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Hussain NM, O'Halloran M, McDermott B, Elahi MA. Fetal monitoring technologies for the detection of intrapartum hypoxia - challenges and opportunities. Biomed Phys Eng Express 2024; 10:022002. [PMID: 38118183 DOI: 10.1088/2057-1976/ad17a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 12/20/2023] [Indexed: 12/22/2023]
Abstract
Intrapartum fetal hypoxia is related to long-term morbidity and mortality of the fetus and the mother. Fetal surveillance is extremely important to minimize the adverse outcomes arising from fetal hypoxia during labour. Several methods have been used in current clinical practice to monitor fetal well-being. For instance, biophysical technologies including cardiotocography, ST-analysis adjunct to cardiotocography, and Doppler ultrasound are used for intrapartum fetal monitoring. However, these technologies result in a high false-positive rate and increased obstetric interventions during labour. Alternatively, biochemical-based technologies including fetal scalp blood sampling and fetal pulse oximetry are used to identify metabolic acidosis and oxygen deprivation resulting from fetal hypoxia. These technologies neither improve clinical outcomes nor reduce unnecessary interventions during labour. Also, there is a need to link the physiological changes during fetal hypoxia to fetal monitoring technologies. The objective of this article is to assess the clinical background of fetal hypoxia and to review existing monitoring technologies for the detection and monitoring of fetal hypoxia. A comprehensive review has been made to predict fetal hypoxia using computational and machine-learning algorithms. The detection of more specific biomarkers or new sensing technologies is also reviewed which may help in the enhancement of the reliability of continuous fetal monitoring and may result in the accurate detection of intrapartum fetal hypoxia.
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Affiliation(s)
- Nadia Muhammad Hussain
- Discipline of Electrical & Electronic Engineering, University of Galway, Ireland
- Translational Medical Device Lab, Lambe Institute for Translational Research, University Hospital Galway, Ireland
| | - Martin O'Halloran
- Discipline of Electrical & Electronic Engineering, University of Galway, Ireland
- Translational Medical Device Lab, Lambe Institute for Translational Research, University Hospital Galway, Ireland
| | - Barry McDermott
- Translational Medical Device Lab, Lambe Institute for Translational Research, University Hospital Galway, Ireland
- College of Medicine, Nursing & Health Sciences, University of Galway, Ireland
| | - Muhammad Adnan Elahi
- Discipline of Electrical & Electronic Engineering, University of Galway, Ireland
- Translational Medical Device Lab, Lambe Institute for Translational Research, University Hospital Galway, Ireland
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2
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Current Innovative Methods of Fetal pH Monitoring—A Brief Review. Diagnostics (Basel) 2022; 12:diagnostics12112675. [DOI: 10.3390/diagnostics12112675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/24/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
In this study, we explore the “why?”, and “how?”, monitoring the pH of the fetal scalp is used, and show its limitations. In addition, we review the development of new devices based on the modern physics and nanomaterials serving this topic. Most of the works we found in our search have focused on improving the prognostic of fetal heart rate monitoring, because it is the “golden standard” in determining fetal distress. Although the best-known screening method, it can only provide limited information about the actual status of the fetus. The best predictive assessment, with the highest reproducibility, states that a normal fetal heart rate is indicative of a healthy baby. However, its excellent sensitivity is much reduced when identifying the actual “distress”. This is when second-line monitoring methods come into play to guide the diagnostics and direct the obstetrician towards an action plan. Although a historic method, fetal scalp pH sampling is still under review as to its efficiency and place in the current obstetrics. Continuous surveillance of the fetal parameters is important, especially for the fetuses undergoing intrauterine growth restricted (IUGR). Since fetal scalp blood sampling is still under research and is a randomized controlled trial, which compares the relevance of pH and lactates to the obstetrical situation, the maternal-fetal medicine could greatly benefit from the introduction of engineered nanomedicines to the field.
