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Abstract This comprehensive review compares clinical protocols of important entities regarding the management of fetal growth restriction (FGR), published since 2015. Five protocols were chosen for data extraction. There were no relevant differences regarding the diagnosis and classification of FGR between the protocols. In general, all protocols suggest that the assessment of fetal vitality must be performed in a multimodally, associating biophysical parameters (such as cardiotocography and fetal biophysical profile) with the Doppler velocimetry parameters of the umbilical artery, middle cerebral artery, and ductus venosus. All protocols reinforce that the more severe the fetal condition, the more frequent this assessment should be made. The timely gestational age and mode of delivery to terminate the pregnancy in these cases can vary much between the protocols. Therefore, this paper presents, in a didactic way, the particularities of different protocols for monitoring FGR, in order to help obstetricians to better manage the cases.
Resumo Esta revisão compreensiva compara protocolos clínicos de entidades importantes em relação ao manejo da restrição de crescimento fetal (RCF), publicados desde 2015. Cinco protocolos foram escolhidos para a extração de dados. Não houve diferenças relevantes quanto ao diagnóstico e classificação da RCF entre os protocolos. Em geral, todos os protocolos sugerem que a avaliação da vitalidade fetal deve ser realizada de forma multimodal, associando parâmetros biofísicos (como cardiotocografia e perfil biofísico fetal) aos parâmetros dopplervelocimétricos da artéria umbilical, artéria cerebral média e ducto venoso. Todos os protocolos reforçam que quanto mais grave a condição fetal, mais frequente essa avaliação deve ser feita. A idade gestacional oportuna e o modo de parto para interromper a gravidez nesses casos podem variar muito entre os protocolos. Portanto, este trabalho apresenta, de forma didática, as particularidades de diferentes protocolos de acompanhamento de RCF, a fim de auxiliar os obstetras no melhor manejo dos casos.
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Humans , Infant, Newborn , Infant, Premature , Cardiotocography , Laser-Doppler Flowmetry , Guidelines as Topic , Fetal Growth RetardationABSTRACT
SUMMARY OBJECTIVE: The aim of this study was to evaluate the accuracy of intrapartum cardiotocography in identifying acidemia at birth by umbilical cord blood gasometry in high-risk pregnancies. METHODS: This was a retrospective cohort study of singleton high-risk parturients using intrapartum cardiotocography categories I, II, and III. The presence of fetal acidemia at birth was identified by the analysis of umbilical cord arterial blood pH (<7.1). Associations between variables were determined using the chi-square test and Kruskal-Wallis tests. RESULTS: We included 105 cases of cardiotocography category I, 20 cases of cardiotocography category II, and 10 cases of cardiotocography category III. cardiotocography category III had a higher prevalence of cesarean sections compared to cardiotocography category I (90.0 vs. 42.9%, p<0.006). Venous pH was higher in patients with cardiotocography category I compared to cardiotocography category III (7.32 vs. 7.23, p=0.036). Prevalence of neonatal intensive care unit (NICU) admission was lower in neonates of patients with cardiotocography category I compared to cardiotocography category III (3.8 vs. 30.0%, p=0.014). Prevalence of composite adverse outcomes was lower in neonates of patients with cardiotocography category I compared to cardiotocography category II (9.5 vs. 30.0%, p=0.022) and cardiotocography category III (9.5 vs. 60.0%, p=0.0004). cardiotocography categories II and III had low sensitivity (0.05 and 0.00, respectively) and high negative predictive value (NPV) (0.84 and 0.91, respectively) for identifying fetal acidemia at birth. The three categories of intrapartum cardiotocography showed high specificities (96.0, 99.0, and 99.0%, respectively). CONCLUSION: All three categories of intrapartum cardiotocography showed low sensitivity and high specificity for identifying acidemia at birth.
