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Ben M’Barek I, Jauvion G, Vitrou J, Holmström E, Koskas M, Ceccaldi PF. DeepCTG® 1.0: an interpretable model to detect fetal hypoxia from cardiotocography data during labor and delivery. Front Pediatr 2023; 11:1190441. [PMID: 37397139 PMCID: PMC10311205 DOI: 10.3389/fped.2023.1190441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Cardiotocography, which consists in monitoring the fetal heart rate as well as uterine activity, is widely used in clinical practice to assess fetal wellbeing during labor and delivery in order to detect fetal hypoxia and intervene before permanent damage to the fetus. We present DeepCTG® 1.0, a model able to predict fetal acidosis from the cardiotocography signals. Materials and methods DeepCTG® 1.0 is based on a logistic regression model fed with four features extracted from the last available 30 min segment of cardiotocography signals: the minimum and maximum values of the fetal heart rate baseline, and the area covered by accelerations and decelerations. Those four features have been selected among a larger set of 25 features. The model has been trained and evaluated on three datasets: the open CTU-UHB dataset, the SPaM dataset and a dataset built in hospital Beaujon (Clichy, France). Its performance has been compared with other published models and with nine obstetricians who have annotated the CTU-UHB cases. We have also evaluated the impact of two key factors on the performance of the model: the inclusion of cesareans in the datasets and the length of the cardiotocography segment used to compute the features fed to the model. Results The AUC of the model is 0.74 on the CTU-UHB and Beaujon datasets, and between 0.77 and 0.87 on the SPaM dataset. It achieves a much lower false positive rate (12% vs. 25%) than the most frequent annotation among the nine obstetricians for the same sensitivity (45%). The performance of the model is slightly lower on the cesarean cases only (AUC = 0.74 vs. 0.76) and feeding the model with shorter CTG segments leads to a significant decrease in its performance (AUC = 0.68 with 10 min segments). Discussion Although being relatively simple, DeepCTG® 1.0 reaches a good performance: it compares very favorably to clinical practice and performs slightly better than other published models based on similar approaches. It has the important characteristic of being interpretable, as the four features it is based on are known and understood by practitioners. The model could be improved further by integrating maternofetal clinical factors, using more advanced machine learning or deep learning approaches and having a more robust evaluation of the model based on a larger dataset with more pathological cases and covering more maternity centers.
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Affiliation(s)
- Imane Ben M’Barek
- Department of Gynecology Obstetrics, Assistance Publique des Hôpitaux de Paris -Beaujon, Clichy, France
- Health Simulation Department, iLumens, Université Paris Cité, Paris, France
| | | | - Juliette Vitrou
- Department of Gynecology Obstetrics, Assistance Publique des Hôpitaux de Paris -Beaujon, Clichy, France
| | - Emilia Holmström
- Department of Gynecology Obstetrics, Assistance Publique des Hôpitaux de Paris -Beaujon, Clichy, France
| | - Martin Koskas
- Department of Gynecology-Obstetrics and Reproduction, Assistance Publique des Hôpitaux de Paris -Bichat, Paris, France
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Ben M'Barek I, Jauvion G, Ceccaldi P. Computerized cardiotocography analysis during labor - A state-of-the-art review. Acta Obstet Gynecol Scand 2022; 102:130-137. [PMID: 36541016 PMCID: PMC9889319 DOI: 10.1111/aogs.14498] [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: 09/07/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
Cardiotocography is defined as the recording of fetal heart rate and uterine contractions and is widely used during labor as a screening tool to determine fetal wellbeing. The visual interpretation of the cardiotocography signals by the practitioners, following common guidelines, is subject to a high interobserver variability, and the efficiency of cardiotocography monitoring is still debated. Since the 1990s, researchers and practitioners work on designing reliable computer-aided systems to assist practitioners in cardiotocography interpretation during labor. Several systems are integrated in the monitoring devices, mostly based on the guidelines, but they have not clearly demonstrated yet their usefulness. In the last decade, the availability of large clinical databases as well as the emergence of machine learning and deep learning methods in healthcare has led to a surge of studies applying those methods to cardiotocography signals analysis. The state-of-the-art systems perform well to detect fetal hypoxia when evaluated on retrospective cohorts, but several challenges remain to be tackled before they can be used in clinical practice. First, the development and sharing of large, open and anonymized multicentric databases of perinatal and cardiotocography data during labor is required to build more accurate systems. Also, the systems must produce interpretable indicators along with the prediction of the risk of fetal hypoxia in order to be appropriated and trusted by practitioners. Finally, common standards should be built and agreed on to evaluate and compare those systems on retrospective cohorts and to validate their use in clinical practice.