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3
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García-Guzmán JJ, Sierra-Padilla A, Palacios-Santander JM, Fernández-Alba JJ, Macías CG, Cubillana-Aguilera L. What Is Left for Real-Life Lactate Monitoring? Current Advances in Electrochemical Lactate (Bio)Sensors for Agrifood and Biomedical Applications. BIOSENSORS 2022; 12:919. [PMID: 36354428 PMCID: PMC9688009 DOI: 10.3390/bios12110919] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/20/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Monitoring of lactate is spreading from the evident clinical environment, where its role as a biomarker is notorious, to the agrifood ambit as well. In the former, lactate concentration can serve as a useful indicator of several diseases (e.g., tumour development and lactic acidosis) and a relevant value in sports performance for athletes, among others. In the latter, the spotlight is placed on the food control, bringing to the table meaningful information such as decaying product detection and stress monitoring of species. No matter what purpose is involved, electrochemical (bio)sensors stand as a solid and suitable choice. However, for the time being, this statement seems to be true only for discrete measurements. The reality exposes that real and continuous lactate monitoring is still a troublesome goal. In this review, a critical overview of electrochemical lactate (bio)sensors for clinical and agrifood situations is performed. Additionally, the transduction possibilities and different sensor designs approaches are also discussed. The main aim is to reflect the current state of the art and to indicate relevant advances (and bottlenecks) to keep in mind for further development and the final achievement of this highly worthy objective.
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Affiliation(s)
- Juan José García-Guzmán
- Instituto de Investigación e Innovación Biomédica de Cadiz (INiBICA), Hospital Universitario ‘Puerta del Mar’, Universidad de Cadiz, 11009 Cadiz, Spain
| | - Alfonso Sierra-Padilla
- Department of Analytical Chemistry, Institute of Research on Electron Microscopy and Materials (IMEYMAT), Faculty of Sciences, Campus de Excelencia Internacional del Mar (CEIMAR), University of Cadiz, Campus Universitario de Puerto Real, Polígono del Río San Pedro S/N, Puerto Real, 11510 Cadiz, Spain
| | - José María Palacios-Santander
- Department of Analytical Chemistry, Institute of Research on Electron Microscopy and Materials (IMEYMAT), Faculty of Sciences, Campus de Excelencia Internacional del Mar (CEIMAR), University of Cadiz, Campus Universitario de Puerto Real, Polígono del Río San Pedro S/N, Puerto Real, 11510 Cadiz, Spain
| | - Juan Jesús Fernández-Alba
- Department of Obstetrics and Gynecology, Hospital Universitario de Puerto Real, Puerto Real, 11510 Cadiz, Spain
| | - Carmen González Macías
- Department of Obstetrics and Gynecology, Hospital Universitario de Puerto Real, Puerto Real, 11510 Cadiz, Spain
| | - Laura Cubillana-Aguilera
- Department of Analytical Chemistry, Institute of Research on Electron Microscopy and Materials (IMEYMAT), Faculty of Sciences, Campus de Excelencia Internacional del Mar (CEIMAR), University of Cadiz, Campus Universitario de Puerto Real, Polígono del Río San Pedro S/N, Puerto Real, 11510 Cadiz, Spain
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4
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Jain S, Acharya N. Fetal Wellbeing Monitoring – A Review Article. Cureus 2022; 14:e29039. [PMID: 36249607 PMCID: PMC9550204 DOI: 10.7759/cureus.29039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/11/2022] [Indexed: 11/15/2022] Open
Abstract
While assessing maternal health is relatively easy, assessing fetal well-being has always been tricky. This has led to tremendous technological development in fetal well-being assessment, thus bridging the gap between biotechnology and antenatal medicine. It is broadly divided into early pregnancy, late pregnancy, and during labour assessment. While the early assessment involves genetic check-ups and malformations, the late pregnancy check-ups aim at delivering a healthy fetus at term by normal vaginal delivery. The early tests can be invasive or non-invasive. Non-invasive include cell-free fetal DNA assessment and fetal cell-based assessment. Invasive tests include amniocentesis and chorionic villous sampling. These are followed by chromosomal microarray and next-generation sequencing. Under this procedure, exome sequencing is done, which is either clinical or whole. Sequencing of the whole genome can also be done. A recent advancement is pre-implantation genetic testing. These are mainly useful in identifying monogenic disorders for which the locus causing disease is identified beyond any doubt. In late pregnancy, the most commonly used test is biophysical. It works on the principle that an increase in the fetal heart rate occurs in conjugation with fetal movements. The next widely employed technology is Doppler, which is used to know fetal heart rates, valve timing intervals, and umbilical artery waveforms. Cardiotocography is also widely used both during pregnancy and during labour. It measures the fetal heart rate while correlating it with uterine contractions. Wireless fetal and maternal heart monitoring and telemonitoring are recent upcoming fields.