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SUMMARY OBJECTIVE: The aim of this study was to evaluate the accuracy of intrapartum cardiotocography in identifying fetal acidemia by umbilical cord blood analysis in low-risk pregnancies. METHODS: This is a retrospective cohort study of low-risk singleton pregnancies in labor after performing intrapartum cardiotocography categories I, II, and III. The presence of fetal acidemia at birth was identified by analyzing the pH of umbilical cord arterial blood (pH<7.1). RESULTS: No significant effect of the cardiotocography category on the arterial (p=0.543) and venous (p=0.770) pH of umbilical cord blood was observed. No significant association was observed between the cardiotocography category and the presence of fetal acidemia (p=0.706), 1-min Apgar score <7 (p=0.260), hospitalization in the neonatal intensive care unit (p=0.605), newborn death within the first 48 h, need for neonatal resuscitation (p=0.637), and adverse perinatal outcomes (p=0.373). Sensitivities of 62, 31, and 6.0%; positive predictive values of 11.0, 16.0, and 10.0%; and negative predictive values of 85, 89.0, and 87.0% were observed for cardiotocography categories I, II, and III, respectively. CONCLUSION: The three categories of intrapartum cardiotocography presented low sensitivities and high negative predictive values to identify fetal acidemia at birth in low-risk pregnancies.
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Abstract Objectives: although mortality and perinatal asphyxia in newborns have been considerably reduced, there are still deficiencies in screening and diagnosis methods for intrapartum fetal well being that aim to detect its early alterations. Therefore, the purpose of this research was to apply a methodology based on probability and entropy and confirm its capacity to detect normal and abnormal fetal cardiac dynamics from 20-minute cardiotocographic tracings. Methods: 80 cardiotocographic tracings of pregnant women in the last trimester were collected, of which the minimum and maximum fetal heart rate were evaluated every 10 seconds, as well as its repetitions along with their probability and the diagnostic S/k ratio. Finally, the statistical analysis was carried out to establish the diagnostic capacity of the method concerning the clinical evaluation and interpretation of the cardiotocographic tracing, taken as the Gold Standard. Results: it was confirmed that S/k ratio values differentiated normal from abnormal fetal cardiac dynamics with sensitivity and specificity values of 100% and a Kappa coefficient of 1. Conclusion: the applicability of a diagnostic mathematical method of cardiotocography was confirmed, which suggests its implementation in the clinical context to detect alterations in fetal well-being in 20 minutes.
Resumo Objetivos: aunque se ha logrado reducir considerablemente la mortalidad y asfixia perinatal en neonatos, aún hay deficiencias en los métodos de tamizaje y diagnóstico del bienestar fetal intraparto que detecten sus alteraciones tempranas. Por lo anterior, el propósito de esta investigación fue aplicar una metodología basada en la probabilidad y la entropía y confirmar su capacidad para diagnosticar la dinámica cardíaca fetal normal de la anormal a partir de trazados cardiotocográficos de 20 minutos. Métodos: se recolectaron 80 trazados cardiotocográficos de gestantes en el último trimestre, de los cuales se evaluaron frecuencia cardíaca fetal mínima y máxima cada 10 segundos al igual que sus repeticiones, su probabilidad y la proporción S/k diagnóstica. Finalmente, se realizó un análisis estadístico para establecer la capacidad diagnóstica del método con respecto a la interpretación el trazado cardiotocográfico y la evaluación clínica, tomadas como Gold Standard. Resultados: se confirmó que los valores de la proporción S/k diferenciaron las dinámicas cardíacas fetales normales de las anormales con valores de sensibilidad y especificidad del 100% y un coeficiente Kappa de 1. Conclusión: se confirmó la aplicabilidad de un método matemático diagnóstico de la cardiotocografía, lo cual sugiere que su implementación en la clínica para detectar alteraciones del bienestar fetal en 20 minutos.