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Affiliation(s)
- Imane Ben M'Barek
- Department of Obstetrics and GynecologyAssistance Publique Hôpitaux de Paris – Hôpital BeaujonClichy La GarenneFrance,Université Paris CitéParisFrance,Health Simulation Department, iLumensUniversité Paris CitéParisFrance
| | | | - Pierre‐François Ceccaldi
- Université Paris CitéParisFrance,Health Simulation Department, iLumensUniversité Paris CitéParisFrance,Department of Gynecology‐Obstetrics and Reproductive MedicineHôpital FochSuresnesFrance
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Victor SF, Bach DBB, Hvelplund AC, Nickelsen C, Lyndrup J, Wilken-Jensen C, Scharff LJ, Weber T, Secher NJ, Krebs L. Cardiotocography combined with ST analysis versus cardiotocography combined with fetal blood sampling in deliveries with abnormal CTG: a randomized trial. Arch Gynecol Obstet 2022; 307:1771-1780. [PMID: 35701639 DOI: 10.1007/s00404-022-06649-3] [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: 04/13/2022] [Accepted: 05/25/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE The aim was to investigate if intrapartum monitoring with cardiotocography (CTG) in combination with ST analysis (STAN) results in an improved perinatal outcome. METHODS We performed a two-center randomized trial. 1013 women with term fetuses in cephalic presentation entered the trial. If a CTG showed intermediate or pathological abnormalities, they were offered fetal blood sampling (FBS) and inclusion if the pH value was above 7.25. They were randomized to either CTG + FBS or CTG + STAN. The primary outcome was neonatal metabolic acidosis, defined as umbilical cord arterial blood pH below 7.05, and base excess equal to or below -10. The secondary outcomes included operative vaginal delivery for fetal distress. RESULTS The rate of metabolic acidosis was 0.8% in the CTG + FBS group and 1.5% in women in the CTG + STAN (P = 0.338). More women in the CTG + STAN group delivered by operative vaginal delivery (25.6% vs 33.5%, P = 0.006). Significantly fewer women in the CTG + STAN group had three to five (28.8% vs 11.0%, P = < 0.001) and six to ten fetal blood samples taken (3.4% vs 0.4%, P = < 0.001). CONCLUSION CTG + STAN did not reduce the incidence of neonatal metabolic acidosis compared to CTG + FBS. CTG + STAN was, however, associated with an increased risk of operative vaginal delivery and a reduced use of FBS. If STAN is used for fetal surveillance, we recommend that it is combined with other methods, such as FBS, for confirmation of the need for operative delivery. CLINICALTRIALS gov ID: NCT01699646. Date of registration: October 4, 2012 (retrospectively registered). https://clinicaltrials.gov/ct2/show/NCT01699646?id=NCT01699646&draw=2&rank=1.
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Affiliation(s)
- Simon Foged Victor
- Department of Obstetrics and Gynecology, Zealand University Hospital, Holbæk, Denmark.
