carrying male fetuses (n = 22) had significantly higher values for linear indices related with MHR average and variability and sympatho-vagal balance, while the opposite occurred in the high-frequency component and most nonlinear indices. Significant differences in FHR were only observed in H1 with higher entropy values in female fetuses. Assessing the differences between FHR and MHR, statistically significant differences were obtained in most nonlinear indices between genders. A significantly higher cross-SampEn was observed in mothers carrying female fetuses (n = 22), denoting lower synchrony or similarity between MHR and FHR. The variability of MHR and the synchrony/similarity between MHR and FHR vary with respect to fetal gender during labor. These findings suggest that fetal gender needs to be taken into account when simultaneously monitoring MHR and FHR.
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Affiliation(s)
- Hernâni Gonçalves
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Diana Fernandes
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paula Pinto
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Porto, Portugal
- Hospital Dr Nélio Mendonça, EPE, Funchal, Portugal
| | - Diogo Ayres-de-Campos
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal
- INEB - Institute of Biomedical Engineering; I3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - João Bernardes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Senhora da Hora, Portugal
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Georgoulas G, Karvelis P, Spilka J, Chudáček V, Stylios CD, Lhotská L. Investigating pH based evaluation of fetal heart rate (FHR) recordings. HEALTH AND TECHNOLOGY 2017; 7:241-254. [PMID: 29201590 PMCID: PMC5686283 DOI: 10.1007/s12553-017-0201-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 05/30/2017] [Indexed: 11/30/2022]
Abstract
Cardiotocography (CTG) is a standard tool for the assessment of fetal well-being during pregnancy and delivery. However, its interpretation is associated with high inter- and intra-observer variability. Since its introduction there have been numerous attempts to develop computerized systems assisting the evaluation of the CTG recording. Nevertheless these systems are still hardly used in a delivery ward. Two main approaches to computerized evaluation are encountered in the literature; the first one emulates existing guidelines, while the second one is more of a data-driven approach using signal processing and computational methods. The latter employs preprocessing, feature extraction/selection and a classifier that discriminates between two or more classes/conditions. These classes are often formed using the umbilical cord artery pH value measured after delivery. In this work an approach to Fetal Heart Rate (FHR) classification using pH is presented that could serve as a benchmark for reporting results on the unique open-access CTU-UHB CTG database, the largest and the only freely available database of this kind. The overall results using a very small number of features and a Least Squares Support Vector Machine (LS-SVM) classifier, are in accordance to the ones encountered in the literature and outperform the results of a baseline classification scheme proving the utility of using advanced data processing methods. Therefore the achieved results can be used as a benchmark for future research involving more informative features and/or better classification algorithms.
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Affiliation(s)
- George Georgoulas
- Control Engineering Group Department of Computer Science, Electrical and Space Engineering Luleå University of Technology, SE-97187 Luleå, Sweden
| | - Petros Karvelis
- Laboratory of Knowledge and Intelligent Computing, Department of Computer Engineering, Technological Educational Institute of Epirus, Arta, Kostakioi Greece
| | - Jiří Spilka
- CIIRC, Czech Technical, University in Prague, Czech Republic, Prague, Czech Republic
| | - Václav Chudáček
- CIIRC, Czech Technical, University in Prague, Czech Republic, Prague, Czech Republic
| | - Chrysostomos D Stylios
- Laboratory of Knowledge and Intelligent Computing, Department of Computer Engineering, Technological Educational Institute of Epirus, Arta, Kostakioi Greece
| | - Lenka Lhotská
- CIIRC, Czech Technical, University in Prague, Czech Republic, Prague, Czech Republic
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12
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Gonçalves H, Pinto P, Silva M, Ayres-de-Campos D, Bernardes J. Electrocardiography versus photoplethysmography in assessment of maternal heart rate variability during labor. SPRINGERPLUS 2016; 5:1079. [PMID: 27462527 PMCID: PMC4945517 DOI: 10.1186/s40064-016-2787-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/06/2016] [Indexed: 11/10/2022]
Abstract
Purpose Evaluation of maternal heart rate (MHR) variability provides useful information on the maternal-fetal clinical state. Electrocardiography (ECG) is the most accurate method to monitor MHR but it may not always be available, and pulse oximetry using photoplethysmography (PPG) can be an alternative. In this study we compared ECG and PPG signals, obtained with conventional fetal monitors, to evaluate signal loss, MHR variability indices, and the ability of the latter to predict fetal acidemia and operative delivery. Methods Both signals were simultaneously acquired in 51 term pregnancies during the last 2 h of labor (H1 and H2). Linear time- and frequency-domain, and nonlinear MHR variability indices were estimated, and the dataset was divided into normal and acidemic cases, as well as into normal and operative deliveries. Differences between ECG and PPG signals were assessed using non-parametric confidence intervals, hypothesis testing, correlation coefficient and a measure of disagreement. Prediction of fetal acidemia and operative delivery was assessed using areas under the receiver operating characteristic curve (auROC). Results Signal loss was higher with ECG during the first segments of H1, and higher with PPG in the last segment of H2, and it increased in both signals with labour progression. MHR variability indices were significantly different when acquired with ECG and PPG signals, with low correlation coefficients and high disagreement for entropy and fast oscillation-based indices, and low disagreement for the mean MHR and slow oscillation-based indices. However, both acquisition modes evidenced significant differences between H1 and H2 and comparable auROC values were obtained in the detection of fetal acidemia and operative vaginal delivery. Conclusion Although PPG captures the faster oscillations of the MHR signal less well than ECG and is prone to have higher signal loss in the last 10-min preceding delivery, it can be considered an alternative for MHR monitoring during labor, with adaptation of cut-off values for MHR variability indices.
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Affiliation(s)
- Hernâni Gonçalves
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Rua Dr Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Paula Pinto
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Rua Dr Plácido da Costa, s/n, 4200-450 Porto, Portugal ; Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal ; Hospital Dr Nélio Mendonça, EPE, Funchal, Portugal
| | - Manuela Silva
- Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal
| | - Diogo Ayres-de-Campos
- Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal ; Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal ; INEB - Institute of Biomedical Engineering, Porto; I3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - João Bernardes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Rua Dr Plácido da Costa, s/n, 4200-450 Porto, Portugal ; Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal ; Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal ; Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Senhora da Hora, Portugal
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