Subject(s)
Humans , Female , Pregnancy , Pregnancy Trimester, Third , Heart Rate, Fetal , Cardiotocography/methods , Neonatal Screening , Perinatal Care , EntropyABSTRACT
ntroduction: The universal aim of maternity care provision is birth of a healthy baby to a healthy mother. Various invasive andnon-invasive antepartum surveillance tests have been devised to access the fetal well-being. In developing countries like India,where workload is heavy with shortage of technical manpower and resource settings are poor, we need techniques which areadequate, simple, cost effective, easy to use, and less time consuming for better postpartum outcome.Materials and Methods: This study was conducted over a period of 1½ years in 251 primigravidae with low-risk pregnanciesat or near term who were observed with admission cardiotocography (CTG) and amniotic fluid index (AFI) and was followedduring the course of labor to access mode of delivery, Apgar score at 0, 1, and 5 min of birth, and need for neonatal intensivecare unit (NICU) admission.Results: When both AFI and CTG together were correlated with mode of delivery, it was seen that in patients with cat 1 CTGirrespective of AFI, most of the patients were delivered by NVD and in cat 3 CTG patients irrespective of AFI, most of them weredelivered by lower segment cesarean section (LSCS). In patients with cat 2 CTG, significant number of those was deliveredby LSCS who had low AFI. When AFI and CTG together were studied for Apgar score at “1-min” of birth and NICU admission,it was seen that irrespective of AFI, low Apgar, and NICU admission was mostly seen in cat 3 CTG patients, but there was noneonatal mortality in our study.Data were entered into a Microsoft Excel Spreadsheet, relationship between categorical variableswas analyzed using a Chi-square test and data were analyzed using STATA version 15.Conclusion: Therefore, admission CTG along with AFI can effectively detect fetal distress if already present at admissionand thereby avoid unnecessary delay in decision to deliver timely and improve fetal outcome. These simple, cost effective,non-invasive, and less time-consuming tests can identify those patients who need continuous fetal monitoring in low resourcesettings and fetal outcome can be improved.
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Background: The objective of the present study was to compare the two most commonly used agents for induction of labor-vaginal misoprostol and intracervical dinoprostone gel in terms of the incidence of cardiotocography (CTG) abnormalities and its correlation with fetal distress and fetomaternal outcome.Methods: This is prospective case-control study conducted in department of obstetrics and gynecology, RIMS, Ranchi over a period of 15 months. 112 women requiring induction were randomly assigned to two groups of 56 each, Group M received vaginal misoprostol and Group D received intracervical dinoprostone E2 gel. 56 women with spontaneous labor served as control group. Groups were compared in terms of the incidence of suspicious or pathological CTG tracings, fetal distress, induction to vaginal delivery time, vaginal delivery rates, dose requirements, rate of emergency cesarean.Results: Misoprostol was associated with shorter induction to delivery time (9.54 hours) than dinoprostone gel (13.54 hours), higher vaginal delivery rates (80.35% versus 62.5%), higher delivery rates (73.9%) with single dose itself unlike Group D, where 47.22% required more than one dose. Incidence of suspicious CTG was higher in group M (15.68%) versus 10.25% in Group D. Incidence of pathological CTG was also highest in Group M (7.8%) followed by Group D (2.56%) and Group C (7.8%). Dinoprostone gel lead to failed induction in 25% women, and hence higher caesarean rates.Conclusions: While misoprostol is a better agent for induction when compared with dinoprostone E2 gel in terms of induction-delivery time, higher vaginal delivery rates, less dose requirement, it is associated with greater incidence of non-reassuring/pathological CTG. There was justified improvement in perinatal outcome due to preparedness beforehand with use of CTG.
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Background: Even in low risk mothers, fetal acidosis occurs as in high risk groups. Aim of fetal monitoring is to detect early response to intrauterine hypoxia and prevent irreversible neurological damage and death. Objective of this study was to correlate the intrapartum fetal distress with the help of cardiotocography CTG with umbilical cord blood sampling.Methods: A total 100 consecutive patients attending the labor ward were studied. Immediately at birth, before the baby’s first breath and before delivery of the placenta, the umbilical cord blood was collected as per the standard guidelines laid down in the standard textbooks. Fetal acidosis was assessed by umbilical cord arterial blood pH. Fetal acidosis was considered when umbilical artery pH <7.2. Cardiotocography features were used to clinically diagnose fetal distress.Results: Most of the mothers were multigravida. They belonged to the age group of 20-25 years. Only 18% had abnormal CTG. Out of 50 mothers with normal vaginal delivery, all had normal CTG. Out of 43 mothers who were delivered by LSCS, no one had normal CTG, 25 had indeterminate CTG and 18 had abnormal CTG. As CTG became abnormal, proportion of mothers with the thick meconium increased. NICU admission proportion increased as CTG changed from normal to the abnormal. There was a significant association between the abnormal CTG and the umbilical cord blood pH being acidic.Conclusions: CTG is a simple test, easy to perform and can alert obstetrician for necessary interventions in case of an abnormal CTG. It can detect fetal distress in labor thus helping to reduce neonatal morbidity by early intervention in cases of abnormal tracing.
