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Sample records for cardiotocography

  1. Fetal cardiotocography before and after water aerobics during pregnancy

    OpenAIRE

    Silveira Carla; Pereira Belmiro G; Cecatti Jose G; Cavalcante Sergio R; Pereira Rosa I

    2010-01-01

    Abstract Objective To evaluate the effect of moderate aerobic physical activity in water on fetal cardiotocography patterns in sedentary pregnant women. Method In a non-randomized controlled trial, 133 previously sedentary pregnant women participated in multiple regular sessions of water aerobics in a heated swimming pool. Cardiotocography was performed for 20 minutes before and just after the oriented exercise. Cardiotocography patterns were analyzed pre- and post-exercise according to gesta...

  2. Correlation between Nonreassuring Patterns in Fetal Cardiotocography and Birth Asphyxia

    OpenAIRE

    Fatemeh Abbasalizadeh; Shamci Abbasalizadeh; Shabnam Pouraliakbar; Parvin Bastani

    2015-01-01

    Objective: Cardiotocography is a tool for assessing the fetus during labor and identification the risk of asphyxia. Abnormal cardiotocography can induce stress on the physician and mother and can result in their deciding to terminate the pregnancy and the complications of an emergency cesarean section. The purpose of this study was the evaluation of the correlation between non-reassuring patterns in fetal cardiotocography and birth asphyxia. Materials and methods: In a cross-sectional anal...

  3. Cardiotocography in the Prognosis of Perinatal Outcome

    OpenAIRE

    Bogdanovic, Gordana; Babovic, Adnan; Rizvanovic, Mirzeta; LJUCA Dzenita; Grgic, Gordana; Djuranovic–Milicic, Jadranaka

    2014-01-01

    ABSTRACT Aim: The objective of the study was to examine whether cardiotocography can (CTG) predict asphyxia of the embryo, manifested as hypoxic-ischemic encephalopathy (HIE), and to what extent one can rely on CTG record. Material and methods: Retrospective research was carried out at the Clinic for Gynecology and Obstetrics UKC Tuzla and medical documentation from the history of mothers and newborns was used. The study group consisted of 68 pregnancies and newborns who developed HIE. The co...

  4. Fetal cardiotocography before and after water aerobics during pregnancy

    Directory of Open Access Journals (Sweden)

    Silveira Carla

    2010-08-01

    Full Text Available Abstract Objective To evaluate the effect of moderate aerobic physical activity in water on fetal cardiotocography patterns in sedentary pregnant women. Method In a non-randomized controlled trial, 133 previously sedentary pregnant women participated in multiple regular sessions of water aerobics in a heated swimming pool. Cardiotocography was performed for 20 minutes before and just after the oriented exercise. Cardiotocography patterns were analyzed pre- and post-exercise according to gestational age groups (24-27, 28-31, 32-35 and 36-40 weeks. Student's t and Wilcoxon, and McNemar tests were used, respectively, to analyze numerical and categorical variables. Results No significant variations were found between pre- and post-exercise values of fetal heart rate (FHR, number of fetal body movements (FM or accelerations (A, FM/A ratio or the presence of decelerations. Variability in FHR was significantly higher following exercise only in pregnancies of 24-27 weeks. Conclusions Moderate physical activity in water was not associated with any significant alterations in fetal cardiotocography patterns, which suggests no adverse effect on the fetus.

  5. Correlation between Nonreassuring Patterns in Fetal Cardiotocography and Birth Asphyxia

    Directory of Open Access Journals (Sweden)

    Fatemeh Abbasalizadeh

    2015-07-01

    Full Text Available Objective: Cardiotocography is a tool for assessing the fetus during labor and identification the risk of asphyxia. Abnormal cardiotocography can induce stress on the physician and mother and can result in their deciding to terminate the pregnancy and the complications of an emergency cesarean section. The purpose of this study was the evaluation of the correlation between non-reassuring patterns in fetal cardiotocography and birth asphyxia. Materials and methods: In a cross-sectional analytic study, 324 term pregnant women were included, and the association between non-reassuring patterns in cardiotocography (fetal tachycardia, fetal bradycardia, absent or minimal baseline variability, and absence of acceleration and periodic or episodic deceleration and birth asphyxia were assessed. Results: Birth asphyxia existed in 10 newborns; in all cases mild hypoxic ischemic encephalopathy was observed. Within the non-reassuring cardiotocography patterns, baseline fetal heart variability and periodic or episodic deceleration had a significant relationship with birth asphyxia. Most asphyxia cases had occurred in absent and minimal baseline fetal heart rate (FHR variability (R = 0.49, P < 0.001. In periodic or episodic decelerations, most asphyxia cases occurred in recurrent late decelerations with normal baseline variability and variable decelerations with shoulders or overshoots (R = 0.42, P = 0.014. Conclusion: With regard to the findings of the present study, we can use non-reassuring cardiotocographic patterns, especially absent and minimal baseline FHR variability and periodic or episodic decelerations, in prediction of birth asphyxia. But it seems that most birth asphyxias occur in normal cardiotocographs.

  6. The Success of Cardiotocography in predicting Perinatal Outcome

    OpenAIRE

    Kaban, Alpaslan; Cengiz, Hüseyin; Kaban, Işık; Özcan, Alim; Karakaş, Sema

    2012-01-01

    Objectives: The determination of the fetal condition during labor is important to minimize fetal death due to asphyxia and the neurological sequelae of fetal hypoxia. This study evaluated the success of fetal cardiotocography in predicting perinatal consequences. Materials and methods: This study enrolled 101 full-term pregnant women admitted for delivery to Vakif Gureba Training and Research Hospital between October 2009 and February 2010. Women were included if they were aged 18-45 year...

  7. Cardiotocography in a perinatal armamentarium: boon or bane?

    OpenAIRE

    Ambily Anu Xavier; Deeksha Pandey; Luvdeep Dogra; Leslie Edward Lewis

    2015-01-01

    Background: As electronic foetal monitoring (EFM) is becoming commoner in obstetric armamentarium, so are caesarean deliveries. Present study was conducted with an aim to find out correlation between cardiotocography (CTG) findings, intraoperative findings, and perinatal outcome in subjects who underwent emergency caesarean deliveries. We also intended to estimate the sensitivity, specificity and positive predictive value of CTG in diagnosing foetal distress. Methods: A total of 271 women ...

  8. Cardiotocography (CTG) as the screening method of fetal condition assessment

    OpenAIRE

    V. Zulčić-Nakić; A. Latifagić; I. Šerak; D. Kapidžić; Dž. Ljuca; Z. Fatušić; M. Kapidžić

    2007-01-01

    A basic function of fetal monitoring is an analysis of fetal cardiac action. Cardiotocography (CTG) cannot provide all necessary information for assessment of the fetal condition as it is not sufficiently reliable and gives a large number of false positive results that increase the number of cesarean sections. An objective of this work was to establish CTG reliability as a method for assessment of intrapartal fetal condition. Based on CTG parameters (baseline fetal heart rate, fetal heart ra...

  9. Leptospirosis in pregnancy with pathological fetal cardiotocography changes

    OpenAIRE

    Koe, Suan-Li Liana; Tan, Kim Teng; Tan, Thiam Chye

    2014-01-01

    We report the case of a 33-year-old primigravida who presented at 37 weeks of gestation with symptoms suggestive of acute fatty liver of pregnancy, but was later diagnosed with leptospirosis (i.e. Weil's disease or syndrome) on serological testing. Cardiotocography showed fetal distress, and an emergency Caesarean section was performed. A healthy neonate with no evidence of congenital leptospirosis was delivered. The patient was treated with intravenous ceftriaxone and discharged well 13 days...

  10. Reliability of admission cardiotocography for intrapartum monitoring in low resource setting

    OpenAIRE

    Hafizur Rahman; Prachi Renjhen; Sudip Dutta

    2012-01-01

    Background To evaluate the role of admission cardiotocography in intrapartum patients in detecting fetal hypoxia already present and to correlate the results of admission cardiotocography with perinatal outcome. Materials and Methods: It was a cross-sectional study conducted in the Labor and Maternity ward during the period 2007-2009. The study included 176 pregnant women (both high risk and low risk), admitted to the emergency department or through the outpatient department with period of ge...

  11. Curriculum development for a national cardiotocography education program

    DEFF Research Database (Denmark)

    Thellesen, Line; Hedegaard, Morten; Bergholt, Thomas;

    2015-01-01

    round, participants listed one to five learning objectives within the predefined topics. Responses were analyzed by a directed approach to content analysis. Phrasing was modified in accordance with Bloom's Taxonomy. In the second and third Delphi rounds, participants rated each objective on a five......OBJECTIVE: To define learning objectives for a national cardiotocography (CTG) education program based on expert consensus. DESIGN: A three-round Delphi survey. POPULATION AND SETTING: One midwife and one obstetrician from each maternity unit in Denmark were appointed based on CTG teaching......-point relevance scale. Consensus was predefined as objectives with a mean rating value of ≥3. MAIN OUTCOME MEASURES: A prioritized list of CTG learning objectives. RESULTS: A total of 42 midwives and obstetricians from 21 maternity units were invited to participate of whom 26 completed all three Delphi rounds...

  12. The success of cardiotocography in predicting perinatal outcome

    Directory of Open Access Journals (Sweden)

    Alpaslan Kaban

    2012-06-01

    Full Text Available Objectives: The determination of the fetal condition duringlabor is important to minimize fetal death due to asphyxiaand the neurological sequelae of fetal hypoxia.This study evaluated the success of fetal cardiotocographyin predicting perinatal consequences.Materials and methods: This study enrolled 101 full-termpregnant women admitted for delivery to Vakif GurebaTraining and Research Hospital between October 2009and February 2010. Women were included if they wereaged 18-45 years and within 36-41 weeks of gestation.During a 20-min period of fetal monitoring, a change inFHR (fetal heart rate lasting for 15 s or two elevated runsof 15 beats was evaluated as a reactive NST (non-stresstest. The umbilical artery pH was used as the “gold standard”for assessing fetal asphyxia.Results: The mean age of the women included in thestudy was 27.82 ± 5.29 years, the average parity was1.09± 0.96. The pH was normal in 85 neonates, while 13 hadfetal asphyxia. No significant difference in umbilical cordblood pH, pO2, or pCO2 was observed between these twogroups (p = 0.497, p = 0.722, and p = 0.053, respectively.No significant difference in maternal age, parity, or birthweight was found between the group with fetal distressbased on CTG (cardiotocography and the normal group.Conclusion: Cardiotocography is an important test duringlabor for labor management, it is insufficient for predictingthe perinatal outcome. Therefore, labor should beevaluated on an individualized basis. J Clin Exp Invest2012; 3(2: 168-171

  13. Cardiotocography (CTG as the screening method of fetal condition assessment

    Directory of Open Access Journals (Sweden)

    V. Zulčić-Nakić

    2007-02-01

    Full Text Available A basic function of fetal monitoring is an analysis of fetal cardiac action. Cardiotocography (CTG cannot provide all necessary information for assessment of the fetal condition as it is not sufficiently reliable and gives a large number of false positive results that increase the number of cesarean sections. An objective of this work was to establish CTG reliability as a method for assessment of intrapartal fetal condition. Based on CTG parameters (baseline fetal heart rate, fetal heart rate variability, oscillations and decelerations 100 pathological CTG records, collected at Obstetrics and Gynecology Department of the Tuzla University Clinic Hospital from 01.12.2004 to 05.08.2005 were identified. Using binomial distribution they were classified as non-pathological (indicating absence of asphyxia and pathological (indicating possible presence of asphyxia. After the delivery the condition of newborns was assessed according to the Apgar score. Based on comparison between certain pathological parametres of CTG records and newborns’ conditions at birth the results indicated high positive predictive values whereas sensitivity and accuracy were low. Apgar score 1. from 7 upwards was given to 96 (96% newborns whereas Apgar score 2 from 7 upwards was given to all the newborns with previous pathological CTG records. Results have confirmed that CTG can be used only as a screening method for assessment of intrapartal fetal condition.

  14. Comparison between visual and computerized cardiotocography in low risk pregnancy

    International Nuclear Information System (INIS)

    To compare between visual and computerized cardiotocography (cCTG) in low-risk pregnant women in predicting pregnancy outcome. One hundred and fifty-three consecutive computerized fetal heart tracings were recorded from non-laboring pregnant women at >/- 30 weeks gestation. All traces were reviewed by 2 experienced obstetricians. The study was carried out at Al-Ain Medical District, United Arab Emirates, between August 2004 and December 2004. Of the 153 pregnant women, 11 (7.2%) were delivered by cesarean section. The interobserver agreement was 0.60. The observers cCTG agreement were 0.48 and 0.45. The difference in cesarean section rate was not statistically significant. Observers interpretation and cCTG did not correlate well with Apgar score at 5 minutes and admission to special care baby unit. Computerized CTG has little advantage over conventional CTG in the prediction of Apgar score and need for neonatal intensive care unit admission in a low-risk population. (author)

  15. A randomised clinical trial on cardiotocography plus fetal blood sampling versus cardiotocography plus ST-analysis of the fetal electrocardiogram (STAN®) for intrapartum monitoring

    OpenAIRE

    Rijnders Robbert JP; Porath Martina M; Oei S Guid; Nijhuis Jan G; Mol Ben WJ; van Lith Jan MM; van Geijn Herman P; Drogtrop Addy P; Bijvoet Saskia M; van Beek Erik; Moons Karel GM; Westerhuis Michelle EMH; Schuitemaker Nico WE; van der Tweel Ingeborg; Visser Gerard HA

    2007-01-01

    Abstract Background Cardiotocography (CTG) is worldwide the method for fetal surveillance during labour. However, CTG alone shows many false positive test results and without fetal blood sampling (FBS), it results in an increase in operative deliveries without improvement of fetal outcome. FBS requires additional expertise, is invasive and has often to be repeated during labour. Two clinical trials have shown that a combination of CTG and ST-analysis of the fetal electrocardiogram (ECG) reduc...

  16. The long-term cost-effectiveness of fetal monitoring during labour: a comparison of cardiotocography complemented with ST analysis versus cardiotocography alone

    OpenAIRE

    Heintz, E.; Brodtkorb, T-H; Nelson, N; Levin, L-Å

    2008-01-01

    Objective To assess the cost-effectiveness of the use of cardiotocography (CTG) complemented with fetal electrocardiography and ST analysis compared with the use of CTG alone in term deliveries when a decision has been made to use fetal monitoring with a scalp electrode. Design A cost-effectiveness analysis based on a probabilistic decision model incorporating relevant strategies and lifelong outcomes. Setting Maternity wards in Sweden. Population Women with term fetuses after a clinical deci...

  17. Transient accelerations of fetal heart rate analyzed by computerized cardiotocography in the third trimester of pregnancy

    Directory of Open Access Journals (Sweden)

    Ana Luisa Fernandes Lauletta

    2014-06-01

    Full Text Available Objective: the aim of this study was to investigate the patterns of transient FHR accelerations (10 bpm and 15 bpm in the third trimester of pregnancy, comparing the occurrence of this event before and after the 32nd gestational week. Methods: This is a prospective study comparing the results of the computerized cardiotocography of 46 low-risk women with singleton pregnancies, maternal age between 18 and 40 years, gestational age between 28 and 40 weeks, absence of maternal morbidity and adequate fetal growth according to ultrasound. Computed Cardiotocography (8002 Sonicaid System and Fetal Care System was performed for 30 minutes to analyze the variables of FHR. Results: twenty-three pregnant women underwent cardiotocography before 32 weeks (mean = 29.9 weeks, SD = 1.4 weeks and were compared with 23 pregnant women who were examined after 32 weeks (mean = 36.3 weeks, SD = 2.5 weeks. Regarding the characteristics of FHR, fetuses evaluated between 32 1/7 weeks and 40 weeks showed a significantly greater number of accelerations above 15 bpm (median = 5, variation 0-18 than the group of pregnant women from 28 to 32 weeks (median = 4, variation 0 to 10; P = 0.048. There was a significant positive correlation between the number of accelerations above 15 bpm and the gestational age at examination (rho = 0.33; P = 0.026. Conclusion: computerized cardiotocography showed an association regarding the number of transient accelerations greater than 15 bpm in the assessment of both periods before and after 32 weeks of gestational age, suggesting the influence of the maturation of the fetal autonomic nervous system with pregnancy progression.

  18. Transient accelerations of fetal heart rate analyzed by computerized cardiotocography in the third trimester of pregnancy

    OpenAIRE

    Ana Luisa Fernandes Lauletta; Roseli Mieko Yamamoto Nomura; Seizo Miyadahira; Rossana Pulcineli Vieira Francisco; Marcelo Zugaib

    2014-01-01

    Objective: the aim of this study was to investigate the patterns of transient FHR accelerations (10 bpm and 15 bpm) in the third trimester of pregnancy, comparing the occurrence of this event before and after the 32nd gestational week. Methods: This is a prospective study comparing the results of the computerized cardiotocography of 46 low-risk women with singleton pregnancies, maternal age between 18 and 40 years, gestational age between 28 and 40 weeks, absence of maternal morbidity and a...

  19. EFFICACY OF ADMISSION CARDIOTOCOGRAPHY (ADMISSION T EST) TO PREDICT OBSTETRIC OUTCOME

    OpenAIRE

    Dwarakanath; Lakshmikantha; Chaitra

    2013-01-01

    ABSTRACT: OBJECTIVE: To determine the efficacy of admission test on perin atal outcome and levels of obstetric interventions. METHODS: Prospective study on 200 pregnant women at admission by cardiotocography and assess th e perinatal outcome and obstetric interventions. RESULTS: Incidence of reactive trace was 69%, suspicious 24% and ominous 7%. Out of 200 cases 159(80%) had vaginal delivery, 28( 14%) had LSCS and 13(6%) had instrumental delivery. ...

  20. Comparison of a Novel Computerized Analysis Program and Visual Interpretation of Cardiotocography

    OpenAIRE

    Chen, Chen-Yu; Yu, Chun; Chang, Chia-Chen; Lin, Chii-Wann

    2014-01-01

    Objective To compare a novel computerized analysis program with visual cardiotocography (CTG) interpretation results. Methods Sixty-two intrapartum CTG tracings with 20- to 30-minute sections were independently interpreted using a novel computerized analysis program, as well as the visual interpretations of eight obstetricians, to evaluate the baseline fetal heart rate (FHR), baseline FHR variability, number of accelerations, number/type of decelerations, uterine contraction (UC) frequency, a...

  1. Reliability of admission cardiotocography for intrapartum monitoring in low resource setting

    Directory of Open Access Journals (Sweden)

    Hafizur Rahman

    2012-01-01

    Full Text Available Background To evaluate the role of admission cardiotocography in intrapartum patients in detecting fetal hypoxia already present and to correlate the results of admission cardiotocography with perinatal outcome. Materials and Methods: It was a cross-sectional study conducted in the Labor and Maternity ward during the period 2007-2009. The study included 176 pregnant women (both high risk and low risk, admitted to the emergency department or through the outpatient department with period of gestation ≥36 weeks, in first stage of labor with fetus in cephalic presentation. All of them were subjected to an admission test, a 20 min recording of fetal heart rate and uterine contractions on cardiotocograph machine at the time of admission. Results: The results of the admission test were ′reactive′ in 82.38%, ′equivocal′ in 10.22%, and ′ominous′ in 7.38% women. Women with the reactive admission test had low risk of intrapartum fetal distress (6.9% as compared to 39.9% in the equivocal and 84.6% in the ominous group (P<0.001. Incidence of moderate to thick meconium stained liqor were more in ominous (61.5% and equivocal group (33.3% in compared to reactive group (4.8% (P<0.001. Incidence of NICU admission was also significantly high (62% in babies delivered from mother with ominous test group compared to those with equivocal (28% and reactive test (3.45% group babies. Neonatal mortality was also seen in babies born to mothers with equivocal (5.5% and ominous (7.6% admission test groups. Operative delivery for fetal distress was required in only 5.5% (8 of 145 woman of the reactive group, in 27.8% (5 of 18 woman of the equivocal group and in 84.6% (11 of 13 women of the ominous group. Conclusion: The admission cardiotocography is a simple non-invasive test that can serve as screening tool to detect fetal distress already present or likely to develop and prevent unnecessary delay in intervention. The test has high specificity and can help in

  2. A critical appraisal of the evidence for using cardiotocography plus ECG ST interval analysis for fetal surveillance in labor. Part I: The randomized controlled trials

    OpenAIRE

    Olofsson, Per; Ayres-de-Campos, Diogo; Kessler, Jörg; Tendal, Britta; Yli, Branislava Markovic; Devoe, Lawrence

    2014-01-01

    We reappraised the five randomized controlled trials that compared cardiotocography plus ECG ST interval analysis (CTG+ST) vs. cardiotocography. The numbers enrolled ranged from 5681 (Dutch randomized controlled trial) to 799 (French randomized controlled trial). The Swedish randomized controlled trial (n = 5049) was the only trial adequately powered to show a difference in metabolic acidosis, and the Plymouth randomized controlled trial (n = 2434) was only powered to show a difference in ope...

  3. A critical appraisal of the evidence for using cardiotocography plus ECG ST interval analysis for fetal surveillance in labor. Part II: The meta-analyses

    OpenAIRE

    Olofsson, Per; Ayres-de-Campos, Diogo; Kessler, Jörg; Tendal, Britta; Yli, Branislava Markovic; Devoe, Lawrence

    2014-01-01

    We appraised the methodology, execution and quality of the five published meta-analyses that are based on the five randomized controlled trials which compared cardiotocography (CTG)+ST analysis to cardiotocography. The meta-analyses contained errors, either created de novo in handling of original data or from a failure to recognize essential differences among the randomized controlled trials, particularly in their inclusion criteria and outcome parameters. No meta-analysis contained complete ...

  4. EFFICACY OF ADMISSION CARDIOTOCOGRAPHY (ADMISSION T EST TO PREDICT OBSTETRIC OUTCOME

    Directory of Open Access Journals (Sweden)

    Dwarakanath

    2013-01-01

    Full Text Available ABSTRACT: OBJECTIVE: To determine the efficacy of admission test on perin atal outcome and levels of obstetric interventions. METHODS: Prospective study on 200 pregnant women at admission by cardiotocography and assess th e perinatal outcome and obstetric interventions. RESULTS: Incidence of reactive trace was 69%, suspicious 24% and ominous 7%. Out of 200 cases 159(80% had vaginal delivery, 28( 14% had LSCS and 13(6% had instrumental delivery. There was increased incidenc e of operative delivery and NICU admissions in suspicious and ominous tracings. This study has a sensitivity of 76% and positive predictive value(PPV of 96%, specificity of 77% and negative predictive value(NPV of 33% for a reactive test. CONCLUSION: Admission test is an effective predictive technique to detect pre- existing fetal distress and plan early intervention to prevent adverse perinatal outcome.

