1
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Kasap B, Vali K, Qian W, Mo L, Chithiwala ZH, Curtin AC, Ghiasi S, Hedriana HL. Transcutaneous Discrimination of Fetal Heart Rate from Maternal Heart Rate: A Fetal Oximetry Proof-of-Concept. Reprod Sci 2024; 31:2331-2341. [PMID: 38728001 DOI: 10.1007/s43032-024-01582-z] [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: 07/14/2023] [Accepted: 04/29/2024] [Indexed: 07/31/2024]
Abstract
Intrapartum care uses electronic fetal heart rate monitoring (EFHRM) for over 50 years to indirectly assess fetal oxygenation. However, this approach has been associated with an increase in cesarean delivery rates and limited improvements in neonatal hypoxic outcome. To address these shortcomings, a novel transabdominal fetal pulse oximeter (TFO) is being developed to provide an objective measurement of fetal oxygenation. Previous studies have evaluated the performance of TFO on pregnant ewe. Building on the animal model, this study aims to determine whether TFO can successfully capture human fetal heart rate (FHR) signals during non-stress testing (NST) as a proof-of-concept. Eight ongoing pregnancies meeting specific inclusion criteria (18-40 years old, singleton, and at least 36 weeks' gestation) were enrolled with consent. Each study session was 15 to 20 min long. Reference maternal heart rate (MHR) and FHR were obtained using finger pulse oximetry and cardiotocography for subsequent comparison. The overall root-mean-square error was 9.7BPM for FHR and 4.4 for MHR, while the overall mean-absolute error was 7.6BPM for FHR and 1.8 for MHR. Bland-Altman analysis displayed a mean bias ± standard deviation between TFO and reference of -3.9 ± 8.9BPM, with limits of agreement ranging from -21.4 to 13.6 BPM. Both maternal and fetal heart rate measurements obtained from TFO exhibited a p-value < 0.001, showing significant correlation with the reference. This proof-of-concept study successfully demonstrates that TFO can accurately differentiate maternal and fetal heart signals in human subjects. This achievement marks the initial step towards enabling fetal oxygen saturation measurement in humans using TFO.
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Affiliation(s)
- Begum Kasap
- Department of Electrical and Computer Engineering, University of California Davis, Davis, CA, USA.
| | - Kourosh Vali
- Department of Electrical and Computer Engineering, University of California Davis, Davis, CA, USA
| | - Weitai Qian
- Department of Electrical and Computer Engineering, University of California Davis, Davis, CA, USA
| | - Lihong Mo
- Department of Obstetrics and Gynecology, University of California Davis Health, Sacramento, CA, USA
| | - Zahabiya H Chithiwala
- Department of Obstetrics and Gynecology, University of California Davis Health, Sacramento, CA, USA
| | - Anna C Curtin
- Department of Obstetrics and Gynecology, University of California Davis Health, Sacramento, CA, USA
| | - Soheil Ghiasi
- Department of Electrical and Computer Engineering, University of California Davis, Davis, CA, USA
| | - Herman L Hedriana
- Department of Obstetrics and Gynecology, University of California Davis Health, Sacramento, CA, USA
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2
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Wisner K, Holschuh C. Fetal Heart Rate Auscultation, 4th Edition. J Obstet Gynecol Neonatal Nurs 2024; 53:e10-e48. [PMID: 38363241 DOI: 10.1016/j.jogn.2023.11.001] [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: 02/17/2024] Open
Abstract
Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.
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3
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Wisner K, Holschuh C. Fetal Heart Rate Auscultation, 4th Edition. Nurs Womens Health 2024; 28:e1-e39. [PMID: 38363259 DOI: 10.1016/j.nwh.2023.11.001] [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: 02/17/2024]
Abstract
Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.
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4
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Jakovac MB, Etrusco A, Mikuš M, Roje D, Marusic J, Palada I, Kosovic I, Aracic N, Sunj M, Laganà AS, Chiantera V, Dujic Z. Evaluation of placental oxygenation by near-infrared spectroscopy in relation to ultrasound maturation grade in physiological term pregnancies. Open Med (Wars) 2023; 18:20230843. [PMID: 38025545 PMCID: PMC10655680 DOI: 10.1515/med-2023-0843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/13/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
A prospective observational study (ClinicalTrial ID: NCT05771415) was conducted to compare placental oxygenation in low-risk, uncomplicated term pregnancies measured by near-infrared spectroscopy (NIRS) in relation to the placental maturity grade determined by ultrasound assessment according to the Grannum scale. We included 34 pregnancies divided into two groups according to placental maturation. For each pregnancy, measurements were taken at the site above the central part of the placenta (test) and at the site outside of the placenta on the lower abdomen (control). Student's t-test was used to compare tissue oxygenation index (TOI) values among the study groups. The normality of distribution was proven by the Kolmogorov‒Smirnov test. In women with low placental maturity grade, the mean TOI value above the placenta was 70.38 ± 3.72, which was lower than the respective value in women with high placental maturity grade (77.99 ± 3.71; p < 0.001). The TOI values above the placenta and the control site were significantly different in both groups (70.38 ± 3.72 vs 67.83 ± 3.21 and 77.99 ± 3.71 vs 69.41 ± 3.93; p < 0.001). The results offer a new perspective on placental function based on specific non-invasive real-time oxygenation measurements. Unfortunately, and because of technical limitations, NIRS cannot yet be implemented as a routine clinical tool.
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Affiliation(s)
| | - Andrea Etrusco
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133Palermo, Italy
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127Palermo, Italy
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, Clinical Hospital Center, 10000Zagreb, Croatia
| | - Damir Roje
- Department of Health Studies, University of Split, 21000Split, Croatia
- University of Split School of Medicine, 21000Split, Croatia
- Department of Obstetrics and Gynecology, University Hospital Center, 21000Split, Croatia
| | - Jelena Marusic
- Department of Health Studies, University of Split, 21000Split, Croatia
- University of Split School of Medicine, 21000Split, Croatia
- Department of Obstetrics and Gynecology, University Hospital Center, 21000Split, Croatia
| | - Ivan Palada
- Department of Health Studies, University of Split, 21000Split, Croatia
- Roda Polyclinic, 21000Split, Croatia
| | - Indira Kosovic
- Department of Obstetrics and Gynecology, University Hospital Center, 21000Split, Croatia
| | - Nadja Aracic
- Department of Health Studies, University of Split, 21000Split, Croatia
- Cito Polyclinic, 21000Split, Croatia
| | - Martina Sunj
- Department of Health Studies, University of Split, 21000Split, Croatia
- Department of Obstetrics and Gynecology, University Hospital Center, 21000Split, Croatia
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133Palermo, Italy
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133Palermo, Italy
- Unit of Gynecologic Oncology, National Cancer Institute – IRCCS – Fondazione “G. Pascale”, 80131Naples, Italy
| | - Zeljko Dujic
- University of Split School of Medicine, 21000Split, Croatia
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5
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Magawa S, Maki S, Nii M, Yamaguchi M, Tamaishi Y, Enomoto N, Takakura S, Toriyabe K, Kondo E, Ikeda T. Evaluation of fetal acidemia during delivery using the conventional 5-tier classification and Rainbow systems. PLoS One 2023; 18:e0287535. [PMID: 37352197 PMCID: PMC10289380 DOI: 10.1371/journal.pone.0287535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/07/2023] [Indexed: 06/25/2023] Open
Abstract
The association between prepartum time-series fetal heart rate pattern changes and cord blood gas data at delivery was examined using the conventional 5-tier classification and the Rainbow system for 229 female patients who delivered vaginally. They were classified into three groups based on the results of umbilical cord blood gas analysis at delivery. The fetal heart rate pattern classifications were based on analysis of measurement taken at 10-min intervals, beginning at 120 min pre-delivery. The relationship between fetal heart rate pattern classification and cord blood pH at delivery changed over time. The 5-tier classification at each interval increased before delivery in the Mild and Severe groups compared with the Normal group. No significant differences were observed between acidemia groups. The Rainbow classification showed a significant differences between the acidemia groups at each interval, particularly during the prepartum period. A relationship between classification and outcome was evident before delivery for both the 5-tier classification and Rainbow system.
