Intra- and interobserver variability of intrapartum cardiotocography: a multicenter study comparing the FIGO classification with computer analysis software.

OBJECTIVE: To evaluate and compare the computer analyzing software system with subjective interpretation using the FIGO classification of intrapartum cardiotocograms. METHODS: Twenty-four obstetricians and 19 midwives from 3 hospitals [19 junior (≤3 years) and 24 senior (>3 years) experience] participated in this study. Forty-three doctors and midwives interpreted intrapartum cardiotocographic (CTG) readings from 12 parturients without knowing the clinical outcome. Two CTG readings were repeated for evaluation of the intraobserver variability. Inter- and intraobserver agreement in CTG interpretation using the FIGO score and the computer analyzing software was assessed via proportions of agreement (Pa), with 95% confidence intervals. The level of inter- and intraobserver agreement was analyzed by calculating Pa values for CTG baseline, variability, accelerations and decelerations. RESULTS: In total, for all parameters of the FIGO classification, Pa was very low. The highest 95% confidence level of Pa was found for the baseline parameter (0.49-1.01), and the lowest for the parameter acceleration. No significant difference was seen between obstetricians and midwives as well as between junior and senior experience. In assessments of normal cases, the Pa were significantly higher than in pathological readings. CONCLUSION: Computer analyzing software can reduce the high inter- and intraobserver variability; however, further studies are needed to find out whether this can improve fetal outcome and reduce the number of Cesarean sections.

[Hypnotherapy, gestational age and incidence of preterm labour]. / Hypnotherapie, Gestationsalter und Frühgeburtenrate.

PURPOSE: This study examines whether or not those women who have participated in a hypnoreflexogenous birth preparation course have a lower incidence of preterm labour and higher gestational age. MATERIAL AND METHODS: 101 women participated in the birth preparation hypnosis course (hypnomental birth preparation) and were evaluated against a parallelised control group. The following parameters were evaluated: education, number of previous pregnancies and live births, average number of cigarettes smoked per day and age of the mother. The control group was selected out of the hospital birth register from 2001 to 2008 (n=10 812). RESULTS: In the hypnosis group (n=101) there were six late preterm deliveries (5.49%) whereas in the parallelised control group there were significantly more preterm deliveries (n=11; 11.3%; p=0.02). There was also a statistically significant correlation between gestational age and maternal participation in the hypnomental birth preparation. CONCLUSION: In the hypnosis group there were significantly less preterm deliveries after parallelising the socio-economical demographics. A planned randomised controlled study of preterm labour should identify whether clinical hypnosis can reduce the incidence of preterm labour.

[Pulse oximetry as an additive procedure in modern fetal assessment during labour]. / Die Pulsoxymetrie als additives Verfahren in der modernen Uberwachung des Feten unter der Entbindung.

INTRODUCTION: The low specificity, together with the high intra- and interobserver variability, of cardiotocography (CTG) necessitates the use of additive fetal assessment methods. The German Society of Obstetrics and Gynaecology (DGGG) advises the use of computerised CTG analysis software systems. In this study we have examined the use of computerised CTG analysis together with the fetal pulse oximetry. MATERIALS AND METHODS: Using the "CTG-Online ((R))" software five consecutive deliveries were simultaneously analysed by the FIGO score and the saturation rate of fetal pulse oximetry. All CTGs were classified as pathological and at least one fetal scalp pH measurement was carried out. Fetal outcome and results of the fetal scalp pH values were evaluated against the fetal pulse oximetry rates. RESULTS: Signal loss was low at less than 5%. No fetus showed a hypoxic state. Only 0.98% of the fetal pulse oximetry saturation rates were below 30% oxygen saturation. No fetus showed an oxygen saturation of below 35% for 10 min duration or more. CONCLUSION: Fetal pulse oximetry saturation rates can be another helpful marker for fetal well-being in a modern labour ward. Further studies are required to verify whether fetal pulse oximetry saturation rates can improve the specificity of CTG for fetal acidosis.

[Changes in resistance of the umbilical artery, foetal movements and short time variation through clinical hypnosis--preliminary results]. / Veränderung des Gefässwiderstands der Arteria umbilicalis, der fetalen Bewegung und der Herzzeitvariation durch Hypnose - Erste Ergebnisse.