| | - Diana Bøttcher Brøndum Bach
- Department of Gynecology and Obstetrics, Copenhagen University Hospital, Amager and Hvidovre Hospital, Copenhagen, Denmark
| | - Anna Carolina Hvelplund
- Department of Pediatrics, Copenhagen University Hospital, Amager and Hvidovre Hospital, Copenhagen, Denmark
| | - Carsten Nickelsen
- Department of Gynecology and Obstetrics, Copenhagen University Hospital, Amager and Hvidovre Hospital, Copenhagen, Denmark
| | - Jens Lyndrup
- Department of Gynecology and Obstetrics, Zealand University Hospital, Roskilde, Denmark
| | | | - Lise Jul Scharff
- Department of Gynecology and Obstetrics, Zealand University Hospital, Roskilde, Denmark
| | - Tom Weber
- Department of Gynecology and Obstetrics, Copenhagen University Hospital, Amager and Hvidovre Hospital, Copenhagen, Denmark
| | - Niels Jørgen Secher
- Department of Gynecology and Obstetrics, Copenhagen University Hospital, Amager and Hvidovre Hospital, Copenhagen, Denmark
| | - Lone Krebs
- Department of Gynecology and Obstetrics, Copenhagen University Hospital, Amager and Hvidovre Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Gilbert M, Ghesquiere L, Drumez E, Subtil D, Fague V, Berveiller P, Garabedian C. How to reduce fetal scalp blood sampling? A retrospective study evaluating the diagnostic value of scalp stimulation to predict fetal wellbeing assessed by scalp blood sampling. Eur J Obstet Gynecol Reprod Biol 2021; 263:153-158. [PMID: 34216939 DOI: 10.1016/j.ejogrb.2021.05.032] [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: 02/15/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Fetal Blood Sample (FBS) is used as an indicator of fetal acidosis during labor. Its place is discussed through the lack of randomized trials, as well as the limitations related to the technical procedure. An alternative could be the Fetal Scalp Stimulation (FSS). AIM Our objective was to describe the FSS diagnostic value to predict fetal wellbeing defined from FBS. METHODS The FSS consisted in a digital scalp stimulation for 15 s. Test was negative when an acceleration and/or a normal variability were elicited in the 2 min following. FSS was performed before each FBS which was classified as normal when pH was > 7.25. The diagnostic value was assessed by sensibility, specificity, positive and negative predictive values. FINDINGS 148 women were included in our center from February to December 2019. Of the 191 FBS procedures, when accelerations were elicited sensibility was 58,3 (36.8-77.1), specificity was 67,5 (59.3-75), positive predictive value was 20,9 (12.5-32.9) and negative predictive value was 91.7 % (95 %CI, 85-95.5). DISCUSSION FBS is considered as the gold standard in our study which could be discussed as it is abandoned in some countries because of its questioned reliability and the lack of controlled randomized trials. CONCLUSION This study suggests that FSS could be an interesting alternative adjunctive test to perform in the first instance as it seems to be reliable, non-invasive and easy to perform in order to limit FBS only to absence of acceleration after FSS.
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Affiliation(s)
- M Gilbert
- CHU Lille, Department of Obstetrics, F-59000, Lille, France.
| | - L Ghesquiere
- CHU Lille, Department of Obstetrics, F-59000, Lille, France; Univ. Lille, ULR 2694 METRICS, Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000, Lille, France
| | - E Drumez
- Univ. Lille, ULR 2694 METRICS, Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000, Lille, France; CHU Lille, Department of Biostatistics, F-59000, Lille, France
| | - D Subtil
- CHU Lille, Department of Obstetrics, F-59000, Lille, France; Univ. Lille, ULR 2694 METRICS, Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000, Lille, France
| | - V Fague
- CH Valenciennes, Department of Obstetrics, F-59300, Valenciennes, France
| | - P Berveiller
- CH Poissy, Department of Obstetrics, F-78300, Poissy, France
| | - C Garabedian
- CHU Lille, Department of Obstetrics, F-59000, Lille, France; Univ. Lille, ULR 2694 METRICS, Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000, Lille, France
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Rajala K, Mönkkönen A, Saarelainen H, Keski-Nisula L. Fetal lactate levels align with the stage of labour. Eur J Obstet Gynecol Reprod Biol 2021; 261:139-143. [PMID: 33934025 DOI: 10.1016/j.ejogrb.2021.04.032] [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: 12/21/2020] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
AIM To evaluate the association between lactate concentrations in fetal blood samples and the different advanced labour stages. METHODS Eighteen-month prospective population-based clinical study of 187 singleton pregnant women in labour who were monitored by fetal blood sampling (FBS) because of non-reassuring intrapartum CTG results at Kuopio University Hospital, Finland. Peripheral lactate concentration and pH were analysed at different stages of labour and in umbilical arterial samples immediately after delivery. RESULTS FBS samples (N = 350) were obtained from 5.4 % of all women in labour during the study period, and 48 % had spontaneous delivery, 27 % had vacuum-assisted vaginal delivery, and 25 % had nonelective Caesarean delivery. FBS lactate levels increased 4-11% with every 1-2 cm of cervical dilation and 18 % from early labour to fully dilated cervix. In 42 women with at least two FBSs, lactate levels increased significantly from the early I stage of labour and up to a fully dilated cervix. Lactate values were significantly higher in umbilical arterial samples compared to FBSs. Sensitivity of the highest FBS lactate values for the detection of birth asphyxia were considerably low varying between 42.9-57.1%. CONCLUSION FBS lactate levels were related to the stage of labour during vaginal delivery attempt. Wide range of lactate levels during labour complicates its use as a predictor of birth asphyxia.
