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Bruin CM, Lobmaier SM, Ganzevoort W, Müller A, Wolf H. Comparison of phase rectified signal averaging and short term variation in predicting perinatal outcome in early onset fetal growth restriction. J Perinat Med 2022:jpm-2022-0409. [PMID: 36441559 DOI: 10.1515/jpm-2022-0409] [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] [Received: 08/21/2022] [Accepted: 11/04/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare short term variation (STV) and phase rectified signal averaging (PRSA) and their association with fetal outcome in early onset fetal growth restriction (FGR). METHODS Data were used from a retrospective cohort study of women who were admitted for FGR and/or pre-eclampsia and who were delivered by pre-labor Cesarean section or had a fetal death before 32 weeks' gestation. Computerized cardiotocography (cCTG) registrations of the 5 days before delivery or fetal death were used for calculation of STV and PRSA. PRSA was expressed as the average acceleration capacity (AAC) and average deceleration capacity (ADC). FHR decelerations were classified visually as absent, 1-2 per hour or recurrent. Abnormality of STV and of PRSA was either analyzed as a single parameter or in combination with recurrent decelerations. Endpoints were defined as composite adverse condition at birth consisting of fetal death, low Apgar score, low umbilical pH, the need for resuscitation after birth and as major neonatal morbidity or neonatal death. RESULTS Included were 367 pregnancies of which 20 resulted in fetal death. An abnormal cCTG with either recurrent decelerations and/or low STV or recurrent decelerations and/or low PRSA were similarly associated with composite adverse condition at birth (n=99), but neither with major neonatal morbidity. CONCLUSIONS PRSA and STV have similar efficacy for measuring fetal heart rate variation in early onset FGR. An increased risk of a composite adverse condition at birth is indicated by a low value of either parameter and/or the presence of recurrent decelerations.
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Affiliation(s)
- Claartje M Bruin
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Silvia M Lobmaier
- Frauenklinik und Poliklinik, Technische Universität München, Munich, Germany
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Alexander Müller
- Klinik und Poliklinik für Innere Medizin I, Technische Universität München, Munich, Germany
| | - Hans Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
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Baschat AA, Galan HL, Lee W, DeVore GR, Mari G, Hobbins J, Vintzileos A, Platt LD, Manning FA. The role of the fetal biophysical profile in the management of fetal growth restriction. Am J Obstet Gynecol 2022; 226:475-486. [PMID: 35369904 DOI: 10.1016/j.ajog.2022.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 11/01/2022]
Abstract
Growth-restricted fetuses are at risk of hypoxemia, acidemia, and stillbirth because of progressive placental dysfunction. Current fetal well-being, neonatal risks following delivery, and the anticipated rate of fetal deterioration are the major management considerations in fetal growth restriction. Surveillance has to quantify the fetal risks accurately to determine the delivery threshold and identify the testing frequency most likely to capture future deterioration and prevent stillbirth. From the second trimester onward, the biophysical profile score correlates over 90% with the current fetal pH, and a normal score predicts a pH >7.25 with a 100% positive predictive value; an abnormal score on the other hand predicts current fetal acidemia with similar certainty. Between 30% and 70% of growth-restricted fetuses with a nonreactive heart rate require biophysical profile scoring to verify fetal well-being, and an abnormal score in 8% to 27% identifies the need for delivery, which is not suspected by Doppler findings. Future fetal well-being is not predicted by the biophysical profile score, which emphasizes the importance of umbilical artery Doppler and amniotic fluid volume to determine surveillance frequency. Studies with integrated surveillance strategies that combine frequent heart rate monitoring with biophysical profile scoring and Doppler report better outcomes and stillbirth rates of between 0% and 4%, compared with those between 8% and 11% with empirically determined surveillance frequency. The variations in clinical behavior and management challenges across gestational age are better addressed when biophysical profile scoring is integrated into the surveillance of fetal growth restriction. This review aims to provide guidance on biophysical profile scoring in the in- and outpatient management of fetal growth restriction.
