Evaluation of clinical application value of remote fetal heart monitoring / 中国实用妇科与产科杂志

Remote fetal heart monitoring technology is an open-distributed monitoring system,which is the supplement of inpatient fetal heart rate monitoring and the outpatient extension of perinatal health care.It has enriched the connotation of family self-monitoring and is a strong guarantee of fetal safety.It opens up an effective,practical and feasible new way for the pregnancy management of high-risk pregnancy and fetus with umbilical cord factors.Scientific management and quality control are the preconditions for the development and promotion of remote fetal heart monitoring.

To compare intrapartum cardiotocographic (CTG) recording with conventional intermittent auscultation during labor.

Standard evaluation of fetal well-being during labor includes the periodic assessment of the fetal heart rate (FHR), its pattern and response to intrapartum stimuli and events. Effective methods of evaluation and meaningful interpretation of FHR data range from non-invasive techniques like Intermittent Auscultation, continuous electronic fetal heart rate (FHR) monitoring to invasive techniques of fetal blood gas analysis and fetal ECG.

Standardized Approach to Intrapartum Fetal Heart Rate Monitoring / 대한주산의학회잡지

Intrapartum fetal heart rate monitoring (FHR) was introduced in the 1970's in this country for the hope of preventing intrapartum hypoxic fetal events. The proper interpretation and the following management of intrapartum FHR are among the items that the obstetricians should be well informed of. This review summarizes the standardized FHR monitoring definition and interpretation based on the report from National Institute of Child Health and Human Development in 2008 and offers updated guidelines suggested by American College of Obstetrics and Gynecology in 2010. This review also details on the intrauterine resuscitation and finally demonstrates recent evidences about the impact of standardization of intrapartum management on adverse perinatal outcomes.

Antenatal Predictors of Neonatal Outcome in Fetal Growth Restriction; Efficacy of Biophysical Score, Doppler Ultrasound, Fetal Heart Rate Monitoring / 대한주산의학회잡지

PURPOSE:To identify the antenatal variables predictive of neonatal outcome and to examine the relationship between biophysical score, multivessel Doppler ultrasound and fetal heart rate monitoring in fetal growth restriction (FGR). METHODS:We retrospectively analyzed the pregnancy and neonatal outcomes of 64 growth restricted fetuses delivered at less than 34 weeks of gestation at Samsung Medical Center, from May 2005 to May 2008. The result of Doppler velocimetry including umbilical artery, middle cerebral artery, and ductus venosus and biophysical score (BPS) and fetal heart rate (FHR) monitoring for each subject were reviewed. Adverse neonatal outcome was defined as bronchopulmonary dysplasia, periventricular leukomalacia, grade 3~4 intraventricular hemorrhage, grade 3~4 retinopathy of prematurity, necrotizing enterocolitis, neonatal sepsis, and perinatal mortality. We performed the univariate and multivariate analysis to determine which antenatal fetal surveillance test is the best to predict the adverse neonatal outcome in preterm FGR. We also assessed the degree of agreement of each antenatal test by the Cohens kappa test. RESULTS:By the univariate analysis, significant variables associated with adverse neonatal outcome were gestational age at delivery, oligohydramnios, and abnormal ductus venosus Doppler. However, in the multivariate analysis, gestational age at delivery and oligohydramnios remained as independent predictors of adverse neonatal outcome. Degree of agreement among the antenatal tests expressed by the Cohens kappa was only significant between BPS and FHR monitoring (kappa=0.303, P=0.019). CONCLUSION:Our data suggests that the timing of delivery of growth restricted fetuses less than 34 weeks of gestation should be determined by the gestational age and oligohydramnios, not by the one abnormal antenatal fetal surveillance result. We also confirmed that there are considerable amount of disagreements among BPS, mutivessel Doppler, and FHR monitoring.

The differences of fetal heart rate according to fetal sex / 대한산부인과학회잡지

OBJECTIVES: The purpose of this study is to analyze the previously unreported effect of fetal sex on the fetal heart rate and to measure its magnitude in relation to the effects of other independent clinical variables. METHODS: Three hundred and seventeen pregnant women who were able to provide electronic fetal heart rate monitoring were evaluated. On the basis of fetal sex after birth, 167 pregnant women who delivered male neonate were for males group and 146 examples who delivered female neonate were for female group. We analyzed fetal heart rate data using the Catholic Computer Assisted Obstetric Diagnosis System(CCAOD). RESULTS: Female fetuses had significantly faster basal heart rate(140.51+/-12.43bpm) than male fetuses(137.64+/-13.68 bpm).(P=0.007) Percent acceleration time(PAT) increased significantly for males(6.10+/-4.00bpm), comparing to females(4.90+/-3.34bpm).(P=0.001) Also percent deceleration time(PDT) was significantly higher in male fetuses(7.50+/-8.70bpm) than female fetuses(6.18+/-7.70bpm).(P=0.039) But there was no differences in standard deviation(SD)(8.84+/-10.11bpm, 8.11+/-3.56bpm), long term variation(LTV)(80.38+/-62.79msec, 73.65+/-54.60msec), and short term variation(STV)(14.06+/-9.79msec, 13.33+/-12.32msec) between male and female fetuses. CONCLUSION: The fetal heart rate of female fetuses differ from that of male fetuses. Computerized linear analysis and nonlinear analysis of antepartum fetal heart rate will need to take into account the multiple factors that influence the fetal heart rate to identify precisely which pattern predict clinical outcome.

Clinical observation of meconium aspiration syndrome : in relation to fetal heart rate monitoring

To identify the neonates at the risk of having meconium aspiration syndrome, the perinatal characteristics and finding of fetal heart rate monitorings in 366 neonates who had meconium-stained amniotic fluid were retrospectively reviewed. The results were as follows; 1) Overall incidence of MAS was 0.7%. 2) Mortality rate of MAS was 5.8%. 3) The mean Apgar scores at 1-and 5-minute were significantly different in the two groups with and without meconium aspiration sydrome (MAS)(p<0.001). 4) PROM, postterm delivery and IUGR were the major obstetric risk factors associated with MAS. 5) Although severe variable decelaeration and decreased variability on FHR monitoring were present more often in the group with MAS, it showed no statistically significant difference between the two groups. 6) The presence of above findings on monitoring and thick meconium in amniotic fluid should alert clinicians to the possibility of a fetus that requires intervention.