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Interpretation of Fetal Heart Rate Monitoring in the Clinical Context. Clin Obstet Gynecol 2021; 63:625-634. [PMID: 32735415 DOI: 10.1097/grf.0000000000000554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Use of intrapartum fetal heart rate (FHR) monitoring has had limited success in preventing hypoxic injury to neonates. One of the most common limitations of FHR interpretation is the failure to consider chronic and acute clinical factors that may increase the risk of evolving acidemia. This manuscript reviews common clinical factors that may affect the FHR and should be considered when determining the need for early intervention based on changes in the FHR.
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Muraoka J, Kodama Y, Ohashi M, Goto T, Sameshima H. Intrapartum fetal heart rate patterns and perinatal outcome in chorioamnionitis at or beyond 34 weeks of gestation. J Obstet Gynaecol Res 2021; 47:1110-1117. [PMID: 33403794 DOI: 10.1111/jog.14641] [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: 08/05/2020] [Revised: 11/30/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022]
Abstract
AIM To investigate intrapartum fetal heart rate (FHR) patterns in women with chorioamnionitis at or beyond 34 weeks of gestation in relation to neonatal outcome and to compare clinical and subclinical chorioamnionitis. METHODS A retrospective questionnaire survey on deliveries during 2015 was conducted by the Perinatology Committee of the Japan Society of Obstetrics and Gynecology from 2016 to 2018. A total of 498 singleton births complicated by chorioamnionitis delivered at ≥34 weeks of gestation without major congenital malformations were included. The subjects were divided into clinical and subclinical chorioamnionitis groups based on Lencki's criteria. Poor perinatal outcome was defined as death or brain damage. We analyzed clinical features, FHR patterns in the last 2 h before delivery, gestational age, birthweight, Apgar score, umbilical arterial blood gas analysis, and infant's outcome. RESULTS Incidence of chorioamnionitis at ≥34 weeks of gestation was 0.59% (522/87827). Clinical and subclinical chorioamnionitis comprised 240 and 258 cases, respectively. Abnormal FHR patterns (late deceleration or decreased baseline variability) were significantly associated with poor perinatal outcome. Combined late deceleration and decreased variability showed low positive predictive value (12.8%) and high negative predictive value (99.5%), and was significantly associated with long-term poor outcome in clinical chorioamnionitis only (odds ratio: 29.4, p < 0.01). Poor perinatal outcome showed no significant difference between the clinical and subclinical chorioamnionitis groups. CONCLUSIONS Combined late deceleration and decreased variability could predict poor perinatal outcome in clinical chorioamnionitis. Poor perinatal outcome occurred in infants born to mothers with clinical and subclinical chorioamnionitis.
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Affiliation(s)
- Junsuke Muraoka
- Department of Obstetrics and Gynecology and Center for Perinatal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yuki Kodama
- Department of Obstetrics and Gynecology and Center for Perinatal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Masanao Ohashi
- Department of Obstetrics and Gynecology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Tomoko Goto
- Department of Obstetrics and Gynecology and Center for Perinatal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiroshi Sameshima
- Department of Obstetrics and Gynecology and Center for Perinatal Medicine, University of Miyazaki, Miyazaki, Japan
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Kyozuka H, Murata T, Fukuda T, Yamaguchi A, Kanno A, Yasuda S, Sato A, Ogata Y, Kuse M, Hosoya M, Yasumura S, Hashimoto K, Nishigori H, Fujimori K. Dietary Inflammatory Index during Pregnancy and the Risk of Intrapartum Fetal Asphyxia: The Japan Environment and Children's Study. Nutrients 2020; 12:nu12113482. [PMID: 33202775 PMCID: PMC7698066 DOI: 10.3390/nu12113482] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/11/2020] [Indexed: 12/11/2022] Open
Abstract
We aimed to examine the impact of a daily pro-inflammatory diet during pregnancy on intrapartum fetal acidemia using a large birth cohort study in Japan. We used data on singleton pregnancies in the Japan Environment and Children’s Study (JECS) involving births from 2011 to 2014 through vaginal delivery to calculate the maternal dietary inflammatory index (DII). Participants were categorized according to DII quintiles. A multiple logistic regression model was used to estimate the risk of a pro-inflammatory diet on fetal umbilical artery pH. In total, 56,490 participants were eligible for this study. Multiple regression analysis showed that nulliparous women who had undergone vaginal delivery and were consuming a pro-inflammatory diet had an increased risk of pH < 7.10 (adjusted odds ratio [aOR]: 1.64, 95% confidence interval [CI]: 1.12–2.39). Among these women, the risk of pH < 7.10 was not affected by the duration of labor (aOR: 1.64, 95% CI: 1.11–2.42). In conclusion, following a pro-inflammatory diet during pregnancy is a risk factor for fetal acidosis among nulliparous women undergoing vaginal delivery. A high DII diet during pregnancy may modify the intrapartum fetal heart rate pattern via intrauterine inflammation.