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Affiliation(s)
- Shoichi Magawa
- Department of Obstetrics and Gynecology, Mie University Faculty of Medicine, Mie, Japan
| | - Shintaro Maki
- Department of Obstetrics and Gynecology, Mie University Faculty of Medicine, Mie, Japan
| | - Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University Faculty of Medicine, Mie, Japan
| | - Mizuki Yamaguchi
- Department of Obstetrics and Gynecology, Mie University Faculty of Medicine, Mie, Japan
| | - Yuya Tamaishi
- Department of Obstetrics and Gynecology, Mie University Faculty of Medicine, Mie, Japan
| | - Naosuke Enomoto
- Department of Obstetrics and Gynecology, Mie University Faculty of Medicine, Mie, Japan
| | - Sho Takakura
- Department of Obstetrics and Gynecology, Mie University Faculty of Medicine, Mie, Japan
| | - Kuniaki Toriyabe
- Department of Obstetrics and Gynecology, Mie University Faculty of Medicine, Mie, Japan
| | - Eiji Kondo
- Department of Obstetrics and Gynecology, Mie University Faculty of Medicine, Mie, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Faculty of Medicine, Mie, Japan
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6
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Roth LM. Defensive versus evidence-based medical technology: Liability risk and electronic fetal monitoring in low-risk births. Soc Sci Med 2023; 317:115565. [PMID: 36493500 DOI: 10.1016/j.socscimed.2022.115565] [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: 03/08/2022] [Revised: 10/18/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022]
Abstract
Technology-intensive birth practices are a hallmark of the overmedicalization of birth. For example, obstetricians routinely use continuous electronic fetal monitoring (EFM), even though this technology is not evidence-based, has a high rate of false positives, and does not improve outcomes in low-risk deliveries. Providers often argue that they must use EFM to protect themselves from malpractice liability, making it a form of defensive medicine. But does variation in actual liability risk contribute significantly to the use of non-evidence-based medical technology like EFM? This study uses multi-level logistic models to examine the effects of malpractice laws and lawsuits on EFM in low-risk births from 1995 to 2003. The models test the hypothesis that state-level variation in liability risk should influence the probability of EFM use. The models reveal that the probability of reporting EFM is higher when states artificially reduce liability risk by capping damage awards, suggesting that objective liability risk does not promote routine EFM and may deter it. In fact, caps on damages limit providers' legal exposure without doing anything to encourage higher quality care. It is possible that states without tort reforms place greater emphasis on patient rights, safety, and quality of care. On the other hand, by reducing liability risk without encouraging improvements in quality, tort reform laws may inadvertently promote more technology use.
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Affiliation(s)
- Louise Marie Roth
- University of Arizona, 400 Social Sciences Building, Tucson, AZ, 85721, USA.
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7
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Tarvonen MJ, Lear CA, Andersson S, Gunn AJ, Teramo KA. Increased variability of fetal heart rate during labour: a review of preclinical and clinical studies. BJOG 2022; 129:2070-2081. [PMID: 35596699 PMCID: PMC9796294 DOI: 10.1111/1471-0528.17234] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/02/2022] [Accepted: 05/16/2022] [Indexed: 01/01/2023]
Abstract
Increased fetal heart rate variability (FHRV) in intrapartum cardiotocographic recording has been variably defined and poorly understood, limiting its clinical utility. Both preclinical (animal) and clinical (human) evidence support that increased FHRV is observed in the early stage of intrapartum fetal hypoxaemia but can also be observed in a subset of fetuses during the preterminal stage of repeated hypoxaemia. This review of available evidence provides data and expert opinion on the pathophysiology of increased FHRV, its clinical significance and a stepwise approach regarding the management of this pattern, and propose recommendations for standardisation of related terminology.
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Affiliation(s)
- Mikko J. Tarvonen
- Department of Obstetrics and GynaecologyUniversity of Helsinki, and Helsinki University HospitalHelsinkiFinland
| | - Christopher A. Lear
- Fetal Physiology and Neuroscience GroupDepartment of PhysiologyUniversity of AucklandAucklandNew Zealand
| | - Sture Andersson
- Children’s Hospital, Paediatric Research CentreUniversity of Helsinki, and Helsinki University HospitalHelsinkiFinland
| | - Alistair J. Gunn
- Fetal Physiology and Neuroscience GroupDepartment of PhysiologyUniversity of AucklandAucklandNew Zealand
| | - Kari A. Teramo
- Department of Obstetrics and GynaecologyUniversity of Helsinki, and Helsinki University HospitalHelsinkiFinland
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8
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Dachew BA, Tessema GA, Alati R. Association between obstetric mode of delivery and emotional and behavioural problems in children and adolescents: the children of the 90s health study. Soc Psychiatry Psychiatr Epidemiol 2022:10.1007/s00127-022-02374-z. [PMID: 36239743 DOI: 10.1007/s00127-022-02374-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/02/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Existing evidence on the relationship between mode of delivery and offspring emotional and behavioural problems, especially in older age groups, is limited and inconsistent. This study aimed to examine the association between obstetric mode of delivery and emotional and behavioural problems in offspring aged 3-16 years. METHODS The sample for this study comprised participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) in the United Kingdom. The study cohort ranged from 7074 (at 3 years of age) to 4071 (at 16 years of age) mother-offspring pairs. Data on obstetric mode of delivery were abstracted from obstetric records by trained research midwives and classified as spontaneous vaginal delivery, assisted vaginal delivery and caesarean delivery (elective and emergency). Offspring emotional and behavioural problems were measured using the Strengths and Difficulties Questionnaire (SDQ) when the child was 3, 7, 9, 11, and 16 years. Logistic regression analyses were used to examine associations. RESULTS Assisted vaginal delivery was associated with an increased risk of emotional problems at age 11 years (OR = 1.42; 95% CI 1.11-1.81). No significant associations were observed at ages 3, 7, 9 and 16. We found no evidence of associations between caesarean delivery (elective or emergency) and emotional and behavioural measures in offspring across all age groups. CONCLUSION Mode of delivery does not appear to be associated with emotional and behavioural problems in children and adolescents. Further research is needed to understand the potential longer-term effects of assisted vaginal deliveries on offspring emotional development.
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Affiliation(s)
| | - Gizachew A Tessema
- School of Population Health, Curtin University, Perth, Australia.,School of Public Health, University of Adelaide, Adelaide, Australia
| | - Rosa Alati
- School of Population Health, Curtin University, Perth, Australia.,Institute for Social Science Research, The University of Queensland, Brisbane, Australia
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9
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Zhou H, Lai KF, Xiang Q, Zhang LL, Xu Y, Cheng C, Huan W. Second-stage cesarean delivery and preterm birth in subsequent pregnancy: A large multi-institutional cohort study. J Gynecol Obstet Hum Reprod 2022; 51:102447. [DOI: 10.1016/j.jogoh.2022.102447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022]
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10
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Uzianbaeva L, Yan Y, Joshi T, Yin N, Hsu CD, Hernandez-Andrade E, Mehrmohammadi M. Methods for Monitoring Risk of Hypoxic Damage in Fetal and Neonatal Brains: A Review. Fetal Diagn Ther 2021; 49:1-24. [PMID: 34872080 PMCID: PMC8983560 DOI: 10.1159/000520987] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/16/2021] [Indexed: 11/19/2022]
Abstract
Fetal, perinatal, and neonatal asphyxia are vital health issues for the most vulnerable groups in human beings, including fetuses, newborns, and infants. Severe reduction in oxygen and blood supply to the fetal brain can cause hypoxic-ischemic encephalopathy (HIE), leading to long-term neurological disorders, including mental impairment and cerebral palsy. Such neurological disorders are major healthcare concerns. Therefore, there has been a continuous effort to develop clinically useful diagnostic tools for accurately and quantitatively measuring and monitoring blood and oxygen supply to the fetal and neonatal brain to avoid severe consequences of asphyxia HIE and neonatal encephalopathy. Major diagnostic technologies used for this purpose include fetal heart rate monitoring, fetus scalp blood sampling, ultrasound imaging, magnetic resonance imaging, X-ray computed tomography, and nuclear medicine. In addition, given the limitations and shortcomings of traditional diagnostic methods, emerging technologies such as near-infrared spectroscopy and photoacoustic imaging have also been introduced as stand-alone or complementary solutions to address this critical gap in fetal and neonatal care. This review provides a thorough overview of the traditional and emerging technologies for monitoring fetal and neonatal brain oxygenation status and describes their clinical utility, performance, advantages, and disadvantages.