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Background: Pregnancy and childbirth is normal physiological process with great pathological potential. The obstetricians are more concerned with the early recognition of fetal distress during labour and such an adverse outcome should be detected at the earliest point of time by an effective surveillance method. Cardiotocography as a part of biophysical profile has become an established diagnostic tool for fetal surveillance. To compare early perinatal outcome of normal and abnormal cardiotocography in terms of APGAR scores, need for neonatal resuscitation, NICU admission, perinatal death and mode of delivery.Methods: It was a cross-sectional study. 200 nulliparous/multiparous women with singleton pregnancy in cephalic presentation at gestational age 37-42 weeks in latent stage of labor were enrolled in the study and subjected to admission test in left lateral position using fetal monitor. Baseline FHR and contraction pattern were determined for 20 minutes and classification of patients was done into normal, and suspicious or abnormal according to the FIGO guidelines 2015.Results: Low APGAR scores, rate of LSCS, need for neonatal resuscitation, neonatal admission were more in the abnormal cardiotocography group. Cardiotocography in the current study has high sensitivity and high negative predictive value for detecting fetal distress.Conclusions: From the analysis of this study, it would be safe to conclude that an ominous cardiotocography should be managed appropriately without delay and obstetrician should be vigilant in suspicious as well as in normal admission test group for timely intervention for bettering the neonatal outcome.
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Background: CTG as an intrapartum fetal surveillance can be judged appropriately taking the abnormal features of CTG individually into account for decision making of early delivery to reduce the fetal and neonatal morbidity. Objectives of this study were to identify the fetuses at risk of developing hypoxia as evidenced by abnormal FHR pattern seen by CTG and to correlate the abnormal features with perinatal outcome and find out the most specific feature among all abnormal features of CTG in detecting the adverse perinatal outcome.Methods: This was an observational study where total of 249 uncomplicated pregnant patients in active labor were selected randomly and CTG were done for them. Progress of labor was recorded in partogram. Only pathological CTGs were considered for early decision of delivery by LSCS. After delivery Apgar score 1 min, 5 min, baby weight, colour of liquor, NICU admission and no of days of admission in NICU were recorded.Results: For liquor colour, variability and absence of acceleration were good screening heart rate features and baseline was considered the most specific feature. For all babies with poor Apgar score at 1 min, abnormal baseline was the most specific feature. For NICU admission, the abnormal baseline the most specific feature. Acceleration was found to be the most sensitive heart rate feature among all other heart rate features. Liquor colour had better sensitivity for detecting poor Apgar score at 1min and 5 min. There was increase rate of cesarean section and operative vaginal delivery.Conclusions: Abnormal intrapartum CTG features of an uncomplicated laboring mother >37 weeks can detect fetuses at distress with different specificities and sensitivities when considered individually and can reduce the perinatal morbidity.
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Abstract Objective To determine the effect of treadmill walking on maternal heart rate (MHR) and cardiotocographic parameters (basal fetal heart rate [FHR], active fetal movements [AFM], number of accelerations and decelerations, and short-term variation [STV] and long-term variation [LTV] of fetal heart rate) in pregnant women at 36 weeks. Methods A nonrandomized, open clinical trial involving 88 healthy pregnant women submitted to moderate intensity walking and computed cardiotocography in 3 20- minute periods (resting, treadmill walking, and postexercise recovery). Results The mean FHR decreased during walking (resting: 137 bpm; treadmill: 98 bpm; recovery: 140 bpm; p<0.001), with bradycardia occurring in 56% of the fetuses in the first 10minutes of exercise, and in 47% after 20minutes. Bradycardia was not detected in the other phases. The mean STV and HV were 7.9, 17.0, and 8.0 milliseconds (p<0.001) and 7.6, 10.8 and 7.6 bpm (p=0.002) in the resting, walking and recovery phases, respectively. Themean number of fetalmovements in 1 hour was 29.9, 22.2 and 45.5, respectively, in the 3 periods (p<0.001). In overweight/obese women, the mean FHR was lower (p=0.02). Following the logistic regression analysis, two variables remained significantly associated with bradycardia: maternal fitness in the 28th week of pregnancy (protective effect) and maternal weight (increased risk). Conclusion In healthy fetuses, physical exercise proved to be safe, since, although FHR and AFM decreased during treadmill walking, an increase in SVT and LTV was observed.