  5. Comparison of a novel computerized analysis program and visual interpretation of cardiotocography.

    Directory of Open Access Journals (Sweden)

    Chen-Yu Chen

    Full Text Available To compare a novel computerized analysis program with visual cardiotocography (CTG interpretation results.Sixty-two intrapartum CTG tracings with 20- to 30-minute sections were independently interpreted using a novel computerized analysis program, as well as the visual interpretations of eight obstetricians, to evaluate the baseline fetal heart rate (FHR, baseline FHR variability, number of accelerations, number/type of decelerations, uterine contraction (UC frequency, and the National Institute of Child Health and Human Development (NICHD 3-Tier FHR classification system.There was no significant difference in interobserver variation after adding the components of computerized analysis to results from the obstetricians' visual interpretations, with excellent agreement for the baseline FHR (ICC 0.91, the number of accelerations (ICC 0.85, UC frequency (ICC 0.97, and NICHD category I (kappa statistic 0.91; good agreement for baseline variability (kappa statistic 0.68, the numbers of early decelerations (ICC 0.78 and late decelerations (ICC 0.67, category II (kappa statistic 0.78, and overall categories (kappa statistic 0.80; and moderate agreement for the number of variable decelerations (ICC 0.60, and category III (kappa statistic 0.50.This computerized analysis program is not inferior to visual interpretation, may improve interobserver variations, and could play a vital role in prenatal telemedicine.

  6. Comparison of normal and abnormal cardiotocography with pregnancy outcomes and early neonatal outcomes.

    Science.gov (United States)

    Sultana, Jobaida; Chowdhury, T A; Begum, Kohinoor; Khan, Manir Hossain

    2009-01-01

    Cardiotocography (CTG) is the most commonly used test for antepartum and intrapartum foetal surveillance in the majority hospitals of developed countries. The purpose of this study was to compare the pregnancy outcome and early neonatal outcome among the normal and abnormal CTG groups. In this prospective study, fifty consecutive normal and fifty consecutive abnormal CTG were collected within one hour before delivery from patients who have singleton pregnancy with gestational age >or=32 weeks and having obstetric or medical indication for CTG. In this study, the measure of pregnancy outcomes were mode of delivery, indications of caesarean section, percentage requiring caesarean section for foetal distress, oligohydramnios, meconium stained liquor, small placenta and cord around the neck. Early neonatal outcomes included apgar score, birth weight, admission into neonatal intensive care unit (NICU), duration of stay in NICU and perinatal mortality. There were significant differences between the two groups regarding pregnancy outcomes and early neonatal outcomes. So, CTG is an important test to assess the foetal condition in both antepartum and intrapartum period. The sensitivity of CTG was 87%, specificity was 66%, positive predictive value was 54% and negative predictive value was 92% in the prediction of abnormal outcomes. So, normal CTG is more predictive of normal outcomes than abnormal CTG regarding abnormal outcomes. PMID:19377417

  7. A randomised clinical trial on cardiotocography plus fetal blood sampling versus cardiotocography plus ST-analysis of the fetal electrocardiogram (STAN® for intrapartum monitoring

    Directory of Open Access Journals (Sweden)

    Rijnders Robbert JP

    2007-07-01

    Full Text Available Abstract Background Cardiotocography (CTG is worldwide the method for fetal surveillance during labour. However, CTG alone shows many false positive test results and without fetal blood sampling (FBS, it results in an increase in operative deliveries without improvement of fetal outcome. FBS requires additional expertise, is invasive and has often to be repeated during labour. Two clinical trials have shown that a combination of CTG and ST-analysis of the fetal electrocardiogram (ECG reduces the rates of metabolic acidosis and instrumental delivery. However, in both trials FBS was still performed in the ST-analysis arm, and it is therefore still unknown if the observed results were indeed due to the ST-analysis or to the use of FBS in combination with ST-analysis. Methods/Design We aim to evaluate the effectiveness of non-invasive monitoring (CTG + ST-analysis as compared to normal care (CTG + FBS, in a multicentre randomised clinical trial setting. Secondary aims are: 1 to judge whether ST-analysis of fetal electrocardiogram can significantly decrease frequency of performance of FBS or even replace it; 2 perform a cost analysis to establish the economic impact of the two treatment options. Women in labour with a gestational age ≥ 36 weeks and an indication for CTG-monitoring can be included in the trial. Eligible women will be randomised for fetal surveillance with CTG and, if necessary, FBS or CTG combined with ST-analysis of the fetal ECG. The primary outcome of the study is the incidence of serious metabolic acidosis (defined as pH ecf > 12 mmol/L in the umbilical cord artery. Secondary outcome measures are: instrumental delivery, neonatal outcome (Apgar score, admission to a neonatal ward, incidence of performance of FBS in both arms and cost-effectiveness of both monitoring strategies across hospitals. The analysis will follow the intention to treat principle. The incidence of metabolic acidosis will be compared across both groups

  8. Cardiotocography as a predictor of fetal outcome in women presenting with reduced fetal movement.

    LENUS (Irish Health Repository)

    Daly, Niamh

    2011-09-05

    OBJECTIVE: To examine the obstetric and perinatal outcomes of women presenting with reduced fetal movement (RFM) during the third trimester, specifically in relation to the diagnostic capacity of non-stress cardiotocography (CTG) used as the primary investigation in this clinical scenario. STUDY DESIGN: This was a retrospective population-based cohort study of pregnancy outcomes of all women ≥28 weeks\\' gestation with singleton pregnancies presenting during one calendar year with maternal perception of RFM, all of whom underwent CTG at presentation. Main outcome measures included: obstetric intervention (induction of labour, spontaneous vaginal delivery, operative vaginal delivery, emergency caesarean section), and perinatal outcome (subsequent perinatal death, low Apgar scores (<7(5)), neonatal resuscitation and NICU admission). RESULTS: In all, 524 women presented with RFM and a live fetus, representing 7% of the antenatal obstetric population; 284 women (54%) were nulliparous. The reassuring CTG group comprised 482 (92%) women in whom initial CTG was reassuring and 15 (3%) where a repeat tracing within 1h was reassuring. The non-reassuring\\/abnormal CTG group (n=27, 5%) either underwent emergency delivery or comprehensive serial fetal assessment; this group had significantly higher rates of emergency caesarean delivery, neonatal resuscitation and NICU admission; the incidence of small-for-gestational-age infants did not differ significantly. No perinatal death occurred in either group following CTG. CONCLUSION: Normal non-stress CTG is a reliable screening indicator of fetal wellbeing in women presenting with perception of RFM in the third trimester; abnormal pregnancy outcomes were more common when initial CTG was abnormal or persistently non-reassuring.

  9. Análise Computadorizada da Cardiotocografia Anteparto em Gestações de Alto Risco Computerized Antepartum Cardiotocography Analysis in High Risk Pregnancies

    Directory of Open Access Journals (Sweden)

    Roseli Mieko Yamamoto Nomura

    2002-01-01

    Full Text Available Objetivos: analisar a freqüência dos resultados das cardiotocografias computadorizadas realizadas em gestantes de alto risco e relacionar o critério proposto pelo sistema com os resultados perinatais. Métodos: estudamos prospectivamente 233 gestantes de alto risco que realizaram 485 cardiotocografias computadorizadas. Foram excluídos casos de anomalias fetais e os exames com perda de sinal superior a 20% (proporção de episódios de 3,75 milissegundos do traçado onde não se constata intervalo de pulso por perda de captação dos sinais de batimentos cardíacos fetais. Para estudo da associação da cardiotocografia com os resultados perinatais, analisou-se o último exame realizado na semana anterior ao parto (71 casos, excluindo-se casos com diagnóstico de diástole zero ou reversa na dopplervelocimetria das artérias umbilicais. Resultados: após a exclusão de 33 exames com perda de sinal superior a 20%, constatou-se que 404 cardiotocografias foram caracterizadas como normais (83,3%. Quanto à duração do exame, em 62,1% foi de até 20 minutos e em 79,0% de até 30 minutos. A análise das correlações com os resultados perinatais demonstrou associação significativa (pPurpose: to study computerized cardiotocography performed in high-risk pregnancies, analyze the results, and correlate the criteria to perinatal results. Patients and Methods: two hundred and thirty-three high-risk pregnancies were studied prospectively, performing a total of 485 computerized cardiotocographies. The exclusion criteria included fetal anomalies and signal loss over 20% (proportion of 3.75-millisecond periods in which there were no valid pulse intervals. The perinatal results of 71 pregnancies were correlated to the last cardiotocography, performed at least seven days before birth, excluding patients with absent or reversed end diastolic velocities in the umbilical arteries. Results: thirty-three examinations with signal loss over 20% were excluded. The

  10. Efeitos da anemia materna na cardiotocografia computadorizada e perfil biofísico fetal Effects of maternal anemia on computerized cardiotocography and fetal biophysical profile

    Directory of Open Access Journals (Sweden)

    Roseli Mieko Yamamoto Nomura

    2009-12-01

    Full Text Available OBJETIVOS: avaliar a influência dos níveis de hemoglobina (Hb materna nos padrões da frequência cardíaca fetal (FCF e no perfil biofísico fetal (PBF em gestações a termo. MÉTODOS: gestantes portadoras de anemia (Hb11,0 g/dL. Foram excluídos casos com anomalias ou restrição do crescimento fetal. A avaliação da FCF foi realizada pela cardiotocografia computadorizada (Sistema8002-Sonicaid e análise do traçado com 30 minutos de exame. O PBF foi realizado em todas as pacientes. Foram utilizados os testes t de Student, teste do χ2 e teste exato de Fisher. O nível de significância utilizado foi de 0,05. RESULTADOS: A média da Hb materna no grupo com anemia (n=18 foi de 9,4 g/dL (DP=1,4 g/dL e no Grupo Controle 12,4 g/dL (DP=1,3 g/dL. Quanto aos parâmetros da cardiotocografia, não foi constatada diferença significativa nas médias entre os grupos com anemia e controle, respectivamente: FCF basal (131,3 bpm versus 133,7 bpm, p=0,5, acelerações da FCF > 10 bpm (7,9 versus. 8,2, p=0,866, acelerações da FCF > 15 bpm (5,2 versus 5,4, p=0,9, episódios de alta variação da FCF (17,1 versus 15,5 min, p=0,5, episódios de baixa variação da FCF (4,4 versus 3,6 min, p=0,6, e variação de curto prazo (10,5 versus 10,9 ms, p=0,5. Em ambos os grupos, todas as pacientes apresentaram PBF normal. CONCLUSÕES: este estudo sugere que a anemia materna leve ou moderada, sem outras comorbidades maternas ou fetais, não se associa a anormalidades nos parâmetros do perfil biofísico fetal e da FCF analisada pela cardiotocografia computadorizada.PURPOSES: to evaluate the influence of maternal hemoglobin (Hb levels in the patterns of fetal heart rate (FHR and in the fetal biophysical profile (FBP in term gestations. METHODS: pregnant women with anemia (Hb11,0 g/dL. Cases of anomalies or fetal growing restrictions were excluded. The FHR evaluation was performed by computerized cardiotocography (8002 System-Sonicaid, and by record analysis during

  11. Cardiotocografia computadorizada na avaliação da resposta cardíaca fetal à estimulação sônica Computerized cardiotocography analysis of fetal heart response to acoustic stimulation

    Directory of Open Access Journals (Sweden)

    Roseli Mieko Yamamoto Nomura

    2009-11-01

    Full Text Available OBJETIVO: estudar o efeito da estimulação sônica na resposta cardíaca fetal de acordo com os parâmetros fornecidos pela cardiotocografia computadorizada em gestações de baixo risco. MÉTODOS: foram incluídas 20 gestantes de baixo risco com os seguintes critérios de inclusão: idade materna superior a 18 anos; gestação única, feto vivo; idade gestacional entre 36 e 40 semanas; índice de líquido amniótico superior a 8,0 cm e ausência de malformações fetais. Foram excluídos os casos com diagnóstico pós-natal de anomalia fetal. A cardiotocografia computadorizada foi realizada por 20 minutos antes e depois da estimulação sônica fetal. Os resultados foram analisados pelo teste t para amostras dependentes, adotando-se o nível de significância de p10 bpm (6,5 versus 6,8, p=0,7; média de acelerações da FCF>15 bpm (3,8 versus 4,3, p=0,5; média da duração dos episódios de alta variação da FCF (11,4 versus 10,9 minutos, p=0,7; média da duração dos episódios de baixa variação da FCF (2,5 versus 1,1 minutos, p=0,2 e média da variação de curto prazo (10,6 versus 10,9 ms, p=0,6. CONCLUSÕES: em gestação de baixo risco, no termo, a cardiotocografia computadorizada não evidenciou diferenças nos parâmetros da FCF após a estimulação sônica fetal.PURPOSE: to study the effect of acoustic stimulation in the fetal cardiac response, according to parameters from computerized cardiotocography in low risk pregnancies. METHODS: twenty low risk pregnant women were included in the study, according to the following criteria: age over 18; single gestation, living fetus; gestational age between 36 and 40 weeks; amniotic liquid index over 8.0 cm and absence of fetal malformation. Cases with post-natal diagnosis of fetal anomaly were excluded. Computerized cardiotocography was performed for 20 minutes, before and after fetal acoustic stimulation. Results were analyzed by the t test for dependent samples, with significance level

  12. Evaluation and impact of cardiotocography training programmes

    DEFF Research Database (Denmark)

    Pehrson, Caroline; Sorensen, J. L.; Amer-Wåhlin, I.

    2011-01-01

    to decrease faster than theoretical knowledge. Author's conclusions: Training can improve CTG competence and clinical practise. Further research on CBT, test-enhanced learning and long-term retention, evaluation of training and impact on clinical outcomes is recommended. © 2011 The Authors BJOG...... of the existing literature on studies on CTG training in order to assess educational strategies, evaluation of training programmes, and impact of training programmes. Search strategy: The Medline database was searched to identify studies describing and/or evaluating CTG training programmes. The literature search...

  13. A qualitative dynamical model for cardiotocography simulation

    OpenAIRE

    Illanes, Alfredo; Haritopoulos, Michel; Robles, Felipe; Guerra, Francisco

    2015-01-01

    The purpose of this work is to present a new mathematical model for fetal monitoring simulation. It involves the simultaneous generation of fetal heart rate and maternal uterine contraction signals through a parametrical model. This model allows the generation of the main fetal monitoring dynamics including fetal movements, acceleration and deceleration of the heart rate and the dynami-cal adjustment of fetal heart rate following an uterine contraction. Simulated tracings were analyzed by spe...

  14. Cardiotocografia em gestações com diástole zero ou reversa nas artérias umbilicais: análise dos resultados perinatais Cardiotocography in pregnancies with absent or reversed end-diastolic velocity in the umbilical arteries: analisys of perinatal outcome

    Directory of Open Access Journals (Sweden)

    Roseli Mieko Yamamoto Nomura

    2003-01-01

    Full Text Available OBJETIVOS: Estudar, em gestações com diástole zero (DZ ou reversa (DR, dopplervelocimetria das artérias umbilicais os resultados perinatais de acordo com os parâmetros cardiotocográficos. MÉTODOS: Entre 1993 e 2000, foram selecionadas 127 gestantes com DZ ou DR. A classificação adotada para a cardiotocografia foi ativo (normal, hipoativo (suspeito e inativo (alterado Os parâmetros analisados foram: variabilidade da FCF, acelerações transitórias, DIP II, DIP umbilical, desaceleração prolongada e padrão pseudo sinusoidal. RESULTADOS: Houve associação (pOBJECTIVES: To study the correlation between cardiotocography parameters and perinatal outcome in pregnancies with absent or reversed end-diastolic velocity (AERDV in the umbilical arteries. METHODS: One hundred and twenty-seven cases presenting with AREDV followed between 1993 and 2000 were selected for analysis. The last cardiotocographic tracing performed on the day of delivery was reviewed and the following parameters were considered: magnitude of long-term variability, presence or absence of acceleration, late deceleration, variable deceleration, prolonged deceleration, pseudo sinusoidal pattern and the classification in normal, suspected and abnormal tracing. RESULTS: A significant (p<0.05 association was found between abnormal tracing and acidemia at birth (pH inferior to 7.20 with 71.9%, first minute Apgar score inferior to seven (73.4%, newborn intubation at delivery (64.1%, and early neonatal death (20.3%. The absence of acceleration was associated (p<0.05 to acidemia at birth (58.8%, first minute Apgar score inferior to seven (67.7%, newborn intubation at delivery (51% and neonatal death (29.4%. Low FHR variability (<5bpm was associated to (p<0.05: acidemia at birth (88.5%, newborn intubation at delivery (69.2%, early neonatal death (34.6% and neonatal death (42.3%. Late decelerations were significantly (p<0,05 related to acidemia at birth.(78.2%. The severe variable

  15. Cardiotocografia computadorizada em gestações complicadas pelo diabete melito pré-gestacional: padrões da freqüência cardíaca em fetos grandes para a idade gestacional Computerized cardiotocography in pregnancies complicated by pregestational diabetes mellitus: heart rate patterns in large for gestational age fetuses

    Directory of Open Access Journals (Sweden)

    Roseli Mieko Yamamoto Nomura

    2005-12-01

    analisados pela cardiotocografia tradicional na higidez fetal. Esse fato sugere a existência de padrões indicativos de melhor condição de oxigenação dos fetos menos comprometidos pelos efeitos do diabetes na gravidez.PURPOSE: to verify the fetal heart rate (FHR patterns of large for gestational age (LGA fetuses in pregnancies at term complicated by pregestational diabetes. METHODS: fetal surveillance was performed weekly in 64 fetuses of mothers with pregestational diabetes. Inclusion criteria were: diagnosis of pregestational diabetes mellitus, single pregnancy, alive fetus, absence of fetal anomalies, and computerized cardiotocography performed at the 37th week of gestation. Exclusion criteria included: postnatal diagnosis of fetal anomalies and delivery not performed at the local hospital. The FHR patterns were studied with computerized cardiotocography and the parameters were analyzed according to a fetal weight as LGA (birth weight above percentile 90. The cardiotocography parameters included: basal FHR, episodes of high variation, episodes of low variation, and short-term variation. RESULTS: forty-two patients fulfilled the proposed criteria. Ten (23.8% newborns were LGA. Normal criteria were met in all performed examinations. FHR accelerations (above 15 bpm were present in 7 (70% LGA cases and in 29 (90.6% non-LGA (p=0.135. Accelerations were more frequent in the non-LGA group (1.5±1.3 accelerations/10 min when compared to LGA group (0.8±0.9 accelerations/10min, p=0.04, Mann-Whitney test. The high variation episodes were detected in all cases. The mean FHR variation in these episodes was different in the LGA group (16.2±2.5 bpm when compared to the non-LGA group (19.7±4.2 bpm, p=0.02, Mann-Whitney test. CONCLUSION: the FHR patterns of non-LGA (higher frequency of accelerations and higher FHR variation in the high variation episodes reflect parameters commonly analyzed by traditional cardiotocography of a healthy fetus. This fact appears to confirm the

  16. CARDIOTOCOGRAPHY DURING LABOUR AND ITS RELATION WIT H NEONATAL OUTCOME

    Directory of Open Access Journals (Sweden)

    Verma

    2013-03-01

    Full Text Available CAPSULE: 120 cases of high risk as well as low risk pregnancy at term in labor were admitted in labor room of S.V.B.P Hospital (attached to L.L.R.M Medical College, Meerut. Continuous E.F.H.R.M was done by Hewlett Packard Cardio-tocogr aph and findings were correlated with neonatal outcome

  17. CARDIOTOCOGRAPHY DURING LABOUR AND ITS RELATION WIT H NEONATAL OUTCOME

    OpenAIRE

    Verma; Gupta

    2013-01-01

    CAPSULE: 120 cases of high risk as well as low risk pregnancy at term in labor were admitted in labor room of S.V.B.P Hospital (attached to L.L.R.M Medical College, Meerut). Continuous E.F.H.R.M was done by Hewlett Packard Cardio-tocogr aph and findings were correlated with neonatal outcome

  18. The success of cardiotocography in predicting perinatal outcome

    OpenAIRE

    Alpaslan Kaban; Hüseyin Cengiz; Işık Kaban; Alim Özcan; Sema KarakaşBakirköy Dr. Sadi Konuk Teaching and Research Hospital, Department of Gynecology and Obstetrics, Istanbul, Turkey

    2012-01-01

    Objectives: The determination of the fetal condition duringlabor is important to minimize fetal death due to asphyxiaand the neurological sequelae of fetal hypoxia.This study evaluated the success of fetal cardiotocographyin predicting perinatal consequences.Materials and methods: This study enrolled 101 full-termpregnant women admitted for delivery to Vakif GurebaTraining and Research Hospital between October 2009and February 2010. Women were included if they wereaged 18-45 years and within ...

  19. Reliability of cardiotocography in predicting baby's condition at birth.

    OpenAIRE

    Curzen, P.; Bekir, J S; McLintock, D G; Patel, M

    1984-01-01

    A prospective study of 6825 labours was undertaken to determine the relation between the Apgar scores of the babies at one minute and the cardiotocograph tracing in labour. The sensitivity of an abnormal tracing was 35.2% for babies who needed intermittent positive pressure ventilation and 20.0% for babies who did not but who had Apgar scores of less than 7. The sensitivity of an abnormal tracing for all babies with an Apgar score of less than 7 was 23.2%. The positive predictive value of an ...