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Mosnino E, Michel AS, Messedi E, Kayem G, Pinton A. [Comparison of the measurement of lactate at the cord by hand-held devices approved for use during labor with a reference device]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:481-485. [PMID: 35288368 DOI: 10.1016/j.gofs.2022.02.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/12/2022] [Accepted: 02/13/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To compare two portable lactate devices, Lactate Scout and StatStrip Xpress, to a laboratory reference device by assessing the concordance of cord blood lactate values at birth. METHODS We conducted a single-center prospective validation study in a level 3 maternity hospital. For all cord samples taken at birth, we analyzed lactates on the reference device (GEM4000®) and on two portable devices Lactate Scout and StatStrip Xpress. We compared the lactate values from each of the two handheld devices to the reference device. RESULTS A total of 101 samples were collected. Each was analyzed by all three machines. The average lactate value obtained by the different machines was 3.7mmol/L. The mean difference between the Lactate Scout and GEM4000® apparatus was 0.0mmol/L±0.8mmol/L. Between these two devices at lactate threshold of 4.8mmol/L, the negative predictive value was 96,2% (76/79) and the area under the curve was 0.98 (95% CI 0.96-1]. The mean difference between StatStrip Xpress and GEM4000® was 0.1mmol/L±0.7mmol/L. Between these two devices at the lactate threshold of 4.8mmol/L, the negative predictive value was 97,4% (76/78) and the area under the curve was 0.95 (95% CI 0.86-1). CONCLUSION There is a good correlation between the lactates obtained by the reference device and the two portable devices Lactate Scout and StatStrip Xpress.
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Affiliation(s)
- E Mosnino
- Service de gynécologie obstétrique, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne Université, AP-HP, 91, boulevard de l'Hôpital, Paris, France
| | - A-S Michel
- Service de gynécologie obstétrique, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne Université, AP-HP, 91, boulevard de l'Hôpital, Paris, France
| | - E Messedi
- Sorbonne Université, AP-HP, 91, boulevard de l'Hôpital, Paris, France; Service de biochimie, hôpital Trousseau, DMU biologie et génomique Médicales, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - G Kayem
- Service de gynécologie obstétrique, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne Université, AP-HP, 91, boulevard de l'Hôpital, Paris, France
| | - A Pinton
- Service de gynécologie obstétrique, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne Université, AP-HP, 91, boulevard de l'Hôpital, Paris, France.
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Abdul Halim SF, Zakaria Z, Pusppanathan J, Mohd Noor A, Norali AN, Fazalul Rahiman MH, Mohd Muji SZ, Abdul Rahim R, Engku-Husna EI, Ali Hassan MK, Aziz Safar MJ, Salleh AF, Mat Som MH. A Review on Magnetic Induction Spectroscopy Potential for Fetal Acidosis Examination. SENSORS 2022; 22:s22041334. [PMID: 35214235 PMCID: PMC8963069 DOI: 10.3390/s22041334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/24/2021] [Accepted: 01/07/2022] [Indexed: 02/06/2023]
Abstract
Fetal acidosis is one of the main concerns during labor. Currently, fetal blood sampling (FBS) has become the most accurate measurement of acidosis detection. However, it is invasive and does not provide a real time measurement due to laboratory procedures. Delays in diagnosis of acidosis have caused serious injury to the fetus, especially for the brain and the heart. This paper reviews the new technique in diagnosis of acidosis non-invasively. Magnetic Induction Spectroscopy (MIS) has been proposed to be a new device for acidosis detection in recent years. This paper explains the basic principle of MIS and outlines the design specifications and design considerations for a MIS pH probe. It is expected that readers will gain a basic understanding of the development of a MIS pH probe from this review.
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Affiliation(s)
- Siti Fatimah Abdul Halim
- Biomedical Electronic Engineering, Faculty of Electronic Engineering Technology, Universiti Malaysia Perlis, Arau 02600, Perlis, Malaysia; (S.F.A.H.); (A.M.N.); (A.N.N.); (A.F.S.); (M.H.M.S.)
| | - Zulkarnay Zakaria
- Biomedical Electronic Engineering, Faculty of Electronic Engineering Technology, Universiti Malaysia Perlis, Arau 02600, Perlis, Malaysia; (S.F.A.H.); (A.M.N.); (A.N.N.); (A.F.S.); (M.H.M.S.)