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Affiliation(s)
- K Rajala
- Department of Clinical Genetics, Kuopio University Hospital, Kuopio, Finland
| | - A Mönkkönen
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - H Saarelainen
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
| | - L Keski-Nisula
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland; Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland.
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Oikonomou M, Chandraharan E. Fetal heart rate monitoring in labor: from pattern recognition to fetal physiology. Minerva Obstet Gynecol 2020; 73:19-33. [PMID: 33238664 DOI: 10.23736/s2724-606x.20.04666-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The journey of human labor involves hypoxic and mechanical stresses as a result of progressively increasing frequency, duration and strength of uterine contractions and resultant compression of the umbilical cord. In addition, occlusion of the spiral arteries during myometrial contractions also leads to repetitive interruptions in the utero-placental circulation, predisposing a fetus to progressively worsening hypoxic stress as labor progresses. The vast majority of fetuses are equipped with compensatory mechanisms to withstand these hypoxic and mechanical stresses. They emerge unharmed at birth. However, some fetuses may sustain an antenatal injury or experience a chronic utero-placental insufficiency prior to the onset of labor. These may impair the fetus to compensate for the ongoing hypoxic stress secondary to ongoing uterine contractions. Non-hypoxic pathways of neurological damage such as chorioamnionitis, fetal anemia or an acute fetal hypovolemia may potentiate fetal neurological injury, especially in the presence of a super-imposed, additional hypoxic stress. The use of utero-tonic agents to induce or augment labor may increase the risk of hypoxic-ischemic injury. Clinicians need to move away from "pattern recognition" guidelines ("normal," "suspicious," "pathological"), and apply the knowledge of fetal physiology to differentiate fetal compensation from decompensation. Individualization of care is essential to optimize outcomes.
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Affiliation(s)
- Maria Oikonomou
- Department of Obstetrics and Gynecology, Watford General Hospital, Watford, UK -
| | - Edwin Chandraharan
- Department of Intrapartum Care Obstetrics and Gynecology, Basildon and Thurrock University Hospital, Basildon, UK
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Amer-Wåhlin I, Ugwumadu A, Yli BM, Kwee A, Timonen S, Cole V, Ayres-de-Campos D, Roth GE, Schwarz C, Ramenghi LA, Todros T, Ehlinger V, Vayssiere C. Fetal electrocardiography ST-segment analysis for intrapartum monitoring: a critical appraisal of conflicting evidence and a way forward. Am J Obstet Gynecol 2019; 221:577-601.e11. [PMID: 30980794 DOI: 10.1016/j.ajog.2019.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND In the past century, some areas of obstetric including intrapartum care have been slow to benefit from the dramatic advances in technology and medical care. Although fetal heart rate monitoring (cardiotocography) became available a half century ago, its interpretation often differs between institutions and countries, its diagnostic accuracy needs improvement, and a technology to help reduce the unnecessary obstetric interventions that have accompanied the cardiotocography is urgently needed. STUDY DESIGN During the second half of the 20th century, key findings in animal experiments captured the close relationship between myocardial glycogenolysis, myocardial workload, and ST changes, thus demonstrating that ST waveform analysis of the fetal electrocardiogram can provide information on oxygenation of the fetal myocardium and establishing the physiological basis for the use of electrocardiogram in intrapartum fetal surveillance. RESULTS Six randomized controlled trials, 10 meta-analyses, and more than 20 observational studies have evaluated the technology developed based on this principle. Nonetheless, despite this intensive assessment, differences in study protocols, inclusion criteria, enrollment rates, clinical guidelines, use of fetal blood sampling, and definitions of key outcome parameters, as well as inconsistencies in randomized controlled trial data handling and statistical methodology, have made this voluminous evidence difficult to interpret. Enormous resources spent on randomized controlled trials have failed to guarantee the generalizability of their results to other settings or their ability to reflect everyday clinical practice. CONCLUSION The latest meta-analysis used revised data from primary randomized controlled trials and data from the largest randomized controlled trials from the United States to demonstrate a significant reduction of metabolic acidosis rates by 36% (odds ratio, 0.64; 95% confidence interval, 0.46-0.88) and operative vaginal delivery rates by 8% (relative risk, 0.92; 95% confidence interval, 0.86-0.99), compared with cardiotocography alone.