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Affiliation(s)
- Liaisan Uzianbaeva
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
| | - Yan Yan
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
| | - Tanaya Joshi
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
| | - Nina Yin
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
- Department of Anatomy, School of Basic Medical Science, Hubei University of Chinese Medicine, Wuhan, China
| | - Chaur-Dong Hsu
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, University of Arizona, College of Medicine, Tucson, Arizona, USA
| | - Edgar Hernandez-Andrade
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center, Houston, Texas, USA
| | - Mohammad Mehrmohammadi
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, and Detroit, MI, USA
- Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
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11
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Clapp MA, McCoy TH. The potential of big data for obstetrics discovery. Curr Opin Endocrinol Diabetes Obes 2021; 28:553-557. [PMID: 34709211 DOI: 10.1097/med.0000000000000679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW The purpose of this article is to introduce the concept of 'Big Data' and review its potential to advance scientific discovery in obstetrics. RECENT FINDINGS Big Data is now ubiquitous in medicine, being used in many specialties to understand the pathophysiology, risk factors, and treatment for many diseases. Big Data analyses often employ machine learning methods to understand the complex relationships that may exist within these sources. We review the basic principles of supervised and unsupervised machine learning methods, including deep learning. We highlight how these methods have been used to study genetic risk factors for preterm birth, interpreting electronic fetal heart rate tracings, and predict adverse maternal and neonatal outcomes during pregnancy and delivery. Despite its promise, there are challenges with using Big Data, including data integrity, generalizability (namely the concerns about perpetuating inequalities), and confidentiality. SUMMARY The combination of new data and enhanced methods present a synergistic opportunity to explore the complex relationships common to human illness and medical practice, including obstetrics. With prediction as a primary objective instead of the more familiar goals of hypothesis testing, these analytic methods can capture multifaceted, rare, and nuanced relationships between exposures and outcomes that exist within these large data sets.
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Affiliation(s)
- Mark A Clapp
- Department of Obstetrics and Gynecology
- Center for Quantitative Health, Massachusetts General Hospital
- Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas H McCoy
- Center for Quantitative Health, Massachusetts General Hospital
- Harvard Medical School, Boston, Massachusetts, USA
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12
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Yan Y, Hernandez-Andrade E, Basij M, Alshahrani SS, Kondle S, Brown BO, Gelovani J, Hassan S, Hsu CD, Mehrmohammadi M. Endocavity ultrasound and photoacoustic system for fetal and maternal imaging: design, implementation, and ex-vivo validation. J Med Imaging (Bellingham) 2021; 8:066001. [PMID: 34778491 DOI: 10.1117/1.jmi.8.6.066001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/22/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose: Transvaginal ultrasound (TVUS) is a widely used real-time and non-invasive imaging technique for fetal and maternal care. It can provide structural and functional measurements about the fetal brain, such as blood vessel diameter and blood flow. However, it lacks certain biochemical estimations, such as hemoglobin oxygen saturation ( SO 2 ), which limits its ability to indicate a fetus at risk of birth asphyxia. Photoacoustic (PA) imaging has been steadily growing in recognition as a complement to ultrasound (US). Studies have shown PA imaging is capable of providing such biochemical estimations as SO 2 at relatively high penetration depth (up to 30 mm). Approach: In this study, we have designed and developed a multi-modal (US, PA, and Doppler) endocavity imaging system (ECUSPA) around a commercialized TVUS probe (Philips ATL C9-5). Results: The integrated system was evaluated through a set of in-vitro, ex-vivo, and in-vivo studies. Imaging of excised sheep brain tissue demonstrated the system's utility and penetration depth in transfontanelle imaging conditions. The accuracy of using the spectroscopic PA imaging (sPA) method to estimate SO 2 was validated by comparing sPA oximetry results with the gold standard measurements indicated by a blood gas analyzer. The ability of US and Doppler to measure moving blood volume was evaluated in-vivo. Spectral unmixing capabilities were tested using fluorophores within sheep brains. Conclusion: The developed system is a high resolution (about 200 μ m at 30 mm depth), real-time (at 30 Hz), and quantitative ( SO 2 estimation error < 10 % ) imaging tool with a total diameter less than 30 mm, making it suitable for intrapartum applications such as fetal and maternal diagnostics.
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Affiliation(s)
- Yan Yan
- Wayne State University, Department of Biomedical Engineering, Detroit, Michigan, United States
| | - Edgar Hernandez-Andrade
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, U.S. Department of Health and Human Services, Detroit, Michigan, United States.,University of Texas, McGovern Medical School, Health Science Center at Houston (UTHealth), Department of Obstetrics and Gynecology and Reproductive Sciences, Houston, Texas, United States
| | - Maryam Basij
- Wayne State University, Department of Biomedical Engineering, Detroit, Michigan, United States
| | - Suhail S Alshahrani
- King Saud University, Department of Biomedical Technology, Riyadh, Kingdom of Saudi Arabia
| | - Sirisha Kondle
- Wayne State University, Department of Biomedical Engineering, Detroit, Michigan, United States
| | - Barrington O Brown
- Wayne State University, Department of Biomedical Engineering, Detroit, Michigan, United States
| | - Juri Gelovani
- Wayne State University, Department of Biomedical Engineering, Detroit, Michigan, United States
| | - Sonia Hassan
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, United States.,Wayne State University School of Medicine, Department of Physiology, Detroit, Michigan, United States.,Wayne State University School of Medicine, Office of Women's Health, Detroit, Michigan, United States
| | - Chaur-Dong Hsu
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, U.S. Department of Health and Human Services, Detroit, Michigan, United States
| | - Mohammad Mehrmohammadi
- Wayne State University, Department of Biomedical Engineering, Detroit, Michigan, United States.,Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, United States.,Wayne State University, Department of Electrical and Computer Engineering, Detroit, Michigan, United States.,Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, United States
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13
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Tarvonen M, Hovi P, Sainio S, Vuorela P, Andersson S, Teramo K. Intrapartal cardiotocographic patterns and hypoxia-related perinatal outcomes in pregnancies complicated by gestational diabetes mellitus. Acta Diabetol 2021; 58:1563-1573. [PMID: 34151398 PMCID: PMC8505288 DOI: 10.1007/s00592-021-01756-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/01/2021] [Indexed: 12/14/2022]
Abstract
AIMS In previous reports, cardiotocographic (CTG) fetal heart rate (FHR) monitoring has shown only limited benefits in decreasing adverse perinatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM). The aim of the present study was to evaluate whether an association exists between the recently reported ZigZag pattern (FHR baseline amplitude changes of > 25 bpm with a duration of 2-30 min) and asphyxia-related neonatal outcomes in GDM pregnancies. METHODS Intrapartal CTGs were recorded in a one-year cohort of 5150 singleton childbirths. The following CTG changes were evaluated: ZigZag pattern, saltatory pattern, late decelerations, episodes of tachycardia and bradycardia, reduced variability, and uterine tachysystole. The cohort was divided into three groups: women with GDM, women with normal oral glucose tolerance test (OGTT), and women with no OGTT performed. Umbilical artery (UA) blood gases, Apgar scores, neonatal respiratory distress, and neonatal encephalopathy were used as outcome variables. RESULTS GDM was diagnosed in 624 (12.1%), OGTT was normal in 4115 (79.9%), and OGTT was not performed in 411 (8.0%) women. Hypoxia-related ZigZag patterns (OR 1.94, 95% CI 1.64-2.34) and late decelerations (OR 1.65, 95% CI 1.27-2.13) of FHR, as well as a greater risk of fetal asphyxia (UA pH < 7.10 and/or UA BE < -12.0 meq/L and/or Apgar scores < 7 at 5-min) (OR 6.64, 95% CI 1.84-12.03) were observed in those with GDM compared with those without GDM. CONCLUSIONS GDM is associated with intrapartal ZigZag pattern and late decelerations, cord blood acidemia and low 5-min Apgar scores at birth indicating increased occurrence of fetal hypoxia in GDM pregnancies.