Resumo Objetivo Determinar o efeito da caminhada em esteira sobre a frequência cardíaca materna (FCM) e parâmetros cardiotocográficos (batimentos cardiofetais basais [BCFs], movimentos ativos fetais [MAFs], número de acelerações e desacelerações e variabilidade de curta [STV] e longa [LTV] duração da frequência cardíaca fetal) em gestantes na 36a semana. Métodos Foi realizado umensaio clínico não randomizado e aberto com 88 gestantes saudáveis submetidas a caminhada de moderada intensidade na esteira e a cardiotocografia computadoriza em 3 momentos de 20 minutos (antes, durante e após a caminhada). Resultados A média dos BCFs diminuiu durante a caminhada, retornando a níveis prévios (antes: 137 bpm; durante: 98 bpm; após: 140 bpm; p<0,001), com bradicardia ocorrendo em 56% dos fetos nos primeiros 10 minutos do exercício, e em 47% após 20 minutos. A bradicardia fetal não foi observada em outrosmomentos (antes ou depois). As médias da STV e da LTV foram 7,9, 17,0 e 8,0milissegundos (p<0,001) e 7,6, 10,7 e 7,6 bpm (p=0,002) antes, durante e após a caminhada, respectivamente. Amédia dos números dos MAFs em 1 hora foi 29,9, 22,2 e 45,5, respectivamente, nos três momentos (p<0,001). Nas mulheres com sobrepeso/obesidade, a média da FCM foi menor (p=0,02). Após a análise de regressão logística, duas variáveis permaneceram significativamente associadas a bradicardia: aptidão maternal na 28a semana de gravidez (efeito protetor) e peso materno (aumento do risco). Conclusão Em fetos saudáveis, o exercício físico mostrou-se seguro, uma vez que, embora os BCFs e osMAFs diminuam durante a caminhada na esteira, foi observado um aumento da SVT e da LTV.
Subject(s)
Humans , Female , Adolescent , Adult , Young Adult , Safety , Heart Rate, Fetal/physiology , Pregnancy/physiology , Exercise/physiology , Fetus/physiology , Pregnancy Trimester, Third/physiology , Blood Pressure/physiology , Cardiotocography , Walking/physiologyABSTRACT
Aims: To determine the patterns of obstetric decisions based on Cardiotocography (CTG) findings and the effect of these decisions on labour outcomes. Study Design: Retrospective observational audit. Place and Duration of Study: Department of Obstetrics and Gynaecology, Babcock University Teaching Hospital, Ilishan-Remo. Data were obtained from all intrapartum CTG tracings done from January 2016 to December 2018. Methodology: A consecutive sampling technique was used and the case files, delivery register and follow up records of all included CTG tracings were used to obtain maternal and perinatal data. Data were analyzed using the SPSS version 21.0. Numerical data were expressed as mean ± standard deviation (SD). The Chi-square test was used to compare categorical variables while the independent T-test was used to compare means of groups studied. Binary logistic regression was used to assess the factors related to maternal and perinatal outcomes. The level of statistical significance was be set at p-value of <0.05. Results: There were 756 deliveries, but only 436 CTGs met the inclusion criteria. The prevalence of abnormal CTG was 130/436 (29.8%); 93/436(21.3%) were suspicious while 37/436 (8.5%) were pathological. On the basis of CTG; 300/436 (68.8%) of the parturients had intermittent fetal heart tone auscultation, 100/436 (22.9%) had continuous Electronic fetal monitoring (EFM) while labour was stopped in 36/436 (8.3%). The 5th minute APGAR score did not depend on the admission CTG finding (0.55), the decision to stop or continue labour (p=0.26) or the use of continuous EFM (P=0.66). Maternal near miss (MNM) was not a consequence of the decision to stop labour (P=0.98) or the use of continuous EFM (P=0.19). The mode of delivery outcome was however a consequence of decisions to continue or stop labour (P <0.001, AOR=0.202, 95%CI=0.153-0.265). Pregnancy risk was a consistent determinant of maternal outcomes; occurrence of MNM (P <0.001, AOR=0.002, 95%CI=0.000-0.032) and mode of delivery (P <0.001, AOR=0.015, 95%CI=0.005-0.043). Conclusion: Decisions based on admission CTG was associated with a high rate of operative deliveries, without any significant effect on fetal or maternal outcomes. CTG in labour should be restricted to pregnancies adjudged as high risk based on obstetric factors and CTG should be used as an adjunctive triaging instrument.