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Chandraharan E. Intrapartum care: An urgent need to question historical practices and ‘non-evidence’-based, illogical foetal monitoring guidelines to avoid patient harm. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2019. [DOI: 10.1177/2516043519878583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Edwin Chandraharan
- Children & Women's Directorate, St. George’s University Hospitals NHS Foundation Trust, London, UK
- Honorary Senior Lecturer, St. George’s University of London, London, UK
- Tianjin Central Hospital of Gynecology & Obstetrics, Tianjin, China
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Uchida T, Kanayama N, Kawai K, Mukai M, Suzuki K, Itoh H, Niwayama M. Reevaluation of intrapartum fetal monitoring using fetal oximetry: A review. J Obstet Gynaecol Res 2018; 44:2127-2134. [PMID: 30084196 DOI: 10.1111/jog.13761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/22/2018] [Indexed: 11/28/2022]
Abstract
AIM Although several studies reported the measurement of fetal oxygen saturation using fetal pulse oximetry (FPO) for evaluation of the fetal intrapartum condition, a systematic review of the seven randomized controlled trials (RCTs) provided no evidence to support FPO for intrapartum fetal monitoring. In the present review, we re-evaluate an overview for the use of FPO and seven RCTs of FPO. METHODS We reviewed numerous previous reports on FPO and seven RCTs of intrapartum FPO. RCTs were conducted with the main outcome measure being a reduction in the cesarean section rate. RESULTS The largest trial with 5341 entries failed to show any reduction. The negative result from this RCT may be explained by the use of a different cutoff value for fetal oxygen saturation compared to the other RCT; in addition, there were differences in the indications for cesarean section due to dystocia and in the definition of non-reassuring fetal status (NRFS). An abnormal FPO value, defined as the fetal oxygen saturation value <30% for at least 10 min, is useful for making a diagnosis of fetal acidosis. A newly developed device, an examiner's finger-mounted tissue oximetry, accurately measures tissue oxygen saturation while overcoming the drawbacks of FPO, such as infection risk and slipping off of the sensor during descent of the fetal head. CONCLUSION FPO (including the new device) with fetal heart rate monitoring in selected cases of NRFS may reduce the cesarean section rate.
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Affiliation(s)
- Toshiyuki Uchida
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naohiro Kanayama
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kenta Kawai
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Mari Mukai
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazunao Suzuki
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroaki Itoh
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masatsugu Niwayama
- Department of Electrical and Electronics Engineering, Shizuoka University, Hamamatsu, Japan
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Uchida T, Kanayama N, Kawai K, Niwayama M. Craniofacial tissue oxygen saturation is associated with blood pH using an examiner's finger-mounted tissue oximetry in mice. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:40502. [PMID: 27071413 DOI: 10.1117/1.jbo.21.4.040502] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Abstract
Although fetal scalp blood sampling is an examination to assess fetal acidosis during the intrapartum period, it has not been widely used by obstetricians because of its invasiveness. We have developed a small, portable oximetry with a sensor attached to the examiner's finger. Our previous report using this oximetry concluded that fetal head tissue oxygen saturation (StO 2 StO2 ) correlated with umbilical cord artery blood pH. We investigated whether the association between StO 2 StO2 and blood pH in mice could be validated using this oximetry. Eleven the Institute for Cancer Research (ICR) mice were measured using a near-infrared spectroscopy probe at the craniofacial site in a closed polyethylene bag while changing the oxygen concentration. A total of nine blood samples were collected and analyzed for pH. The StO 2 StO2 and tissue blood pH showed a strong positive correlation (r=0.90 r=0.90 and P=0.0009 P=0.0009 ). The StO 2 StO2 and total hemoglobin index also showed a positive correlation (r=0.84 r=0.84 and P=0.0049 P=0.0049 ). Thus, the results of the present study support those of our previous report on clinical cases and allow examiners to easily check the status of fetal acidosis. Fetal management using this oximetry might gain popularity with obstetricians in the near future.