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Affiliation(s)
- Hyo Kyozuka
- Fukushima Regional Center for the Japan Environmental and Children’s Study, 1 Hikarigaoka, Fukushima 960-1295, Japan; (T.M.); (T.F.); (A.Y.); (A.K.); (S.Y.); (A.S.); (Y.O.); (M.K.); (M.H.); (S.Y.); (K.H.); (H.N.); (K.F.)
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan
- Correspondence: ; Tel.: +81-24-547-1288
| | - Tsuyoshi Murata
- Fukushima Regional Center for the Japan Environmental and Children’s Study, 1 Hikarigaoka, Fukushima 960-1295, Japan; (T.M.); (T.F.); (A.Y.); (A.K.); (S.Y.); (A.S.); (Y.O.); (M.K.); (M.H.); (S.Y.); (K.H.); (H.N.); (K.F.)
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Toma Fukuda
- Fukushima Regional Center for the Japan Environmental and Children’s Study, 1 Hikarigaoka, Fukushima 960-1295, Japan; (T.M.); (T.F.); (A.Y.); (A.K.); (S.Y.); (A.S.); (Y.O.); (M.K.); (M.H.); (S.Y.); (K.H.); (H.N.); (K.F.)
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Akiko Yamaguchi
- Fukushima Regional Center for the Japan Environmental and Children’s Study, 1 Hikarigaoka, Fukushima 960-1295, Japan; (T.M.); (T.F.); (A.Y.); (A.K.); (S.Y.); (A.S.); (Y.O.); (M.K.); (M.H.); (S.Y.); (K.H.); (H.N.); (K.F.)
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Aya Kanno
- Fukushima Regional Center for the Japan Environmental and Children’s Study, 1 Hikarigaoka, Fukushima 960-1295, Japan; (T.M.); (T.F.); (A.Y.); (A.K.); (S.Y.); (A.S.); (Y.O.); (M.K.); (M.H.); (S.Y.); (K.H.); (H.N.); (K.F.)
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Shun Yasuda
- Fukushima Regional Center for the Japan Environmental and Children’s Study, 1 Hikarigaoka, Fukushima 960-1295, Japan; (T.M.); (T.F.); (A.Y.); (A.K.); (S.Y.); (A.S.); (Y.O.); (M.K.); (M.H.); (S.Y.); (K.H.); (H.N.); (K.F.)
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environmental and Children’s Study, 1 Hikarigaoka, Fukushima 960-1295, Japan; (T.M.); (T.F.); (A.Y.); (A.K.); (S.Y.); (A.S.); (Y.O.); (M.K.); (M.H.); (S.Y.); (K.H.); (H.N.); (K.F.)
| | - Yuka Ogata
- Fukushima Regional Center for the Japan Environmental and Children’s Study, 1 Hikarigaoka, Fukushima 960-1295, Japan; (T.M.); (T.F.); (A.Y.); (A.K.); (S.Y.); (A.S.); (Y.O.); (M.K.); (M.H.); (S.Y.); (K.H.); (H.N.); (K.F.)
