1
|
Brown J, Kanagaretnam D, Zen M. Clinical practice guidelines for intrapartum cardiotocography interpretation: A systematic review. Aust N Z J Obstet Gynaecol 2023. [PMID: 36898674 DOI: 10.1111/ajo.13667] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
BACKGROUND Clinical practice guidelines on intrapartum cardiotocography (CTG) interpretation provide structured tools to detect fetal hypoxia. Despite frequent use of different guidelines, little is known about their comparable consistency. We sought to appraise guidelines relevant to intrapartum CTG interpretation and summarise consensus and non-consensus recommendations. AIMS To compare existing intrapartum CTG interpretation guidelines. MATERIALS AND METHODS We searched PubMed, CINAHL, Cochrane, Embase, guideline databases and websites of guideline development institutions using terms 'cardiotocography', 'electronic fetal/foetal monitoring', and 'guideline' or equivalent term. The search was restricted to English-language articles published between January 1980 and January 2023 and excluded animal studies. The initial search yielded 2128 articles with 1253 unique citations. Guidelines were included if they: used English as the reporting language; included CTG interpretation criteria or guidelines as a primary objective; were published or updated since 1980; and were the most recently updated publications when multiple versions were identified. RESULTS Nineteen studies were considered for full review, and 13 met inclusion criteria. Two reviewers independently assessed guideline quality using the AGREE II instrument, and synthesised consensus and non-consensus recommendations using the content analysis approach. Most guidelines employed a three-tier interpretation framework. There were significant differences between the guidelines for relative importance of key CTG features such as accelerations, decelerations and variability, with respect to the outcome of fetal hypoxia. CONCLUSIONS There are significant differences between key intrapartum CTG interpretation guidelines currently being used. Greater consistency is needed across CTG interpretation guidelines to improve the quality of data, clinical governance, monitoring of outcomes, and to support future developments.
Collapse
Affiliation(s)
- James Brown
- Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | | | - Monica Zen
- Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
van Montfort P, Smits LJM, van Dooren IMA, Lemmens SMP, Zelis M, Zwaan IM, Spaanderman MEA, Scheepers HCJ. Implementing a Preeclampsia Prediction Model in Obstetrics: Cutoff Determination and Health Care Professionals' Adherence. Med Decis Making 2019; 40:81-89. [PMID: 31789093 PMCID: PMC6985995 DOI: 10.1177/0272989x19889890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background. Despite improved management, preeclampsia remains an important cause of maternal and neonatal mortality and morbidity. Low-dose aspirin (LDA) lowers the risk of preeclampsia. Although several guidelines recommend LDA prophylaxis in women at increased risk, they disagree about the definition of high risk. Recently, an externally validated prediction model for preeclampsia was implemented in a Dutch region combined with risk-based obstetric care paths. Objectives. To demonstrate the selection of a risk threshold and to evaluate the adherence of obstetric health care professionals to the prediction tool. Study Design. Using a survey (n = 136) and structured meetings among health care professionals, possible cutoff values at which LDA should be discussed were proposed. The prediction model, with chosen cutoff and corresponding risk-based care paths, was embedded in an online tool. Subsequently, a prospective multicenter cohort study (n = 850) was performed to analyze the adherence of health care professionals. Patient questionnaires, linked to the individual risk profiles calculated by the online tool, were used to evaluate adherence. Results. Health care professionals agreed upon employing a tool with a high detection rate (cutoff: 3.0%; sensitivity 75%, specificity 64%) followed by shared decision between patients and health care professionals on LDA prophylaxis. Of the 850 enrolled women, 364 women had an increased risk of preeclampsia. LDA was discussed with 273 of these women, resulting in an 81% adherence rate. Conclusion. Consensus regarding a suitable risk cutoff threshold was reached. The adherence to this recommendation was 81%, indicating adequate implementation.