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Affiliation(s)
- Toshiyuki Uchida
- Hamamatsu University School of Medicine, Department of Obstetrics and Gynecology, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka 431-3192, Japan
| | - Naohiro Kanayama
- Hamamatsu University School of Medicine, Department of Obstetrics and Gynecology, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka 431-3192, Japan
| | - Kenta Kawai
- Hamamatsu University School of Medicine, Department of Obstetrics and Gynecology, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka 431-3192, Japan
| | - Masatsugu Niwayama
- Shizuoka University, Department of Electrical and Electronic Engineering, 3-5-1 Johoku, Nakaku, Hamamatsu 432-8561, Japan
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Chandraharan E. Should national guidelines continue to recommend fetal scalp blood sampling during labor? J Matern Fetal Neonatal Med 2016; 29:3682-5. [DOI: 10.3109/14767058.2016.1140740] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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East CE, Leader LR, Sheehan P, Henshall NE, Colditz PB, Lau R. Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a non-reassuring fetal heart rate trace. Cochrane Database Syst Rev 2015; 2015:CD006174. [PMID: 25929461 PMCID: PMC10823414 DOI: 10.1002/14651858.cd006174.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Fetal scalp blood sampling for lactate estimation may be considered following identification of an abnormal or non-reassuring fetal heart rate pattern. The smaller volume of blood required for this test, compared with the more traditional pH estimation, may improve sampling rates. The appropriate use of this practice mandates systematic review of its safety and clinical effectiveness prior to widespread introduction. OBJECTIVES To evaluate the effectiveness and risks of fetal scalp lactate sampling in the assessment of fetal well-being during labour, compared with no testing or alternative testing. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2015). SELECTION CRITERIA All published and unpublished randomised and quasi-randomised trials that compared fetal scalp lactate testing with no testing or alternative testing to evaluate fetal status in the presence of a non-reassuring cardiotocograph during labour. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures of the Cochrane Pregnancy and Childbirth Group. Two review authors independently assessed the studies. MAIN RESULTS The search identified two completed randomised controlled trials (RCTs) and two ongoing trials. The two published RCTs considered outcomes for 3348 mother-baby pairs allocated to either lactate or pH estimation of fetal blood samples when clinically indicated in labour. Overall, the published RCTs were of low or unclear risk of bias. There was a high risk of performance bias, because it would not have been feasible to blind clinicians or participants.No statistically significant between-group differences were found for neonatal encephalopathy (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.32 to 3.09, one study, 2992 infants) or death. No studies reported neonatal seizures. We had planned to report death with other morbidities, for example, neonatal encephalopathy; however, the data were not available in a format suitable for this, therefore death due to congenital abnormality was considered alone. The three reported neonatal deaths occurred in babies with diaphragmatic hernias (n = 2) or congenital cardiac fibrosis (n = 1). All three babies had been randomised to the pH group and were not acidaemic at birth.There were no statistically significant differences for any of the pre-specified secondary fetal/neonatal/infant outcomes for which data were available. This included low Apgar score at five minutes (RR 1.13, 95% CI 0.76 to 1.68, two studies, 3319 infants) and admission to neonatal intensive care units (RR 1.02, 95% CI 0.83 to 1.25, one study, 2992 infants), or metabolic acidaemia (RR 0.91, 95% CI 0.60 to 1.36, one study, 2675 infants) considered within the studies, either overall or where data were available for those where fetal blood sampling had occurred within 60 minutes of delivery.Similar proportions of fetuses underwent additional tests to further evaluate well-being during labour, including scalp pH if in the lactate group or scalp lactate if in the pH group (RR 0.22, 95% CI 0.04 to 1.30, two studies, 3333 infants;Tau² 1.00, I² = 58%). Fetal blood sampling attempts for lactate and pH estimation were successful in 98.7% and 79.4% of procedures respectively in the one study that reported this outcome.There were no significant between-group differences in mode of birth or operative birth for non-reassuring fetal status, either for all women, or within the group where the fetal blood sample had been taken within 60 minutes of delivery (for example, caesarean section for all enrolled, RR 1.09, 95% CI 0.97 to 1.22, two studies, 3319 women; operative delivery for non-reassuring fetal status for all enrolled RR 1.02, 95% CI 0.93 to 1.11, one study, 2992 women).Neither study reported on adverse effects of fetal scalp lacerations or maternal anxiety. AUTHORS' CONCLUSIONS When further testing to assess fetal well-being in labour is indicated, fetal scalp blood lactate estimation is more likely to be successfully undertaken than pH estimation. Further studies may consider subgroup analysis by gestational age, the stage of labour and sampling within a prolonged second stage of labour. Additionally, we await the findings from the ongoing studies that compare allocation to no fetal blood sample with sampling for lactate and address longer-term neonatal outcomes, maternal satisfaction with intrapartum fetal monitoring and an economic analysis.