  20. Continuous cardiotocography during labour: Analysis, classification and management.

    Science.gov (United States)

    Pinas, Ana; Chandraharan, Edwin

    2016-01-01

    The use of continuous intrapartum electronic fetal heart rate monitoring (EFM) using a cardiotocograph (CTG) was developed to enable obstetricians and midwives to analyse the changes of fetal heart rate during labour so as to institute timely intervention to avoid intrapartum hypoxic-ischaemic injury. Although CTG was initially developed as a screening tool to predict fetal hypoxia, its positive predictive value for intrapartum fetal hypoxia is approximately only 30%. Even though different international classifications have been developed with the aim of defining combinations of features that help predict intrapartum fetal hypoxia, the false-positive rate of the CTG is high (60%). Moreover, there has not been a demonstrable improvement in the rate of cerebral palsy or perinatal deaths since the introduction of CTG into clinical practice approximately 45 years ago. However, there has been a significant increase in intrapartum caesarean section and operative vaginal delivery rates. Unfortunately, existing guidelines employ the visual interpretation of CTG based on 'pattern recognition', which is fraught with inter- and intra-observer variability. Therefore, clinicians need to understand the physiology behind fetal heart rate changes and to respond to them accordingly, instead of purely relying on guidelines for management. It is very likely that such a 'physiology-based' approach would reduce unnecessary operative interventions and improve perinatal outcomes whilst reducing the need for 'additional tests' of fetal well-being. PMID:26165747

  1. Cardiotocography in a perinatal armamentarium: boon or bane?

    Directory of Open Access Journals (Sweden)

    Ambily Anu Xavier

    2015-12-01

    Conclusions: CTG should only be used as a screening tool for monitoring of foetal status during labour. It is worth remembering that normal CTG is more predictive of normal outcomes than abnormal CTG regarding abnormal outcomes. [Int J Reprod Contracept Obstet Gynecol 2015; 4(6.000: 2000-2004

  2. [Antepartum cardiotocography in high-risk pregnancies and its effect on perinatal morbidity and mortality].

    Science.gov (United States)

    Manterola Alvarez, A D; García Tagle, J; Calleja, L A; Rodríguez Flores, F; Alonso López, A G

    1987-04-01

    2635 prenatal cardiotocographic recordings were correlated with perinatal mortality in 1000 patients. In some cases, there were extenuating circumstances which, when combined with obstetrical intervention, resulted in an increase in mortality. These included congenital malformations, poor maternal conditions for surgery, a hypertensive crisis, and a delay in surgery. The correlated perinatal mortality was 9x1000. (author's modified)

  3. admission cardiotocography:its role predicting foetal outcome in high risk obstetric patients

    Directory of Open Access Journals (Sweden)

    Sudip Dutta

    2012-05-01

    Full Text Available AbstractBackground Routine and continuous electronic monitoring of foetal heart rate (FHR in labour has become an established obstetric practice in high-risk pregnancies in industrialised countries. However, the same may not be possible in non-industrialised countries where antenatal care is inadequate with a large number of high-risk pregnancies being delivered in crowded settings and inadequate health care provider to patient ratios. Aims The objective of this study was to evaluate the predictive value of the admission cardiotocogram (CTG in detecting foetal hypoxia at the time of admission in labour and to correlate the results of the admission CTG with the perinatal outcome in high-risk obstetric cases. Method This was a prospective observational study conducted in the labour and maternity ward of a hospital in Gangtok, India, during the period 2008 to 2010. The study included high-risk pregnant women, admitted via the emergency or outpatient department with a period of gestation ≥36 weeks, in first stage of labour with foetus in the cephalic presentation. All women were subjected to an admission CTG, which included a 20 minute recording of FHR and uterine contractions. Results One hundred and sixty patients were recruited. The majority of women were primigravida in the 21-30 years age group. About 42% patients were postdated pregnancy followed by pregnancy-induced hypertension (PIH (15.6% and premature rupture of membranes (PROM (11.3% as the major risk factors. The admission CTG were ‘reactive’ in 77%, ‘equivocal’ in 14.4% and ‘ominous’ in 8.7% women. Incidence of foetal distress, moderate-thick meconium stained liquor and neonatal intensive care unit (NICU admission was significantly more frequent among patients with ominous test results compared with equivocal or reactive test results on admission. Incidence of vaginal delivery was more common when the test was reactive. Conclusion The admission CTG appears to be a simple non-invasive test that can serve as a screening tool in ‘triaging’ foetuses of high-risk obstetric patients in non-industrialised countries with a heavy workload and limited resources.

  4. Unstressed antepartum cardiotocography in the management of the fetus suspected of growth retardation.

    Science.gov (United States)

    Flynn, Anna M; Kelly, J; O'Conor, M

    2014-12-01

    A detailed analysis of the antenatal cardiotocographs (CTGs) in 57 patients with suspected fetal growth retardation is presented. Four traces were normal and 53 were 'non-reactive. 'Non-reactive' traces can be sub-divided into three categories, which, in order of severity are, 'suspect', 'flat' and 'ominous'. When compared with the 'suspect' group, perinatal mortality was significantly increased and the Apgar scores at one and five minutes significantly decreased in the 'flat' and 'ominous' groups. The presence of fetal distress in labour was significantly higher in the 'flat' group as compared with the 'suspect' group. Intrauterine deaths occurred only in the 'ominous' group. With experience, ten patients later in the series with 'ominous' patterns were delivered within 24 hours of the detection of such and nine infants survived. At follow-up between 6 and 34 months after birth, psychomotor development was normal in 47 of the 49 surviving infants. PMID:25488082

  5. Can Intrapartum Cardiotocography Predict Uterine Rupture among Women with Prior Caesarean Delivery?: A Population Based Case-Control Study.

    Directory of Open Access Journals (Sweden)

    Malene M Andersen

    Full Text Available To compare cardiotocographic abnormalities recorded during labour in women with prior caesarean delivery (CD and complete uterine rupture with those recorded in controls with prior CD without uterine rupture.Women with complete uterine rupture during labour between 1997 and 2008 were identified in the Danish Medical Birth Registry (n = 181. Cases were validated by review of medical records and 53 cases with prior CD, trial of labour, available cardiotocogram (CTG and complete uterine rupture were included and compared with 43 controls with prior CD, trial of labour and available CTG. The CTG tracings were assessed by 19 independent experts divided into groups of three different experts for each tracing. The assessors were blinded to group, outcome and clinical data. They analyzed occurrence of defined abnormalities and classified the traces as normal, suspicious, pathological or pre-terminal according to international guidelines (FIGO.A pathological CTG during the first stage of labour was present in 77% of cases and in 53% of the controls (OR 2.58 [CI: 0.96-6.94] P = 0.066. Fetal tachycardia was more frequent in cases with uterine rupture (OR 2.50 [CI: 1.0-6.26] P = 0.053. Significantly more cases showed more than 10 severe variable decelerations compared with controls (OR 22 [CI: 1.54-314.2] P = 0.022. Uterine tachysystole was not correlated with the presence of uterine rupture.A pathological cardiotocogram should lead to particular attention on threatening uterine rupture but cannot be considered a strong predictor as it is common in all women with trial of labour after caesarean delivery.

  6. ST waveform analysis vs. cardiotocography alone for intrapartum fetal monitoring: A systematic review and meta-analysis of randomized trials

    OpenAIRE

    Blix, Ellen; Brurberg, Kjetil Gundro; Reierth, Eirik; Reinar, Liv Merete; Øian, Pål

    2015-01-01

    Key message: ST waveform analysis is purposed to be better for labor surveillance than conventional CTG. We quantified the efficacy of these two methods, assessing quality of the scientific evidence with the GRADE tool, and determined that evidence is insufficient to justify the use of ST waveform analysis as intrapartum monitoring.

  7. Efeitos da anemia materna na cardiotocografia computadorizada e perfil biofísico fetal Effects of maternal anemia on computerized cardiotocography and fetal biophysical profile

    OpenAIRE

    Roseli Mieko Yamamoto Nomura; Marina Caldana Gordon; Giancarlo Fatobene; Ana Maria Kondo Igai; Marcelo Zugaib

    2009-01-01

    OBJETIVOS: avaliar a influência dos níveis de hemoglobina (Hb) materna nos padrões da frequência cardíaca fetal (FCF) e no perfil biofísico fetal (PBF) em gestações a termo. MÉTODOS: gestantes portadoras de anemia (Hb11,0 g/dL). Foram excluídos casos com anomalias ou restrição do crescimento fetal. A avaliação da FCF foi realizada pela cardiotocografia computadorizada (Sistema8002-Sonicaid) e análise do traçado com 30 minutos de exame. O PBF foi realizado em todas as pacientes. Foram utilizad...

  8. Studies to evaluate radioimmunoassay of the placental hormones HPL and estriol, and cardiotocography induding the oxytocin tolerance test for early diagnosis of placental insufficiency

    International Nuclear Information System (INIS)

    The diagnostic methods studied here for early recognition of placental deficiency have justifiably been adopted in obstetrics. A determination of estriol and Human-Placenta-Lactogen gives an indication of an approaching threat to the fetus even at an early stage of pregnancy. The results from E3 and HPL have the same medical significance. The oxytocin tolerance test is the only single method for forecasting placental insufficiency. However a combination of all methods is preferable. (orig./MG)

  9. Análise Computadorizada da Cardiotocografia Anteparto em Gestações de Alto Risco Computerized Antepartum Cardiotocography Analysis in High Risk Pregnancies

    OpenAIRE

    Roseli Mieko Yamamoto Nomura; Rossana Pulcineli Vieira Francisco; Débora Simões Steinman; Seizo Miyadahira; Marcelo Zugaib

    2002-01-01

    Objetivos: analisar a freqüência dos resultados das cardiotocografias computadorizadas realizadas em gestantes de alto risco e relacionar o critério proposto pelo sistema com os resultados perinatais. Métodos: estudamos prospectivamente 233 gestantes de alto risco que realizaram 485 cardiotocografias computadorizadas. Foram excluídos casos de anomalias fetais e os exames com perda de sinal superior a 20% (proporção de episódios de 3,75 milissegundos do traçado onde não se constata intervalo d...

  10. AN OVERVIEW OF RESEARCH CHALLENGES FOR CLASSIFICATION OF CARDIOTOCOGRAM DATA

    OpenAIRE

    C. Sundar; M. Chitradevi; G. Geetharamani

    2013-01-01

    Cardiotocography (CTG) is a simultaneous recording of Fetal Heart Rate (FHR) and Uterine Contractions (UC). The most common diagnostic techniques to evaluate maternal and fetal well-being during pregnancy and before delivery. By observing the Cardiotocography trace patterns doctors can understand the state of the fetus. There are several signal processing and computer programming based techniques for interpreting a typical Cardiotocography data. A model based CTG data classification system us...

  11. Cardiotocografia computadorizada na avaliação da resposta cardíaca fetal à estimulação sônica Computerized cardiotocography analysis of fetal heart response to acoustic stimulation

    OpenAIRE

    Roseli Mieko Yamamoto Nomura; Clarice Kwon; Seizo Miyadahira; Marcelo Zugaib

    2009-01-01

    OBJETIVO: estudar o efeito da estimulação sônica na resposta cardíaca fetal de acordo com os parâmetros fornecidos pela cardiotocografia computadorizada em gestações de baixo risco. MÉTODOS: foram incluídas 20 gestantes de baixo risco com os seguintes critérios de inclusão: idade materna superior a 18 anos; gestação única, feto vivo; idade gestacional entre 36 e 40 semanas; índice de líquido amniótico superior a 8,0 cm e ausência de malformações fetais. Foram excluídos os casos com diagnóstic...

  12. Foetal heart rate recording: analysis and comparison of different methodologies

    OpenAIRE

    Ruffo, Mariano

    2011-01-01

    Monitoring foetal health is a very important task in clinical practice to appropriately plan pregnancy management and delivery. In the third trimester of pregnancy, ultrasound cardiotocography is the most employed diagnostic technique: foetal heart rate and uterine contractions signals are simultaneously recorded and analysed in order to ascertain foetal health. Because ultrasound cardiotocography interpretation still lacks of complete reliability, new parameters and methods of interpreta...

  13. Pohled rodiček na kardiotokografické monitorování plodu v průběhu porodu

    OpenAIRE

    PAPÍRNÍKOVÁ, Petra

    2009-01-01

    Cardiotocography is a noninvasive method providing information on the condition of the fetus during pregnancy and childbirth. Fetal monitoring has become standard in obstetric care for pregnant women and mothers. The procedures recommended by the Czech Gynecological-Obstetrical Society determine indications of the use of cardiotocography and state rules of how to interpret the results of the method. During physiological childbirth the mother can be observed intermittently, i.e. at regular int...

  14. Sensibilidade e especificidade da oximetria fetal de pulso e da cardiotocografia durante o parto: comparação entre os métodos no prognóstico de recém-nascidos Acidóticos Sensitivity and specificity of fetal pulse oximetry and cardiotocography during labor: comparison of both methods regarding prognosis of acidotic newborns

    Directory of Open Access Journals (Sweden)

    Edson Nunes de Morais

    1999-07-01

    Full Text Available Objetivo: estudar a sensibilidade e a especificidade dos valores de saturação de oxigênio fetal (SpO2 e padrões da freqüência cardíaca fetal (FCF durante o parto, no prognóstico de fetos acidóticos ao nascimento. Pacientes e Métodos: os valores fetais de SpO2 foram obtidos pela técnica da oximetria de pulso. Um valor de SpO2 > ou = 30% foi considerado normal, e 10 minutos no intervalo entre contrações, foi considerado anormal. A SpO2 fetal e os traçados de FCF foram obtidos continuamente no primeiro e segundo períodos do parto. A classificação utilizada para a FCF foi a do NICHD19. Resultados: um total de 72 casos foram estudados. A sensibilidade e especificidade com base na SpO2 fetal foram respectivamente de 61,5% e 96,6%, ao passo que a sensibilidade e especificidade baseadas nos padrões de FCF foram respectivamente 69,2% e 66,1%. Os valores preditivos positivo e negativo em função da SpO2 fetal foram respectivamente 80% e 91,9%; em função dos padrões de FCF foram respectivamente 31% e 90,7%. Conclusões: uma boa especificidade da SpO2 para o prognóstico de recém-nascidos acidóticos foi encontrada, se comparada com a especificidade dos padrões de FCF, ao passo que a sensibilidade foi relativamente baixa para os dois métodos. Entretanto, o número de fetos acidóticos é muito pequeno para conclusões.Purpose: to study the sensitivity and specificity based on fetal oxygen saturation (SpO2 values and fetal heart rate (FHR patterns during labor, for the prognosis of acidotic fetuses at birth. Patients and Methods: SpO2 values were obtained by fetal pulse oximetry technique. A fetal SpO2 value > or = 30% was considered normal, and an SpO2 which remained <30.0% for more than 10 min between contractions was considered abnormal. Fetal SpO2 and FHR tracings were obtained during the first and second stage of labor. FHR classification used in the study has been derived from the National Institute of Child Health and Human Development19. Results: a total of 72 subjects were studied. The sensitivity and specificity, based on SpO2, were 61.5% and 96.6%, respectively, whereas the sensitivity and specificity based on FHR patterns were 69.2% and 66.1%. Positive and negative predictive values based on SpO2 were 80% and 91.9%, respectively, and based on FHR patterns were 31% and 90.7%, respectively. Conclusions: a good fetal SpO2 specificity for prognosis of acidotic fetuses at birth was found, if compared with FHR pattern specificity, whereas sensitivity was poor for both methods. However, the number of acidotic fetuses was too small to allow more conclusions

  15. Cardiotocografia computadorizada em gestações complicadas pelo diabete melito pré-gestacional: padrões da freqüência cardíaca em fetos grandes para a idade gestacional Computerized cardiotocography in pregnancies complicated by pregestational diabetes mellitus: heart rate patterns in large for gestational age fetuses

    OpenAIRE

    Roseli Mieko Yamamoto Nomura; Verbênia Nunes Costa; Kathia Sakamoto; Carlos Alberto Maganha; Seizo Miyadahira; Marcelo Zugaib

    2005-01-01

    OBJETIVO: verificar os padrões da freqüência cardíaca de fetos grandes para a idade gestacional (GIG), em gestantes com diabete melito pré-gestacional. MÉTODOS: sessenta e quatro gestantes diabéticas pré-gestacionais foram avaliadas semanalmente quanto à vitalidade fetal. Os critérios de inclusão foram: diagnóstico pré-gestacional de diabetes melito, gestação única, feto vivo, ausência de anomalia fetal e cardiotocografia computadorizada realizada na 37ª semana. Os critérios de exclusão foram...

  16. Cardiotocografia em gestações com diástole zero ou reversa nas artérias umbilicais: análise dos resultados perinatais Cardiotocography in pregnancies with absent or reversed end-diastolic velocity in the umbilical arteries: analisys of perinatal outcome

    OpenAIRE

    Roseli Mieko Yamamoto Nomura; Rossana Pulcineli Vieira Francisco; Seizo Miyadahira; Marcelo Zugaib

    2003-01-01

    OBJETIVOS: Estudar, em gestações com diástole zero (DZ) ou reversa (DR), dopplervelocimetria das artérias umbilicais os resultados perinatais de acordo com os parâmetros cardiotocográficos. MÉTODOS: Entre 1993 e 2000, foram selecionadas 127 gestantes com DZ ou DR. A classificação adotada para a cardiotocografia foi ativo (normal), hipoativo (suspeito) e inativo (alterado) Os parâmetros analisados foram: variabilidade da FCF, acelerações transitórias, DIP II, DIP umbilical, desaceleração prolo...

  17. Diagnostic efficacy of biophysical tests and cerebral-umbilical index when assessing fetal oxygenation

    Directory of Open Access Journals (Sweden)

    Čančarević-Đajić Branka

    2013-01-01

    Full Text Available Introduction. Perinatal morbidity and mortality are the ultimate indicators of antenatal care today, whose responsible task is to assess the respiratory function of the placenta, fetal growth and placental maturation in order to provide conditions for the delivery of a living and viable newborn. The diagnostic procedures of antenatal care tested within this study were the biophysical tests of cardiotocography and the fetal biophysical profile, along with the colour doppler evaluation of the cerebral-umbilical ratio. The objective of this study was to determine the most effective diagnostic procedure when assessing fetal oxygenation. Materials and Methods. The prospective study included 119 pregnant women. They all underwent cardiotocography, biophysical profile and colour doppler evaluation of the cerebral-umbilical ratio. The babies’ umbilical artery blood pH was determined in the first minute upon birth, along with the Apgar score. Results. The results were processed statistically and the most effective diagnostic procedure for the evaluation of fetal oxygenation was selected, after which the rates of perinatal morbidity and mortality were calculated. The findings revealed that cardiotocography was the most sensitive antepartal predictor of fetal acidosis, while the fetal biophysical profile proved the most specific. The rates of perinatal morbidity and of perinatal mortality were 24.37% and 1.68%, respectively. Conclusion. The findings analysis revealed a high statistical significance of both biophysical tests and the cerebral-umbilical ratio evaluation as predictors of the fetal distress syndrome. The analysis of the cerebral-umbilical ratio and biophysical tests showed that the cerebral-umbilical ratio evaluation not only was more sensitive as a parameter compared to biophysical tests but it was also more specific than cardiotocography. Cardiotocography is the most sensitive antepartal predictor of fetal acidosis, followed by the cerebral

  18. Fetal scalp blood sampling during labor

    DEFF Research Database (Denmark)

    Chandraharan, Edwin; Wiberg, Nana

    2014-01-01

    Fetal cardiotocography is characterized by low specificity; therefore, in an attempt to ensure fetal well-being, fetal scalp blood sampling has been recommended by most obstetric societies in the case of a non-reassuring cardiotocography. The scientific agreement on the evidence for using fetal...... and Clinical Excellence guideline considers that fetal scalp blood sampling decreases instrumental delivery without differences in other outcome variables. The fetal scalp is supplied by vessels outside the skull below the level of the cranial vault, which is likely to be compressed during contractions...

  19. Fetal scalp blood sampling in labor - a review

    DEFF Research Database (Denmark)

    Jørgensen, Jan Stener; Weber, Tom

    2014-01-01

    surveillance methods and data from the Danish National Birth Registry, we have assessed the usefulness of FBS as a complementary tool to improve the specificity and sensitivity of electronic cardiotocography (CTG). Based on heterogeneous studies of modest quality with somewhat inconsistent results, we conclude...

  20. Expert systems for fetal assessment in labour

    NARCIS (Netherlands)

    Lutomski, J.E.; Meaney, S.; Greene, R.A.; Ryan, A.C.; Devane, D.

    2015-01-01

    BACKGROUND: Cardiotocography (CTG) records the fetal heart rate in relation to maternal uterine contractions and is one of the most common forms of fetal assessment during labour. Despite guidelines for CTG interpretation, substantial inter- and intra-observer variation in interpretation has been re

  1. Cimetidine as pre-anesthetic agent for cesarean section

    DEFF Research Database (Denmark)

    Qvist, N; Storm, K; Holmskov, A

    1985-01-01

    In a prospective randomized study of 39 consecutive cesarean sections, 20 patients received cimetidine 400 mg intramuscularly as a pre-anesthetic, an 19 control patients were given NaCl. No perinatal effects on the infants were observed by cardiotocography before delivery, and K, Na, pH, PCO2, HCO...

  2. 胎心电子监护国外指南解读

    Institute of Scientific and Technical Information of China (English)

    姚强; 刘兴会

    2010-01-01

    @@ 胎心电子监护(electronic fetal monitoring, EFM)亦称为胎心宫缩描记图(cardiotocography, CTG),包括无应激试验(non-stress test, NST)及宫缩应激试验(contraction stress test, CST).

  3. The assessment of fetus in distress using MRI and 1H MRS - based on performed observation

    International Nuclear Information System (INIS)

    Hypoxia is one of the basic factor that cause lesions and intrauterine fetus' death. This is why the recognition of early changes before the appearance of irreversible damages should be the main aim of the assessment and monitoring of a fetus. Apart from the methods of the assessment of a fetus' state that have been applied so far, a new non-invasive imaging technique in obstetrics as MR has appeared. This method makes it possible to assess morphologic structures of a brain, and metabolic processes with use of magnetic resonance spectroscopy (MRS). The study was carried out in 20 pregnant women with pregnancy-induced hypertension (11 cases), chronic hypertension (2 cases), gestational diabetes (6 cases) and IUGR (6 cases). The cardiotocography color Doppler flow assessment of umbilical artery and medial cerebral artery were performed. In cases of abnormal cardiotocography, and Doppler examinations suggested ischemic lesions 5 cases of focal ischemic areas in MR and 6 abnormal MRS spectra were demonstrated. (author)

  4. Symbolic Dynamics Analysis: a new methodology for foetal heart rate variability analysis

    OpenAIRE

    Improta, Giovanni

    2015-01-01

    Cardiotocography (CTG) is a widespread foetal diagnostic methods. However, it lacks of objectivity and reproducibility since its dependence on observer's expertise. To overcome these limitations, more objective methods for CTG interpretation have been proposed. In particular, many developed techniques aim to assess the foetal heart rate variability (FHRV). Among them, some methodologies from nonlinear systems theory have been applied to the study of FHRV. All the techniques have proved to be ...