| | - Masahito Kuse
- Fukushima Regional Center for the Japan Environmental and Children’s Study, 1 Hikarigaoka, Fukushima 960-1295, Japan; (T.M.); (T.F.); (A.Y.); (A.K.); (S.Y.); (A.S.); (Y.O.); (M.K.); (M.H.); (S.Y.); (K.H.); (H.N.); (K.F.)
| | - Mitsuaki Hosoya
- Fukushima Regional Center for the Japan Environmental and Children’s Study, 1 Hikarigaoka, Fukushima 960-1295, Japan; (T.M.); (T.F.); (A.Y.); (A.K.); (S.Y.); (A.S.); (Y.O.); (M.K.); (M.H.); (S.Y.); (K.H.); (H.N.); (K.F.)
- Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environmental and Children’s Study, 1 Hikarigaoka, Fukushima 960-1295, Japan; (T.M.); (T.F.); (A.Y.); (A.K.); (S.Y.); (A.S.); (Y.O.); (M.K.); (M.H.); (S.Y.); (K.H.); (H.N.); (K.F.)
- Department of Public Health, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Koichi Hashimoto
- Fukushima Regional Center for the Japan Environmental and Children’s Study, 1 Hikarigaoka, Fukushima 960-1295, Japan; (T.M.); (T.F.); (A.Y.); (A.K.); (S.Y.); (A.S.); (Y.O.); (M.K.); (M.H.); (S.Y.); (K.H.); (H.N.); (K.F.)
- Department of Public Health, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Hidekazu Nishigori
- Fukushima Regional Center for the Japan Environmental and Children’s Study, 1 Hikarigaoka, Fukushima 960-1295, Japan; (T.M.); (T.F.); (A.Y.); (A.K.); (S.Y.); (A.S.); (Y.O.); (M.K.); (M.H.); (S.Y.); (K.H.); (H.N.); (K.F.)
- Fukushima Medical Center for Children and Women, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Keiya Fujimori
- Fukushima Regional Center for the Japan Environmental and Children’s Study, 1 Hikarigaoka, Fukushima 960-1295, Japan; (T.M.); (T.F.); (A.Y.); (A.K.); (S.Y.); (A.S.); (Y.O.); (M.K.); (M.H.); (S.Y.); (K.H.); (H.N.); (K.F.)
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan
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Parker SJ, Kuzniewicz M, Niki H, Wu YW. Antenatal and Intrapartum Risk Factors for Hypoxic-Ischemic Encephalopathy in a US Birth Cohort. J Pediatr 2018; 203:163-169. [PMID: 30270166 DOI: 10.1016/j.jpeds.2018.08.028] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/12/2018] [Accepted: 08/13/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To identify risk factors for hypoxic-ischemic encephalopathy (HIE) within a recent US birth cohort. STUDY DESIGN In a retrospective cohort study of 44 572 singleton infants ≥36 weeks of gestation born at Kaiser Permanente Northern California in 2008-2015, we identified all infants with HIE based on the presence of 3 inclusion criteria: clinical signs of neonatal encephalopathy, NICU admission, and either a 10-minute Apgar of ≤5 or a base excess of ≤-15 mmol/L. Neonatal acidemia was defined as a base excess of ≤-12 mmol/L. We ascertained antenatal and intrapartum complications from electronic records. Multivariable analysis was performed using logistic regression. RESULTS There were 45 infants (1.0 per 1000) with HIE and 197 (4.4 per 1000) with neonatal acidemia. Of the infants with HIE, 64% had an intrapartum complication consisting of a sentinel event (36%), clinical chorioamnionitis (40%), or both (11%). Risk factors for HIE on multivariable analysis were sentinel event (relative risk [RR], 16.1; 95% CI, 8.4-33) and clinical chorioamnionitis (RR, 5.2; 95% CI, 2.7-9.9). After removing the 16 infants with HIE who were exposed to a sentinel event from multivariate analysis, maternal age of ≥35 years (RR, 2.5; 95% CI, 1.1-5.6) and a urinary tract infection during pregnancy (RR, 2.6; 95% CI, 1.0-6.5) emerged as potential antenatal risk factors for HIE. CONCLUSIONS A significant proportion of HIE is preceded by a sentinel event, emphasizing the importance of developing improved methodologies to predict and prevent this perinatal complication. Strategies focused on reducing other complications such as clinical chorioamnionitis and/or maternal pyrexia may also improve our ability to prevent HIE.