Collapse
Affiliation(s)
- Pim van Montfort
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Limburg, the Netherlands
| | - Luc J M Smits
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Limburg, the Netherlands
| | - Ivo M A van Dooren
- Department of Obstetrics and Gynecology, Sint Jans Gasthuis Weert, Weert, Limburg, the Netherlands
| | - Stéphanie M P Lemmens
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre, Maastricht, Limburg, the Netherlands
| | - Maartje Zelis
- Department of Obstetrics and Gynecology, Zuyderland Medical Centre, Heerlen, Limburg, the Netherlands
| | - Iris M Zwaan
- Department of Obstetrics and Gynecology, Laurentius Hospital, Roermond, Limburg, the Netherlands
| | - Marc E A Spaanderman
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre, Maastricht, Limburg, the Netherlands
| | - Hubertina C J Scheepers
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre, Maastricht, Limburg, the Netherlands
| |
Collapse
|
3
|
Saleem S, Naqvi SS, Manzoor T, Saeed A, ur Rehman N, Mirza J. A Strategy for Classification of "Vaginal vs. Cesarean Section" Delivery: Bivariate Empirical Mode Decomposition of Cardiotocographic Recordings. Front Physiol 2019; 10:246. [PMID: 30941054 PMCID: PMC6433745 DOI: 10.3389/fphys.2019.00246] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 02/25/2019] [Indexed: 11/13/2022] Open
Abstract
We propose objective and robust measures for the purpose of classification of "vaginal vs. cesarean section" delivery by investigating temporal dynamics and complex interactions between fetal heart rate (FHR) and maternal uterine contraction (UC) recordings from cardiotocographic (CTG) traces. Multivariate extension of empirical mode decomposition (EMD) yields intrinsic scales embedded in UC-FHR recordings while also retaining inter-channel (UC-FHR) coupling at multiple scales. The mode alignment property of EMD results in the matched signal decomposition, in terms of frequency content, which paves the way for the selection of robust and objective time-frequency features for the problem at hand. Specifically, instantaneous amplitude and instantaneous frequency of multivariate intrinsic mode functions are utilized to construct a class of features which capture nonlinear and nonstationary interactions from UC-FHR recordings. The proposed features are fed to a variety of modern machine learning classifiers (decision tree, support vector machine, AdaBoost) to delineate vaginal and cesarean dynamics. We evaluate the performance of different classifiers on a real world dataset by investigating the following classifying measures: sensitivity, specificity, area under the ROC curve (AUC) and mean squared error (MSE). It is observed that under the application of all proposed 40 features AdaBoost classifier provides the best accuracy of 91.8% sensitivity, 95.5% specificity, 98% AUC, and 5% MSE. To conclude, the utilization of all proposed time-frequency features as input to machine learning classifiers can benefit clinical obstetric practitioners through a robust and automatic approach for the classification of fetus dynamics.
Collapse
Affiliation(s)
- Saqib Saleem
- Department of Electrical and Computer Engineering, COMSATS University Islamabad, Sahiwal, Pakistan
| | - Syed Saud Naqvi
- Department of Electrical and Computer Engineering, COMSATS University Islamabad, Islamabad, Pakistan
| | - Tareq Manzoor
- Energy Research Center, COMSATS University Islamabad, Islamabad, Pakistan
| | - Ahmed Saeed
- School of Computing, Ulster University, Newtownabbey, United Kingdom
| | - Naveed ur Rehman
- Department of Electrical and Computer Engineering, COMSATS University Islamabad, Islamabad, Pakistan
| | - Jawad Mirza
- Department of Electrical and Computer Engineering, COMSATS University Islamabad, Islamabad, Pakistan
| |
Collapse
|
4
|
|
5
|
Oh TT, Martel CG, Clark AG, Russo MB, Nossaman BD. Impact of Anesthetic Predictors on Postpartum Hospital Length of Stay and Adverse Events Following Cesarean Delivery: A Retrospective Study in 840 Consecutive Parturients. Ochsner J 2015; 15:228-236. [PMID: 26412993 PMCID: PMC4569153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Cesarean deliveries are increasing, and associated postoperative adverse events are extending hospitalizations. The aims of the present study were to analyze the role of anesthestic predictors during cesarean delivery on the incidences of extended postpartum hospital length of stay (>4 postoperative days) and adverse events. METHODS The medical records of 840 consecutive patients who underwent cesarean