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Background: Continuous fetal heart monitoring in all pregnant women in labour has gained prominence in obstetric practice in the recent years. The aim of this study was to emphasize on the role of admission cardiotocography (CTG) in labour as a predictor of foetal outcome in high risk pregnancies.Methods: This was a prospective observational study done on 340 high risk patients admitted in labour with a period of gestation of ≥37 weeks. An admission CTG which consists of a 20-minute recording of FHR and uterine contractions was taken and the foetal outcome was correlated with it. The non-parametric Chi-square test was used for statistical calculations and a p valve of <0.05 was considered to designate statistical significance.Results: The admission CTG was reactive in 69.4% of all patients, equivocal in 22.2% and pathological in 8.4% of the 340 recruited patients. A total of 37.5% of the patients were post-dated followed by 20.6% of pregnancy incuded hypertensive patients. The neonatal outcomes in terms of fetal distress, meconium stained liquor, NICU admission were considerably higher in pathological test. The specificity of the test was 53.3%, and the negative predictive was 86.49%.Conclusions: Admission CTG is a simple, useful screening test and serves as a non-invasive tool in forecasting the adverse foetal outcomes in high risk pregnancies.
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OBJECTIVE: To explore the characteristics of CTG(cardiotocography)and discuss pregnancy management of fetal extrasystole.METHODS: It's a retrospective analysis of women who gave birth in May 2011-March 2018 in PekingUniversity Third hospital.A total of 13 cases were diagnosed as fetal extrasystole through echocardiography or M type ultrasound.The characteristics of CTG,delivery weeks,delivery mode,neonatal arrhythmia diagnosis and treatment weresummarized.RESULTS: In 13 cases,except 2 cases with normal CTG,the others showed that normal fetal heart raterhythm and deceleration alternately appeared,but it was different from hypoxia-induced deceleration.Eight of 13 cases underwent cesarean section,and 4 of these cases were with fetal arrhythmia or fetal distress as an indication.All neonates were alive.One case turned into supraventricular tachycardia,which resolved after receiving medicine.For the other cases,the ECGs resolved or returned to normal within two weeks after the birth.CONCLUSION:s The most common type of extrasystole is atrial extrasystole.When premature beats are not transmitted,we call it blocked atrialextrasystole,which causes deceleration.If there is no heart structure abnormality and heart failure,vaginal delivery canbe performed under closely monitoring.
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Intrapartum fetal monitoring is of great importance to ensuring the safety of the fetus during labor,timely discovering the fetal hypoxia and reducing the incidence of short-term and long-term adverse outcomes of the newborn. Cardiotocography has been widely recommended for fetal monitoring during labor in the world.The clinical interpretation of it includes the definition of the basic waveform,the physiological and pathological significance of the waveform,and the management according to the cardiotocography classifications. This paper summarizes intrapartum cardiotocography based on the relevant guidelines at home and abroad in recent years.