  5. Retrospektive Analyse von pränatalen Dopplerparametern und des Oxford-CTGs bei Feten mit Intrauteriner Wachstumsrestriktion hinsichtlich der postnatalen Mortalität und der neurologischen Entwicklung

    OpenAIRE

    Lehmann, Henriette

    2016-01-01

    Objective: We evaluated the relationship between doppler findings of the umbilical artery (UA), the middle cerebral artery (MCA) and the Ductus venosus (DV) as well as the Short-term variation (STV) of the Oxford-cardiotocography (-CTG) of fetuses with a Intrauterine Growth Restriction (IUGR) and the postnatal mortality together with the neurodevelopment of the children after one and two years of age. Methods: This was a retrospective cohort-study of 176 live born singeltons characterised ...

  6. Protocol for a randomised controlled trial of fetal scalp blood lactate measurement to reduce caesarean sections during labour: the Flamingo trial [ACTRN12611000172909

    OpenAIRE

    East, Christine E.; Stefan C. Kane; Davey, Mary-Ann; Kamlin, C. Omar; Brennecke, Shaun P.; ,

    2015-01-01

    Background The rate of caesarean sections around the world is rising each year, reaching epidemic proportions. Although many caesarean sections are performed for concerns about fetal welfare on the basis of abnormal cardiotocography, the majority of babies are shown to be well at birth, meaning that the operation, with its inherent short and long term risks, could have been avoided without compromising the baby’s health. Previously, fetal scalp blood sampling for pH estimation was performed i...

  7. Prospective Risk of Intrauterine Death of Monochorionic-Diamniotic Twins

    OpenAIRE

    Simões, T; Amaral, N; Lerman, R; Ribeiro, F; Dias, E; Blickstein, I

    2006-01-01

    OBJECTIVE: The purpose of this study was to calculate the prospective risk of fetal death in monochorionic-diamniotic twins. STUDY DESIGN: We evaluated 193 monochorionic diamniotic twin pregnancies that were followed and delivered after 24 weeks. Surveillance included cardiotocography and sonography performed at least once weekly. The prospective risk of fetal death was calculated as the total number of deaths at the beginning of the gestational period divided by the number of continuing ...

  8. Reducing risk by improving standards of intrapartum fetal care

    OpenAIRE

    Young, Peter; Hamilton, Rosie; Hodgett, Sheena; Moss, Mary; Rigby, Claire; Jones, Peter; Johanson, Richard

    2001-01-01

    Confidential Enquiries into Stillbirths and Deaths in Infancy (CESDI) have pointed to a high frequency of suboptimal intrapartum fetal care of a kind that, in the event of an adverse outcome, is hard to defend in court. In an effort to minimize liability, various strategies were applied in a district hospital labour ward—guidelines, cyclical audit, monthly feedback meetings and training sessions in cardiotocography (CTG). The effects of these interventions on quality o...

  9. Intelligent Structured Intermittent Auscultation (ISIA): evaluation of a decision-making framework for fetal heart monitoring of low-risk women

    OpenAIRE

    Maude, Robyn M; Skinner, Joan P; Foureur, Maralyn J

    2014-01-01

    Background Research-informed fetal monitoring guidelines recommend intermittent auscultation (IA) for fetal heart monitoring for low-risk women. However, the use of cardiotocography (CTG) continues to dominate many institutional maternity settings. Methods A mixed methods intervention study with before and after measurement was undertaken in one secondary level health service to facilitate the implementation of an initiative to encourage the use of IA. The intervention initiative was a decisi...

  10. Umbilical Cord Segmental Hemorrhage and Fetal Distress

    OpenAIRE

    Larciprete, Giovanni; Romanini, Maria Elisabetta; Arduini, Domenico; Cirese, Elio; Slowikowska-Hilczer, Jolanta; Kula, Krzysztof

    2006-01-01

    We describe an unexplained case of umbilical cord segmental hemorrhage linked with meconium-stained amniotic fluid. A severely asphyxiated infant was delivered at term by Caesarean section. There were poor prognostic signs on fetal cardiotocography with rupture of membranes with meconium-stained amniotic fluid. The pathophysiologic mechanism in this case is still unknown, even if we argued a possible role of the umbilical cord shortness.

  11. Application of ultrasound echography and magnetic resonance imaging to diagnosis of fetoplacental insufficiency

    International Nuclear Information System (INIS)

    Eighty pregnant women underwent complex clinico laboratory investigation, of them 20 with normal gestation cause (the controls) and 60 with iron deficiency anemia of different degree. The function of fetoplacental complex was evaluated with ultrasound echography, cardiotocography, MRI, ultrasound placentography. Iron deficiency anemia in pregnant is accompanied by development of fetoplacental insufficiency. To diagnose the latter it is necessary to use ultrasound echography and MRI

  12. Detecting Fetal Movements Using Non-Invasive Accelerometers: A Preliminary Analysis

    OpenAIRE

    Girier, T.; O'Toole, J; Mesbah, M.; Boashash, B.; Clough, I.; Wilson, S; Fuentes, M; Callan, S.; East, C; COLDITZ, P

    2010-01-01

    Monitoring fetal movement is important to assess fetal health. Standard clinical fetal monitoring technologies include ultrasound imaging and cardiotocography. Both have limited prognostic value and require significant health resources. We have recently developed a low-cost, passive, non-invasive system to monitor fetal activity, and therefore fetal health. This accelerometer-based system does not require trained operators and can be used outside a clinic. This work is a preliminary study to ...

  13. Intrauterine Extremity Gangrene and Cerebral Infarction at Term: A Case Report

    OpenAIRE

    G. Zachariassen; Nybo, M.; J. S. Jørgensen; Tanvig, M.

    2011-01-01

    Intrauterine extremity gangrene in combination with cerebral infarction is a serious and rare event. We present a case with a healthy mother who gave birth to a child with this condition. At term, the mother presented at the antenatal clinic with decreased fetal movements. Cardiotocography (CTG) showed signs of fetal distress and a caesarean section was performed. The left arm of the newborn was found gangrenous. Amputation of the arm was necessary and the child was subsequently treated with ...

  14. Fetal electrocardiogram: ST waveform analysis in intrapartum surveillance

    OpenAIRE

    Amer-Wahlin, I; Arulkumaran, S; Hagberg, H.; Maršál, K; Visser, GHA

    2007-01-01

    ST waveform analysis of fetal electrocardiogram (ECG) for intrapartum surveillance (STAN) is a newly introduced method for fetal surveillance. The purpose of this commentary is to assist in the proper use of fetal ECG in combination with cardiotocography (CTG) during labour. Guidelines and recommendations concerning CTG and ST waveform interpretation and classification are stated that were agreed on by the European experts on ST waveform analysis for intrapartum surveillance during a meeting ...

  15. Diagnostic and prognostic value of analysis of heart rhythm variability in pregnant patients under estimation of fetal hypoxia evidence

    OpenAIRE

    Piskunova L.V.; Chekhonatskaya M.L; Arenina N.Yu.

    2010-01-01

    The correlation between fetal hypoxia degrees according to the data of cardiotocography and status of mother's vegetative nervous system as a result of heart rhythm variability research have been analyzed. It has been revealed that during the increase of fetal hypoxia severity, mother has observed activation of sympathetic section of vegetative nervous system, which has changed by vagotonia in severe and terminal states. These findings can be used both for indirect estimation of fetal hy...

  16. Diagnostic efficacy of biophysical tests and cerebral-umbilical index when assessing fetal oxygenation

    OpenAIRE

    Čančarević-Đajić Branka; Vilendečić Rade

    2013-01-01

    Introduction. Perinatal morbidity and mortality are the ultimate indicators of antenatal care today, whose responsible task is to assess the respiratory function of the placenta, fetal growth and placental maturation in order to provide conditions for the delivery of a living and viable newborn. The diagnostic procedures of antenatal care tested within this study were the biophysical tests of cardiotocography and the fetal biophysical profile, along with the colour doppler evaluation of...

  17. Utility of Intraoperative Fetal Heart Rate Monitoring for Cerebral Arteriovenous Malformation Surgery during Pregnancy

    OpenAIRE

    FUKUDA, Kenji; MASUOKA, Jun; TAKADA, Shigeki; Katsuragi, Shinji; Ikeda, Tomoaki; IIHARA, Koji

    2014-01-01

    We report two methods of intraoperative fetal heart rate (FHR) monitoring in cases of cerebral arteriovenous malformation surgery during pregnancy. In one case in her third trimester, cardiotocography was used. In another case in her second trimester, ultrasound sonography was used, with a transesophageal echo probe attached to her lower abdomen. Especially, the transesophageal echo probe was useful because of the advantages of being flexible and easy to attach to the mother's lower abdomen c...

  18. Zmiany morfologii odcinka ST bezpośredniego elektrokardiogramu płodowego i ich wpływ na stężenia aminotransferazy asparaginianowej i alaninowej u rodzących w wieku powyżej 30 lat z ciążą powikłaną cukrzycą

    OpenAIRE

    Agnieszka Kubiak-Fortecka; Jan Wilczyński

    2010-01-01

    New technical and technological possibilities, which have recently appeared, led to an increase in the interest in thefoetal electrocardiography. Thanks to the construction of special electrodes, the method of direct electrocardiography wasimplemented into general use in the intrapartum supervision of the condition of the foetus. The analysis of the directfoetal electrocardiograms may turn out to be a more precise diagnostic method with a greater prediction value than cardiotocography when it...

  19. ANTENATALNI TESTOVI I ISHODI TRUDNOĆA S TEŠKIM ZASTOJEM FETALNOG RASTA KOJE SU PRIJEVREMENO DOVRŠENE ELEKTIVNIM CARSKIM REZOM – ISKUSTVA OPĆE BOLNICE PULA

    OpenAIRE

    Belci, Dragan; Zoričić, Davor; Perkov, Tomislav; Milevoj-Ražem, Mirna; Žužek, Adele; Rogulj, Gracijela; Ravnić-Bunčić, Tatjana; Slivar, Anđelo; Grdinić, Ivan; Gattoni-Stepanov, Elena

    2008-01-01

    Antenatal tests determining fetal growth are performed in order to recognize intrauterine growth restriction (IUGR) and find early signs of fetal compensatory mechanisms failure. Cardiotocography (non-stress and stress test), doppler measurements of fetal and placentar circulation and the fetal biophysical profile are presently used for this purpose. They should scan fetuses with risk for a bad pregnancy outcome. A severe IUGR can occur due to several reasons, but it is most commonly caused b...

  20. Intrapartum fetal monitoring by ST-analysis of the fetal ECG

    OpenAIRE

    Westerhuis, M.E.M.H.

    2010-01-01

    Objective Intrapartum fetal monitoring aims to identify fetuses at risk for neonatal and long-term injury due to asphyxia. To serve this purpose, cardiotocography (CTG) combined with ST-analysis of the fetal electrocardiogram (ECG), which is a relatively new method, may be used. The main aim of this thesis was to quantify the (cost) effectiveness of intrapartum fetal monitoring by ST-analysis of the fetal ECG in women with a singleton term pregnancy in cephalic position. Methods Several studi...

  1. Doppler Findings in Intrapartum Fetal Distress

    OpenAIRE

    Khatereh Tooba; Laleh Eslamian

    2011-01-01

    The umbilical vein (UV) has a non pulsating and even pattern in normal fetuses. Pulsation of UV has been described in severely growth restricted fetuses with chronic hypoxia. We wanted to see whether UV pulsations could also be seen in fetuses with heart deceleration during labor, as an adjunctive measure to assess the intra partum hypoxia. In a prospective study Doppler examination was performed on 34 fetuses with normal cardiotocography (CGT) and 26 fetuses with abnormal CTGs (GA>37w and ce...

  2. Sequential Total Variation Denoising for the Extraction of Fetal ECG from Single-Channel Maternal Abdominal ECG

    OpenAIRE

    Kwang Jin Lee; Boreom Lee

    2016-01-01

    Fetal heart rate (FHR) is an important determinant of fetal health. Cardiotocography (CTG) is widely used for measuring the FHR in the clinical field. However, fetal movement and blood flow through the maternal blood vessels can critically influence Doppler ultrasound signals. Moreover, CTG is not suitable for long-term monitoring. Therefore, researchers have been developing algorithms to estimate the FHR using electrocardiograms (ECGs) from the abdomen of pregnant women. However, separating ...

  3. Intracerebral regional distribution of blood flow in response to uterine contractions in growth-restricted human fetuses.

    OpenAIRE

    Fu, Jing; Olofsson, Per

    2007-01-01

    Objective: To explore middle cerebral artery (MCA) and anterior cerebral artery (ACA) blood flow responses to superimposed acute hypoxemia in growth -restricted fetuses with and without established brain-sparing flow during basal conditions. Material and methods: 47 term fetuses suspected of growth restriction were exposed to an oxytocin challenge test with simultaneous cardiotocography and Doppler velocimetry in the umbilical artery, MCA and ACA. The MCA-to-ACA pulsatility index (PI) ratio w...

  4. PREDICTIVE VALUE OF CTG IN POST-DATED PREGNANCY

    Directory of Open Access Journals (Sweden)

    Suganthi

    2016-05-01

    Full Text Available AIM This study evaluates the usefulness of intrapartum cardiotocography in patients with post-dated pregnancy compared to intermittent auscultation. MATERIALS AND METHODS 100 patients with pregnancies beyond EDD and with no other risk factors were included in the study; 50 patients who underwent CTG on admission into labour ward formed the study group and 50 patients who underwent intermittent auscultation formed the control group. Antenatal foetal monitoring namely daily foetal movement count, twice-weekly non-stress test with amniotic fluid assessment and Doppler velocimetry using ultrasound were done in all patients until the onset of labour. Labour was induced whenever NST was non-reassuring or ultrasound showed oligohydramnios. Partogram was used to monitor the course of labour. RESULTS The foetal outcome was better in the study group than in the control group with fewer depressed babies. Cardiotocography had a positive predictive value of 36 36% and a negative predictive value of 94.04% with a P value of 0.010. CONCLUSION Cardiotocography is definitely superior to intermittent auscultation in intrapartum foetal monitoring. Despite the high number of false positives, CTG predicts the outcome of labour in every patient and especially in cases with prolonged pregnancy it serves as a valuable screening tool to pick up those cases that may be compromised by the events of labour.

  5. AN OVERVIEW OF RESEARCH CHALLENGES FOR CLASSIFICATION OF CARDIOTOCOGRAM DATA

    Directory of Open Access Journals (Sweden)

    C. Sundar

    2013-01-01

    Full Text Available Cardiotocography (CTG is a simultaneous recording of Fetal Heart Rate (FHR and Uterine Contractions (UC. The most common diagnostic techniques to evaluate maternal and fetal well-being during pregnancy and before delivery. By observing the Cardiotocography trace patterns doctors can understand the state of the fetus. There are several signal processing and computer programming based techniques for interpreting a typical Cardiotocography data. A model based CTG data classification system using a supervised Artificial Neural Network (ANN which can classify the CTG data based on its training data. The performance neural network based classification model has been compared with the most commonly used unsupervised clustering methods Fuzzy C-mean and k-mean clustering. The arrived results show that the performance of the supervised machine learning based classification approach provided significant performance than other compared unsupervised clustering methods. The traditional clustering methods can identify the Normal CTG patterns; they were incapable of finding Suspicious and Pathologic patterns. The ANN based classifier was capable of identifying Normal, Suspicious and Pathologic condition, from the nature of CTG data with very good accuracy.

  6. Análise dos Testes de Vitalidade Fetal e dos Resultados Perinatais em Gestações de Alto Risco com Oligoidrâmnio Analysis of Fetal Well-being and Perinatal Outcome in the High-risk Pregnancies Complicated by Oligohydramnios

    Directory of Open Access Journals (Sweden)

    Roseli Mieko Yamamoto Nomura

    2002-07-01

    Full Text Available Objetivos: analisar, em gestações de alto risco com diagnóstico de oligoidrâmnio, os resultados dos testes de avaliação da vitalidade fetal e os resultados perinatais. Métodos: foram selecionadas retrospectivamente 572 gestações de alto risco com diagnóstico de oligoidrâmnio, caracterizado por ILA inferior ou igual a 5,0 cm. Destas, 220 apresentavam diagnóstico de oligoidrâmnio grave (ILA Purpose: to evaluate, in the high-risk pregnancies with oligohydramnios, the assessment tools for fetal well-being and perinatal results. Methods: five hundred seventy-two high-risk pregnancies were retrospectively analyzed. All of them presented with oligohydramnios established by AFI <=5.0 cm. Severe oligohydramnios was detected in 220 cases (AFI<=3,0 cm. The fetal well-being tests included: antepartum cardiotocography, biophysical profile score (BPS and dopplervelocimetry of umbilical and middle cerebral arteries. Multiple gestation, fetal anomalies and premature rupture of membrane cases were excluded. Results: severe oligohydramnios was significantlly associated with abnormal and suspected cardiotocography results (23.2%, abnormal biophysical profile score (10.5%, abnormal results of middle cerebral artery dopplervelocimetry (54.5%, small for gestational age infants (32.7% and meconial amniotic fluid (27.9% when compared to pregnancies with AFI between 3.1 and 5.0 cm. This group presented: abnormal or suspected cardiotocography results (13.9%, abnormal biophysical profile score (4.3%, abnormal results of middle cerebral artery dopplervelocimetry (33.9%, small for gestational age infants (21.0% and meconial amniotic fluid (16.8%. Conclusion: the oligohydramnios severity in high-risk pregnancies allows to discriminate the cases that are related to adverse perinatal outcome.

  7. [A new ECG electrode concept for the conduction of fetal heart action potentials without penetration of the skin].

    Science.gov (United States)

    Schmidt, S; Langner, K; Rothe, J; Saling, E

    1982-10-01

    Internal cardiotocography is an important method for reliable supervision of the fetus during labor. The main task is the prevention of fetal hypoxia. However, there is a considerable disadvantage as the electrodes used penetrate the fetal skin, creating a possible entry point for organisms. The concept we have developed forms a new way of decreasing the risk of infection during labor by conducting the fetal heart rate potentials without penetrating the skin. The electrode is fixed to the skin of the presenting part by tissue adhesive and electrical contact between the fetal skin and the wire of the electrode is established through using electrolyte fluid.

  8. Intrauterine extremity gangrene and cerebral infarction at term

    DEFF Research Database (Denmark)

    Tanvig, M; Jørgensen, J S; Nybo, M;

    2011-01-01

    Intrauterine extremity gangrene in combination with cerebral infarction is a serious and rare event. We present a case with a healthy mother who gave birth to a child with this condition. At term, the mother presented at the antenatal clinic with decreased fetal movements. Cardiotocography (CTG......) showed signs of fetal distress and a caesarean section was performed. The left arm of the newborn was found gangrenous. Amputation of the arm was necessary and the child was subsequently treated with anticoagulant therapy due to thrombosis and cerebral infarction in the left hemisphere found by magnetic...

  9. Diagnostic and prognostic value of analysis of heart rhythm variability in pregnant patients under estimation of fetal hypoxia evidence

    Directory of Open Access Journals (Sweden)

    Piskunova L.V.

    2010-09-01

    Full Text Available The correlation between fetal hypoxia degrees according to the data of cardiotocography and status of mother's vegetative nervous system as a result of heart rhythm variability research have been analyzed. It has been revealed that during the increase of fetal hypoxia severity, mother has observed activation of sympathetic section of vegetative nervous system, which has changed by vagotonia in severe and terminal states. These findings can be used both for indirect estimation of fetal hypoxia severity and for its course prognosis

  10. Prenatal constriction of the ductus arteriosus following maternal diclofenac medication in the third trimester.

    Science.gov (United States)

    Aker, Karoline; Brantberg, Anne; Nyrnes, Siri Ann

    2015-01-01

    We describe a case of a 21-year-old primigravida at 36 weeks' gestation who was admitted to a local hospital because of abdominal pain. She was prescribed a total of six doses of diclofenac 50 mg over 2 days. One day later, there was difficulty registering the fetal heartbeats on cardiotocography. Ultrasound examination revealed a fetus with ascites and pathological flow over the tricuspid valve. The patient was referred to a tertiary centre for fetal medicine. Fetal echocardiography revealed, in addition to ascites and tricuspid regurgitation, a constricted ductus arteriosus, dilated right ventricle and reduced flow in the pulmonary artery. Immediate caesarean section resulted in an excellent neonatal outcome. PMID:26427495

  11. Fetal short time variation during labor: a non-invasive alternative to fetal scalp pH measurements?

    OpenAIRE

    Schiermeier, Sven; Reinhard, Joscha; Hatzmann, Hendrike; Zimmermann, Ralf C.; Westhof, Gregor

    2009-01-01

    Objective: To determine whether short time variation (STV) of fetal heart beat correlates with scalp pH measurements during labor. Patients and methods: From 1279 deliveries, 197 women had at least one fetal scalp pH measurement. Using the CTG-Player®, STVs were calculated from the electronically saved cardiotocography (CTG) traces and related to the fetal scalp pH measurements. Results: There was no correlation between STV and fetal scalp pH measurements (r=−0.0592). Conclusions: Fetal ST...

  12. A Device for Fetal Monitoring by Means of Control Over Cardiovascular Parameters Based on Acoustic Data

    Science.gov (United States)

    Khokhlova, L. A.; Seleznev, A. I.; Zhdanov, D. S.; Zemlyakov, I. Yu; Kiseleva, E. Yu

    2016-01-01

    The problem of monitoring fetal health is topical at the moment taking into account a reduction in the level of fertile-age women's health and changes in the concept of perinatal medicine with reconsideration of live birth criteria. Fetal heart rate monitoring is a valuable means of assessing fetal health during pregnancy. The routine clinical measurements are usually carried out by the means of ultrasound cardiotocography. Although the cardiotocography monitoring provides valuable information on the fetal health status, the high quality ultrasound devices are expensive, they are not available for home care use. The recommended number of measurement is also limited. The passive and fully non-invasive acoustic recording provides an alternative low-cost measurement method. The article describes a device for fetal and maternal health monitoring by analyzing the frequency and periodicity of heart beats by means of acoustic signal received on the maternal abdomen. Based on the usage of this device a phonocardiographic fetal telemedicine system, which will allow to reduce the antenatal fetal mortality rate significantly due to continuous monitoring over the state of fetus regardless of mother's location, can be built.