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Affiliation(s)
- Sarah-Jane Parker
- Perinatal Research Unit, Division of Research, Kaiser Permanente, Oakland, CA
| | - Michael Kuzniewicz
- Perinatal Research Unit, Division of Research, Kaiser Permanente, Oakland, CA; Department of Pediatrics, University of California, San Francisco, CA
| | - Hamid Niki
- Perinatal Research Unit, Division of Research, Kaiser Permanente, Oakland, CA
| | - Yvonne W Wu
- Department of Pediatrics, University of California, San Francisco, CA; Department of Neurology, University of California, San Francisco, CA.
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Wilczyński J, Karolak P, Karolak J, Wilczyński I, Pedrycz A. Electromyographic analysis of erector spinae muscle for a child with cerebral palsy. POLISH HYPERBARIC RESEARCH 2016. [DOI: 10.1515/phr-2016-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The aim of this study was the electromyographic analysis of the erector spinae muscle, using the Noraxon Tele Myo DTS equipment. It’s used to test the neuromuscular function, during physical activity. It allows for detailed localization of the pathological changes in the muscle tissue. It can be also helpful to define the functional disorders of the muscular system in children with cerebral palsy. For the purpose of the study, a six-year-old girl with this disease was examined, one of the types of EMG - surface electromyography being used. The problem which is of primary importance in children with cerebral palsy is a widely understood damage of the musculoskeletal system. The test was performed in five starting positions, with the electrodes placed on the lumbar spine. As a result of the analysis, a motor skills disorder, asymmetry of muscle tension and dystonia was diagnosed. Dystonia may be the result of other disease, characteristic to children with cerebral palsy – scoliosis.
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Affiliation(s)
- Jacek Wilczyński
- Institute of Physiotherapy, Department of Medicine and Health Sciences, Jan Kochanowski University of Kielce, Poland
| | | | | | - Igor Wilczyński
- Phisiotherapy Student, Wincenty Pol Higher School of Social and Natural Science, Lublin, Poland
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Fukushima K, Morokuma S, Kitadai Y, Tazaki Y, Sumie M, Nakanami N, Ushiro S, Matsuda Y, Tsukimori K. Analysis of antenatal-onset cerebral palsy secondary to transient ischemia in utero
using a national database in Japan. J Obstet Gynaecol Res 2016; 42:1297-1303. [DOI: 10.1111/jog.13046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Kotaro Fukushima
- Department of Obstetrics; Fukuoka Children's Hospital; Fukuoka Japan
| | - Seiichi Morokuma
- Department of Obstetrics and Gynecology; Kyushu University Hospital; Fukuoka Japan
| | - Yuzo Kitadai
- Department of Obstetrics; Fukuoka Children's Hospital; Fukuoka Japan
| | - Yukiko Tazaki
- Department of Obstetrics; Fukuoka Children's Hospital; Fukuoka Japan
| | - Masahiro Sumie
- Department of Obstetrics; Fukuoka Children's Hospital; Fukuoka Japan
| | - Naoyuki Nakanami
- Department of Obstetrics; Fukuoka Children's Hospital; Fukuoka Japan
| | - Shin Ushiro
- Division of Patient Safety; Kyushu University Hospital; Fukuoka Japan
| | - Yoshio Matsuda
- Department of Obstetrics and Gynecology; International University of Health and Welfare Hospital; Tochigi Japan
| | - Kiyomi Tsukimori
- Department of Obstetrics; Fukuoka Children's Hospital; Fukuoka Japan
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