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In the clinical work of our country,more and more attention is paid to the people-centered concept. It is more focuses on avoiding excessive intervention and strengthening management of labor course. Interventions that should be limited during childbirth for low-risk spontaneous labour.The limited interventions are including the application of the new parturition process criteria,the use of early amniotomy with early oxytocin augmentation for prevention of delay in labour is not recommended,routine cardiotocography is not recommended,encouraging the adoption of a birth position of the individual woman's choicey,routine episiotomy is not recommend,et al.Itis necessary to manage women and their fetus depending on patients' s situation,and to ensure the safety of mother and child.As well as to reduce excessive intervention,thereby reducing caesarean section rate,ensure that the mother has a good delivery experience,and improve the outcomes of mother and child.
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Cardiotocography (CTG) is a commonly used technique of electronic fetal monitoring (EFM) for evaluating fetal well-being, which has the disadvantage of lower diagnostic rate caused by subjective factors. To reduce the rate of misdiagnosis and assist obstetricians in making accurate medical decisions, this paper proposed an intelligent assessment approach for analyzing fetal state based on fetal heart rate (FHR) signals. First, the FHR signals from the public database of the Czech Technical University-University Hospital in Brno (CTU-UHB) was preprocessed, and the comprehensive features were extracted. Then the optimal feature subset based on the -nearest neighbor (KNN) genetic algorithm (GA) was selected. At last the classification using least square support vector machine (LS-SVM) was executed. The experimental results showed that the classification of fetal state achieved better performance using the proposed method in this paper: the accuracy is 91%, sensitivity is 89%, specificity is 94%, quality index is 92%, and area under the receiver operating characteristic curve is 92%, which can assist clinicians in assessing fetal state effectively.
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Currently, the rate of cesarean sections being performed in Korea is approximately 40%, with Korea ranking 4th among the Organization for Economic Co-operation and Development countries with respect to cesarean deliveries. Breech presentation at term is an important indication for cesarean section among other factors, including medicolegal concerns and pregnancies in women of advanced maternal age. Term breech presentation is associated with a higher fetal mortality rate than that associated with a cephalic presentation. Therefore, in Korea, most of these women deliver by cesarean section to avoid the complications of vaginal breech delivery. However, cesarean section is itself associated with considerable obstetric morbidity and sometimes, mortality. External cephalic version (ECV) is a useful method to reduce the cesarean section rate in women with breech presentation and therefore to reduce the incidence of breech presentation at delivery. Studies have shown that routine use of ECV reduces the cesarean section rate by approximately two-thirds in term pregnancies with breech presentation. ECV is accepted as a safe, efficacious, and cost-effective method and is recommended by both the American College of Obstetricians and Gynecologists and the Royal College of Obstetricians and Gynecologists in all pregnancies with term breech presentation, if not contraindicated. In Korea, although most clinicians are aware of the option of ECV, their relative lack of experience in performing the procedure and fear of complications render them hesitant to perform ECV. This review is aimed at guiding obstetricians by describing the efficacy, safety concerns, and technical aspects of this procedure.
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Female , Humans , Pregnancy , Breech Presentation , Cardiotocography , Cesarean Section , Fetal Mortality , Incidence , Korea , Maternal Age , Methods , Mortality , Version, FetalABSTRACT
ABSTRACT Objective: We speculate that genetic racial disparity exists in fetal life and can be detected by modern computerized cardiotocography (cCTG) . Methods: This is a retrospective study comparing the results of the cCTG of pregnant patients at 37-42 weeks according to the parental ethnicity (black versus white). A cCTG was performed to analyze the variables of fetal heart rate (FHR). The cCTG variables analyzed were: percentage of signal loss; number of contractions; basal FHR; number of accelerations; number of decelerations; length of high variation episodes; short-term variability (STV); total trace duration time; and number of fetal active movements. Non-stress test (NST) parameters in the two groups were compared using the Mann-Whitney test for continuous data, and the Chi-square test for categorical variables. Results: We found a significantly lower number of active fetal movements (p 1/4 0.007) and longer periods of low variation (p 1/4 0.047) in the cCTG of black patients when compared with white patients. Conclusions: In conclusion, identifying the factors responsible for the variance in the objective analysis of CTG results is important to improve the outcomes of patients. Our study lends further evidence as to the importance of ethnicity in clinical cCTG interpretation.