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Affiliation(s)
- Mikko Tarvonen
- Department of Obstetrics and Gynecology, University of Helsinki, and Helsinki University Central Hospital, Helsinki, Finland.
| | - Petteri Hovi
- National Institute for Health and Welfare (THL), Helsinki, Finland
- Pediatric Research Center, Children's Hospital, University of Helsinki, and Helsinki University Central Hospital, Helsinki, Finland
| | - Susanna Sainio
- Finnish Red Cross Blood Transfusion Service, Helsinki, Finland
| | - Piia Vuorela
- Health and Social Welfare Department, Vantaa, Finland
| | - Sture Andersson
- Pediatric Research Center, Children's Hospital, University of Helsinki, and Helsinki University Central Hospital, Helsinki, Finland
| | - Kari Teramo
- Department of Obstetrics and Gynecology, University of Helsinki, and Helsinki University Central Hospital, Helsinki, Finland
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Leybovitz-Haleluya N, Wainstock T, Pariente G, Sheiner E. Non-reassuring fetal heart rate patterns: Is it a risk factor for long- term pediatric cardiovascular diseases of the offspring? Early Hum Dev 2021; 155:105330. [PMID: 33636513 DOI: 10.1016/j.earlhumdev.2021.105330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We aimed to study the long-term effect of non-reassuring fetal heart rate (NRFHR) patterns on the risk for subsequent pediatric cardiovascular morbidity of the offspring. STUDY DESIGN A population based cohort study, comparing total and different subtypes of cardiovascular morbidity related pediatric hospitalizations among offspring born by caesarean delivery (CD) due to NRFHR versus labor dystocia (failure of labor to progress during the 1st or 2nd stage). The analysis included all singletons born between the years 1999-2014 at a single tertiary regional medical center. Cardiovascular related morbidities included hospitalizations involving a pre-defined set of ICD-9 codes, as recorded in hospital computerized files. Infants with congenital malformations, multiple gestations, vaginal deliveries and vacuum failure were excluded from the analysis. Perinatal mortality cases were excluded from the long-term analysis. A Kaplan-Meier survival curve was used to compare the cumulative cardiovascular morbidity incidence, and a Cox proportional hazards model was used to adjust for confounders. RESULTS The study population included 9956 newborns who met inclusion criteria; among them, 5810 (58%) were born by CD due to NRFHR, and 4146 (42%) due to labor dystocia with normal FHR (comparison group). Rate of long- term cardiovascular related hospitalizations was comparable between both groups (0.8% vs. 0.7%, OR 0.9, 95% CI 0.6-1.4, p = 0.664; Kaplan-Meier survival curve p = 0.320(. Using a Cox proportional hazards model, controlling for gestational age, no association was found between NRFHR patterns and the risk for subsequent pediatric cardiovascular morbidity of the offspring (Adjusted HR = 0.8, 95% CI 0.5-1.3, p = 0.376). CONCLUSION In our population, NRFHR patterns do not affect the risk of long- term pediatric cardiovascular morbidity of the offspring.
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Affiliation(s)
- Noa Leybovitz-Haleluya
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Fong DD, Yamashiro KJ, Vali K, Galganski LA, Thies J, Moeinzadeh R, Pivetti C, Knoesen A, Srinivasan VJ, Hedriana HL, Farmer DL, Johnson MA, Ghiasi S. Design and In Vivo Evaluation of a Non-Invasive Transabdominal Fetal Pulse Oximeter. IEEE Trans Biomed Eng 2020; 68:256-266. [PMID: 32746021 DOI: 10.1109/tbme.2020.3000977] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Current intrapartum fetal monitoring technology is unable to provide physicians with an objective metric of fetal well-being, leading to degraded patient outcomes and increased litigation costs. Fetal oxygen saturation (SpO2) is a more suitable measure of fetal distress, but the inaccessibility of the fetus prior to birth makes this impossible to capture through current means. In this paper, we present a fully non-invasive, transabdominal fetal oximetry (TFO) system that provides in utero measures of fetal SpO2. METHODS TFO is performed by placing a reflectance-mode optode on the maternal abdomen and sending photons into the body to investigate the underlying fetal tissue. The proposed TFO system design consists of a multi-detector optode, an embedded optode control system, and custom user-interface software. To evaluate the developed TFO system, we utilized an in utero hypoxic fetal lamb model and performed controlled desaturation experiments while capturing gold standard arterial blood gases (SaO2). RESULTS Various degrees of fetal hypoxia were induced with true SaO2 values ranging between 10.5% and 66%. The non-invasive TFO system was able to accurately measure these fetal SpO2 values, supported by a root mean-squared error of 6.37% and strong measures of agreement with the gold standard. CONCLUSION The results support the efficacy of the presented TFO system to non-invasively measure a wide-range of fetal SpO2 values and identify critical levels of fetal hypoxia. SIGNIFICANCE TFO has the potential to improve fetal outcomes by providing obstetricians with a non-invasive measure of fetal oxygen saturation prior to delivery.
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Alemu AA, Zeleke LB. <p>Magnitude and Determinants of Primary Cesarean Section Among Women Who Gave Birth in Shire, Northern Ethiopia</p>. OPEN ACCESS SURGERY 2020. [DOI: 10.2147/oas.s254758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Suzuki S. Case Report: Peripartum periventricular leukomalacia resulting in cerebral palsy associated with placenta previa in Japan. F1000Res 2020; 9:241. [PMID: 39100101 PMCID: PMC11294804 DOI: 10.12688/f1000research.22878.2] [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] [Accepted: 04/30/2020] [Indexed: 08/06/2024] Open
Abstract
Intrapartum fetal heart rate monitoring abnormalities had been reported to correlate with decreased umbilical artery base excess associated with neonatal seizures. However, we present an infant born at 35 weeks of gestation diagnosed with cerebral palsy associated with periventricular leukomalacia (PVL) without fetal heart rate (FHR) monitoring abnormalities, According to the summary reports of PVL cases published on the home page of the Japan Obstetric Compensation System for Cerebral Palsy (JOCSC)), the percentage of placenta previa without FHR monitoring abnormalities in the cases of PVL was 5.7% (12/209), which seemed to be higher than the total percentage of placenta previa reported in Japan (0.3-0.5%).
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Affiliation(s)
- Shunji Suzuki
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Katsushika-ku, Tokyo, 124-0012, Japan
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18
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Garcia-Canadilla P, Sanchez-Martinez S, Crispi F, Bijnens B. Machine Learning in Fetal Cardiology: What to Expect. Fetal Diagn Ther 2020; 47:363-372. [PMID: 31910421 DOI: 10.1159/000505021] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/25/2019] [Indexed: 11/19/2022]
Abstract
In fetal cardiology, imaging (especially echocardiography) has demonstrated to help in the diagnosis and monitoring of fetuses with a compromised cardiovascular system potentially associated with several fetal conditions. Different ultrasound approaches are currently used to evaluate fetal cardiac structure and function, including conventional 2-D imaging and M-mode and tissue Doppler imaging among others. However, assessment of the fetal heart is still challenging mainly due to involuntary movements of the fetus, the small size of the heart, and the lack of expertise in fetal echocardiography of some sonographers. Therefore, the use of new technologies to improve the primary acquired images, to help extract measurements, or to aid in the diagnosis of cardiac abnormalities is of great importance for optimal assessment of the fetal heart. Machine leaning (ML) is a computer science discipline focused on teaching a computer to perform tasks with specific goals without explicitly programming the rules on how to perform this task. In this review we provide a brief overview on the potential of ML techniques to improve the evaluation of fetal cardiac function by optimizing image acquisition and quantification/segmentation, as well as aid in improving the prenatal diagnoses of fetal cardiac remodeling and abnormalities.