  13. Arteriovenous malformation of vein of Galen as a rare non-hypoxic cause of changes in fetal heart rate pattern during labor.

    Science.gov (United States)

    Biringer, Kamil; Zubor, Pavol; Kudela, Erik; Kolarovszki, Branislav; Zibolen, Mirko; Danko, Jan

    2016-03-01

    The aim of this case report is to describe a rare non-hypoxic cause of pathological changes in fetal heart rate pattern during labor, and to determine management, including a description of important prenatal aspects when pathologic cardiotocographic recording is performed during labor. A fetus with rare arteriovenous malformation of the vein of Galen, which represents less than 1% of all intracranial arteriovenous malformations, was monitored by intrapartum external cardiotocography in the 37 + 5 gestational week. The baby was born by cesarean section because of signs of imminent intrauterine hypoxia on cardiotocography. However, metabolic acidosis was not confirmed in umbilical cord blood sampling. Despite intensive neonatal care management, the newborn died 31 h after delivery because of progressive cardiac decompensation, hypotension and multi-organ failure. Precise diagnosis of the abovementioned pathology, a pre-labor plan for delivery and postnatal prognosis assessment can significantly contribute to the avoidance of a misdiagnosis of fetal hypoxia and unnecessary operative delivery with marked medico-legal consequences. PMID:26694901

  14. [Case of intrauterine retardation and fetal death during labor].

    Science.gov (United States)

    Frundeva, B; Dimitrova, V; Museva, A; Dimitrov, A; Zlatkov, V

    2014-01-01

    The case concerns to a 37 years old pregnant woman with a history of three miscarriages. Ultrasound biometry in early pregnancy corresponds to the term calculated according the last menstrual period (LMP). At 37 week of gestation was determined retardation of 5 weeks. Doppler velocimetry and quantity of amniotic fluid were in normal ranges and the pregnant refused hospitalization. She was admitted to the hospital three days after the appointed term without uterine contractions. The fetal ultrasound biometry meets 33 weeks and the Doppler examination of a. umbilicalis found resistance index (RI) of the upper limit of normal. The cardiotocography record shows: baseline fetal heart rate--143 beats/min, good variability and reactivity. There was one deceleration for 3 minutes, and then the recording returns to normal. Re-monitoring after 30 minutes establishes of a periodic decelerations and a tendency to bradycardia with reserved variability. At the start of the emergency Cesarean Section fetal heart beats are single. The delivered babe was with Apgar O. The reanimation was not successful and the fetus died. From the autopsy signs of severe asphyxia. In conclusion, it can be assumed that in strongly retarded fetuses, cardiotocography recording and Doppler velosimetry are not sufficiently reliable methods for continued monitoring. In late-onset and severe intrauterine growth retardation (IUGR) desirable delivery time is after reaching biological maturity at 36-37 week. PMID:25558672

  15. Avaliação da Vitalidade Fetal em Gestantes Diabéticas: Análise dos Resultados Neonatais Fetal Surveillance in Pregnancies Complicated by Diabetes: Analysis of Neonatal Outcome

    Directory of Open Access Journals (Sweden)

    Roseli Mieko Yamamoto

    2000-10-01

    Full Text Available Objetivos: estudar os testes de avaliação da vitalidade fetal em gestantes diabéticas e relacionar com os resultados neonatais. Métodos: estudamos 387 gestantes diabéticas atendidas no Setor de Vitalidade Fetal. O último exame (cardiotocografia, perfil biofísico fetal, índice de líquido amniótico e dopplervelocimetria foi relacionado com os resultados neonatais. Resultados: a população foi de 46 gestantes diabéticas tipo I (12%, 45 tipo II (12% e 296 gestacionais (76%. Entre as do tipo I, a cardiotocografia suspeita ou alterada correlacionou-se com Apgar de 1º minuto alterado (50 e 75%; pPurpose: to study the fetal well-being assessment in pregnancies complicated by diabetes, and to analyze the neonatal results. Methods: we studied 387 pregnant women with diabetes at the Fetal Surveillance Unit. The last examination (cardiotocography, fetal biophysical profile, amniotic fluid index and dopplervelocimetry was correlated with the neonatal outcome. Results: the studied population included 46 (12% type I diabetes, 45 (12% type II and 296 (76% gestational diabetes. Type I diabetes with abnormal or suspected cardiotocography was related to abnormal 1st minute Apgar (50 and 75%, p<0.05 and to the need for neonatal intensive care unit (50 and 75%, p<0.05. The abnormal biophysical profile in type II diabetic pregnancy was related to the need for neonatal intensive care (67%, p<0.05, and abnormal umbilical artery Doppler study was related to abnormal 1st minute Apgar (67%, p<0.05. Gestational diabetes with abnormal cardiotocography presented 36% abnormal 1st minute Apgar (p<0.05, 18% abnormal 5th minute Apgar (p<0.01 and 18% neonatal death (p<0.01. Abnormal amniotic fluid index was related to abnormal 5th minute Apgar (p<0.05 and need for neonatal intensive care unit (p<0.05. Gestational diabetes with abnormal umbilical artery Doppler was related (p<0.05 to: abnormal 1st and 5th minute Apgar, respectively, 25 and 8%, Need for neonatal

  16. Cardiac function in offspring of women with diabetes using fetal ECG, umbilical cord blood pro-BNP, and neonatal interventricular septal thickness

    DEFF Research Database (Denmark)

    Halse, Karen; Lindegaard, Marie Louise Skakkebæk; Amer-Wahlin, Isis;

    2013-01-01

    Objective: Increased pro-brain natriuretic peptide (BNP) concentrations in newborns of diabetic women are associated with fetal stress, and fetal ECG changes often occur in labor in diabetic women. These findings could reflect a degree of fetal cardiomyopathy. We aimed to explore possible relations...... between serological and morphological markers of cardiac dysfunction and abnormal changes on fetal ECGs during labor and delivery in pregnancies complicated by diabetes. Materials and methods: Pregnant women with diabetes (30 type 1, nine type 2, and 60 gestational diabetes) and their newborn offspring...... were included prospectively. Umbilical cord blood pro-BNP concentrations were measured immediately after delivery (n=68) and echocardiography was performed in the newborns (n=75). Fetal ECG in combination with cardiotocography, that is STAN technology was also performed during labor. Results...

  17. A case of euglyacemic diabetic ketoacidosis in a patient with gestational diabetes mellitus

    Science.gov (United States)

    Cooke, IE; McCance, DR

    2014-01-01

    A 30-year old woman at 30 weeks gestation with insulin-controlled gestational diabetes was admitted with nausea and vomiting. Plasma glucose was 3.3 mmol/l with pH 7.23 and raised capillary ketones at 6.1 mmol/l. She was diagnosed with euglycaemic diabetic ketoacidosis. Cardiotocography showed good fetal movement and accelerations. She was given intramuscular betamethasone and started on intravenous dextrose, insulin and 0.9% saline with potassium chloride with resolution of ketosis. Euglycaemic diabetic ketoacidosis has been reported during pregnancy in patients with type 1 and type 2 diabetes. We believe that this is a report of such an occurrence in a patient with gestational diabetes.

  18. Clinical significance of radioimmunological HPL findings in long-term management of premature delivery risk

    Energy Technology Data Exchange (ETDEWEB)

    Ruckhaeberle, K.E.; Bilek, K.; Viehweg, B.; Kuehndel, K.; Colditz, U.; Baer, G.

    1981-01-01

    Premature birth is not only characterized by premature delivery action but it is ever more frequently interpreted as the disturbed fetoplacental unit syndrome. In an attempt to therapeutically prevent premature delivery the placental function should be monitored. Possible intrauterine survival should be assessed as accurately as possible against extrauterine survival in order that the necessary tocolysis time could be determined. In our observations, clinical significance was studied of radioimmunologically determined HPL values in the serum under tocolysis conditions at premature birth risk on the basis of postnatal classification of the postnatal condition and of the particularity of the adaptation phase of the neonates. The significance of HPL determination in checking the fetoplacental unit during tocolysis should be arrived at while also using other diagnostic techniques, such as oxytocinase or estriol, ultrasound biometry, cardiotocography.

  19. FETAL MONITORING DURING THE OBSTETRIC LABOR

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    Salcedo-Ramos Francisco

    2015-01-01

    Full Text Available The intrapartum fetal monitoring is part of the tests to assess the fetal well-being. It is an easy, cheap, reproducible and non-invasive method without adverse effects or contraindications. The main objective of this method is to assess the fetal status during the obstetric labor, identifying the fetus that probably could have alterations. It is determined for alterations in the next variables: [A] Frequency, variability and decelerations of the fetal cardiac rhythm [B] Fetal movements. [C] Changes in the cardiac activity according to the uterine activity. The findings allow classifying the fetal status in three categories. And in this way, the adequate measures could be established before irreversible lesions and death could occur in the fetus. Rev.cienc.biomed. 2015;6(1:170-178 KEYWORDS Cardiotocography; Fetal Monitoring; Heart fetal rate; Obstetric labor.

  20. Modern Possibilities of Hyperbaric Oxygen Therapy in Pregnant Women with Anemia

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    Agamurad A. Orasmuradov

    2014-06-01

    Full Text Available Over the past 20 years, the number of anemia cases has increased more than 6-fold. Unfortunately, the treatment of pregnant women with anemia using an iron supplement gives unsatisfactory results. However, the data from the present study can change situation for the better. This conclusion was derived from a comparative analysis of the treatment of 65 pregnant women suffering from anemia, divided into two groups: the study and control groups. Patients of the study group received, along with standard therapy, courses of hyperbaric oxygenation (HBO. Evaluation of treatment efficiency was based on data from laboratory methods, Doppler, and cardiotocography before and after treatment, as well as a morphological study of the placenta. The received results show that the use of HBO in the complex treatment of pregnant women with anemia may take place in clinical practice both for treatment of anemia during pregnancy, and for the prevention of complications of pregnancy and childbirth.

  1. Intrauterine Extremity Gangrene and Cerebral Infarction at Term: A Case Report

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    M. Tanvig

    2011-01-01

    Full Text Available Intrauterine extremity gangrene in combination with cerebral infarction is a serious and rare event. We present a case with a healthy mother who gave birth to a child with this condition. At term, the mother presented at the antenatal clinic with decreased fetal movements. Cardiotocography (CTG showed signs of fetal distress and a caesarean section was performed. The left arm of the newborn was found gangrenous. Amputation of the arm was necessary and the child was subsequently treated with anticoagulant therapy due to thrombosis and cerebral infarction in the left hemisphere found by magnetic resonance imaging (MRI. At one year of age the boy was doing well and had prosthesis as a left arm. He had no signs of further complications. Despite thorough examination of the parents and the child, the reason for the thrombosis is still unknown.

  2. Litigation related to intrapartum fetal surveillance.

    Science.gov (United States)

    Schifrin, Barry S; Soliman, Mohamed; Koos, Brian

    2016-01-01

    The role of intrapartum care including cardiotocography (CTG) monitoring in cases of perinatal neurological injury receives considerable debate in both clinical and medicolegal settings. The debate, however, has distracted attention from fundamental questions about the timing, mechanism, and preventability of perinatal injury. CTG tracings are used as a surrogate for asphyxia with the timing of intervention ("rescue") predicated on the presumed severity of asphyxia. Using CTG in this way has prevented intrapartum stillbirth, but it has not reduced the long-term injury in part, because, contrary to popular belief, the majority of intrapartum fetal injuries are unassociated with severe hypoxia or severe neonatal depression. This article describes the timing and mechanisms, including mechanical factors, of intrapartum perinatal injury and the benefit of using the CTG, not for the purpose of "rescue", but for identifying risk factors for fetal injury and keeping the fetus out of harm's way. PMID:26227999

  3. Clinical significance of radioimmunological HPL findings in long-term management of premature delivery risk

    International Nuclear Information System (INIS)

    Premature birth is not only characterized by premature delivery action but it is ever more frequently interpreted as the disturbed fetoplacental unit syndrome. In an attempt to therapeutically prevent premature delivery the placental function should be monitored. Possible intrauterine survival should be assessed as accurately as possible against extrauterine survival in order that the necessary tocolysis time could be determined. In our observations, clinical significance was studied of radioimmunologically determined HPL values in the serum under tocolysis conditions at premature birth risk on the basis of postnatal classification of the postnatal condition and of the particularity of the adaptation phase of the neonates. The significance of HPL determination in checking the fetoplacental unit during tocolysis should be arrived at while also using other diagnostic techniques, such as oxytocinase or estriol, ultrasound biometry, cardiotocography. (author)

  4. Theoretical considerations to optimize transabdominal monitoring of fetal arterial blood oxygenation using pulse oximetry

    Science.gov (United States)

    Zourabian, Anna; Boas, David A.

    2001-06-01

    Pulse oximetry (oxygen saturation monitoring) has markedly improved medical care in many fields, including anesthesiology, intensive care, and newborn intensive care. In obstetrics, fetal heart rate monitoring remains the standard for intrapartum assessment of fetal well being. Fetal oxygen saturation monitoring is a new technique currently under development. It is potentially superior to electronic fetal heart rate monitoring (cardiotocography) because it allows direct assessment of both fetal oxygen status and fetal tissue perfusion. Here we present the analysis for determining the most optimal wavelength selection for pulse oximetry. The wavelengths we chose as the most optimal are: the first in the range of 670-720nm and the second in the range of 825-925nm. Further we discuss the possible systematic errors during our measurements, and their contribution to the obtained saturation results.

  5. [Brain damage in a child after outpatient induction of labour].

    Science.gov (United States)

    Hill, Stig A; Aasheim, Erlend T

    2013-06-17

    A 32-year-old woman had labour induced (25 + 25 microgram misoprostol vaginally) at 291 days gestation for post-term pregnancy. A cardiotocography (CTG) showed normal conditions. The woman went home to await regular contractions in line with hospital policy. She awoke at 3.15 a.m. with abdominal pain and came to the labour ward at 3.45 a.m. with less pain but a desire to push. The cervix was dilated but the foetal head sat high in the pelvis. Internal CTG showed a pre-terminal pattern. A girl was born at 4.27 a.m. She had hypoxic-ischaemic encephalopathy (APGAR at 1, 5 and 10 min.: 1, 3, 3; umbilical cord arterial blood pH 6.71, base excess -19.9 mmol/l). At the age of three years she had severe cerebral palsy. PMID:23773216

  6. Reducing stillbirths: screening and monitoring during pregnancy and labour

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    Darmstadt Gary L

    2009-05-01

    studies of cardiotocography have reported stillbirth outcomes, but steep declines in stillbirth rates have been observed in high-income settings such as the U.S., where cardiotocography is used in conjunction with Caesarean section for fetal distress. Conclusion There are numerous research gaps and large, adequately controlled trials are still needed for most of the interventions we considered. The impact of monitoring interventions on stillbirth relies on use of effective and timely intervention should problems be detected. Numerous studies indicated that positive tests were associated with increased perinatal mortality, but while some tests had good sensitivity in detecting distress, false-positive rates were high for most tests, and questions remain about optimal timing, frequency, and implications of testing. Few studies included assessments of impact of subsequent intervention needed before recommending particular monitoring strategies as a means to decrease stillbirth incidence. In high-income countries such as the US, observational evidence suggests that widespread use of cardiotocography with Caesarean section for fetal distress has led to significant declines in stillbirth rates. Efforts to increase availability of Caesarean section in low-/middle-income countries should be coupled with intrapartum monitoring technologies where resources and provider skills permit.

  7. Correlação entre Testes para Avaliação da Vitalidade Fetal, pH da Artéria Umbilical e os Resultados Neonatais em Gestações de Alto Risco Correlation between the Assessment of Fetal Well-being, Umbilical Artery pH at Birth and the Neonatal Results in High-risk Pregnancies

    Directory of Open Access Journals (Sweden)

    Rossana Pulcineli Vieira Francisco

    2000-09-01

    Full Text Available Objetivos: analisar a relação entre valores de pH no nascimento, testes de vitalidade fetal e resultados neonatais. Métodos: foram incluídas 1346 pacientes com gestação de alto risco atendidas no Setor de Vitalidade Fetal do HCFMUSP. Para estudo do bem-estar fetal foram realizados exames de cardiotocografia, perfil biofísico fetal e índice de líquido amniótico. Após o parto foram obtidos os seguintes parâmetros dos recém-nascidos: idade gestacional no parto, sexo e peso dos recém-nascidos, índices de Apgar de 1º e 5º minutos, pH da artéria umbilical no nascimento e a ocorrência de óbito neonatal. Para estudo destes resultados neonatais, os casos foram divididos em quatro grupos: G1 (pH ou = 7,20. Resultados: a cardiotocografia anormal relacionou-se com valores de pH inferiores a 7,20 (p = 0,001. Resultados anormais do perfil biofísico fetal (Purpose: to analyze the relationship between the values of pH at birth, fetal surveillance examinatios and neonatal results. Methods: one thousand, three hundred and forty-six high-risk pregnancies were evaluated at the Fetal Surveillance Unit. The assessment of fetal well-being included cardiotocography, fetal biophysical profile and amniotic fluid index. After birth, the perinatal results (gestational age at birth, birth weight, Apgar scores at 1st and 5th minutes, umbilical cord pH at birth were collected. To study the results, the patients were divided into four groups: G1 (pH or = 7.20. Results: the abnormal patterns of cardiotocography were associated with pH at birth inferior to 7.20 (p = 0.001. Abnormal results of the fetal biophysical profile (<=4 were related to decrease in pH values at birth (p<0.001. The adverse neonatal outcomes were associated with acidosis at birth, and they were selected to be analyzed by the logistic regression model, showing that the odds ratio of each adverse neonatal outcome increases significantly when the values of pH at birth decrease. Conclusions

  8. [Anesthesia in obstetrics: Tried and trusted methods, current standards and new challenges].

    Science.gov (United States)

    Kranke, P; Annecke, T; Bremerich, D H; Hanß, R; Kaufner, L; Klapp, C; Ohnesorge, H; Schwemmer, U; Standl, T; Weber, S; Volk, T

    2016-01-01

    Obstetric analgesia and anesthesia have some specific aspects, which in particular are directly related to pathophysiological alterations during pregnancy and also to the circumstance that two or even more individuals are always affected by complications or therapeutic measures. This review article deals with some evergreens and hot topics of obstetric anesthesia and essential new knowledge on these aspects is described. The article summarizes the talks given at the 16th symposium on obstetric anesthesia organized by the Scientific Committee for Regional Anaesthesia and Obstetric Anaesthesia within the German Society of Anaesthesiology. The topics are in particular, special features and pitfalls of informed consent in the delivery room, challenges in education and training in obstetric anesthesia, expedient inclusion of simulation-assisted training and further education on risk minimization, knowledge and recommendations on fasting for the delivery room and cesarean sections, monitoring in obstetric anesthesia by neuraxial and alternative procedures, the possibilities and limitations of using ultrasound for lumbal epidural catheter positioning in the delivery room, recommended approaches in preparing peridural catheters for cesarean section, basic principles of cardiotocography, postoperative analgesia after cesarean section, the practice of early bonding in the delivery room during cesarean section births and the management of postpartum hemorrhage. PMID:26745995

  9. Software for computerised analysis of cardiotocographic traces.

    Science.gov (United States)

    Romano, M; Bifulco, P; Ruffo, M; Improta, G; Clemente, F; Cesarelli, M

    2016-02-01

    Despite the widespread use of cardiotocography in foetal monitoring, the evaluation of foetal status suffers from a considerable inter and intra-observer variability. In order to overcome the main limitations of visual cardiotocographic assessment, computerised methods to analyse cardiotocographic recordings have been recently developed. In this study, a new software for automated analysis of foetal heart rate is presented. It allows an automatic procedure for measuring the most relevant parameters derivable from cardiotocographic traces. Simulated and real cardiotocographic traces were analysed to test software reliability. In artificial traces, we simulated a set number of events (accelerations, decelerations and contractions) to be recognised. In the case of real signals, instead, results of the computerised analysis were compared with the visual assessment performed by 18 expert clinicians and three performance indexes were computed to gain information about performances of the proposed software. The software showed preliminary performance we judged satisfactory in that the results matched completely the requirements, as proved by tests on artificial signals in which all simulated events were detected from the software. Performance indexes computed in comparison with obstetricians' evaluations are, on the contrary, not so satisfactory; in fact they led to obtain the following values of the statistical parameters: sensitivity equal to 93%, positive predictive value equal to 82% and accuracy equal to 77%. Very probably this arises from the high variability of trace annotation carried out by clinicians.

  10. Assessment of features for automatic CTG analysis based on expert annotation.

    Science.gov (United States)

    Chudácek, Vacláv; Spilka, Jirí; Lhotská, Lenka; Janku, Petr; Koucký, Michal; Huptych, Michal; Bursa, Miroslav

    2011-01-01

    Cardiotocography (CTG) is the monitoring of fetal heart rate (FHR) and uterine contractions (TOCO) since 1960's used routinely by obstetricians to detect fetal hypoxia. The evaluation of the FHR in clinical settings is based on an evaluation of macroscopic morphological features and so far has managed to avoid adopting any achievements from the HRV research field. In this work, most of the ever-used features utilized for FHR characterization, including FIGO, HRV, nonlinear, wavelet, and time and frequency domain features, are investigated and the features are assessed based on their statistical significance in the task of distinguishing the FHR into three FIGO classes. Annotation derived from the panel of experts instead of the commonly utilized pH values was used for evaluation of the features on a large data set (552 records). We conclude the paper by presenting the best uncorrelated features and their individual rank of importance according to the meta-analysis of three different ranking methods. Number of acceleration and deceleration, interval index, as well as Lempel-Ziv complexity and Higuchi's fractal dimension are among the top five features. PMID:22255719

  11. Magnetic resonance imaging of the active second stage of labour: Proof of principle

    Energy Technology Data Exchange (ETDEWEB)

    Guettler, F.V.; Heinrich, A.; Rump, J.; Bucourt, M. de; Hamm, B.; Teichgraeber, U.K. [Charite University Hospital, Department of Radiology, Berlin (Germany); Schnackenburg, B. [Philips GmbH Unternehmensbereich Healthcare, Hamburg (Germany); Bamberg, C. [Charite University Hospital, Department of Obstetrics, Berlin (Germany)

    2012-09-15

    To prove that magnetic resonance imaging of foetal anatomy during the active second stage of vaginal delivery is feasible. Initially, five pregnant volunteers around the 30th week of gestation were examined in an open MRI. Based on the findings, one vaginal delivery was acquired under real-time imaging. To monitor the birth status during image acquisition, an MR-compatible wireless cardiotocography (CTG) system was built. Single-shot sequence parameters were optimised to compensate motion artefacts during labour. Safety requirements to monitor the birth process under real-time MR imaging were met. High-resolution MR images were acquired immediately before and after delivery. In one patient, TSE single-shot cinematic sequences of the active second stage of labour were obtained. All sequences were adapted to tolerate movement of the mother and infant, as well as residual noise from the CTG. Furthermore, the MR imaging during labour showed only minor image artefacts. CTG-monitored acquisition of MRI series during the active second stage of delivery is feasible. Image quality should allow various further studies to improve models for birth simulation as well as potential investigation of obstructed labour and obstetric complications. (orig.)