delivery during a 1-year period were abstracted. Previously reported anesthetic predictors underwent recursive partitioning with 5-fold cross-validation and with LogWorth values ≥2.0 statistically significant at the <0.01 level. RESULTS In this study of 840 cesarean delivery patients, 120 parturients (14.3%; confidence interval 12.1%-16.8%) experienced extended postpartum hospital length of stay (>4 hospital days). One anesthetic predictor associated with extended postpartum hospital length of stay was type of anesthetic technique: a 25.6% incidence in parturients receiving general or epidural anesthesia compared to a 9.6% incidence in parturients receiving either spinal or combined spinal-epidural anesthesia (LogWorth value of 7.3). When the amount of intravenous fluids intraoperatively administered to Americian Society of Anesthesiologists Physical Status III and IV parturients was ≥2,000 mL, the incidence of extended postpartum hospital length of stay decreased from a baseline value of 30.0% to 17.3% (LogWorth value of 2.8). The incidence of adverse events ranged from 0%-5.0%. All regional anesthetic techniques were significantly associated with a decreased incidence of adverse events: 0.7% with spinal anesthesia, 1.9% with epidural anesthesia, and 3.2% with combined spinal-epidural anesthesia when compared to the 51.4% incidence associated with general anesthesia (LogWorth value of 4.0). CONCLUSION These findings suggest that type of anesthetic technique and amount of intraoperative fluids administered during cesarean delivery have important effects on the incidences of extended postpartum hospital length of stay and adverse events following cesarean delivery.
Collapse
Affiliation(s)
- Ting Ting Oh
- Department of Anesthesia, KK Women's and Children's Hospital, Singapore
| | - Colleen G. Martel
- Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA
| | - Allison G. Clark
- Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA
| | - Melissa B. Russo
- Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA
| | - Bobby D. Nossaman
- Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| |
Collapse
|
6
|
Chudáček V, Spilka J, Burša M, Janků P, Hruban L, Huptych M, Lhotská L. Open access intrapartum CTG database. BMC Pregnancy Childbirth 2014; 14:16. [PMID: 24418387 PMCID: PMC3898997 DOI: 10.1186/1471-2393-14-16] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 12/06/2013] [Indexed: 11/10/2022] Open
Abstract
Background Cardiotocography (CTG) is a monitoring of fetal heart rate and uterine contractions. Since 1960 it is routinely used by obstetricians to assess fetal well-being. Many attempts to introduce methods of automatic signal processing and evaluation have appeared during the last 20 years, however still no significant progress similar to that in the domain of adult heart rate variability, where open access databases are available (e.g. MIT-BIH), is visible. Based on a thorough review of the relevant publications, presented in this paper, the shortcomings of the current state are obvious. A lack of common ground for clinicians and technicians in the field hinders clinically usable progress. Our open access database of digital intrapartum cardiotocographic recordings aims to change that. Description The intrapartum CTG database consists in total of 552 intrapartum recordings, which were acquired between April 2010 and August 2012 at the obstetrics ward of the University Hospital in Brno, Czech Republic. All recordings were stored in electronic form in the OB TraceVue®;system. The recordings were selected from 9164 intrapartum recordings with clinical as well as technical considerations in mind. All recordings are at most 90 minutes long and start a maximum of 90 minutes before delivery. The time relation of CTG to delivery is known as well as the length of the second stage of labor which does not exceed 30 minutes. The majority of recordings (all but 46 cesarean sections) is – on purpose – from vaginal deliveries. All recordings have available biochemical markers as well as some more general clinical features. Full description of the database and reasoning behind selection of the parameters is presented in the paper. Conclusion A new open-access CTG database is introduced which should give the research community common ground for comparison of results on reasonably large database. We anticipate that after reading the paper, the reader will understand the context of the field from clinical and technical perspectives which will enable him/her to use the database and also understand its limitations.