- Medical Device & Life Sciences Cluster, Sports Engineering Research Centre (SERC), Universiti Malaysia Perlis, Arau 02600, Perlis, Malaysia; (M.K.A.H.); (M.J.A.S.)
- Correspondence:
| | - Jaysuman Pusppanathan
- Sport Innovation & Technology Centre (SiTC), Institute of Human Centered Engineering (iHumen), Universiti Teknologi Malaysia, Skudai 81310, Johor, Malaysia;
| | - Anas Mohd Noor
- Biomedical Electronic Engineering, Faculty of Electronic Engineering Technology, Universiti Malaysia Perlis, Arau 02600, Perlis, Malaysia; (S.F.A.H.); (A.M.N.); (A.N.N.); (A.F.S.); (M.H.M.S.)
- Medical Device & Life Sciences Cluster, Sports Engineering Research Centre (SERC), Universiti Malaysia Perlis, Arau 02600, Perlis, Malaysia; (M.K.A.H.); (M.J.A.S.)
| | - Ahmad Nasrul Norali
- Biomedical Electronic Engineering, Faculty of Electronic Engineering Technology, Universiti Malaysia Perlis, Arau 02600, Perlis, Malaysia; (S.F.A.H.); (A.M.N.); (A.N.N.); (A.F.S.); (M.H.M.S.)
- Medical Device & Life Sciences Cluster, Sports Engineering Research Centre (SERC), Universiti Malaysia Perlis, Arau 02600, Perlis, Malaysia; (M.K.A.H.); (M.J.A.S.)
| | | | - Siti Zarina Mohd Muji
- Department of Electronic Engineering, Faculty of Electrical and Electronic Engineering, Universiti Tun Hussein Onn Malaysia, Parit Raja, Batu Pahat 86400, Johor, Malaysia;
| | - Ruzairi Abdul Rahim
- School of Electrical Engineering, Faculty of Engineering, Universiti Teknologi Malaysia, Skudai 81310, Johor, Malaysia;
| | - Engku Ismail Engku-Husna
- Department of Obstetrics and Gynaecology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
| | - Muhamad Khairul Ali Hassan
- Medical Device & Life Sciences Cluster, Sports Engineering Research Centre (SERC), Universiti Malaysia Perlis, Arau 02600, Perlis, Malaysia; (M.K.A.H.); (M.J.A.S.)
- Faculty of Electrical Engineering Technology, Universiti Malaysia Perlis, Arau 02600, Perlis, Malaysia;
| | - Muhammad Juhairi Aziz Safar
- Medical Device & Life Sciences Cluster, Sports Engineering Research Centre (SERC), Universiti Malaysia Perlis, Arau 02600, Perlis, Malaysia; (M.K.A.H.); (M.J.A.S.)
- Faculty of Electrical Engineering Technology, Universiti Malaysia Perlis, Arau 02600, Perlis, Malaysia;
| | - Ahmad Faizal Salleh
- Biomedical Electronic Engineering, Faculty of Electronic Engineering Technology, Universiti Malaysia Perlis, Arau 02600, Perlis, Malaysia; (S.F.A.H.); (A.M.N.); (A.N.N.); (A.F.S.); (M.H.M.S.)
- Medical Device & Life Sciences Cluster, Sports Engineering Research Centre (SERC), Universiti Malaysia Perlis, Arau 02600, Perlis, Malaysia; (M.K.A.H.); (M.J.A.S.)
| | - Mohd Hanafi Mat Som
- Biomedical Electronic Engineering, Faculty of Electronic Engineering Technology, Universiti Malaysia Perlis, Arau 02600, Perlis, Malaysia; (S.F.A.H.); (A.M.N.); (A.N.N.); (A.F.S.); (M.H.M.S.)
- Medical Device & Life Sciences Cluster, Sports Engineering Research Centre (SERC), Universiti Malaysia Perlis, Arau 02600, Perlis, Malaysia; (M.K.A.H.); (M.J.A.S.)