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Wolf H, Gordijn SJ, Onland W, Vliegenthart RJS, Ganzevoort JW. Computerized fetal heart rate analysis in early preterm fetal growth restriction. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:51-60. [PMID: 31605504 DOI: 10.1002/uog.21887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/09/2019] [Accepted: 09/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess the value of computerized cardiotocography (cCTG) with calculation of fetal heart rate (FHR) short-term variability (STV) in early preterm fetal growth restriction (FGR) for prevention of fetal death and neonatal asphyxia, neonatal morbidity, and 2-year neurodevelopmental impairment. METHODS This was a retrospective cohort study of all women who were admitted to the Amsterdam University Medical Center-AMC between 2003 and 2015 due to FGR and/or pre-eclampsia, and who were delivered by prelabor Cesarean section, or had a fetal death, before 32 weeks' gestation. STV of all available cCTG registrations during the 5 days preceding fetal death or delivery was calculated retrospectively, and FHR decelerations were classified visually as absent, 1-2/h or recurrent (> 2/h). Adverse outcome endpoints were defined as fetal death, neonatal asphyxia at birth (including fetal death), neonatal death, major neonatal morbidity and 2-year neurodevelopmental outcome. A simulation analysis was performed to assess the incidence of adverse outcome using two thresholds for cCTG: (1) highly abnormal (STV < 2.6 ms before 29 weeks and < 3.0 ms thereafter, and/or recurrent FHR decelerations); and (2) moderately abnormal (STV < 3.5 ms before 29 weeks and < 4.0 ms thereafter, and/or recurrent FHR decelerations). Three management strategies were assessed using a strict schedule for the frequency of cCTG recordings: (1) cCTG without use of fetal arterial Doppler; (2) cCTG with additional fetal arterial Doppler after 29 weeks; and (3) cCTG with additional fetal arterial Doppler after 27 weeks. RESULTS Included were 367 pregnancies (3295 cCTG recordings), of which 20 resulted in fetal death and 347 were delivered by Cesarean section before the onset of labor. Cesarean delivery was indicated by fetal condition in 94% of cases and by maternal condition in 6%. Median gestational age at delivery was 30 (interquartile range (IQR), 28-31) weeks and median birth weight was 900 (IQR, 740-1090) g. Six cases of fetal death were not anticipated by standard practice using visual assessment of CTG. A last highly abnormal cCTG was associated with fetal death and with neonatal asphyxia (including fetal death; n = 99), but not with major neonatal morbidity and 2-year neurodevelopmental outcome. Moderately abnormal cCTG had no significant association with any endpoint. Simulation analysis showed that a strategy that combined cCTG results with umbilicocerebral ratio or umbilical absent or reversed end-diastolic flow could detect all fetal deaths. CONCLUSIONS Computerized CTG in combination with fetal arterial Doppler, with a strict protocol for the frequency of recordings, is likely to be more effective than visual CTG assessment for preventing fetal death in early preterm FGR. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- H Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - S J Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Onland
- Department of Neonatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R J S Vliegenthart
- Department of Neonatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J W Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
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Ghi T, Dall'Asta A, Saccone G, Bellussi F, Frusca T, Martinelli P, Pilu G, Rizzo N. Reduced short-term variation following antenatal administration of betamethasone: Is reduced fetal size a predisposing factor? Eur J Obstet Gynecol Reprod Biol 2017; 216:74-78. [PMID: 28735176 DOI: 10.1016/j.ejogrb.2017.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/05/2017] [Accepted: 07/07/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the association between fetal size and the incidence of reduced short-term variability (STV) following bethametasone administration for fetal lung maturity. STUDY DESIGN This was a retrospective, multicenter, cohort study conducted in two Tertiary University Units. Only uncomplicated singleton pregnancies admitted for threatened preterm labor between 26 and 34 weeks and submitted to betamethasone for fetal lung maturity were included. Delivery occurring within 72h from betamethasone administration represented criteria for exclusion. Computerized cardiotocography was carried out on a daily basis. Cases were identified by persistently reduced STV, defined as <5th percentile for gestational age and lasting for at least 72h after the first dose of betamethasone. The primary outcome was estimated fetal weight (EFW) at ultrasound in fetuses with normal and in those with persistently reduced STV. Pregnancy outcomes were also evaluated. RESULTS Persistently reduced STV occurred in 33/405 of the included patients (8.1%). Compared to women with normal STV, those with persistently reduced STV had significantly lower EFW (1472±435 vs 1812±532g, p 0.04), lower birthweight (2353±635 vs 2857±796g, p<0.01) and earlier gestational age at delivery (35.1±4.2 vs 37.3±2.4weeks, p<0.01), whereas all the other variables including gestational age on admission were comparable. CONCLUSIONS Reduced STV following maternal betamethasone administration among appropriately grown fetuses seems to correlate with lower fetal size. Furthermore, fetuses with such abnormal response to steroids seem to carry a higher risk of perinatal complications, including lower birthweight and earlier gestational age at delivery.