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Affiliation(s)
- Christine E East
- Monash University/Monash HealthSchool of Nursing and Midwifery/Maternity Services246 Clayton RoadClaytonVictoriaAustralia3168
| | - Leo R Leader
- University of New South WalesWomen's and Children's HealthRoyal Hospital for WomenBarker StreetRandwickNSWAustralia2031
| | - Penelope Sheehan
- University of MelbourneDepartment of Obstetrics and GynaecologyPregnancy Research Centre, 7th Floor, Royal Women's Hospital20 Flemington Road, ParkvilleMelbourneVictoriaAustralia3052
| | - Naomi E Henshall
- Royal Hospital for WomenDelivery SuiteRandwickNew South WalesAustralia
| | - Paul B Colditz
- The University of Queensland, Royal Brisbane & Women's HospitalPerinatal Research CentreButterfield StreetHerstonQueenslandAustralia4029
| | - Rosalind Lau
- Monash UniversitySchool of Nursing and MidwiferyWellington RoadClaytonVictoriaAustralia3800
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Chandraharan E. Author's reply: Is intrapartum fetal blood sampling still useful in modern obstetrics? BJOG 2014; 121:1752-3. [PMID: 25413769 DOI: 10.1111/1471-0528.13126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2014] [Indexed: 11/30/2022]
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Uccella S, Cromi A, Colombo GF, Bogani G, Casarin J, Agosti M, Ghezzi F. Interobserver reliability to interpret intrapartum electronic fetal heart rate monitoring: Does a standardized algorithm improve agreement among clinicians? J OBSTET GYNAECOL 2014; 35:241-5. [DOI: 10.3109/01443615.2014.958144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Jørgensen JS, Weber T. Fetal scalp blood sampling in labor - a review. Acta Obstet Gynecol Scand 2014; 93:548-55. [DOI: 10.1111/aogs.12421] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 05/05/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Jan S. Jørgensen
- Department of Gynecology and Obstetrics; Odense University Hospital; University of Southern Denmark; Institute of Clinical Research; Perinatal Research Unit; Odense Denmark
| | - Tom Weber
- Department of Gynecology and Obstetrics; Hvidovre Hospital; University of Copenhagen; Hvidovre Denmark
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Chandraharan E, Wiberg N. Fetal scalp blood sampling during labor: an appraisal of the physiological basis and scientific evidence. Acta Obstet Gynecol Scand 2014; 93:544-7. [DOI: 10.1111/aogs.12416] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/01/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | - Nana Wiberg
- Department of Obstetrics and Gynecology; Herlev Hospital; Copenhagen Denmark
- Faculty of Medicine; Lund University; Lund Sweden
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Chandraharan E. Fetal scalp blood sampling during labour: is it a useful diagnostic test or a historical test that no longer has a place in modern clinical obstetrics? BJOG 2014; 121:1056-60; discussion 1060-2. [DOI: 10.1111/1471-0528.12614] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 11/29/2022]
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