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Affiliation(s)
- Patricia Garcia-Canadilla
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain, .,Institute of Cardiovascular Science, University College London, London, United Kingdom,
| | | | - Fatima Crispi
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Bart Bijnens
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,ICREA, Barcelona, Spain
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Maternity Providers' Perspectives on Barriers to Utilization of Intermittent Fetal Monitoring: A Qualitative Study. J Perinat Neonatal Nurs 2020; 34:46-55. [PMID: 31996644 DOI: 10.1097/jpn.0000000000000453] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There are 2 approaches to fetal assessment during labor: continuous electronic fetal monitoring (EFM) and intermittent auscultation (IA). The vast majority of healthy labors in the United States use EFM, despite professional organization recommendations against its use for low-risk pregnancies. This qualitative investigation explores maternity care team members' perspectives on why EFM is the dominant approach to fetal assessment instead of IA. Focus groups comprised of nurses, midwives, and physicians were conducted using a semistructured interview guide. Transcripts were analyzed using directed content analysis to identify themes related to clinical and nonclinical factors influencing the type of fetal assessment employed during labor. Seven focus groups with a total of 41 participants were completed. Seven themes were identified: clinical environment; technology; policies, procedures, and evidence-based protocols; patient-centered influences; fear of liability; providers as members of healthcare team; and deflection of responsibility. All maternity care team members had knowledge of the evidence base supporting IA use for low-risk care. Nurses identified unique challenges in having agency over monitoring decision making and executing best practices. Improved communication among team members can facilitate evidence-based approaches to IA use, facilitating increased utilization for low-risk labor care.
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20
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Mawson AR, Croft AM. Rubella Virus Infection, the Congenital Rubella Syndrome, and the Link to Autism. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3543. [PMID: 31546693 PMCID: PMC6801530 DOI: 10.3390/ijerph16193543] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/09/2019] [Accepted: 09/15/2019] [Indexed: 12/16/2022]
Abstract
Rubella is a systemic virus infection that is usually mild. It can, however, cause severe birth defects known as the congenital rubella syndrome (CRS) when infection occurs early in pregnancy. As many as 8%-13% of children with CRS developed autism during the rubella epidemic of the 1960s compared to the background rate of about 1 new case per 5000 children. Rubella infection and CRS are now rare in the U.S. and in Europe due to widespread vaccination. However, autism rates have risen dramatically in recent decades to about 3% of children today, with many cases appearing after a period of normal development ('regressive autism'). Evidence is reviewed here suggesting that the signs and symptoms of rubella may be due to alterations in the hepatic metabolism of vitamin A (retinoids), precipitated by the acute phase of the infection. The infection causes mild liver dysfunction and the spillage of stored vitamin A compounds into the circulation, resulting in an endogenous form of hypervitaminosis A. Given that vitamin A is a known teratogen, it is suggested that rubella infection occurring in the early weeks of pregnancy causes CRS through maternal liver dysfunction and exposure of the developing fetus to excessive vitamin A. On this view, the multiple manifestations of CRS and associated autism represent endogenous forms of hypervitaminosis A. It is further proposed that regressive autism results primarily from post-natal influences of a liver-damaging nature and exposure to excess vitamin A, inducing CRS-like features as a function of vitamin A toxicity, but without the associated dysmorphogenesis. A number of environmental factors are discussed that may plausibly be candidates for this role, and suggestions are offered for testing the model. The model also suggests a number of measures that may be effective both in reducing the risk of fetal CRS in women who acquire rubella in their first trimester and in reversing or minimizing regressive autism among children in whom the diagnosis is suspected or confirmed.
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Affiliation(s)
- Anthony R Mawson
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Jackson State University, Jackson, MS 39213, USA.
| | - Ashley M Croft
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth PO1 2DT, UK.
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Abstract
The use of intermittent auscultation (IA) for fetal surveillance during labor decreased with the introduction of electronic fetal monitoring (EFM). The increased use of EFM is associated with an increase in cesarean births. IA is an evidence-based method of fetal surveillance during labor for women with low risk pregnancies and considered one component of comprehensive efforts to reduce the primary cesarean rate and promote vaginal birth. Many clinicians are not familiar with IA practice. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues, and strategies to promote implementation of IA into practice.
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22
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Fong DD, Knoesen A, Motamedi M, O'Neill T, Ghiasi S. Recovering the fetal signal in transabdominal fetal pulse oximetry. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.smhl.2018.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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23
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Cahill AG, Tuuli MG, Stout MJ, López JD, Macones GA. A prospective cohort study of fetal heart rate monitoring: deceleration area is predictive of fetal acidemia. Am J Obstet Gynecol 2018; 218:523.e1-523.e12. [PMID: 29408586 PMCID: PMC5916338 DOI: 10.1016/j.ajog.2018.01.026] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/12/2018] [Accepted: 01/22/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intrapartum electronic fetal monitoring is the most commonly used tool in obstetrics in the United States; however, which electronic fetal monitoring patterns predict acidemia remains unclear. OBJECTIVE This study was designed to describe the frequency of patterns seen in labor using modern nomenclature, and to test the hypothesis that visually interpreted patterns are associated with acidemia and morbidities in term infants. We further identified patterns prior to delivery, alone or in combination, predictive of acidemia and neonatal morbidity. STUDY DESIGN This was a prospective cohort study of 8580 women from 2010 through 2015. Patients were all consecutive women laboring at ≥37 weeks' gestation with a singleton cephalic fetus. Electronic fetal monitoring patterns during the 120 minutes prior to delivery were interpreted in 10-minute epochs. Interpretation included the category system and individual electronic fetal monitoring patterns per the Eunice Kennedy Shriver National Institute of Child Health and Human Development criteria as well as novel patterns. The primary outcome was fetal acidemia (umbilical artery pH ≤7.10); neonatal morbidities were also assessed. Final regression models for acidemia adjusted for nulliparity, pregestational diabetes, and advanced maternal age. Area under the receiver operating characteristic curves were used to assess the test characteristics of individual models for acidemia and neonatal morbidity. RESULTS Of 8580 women, 149 (1.7%) delivered acidemic infants. Composite neonatal morbidity was diagnosed in 757 (8.8%) neonates within the total cohort. Persistent category I, and 10-minute period of category III, were significantly associated with normal pH and acidemia, respectively. Total deceleration area was most discriminative of acidemia (area under the receiver operating characteristic curves, 0.76; 95% confidence interval, 0.72-0.80), and deceleration area with any 10 minutes of tachycardia had the greatest discriminative ability for neonatal morbidity (area under the receiver operating characteristic curves, 0.77; 95% confidence interval, 0.75-0.79). Once the threshold of deceleration area is reached the number of cesareans needed-to-be performed to potentially prevent 1 case of acidemia and morbidity is 5 and 6, respectively. CONCLUSION Deceleration area is the most predictive electronic fetal monitoring pattern for acidemia, and combined with tachycardia for significant risk of morbidity, from the electronic fetal monitoring patterns studied. It is important to acknowledge that this study was performed in patients delivering ≥37 weeks, which may limit the generalizability to preterm populations. We also did not use computerized analysis of the electronic fetal monitoring patterns because human visual interpretation was the basis for the Eunice Kennedy Shriver National Institute of Child Health and Human Development categories, and importantly, it is how electronic fetal monitoring is used clinically.
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Affiliation(s)
- Alison G Cahill
- Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO.
| | - Methodius G Tuuli
- Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO
| | - Molly J Stout
- Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO
| | - Julia D López
- Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO
| | - George A Macones
- Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO
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Sartwelle TP, Johnston JC. Continuous Electronic Fetal Monitoring during Labor: A Critique and a Reply to Contemporary Proponents. Surg J (N Y) 2018; 4:e23-e28. [PMID: 29527573 PMCID: PMC5842073 DOI: 10.1055/s-0038-1632404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/12/2018] [Indexed: 01/16/2023] Open
Abstract
A half century after continuous electronic fetal monitoring (EFM) became the omnipresent standard of care for the vast majority of labors in the developed countries, and the cornerstone for cerebral palsy litigation, EFM advocates still do not have any scientific evidence justifying EFM use in most labors or courtrooms. Yet, these EFM proponents continue rationalizing the procedure with a rhetorical fog of meaningless words, misleading statistics, archaic concepts, and a complete disregard for medical ethics. This article illustrates the current state of affairs by providing an evidence-based review penetrating the rhetorical fog of a prototypical EFM advocate.