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Affiliation(s)
- Tullio Ghi
- Obstetrics and Gynecology Unit, University of Parma, Parma, Italy.
| | - Andrea Dall'Asta
- Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Federica Bellussi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Tiziana Frusca
- Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Pasquale Martinelli
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gianluigi Pilu
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Nicola Rizzo
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Senat MV, Tsatsaris V. Surveillance anténatale, prise en charge et indications de naissance en cas de RCIU vasculaire isolé. ACTA ACUST UNITED AC 2013; 42:941-65. [DOI: 10.1016/j.jgyn.2013.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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CHOURASIA VIJAYS, TIWARI ANILKUMAR. FETAL HEART RATE VARIABILITY ANALYSIS FROM PHONOCARDIOGRAPHIC RECORDINGS. J MECH MED BIOL 2012. [DOI: 10.1142/s0219519411004174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper presents an algorithm for classification of fetal health status using fetal heart rate variability (fHRV) analysis through phonocardiography. First, the fetal heart sound signals are acquired from the maternal abdominal surface using a specially developed Bluetooth-based wireless data recording system. Then, fetal heart rate (FHR) traces are derived from these signals. Ten numbers of linear and nonlinear features are extracted from each FHR trace. Finally, the multilayer perceptron (MLP) neural network is used to classify the health status of the fetus. Results show very promising performance toward the prediction of fetal wellbeing on the set of collected fetal heart sound signals. Finally, this work is likely to lead to an automatic screening device with additional potential of predicting fetal wellbeing.
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GEORGOULAS GEORGE, STYLIOS CHRYSOSTOMOS, GROUMPOS PETER. FEATURE EXTRACTION AND CLASSIFICATION OF FETAL HEART RATE USING WAVELET ANALYSIS AND SUPPORT VECTOR MACHINES. INT J ARTIF INTELL T 2011. [DOI: 10.1142/s0218213006002746] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Since the fetus is not available for direct observations, only indirect information can guide the obstetrician in charge. Electronic Fetal Monitoring (EFM) is widely used for assessing fetal well being. EFM involves detection of the Fetal Heart Rate (FHR) signal and the Uterine Activity (UA) signal. The most serious fetal incident is the hypoxic injury leading to cerebral palsy or even death, which is a condition that must be predicted and avoided. This research work proposes a new integrated method for feature extraction and classification of the FHR signal able to associate FHR with umbilical artery pH values at delivery. The proposed method introduces the use of the Discrete Wavelet Transform (DWT) to extract time-scale dependent features of the FHR signal and the use of Support Vector Machines (SVMs) for the categorization. The proposed methodology is tested on a data set of intrapartum recordings were the FHR categories are associated with umbilical artery pH values, This proposed approach achieved high overall classification performance proving its merits.
