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Neppelenbroek EM, van der Heijden OWH, de Vet HCW, de Groot AJJ, Daemers DOA, de Jonge A, Verhoeven CJM. Inter- and intraobserver agreement of antenatal cardiotocography assessments by maternity care professionals: A prospective study. Int J Gynaecol Obstet 2024; 166:1114-1120. [PMID: 38516915 DOI: 10.1002/ijgo.15497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 03/03/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE In the Netherlands, antenatal cardiotocography (aCTG) to assess fetal well-being is performed in obstetrician-led care. An innovative initiative was started to evaluate whether aCTG for specific indications-reduced fetal movements, external cephalic version, or postdate pregnancy-is feasible in non-obstetrician-led care settings by independent primary care midwives. Quality assessment is essential when reorganizing and shifting tasks and responsibilities. Therefore, we aimed to assess the inter- and intraobserver agreement for aCTG assessments between and within four professional groups involved in Dutch maternity care regarding the overall classification and assessment of the various components of aCTG. METHOD This was a prospective study among 47 Dutch primary care midwives, hospital-based midwives, residents, and obstetricians. Ten aCTG traces were assessed twice at a 1 month interval. To ensure a representative sample, we used two different sets of 10 aCTG traces each. We calculated the degree of agreement using the proportions of agreement. RESULTS The proportions of agreement for interobserver agreement on the classification of aCTG between and within the four professional groups varied from 0.82 to 0.94. The proportions of agreement for each professional group were slightly higher for intraobserver (0.86-0.94) than for interobserver agreement. For the various aCTG components, the proportions of agreement for interobserver agreement varied from 0.64 (presence of contractions) to 0.98 (baseline heart frequency). CONCLUSION The proportion of agreement levels between and within the maternity care professionals in the classification of aCTG traces among healthy women were comparable. This means that these professional groups are equally well able to classify aCTGs in healthy pregnant women.
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Affiliation(s)
- Elise M Neppelenbroek
- Midwifery Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Olivier W H van der Heijden
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, Netherlands
| | - Henrica C W de Vet
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Amanda J J de Groot
- Department of Obstetrics and Gynecology, University Medical Center Rotterdam, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - Darie O A Daemers
- Research Center for Midwifery Practice, Zuyd University of Applied Sciences, Maastricht, Netherlands
| | - Ank de Jonge
- Midwifery Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Amsterdam Reproduction and Development, Amsterdam, Netherlands
| | - Corine J M Verhoeven
- Midwifery Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, UK
- Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, Netherlands
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Campos I, Gonçalves H, Bernardes J, Castro L. Fetal Heart Rate Preprocessing Techniques: A Scoping Review. Bioengineering (Basel) 2024; 11:368. [PMID: 38671789 PMCID: PMC11048563 DOI: 10.3390/bioengineering11040368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/01/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
Monitoring fetal heart rate (FHR) through cardiotocography is crucial for the early diagnosis of fetal distress situations, necessitating prompt obstetrical intervention. However, FHR signals are often marred by various contaminants, making preprocessing techniques essential for accurate analysis. This scoping review, following PRISMA-ScR guidelines, describes the preprocessing methods in original research articles on human FHR (or beat-to-beat intervals) signal preprocessing from PubMed and Web of Science, published from their inception up to May 2021. From the 322 unique articles identified, 54 were included, from which prevalent preprocessing approaches were identified, primarily focusing on the detection and correction of poor signal quality events. Detection usually entailed analyzing deviations from neighboring samples, whereas correction often relied on interpolation techniques. It was also noted that there is a lack of consensus regarding the definition of missing samples, outliers, and artifacts. Trends indicate a surge in research interest in the decade 2011-2021. This review underscores the need for standardizing FHR signal preprocessing techniques to enhance diagnostic accuracy. Future work should focus on applying and evaluating these methods across FHR databases aiming to assess their effectiveness and propose improvements.
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Affiliation(s)
- Inês Campos
- Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
- Institute of Biomedical Sciences Abel Salazar, University of Porto, 4050-313 Porto, Portugal
| | - Hernâni Gonçalves
- Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (H.G.); (J.B.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - João Bernardes
- Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (H.G.); (J.B.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Obstetrics and Gynecology, São João Hospital, 4200-319 Porto, Portugal
| | - Luísa Castro
- Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (H.G.); (J.B.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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Stampalija T, Bhide A, Heazell AEP, Sharp A, Lees C. Computerized cardiotocography and Dawes-Redman criteria: how should we interpret criteria not met? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:661-666. [PMID: 36905681 DOI: 10.1002/uog.26198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 06/03/2023]
Affiliation(s)
- T Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - A E P Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - A Sharp
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - C Lees
- Institute of Developmental and Reproductive Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK
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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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Frequency-Based Maternal Electrocardiogram Attenuation for Fetal Electrocardiogram Analysis. Ann Biomed Eng 2022; 50:836-846. [PMID: 35403976 PMCID: PMC9148873 DOI: 10.1007/s10439-022-02959-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/23/2022] [Indexed: 11/01/2022]
Abstract
Fetal electrocardiogram (ECG) waveform analysis along with cardiac time intervals (CTIs) measurements are critical for the management of high-risk pregnancies. Currently, there is no system that can consistently and accurately measure fetal ECG. In this work, we present a new automatic approach to attenuate the maternal ECG in the frequency domain and enhance it with measurable CTIs. First, the coherent components between the maternal ECG and abdominal ECG were identified and subtracted from the latter in the frequency domain. The residual was then converted into the time domain using the inverse Fourier transform to yield the fetal ECG. This process was improved by averaging multiple beats. Two fetal cardiologists, blinded to the method, assessed the quality of fetal ECG based on a grading system and measured the CTIs. We evaluated the fetal ECG quality of our method and time-based methods using one synthetic dataset, one human dataset available in the public domain, and 37 clinical datasets. Among the 37 datasets analyzed, the mean average (± standard deviation) grade was 3.49 ± 1.22 for our method vs. 2.64 ± 1.26 for adaptive interference cancellation (p-value < 0.001), thus showing the frequency-based fetal ECG extraction was the superior method, as assessed from our clinicians' perspectives. This method has the potential for use in clinical settings.
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Bovbjerg ML. Current Resources for Evidence-Based Practice, November 2021. J Obstet Gynecol Neonatal Nurs 2021; 50:789-800. [PMID: 34653377 DOI: 10.1016/j.jogn.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of autonomy and respect in maternity care and commentaries on reviews focused on whether to induce women who present with mild preeclampsia in the late preterm period and the extent to which urinary incontinence symptoms prevent women from participating in exercise. It also includes a brief update about the USPSTF guidelines on screening for gestational diabetes.
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