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Takeshita M, Toyomoto R, Marui K, Ito M, Eto H, Takehara K, Matsui M. Cardiotocography use for fetal assessment during labor in low- and middle-income countries: A scoping review. Int J Gynaecol Obstet 2024; 166:580-595. [PMID: 38287690 DOI: 10.1002/ijgo.15390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/31/2023] [Accepted: 01/09/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND The use of cardiotocography (CTG) to improve neonatal outcomes is controversial. The medical settings, subjects, utilizations, and interpretation guidelines of CTG are unclear for low- and middle-income countries (LMICs). OBJECTIVES To assess and review CTG use for studies identified in LMICs and provide insights on the potential for effective use of CTG to improve maternal and neonatal outcomes. SEARCH STRATEGY The databases Medline, CINAHL, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for published and unpublished literature through September 2023. SELECTION CRITERIA Publications were identified which were conducted in LMICs, based on the World Bank list of economies for 2019; targeting pregnant women in childbirth; and focusing on the utilization of CTG and neonatal outcomes. DATA COLLECTION AND ANALYSIS Publications were screened, and duplicates were removed. A scoping review was conducted using PRISMA-ScR guidelines. RESULTS The searches generated 1157 hits, of which 67 studies were included in the review. In the studies there was considerable variation and ambiguity regarding the study settings, target populations, utilizations, timing, frequency, and duration of CTG. While cesarean section rates were extensively investigated as an outcome of studies of CTG itself and the effect of additional techniques on CTG, other clinically significant outcomes, including neonatal mortality, were not well reported. CONCLUSIONS Variations and ambiguities were found in the use of CTG in LMICs. Due to the limited amount of evidence, studies are needed to examine CTG availability in the context of LMICs.
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Affiliation(s)
- Mai Takeshita
- Department of Health Informatics, Graduate School of Medicine / School of Public Health, Kyoto University, Kyoto, Japan
| | - Rie Toyomoto
- Department of Health Promotion and Human Behavior, Graduate School of Medicine / School of Public Health, Kyoto University, Kyoto, Japan
| | - Kanae Marui
- Department of Health Informatics, Graduate School of Medicine / School of Public Health, Kyoto University, Kyoto, Japan
| | - Masami Ito
- Department of Health Promotion and Human Behavior, Graduate School of Medicine / School of Public Health, Kyoto University, Kyoto, Japan
| | - Hiromi Eto
- Department of Reproductive Health, Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Kenji Takehara
- Department of Health Policy, Research Institute, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuaki Matsui
- Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
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Park TJ, Chang HJ, Choi BJ, Jung JA, Kang S, Yoon S, Kim M, Yoon D. Machine Learning Model for Classifying the Results of Fetal Cardiotocography Conducted in High-Risk Pregnancies. Yonsei Med J 2022; 63:692-700. [PMID: 35748081 PMCID: PMC9226828 DOI: 10.3349/ymj.2022.63.7.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/24/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Fetal well-being is usually assessed via fetal heart rate (FHR) monitoring during the antepartum period. However, the interpretation of FHR is a complex and subjective process with low reliability. This study developed a machine learning model that can classify fetal cardiotocography results as normal or abnormal. MATERIALS AND METHODS In total, 17492 fetal cardiotocography results were obtained from Ajou University Hospital and 100 fetal cardiotocography results from Czech Technical University and University Hospital in Brno. Board-certified physicians then reviewed the fetal cardiotocography results and labeled 1456 of them as gold-standard; these results were used to train and validate the model. The remaining results were used to validate the clinical effectiveness of the model with the actual outcome. RESULTS In a test dataset, our model achieved an area under the receiver operating characteristic curve (AUROC) of 0.89 and area under the precision-recall curve (AUPRC) of 0.73 in an internal validation dataset. An average AUROC of 0.73 and average AUPRC of 0.40 were achieved in the external validation dataset. Fetus abnormality score, as calculated from the continuous fetal cardiotocography results, was significantly associated with actual clinical outcomes [intrauterine growth restriction: odds ratio, 3.626 (p=0.031); Apgar score 1 min: odds ratio, 9.523 (p<0.001), Apgar score 5 min: odds ratio, 11.49 (p=0.001), and fetal distress: odds ratio, 23.09 (p<0.001)]. CONCLUSION The machine learning model developed in this study showed precision in classifying FHR signals. This suggests that the model can be applied to medical devices as a screening tool for monitoring fetal status.
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Affiliation(s)
- Tae Jun Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Hye Jin Chang
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Byung Jin Choi
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Jung Ah Jung
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Seongwoo Kang
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Seokyoung Yoon
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Miran Kim
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
- COSMOSWHALE Inc., Ansan, Korea.
| | - Dukyong Yoon
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
- Center for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
- BUD.on Inc., Jeonju, Korea.