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Affiliation(s)
- GEORGE GEORGOULAS
- Laboratory for Automation & Robotics, University of Patras, 26500, Patras, Greece
| | - CHRYSOSTOMOS STYLIOS
- Department of Communications, Informatics and Management, Technological Educational Institute of Epirus, Artas, Greece
| | - PETER GROUMPOS
- Laboratory for Automation & Robotics, University of Patras, 26500, Patras, Greece
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Krupa N, Ali M, Zahedi E, Ahmed S, Hassan FM. Antepartum fetal heart rate feature extraction and classification using empirical mode decomposition and support vector machine. Biomed Eng Online 2011; 10:6. [PMID: 21244712 PMCID: PMC3033856 DOI: 10.1186/1475-925x-10-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 01/19/2011] [Indexed: 11/13/2022] Open
Abstract
Background Cardiotocography (CTG) is the most widely used tool for fetal surveillance. The visual analysis of fetal heart rate (FHR) traces largely depends on the expertise and experience of the clinician involved. Several approaches have been proposed for the effective interpretation of FHR. In this paper, a new approach for FHR feature extraction based on empirical mode decomposition (EMD) is proposed, which was used along with support vector machine (SVM) for the classification of FHR recordings as 'normal' or 'at risk'. Methods The FHR were recorded from 15 subjects at a sampling rate of 4 Hz and a dataset consisting of 90 randomly selected records of 20 minutes duration was formed from these. All records were labelled as 'normal' or 'at risk' by two experienced obstetricians. A training set was formed by 60 records, the remaining 30 left as the testing set. The standard deviations of the EMD components are input as features to a support vector machine (SVM) to classify FHR samples. Results For the training set, a five-fold cross validation test resulted in an accuracy of 86% whereas the overall geometric mean of sensitivity and specificity was 94.8%. The Kappa value for the training set was .923. Application of the proposed method to the testing set (30 records) resulted in a geometric mean of 81.5%. The Kappa value for the testing set was .684. Conclusions Based on the overall performance of the system it can be stated that the proposed methodology is a promising new approach for the feature extraction and classification of FHR signals.
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Affiliation(s)
- Niranjana Krupa
- Department of Electrical Electronic and Systems Engineering, Universiti Kebangsaan Malaysia, Bangi, Malaysia.
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Elden H, Ostgaard HC, Fagevik-Olsen M, Ladfors L, Hagberg H. Treatments of pelvic girdle pain in pregnant women: adverse effects of standard treatment, acupuncture and stabilising exercises on the pregnancy, mother, delivery and the fetus/neonate. Altern Ther Health Med 2008; 8:34. [PMID: 18582370 PMCID: PMC2467402 DOI: 10.1186/1472-6882-8-34] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 06/26/2008] [Indexed: 01/13/2023]
Abstract
BACKGROUND Previous publications indicate that acupuncture is efficient for the treatment of pelvic girdle pain, PGP, in pregnant women. However, the use of acupuncture for PGP is rare due to insufficient documentation of adverse effects of this treatment in this specific condition. The aim of the present work was to assess adverse effects of acupuncture on the pregnancy, mother, delivery and the fetus/neonate in comparison with women that received stabilising exercises as adjunct to standard treatment or standard treatment alone. METHODS In all, 386 women with PGP entered this controlled, single-blind trial. They were randomly assigned to standard treatment plus acupuncture (n = 125), standard treatment plus specific stabilising exercises (n = 131) or to standard treatment alone (n = 130) for 6 weeks. Acupuncture that may be considered strong was used and treatment was started as early as in the second trimester of pregnancy. Adverse effects were recorded during treatment and throughout the pregnancy. Influence on the fetus was measured with cardiotocography (CTG) before-during and after 43 acupuncture sessions in 43 women. A standardised computerized method to analyze the CTG reading numerically (Oxford 8000, Oxford, England) was used. After treatment, the women rated their overall experience of the treatment and listed adverse events if any in a questionnaire. Data of analgesia and oxytocin augmentation during labour, duration of labour, frequency of preterm birth, operative delivery, Apgar score, cord-blood gas/acid base balance and birth weight were also recorded. RESULTS There were no serious adverse events after any of the treatments. Minor adverse events were common in the acupuncture group but women rated acupuncture favourably even despite this. The computerized or visually assessed CTG analyses of antenatal recordings in connection with acupuncture were all normal. CONCLUSION This study shows that acupuncture administered with a stimulation that may be considered strong led to minor adverse complaints from the mothers but had no observable severe adverse influences on the pregnancy, mother, delivery or the fetus/neonate.