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Spector-Bagdady K, De Vries R, Harris LH, Low LK. Stemming the Standard-of-Care Sprawl. Hastings Cent Rep 2017; 47:16-24. [DOI: 10.1002/hast.781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Sartwelle TP, Johnston JC, Arda B. A half century of electronic fetal monitoring and bioethics: silence speaks louder than words. Matern Health Neonatol Perinatol 2017; 3:21. [PMID: 29201387 PMCID: PMC5697350 DOI: 10.1186/s40748-017-0060-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 09/08/2017] [Indexed: 11/10/2022] Open
Abstract
Bioethics abolished the prevailing Hippocratic tenet instructing physicians to make treatment decisions, replacing it with autonomy through informed consent. Informed consent allows the patient to choose treatment after options are explained by the physician. The appearance of bioethics in 1970 coincided with the introduction of electronic fetal monitoring (EFM), which evolved to become the fetal surveillance modality of choice for virtually all women in labor. Autonomy rapidly pervaded all medical procedures, but there was a clear exemption for EFM. Even today, EFM remains immune to the doctrine of informed consent despite continually mounting evidence which proves the procedure is nothing more than myth, illusion and junk science that subjects mothers and babies alike to increased risks of morbidity and mortality. And ethicists have remained utterly silent through a half century of EFM misuse. Our article explores this egregious ethical failure by reviewing EFM's lack of clinical efficacy, discussing the EFM related harm to mothers and babies, and focusing on the reasons that this obstetrical procedure eluded the revolutionary change from the Hippocratic tradition to autonomy through informed consent.
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Affiliation(s)
| | - James C. Johnston
- 1150 N Loop 1604 W, Ste 108-625, San Antonio, TX 98110 USA
- Global Neurology Consultants, Auckland, New Zealand
| | - Berna Arda
- Department of Medical Ethics, University of Ankara, Ankara, Turkey
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Abstract
Physician wellness directly affects patient and physician health and has broader implications for our health systems. A summary of what is known about physician wellness in medicine, and obstetrics and gynecology in particular, identifies several areas for future focus. To change our culture and the structure of our academic health centers in a way that promotes resilience, we suggest greater attention to preparedness for practice and attention to work-life integration as well as mentoring and professional development.
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Affiliation(s)
- Max Wiznitzer
- 1 Division of Pediatric Neurology, Rainbow Babies & Childrens Hospital, Cleveland, OH, USA
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Nelson KB, Sartwelle TP, Rouse DJ. Electronic fetal monitoring, cerebral palsy, and caesarean section: assumptions versus evidence. BMJ 2016; 355:i6405. [PMID: 27908902 PMCID: PMC6883481 DOI: 10.1136/bmj.i6405] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Karin B Nelson
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, 20892, USA
| | | | - Dwight J Rouse
- Women and Infants' Hospital of Rhode Island and Brown University, Providence, RI, USA
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Johnston JC, Wester K, Sartwelle TP. Neurological Fallacies Leading to Malpractice: A Case Studies Approach. Neurol Clin 2016; 34:747-73. [PMID: 27445252 DOI: 10.1016/j.ncl.2016.04.011] [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] [Indexed: 11/25/2022]
Abstract
A young woman presents with an intracranial arachnoid cyst. Another is diagnosed with migraine headache. An elderly man awakens with a stroke. And a baby delivered vaginally after 2 hours of questionable electronic fetal monitoring patterns grows up to have cerebral palsy. These seemingly disparate cases share a common underlying theme: medical myths. Myths that may lead not only to misdiagnosis and treatment harms but to seemingly never-ending medical malpractice lawsuits, potentially culminating in a settlement or judgment against an unsuspecting neurologist. This article provides a case studies approach exposing the fallacies and highlighting proper management of these common neurologic presentations.
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Affiliation(s)
- James C Johnston
- Legal Medicine Consultants, 1150 N Loop 1604 West, Suite 108-625, San Antonio, TX 78248, USA.
| | - Knut Wester
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Department of Neurosurgery, Haukeland University Hospital, Bergen 5021, Norway
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Cardiotocographic findings in the second stage of labor among fetuses delivered with acidemia: a comparison of two classification systems. Eur J Obstet Gynecol Reprod Biol 2016; 203:297-302. [PMID: 27423030 DOI: 10.1016/j.ejogrb.2016.06.028] [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: 01/24/2016] [Revised: 06/24/2016] [Accepted: 06/28/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND The RCOG classification system of CTG trace is widely used for the analysis of the fetal heart rate during the first and second stage of labor. Other authors proposed specific classification systems for the second stage traces. OBJECTIVE To evaluate the accuracy of RCOG and Piquard cardiotocographic patterns classification systems in predicting fetal acidemia in the second stage of labor. STUDY DESIGN This was a nested retrospective case-control study including fetuses delivered with metabolic acidemia in the second stage of labor and a matched group of non-acidemic fetuses as controls. Cases and controls were selected from the electronic medical records of the University Hospital of Bologna between 2008 and 2013. The last 60min of the cardiotocograms recorded during the second stage of labor were independently classified by a senior consultant and a trainee according to RCOG and Piquard classifications. The inter-observer agreement and the accuracy of the two classifications in predicting fetal acidemia were evaluated. RESULTS In all, 82 acidemic fetuses and 164 controls were recruited in the study period. Regarding the CTG traces assessment, the inter-observer agreement was moderate for both the categorizations (RCOG κ=0.584). Unclassifiable CTG patterns were more frequent among acidemic fetuses vs controls either at RCOG and at Piquard evaluation (26.8% vs 7.9%, p<0.001). Both systems yielded a moderate and comparable ability to predict fetal acidemia (RCOG ROC AUC=0.731; 95% CI 0.660-0.795; Piquard ROC AUC=0.773; 95% CI 0.704-0.833. DeLong z-test=1.186, p=0.236). CONCLUSIONS RCOG and Piquard systems have a moderate accuracy in identifying acidemic fetuses during the second stage of labor. The occurrence of unclassifiable findings seems significantly more common among the acidemic fetuses.
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Silberstein T, Sheiner E, Salem SY, Hamou B, Aricha B, Baumfeld Y, Yohay Z, Elharar D, Idan I, Yohay D. Fetal heart rate monitoring category 3 during the 2nd stage of labor is an independent predictor of fetal acidosis. J Matern Fetal Neonatal Med 2016; 30:257-260. [DOI: 10.3109/14767058.2016.1172064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Tali Silberstein
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
| | - Shimrit Yaniv Salem
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
| | - Batel Hamou
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
| | - Barak Aricha
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
| | - Zehava Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
| | - Debora Elharar
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
| | - Inbal Idan
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
| | - David Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
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Behar J, Andreotti F, Zaunseder S, Oster J, Clifford GD. A practical guide to non-invasive foetal electrocardiogram extraction and analysis. Physiol Meas 2016; 37:R1-R35. [DOI: 10.1088/0967-3334/37/5/r1] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Intermittent Auscultation for Intrapartum Fetal Heart Rate Surveillance: American College of Nurse‐Midwives. J Midwifery Womens Health 2015; 60:626-32. [DOI: 10.1111/jmwh.12372] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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[Can caesarean delivery prevent cerebral palsy? Medico-legal implications of a French ecological study]. ACTA ACUST UNITED AC 2014; 43:8-12. [PMID: 25497386 DOI: 10.1016/j.gyobfe.2014.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 09/24/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE For a long time, the benefit of a caesarean delivery in the prevention of cerebral palsy (CP) has been put forward, which was based on the assumption that CP is due to asphyxia in more than 50 % of the cases. However, from register-based data, this rate has been estimated less than 4 %. The aim of this study was to evaluate whether the rate of caesarean sections for fetal indication was correlated with the prevalence rate of CP in a French county. PATIENTS AND METHODS This was an ecological study of register-based prevalence estimates of children with CP (postnatal cases excluded) born between 1997 and 2003 in a French county compared with the rates of caesarean section for fetal distress obtained from the maternal and infant protection service of the county. RESULTS Whilst the rate of caesarean section for fetal indication increased by 44% during the period studied, the prevalence of CP remained nearly stable around 1.5 per 1000 live births. There was no correlation between caesarean section and CP prevalence (r'=-0.36, P=0.43). DISCUSSION AND CONCLUSION The present study was in accordance with the results of a recent meta-analysis which concluded that emergency and prophylactic caesarean deliveries were not efficient in the prevention of CP. Indication of caesarean delivery for foetal heart rhythm anomaly, which is the most relevant cause for the growing rate of caesarean sections, should be justified by additional examinations in ambivalent cases, in order not to consider it as defensive medicine, which is ethically and therefore juridically blameworthy.