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Jhirwal M, Sharma C, Shekhar S, Singh P, Meena SP. Decreasing the Duration of Point of Decision to Getting Non-stress Test Done: A Quality Improvement Study. J Obstet Gynaecol India 2021; 72:61-67. [PMID: 34629785 PMCID: PMC8487224 DOI: 10.1007/s13224-021-01551-5] [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: 07/08/2021] [Accepted: 08/11/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Non-stress test is an important non-invasive tool of antepartum surveillance. The hypoxia, acidemia in the fetus can easily be picked up by a non-stress test. It is important to get a non-stress test done on time to prevent the adverse neonatal outcome. Aim This quality improvement project aims to evaluate the waiting period for a non-stress test (NST) from the point of decision in the antenatal outpatient department and to increase the percentage of pregnant women getting NST done in less than 4 h from the point of decision from a baseline of 41% to 80% in 4 weeks. Method This observational study was conducted in the Department of Obstetrics & Gynecology at All India Institute of Medical Sciences Jodhpur for twelve weeks. This study has three phases—baseline assessment, implementation phase and continued implementation with the assessment phase. The tool used for the analysis of this problem was the Fishbone method. Results The baseline assessment showed that only 41% of pregnant women got the non-stress test done in 4 h. We conducted a plan-do-study-act (PDSA) cycle 3 times, and the target was achieved in the second PDSA cycle. Conclusion This quality improvement project has demonstrated that increasing awareness among all the team members who are dealing with pregnant women requiring NST can significantly increase the percentage of pregnant women getting NST done within 4 h from the point of decision. By detecting the fetal heart rate variation, we can prevent adverse fetal and neonatal outcomes.
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Affiliation(s)
- Manisha Jhirwal
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan India
| | - Charu Sharma
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan India
| | - Shashank Shekhar
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan India
| | - Pratibha Singh
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan India
| | - Satya Prakash Meena
- Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan India
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Soylu N, Bülbül T, Müderris İİ. The effect of music on fetal well-being and anxiety levels and vital signs of pregnant women during non-stress test: Turkey sample. Health Care Women Int 2021; 43:499-517. [PMID: 34520324 DOI: 10.1080/07399332.2021.1973010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To assess the effect of music on fetal well-being and anxiety levels and vital signs of pregnant women during the non-stress test. The study was a randomized controlled clinical trial. The sample comprised of 74 (37 music and 37 control group) pregnant women. In the music group, post-procedure pulse values were statistically lower than the pre-procedure values (p < 0.001). There was no difference between the groups in terms of baseline fetal heart rate, variability, fetal movement, presence and number of accelerations-decelerations, non-stress test result parameters. The number of fetal movements was statistically higher in the music group, compared to the control group (p < 0.001). The state anxiety inventory scores lower in the music group after the procedure, compared to the control group (p < 0.001). Researchers determined that music affects vital sign values, fetal movements, reduced the state and trait anxiety levels of pregnant women during the non-stress test procedure.
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Affiliation(s)
- Nurseli Soylu
- Faculty of Health Sciences, Department of Obstetrics and Gynecology Nursing, Erciyes University, Kayseri, Turkey
| | - Tülay Bülbül
- Faculty of Health Sciences, Department of Obstetrics and Gynecology Nursing, Erciyes University, Kayseri, Turkey
| | - İptisam İpek Müderris
- Faculty of Medicine, Department of Obstetrics and Gynecology, Erciyes University, Kayseri, Turkey
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Housseine N, Punt MC, Browne JL, Meguid T, Klipstein-Grobusch K, Kwast BE, Franx A, Grobbee DE, Rijken MJ. Strategies for intrapartum foetal surveillance in low- and middle-income countries: A systematic review. PLoS One 2018; 13:e0206295. [PMID: 30365564 PMCID: PMC6203373 DOI: 10.1371/journal.pone.0206295] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 10/10/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The majority of the five million perinatal deaths worldwide take place in low-resource settings. In contrast to high-resource settings, almost 50% of stillbirths occur intrapartum. The aim of this study was to synthesise available evidence of strategies for foetal surveillance in low-resource settings and associated neonatal and maternal outcomes, including barriers to their implementation. METHODS AND FINDINGS The review was registered with Prospero (CRD42016038679). Five databases were searched up to May 1st, 2016 for studies related to intrapartum foetal monitoring strategies and neonatal outcomes in low-resource settings. Two authors extracted data and assessed the risk of bias for each study. The outcomes were narratively synthesised. Strengths, weaknesses, opportunities and threats analysis (SWOT) was conducted for each monitoring technique to analyse their implementation. There were 37 studies included: five intervention and 32 observational studies. Use of the partograph improved perinatal outcomes. Intermittent auscultation with Pinard was associated with lowest rates of caesarean sections (10-15%) but with comparable perinatal outcomes to hand-held Doppler and Cardiotocography (CTG). CTG was associated with the highest rates of caesarean sections (28-34%) without proven benefits for perinatal outcome. Several tests on admission (admission tests) and adjunctive tests including foetal stimulation tests improved the accuracy of foetal heart rate monitoring in predicting adverse perinatal outcomes. CONCLUSIONS From the available evidence, the partograph is associated with improved perinatal outcomes and is recommended for use with intermittent auscultation for intrapartum monitoring in low resource settings. CTG is associated with higher caesarean section rates without proven benefits for perinatal outcomes, and should not be recommended in low-resource settings. High-quality evidence considering implementation barriers and enablers is needed to determine the optimal foetal monitoring strategy in low-resource settings.
