How to read fetal heart rate tracings in labor: a comparison between ACOG and NICE guidelines.

The aim of this study was to assess reproducibility and clinical relevance of current guidelines on fetal heart rate interpretation in labor. Two obstetricians with comparable experience analyzed one hundred fetal heart rate tracings. One doctor made a first analysis using American College of Obstetricians and Gynecologists (ACOG) 2009 guideline's criteria; the other used National Institute for Health and Clinical Excellence (NICE) 2007 guideline's criteria; subsequently they repeated the evaluation crossing the guidelines used. The primary outcome of this experiment was to determine the time spent to evaluate the tracings, secondary outcomes were: the intraobserver concordance (concordance of the evaluation with the two systems for each investigator), the interobserver concordance (concordance between the interpretation given by each investigator) and. the concordance between operators' grading and actual outcome of labor. The interpretation of fetal heart rate tracings was longer using ACOG criteria. The intraobserver agreement was significant. The interobserver agreement was better using NICE guidelines. The same trend showed for the concordance between investigators' grading and actual outcomes There was more discordance in worse outcomes. Both guidelines are interesting and useful, but NICE seems easier to handle than ACOG.

The effects of maternal caffeine and chocolate intake on fetal heart rate.

OBJECTIVE: The aim of our study was to analyze the effects of caffeine and chocolate (70% cocoa) on fetal heart rate (FHR). STUDY DESIGN: Fifty pregnant women with uncomplicated gestation, matched for age and parity, underwent computerized FHR recording before and after the consumption of caffeine and then, after one week, before and after 70% cocoa chocolate intake. Computerized cardiotocography (cCTG) parameters were expressed as mean and SD. The differences were tested for statistical significance using the paired t-test, with significance at p < 0.05. RESULTS: The number of uterine contraction peaks, the number of small and large accelerations (10 and 15 beats per minute for 15 seconds), the duration of episodes of high variation and the short-term FHR variation were significantly higher (p < 0.001) after maternal coffee intake. The number of large accelerations, the duration of episodes of high variation and the short-term FHR variation were significantly higher (p < 0.001) after maternal consumption of chocolate, whilst no effect of cocoa was found during contractions. CONCLUSIONS: Our results suggest that maternal intake of both caffeine and 70% cocoa have a stimulating action on fetal reactivity. This finding is likely due to the pharmacological action of theobromine, a methilxanthine present in coffee and in chocolate. The correlation between maternal caffeine intake and increased uterine contraction peaks is likely due to the effect of caffeine on the uterine muscle.

Computerized analysis of fetal heart rate in pregnancies complicated by gestational diabetes mellitus, gestational hypertension, intrauterine growth restriction and premature rupture of membranes.

OBJECTIVE: We aimed to compare individual fetal heart rate (FHR) indices, as determined by computer analysis of the tracing, in pregnancies complicated by gestational diabetes mellitus (GDM), gestational hypertension (PIH), intrauterine growth restriction (IUGR) and premature rupture of membranes (pPROM). METHODS: The study population consisted of 100 pregnant women affected by GDM on diet therapy, 100 pregnant women affected by GDM on insulin therapy, 100 pregnant women affected by PIH, 100 pregnant women affected by IUGR, 100 with premature rupture of membranes far from the term (pPROM) and 100 normal pregnancies matched for age, parity and gestation as controls. The 30-min FHR tracing was analyzed by computer. RESULTS: Baseline FHR, the duration of episodes of low variation and short-term variation was significantly higher in pregnancies complicated by gestational diseases than in controls; only in PIH, IUGR and pPROM were a significant reduction of the numbers of fetal movements. CONCLUSIONS: Our study demonstrates that pregnancies complicated by gestational diseases do an impact on FHR. The alteration is slight but evident; it reflects fetal well-being. Computerized FHR tracing analysis may improve the clinical care and the timing of delivery.

Computerized analysis of fetal heart rate in pregnancies complicated by gestational diabetes mellitus.

OBJECTIVE: We evaluated the value of computerized cardiotocography (cCTG) in pregnancies complicated by gestational diabetes mellitus (GDM). Purpose of study. We studied fetal heart rate (FHR) recordings from 100 pregnant women affected by GDM on diet therapy, 60 pregnant women affected by GDM on insulin therapy and 100 normal pregnant controls. The results were compared among the groups and related to neonatal umbilical artery cord blood analysis at birth. RESEARCH DESIGN AND METHODS: Baseline FHR and the duration of episodes of low variation were significantly higher in diabetic than in controls and were negatively related to umbilical artery glycemia at birth, whereas the short-term variation in diabetics was significantly lower than in controls and was positively related to. CONCLUSIONS: Our study demonstrates that GDM does impact FHR. The alteration is slight but evident; it reflects fetal wellbeing and correlate with neonatal reactivity. Only cCTG may allow to detect those slight but significant differences.

Deceleration area of fetal heart rate trace and fetal acidemia at delivery: a case-control study.

OBJECTIVE: To assess the correlation between the total deceleration area of the fetal heart rate (FHR) pre-delivery trace and intrapartum fetal acid-base status in a low risk population. STUDY DESIGN: We analyzed the electronic fetal monitoring (EFM) traces of 26 pregnancies with fetuses presenting acidemia at delivery and those of thirty controls. All laboring patients had at least 1 hour of EFM without interruption. The deceleration area was calculated, after digital analysis, with Autocad System 2004. RESULTS: We found that the number of decelerations (8.03 +/- 3.77 vs. 4.64 +/- 3.84) and the total deceleration area/hour (35.56 +/- 11.87 vs. 17.81 +/- 9.38) were significantly higher in the study group than in the control group. CONCLUSIONS: Our results show that quantitative analysis of the deceleration areas by digitized cardiotocography may have a discriminative capacity to predict fetal acidemia at delivery.