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Rivolta MW, Barbieri M, Stampalija T, Sassi R, Frasch MG. Relationship Between Deceleration Morphology and Phase Rectified Signal Averaging-Based Parameters During Labor. Front Med (Lausanne) 2021; 8:626450. [PMID: 34901040 PMCID: PMC8655232 DOI: 10.3389/fmed.2021.626450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 10/31/2021] [Indexed: 01/03/2023] Open
Abstract
During labor, uterine contractions trigger the response of the autonomic nervous system (ANS) of the fetus, producing sawtooth-like decelerations in the fetal heart rate (FHR) series. Under chronic hypoxia, ANS is known to regulate FHR differently with respect to healthy fetuses. In this study, we hypothesized that such different ANS regulation might also lead to a change in the FHR deceleration morphology. The hypothesis was tested in an animal model comprising nine normoxic and five chronically hypoxic fetuses that underwent a protocol of umbilical cord occlusions (UCOs). Deceleration morphologies in the fetal inter-beat time interval (FRR) series were modeled using a trapezoid with four parameters, i.e., baseline b, deceleration depth a, UCO response time τ u and recovery time τ r . Comparing normoxic and hypoxic sheep, we found a clear difference for τ u (24.8±9.4 vs. 39.8±9.7 s; p < 0.05), a (268.1±109.5 vs. 373.0±46.0 ms; p < 0.1) and Δτ = τ u - τ r (13.2±6.9 vs. 23.9±7.5 s; p < 0.05). Therefore, the animal model supported the hypothesis that hypoxic fetuses have a longer response time τ u and larger asymmetry Δτ as a response to UCOs. Assessing these morphological parameters during labor is challenging due to non-stationarity, phase desynchronization and noise. For this reason, in the second part of the study, we quantified whether acceleration capacity (AC), deceleration capacity (DC), and deceleration reserve (DR), computed through Phase-Rectified Signal Averaging (PRSA, known to be robust to noise), were correlated with the morphological parameters. DC, AC and DR were correlated with τ u , τ r and Δτ for a wide range of the PRSA parameter T (Pearson's correlation ρ > 0.8, p < 0.05). In conclusion, deceleration morphologies have been found to differ between normoxic and hypoxic sheep fetuses during UCOs. The same difference can be assessed through PRSA based parameters, further motivating future investigations on the translational potential of this methodology on human data.
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Affiliation(s)
- Massimo W. Rivolta
- Dipartimento di Informatica, Università degli Studi di Milano, Milan, Italy
| | - Moira Barbieri
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Roberto Sassi
- Dipartimento di Informatica, Università degli Studi di Milano, Milan, Italy
| | - Martin G. Frasch
- Department of Obstetrics and Gynecology and Center on Human Development and Disability (CHDD), School of Medicine, University of Washington, Seattle, WA, United States
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Neacsu A, Herghelegiu CG, Voinea S, Dimitriu MCT, Ples L, Bohiltea RE, Braila AD, Nastase L, Bacalbasa N, Chivu LI, Furtunescu F, Ioan RG. Umbilical cord lactate compared with pH as predictors of intrapartum asphyxia. Exp Ther Med 2020; 21:80. [PMID: 33363591 DOI: 10.3892/etm.2020.9513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023] Open
Abstract
Despite advances in fetal monitoring during labor, one of the most critical causes of neonatal death and neurologic injuries remains intrapartum asphyxia. Umbilical cord gases can be used to detect acidosis and fetal distress. We conducted a retrospective, multicenter study to evaluate umbilical cord blood pH and lactate as a mean of evaluating the degree of intrapartum hypoxia and also to establish which of the two is more reliable in predicting morbidity in term neonates. The present study utilized a total of 124 cases that met the criteria for intrapartum asphyxia and 150 normal term newborns that were randomly selected as case control. Both umbilical cord lactate and pH proved to be accurate predictors of neonatal morbidity caused by intrapartum hypoxia. Lactate proved to be superior to pH in predicting adverse neonatal outcome. The greatest sensibility and specificity in predicting intrapartum asphyxia were achieved in our study by using a cutoff value of 3.75 mmol/l for lactate and 7.24 for pH.