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Frasch MG, Xu Y, Stampalija T, Durosier LD, Herry C, Wang X, Casati D, Seely AJ, Alfirevic Z, Gao X, Ferrazzi E. Correlating multidimensional fetal heart rate variability analysis with acid-base balance at birth. Physiol Meas 2014; 35:L1-12. [PMID: 25407948 DOI: 10.1088/0967-3334/35/12/l1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Fetal monitoring during labour currently fails to accurately detect acidemia. We developed a method to assess the multidimensional properties of fetal heart rate variability (fHRV) from trans-abdominal fetal electrocardiogram (fECG) during labour. We aimed to assess this novel bioinformatics approach for correlation between fHRV and neonatal pH or base excess (BE) at birth.We enrolled a prospective pilot cohort of uncomplicated singleton pregnancies at 38-42 weeks' gestation in Milan, Italy, and Liverpool, UK. Fetal monitoring was performed by standard cardiotocography. Simultaneously, with fECG (high sampling frequency) was recorded. To ensure clinician blinding, fECG information was not displayed. Data from the last 60 min preceding onset of second-stage labour were analyzed using clinically validated continuous individualized multiorgan variability analysis (CIMVA) software in 5 min overlapping windows. CIMVA allows simultaneous calculation of 101 fHRV measures across five fHRV signal analysis domains. We validated our mathematical prediction model internally with 80:20 cross-validation split, comparing results to cord pH and BE at birth.The cohort consisted of 60 women with neonatal pH values at birth ranging from 7.44 to 6.99 and BE from -0.3 to -18.7 mmol L(-1). Our model predicted pH from 30 fHRV measures (R(2) = 0.90, P < 0.001) and BE from 21 fHRV measures (R(2) = 0.77, P < 0.001).Novel bioinformatics approach (CIMVA) applied to fHRV derived from trans-abdominal fECG during labor correlated well with acid-base balance at birth. Further refinement and validation in larger cohorts are needed. These new measurements of fHRV might offer a new opportunity to predict fetal acid-base balance at birth.
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Affiliation(s)
- Martin G Frasch
- Department of Obstetrics and Gynecology and Department of Neuroscience, CHU Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada
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Canine fetal heart rate: Do accelerations or decelerations predict the parturition day in bitches? Theriogenology 2014; 82:933-41. [DOI: 10.1016/j.theriogenology.2014.04.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/22/2014] [Accepted: 04/30/2014] [Indexed: 11/18/2022]
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Jonsson M, Ågren J, Nordén-Lindeberg S, Ohlin A, Hanson U. Suboptimal care and metabolic acidemia is associated with neonatal encephalopathy but not with neonatal seizures alone: a population-based clinical audit. Acta Obstet Gynecol Scand 2014; 93:477-82. [DOI: 10.1111/aogs.12381] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 03/11/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Maria Jonsson
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Johan Ågren
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | | | - Andreas Ohlin
- Department of Pediatrics; Örebro University Hospital; Örebro Sweden
| | - Ulf Hanson
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
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Ross MG, Jessie M, Amaya K, Matushewski B, Durosier LD, Frasch MG, Richardson BS. Correlation of arterial fetal base deficit and lactate changes with severity of variable heart rate decelerations in the near-term ovine fetus. Am J Obstet Gynecol 2013; 208:285.e1-6. [PMID: 23107611 DOI: 10.1016/j.ajog.2012.10.883] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 08/24/2012] [Accepted: 10/24/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Recent guidelines classify variable decelerations without detail as to degree of depth. We hypothesized that variable deceleration severity is highly correlated with fetal base deficit accumulation. STUDY DESIGN Seven near-term fetal sheep underwent a series of graded umbilical cord occlusions resulting in mild (30 bpm decrease), moderate (60 bpm decrease), or severe (decrease of 90 bpm to baseline <70 bpm) variable decelerations at 2.5 minute intervals. RESULTS Mild, moderate, and severe variable decelerations increased fetal base deficit (0.21 ± 0.03, 0.27 ± 0.03, and 0.54 ± 0.09 mEq/L per minute) in direct proportion to severity. During recovery, fetal base deficit cleared at 0.12 mEq/L per minute. CONCLUSION In this model, ovine fetuses can tolerate repetitive mild and moderate variable decelerations with minimal change in base deficit and lactate. In contrast, repetitive severe variable decelerations may result in significant base deficit increases, dependent on frequency. Modified guideline differentiation of mild/moderate vs severe variable decelerations may aid in the interpretation of fetal heart rate tracings and optimization of clinical management paradigms.
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Affiliation(s)
- Michael G Ross
- Department of Obstetrics and Gynecology, LA BioMed at Harbor-UCLA Medical Center, Torrance, CA, USA.
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Oh SY, Roh CR. Contemporary medical understanding of the 'no-fault accident' during birth: amniotic fluid embolism, pulmonary embolism, meconium aspiration syndrome, and cerebral palsy. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2013. [DOI: 10.5124/jkma.2013.56.9.784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheong-Rae Roh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Harris JM, Franck L, Michie S. Assessing the psychological effects of prenatal screening tests for maternal and foetal conditions: a systematic review. J Reprod Infant Psychol 2012. [DOI: 10.1080/02646838.2012.710834] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- James Matthew Harris
- a Department of Clinical, Educational and Health Psychology , University College London , London , UK
| | - Linda Franck
- b University of California–San Francisco, Family Health Care Nursing , San Francisco , CA , USA
| | - Susan Michie
- a Department of Clinical, Educational and Health Psychology , University College London , London , UK
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Intrapartum signal quality with external fetal heart rate monitoring: a two way trial of external Doppler CTG ultrasound and the abdominal fetal electrocardiogram. Arch Gynecol Obstet 2012; 286:1103-7. [DOI: 10.1007/s00404-012-2413-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 06/04/2012] [Indexed: 11/26/2022]
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Schnettler WT, Rogers J, Barber RE, Hacker MR. A modified fetal heart rate tracing interpretation system for prediction of cesarean section. J Matern Fetal Neonatal Med 2011; 25:1055-8. [PMID: 21942513 DOI: 10.3109/14767058.2011.614975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate whether a modified version of the 2008 National Institute of Child Health and Human Development (NICHD) interpretation system upon admission decreases cesarean delivery risk. METHODS This retrospective cohort study ascribed a modified category to the first 30 min of fetal heart rate (FHR) tracings in labor. Category I was divided into two subsets (Ia and Ib) by the presence of accelerations. Category II was divided into four subsets (IIa-IId) based on baseline FHR, variability, response to stimulation and decelerations. Log-binomial regression was used to calculate risk ratios (RR) and 95% confidence intervals (CI). RESULTS A category was ascribed to 910 women. Most FHR tracings were Category Ia (65.8%), Ib (7.7%), IIb (11.8%) and IId (14.0%). Category Ib tracings (fewer than two accelerations) were 2.26 (95% CI: 1.13-4.52) times more likely to result in cesarean delivery for abnormal FHR tracing than Category Ia tracings. A similar increase in risk was seen when comparing Category IIb and Category IId with Category Ia. CONCLUSION Application of a modified version of the 2008 NICHD FHR interpretation system to the initial 30 min of labor can identify women at increased risk of cesarean delivery for abnormal FHR tracing.
