Nonstress testing at ≤ 32.0 weeks' gestation: a randomized trial comparing different assessment criteria

Effectiveness of selected Maternal Positions Onbiophysiological Parameters of Antenatal Mothers and Fetus During Non Stress Test

Non-Stress test is a non-invasive test performed over 28 week of gestation for detection of ante partum fetal surveillance. Maternal positioning can have an impact on both the mother’s and fetal physiological well-being. Objective: Assess and compare the effectiveness of maternal positions on bio physiological parameters of the fetus during NST. Methods: Quantitative quasi-experimental pretest, posttest only research design, 60 mothers were selected by random sampling technique. Maternal, fetal bio physiological parameters tool was used. The mothers were placed in left lateral, supine position while performing NST and fetal parameters were monitored and interpreted. Mother vitals also monitored. Results: The post test score of fetal reaction in supine was 4.20±1.16 and in lateral 4.90±0.31. The calculated independents’ test value of t = 3.205 was found to be statistically significant at p<0.01 level. Conclusion: This reveals that the left lateral position is highly effective position for the mother while performing NST.

Antepartum Fetal Surveillance: ACOG Practice Bulletin, Number 229

The goal of antepartum fetal surveillance is to reduce the risk of stillbirth. Antepartum fetal surveillance techniques based on assessment of fetal heart rate (FHR) patterns have been in clinical use for almost four decades and are used along with real-time ultrasonography and umbilical artery Doppler velocimetry to evaluate fetal well-being. Antepartum fetal surveillance techniques are routinely used to assess the risk of fetal death in pregnancies complicated by preexisting maternal conditions (eg, diabetes mellitus) as well as those in which complications have developed (eg, fetal growth restriction). The purpose of this document is to provide a review of the current indications for and techniques of antepartum fetal surveillance and outline management guidelines for antepartum fetal surveillance that are consistent with the best scientific evidence.

FIGO (international Federation of Gynecology and obstetrics) initiative on fetal growth: best practice advice for screening, diagnosis, and management of fetal growth restriction

Fetal growth restriction (FGR) is defined as the failure of the fetus to meet its growth potential due to a pathological factor, most commonly placental dysfunction. Worldwide, FGR is a leading cause of stillbirth, neonatal mortality, and short- and long-term morbidity. Ongoing advances in clinical care, especially in definitions, diagnosis, and management of FGR, require efforts to effectively translate these changes to the wide range of obstetric care providers. This article highlights agreements based on current research in the diagnosis and management of FGR, and the areas that need more research to provide further clarification of recommendations. The purpose of this article is to provide a comprehensive summary of available evidence along with practical recommendations concerning the care of pregnancies at risk of or complicated by FGR, with the overall goal to decrease the risk of stillbirth and neonatal mortality and morbidity associated with this condition. To achieve these goals, FIGO (the International Federation of Gynecology and Obstetrics) brought together international experts to review and summarize current knowledge of FGR. This summary is directed at multiple stakeholders, including healthcare providers, healthcare delivery organizations and providers, FIGO member societies, and professional organizations. Recognizing the variation in the resources and expertise available for the management of FGR in different countries or regions, this article attempts to take into consideration the unique aspects of antenatal care in low-resource settings (labelled “LRS” in the recommendations). This was achieved by collaboration with authors and FIGO member societies from low-resource settings such as India, Sub-Saharan Africa, the Middle East, and Latin America.

Characteristics of Heart Rate Tracings in Preterm Fetus

Background and Objectives: Prematurity is currently a serious public health issue worldwide, because of its high associated morbidity and mortality. Optimizing the management of these pregnancies is of high priority to improve perinatal outcomes. One tool frequently used to determine the degree of fetal wellbeing is cardiotocography (CTG). A review of the available literature on fetal heart rate (FHR) monitoring in preterm fetuses shows that studies are scarce, and the evidence thus far is unclear. The lack of reference standards for CTG patterns in preterm fetuses can lead to misinterpretation of the changes observed in electronic fetal monitoring (EFM). The aims of this narrative review were to summarize the most relevant concepts in the field of CTG interpretation in preterm fetuses, and to provide a practical approach that can be useful in clinical practice. Materials and Methods: A MEDLINE search was carried out, and the published articles thus identified were reviewed. Results: Compared to term fetuses, preterm fetuses have a slightly higher baseline FHR. Heart rate is faster in more immature fetuses, and variability is lower and increases in more mature fetuses. Transitory, low-amplitude decelerations are more frequent during the second trimester. Transitory increases in FHR are less frequent and become more frequent and increase in amplitude as gestational age increases. Conclusions: The main characteristics of FHR tracings changes as gestation proceeds, and it is of fundamental importance to be aware of these changes in order to correctly interpret CTG patterns in preterm fetuses.