  12. Magnetic resonance imaging of the active second stage of labour: Proof of principle

    International Nuclear Information System (INIS)

    To prove that magnetic resonance imaging of foetal anatomy during the active second stage of vaginal delivery is feasible. Initially, five pregnant volunteers around the 30th week of gestation were examined in an open MRI. Based on the findings, one vaginal delivery was acquired under real-time imaging. To monitor the birth status during image acquisition, an MR-compatible wireless cardiotocography (CTG) system was built. Single-shot sequence parameters were optimised to compensate motion artefacts during labour. Safety requirements to monitor the birth process under real-time MR imaging were met. High-resolution MR images were acquired immediately before and after delivery. In one patient, TSE single-shot cinematic sequences of the active second stage of labour were obtained. All sequences were adapted to tolerate movement of the mother and infant, as well as residual noise from the CTG. Furthermore, the MR imaging during labour showed only minor image artefacts. CTG-monitored acquisition of MRI series during the active second stage of delivery is feasible. Image quality should allow various further studies to improve models for birth simulation as well as potential investigation of obstructed labour and obstetric complications. (orig.)

  13. Fetal Vibroacoustic Stimulation in Computerized Cardiotocographic Analysis: The Role of Short-Term Variability and Approximate Entropy

    Directory of Open Access Journals (Sweden)

    Maria Laura Annunziata

    2012-01-01

    Full Text Available The aim of this study was to evaluate the impact of vibroacoustic stimulation (VAS on computerized cardiotocography short-term variability (STV and approximate entropy (ApEn in both low- and high-risk pregnancies. VAS was performed on 121 high- and 95 low-risk pregnancies after 10 minutes of continuous quiet, while their FHR parameters were monitored and recorded by cCTG analysis. Fetal heart rate was recorded using a computer-assisted equipment. Baseline FHR, accelerations, decelerations, STV, long-term irregularity (LTI, ApEn, and fetal movements (FMs were calculated for defined observational periods before VAS and after 10 minutes. Data were also investigated in relationship with the perinatal outcome. In each group of patients, FHR after VAS remained almost unmodified. Fetal movements significantly increased after VAS in both groups. Results show that only in the high-risk pregnancies, the increase of STV and the decrease of ApEn after VAS were significantly associated with favorable perinatal outcomes.

  14. Decisions to Perform Emergency Caesarean Sections at a University Hospital; Do obstetricians agree?

    Directory of Open Access Journals (Sweden)

    Gowri Vaidyanathan

    2016-02-01

    Full Text Available Objectives: This study was undertaken to assess the degree of agreement amongst obstetricians regarding decisions to perform emergency Caesarean section (CS procedures at a university hospital. Methods: This retrospective clinical audit was carried out on 50 consecutive emergency CS procedures performed between November 2012 and March 2013 on women with singleton pregnancies at the Sultan Qaboos University Hospital in Muscat, Oman. Data on each procedure were collected from electronic patient records and independently reviewed by six senior obstetricians to determine agreement with the decision. Results: Of the 50 women who underwent CS procedures, the mean age was 28.9 ± 5.1 years and 48% were primigravidae. A total of 65% of the CS procedures were category I. The most common indications for a CS was a non-reassuring fetal heart trace (40% and dystocia (32%. There was complete agreement on the decision to perform 62% of the CS procedures. Five and four obstetricians agreed on 80% and 95% of the procedures, respectively. The range of disagreement was 4–20%. Disagreement occurred primarily with category II and III procedures compared to category I. Additionally, disagreement occurred in cases where the fetal heart trace pattern was interpreted as an indication for a category II CS. Conclusion: The majority of obstetricians agreed on the decisions to perform 94% of the emergency CS procedures. Obstetric decision-making could be improved with the implementation of fetal scalp pH testing facilities, fetal heart trace interpretation training and cardiotocography review meetings.

  15. Sequential Total Variation Denoising for the Extraction of Fetal ECG from Single-Channel Maternal Abdominal ECG

    Directory of Open Access Journals (Sweden)

    Kwang Jin Lee

    2016-07-01

    Full Text Available Fetal heart rate (FHR is an important determinant of fetal health. Cardiotocography (CTG is widely used for measuring the FHR in the clinical field. However, fetal movement and blood flow through the maternal blood vessels can critically influence Doppler ultrasound signals. Moreover, CTG is not suitable for long-term monitoring. Therefore, researchers have been developing algorithms to estimate the FHR using electrocardiograms (ECGs from the abdomen of pregnant women. However, separating the weak fetal ECG signal from the abdominal ECG signal is a challenging problem. In this paper, we propose a method for estimating the FHR using sequential total variation denoising and compare its performance with that of other single-channel fetal ECG extraction methods via simulation using the Fetal ECG Synthetic Database (FECGSYNDB. Moreover, we used real data from PhysioNet fetal ECG databases for the evaluation of the algorithm performance. The R-peak detection rate is calculated to evaluate the performance of our algorithm. Our approach could not only separate the fetal ECG signals from the abdominal ECG signals but also accurately estimate the FHR.

  16. Evaluation of cardiotocographic and cord blood changes in induced labor with dinoprostone and misoprostol

    Directory of Open Access Journals (Sweden)

    Kiran Pandey

    2014-02-01

    Methods: This study was conducted in the department of Obstetrics and Gynecology of G.S.V.M. Medical College, Kanpur with 80 patients. Cases were randomly divided into two groups with n=40. In first group 50 µgm misoprostol per vaginally and in second group 0.5 mg of dinoprostone gel was used for induction. Cardiotocography of all the study candidates was performed and following delivery cord blood gas analysis was done. Results: It was found that 45% percent of women treated with misoprostol demonstrated an abnormal tracing event within the initial 24 hours of induction, compared with 17.5% in the dinoprostone gel. Both hypertonus and tachysystole events were significantly more frequent in women treated with misoprostol group and this difference is statistically significant (p=0.0099. We also found that these events occurred earlier after initial misoprostol dosing (6.98 ± 4.14hr, compared with the dinoprostone gel (9.19 ± 6.29 hr. Conclusions: Cardiotocographic abnormalities are more frequent after misoprostol administration compared with the dinoprostone gel. Neonatal outcome in terms of NICU admission and Umbilical artery cord blood changes are apparently similar in both. [Int J Reprod Contracept Obstet Gynecol 2014; 3(1.000: 199-203

  17. Zmiany morfologii odcinka ST bezpośredniego elektrokardiogramu płodowego i ich wpływ na stężenia aminotransferazy asparaginianowej i alaninowej u rodzących w wieku powyżej 30 lat z ciążą powikłaną cukrzycą

    Directory of Open Access Journals (Sweden)

    Agnieszka Kubiak-Fortecka

    2010-06-01

    Full Text Available New technical and technological possibilities, which have recently appeared, led to an increase in the interest in thefoetal electrocardiography. Thanks to the construction of special electrodes, the method of direct electrocardiography wasimplemented into general use in the intrapartum supervision of the condition of the foetus. The analysis of the directfoetal electrocardiograms may turn out to be a more precise diagnostic method with a greater prediction value than cardiotocography when it comes to the condition of the foetus and the newborn. Many works indicate an increase in theimportance of the supervision by combining both methods.The aim of this study was to analyse changes of the ST segment of the foetal electrocardiogram (FECGmonitored using STAN®S21 and their correlations with levels of aspartate aminotransferase and alanineaminotransferase. We also analysed AST, ALT correlation with the pH value. We had 54 patients divided into threegroups. Group one included 54 diabetic patients at the age of 30-34. Group two comprised 15 diabetic patients atthe age of 35-39 and group three included 6 patients more than 40 years of age. For intrapartum monitoring we used the STAN®S21 system. The results were as follows: in diabetic patients at theage of 30-43, changes of the ST segment of FECG correlated with the higher level of AST and ALT. The higher level ofAST correlated with the lower pH value. We did not notice any correlations of AST and ALT with ST segment changes.

  18. Decisions to Perform Emergency Caesarean Sections at a University Hospital

    Science.gov (United States)

    Pillai, Silja A.; Vaidyanathan, Gowri; Al-Shukri, Maryam; Al-Dughaishi, Tamima R.; Tazneem, Shahila; Khan, Durdana; El-Tayeb, Saniya; Mathew, Mariam

    2016-01-01

    Objectives: This study was undertaken to assess the degree of agreement amongst obstetricians regarding decisions to perform emergency Caesarean section (CS) procedures at a university hospital. Methods: This retrospective clinical audit was carried out on 50 consecutive emergency CS procedures performed between November 2012 and March 2013 on women with singleton pregnancies at the Sultan Qaboos University Hospital in Muscat, Oman. Data on each procedure were collected from electronic patient records and independently reviewed by six senior obstetricians to determine agreement with the decision. Results: Of the 50 women who underwent CS procedures, the mean age was 28.9 ± 5.1 years and 48% were primigravidae. A total of 65% of the CS procedures were category I. The most common indications for a CS was a non-reassuring fetal heart trace (40%) and dystocia (32%). There was complete agreement on the decision to perform 62% of the CS procedures. Five and four obstetricians agreed on 80% and 95% of the procedures, respectively. The range of disagreement was 4–20%. Disagreement occurred primarily with category II and III procedures compared to category I. Additionally, disagreement occurred in cases where the fetal heart trace pattern was interpreted as an indication for a category II CS. Conclusion: The majority of obstetricians agreed on the decisions to perform 94% of the emergency CS procedures. Obstetric decision-making could be improved with the implementation of fetal scalp pH testing facilities, fetal heart trace interpretation training and cardiotocography review meetings. PMID:26909212

  19. Using uterine activity to improve fetal heart rate variability analysis for detection of asphyxia during labor.

    Science.gov (United States)

    Warmerdam, G J J; Vullings, R; Van Laar, J O E H; Van der Hout-Van der Jagt, M B; Bergmans, J W M; Schmitt, L; Oei, S G

    2016-03-01

    During labor, uterine contractions can cause temporary oxygen deficiency for the fetus. In case of severe and prolonged oxygen deficiency this can lead to asphyxia. The currently used technique for detection of asphyxia, cardiotocography (CTG), suffers from a low specificity. Recent studies suggest that analysis of fetal heart rate variability (HRV) in addition to CTG can provide information on fetal distress. However, interpretation of fetal HRV during labor is difficult due to the influence of uterine contractions on fetal HRV. The aim of this study is therefore to investigate whether HRV features differ during contraction and rest periods, and whether these differences can improve the detection of asphyxia. To this end, a case-control study was performed, using 14 cases with asphyxia that were matched with 14 healthy fetuses. We did not find significant differences for individual HRV features when calculated over the fetal heart rate without separating contractions and rest periods (p  >  0.30 for all HRV features). Separating contractions from rest periods did result in a significant difference. In particular the ratio between HRV features calculated during and outside contractions can improve discrimination between fetuses with and without asphyxia (p  <  0.04 for three out of four ratio HRV features that were studied in this paper). PMID:26862891

  20. Trans-abdominal monitoring of fetal arterial blood oxygenation using pulse oximetry

    Science.gov (United States)

    Zourabian, Anna; Siegel, Andrew M.; Chance, Britton; Ramanujam, Nirmala; Rode, Martha; Boas, David A.

    2000-10-01

    Pulse oximetry (oxygen saturation monitoring) has markedly improved medical care in many fields, including anesthesiology, intensive care, and newborn intensive care. In obstetrics, fetal heart rate monitoring remains the standard for intrapartum assessment of fetal well being. Fetal oxygen saturation monitoring is a new technique currently under development. It is potentially superior to electronic fetal heart rate monitoring (cardiotocography) because it allows direct assessment of both the fetal oxygen status and fetal tissue perfusion. Here we present the analysis for determining the most optimal wavelength selection for pulse oximetry. The wavelengths we chose as the most optimal are the first in the range of 670 - 720 nm and the second in the range of 825 - 925 nm. Further, we discuss the possible systematic errors during our measurements and their contribution to the obtained saturation results. We present feasibility studies for fetal pulse oximetry, monitored noninvasively through the maternal abdomen. Our preliminary experiments show that the fetal pulse can be discriminated from the maternal pulse and thus, in principle, the fetal arterial oxygen saturation can be obtained. We present the methodology for obtaining these data, and discuss the dependence of our measurements on the fetal position with respect to the optode assembly.

  1. Software for computerised analysis of cardiotocographic traces.

    Science.gov (United States)

    Romano, M; Bifulco, P; Ruffo, M; Improta, G; Clemente, F; Cesarelli, M

    2016-02-01

    Despite the widespread use of cardiotocography in foetal monitoring, the evaluation of foetal status suffers from a considerable inter and intra-observer variability. In order to overcome the main limitations of visual cardiotocographic assessment, computerised methods to analyse cardiotocographic recordings have been recently developed. In this study, a new software for automated analysis of foetal heart rate is presented. It allows an automatic procedure for measuring the most relevant parameters derivable from cardiotocographic traces. Simulated and real cardiotocographic traces were analysed to test software reliability. In artificial traces, we simulated a set number of events (accelerations, decelerations and contractions) to be recognised. In the case of real signals, instead, results of the computerised analysis were compared with the visual assessment performed by 18 expert clinicians and three performance indexes were computed to gain information about performances of the proposed software. The software showed preliminary performance we judged satisfactory in that the results matched completely the requirements, as proved by tests on artificial signals in which all simulated events were detected from the software. Performance indexes computed in comparison with obstetricians' evaluations are, on the contrary, not so satisfactory; in fact they led to obtain the following values of the statistical parameters: sensitivity equal to 93%, positive predictive value equal to 82% and accuracy equal to 77%. Very probably this arises from the high variability of trace annotation carried out by clinicians. PMID:26638805

  2. Foetal heart rate deceleration with combined spinal-epidural analgesia during labour: a maternal haemodynamic cardiac study.

    Science.gov (United States)

    Valensise, Herbert; Lo Presti, Damiano; Tiralongo, Grazia Maria; Pisani, Ilaria; Gagliardi, Giulia; Vasapollo, Barbara; Frigo, Maria Grazia

    2016-06-01

    To understand the mechanisms those are involved in the appearance of foetal heart rate decelerations (FHR) after the combined epidural analgesia in labour. Observational study done at University Hospital for 86-term singleton pregnant women with spontaneous labour. Serial bedside measurement of the main cardiac maternal parameters with USCOM technique; stroke volume (SV), heart rate (HR), cardiac output (CO) and total vascular resistances (TVR) inputting systolic and diastolic blood pressure before combined epidural analgesia and after 5', 10', 15' and 20 min. FHR was continuously recorded though cardiotocography before and after the procedure. Correlation between the appearance of foetal heart rate decelerations and the modification of maternal haemodynamic parameters. Fourteen out of 86 foetuses showed decelerations after the combined spino epidural procedure. No decelerations occurred in the women with low TVR (1200 dyne/s/cm(-5)). Soon after the epidural procedure, the absence of increase in SV and CO was observed in these women. No variations in systolic and diastolic blood pressure values were found. The level of TVR before combined epidural analgesia in labour may indicate the risk of FHR abnormalities after the procedure. Low TVR (<1000 dyne/s/cm(-5)) showed a reduced risk of FHR abnormalities. FHR decelerations seem to occur in women without the ability to upregulate SV and CO in response to the initial effects of analgesia. PMID:26333691

  3. Foetal scalp blood sampling during labour for pH and lactate measurements.

    Science.gov (United States)

    Carbonne, Bruno; Pons, Kelly; Maisonneuve, Emeline

    2016-01-01

    Second-line methods of foetal monitoring have been developed in an attempt to reduce unnecessary interventions due to continuous cardiotocography (CTG), and to better identify foetuses that are at risk of intrapartum asphyxia. Very few studies directly compared CTG with foetal scalp blood (FBS) and CTG only. Only one randomised controlled trial (RCT) was published in the 1970s and had limited power to assess neonatal outcome. Direct and indirect comparisons conclude that FBS could reduce the number of caesarean deliveries associated with the use of continuous CTG. The main drawbacks of FBS are its invasive and discontinuous nature and the need for a sufficient volume of foetal blood for analysis, especially for pH measurement, resulting in failure rates reaching 10%. FBS for lactate measurement became popular with the design of test-strip devices, requiring <0.5 mL of foetal blood. RCTs showed similar outcomes with the use of FBS for lactates compared with pH in terms of obstetrical interventions and neonatal outcomes. In conclusion, there is some evidence that FBS reduces the need for operative deliveries. However, the evidence is limited with regard to actual standards, and large RCTs, directly comparing CTG only with CTG with FBS, are still needed. PMID:26253238

  4. Combined cardiotocographic and ST event analysis: A review.

    Science.gov (United States)

    Amer-Wahlin, Isis; Kwee, Anneke

    2016-01-01

    ST-analysis of the fetal electrocardiogram (ECG) (STAN(®)) combined with cardiotocography (CTG) for intrapartum fetal monitoring has been developed following many years of animal research. Changes in the ST-segment of the fetal ECG correlated with fetal hypoxia occurring during labor. In 1993 the first randomized controlled trial (RCT), comparing CTG with CTG + ST-analysis was published. STAN(®) was introduced for daily practice in 2000. To date, six RCTs have been performed, out of which five have been published. Furthermore, there are six published meta-analyses. The meta-analyses showed that CTG + ST-analysis reduced the risks of vaginal operative delivery by about 10% and fetal blood sampling by 40%. There are conflicting results regarding the effect on metabolic acidosis, much because of controveries about which RCTs should be included in a meta-analysis, and because of differences in methodology, execution and quality of the meta-analyses. Several cohort studies have been published, some showing significant decrease of metabolic acidosis after the introduction of ST-analysis. In this review, we discuss not only the scientific evidence from the RCTs and meta-analyses, but also the limitations of these studies. In conclusion, ST-analysis is effective in reducing operative vaginal deliveries and fetal blood sampling but the effect on neonatal metabolic acidosis is still under debate. Further research is needed to determine the place of ST-analysis in the labor ward for daily practice. PMID:26206514

  5. Doppler findings in intrapartum fetal distress.

    Science.gov (United States)

    Eslamian, Laleh; Tooba, Khatereh

    2011-01-01

    The umbilical vein (UV) has a non pulsating and even pattern in normal fetuses. Pulsation of UV has been described in severely growth restricted fetuses with chronic hypoxia. We wanted to see whether UV pulsations could also be seen in fetuses with heart deceleration during labor, as an adjunctive measure to assess the intra partum hypoxia. In a prospective study Doppler examination was performed on 34 fetuses with normal cardiotocography (CGT) and 26 fetuses with abnormal CTGs (GA>37w and cervical dilatation>3cm). Perinatal outcome was assessed according to presence or absence of UV pulsations. The 2 groups were similar regarding gestational age, cervical dilatation, Umbilical artery blood pH, S/D ratio,Pulsatility Index( PI) and Resistance Index (RI). Intraabdominal UV pulsation were present in 6 (23.1%) of abnormal CTG group but no case were seen in normal CTG group (P= 0.005). Five of 6 (83.3%) fetuses with UV pulsation underwent cesarean delivery. The rate of cesarean delivery was 90% in abnormal CTG group without pulsation and 14.7% in normal CTG group. The frequency of Apgar score Apgar sore <7or NICU admission were seen. PMID:22009812

  6. Is intrapartum fetal blood sampling a gold standard diagnostic tool for fetal distress?

    Science.gov (United States)

    Mahendru, Amita A; Lees, Christoph C

    2011-06-01

    Developed in 1960s, cardiotocography is a screening test and fetal blood sampling (FBS) is an adjunctive, diagnostic technique to detect fetal hypoxia. A fetal blood sample pH value of less than 7.20 has a higher specificity than a pathological CTG to predict low Apgar score at 1 min. Though with a pathological CTG and despite a normal FBS pH value the risk of delivering a hypoxic infant is 30-50%, FBS has assumed considerable importance in purportedly reducing unnecessary obstetric intervention. The evidence for this is weak: the use of FBS with CTG has been shown to reduce operative vaginal deliveries though not Caesarean sections due to fetal distress. There is no difference in the umbilical artery pH at delivery with the use of intermittent FBS with CTG compared to CTG alone. FBS is an invasive procedure: obtaining an adequate blood sample is often difficult and the pH results are affected by handling of the sample, aerobic contamination and processing. Validation of intrapartum FBS requires that the pH and other values obtained are compared to a 'gold standard' technique. Although FBS has been compared to other tests such as scalp lactate, pulse oximetry, fetal ECG waveform analysis, and central haemodynamics in labouring rhesus monkeys, none of these can be considered as 'gold standard'. In the light of the existing evidence, the role of intrapartum FBS as a gold standard diagnostic technique is unproven. PMID:21300427

  7. Combined cardiotocographic and ST event analysis: A review.

    Science.gov (United States)

    Amer-Wahlin, Isis; Kwee, Anneke

    2016-01-01

    ST-analysis of the fetal electrocardiogram (ECG) (STAN(®)) combined with cardiotocography (CTG) for intrapartum fetal monitoring has been developed following many years of animal research. Changes in the ST-segment of the fetal ECG correlated with fetal hypoxia occurring during labor. In 1993 the first randomized controlled trial (RCT), comparing CTG with CTG + ST-analysis was published. STAN(®) was introduced for daily practice in 2000. To date, six RCTs have been performed, out of which five have been published. Furthermore, there are six published meta-analyses. The meta-analyses showed that CTG + ST-analysis reduced the risks of vaginal operative delivery by about 10% and fetal blood sampling by 40%. There are conflicting results regarding the effect on metabolic acidosis, much because of controveries about which RCTs should be included in a meta-analysis, and because of differences in methodology, execution and quality of the meta-analyses. Several cohort studies have been published, some showing significant decrease of metabolic acidosis after the introduction of ST-analysis. In this review, we discuss not only the scientific evidence from the RCTs and meta-analyses, but also the limitations of these studies. In conclusion, ST-analysis is effective in reducing operative vaginal deliveries and fetal blood sampling but the effect on neonatal metabolic acidosis is still under debate. Further research is needed to determine the place of ST-analysis in the labor ward for daily practice.