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Georgoulas G, Gavrilis D, Tsoulos IG, Stylios C, Bernardes J, Groumpos PP. Novel approach for fetal heart rate classification introducing grammatical evolution. Biomed Signal Process Control 2007. [DOI: 10.1016/j.bspc.2007.05.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Georgoulas G, Stylios CD, Groumpos PP. Predicting the risk of metabolic acidosis for newborns based on fetal heart rate signal classification using support vector machines. IEEE Trans Biomed Eng 2006; 53:875-84. [PMID: 16686410 DOI: 10.1109/tbme.2006.872814] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiotocography is the main method used for fetal assessment in every day clinical practice for the last 30 years. Many attempts have been made to increase the effectiveness of the evaluation of cardiotocographic recordings and minimize the variations of their interpretation utilizing technological advances. This research work proposes and focuses on an advanced method able to identify fetuses compromised and suspicious of developing metabolic acidosis. The core of the proposed method is the introduction of a support vector machine to "foresee" undesirable and risky situations for the fetus, based on features extracted from the fetal heart rate signal at the time and frequency domains along with some morphological features. This method has been tested successfully on a data set of intrapartum recordings, achieving better and balanced overall performance compared to other classification methods, constituting, therefore, a promising new automatic methodology for the prediction of metabolic acidosis.
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Affiliation(s)
- George Georgoulas
- Laboratory for Automation and Robotics, Department of Electrical and Computer Engineering, University of Patras, Rion 26500, Greece.
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Romano M, Bifulco P, Cesarelli M, Sansone M, Bracale M. Foetal heart rate power spectrum response to uterine contraction. Med Biol Eng Comput 2006; 44:188-201. [PMID: 16937160 DOI: 10.1007/s11517-006-0022-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Accepted: 01/08/2006] [Indexed: 11/25/2022]
Abstract
Cardiotocography is the most diffused prenatal diagnostic technique in clinical routine. The simultaneous recording of foetal heart rate (FHR) and uterine contractions (UC) provides useful information about foetal well-being during pregnancy and labour. However, foetal electronic monitoring interpretation still lacks reproducibility and objectivity. New methods of interpretation and new parameters can further support physicians' decisions. Besides common time-domain analysis, study of the variability of FHR can potentially reveal autonomic nervous system activity of the foetus. In particular, it is clinically relevant to investigate foetal reactions to UC to diagnose foetal distress early. Uterine contraction being a strong stimulus for the foetus and its autonomic nervous system, it is worth exploring the FHR variability response. This study aims to analyse modifications of the power spectrum of FHR variability corresponding to UC. Cardiotocographic signal tracts corresponding to 127 UC relative to 30 healthy foetuses were analysed. Results mainly show a general, statistically significant (t test, p<0.01) power increase of the FHR variability in the LF 0.03-0.2 Hz and HF 0.2-1 in correspondence of the contraction with respect to a reference tract set before contraction onset. Time evolution of the power within these bands was computed by means of time-varying spectral estimation to concisely show the FHR response along a uterine contraction. A synchronised grand average of these responses was also computed to verify repeatability, using the contraction apex as time reference. Such modifications of the foetal HRV that follow a contraction can be a sign of ANS reaction and, therefore, additional, objective information about foetal reactivity during labour.