RESUMO Objetivo: Especulamos que disparidade genética racial exist ana vida do feto, e que possa ser detectada por moderna cardiotocografia computadorizada (cCTG). Métodos: Estudo retrospective comparando resultados do cCTG de gestantes entre 37-42 semanas de gestação de acordo com etnicidade dos pais (negro vs. brancos). cCTG foi usado para analisar as variáveis a frequência cardíaca do feto (FHR). As variáveis abalizadas do cCTG foram o % de perda de sinal, número de contrações, basal FHR, número de acelerações, número de desacelerações, comprimento dos episódios de alta variação, viabilidade de curto prazo, tempo total de duração do rastreamento, e número de movimentos de atividade fetal. Os parâmetros do teste de não estresse (NST) em dois grupos foram comparados usando o teste de Mann-Whitney para dados contínuos e teste qui-square para variáveis categóricas. Resultados: Encontramos números significativamente mais baixos de movimentos de atividade fetal (p 1/4 0,007) e períodos mais longos de baixa variação (p 1/4 0,047) no cCTG de pacientes negros se comparados a pacientes brancos. Conclusões: Identificar fatores responsáveis pela variação na análise objetiva dos resultados de CTG é importante em resultados de pacientes que apresentam melhora. Nosso estudo fornece evidências adicionais à importância de estudos clínicos da etnicidade interpretada pelo cCTG.
Subject(s)
Humans , Female , Pregnancy , Black People , Cardiotocography/methods , Diagnosis, Computer-Assisted , White People , Heart Rate, Fetal/physiology , Chi-Square Distribution , Fetal Movement , Retrospective Studies , Statistics, NonparametricABSTRACT
The monitoring of fetal heart rate (FHR) status is an important method to check well-being of the baby during labor. Since the electronic FHR monitoring was introduced 40 years ago, it has been expected to be an innovative screening test to detect fetuses who are becoming hypoxic and who may benefit from cesarean delivery or operative vaginal delivery. However, several randomized controlled trials have failed to prove that electronic FHR monitoring had any benefit of reducing the perinatal mortality and morbidity. Also it is now clear that the FHR monitoring had high intra- and interobserver disagreements and increased the rate of cesarean delivery. Despite such limitations, the FHR monitoring is still one of the most important obstetric procedures in clinical practice, and the cardiotocogram is the most-used equipment. To supplement cardiotocogram, new methods of computerized FHR analysis and electrocardiogram have been developed, and several clinical researches have been currently performed. Computerized equipment makes us to analyze beat-to-beat variability and short term heart rate patterns. Furthermore, researches about multiparameters of FHR variability will be ongoing.
Subject(s)
Female , Pregnancy , Cardiotocography , Electrocardiography , Fetal Heart , Fetus , Heart Rate , Heart Rate, Fetal , Mass Screening , Perinatal MortalityABSTRACT
PURPOSE: The purpose of this cross-over experimental study was to examine effects of music intervention on maternal anxiety, fetal heart rate pattern and testing time during non-stress tests (NST) for antenatal fetal assessment. METHODS: Sixty pregnant women within 28 to 40 gestational weeks were randomly assigned to either the experimental group (n=30) or control group (n=30). Music intervention was provided to pregnant women in the experimental group during NST. Degree of maternal anxiety and fetal heart rate pattern were our primary outcomes. State-trait anxiety inventory, blood pressure, pulse rate, and changes in peripheral skin temperature were assessed to determine the degree of maternal anxiety. Baseline fetal heart rate, frequency of acceleration in fetal heart rate, fetal movement test and testing time for reactive NST were assessed to measure the fetal heart rate pattern. RESULTS: The experimental group showed significantly lower scores in state anxiety than the control group. There were no significant differences in systolic blood pressure and pulse rate between the two groups. Baseline fetal heart rate was significantly lower in the experimental group than in the control group. Frequency of acceleration in fetal heart rate was significantly increased in the experimental group compared to the control group. There were no significant differences in fetal movement and testing time for reactive NST between the two groups. CONCLUSION: Present results suggest that music intervention could be an effective nursing intervention for alel viating anxiety during non-stress test.