What you need to know about maternal-fetal medicine

The field of pediatric Surgery now encompasses fetal Surgery. The purpose of this article is to review aspects of antepartum care pertinent to the fetal and pediatric surgeon. We summarize antepartum screening, methods to assess the fetus, gestational disorders and variants of umbilical cord insertion sites and the placenta.

The Effects of Maternal Opium Abuse on Fetal Heart Rate using Non-Stress Test

BACKGROUND

Opium is one of the most commonly abused opiates in developing countries including Iran. Considering the importance of maternal health on the newborn, we aimed to assess the effect of opium abuse on fetal heart rate (FHR) characteristics in a sample of pregnant women in Zahedan, Southeast Iran.

METHODS

This cross-sectional study was done on 100 pregnant women referring to Ali-Ibn-Abi Talib Hospital in Zahedan, during 2011-2013. The participants were divided into two groups comprising of opium abusers and healthy individuals. The participants received 500cc intravenous fluid containing dextrose and then non-stress test results were recorded for 20 minutes.

RESULTS

We found no significant difference between the two groups with respect to their demographic characteristics. Fetal movements, variability, acceleration, and reactivity were significantly higher among addicted women (P<0.0001 for all). Periodic change was 9.8 times higher among opium abusers compared with the healthy women. Abnormal variability or oscillations of <15 beats/min, which indicates lack of beat-to-beat variability, was significantly higher in the fetuses of addicted mothers (P<0.0001).

CONCLUSION

Considering significant abnormal patterns in FHR characteristics among the opium abuser group, mothers addicted to opium need specific prenatal care.

Antenatal cardiotocography for fetal assessment

BACKGROUND

Cardiotocography (CTG) is a continuous recording of the fetal heart rate obtained via an ultrasound transducer placed on the mother's abdomen. CTG is widely used in pregnancy as a method of assessing fetal well-being, predominantly in pregnancies with increased risk of complications.

OBJECTIVES

To assess the effectiveness of antenatal CTG (both traditional and computerised assessments) in improving outcomes for mothers and babies during and after pregnancy.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (26 June 2015) and reference lists of retrieved studies.

SELECTION CRITERIA

Randomised and quasi-randomised trials that compared traditional antenatal CTG with no CTG or CTG results concealed; computerised CTG with no CTG or CTG results concealed; and computerised CTG with traditional CTG.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.

MAIN RESULTS

Six studies (involving 2105 women) are included. Overall, the included studies were not of high quality, and only two had both adequate randomisation sequence generation and allocation concealment. All studies that were able to be included enrolled only women at increased risk of complications.Comparison of traditional CTG versus no CTG showed no significant difference identified in perinatal mortality (risk ratio (RR) 2.05, 95% confidence interval (CI) 0.95 to 4.42, 2.3% versus 1.1%, four studies, N = 1627, low quality evidence) or potentially preventable deaths (RR 2.46, 95% CI 0.96 to 6.30, four studies, N = 1627), though the meta-analysis was underpowered to assess this outcome. Similarly, there was no significant difference identified in caesarean sections (RR 1.06, 95% CI 0.88 to 1.28, 19.7% versus 18.5%, three trials, N = 1279, low quality evidence). There was also no significant difference identified for secondary outcomes related to Apgar scores less than seven at five minutes (RR 0.83, 95% CI 0.37 to 1.88, one trial, N = 396, very low quality evidence); or admission to neonatal special care units or neonatal intensive care units (RR 1.08, 95% CI 0.84 to 1.39, two trials, N = 883, low quality evidence), nor in the other secondary outcomes that were assessed.There were no eligible studies that compared computerised CTG with no CTG.Comparison of computerised CTG versus traditional CTG showed a significant reduction in perinatal mortality with computerised CTG (RR 0.20, 95% CI 0.04 to 0.88, two studies, 0.9% versus 4.2%, 469 women, moderate quality evidence). However, there was no significant difference identified in potentially preventable deaths (RR 0.23, 95% CI 0.04 to 1.29, two studies, N = 469), though the meta-analysis was underpowered to assess this outcome. There was no significant difference identified in caesarean sections (RR 0.87, 95% CI 0.61 to 1.24, 63% versus 72%, one study, N = 59, low quality evidence), Apgar scores less than seven at five minutes (RR 1.31, 95% CI 0.30 to 5.74, two studies, N = 469, very low quality evidence) or in secondary outcomes.

AUTHORS' CONCLUSIONS

There is no clear evidence that antenatal CTG improves perinatal outcome, but further studies focusing on the use of computerised CTG in specific populations of women with increased risk of complications are warranted.