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Affiliation(s)
- Adrian Neacsu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Ioan' Emergency Clinical Hospital, 042122 Bucharest, Romania
| | - Cătălin Gabriel Herghelegiu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Alessandrescu-Rusescu' National Institute for Healthcare of Mother and Child, 020395 Bucharest, Romania
| | - Silviu Voinea
- Department of Surgery, Institute of Oncology 'Prof. Dr. Alexandru Trestioreanu', 020122 Bucharest, Romania
| | - Mihai Cornel Traian Dimitriu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics-Gynecology, 'Sf. Pantelimon' Emergency University Hospital, 021623 Bucharest, Romania
| | - Liana Ples
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, Bucur Maternity Hospital, 012361 Bucharest, Romania
| | - Roxana Elena Bohiltea
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Anca Daniela Braila
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Leonard Nastase
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Alessandrescu-Rusescu' National Institute for Healthcare of Mother and Child, 020395 Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'I. Cantacuzino' Clinical Hospital, 030167 Bucharest, Romania
| | - Laura Ioana Chivu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Pathophysiology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Florentina Furtunescu
- Department of Public Health and Management, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050463 Bucharest, Romania
| | - Raluca Gabriela Ioan
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Alessandrescu-Rusescu' National Institute for Healthcare of Mother and Child, 020395 Bucharest, Romania
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9
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Olaetxea I, Valero A, Lopez E, Lafuente H, Izeta A, Jaunarena I, Seifert A. Machine Learning-Assisted Raman Spectroscopy for pH and Lactate Sensing in Body Fluids. Anal Chem 2020; 92:13888-13895. [PMID: 32985871 DOI: 10.1021/acs.analchem.0c02625] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study presents the combination of Raman spectroscopy with machine learning algorithms as a prospective diagnostic tool capable of detecting and monitoring relevant variations of pH and lactate as recognized biomarkers of several pathologies. The applicability of the method proposed here is tested both in vitro and ex vivo. In a first step, Raman spectra of aqueous solutions are evaluated for the identification of characteristic patterns resulting from changes in pH or in the concentration of lactate. The method is further validated with blood and plasma samples. Principal component analysis is used to highlight the relevant features that differentiate the Raman spectra regarding their pH and concentration of lactate. Partial least squares regression models are developed to capture and model the spectral variability of the Raman spectra. The performance of these predictive regression models is demonstrated by clinically accurate predictions of pH and lactate from unknown samples in the physiologically relevant range. These results prove the potential of our method to develop a noninvasive technology, based on Raman spectroscopy, for continuous monitoring of pH and lactate in vivo.
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Affiliation(s)
- Ion Olaetxea
- Nanoengineering Group, CIC nanoGUNE BRTA, Tolosa Hiribidea 76, 20018 San Sebastián, Spain.,PhD Student, Department of Communications Engineering, University of the Basque Country (UPV/EHU), Torres Quevedo Ingeniaria Plaza 1, 48013 Bilbao, Spain
| | - Ana Valero
- Nanoengineering Group, CIC nanoGUNE BRTA, Tolosa Hiribidea 76, 20018 San Sebastián, Spain
| | - Eneko Lopez
- Nanoengineering Group, CIC nanoGUNE BRTA, Tolosa Hiribidea 76, 20018 San Sebastián, Spain
| | - Héctor Lafuente
- Tissue Engineering, Biodonostia Health Research Institute, Begiristain Doktorea Pasealekua, 20014 San Sebastián, Spain
| | - Ander Izeta
- Tissue Engineering, Biodonostia Health Research Institute, Begiristain Doktorea Pasealekua, 20014 San Sebastián, Spain
| | - Ibon Jaunarena
- Obstetrics and Gynaecology, Biodonostia Health Research Institute, Begiristain Doktorea Pasealekua, 20014 San Sebastián, Spain.,Donostia University Hospital, Begiristain Doktorea Pasealekua, 20014 San Sebastián, Spain
| | - Andreas Seifert
- Nanoengineering Group, CIC nanoGUNE BRTA, Tolosa Hiribidea 76, 20018 San Sebastián, Spain.,IKERBASQUE, Basque Foundation for Science, Euskadi Plaza 5, 48009 Bilbao, Spain