BACKGROUND: The aim of this study was to determine whether there are any changes in short time variation (STV), foetal movements, and blood flow in the umbilical artery in the trance state. METHODS: Six pregnant patients who had already attended two hypnoreflexogenous birth preparation course units had a standardised hypnosis intervention under cardiotocography (CTG). Using the CTG-Player ((R)) STVs and foetal movements were calculated from the electronically saved CTG traces and evaluated against control CTGs recorded before and after hypnosis. Before and after the induction of hypnosis, blood flow in the umbilical artery was measured. RESULTS: Using the Wilcoxon test there is a significant lowering of blood flow resistance in the umbilical artery after hypnosis (p=0.042). There was a trend that the foetal movements increas at the beginning of the trance (Wilcoxon test, p=0.075). There was no significant difference in the STVs before, during and after trance. CONCLUSIONS: Preliminary results showed that blood flow of the umbilical artery can be improved by hypnosis. Further clinical studies are required to verify this hypothesis. The subjective impression of participants that foetal movements increase at the beginning of the trance seems to be correct.

[Foetal electrocardiography (ECG) is an alternative to Doppler ultrasound cardiotocogram (CTG) for antenatal assessment of foetal well-being--preliminary results]. / Fetales Elektrokardiogramm (EKG) als Alternative der Doppler-Kardiotokografie (CTG) zur antepartualen Uberwachung des Feten--erste Ergebnisse.

INTRODUCTION: Computer analysing software is required for the assessment of CTGs because of the low sensitivity and high intra- and interobserver variability. The German Society of Gynaecology and Obstetrics advises the use of computer analysing CTG software. This study is aimed at evaluating the use of a new foetal ECG analysis system as an alternative to the traditional Doppler ultrasound CTGs in the setting of a university labour suite. MATERIALS AND METHODS: 10 pregnant women beyond the 32 (nd) week of gestation, who were admitted to hospital and gave informed consent to this study, were connected to the foetal EKG monitor system Monica AN24. Patient satisfaction, maternal and foetal EKG detection rates and time required to connect the patient were evaluated. RESULTS: 8 out of 10 women would prefer the Monica AN24 monitor system over the traditional Doppler ultrasound CTG. In total, the mean foetal ECG detection rate was 62.3 % (SD +/- 30.4) during the recorded time interval; at rest the detection rate was 75.3 % (SD +/- 33.2); during the night time (23.00 to 7.00) the detection rate was 78.3 % (SD +/- 25.4); and during night time and at rest the detection rate was 82.2 % (SD +/- 24.3). The mean recorded time interval was 6 h and 54 min (SD +/- 2 h and 43 min). In total, the maternal ECG detection rate was as high as 99.7 % (SD +/- 0.4). The mean time required for applying the Monica AN24 monitor system was 3.2 min (SD +/- 0.6). CONCLUSION: The foetal ECG monitor system may be a good alternative to Doppler ultrasound CTGs. With the perspective to analyse in a beat to beat manner foetal EKG heart rates, this new monitor system should be superior to Doppler ultrasound CTGs, however further larger studies are needed to confirm this hypothesis.

[The value of Doppler cardiotocogram computer analysis system 70 minutes before delivery]. / Die Wertigkeit der computergestützten CTG-Analyse in den letzten 70 Minuten vor der Entbindung.

BACKGROUND: Since the second half of the 20th century, foetal wellbeing has been assessed using cardiotocography (CTG) during labour. Many studies have shown that the CTG has very high intra- and interobserver variability. Many score systems have been developed for more objective analysis of the foetal heart rate. The German Society of Obstetrics and Gynaecology recommends the use of computerised analysis programmes for CTG evaluation in order to reduce subjectivity. This study examines whether there is a correlation of foetal outcome with computerised CTG analysis using the "CTG-Online" programme. MATERIALS AND METHODS: Out of 1,251 consecutive deliveries, two groups were selected depending on foetal outcome (very good foetal outcome [n=76] and poor foetal outcome [n=56]). The last 70 min before delivery were evaluated using "CTG-Online" and "CTG-Player". These results were correlated with foetal outcome. RESULTS: In the time interval of 25 to 5 min before delivery, the FIGO parameter "deceleration" had a statistically significant correlation with poor foetal outcome (p<0.0199). Variability and acceleration showed no correlation during the evaluation period. Five minutes before delivery the baseline showed a weak statistically significant correlation with foetal outcome (p<0.0290). CONCLUSIONS: Norm values of the FIGO parameters baseline, acceleration and deceleration should be re-examined using large computer databases. Computerised analyses of the FIGO parameter for deceleration is promising, however, further studies are needed to increase its sensitivity and specificity.