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Affiliation(s)
- M Romano
- Biomedical Engineering Unit Electronics and Telecommunications Engineering Department, University Federico II of Naples, Via Claudio, 21, 80125, Napoli, Italy
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Georgoulas G, Stylios C, Groumpos P. CLASSIFICATION OF FETAL HEART RATE USING SCALE DEPENDENT FEATURES AND SUPPORT VECTOR MACHINES. ACTA ACUST UNITED AC 2005. [DOI: 10.3182/20050703-6-cz-1902.02167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bellver J, Perales A, Maiques V, Serra V. Can antepartum computerized cardiotocography predict the evolution of intrapartum acid-base status in normal fetuses? Acta Obstet Gynecol Scand 2004; 83:267-71. [PMID: 14995923 DOI: 10.1111/j.0001-6349.2004.0319.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND To study the relationship between antepartum computerized cardiotocography (cCTG) and the evolution of intrapartum fetal acid-base balance in a low-risk population. METHODS Forty-nine healthy fetuses were prospectively followed up by antepartum cCTG (Oxford System 8002), fetal scalp blood sampling at the onset of the active phase of dilatation (3 cm) and at the beginning of the second stage of labor (10 cm) and study of acid-base status at birth in the umbilical cord. Correlation studies and linear regression analysis were performed. RESULTS Normal prelabor cCTG was followed by normal fetal acid-base balance in the different study periods. No relationship was found between cCTG parameters and the absolute values of fetal acid-base status. However, the more favorable the antepartum cCTG parameters were, the more favorable the fetal acid-base evolution during the active phase of dilatation was. In contrast, no significant correlations were found between antepartum cCTG and fetal acid-base changes during the second stage of labor. CONCLUSIONS In normal fetuses, a single antepartum cCTG identified correctly fetal well-being during labor and at birth and was able to predict fetal acid-base evolution during the active phase of dilatation. However, fetal biochemical changes during the second stage could not be predicted by any antepartum cCTG parameter.
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Affiliation(s)
- José Bellver
- Unidad de Medicina Materno-Fetal, Instituto Valenciano de Infertilidad, Valencia, Spain.
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Signorini MG, Magenes G, Cerutti S, Arduini D. Linear and nonlinear parameters for the analysis of fetal heart rate signal from cardiotocographic recordings. IEEE Trans Biomed Eng 2003; 50:365-74. [PMID: 12669993 DOI: 10.1109/tbme.2003.808824] [Citation(s) in RCA: 161] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Antepartum fetal monitoring based on the classical cardiotocography (CTG) is a noninvasive and simple tool for checking fetal status. Its introduction in the clinical routine limited the occurrence of fetal problems leading to a reduction of the precocious child mortality. Nevertheless, very poor indications on fetal pathologies can be inferred from the even automatic CTG analysis methods, which are actually employed. The feeling is that fetal heart rate (FHR) signals and uterine contractions carry much more information on fetal state than is usually extracted by classical analysis methods. In particular, FHR signal contains indications about the neural development of the fetus. However, the methods actually adopted for judging a CTG trace as "abnormal" give weak predictive indications about fetal dangers. We propose a new methodological approach for the CTG monitoring, based on a multiparametric FHR analysis, which includes spectral parameters from autoregressive models and nonlinear algorithms (approximate entropy). This preliminary study considers 14 normal fetuses, eight cases of gestational (maternal) diabetes, and 13 intrauterine growth retarded fetuses. A comparison with the traditional time domain analysis is also included. This paper shows that the proposed new parameters are able to separate normal from pathological fetuses. Results constitute the first step for realizing a new clinical classification system for the early diagnosis of most common fetal pathologies.
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Affiliation(s)
- Maria G Signorini
- Dipartimento di Bioingegneria, University Politecnico di Milan, 20133 Milano, Italy.
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Abstract
Computer analysis of the fetal heart rate is a technology of the Information Age commercially available for research and clinical practice. Intelligent systems are engineered with algorithms or neural networks designed to simulate expert knowledge. Automated analysis has provided objective, standardized, and reproducible data used to research fetal heart rate responses in the antepartum and intrapartum setting. Perinatal information systems can integrate FHR analysis and data management.
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Affiliation(s)
- P R McCartney
- School of Nursing, State University of New York, Buffalo, USA
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