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Affiliation(s)
- Natasha Housseine
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Marieke C. Punt
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joyce L. Browne
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tarek Meguid
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
- School of Health and Medical Science, State University of Zanzibar (SUZA), Zanzibar, Tanzania
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Barbara E. Kwast
- International Consultant Maternal Health and Safe Motherhood, Leusden, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Diederick E. Grobbee
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marcus J. Rijken
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Paterno MT, McElroy K, Regan M. Electronic Fetal Monitoring and Cesarean Birth: A Scoping Review. Birth 2016; 43:277-284. [PMID: 27565450 DOI: 10.1111/birt.12247] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND In many United States hospitals, electronic fetal monitoring (EFM) is used continuously during labor for all patients regardless of risk status. Application of EFM, particularly at labor admission, may trigger a chain of interventions resulting in increased risk for cesarean birth among low-risk women. The goal of this review was to summarize evidence on use of EFM during low-risk labors and identify gaps in research. METHODS We conducted a scoping review of studies published in English since 1996 that addressed the relationship between EFM use and cesarean among low-risk women. We screened 57 full-text articles for appropriateness. Seven articles were included in the final review. RESULTS The largest study demonstrated an 81 percent increased risk of primary cesarean birth when EFM was used in labor, but did not differentiate between high- and low-risk pregnancies. Four randomized controlled trials examined the association of admission EFM with obstetric outcomes; only one considered cesarean birth as a primary outcome and found a 23 percent increase in operative birth when EFM lasted more than 1 hour. A study examining application of continuous EFM before and after 4 centimeters dilatation found no differences between groups. CONCLUSIONS In general, the research on this topic suggests an association between the use of EFM and cesarean birth; however, more well-designed studies are needed to examine benefits of EFM versus auscultation, determine if EFM is associated with use of other technologies that could cumulatively increase risk of cesarean birth, and understand provider motivation to use EFM over auscultation.
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Affiliation(s)
| | | | - Mary Regan
- University of Maryland's School of Nursing, Baltimore, MD, USA
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Keikha F, Vahdani FG, Latifi S. The Effects of Maternal Opium Abuse on Fetal Heart Rate using Non-Stress Test. IRANIAN JOURNAL OF MEDICAL SCIENCES 2016; 41:479-485. [PMID: 27853327 PMCID: PMC5106562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
BACKGROUND Opium is one of the most commonly abused opiates in developing countries including Iran. Considering the importance of maternal health on the newborn, we aimed to assess the effect of opium abuse on fetal heart rate (FHR) characteristics in a sample of pregnant women in Zahedan, Southeast Iran. METHODS This cross-sectional study was done on 100 pregnant women referring to Ali-Ibn-Abi Talib Hospital in Zahedan, during 2011-2013. The participants were divided into two groups comprising of opium abusers and healthy individuals. The participants received 500cc intravenous fluid containing dextrose and then non-stress test results were recorded for 20 minutes. RESULTS We found no significant difference between the two groups with respect to their demographic characteristics. Fetal movements, variability, acceleration, and reactivity were significantly higher among addicted women (P<0.0001 for all). Periodic change was 9.8 times higher among opium abusers compared with the healthy women. Abnormal variability or oscillations of <15 beats/min, which indicates lack of beat-to-beat variability, was significantly higher in the fetuses of addicted mothers (P<0.0001). CONCLUSION Considering significant abnormal patterns in FHR characteristics among the opium abuser group, mothers addicted to opium need specific prenatal care.
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Affiliation(s)
- Fatemeh Keikha
- Department of Obstetrics and Gynecology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ghotbizadeh Vahdani
- Department of Obstetrics and Gynecology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran,Correspondence: Fahimeh Ghotbizade Vahdani, MD; Department of Obstetrics and Gynecology, Vali-Asr Hospital, Imam Khomeini Hospital Complex, Keshavarz Boulevard, Postal code: 14197-33141, Tehran, Iran Tel: +98 21 66581616 Fax: +98 21 66581658 /
| | - Sahar Latifi
- Department of Obstetrics and Gynecology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
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