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Tigchelaar F, Groen H, Westgren M, Huinink KD, Cremers T, van den Berg PP. A new microdialysis probe for continuous lactate measurement during fetal monitoring: Proof of concept in an animal model. Acta Obstet Gynecol Scand 2020; 99:1411-1416. [PMID: 32274792 PMCID: PMC7540415 DOI: 10.1111/aogs.13865] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/28/2020] [Accepted: 03/31/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Cardiotocography (CTG) is currently the most commonly used method for intrapartum fetal monitoring during labor. However, a high false-positive rate of fetal acidosis indicated by CTG leads to an increase in obstetric interventions. We developed a microdialysis probe that is integrated into a fetal scalp electrode allowing continuous measurement of lactate subcutaneously, thus giving instant information about the oxygenation status of the fetus. Our aim was to establish proof of concept in an animal model using a microdialysis probe to monitor lactate subcutaneously. MATERIAL AND METHODS We performed an in vivo study in adult male wild-type Wistar rats. We modified electrodes used for CTG monitoring in human fetuses to incorporate a microdialysis membrane. Optimum flow rates for microdialysis were determined in vitro. For the in vivo experiment, a microdialysis probe was inserted into the skin on the back of the animal. De-oxygenation and acidosis were induced by lowering the inspiratory oxygen pressure. Oxygenation and heart rate were monitored. A jugular vein cannula was inserted to draw blood samples for analysis of lactate, pH, pco2 , and saturation. Lactate levels in dialysate were compared with plasma lactate levels. RESULTS Baseline blood lactate levels were around 1 mmol/L. Upon de-oxygenation, oxygen saturation fell to below 40% for 1 h and blood lactate levels increased 2.5-fold. Correlation of dialysate lactate levels with plasma lactate levels was 0.89 resulting in an R2 of .78 in the corresponding linear regression. CONCLUSIONS In this animal model, lactate levels in subcutaneous fluid collected by microdialysis closely reflected blood lactate levels upon transient de-oxygenation, indicating that our device is suitable for subcutaneous measurement of lactate. Microdialysis probe technology allows the measurement of multiple compounds in the dialysate, such as glucose, albumin, or inflammatory mediators, so this technique may offer the unique possibility to shed light on fetal physiology during the intrapartum period.
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Affiliation(s)
- Froukje Tigchelaar
- Faculty of Medical SciencesUniversity of GroningenGroningenthe Netherlands
| | - Henk Groen
- Department of EpidemiologyUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | | | | | - Thomas Cremers
- CAN Holding B.V.Groningenthe Netherlands
- Department of Pharmaceutical AnalysisFaculty of Science and EngineeringUniversity of GroningenGroningenthe Netherlands
| | - Paul P. van den Berg
- Department of Obstetrics & GynecologyUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
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Olaetxea I, Lopez E, Valero A, Seifert A. Determination of physiological lactate and pH by Raman spectroscopy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:475-481. [PMID: 31945941 DOI: 10.1109/embc.2019.8856471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lactate and pH values in human blood are important physiological parameters that can reflect serious pathological states as sepsis or hypoxia. In this study we demonstrate that we can determine lactate and pH values from blood samples by Raman spectroscopy combined with multivariate analysis at medically relevant resolution and reliability. The method prepares the base for new real-time in vivo analytics for a number of pathological cases and physiological control in competitive sports. We demonstrate the capability to resolve pH variations of 0.04 and lactate concentrations of 0.20 mM ex vivo.
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Environmental Contaminants Exposure and Preterm Birth: A Systematic Review. TOXICS 2019; 7:toxics7010011. [PMID: 30832205 PMCID: PMC6468584 DOI: 10.3390/toxics7010011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/04/2019] [Accepted: 02/25/2019] [Indexed: 12/31/2022]
Abstract
Preterm birth is an obstetric condition associated with a high risk of infant mortality and morbidities in both the neonatal period and later in life, which has also a significant public health impact because it carries an important societal economic burden. As in many cases the etiology is unknown, it is important to identify environmental factors that may be involved in the occurrence of this condition. In this review, we report all the studies published in PubMed and Scopus databases from January 1992 to January 2019, accessible as full-text articles, written in English, including clinical studies, original studies, and reviews. We excluded articles not written in English, duplicates, considering inappropriate populations and/or exposures or irrelevant outcomes and patients with known risk factors for preterm birth (PTB). The aim of this article is to identify and summarize the studies that examine environmental toxicants exposure associated with preterm birth. This knowledge will strengthen the possibility to develop strategies to reduce the exposure to these toxicants and apply clinical measures for preterm birth prevention.
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