Collapse
Affiliation(s)
- Václav Chudáček
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic.
| | | | | | | | | | | | | |
Collapse
|
7
|
Schoorel ENC, Vankan E, Scheepers HCJ, Augustijn BCC, Dirksen CD, de Koning M, van Kuijk SMJ, Kwee A, Melman S, Nijhuis JG, Aardenburg R, de Boer K, Hasaart THM, Mol BWJ, Nieuwenhuijze M, van Pampus MG, van Roosmalen J, Roumen FJME, de Vries R, Wouters MGAJ, van der Weijden T, Hermens RPMG. Involving women in personalised decision-making on mode of delivery after caesarean section: the development and pilot testing of a patient decision aid. BJOG 2013; 121:202-9. [DOI: 10.1111/1471-0528.12516] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2013] [Indexed: 11/28/2022]
Affiliation(s)
- ENC Schoorel
- Department of Obstetrics and Gynaecology; GROW, School for Oncology and Developmental Biology; Maastricht University Medical Centre+; Maastricht The Netherlands
| | - E Vankan
- Department of Obstetrics and Gynaecology; Atrium Medical Centre; Heerlen The Netherlands
| | - HCJ Scheepers
- Department of Obstetrics and Gynaecology; GROW, School for Oncology and Developmental Biology; Maastricht University Medical Centre+; Maastricht The Netherlands
| | - BCC Augustijn
- Department of Obstetrics and Gynaecology; GROW, School for Oncology and Developmental Biology; Maastricht University Medical Centre+; Maastricht The Netherlands
| | - CD Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment; Maastricht University Medical Centre+; Maastricht The Netherlands
| | - M de Koning
- Department of Obstetrics and Gynaecology; GROW, School for Oncology and Developmental Biology; Maastricht University Medical Centre+; Maastricht The Netherlands
| | - SMJ van Kuijk
- Department of Epidemiology; Caphri School for Public Health and Primary Care; Maastricht University Medical Centre+; Maastricht The Netherlands
| | - A Kwee
- Department of Obstetrics and Gynaecology; University Medical Centre; Utrecht The Netherlands
| | - S Melman
- Department of Obstetrics and Gynaecology; GROW, School for Oncology and Developmental Biology; Maastricht University Medical Centre+; Maastricht The Netherlands
| | - JG Nijhuis
- Department of Obstetrics and Gynaecology; GROW, School for Oncology and Developmental Biology; Maastricht University Medical Centre+; Maastricht The Netherlands
| | - R Aardenburg
- Department of Obstetrics and Gynaecology; Orbis Medical Centre; Sittard The Netherlands
| | - K de Boer
- Department of Obstetrics and Gynaecology; Hospital Rijnstate; Arnhem The Netherlands
| | - THM Hasaart
- Department of Obstetrics and Gynaecology; Catharina Hospital; Eindhoven The Netherlands
| | - BWJ Mol
- Department of Obstetrics and Gynaecology; Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - M Nieuwenhuijze
- Midwifery Education and Studies Maastricht-ZUYD; Research Department Midwifery Science; Maastricht The Netherlands
| | - MG van Pampus
- Department of Obstetrics and Gynaecology; Onze Lieve Vrouwe Gasthuis; Amsterdam The Netherlands
| | - J van Roosmalen
- Department of Obstetrics and Gynaecology; Leiden University Medical Centre; Leiden The Netherlands
| | - FJME Roumen
- Department of Obstetrics and Gynaecology; Atrium Medical Centre; Heerlen The Netherlands
| | - R de Vries
- Midwifery Education and Studies Maastricht-ZUYD; Research Department Midwifery Science; Maastricht The Netherlands
| | - MGAJ Wouters
- Department of Obstetrics and Gynaecology; VU University Medical Centre; Amsterdam The Netherlands
| | - T van der Weijden
- Department of Family Medicine; Caphri School for Public Health and Primary Care Research; Maastricht University Medical Centre+; Maastricht The Netherlands
| | - RPMG Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare); Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| |
Collapse
|