  8. Sequential Total Variation Denoising for the Extraction of Fetal ECG from Single-Channel Maternal Abdominal ECG.

    Science.gov (United States)

    Lee, Kwang Jin; Lee, Boreom

    2016-01-01

    Fetal heart rate (FHR) is an important determinant of fetal health. Cardiotocography (CTG) is widely used for measuring the FHR in the clinical field. However, fetal movement and blood flow through the maternal blood vessels can critically influence Doppler ultrasound signals. Moreover, CTG is not suitable for long-term monitoring. Therefore, researchers have been developing algorithms to estimate the FHR using electrocardiograms (ECGs) from the abdomen of pregnant women. However, separating the weak fetal ECG signal from the abdominal ECG signal is a challenging problem. In this paper, we propose a method for estimating the FHR using sequential total variation denoising and compare its performance with that of other single-channel fetal ECG extraction methods via simulation using the Fetal ECG Synthetic Database (FECGSYNDB). Moreover, we used real data from PhysioNet fetal ECG databases for the evaluation of the algorithm performance. The R-peak detection rate is calculated to evaluate the performance of our algorithm. Our approach could not only separate the fetal ECG signals from the abdominal ECG signals but also accurately estimate the FHR. PMID:27376296

  9. Antepartum findings and obstetric aspects in pregnancies followed by neonatal persistent hyperinsulinemic hypoglycemia.

    Science.gov (United States)

    Parviainen, Anna-Maria; Puolakka, Jukka; Kirkinen, Pertti

    2002-04-01

    In this study we report antepartum and obstetric findings in cases of persistent hyperinsulinemic hypoglycemia of infancy (PHHI). The study is retrospective and covers the years 1983 to 1994, when there were 9 infants treated for PHHI in the region of the University Hospital of Kuopio. One of the mothers had gestational diabetes mellitus and one had insulin-dependent diabetes mellitus (IDDM). There were signs of fetal distress in cardiotocography (CTG) in 3 of 9 cases prenatally and in 3 of 9 cases intrapartum (33%). There were 5 premature deliveries (56%) and 5 cesarean sections (56%) in this series. Five neonates (56%) were macrosomic and one delivery was complicated by shoulder dystocia. Three neonates (33%) had a 1-minute Apgar score of <6, but there were no cases at 5 minutes. In cases of fetal macrosomia without a maternal diabetic problem amniocentesis may be carried out after 34 weeks of gestation to assay amniotic fluid insulin, C-peptide and erythropoietin to reveal rare cases of PHHI where there may be problems of fetal hypoxemia similar to those in diabetic pregnancies.

  10. Automatic evaluation of intrapartum fetal heart rate recordings: a comprehensive analysis of useful features

    International Nuclear Information System (INIS)

    Cardiotocography is the monitoring of fetal heart rate (FHR) and uterine contractions (TOCO), used routinely since the 1960s by obstetricians to detect fetal hypoxia. The evaluation of the FHR in clinical settings is based on an evaluation of macroscopic morphological features and so far has managed to avoid adopting any achievements from the HRV research field. In this work, most of the features utilized for FHR characterization, including FIGO, HRV, nonlinear, wavelet, and time and frequency domain features, are investigated and assessed based on their statistical significance in the task of distinguishing the FHR into three FIGO classes. We assess the features on a large data set (552 records) and unlike in other published papers we use three-class expert evaluation of the records instead of the pH values. We conclude the paper by presenting the best uncorrelated features and their individual rank of importance according to the meta-analysis of three different ranking methods. The number of accelerations and decelerations, interval index, as well as Lempel–Ziv complexity and Higuchi's fractal dimension are among the top five features

  11. Avaliação da vitalidade fetal em gestações complicadas pela plaquetopenia materna moderada ou grave Assessment of fetal well-being in pregnancies complicated by maternal moderate to severe thrombocytopenia

    Directory of Open Access Journals (Sweden)

    Roseli Mieko Yamamoto Nomura

    2011-10-01

    retrospectively analyzed. We analyzed the following tests performed during the antepartum period for fetal assessment: cardiotocography, fetal biophysical profile, amniotic fluid index and umbilical artery Doppler velocimetry. RESULTS: A total of 96 pregnancies with the following diagnoses were analyzed: gestational thrombocytopenia (n=37, 38.5% hypersplenism (n=32, 33.3%, immune thrombocytopenic purpura (ITP, n=14, 14.6%, secondary immune thrombocytopenia (n=6, 6.3%, bone marrow aplasia (n=3, 3.1%, and others (n=4, 4.1%. Cardiotocography showed normal results in 94% of cases, a fetal biophysical profile with an index of 8 or 10 in 96.9% and an amniotic fluid index >5.0 cm in 89.6%. Doppler umbilical artery velocimetry showed normal results in 96.9% of cases. In the analysis of the major groups of thrombocytopenia, the diagnosis of oligohydramnios was found to be significantly more frequent in the group with ITP (28.6% compared to the other groups (gestational thrombocytopenia: 5.4% and hypersplenism: 9.4%, p=0.04. CONCLUSIONS: This study indicates that in pregnancies complicated by moderate or severe maternal thrombocytopenia, even though the fetal well-being remains preserved in most cases, fetal surveillance is important in pregnant women with ITP, with emphasis on amniotic fluid volume evaluation due to its association with oligohydramnios.

  12. Developments in CTG analysis.

    Science.gov (United States)

    Van Geijn, H P

    1996-06-01

    FHR monitoring has been the subject of many debates. The technique, in itself, can be considered to be accurate and reliable both in the antenatal period, when using the Doppler signal in combination with autocorrelation techniques, and during the intrapartum period, in particular when the FHR signal can be obtained from a fetal ECG electrode placed on the presenting part. The major problems with FHR monitoring relate to the reading and interpretation of the CTG tracings. Since the FHR pattern is primarily an expression of the activity of the control by the central and peripheral nervous system over cardiovascular haemodynamics, it is possibly too indirect a signal. In other specialities such as neonatology, anaesthesiology and cardiology, monitoring and graphic display of heart rate patterns have not gained wide acceptance among clinicians. Digitized archiving, numerical analysis and even more advanced techniques, as described in this chapter, have primarily found a place in obstetrics. This can be easily explained, since the obstetrician is fully dependent on indirectly collected information regarding the fetal condition, such as (a) movements experienced by the mother, observed with ultrasound or recorded with kinetocardiotocography (Schmidt, 1994), (b) perfusion of various vessels, as assessed by Doppler velocimetry, (c) the amount of amniotic fluid or (d) changes reflected in the condition of the mother, such as the development of gestation-induced hypertension and (e) the easily, continuously obtainable FHR signal. It is of particular comfort to the obstetrician that a normal FHR tracing reliably predicts the birth of the infant in a good condition, which makes cardiotocography so attractive for widespread application. However, in the intrapartum period, many traces cannot fulfil the criteria of normality, especially in the second stage. In this respect, cardiotocography remains primarily a screening and not so much a diagnostic method. As long as continuous

  13. Avaliação da vitalidade fetal e resultados perinatais em gestações após gastroplastia com derivação em Y de Roux Assessment of fetal vitality and perinatal results in pregnancies after gastroplasty with Roux-en-Y gastric bypass

    Directory of Open Access Journals (Sweden)

    Roseli Mieko Yamamoto Nomura

    2010-01-01

    Full Text Available OBJETIVO: Analisar os resultados da avaliação da vitalidade fetal de gestações após gastroplastia com derivação em Y de Roux, verificando as complicações maternas e os resultados perinatais. MÉTODOS: No período de julho de 2001 a setembro de 2009, foram analisados, retrospectivamente, dados de prontuário de pacientes com gestação após gastroplastia com derivação em Y de Roux, acompanhadas em pré-natal especializado e cujo parto foi realizado na instituição. Foram analisados os exames de avaliação da vitalidade fetal (cardiotocografia, perfil biofísico fetal e dopplervelocimetria das artérias umbilicais realizada na semana anterior ao parto. As variáveis maternas investigadas foram: dados demográficos, complicações clínicas maternas, tipo de parto, complicações no parto e pós-parto, exames hematimétricos maternos e resultados perinatais. RESULTADOS: Trinta gestações após gastroplastia com derivação em Y de Roux foram identificadas e 24 delas foram submetidas à avaliação da vitalidade fetal. Todas as pacientes apresentaram resultados normais na cardiotocografia, no perfil biofísico fetal e na dopplervelocimetria das artérias umbilicais. Houve um caso de oligohidrâmnio. A principal complicação observada foi anemia materna (Hb OBJECTIVE: To study fetal vitality assessed in pregnancies after gastroplasty with Roux-en-Y gastric bypass'and verify maternal complications and perinatal results. METHODS: Hospital charts of all pregnancies after gastroplasty with Roux-en-Y gastric bypass were reviewed retrospectively. All cases followed at the specialized prenatal care that gave birth in this institution, between July 2001 and September 2009, were reviewed. The assessment of fetal vitality (cardiotocography, fetal biophysical profile and umbilical artery Doppler velocimetry performed in the last week before delivery were analyzed. The maternal variables investigated were: demographic data, maternal complications

  14. Umbilical cord blood pH in intrapartum hypoxia

    International Nuclear Information System (INIS)

    To determine the association of cord arterial blood pH with neonatal outcome in cases of intrapartum fetal hypoxia. Study Design: Descriptive analytical study. Place and Duration of Study: Gynaecology Unit-II, Civil Hospital, Karachi, from September 2011 to November 2012. Methodology: All singleton cephalic fetuses at term gestation were included in the study. Those with any anomaly, malpresentation, medical disorders, maternal age < 18 years, multiple gestation and ruptured membranes were excluded. Patients with abnormal cardiotocography and/or meconium stained liquor were enrolled as index case and immediate next delivery with no such signs as a control. Demographic characteristics, pH level < or > 7.25, neonatal outcome measures (healthy, NICU admission or neonatal death), color of liquor and mode of delivery recorded on predesigned proforma. Statistical analysis performed by SPSS 16 by using independent-t test or chi-square test and ANOVA test as needed. Results: A total of 204 newborns were evaluated. The mean pH level was found to be significantly different (p=0.007) in two groups. The pH value 7.25 had significant association (p < 0.001) with the neonatal outcome. However, the association of neonatal outcome with severity of acidemia was not found to be significant. Grading of Meconium Stained Liquor (MSL) also did not relate positively with pH levels as 85.7% of grade I, 68.9% of grade II and 59.4% of grade III MSL had pH > 7.25. Majority (63.6%) cases needed caesarean section as compared to 31.4% controls. Conclusion: There is a significant association of cord arterial blood pH at birth with neonatal outcome at pH < or > 7.25; but below the level of pH 7.25 it is still inconclusive. (author)

  15. [Pregnancy and childbirth in a patient with a spinal cord lesion].

    Science.gov (United States)

    Vanderbeke, I; Boll, D; Verguts, J K

    2008-05-17

    A 37-year-old woman with a spinal cord lesion at the level of TvIII due to a car-accident, became pregnant. She had posttraumatic syringomyely at Cv-TvIII, for which she underwent syringo-arachnoidal drainage. At approximately six weeks of amenorrhoea she presented at the emergency room with vaginal bleeding. She was treated with dalteparine 5000 IU once daily given by intramuscular injection until 6 weeks post partum. Weekly urine checks were advised. At 36 6/7 weeks of pregnancy, the patient was admitted to hospital for daily cardiotocography and 4-hourly contraction monitoring. After spontaneous rupture of the membranes she went into labour and had a vaginal delivery of a son weighing 3320 g. His Apgar score was 6 after 1 min and 9 after 5 min; arterial pH was 7.31. For three months after giving birth she received specialist care at home as well as help and counselling from a rehabilitation centre. In pregnant women with a spinal cord lesion, special attention should be paid to urinary tract infections, pressure areas, anaemia and thrombo-embolic symptoms. During partus, cardiotocographic monitoring should be carried out, also in patients with TvI-Tx lesions regularly from 36 weeks. In pregnant women with lesions from TvI, medical attendants should be aware of the possibility of autonomous dysreflection. Epidural anaesthesia should be administered and episiotomy or rupture avoided. Post partum, the bladder should always be completely emptied and pressure areas and signs ofthrombo-embolic complications monitored. A urological bladder function consultation should be requested, and, ifepisiotomy or rupture does occur, extra care should be taken to avoid infection. The ergonomic situation at home should be evaluated to ensure that any ergonomic changes necessary for the care of the patient and her newborn, take place in time.

  16. Antepartum fetal heart rate feature extraction and classification using empirical mode decomposition and support vector machine

    Directory of Open Access Journals (Sweden)

    Ahmed Shuhaila

    2011-01-01

    Full Text Available Abstract Background Cardiotocography (CTG is the most widely used tool for fetal surveillance. The visual analysis of fetal heart rate (FHR traces largely depends on the expertise and experience of the clinician involved. Several approaches have been proposed for the effective interpretation of FHR. In this paper, a new approach for FHR feature extraction based on empirical mode decomposition (EMD is proposed, which was used along with support vector machine (SVM for the classification of FHR recordings as 'normal' or 'at risk'. Methods The FHR were recorded from 15 subjects at a sampling rate of 4 Hz and a dataset consisting of 90 randomly selected records of 20 minutes duration was formed from these. All records were labelled as 'normal' or 'at risk' by two experienced obstetricians. A training set was formed by 60 records, the remaining 30 left as the testing set. The standard deviations of the EMD components are input as features to a support vector machine (SVM to classify FHR samples. Results For the training set, a five-fold cross validation test resulted in an accuracy of 86% whereas the overall geometric mean of sensitivity and specificity was 94.8%. The Kappa value for the training set was .923. Application of the proposed method to the testing set (30 records resulted in a geometric mean of 81.5%. The Kappa value for the testing set was .684. Conclusions Based on the overall performance of the system it can be stated that the proposed methodology is a promising new approach for the feature extraction and classification of FHR signals.

  17. Fatores perinatais associados a recém-nascidos de termo com pH<7,1 na artéria umbilical e índice de Apgar <7,0 no 5º minuto Perinatal factors associated with pH<7.1 in umbilical artery and Apgar 5 min <7.0 in term newborn

    Directory of Open Access Journals (Sweden)

    Patrícia de Moraes De Zorzi

    2012-08-01

    Full Text Available OBJETIVO: Avaliar os fatores perinatais associados a recém-nascidos de termo com pHPURPOSE: To assess perinatal factors associated with term newborns with pH<7.1 in the umbilical artery and 5th min Apgar score<7,0. METHODS: Retrospective case-control study carried out after reviewing the medical records of all births from September/1998 to March/2008, that occurred at the General Hospital of Caxias do Sul. The inclusion criterion was term newborns who presented a 5th min Apgar score <7.0 and umbilical artery pH<7.10. In the univariate analysis, we used the Student's t-test and the Mann-Whitney test for continuous variables, the c² test for dichotomous variables and risk estimation by the odds ratio (OR. The level of significance was set at p<0.05. RESULTS: Of a total of 15,495 consecutive births, 25 term neonates (0.16% had pH<7.1 in the umbilical artery and a 5th min Apgar score <7.0. Breech presentation (OR=12.9, p<0.005, cesarean section (OR=3.5, p<0.01 and modified intrapartum cardiotocography (OR=7.8, p<0.02 presented a significant association with the acidosis event. Among the fetal characteristics, need for hospitalization in the neonatal intensive care unit (OR=79.7, p <0.0001, need for resuscitation (OR=12.2, p <0.0001 and base deficit were associated with the event (15.0 versus -4.5, p<0.0001. CONCLUSION: Low Apgar score at the 5th min of life associated with pH<7.1 in the umbilical artery can predict adverse neonatal outcomes.

  18. Asphyxia from the eyes of the obstetrician

    Directory of Open Access Journals (Sweden)

    Alessandra Meloni

    2014-06-01

    Full Text Available Nowadays it is well recognized that there are multiple potential pathways causing hypoxic-ischemic events that may lead to cerebral palsy in term infants. The signs and symptoms of neonatal encephalopathy may range from mild to severe, depending on nature and timing of brain injury. The incidence of cerebral palsy has not changed over the last 30 years and one of the obstetricians’challenge is how to recognize babies at intrapartum risk both before and during labour. A detailed description of prepartum and intrapartum risk factors is available. A close surveillance of labour and intrapartum time should be mandatory as the valuation of all available data from obstetrical examination, cardiotocography, ultrasound and labour progression to reach the correct diagnosis with the lowest possible rate of error. The close monitoring should not exclude a humanized and compliant attitude versus labouring women and their families. We analysed the Cagliari Neonatal Intensive Care Unit (NICU activity during the last four years considering 22 asphyxiated babies (coming from 9 different hospitals who underwent hypothermia treatment. The main result was that the need to resuscitation procedures at birth correlates with adverse outcomes. Asphyxia still remains a matter of great concern also as medico legal claims. Considering that neonatal encephalopathy is a heterogeneous condition, it is unlikely that it will be eradicated. However, a comprehensive evaluation of all risk factors and of intrapartum surveillance available tools may reduce as much as possible adverse events.Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

  19. Doppler Findings in Intrapartum Fetal Distress

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    Khatereh Tooba

    2011-08-01

    Full Text Available The umbilical vein (UV has a non pulsating and even pattern in normal fetuses. Pulsation of UV has been described in severely growth restricted fetuses with chronic hypoxia. We wanted to see whether UV pulsations could also be seen in fetuses with heart deceleration during labor, as an adjunctive measure to assess the intra partum hypoxia. In a prospective study Doppler examination was performed on 34 fetuses with normal cardiotocography (CGT and 26 fetuses with abnormal CTGs (GA>37w and cervical dilatation>3cm. Perinatal outcome was assessed according to presence or absence of UV pulsations. The 2 groups were similar regarding gestational age, cervical dilatation, Umbilical artery blood pH, S/D ratio,Pulsatility Index( PI and Resistance Index (RI. Intraabdominal UV pulsation were present in 6 (23.1% of abnormal CTG group but no case were seen in normal CTG group (P= 0.005. Five of 6 (83.3% fetuses with UV pulsation underwent cesarean delivery. The rate of cesarean delivery was 90% in abnormal CTG group without pulsation and 14.7% in normal CTG group. The frequency of Apgar score <7 was more in fetuses with UV pulsations (16.7% vs 5% although not statistically significant. NICU admission was considerably more in UV pulsation group (33% vs 5%, P= 0.123. After exclusion of LBW fetuses the UV pulsation was present in 4 (19% of abnormal CTG group, who 3 of them underwent cesarean section. Neither umbilical artery pH<7 nor Apger score <7 or NICU admission were seen in these 4 neonates. Pulsation in UV was seen in 23% of fetuses with abnormal CTG during intra partum period. Cesarean delivery and NICU admission was increased in fetuses with UV pulsations, although not statistically significant. When LBW fetuses were excluded no case of UA pH<7, Apgar sore <7or NICU admission were seen.

  20. What is the “normal” fetal heart rate?

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    Stephanie Pildner von Steinburg

    2013-06-01

    Full Text Available Aim. There is no consensus about the normal fetal heart rate. Current international guidelines recommend for the normal fetal heart rate (FHR baseline different ranges of 110 to 150 beats per minute (bpm or 110 to 160 bpm. We started with a precise definition of “normality” and performed a retrospective computerized analysis of electronically recorded FHR tracings. Methods. We analyzed all recorded cardiotocography tracings of singleton pregnancies in three German medical centers from 2000 to 2007 and identified 78,852 tracings of sufficient quality. For each tracing, the baseline FHR was extracted by eliminating accelerations/decelerations and averaging based on the “delayed moving windows” algorithm. After analyzing 40% of the dataset as “training set” from one hospital generating a hypothetical normal baseline range, evaluation of external validity on the other 60% of the data was performed using data from later years in the same hospital and externally using data from the two other hospitals. Results. Based on the training data set, the “best” FHR range was 115 or 120 to 160 bpm. Validation in all three data sets identified 120 to 160 bpm as the correct symmetric “normal range”. FHR decreases slightly during gestation. Conclusions. Normal ranges for FHR are 120 to 160 bpm. Many international guidelines define ranges of 110 to 160 bpm which seem to be safe in daily practice. However, further studies should confirm that such asymmetric alarm limits are safe, with a particular focus on the lower bound, and should give insights about how to show and further improve the usefulness of the widely used practice of CTG monitoring.

  1. A novel LabVIEW-based multi-channel non-invasive abdominal maternal-fetal electrocardiogram signal generator.

    Science.gov (United States)

    Martinek, Radek; Kelnar, Michal; Koudelka, Petr; Vanus, Jan; Bilik, Petr; Janku, Petr; Nazeran, Homer; Zidek, Jan

    2016-02-01

    This paper describes the design, construction, and testing of a multi-channel fetal electrocardiogram (fECG) signal generator based on LabVIEW. Special attention is paid to the fetal heart development in relation to the fetus' anatomy, physiology, and pathology. The non-invasive signal generator enables many parameters to be set, including fetal heart rate (FHR), maternal heart rate (MHR), gestational age (GA), fECG interferences (biological and technical artifacts), as well as other fECG signal characteristics. Furthermore, based on the change in the FHR and in the T wave-to-QRS complex ratio (T/QRS), the generator enables manifestations of hypoxic states (hypoxemia, hypoxia, and asphyxia) to be monitored while complying with clinical recommendations for classifications in cardiotocography (CTG) and fECG ST segment analysis (STAN). The generator can also produce synthetic signals with defined properties for 6 input leads (4 abdominal and 2 thoracic). Such signals are well suited to the testing of new and existing methods of fECG processing and are effective in suppressing maternal ECG while non-invasively monitoring abdominal fECG. They may also contribute to the development of a new diagnostic method, which may be referred to as non-invasive trans-abdominal CTG +  STAN. The functional prototype is based on virtual instrumentation using the LabVIEW developmental environment and its associated data acquisition measurement cards (DAQmx). The generator also makes it possible to create synthetic signals and measure actual fetal and maternal ECGs by means of bioelectrodes. PMID:26799770

  2. Intermittent Auscultation in Labor: Could It Be Missing Many Pathological (Late) Fetal Heart Rate Decelerations? Analytical Review and Rationale for Improvement Supported by Clinical Cases.