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Affiliation(s)
- William T Schnettler
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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Georgieva A, Payne SJ, Moulden M, Redman CWG. Computerized fetal heart rate analysis in labor: detection of intervals with un-assignable baseline. Physiol Meas 2011; 32:1549-60. [PMID: 21862845 DOI: 10.1088/0967-3334/32/10/004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The fetal heart rate (FHR) is monitored during labor to assess fetal health. Both visual and computerized interpretations of the FHR depend on assigning a baseline to detect key features such as accelerations or decelerations. However, it is sometimes impossible to assign a baseline reliably, by eye or by numerical methods. To address this issue, we used the Oxford Intrapartum FHR Database to derive an algorithm based on the distribution of the FHR that detects heart rate intervals without a clear baseline. We aimed to recognize when a fetus cannot maintain its heart rate baseline and use this to assist computerized FHR analysis. Twenty-three FHR windows (15 min long) were used to develop the method. The algorithm was then validated by comparison with experts who classified 50 FHR windows into two groups: baseline assignable or un-assignable. The average agreement between experts (κ = 0.76) was comparable to the agreement between method and experts (κ = 0.67). The algorithm was used in 22 559 patients with intrapartum FHR records to retrospectively determine the incidence of intervals (defined as 15 min windows) that had un-assignable baselines. Sixty-six percent had one or more such episodes at some stage, most commonly after the onset of pushing (55%) and least commonly pre-labor (16%). These episodes are therefore relatively common. Their detection should improve the reliability of computerized analysis and allow further studies of what they signify clinically.
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Affiliation(s)
- Antoniya Georgieva
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Level 3, Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK.
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Obstetric conditions and risk of first ever mental health contact during infancy, childhood and adolescence. Midwifery 2011; 28:379-84. [PMID: 21820779 DOI: 10.1016/j.midw.2011.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 05/19/2011] [Accepted: 06/13/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE the main aim of this study was to investigate whether risk of first ever occasion of outpatient or inpatient service for a mental disorder among male children and adolescents may be associated with obstetric conditions. DESIGN, SETTING AND PARTICIPANTS this study was a population-based birth-cohort study of males born between 1980 and 1984 in Western Australia (WA). Males were identified using birth registry records and followed-up over a 19 year period using linked health data available through the Western Australian Data Linkage System. MEASUREMENTS multivariate logistic regression was employed to estimate the risk of first ever mental health contact at different stages of mental development in childhood and adolescence. MAIN FINDINGS vacuum and forceps assisted delivery and emergency caesarean were associated with an increased risk of first ever mental health contact. The risk of first ever mental health contact was similar for spontaneous vaginal delivery and elective caesarean. Although outcomes varied by age group, children with stillborn siblings were at increased risk of first ever mental health contact as were babies with 7-9 Apgar score at 5 mins and those born to mothers with several previous live births. CONCLUSIONS AND IMPLICATIONS vacuum and forceps assisted delivery and/or the pathophysiological causes that lead to these clinical procedures, as well as other obstetric conditions, which may be associated with (asymptomatic) brain injury at birth, which may increase the risk of mental disorders.
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Chen HY, Chauhan SP, Ananth CV, Vintzileos AM, Abuhamad AZ. Electronic fetal heart rate monitoring and its relationship to neonatal and infant mortality in the United States. Am J Obstet Gynecol 2011; 204:491.e1-10. [PMID: 21752753 DOI: 10.1016/j.ajog.2011.04.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 03/22/2011] [Accepted: 04/13/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine the association between electronic fetal heart rate monitoring and neonatal and infant mortality, as well as neonatal morbidity. STUDY DESIGN We used the United States 2004 linked birth and infant death data. Multivariable log-binomial regression models were fitted to estimate risk ratio for association between electronic fetal heart rate monitoring and mortality, while adjusting for potential confounders. RESULTS In 2004, 89% of singleton pregnancies had electronic fetal heart rate monitoring. Electronic fetal heart rate monitoring was associated with significantly lower infant mortality (adjusted relative risk, 0.75); this was mainly driven by the lower risk of early neonatal mortality (adjusted relative risk, 0.50). In low-risk pregnancies, electronic fetal heart rate monitoring was associated with decreased risk for Apgar scores <4 at 5 minutes (relative risk, 0.54); in high-risk pregnancies, with decreased risk of neonatal seizures (relative risk, 0.65). CONCLUSION In the United States, the use of electronic fetal heart rate monitoring was associated with a substantial decrease in early neonatal mortality and morbidity that lowered infant mortality.
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Ribak R, Harlev A, Ohel I, Sergienko R, Wiznitzer A, Sheiner E. Refusal of emergency caesarean delivery in cases of non-reassuring fetal heart rate is an independent risk factor for perinatal mortality. Eur J Obstet Gynecol Reprod Biol 2011; 158:33-6. [PMID: 21621896 DOI: 10.1016/j.ejogrb.2011.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 03/09/2011] [Accepted: 04/14/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess pregnancy outcome in women who initially refused medically indicated caesarean delivery (CD) in cases of non-reassuring fetal heart rate (FHR) patterns. STUDY DESIGN A retrospective cohort study, comparing patients who refused and did not refuse caesarean delivery (CD) due to non-reassuring FHR tracings, was conducted. Deliveries occurred between the years 1988 and 2009 in a tertiary medical center. Multivariate analysis was performed to control for confounders. RESULTS Out of 10,944 women who were advised to undergo CD due to non-reassuring FHR patterns, 203 women initially refused CD. Women refusing medical intervention tended to be older (30.6 ± 6.9 vs. 28.29 ± 6.1, P<0.001) and of higher parity (46.8% vs. 19.9% had more than 5 deliveries; P<0.001) as compared to the comparison group. Refusal of CD was significantly associated with adverse perinatal outcome. Using a multiple logistic regression model controlling for confounders such as maternal age, refusal of treatment was found as an independent risk factor for perinatal mortality (adjusted OR=3.3, C.I. 95% 1.8-5.9, P<0.001). A non-significant trend towards higher rates of adverse perinatal outcome was found when refusal latency time was longer than 20 min (OR=2, 95% CI 0.36-11.95; P=0.29). CONCLUSION Refusal of CD in cases of non-reassuring FHR tracings is an independent risk factor for perinatal mortality.
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Affiliation(s)
- Rachel Ribak
- Faculty of Health Sciences, Joyce and Irving Goldman Medical School, Soroka University Medical Center, Ben Gurion University of the Negev, Be'er-Sheva, Israel
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Wardlaw MP. American medicine as religious practice: care of the sick as a sacred obligation and the unholy descent into secularization. JOURNAL OF RELIGION AND HEALTH 2011; 50:62-74. [PMID: 20094797 DOI: 10.1007/s10943-010-9320-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Modern medicine serves a religious function for modern Americans as a conduit through which science can be applied directly to the human body. The first half of this paper will focus on the theoretical foundations for viewing medicine as a religious practice arguing that just as a hierarchical structured authoritarian church historically mediated access to God, contemporary Western medicine provides a conduit by which the universalizable truths of science can be applied to the human being thereby functioning as a new established religion. I will then illustrate the many parallels between medicine and religion through an analysis of rituals and symbols surrounding and embedded within the modern practice of medicine. This analysis will pay special attention to the primacy placed on secret interior knowledge of the human body. I will end by responding to the hope for a "secularization of American medicine," exploring some of the negative consequences of secularization, and arguing that, rather than seeking to secularize, American medicine should strive to use its religious features to offer hope and healing to the sick, in keeping with its historically religious legacy.
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Affiliation(s)
- Margaret P Wardlaw
- The Institute for Medical Humanities, The University of Texas Medical Branch at Galveston, 1019 Ball, Galveston, TX 77550, USA.
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50
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Foreword. The challenge of monitoring a fetus. Clin Perinatol 2011; 38:xi-xii. [PMID: 21353084 DOI: 10.1016/j.clp.2011.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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