    Science.gov (United States)

    Sholapurkar, Shashikant L

    2015-12-01

    Intermittent auscultation (IA) of fetal heart rate (FHR) is recommended/preferred in low risk labors. Its usage even in developed countries is poised to increase because of perceived benefit of reduction in operative intervention and some disillusionment with the cardiotocography (CTG). Many national guidelines have stipulated regimes (frequency/timing) of IA based on level IV evidence. These tend to get faithfully and exactingly followed. It was observed that deliveries of many unexpectedly asphyxiated infants occurred despite rigorously performed and documented IA compliant with the guidelines. This triggered a reappraisal of the robustness of IA leading to this focused review supplemented by two anonymized cases. It concludes that the current methodology of IA may be flawed in that it poses a risk of missing many or most late (pathological) FHR decelerations, one of the foremost goals of IA. This is because many late decelerations reach their nadir before the end of the contraction. Thus the currently recommended auscultation of FHR for 60 seconds after the contraction by all national guidelines seemed to encompass their "recovery" phase and appeared to be misinterpreted as normal FHR or even as a reassuring accelerative pattern in the clinical practice. A recent recommendation of recording of the FHR as a single figure (rather than a range) does not remedy this anomaly and seems even less informative. It would be better to auscultate FHR before and after the contractions (or contraction to contraction) and take the FHR just before the contraction as the baseline FHR and interpret the FHR after contraction in the context of this baseline. This relatively simple improvement would detect most late FHR decelerations thus ameliorating the risk and significantly enhancing the patient safety. PMID:26566404

  3. Emergency cesarean section as a result of acute eosinophilic pneumonia during pregnancy.

    Science.gov (United States)

    Kotani, Yasushi; Shiota, Mitsuru; Umemoto, Masahiko; Nakai, Hidekatsu; Tobiume, Takako; Tsuritani, Hiromitsu; Shimaoka, Masao; Doh, Kunihiko; Hoshiai, Hiroshi

    2009-11-01

    Acute eosinophilic pneumonia is a disease of unknown etiology characterized by peripheral blood eosinophilia and pulmonary infiltrative shadows on radiography. Acute eosinophilic pneumonia follows an acute course within 1 week and the symptoms include fever, dyspnea, and cough. Acute eosinophilic pneumonia has a good prognosis and responds promptly to steroid treatments. Here we present a critical case of acute eosinophilic pneumonia during pregnancy, which led to emergency cesarean section because of fetal distress. The patient was a 24-year-old gravida at 34 + 6 weeks gestation, with fever, and an elevated CRP; thus antibiotics were started. At 35 + 1 weeks gestation, cardiotocography (CTG) revealed late decelerations, fetal distress was diagnosed, and an emergency cesarean section was performed. The pre-operative maternal blood gas analysis showed a low PaO(2) of 55.7 mmHg and a chest X-ray revealed ground-glass opacities and pleural effusions in the middle lower lung fields bilaterally. A male of 2,336 g in weight was delivered with Apgar scores of 8 and 8 at 1 and 5 min, respectively. Due to the clinical progress and the elevated eosinophil count (532/microl) in the peripheral blood differential leukocyte count, the diagnosis of acute eosinophilic pneumonia was made. With the administration of oxygen and steroid treatment, the patient's general condition recovered. Both the mother and the baby were discharged on the 10(th) post-operative day and the patient has been leading a normal life with no recurrence for > 3 years since delivery. PMID:19851054

  4. [Pregnancy and childbirth in a patient with a spinal cord lesion].

    Science.gov (United States)

    Vanderbeke, I; Boll, D; Verguts, J K

    2008-05-17

    A 37-year-old woman with a spinal cord lesion at the level of TvIII due to a car-accident, became pregnant. She had posttraumatic syringomyely at Cv-TvIII, for which she underwent syringo-arachnoidal drainage. At approximately six weeks of amenorrhoea she presented at the emergency room with vaginal bleeding. She was treated with dalteparine 5000 IU once daily given by intramuscular injection until 6 weeks post partum. Weekly urine checks were advised. At 36 6/7 weeks of pregnancy, the patient was admitted to hospital for daily cardiotocography and 4-hourly contraction monitoring. After spontaneous rupture of the membranes she went into labour and had a vaginal delivery of a son weighing 3320 g. His Apgar score was 6 after 1 min and 9 after 5 min; arterial pH was 7.31. For three months after giving birth she received specialist care at home as well as help and counselling from a rehabilitation centre. In pregnant women with a spinal cord lesion, special attention should be paid to urinary tract infections, pressure areas, anaemia and thrombo-embolic symptoms. During partus, cardiotocographic monitoring should be carried out, also in patients with TvI-Tx lesions regularly from 36 weeks. In pregnant women with lesions from TvI, medical attendants should be aware of the possibility of autonomous dysreflection. Epidural anaesthesia should be administered and episiotomy or rupture avoided. Post partum, the bladder should always be completely emptied and pressure areas and signs ofthrombo-embolic complications monitored. A urological bladder function consultation should be requested, and, ifepisiotomy or rupture does occur, extra care should be taken to avoid infection. The ergonomic situation at home should be evaluated to ensure that any ergonomic changes necessary for the care of the patient and her newborn, take place in time. PMID:18549144

  5. Correlating multidimensional fetal heart rate variability analysis with acid-base balance at birth.

    Science.gov (United States)

    Frasch, Martin G; Xu, Yawen; Stampalija, Tamara; Durosier, Lucien D; Herry, Christophe; Wang, Xiaogang; Casati, Daniela; Seely, Andrew Je; Alfirevic, Zarko; Gao, Xin; Ferrazzi, Enrico

    2014-12-01

    Fetal monitoring during labour currently fails to accurately detect acidemia. We developed a method to assess the multidimensional properties of fetal heart rate variability (fHRV) from trans-abdominal fetal electrocardiogram (fECG) during labour. We aimed to assess this novel bioinformatics approach for correlation between fHRV and neonatal pH or base excess (BE) at birth.We enrolled a prospective pilot cohort of uncomplicated singleton pregnancies at 38-42 weeks' gestation in Milan, Italy, and Liverpool, UK. Fetal monitoring was performed by standard cardiotocography. Simultaneously, with fECG (high sampling frequency) was recorded. To ensure clinician blinding, fECG information was not displayed. Data from the last 60 min preceding onset of second-stage labour were analyzed using clinically validated continuous individualized multiorgan variability analysis (CIMVA) software in 5 min overlapping windows. CIMVA allows simultaneous calculation of 101 fHRV measures across five fHRV signal analysis domains. We validated our mathematical prediction model internally with 80:20 cross-validation split, comparing results to cord pH and BE at birth.The cohort consisted of 60 women with neonatal pH values at birth ranging from 7.44 to 6.99 and BE from -0.3 to -18.7 mmol L(-1). Our model predicted pH from 30 fHRV measures (R(2) = 0.90, P base balance at birth. Further refinement and validation in larger cohorts are needed. These new measurements of fHRV might offer a new opportunity to predict fetal acid-base balance at birth. PMID:25407948

  6. Food-induced acute generalized exanthematous pustulosis in a pregnant woman.

    Science.gov (United States)

    Valkova, Sonya

    2006-01-01

    skin biopsy specimen of lesional skin revealed subcorneal pustules containing leukocytes and necrotic keratinocytes and a mixed perivascular inflammatory infiltrate with isolated eosinophils in the dermis (Figure 3). The patient was treated with systemic methylprednisolone in gradually reduced doses, fluocinonide cream 0.05%, and emollients. As a result, her fever disappeared and her erythema faded. Frequent obstetric examination and cardiotocography were normal and showed no evidence of placental insufficiency. At 40 weeks' gestation, the patient spontaneously gave birth without any complications to a healthy boy. She was discharged with complete resolution of the skin lesions, preceded by massive desquamation of the epidermis. The 1-year follow-up of the patient revealed no relapses or new pustular eruptions.

  7. Is scar tenderness a reliable sign of scar complications in labor?

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    Isha Gutgutia

    2012-12-01

    Full Text Available Background: Cesarean section has come a long way from being a risky & restrictive surgery to one that is safe and quick. Due to a rise in the rates of primary caesarean section globally, repeat cesarean section has also become very common. The chief concern during labor with scarred uteri is that of scar rupture which can have devastating fetal and maternal consequences, including mortality. Several studies monitoring for the features of scar rupture like abnormal cardiotocography (CTG, severe abdominal pain persisting between contractions, acute onset scar tenderness, hematuria or abnormal vaginal bleeding, maternal tachycardia or shock, cessation of uterine activity and loss of station of the presenting part exist with the exception of scar tenderness which has not been evaluated separately in any study. The present prospective observational study was undertaken in a tertiary care hospital to evaluate the sensitivity and specificity of scar tenderness as a sign of scar complications in labor. Methods: 78 women with one previous cesarean delivery in spontaneous labor at term undergoing trial of scar were monitored for progress of labor and observed for vaginal bleeding, scar tenderness, maternal pulse and blood pressure every 30 minutes. Scar tenderness was elicited by pressing below and behind the pubic symphysis in between uterine contractions while engaging the woman in conversation and noting for a visible wince. Fetal heart rate auscultation was done as per protocol. Trial of scar was terminated for scar tenderness, unexplained maternal tachycardia, fresh vaginal bleeding, fetal heart rate abnormalities and non-progress of labor. Results: The sensitivity and specificity of scar tenderness as a predictor of scar complications was 92.3% and 3.8%, while accuracy was 33.3%. The likelihood ratio of a positive sign of scar tenderness being associated with scar complications in labour is 1.48. Maternal tachycardia was not a significant predictor

  8. Treatments of pelvic girdle pain in pregnant women: adverse effects of standard treatment, acupuncture and stabilising exercises on the pregnancy, mother, delivery and the fetus/neonate

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    Ladfors Lars

    2008-06-01

    Full Text Available Abstract Background Previous publications indicate that acupuncture is efficient for the treatment of pelvic girdle pain, PGP, in pregnant women. However, the use of acupuncture for PGP is rare due to insufficient documentation of adverse effects of this treatment in this specific condition. The aim of the present work was to assess adverse effects of acupuncture on the pregnancy, mother, delivery and the fetus/neonate in comparison with women that received stabilising exercises as adjunct to standard treatment or standard treatment alone. Methods In all, 386 women with PGP entered this controlled, single-blind trial. They were randomly assigned to standard treatment plus acupuncture (n = 125, standard treatment plus specific stabilising exercises (n = 131 or to standard treatment alone (n = 130 for 6 weeks. Acupuncture that may be considered strong was used and treatment was started as early as in the second trimester of pregnancy. Adverse effects were recorded during treatment and throughout the pregnancy. Influence on the fetus was measured with cardiotocography (CTG before-during and after 43 acupuncture sessions in 43 women. A standardised computerized method to analyze the CTG reading numerically (Oxford 8000, Oxford, England was used. After treatment, the women rated their overall experience of the treatment and listed adverse events if any in a questionnaire. Data of analgesia and oxytocin augmentation during labour, duration of labour, frequency of preterm birth, operative delivery, Apgar score, cord-blood gas/acid base balance and birth weight were also recorded. Results There were no serious adverse events after any of the treatments. Minor adverse events were common in the acupuncture group but women rated acupuncture favourably even despite this. The computerized or visually assessed CTG analyses of antenatal recordings in connection with acupuncture were all normal. Conclusion This study shows that acupuncture administered with a

  9. Assessment of coupling between trans-abdominally acquired fetal ECG and uterine activity by bivariate phase-rectified signal averaging analysis.

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    Daniela Casati

    Full Text Available Couplings between uterine contractions (UC and fetal heart rate (fHR provide important information on fetal condition during labor. At present, couplings between UC and fHR are assessed by visual analysis and interpretation of cardiotocography. The application of computerized approaches is restricted due to the non-stationarity of the signal, missing data and noise, typical for fHR. Herein, we propose a novel approach to assess couplings between UC and fHR, based on a signal-processing algorithm termed bivariate phase-rectified signal averaging (BPRSA.Electrohysterogram (EHG and fetal electrocardiogram (fECG were recorded non-invasively by a trans-abdominal device in 73 women at term with uneventful singleton pregnancy during the first stage of labor. Coupling between UC and fHR was analyzed by BPRSA and by conventional cross power spectral density analysis (CPSD. For both methods, degree of coupling was assessed by the maximum coefficient of coherence (CPRSA and CRAW, respectively in the UC frequency domain. Coherence values greater than 0.50 were consider significant. CPRSA and CRAW were compared by Wilcoxon test.At visual inspection BPRSA analysis identified coupled periodicities in 86.3% (63/73 of the cases. 11/73 (15% cases were excluded from further analysis because no 30 minutes of fECG recording without signal loss was available for spectral analysis. Significant coupling was found in 90.3% (56/62 of the cases analyzed by BPRSA, and in 24.2% (15/62 of the cases analyzed by CPSD, respectively. The difference between median value of CPRSA and CRAW was highly significant (0.79 [IQR 0.69-0.90] and 0.29 [IQR 0.17-0.47], respectively; p<0.0001.BPRSA is a novel computer-based approach that can be reliably applied to trans-abdominally acquired EHG-fECG. It allows the assessment of correlations between UC and fHR patterns in the majority of labors, overcoming the limitations of non-stationarity and artifacts. Compared to standard techniques of

  10. Pregnancy with hyperthyroidism

    International Nuclear Information System (INIS)

    Objective: The purpose of the study was (i) to diagnose the pregnant women suffering from hyperthyroidism by differentiating their symptoms from normal pregnancy and confirming this disease biochemically and (ii) to treat such patients medically to achieve euthyroid state of the mother while monitoring the developing fetus for better obstetrical outcome. Subjects and Methods: A total of 30 patients in reproductive age group, suffering from hyperthyroidism with pregnancy, were studied. Patients were recruited in the study in their first trimester having no associated medical problems. The patients were divided into two groups. Group I patients were diagnosed by hyperthyroidism for the first time during pregnancy by biochemical methods. These patients were treated medically methods. These patients were treated medically. After treatment effects on their previous obstetrical complications, general health and fetal well-being were monitored. The group II patients were already under medical treatment and served as control. Their thyroid status in all trimesters, types of medicine, dose adjustment and maternal and fetal well-being were compared with the patients of group I. The patients of both the groups were treated medically with beta blockers and anti-thyroids drugs mainly carbimazole. For fetal monitoring, ultrasonography (USG) and cardiotocography (CTG) were carried out. Results: The most common type of hyperthyroidism, in patients of both the groups was toxic nodular goiter that affected 70% of the patients. The most common previous obstetrical complication in patients of both the groups was abortion (85.7%), followed by premature labour (7%). Carbimazole was the drug of choice given to 70% and 60% patients of group I and group II respectively. Having achieved euthyroid state, dose reduction was possible in 65% patients of group I and 83% patients of group II. Conclusion: Euthyroid state in mothers, by the time of deliver, can be easily achieved with antithyroid

  11. Correlating multidimensional fetal heart rate variability analysis with acid-base balance at birth

    International Nuclear Information System (INIS)

    Fetal monitoring during labour currently fails to accurately detect acidemia. We developed a method to assess the multidimensional properties of fetal heart rate variability (fHRV) from trans-abdominal fetal electrocardiogram (fECG) during labour. We aimed to assess this novel bioinformatics approach for correlation between fHRV and neonatal pH or base excess (BE) at birth. We enrolled a prospective pilot cohort of uncomplicated singleton pregnancies at 38–42 weeks’ gestation in Milan, Italy, and Liverpool, UK. Fetal monitoring was performed by standard cardiotocography. Simultaneously, with fECG (high sampling frequency) was recorded. To ensure clinician blinding, fECG information was not displayed. Data from the last 60 min preceding onset of second-stage labour were analyzed using clinically validated continuous individualized multiorgan variability analysis (CIMVA) software in 5 min overlapping windows. CIMVA allows simultaneous calculation of 101 fHRV measures across five fHRV signal analysis domains. We validated our mathematical prediction model internally with 80:20 cross-validation split, comparing results to cord pH and BE at birth. The cohort consisted of 60 women with neonatal pH values at birth ranging from 7.44 to 6.99 and BE from −0.3 to −18.7 mmol L−1. Our model predicted pH from 30 fHRV measures (R2 = 0.90, P < 0.001) and BE from 21 fHRV measures (R2 = 0.77, P < 0.001). Novel bioinformatics approach (CIMVA) applied to fHRV derived from trans-abdominal fECG during labor correlated well with acid-base balance at birth. Further refinement and validation in larger cohorts are needed. These new measurements of fHRV might offer a new opportunity to predict fetal acid-base balance at birth. (fast track communication)

  12. STUDY OF MATERNAL AND FETAL OUTCOME AND FACTORS AFFECTING SUCCESS WITH VAGINAL BIRTH AFTER CESAREAN SECTION IN TERTIARY CARE CENTRE

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    Vijayasree

    2014-01-01

    Full Text Available Cesarean section must be justified only when benefits outweigh harm to the mother and fetus. The impact of Cesarean section on maternal and child health and its high cost compared with vaginal birth represent a public health problem. Cesarean section rate is increasing globally and reported to be 25 - 30% in recent studies . Several factors contribute to this increase , but repeat CS stands as the most relevant factor and contribute to about 29% of performed CS. One of the strategies proposed to reduce the CS rate is to increase the number of trials of labor among women who had previous one lower segment cesarean section. However , concern still remains r egarding associated maternal or neonatal complications and factors that lead to success or failure of VBAC. So , we undertook this study to evaluate the factors affecting success of VBAC. AIMS AND OBJECTIVE: To study maternal and fetal outcomes associated w ith trial of vaginal birth after cesarean section and to evaluate factors associated with its success. MATERIALS AND METHODS : It is an Observational prospective study performed on 100 partu rients in the department of OBG, in Mamata General Hospital , K hammam , Andhra Pradesh. Patients with previous one lower segment Cesarean section and a single fetus with cephalic presentation without cephalo - pelvic disproportion were included in the study. These women were given a trial for vaginal birth with observati on during labor by a partogram and external fetal cardiotocography. RESULTS: Vaginal birth was successful in 50%. Repeat Cesarean section was done in the other 50% due to suspicious scar (62% , fetal distress (24% and failure to progress (14%. Scar Ruptu re occurred in (6% , postpartum hemorrhage in (4% , neonatal incubation in (10% and the neonatal mortality was (2%. Vaginal birth was significantly higher in the age group 20 - 30 years , body mass index in between 20 - 25 , patients with prior vaginal birth , inter - pregnancy interval

  13. Sonda de Foley cervical versus misoprostol vaginal para o preparo cervical e indução do parto: um ensaio clínico randomizado Cervical Foley catheter versus vaginal misoprostol for cervical ripening and induction of labor: a randomized clinical trial

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    Maria Virginia de Oliveira e Oliveira

    2010-07-01

    oxytocin (41.2 versus 76.2%, and this group presented more tachysystole (21.2 versus 5.0%. The Foley catheter caused more discomfort to the patient (28.7 versus 1.2%. There were no differences in the time required for development of the Bishop score (20.69 versus 21.36 hours, for triggering delivery (36.42 versus 29.57 hours or in rates of cesarean delivery (51.2 versus 42.5%. There were no significant differences in perinatal performance, with similar rates of abnormal cardiotocography (20.0 versus 21.2%, presence of meconium (13.7 versus 17.5% and need for neonatal intensive care unit (3.7 versus 6.2%. CONCLUSIONS: the use of the Foley catheter was as effective as misoprostol for cervical ripening, but less effective in triggering spontaneous labor. Our results support the recommendation of its use for cervical ripening, especially in patients with cesarean scar.

  14. Fatores Prognósticos para o Óbito Perinatal em Gestações com Diástole Zero ou Reversa na Dopplervelocimetria das Artérias Umbilicais Prognostic Parameters for Perinatal Death in Pregnancies with Absent or Reversed End-Diastolic Flow Velocity in the Umbilical Arteries

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    Roseli Mieko Yamamoto

    2000-01-01

    Full Text Available Objetivos: estudar os fatores prognósticos para o óbito perinatal em gestações com diagnóstico de diástole zero (DZ ou reversa (DR na dopplervelocimetria das artérias umbilicais. Métodos: foram analisadas retrospectivamente 204 gestantes com DZ ou DR, sendo realizados os exames de cardiotocografia, perfil biofísico fetal, índice do líquido amniótico e dopplervelocimetria do ducto venoso e das artérias umbilicais, uterinas, aorta e cerebral média. Em 170 casos foi aplicado o modelo de regressão logística para determinar a variável com melhor acurácia na predição do óbito perinatal. Resultados: a mortalidade foi de 28 casos de óbito fetal (13,7% e 45 de óbito pós-natal (22,1%. Houve correlação significativa entre os óbitos e as variáveis analisadas. A proporção de óbitos no grupo com recém-nascidos de peso inferior a 1.000 g foi de 74,7% e no grupo com idade gestacional inferior a 31 semanas, de 66,3%. Na regressão logística, o peso do recém-nascido foi a melhor variável capaz de predizer o óbito perinatal (pPurpose: to study the prognostic parameters for perinatal death in pregnancies with absent or reversed end-diastolic flow velocity on umbilical artery dopplervelocimetry. Methods: two hundred and four pregnancies were retrospectively reviewed. The methods used were cardiotocography, fetal biophysical profile, amniotic fluid index and dopplervelocimetry of ductus venosus, fetal aorta, middle cerebral artery, umbilical arteries and uterine artery. The logistic regression model was applied to one hundred and seventy cases in order to determine the most accurate variable for predicting perinatal death. Results: the mortality rates were: 28 cases of intrauterine fetal death (13.7% and 45 neonatal deaths (22.1%. A statistically significant correlation was found between death and the studied variables. The perinatal death rate in the group with birth weight below 1,000 g was 74.7%, and in the group with

  15. Sentimentos e percepções de puérperas com relação à assistência prestada pelo serviço materno-infantil de um hospital universitário Mother's feelings and perceptions of the obstetric-neonatal care in an a terciary level teaching hospital

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    Ligia Maria Suppo de Souza Rugolo

    2004-12-01

    . chi2 test or Fisher test were used to compare groups and wards, alpha = 5%. RESULTS: obstetric ultrasound and cardiotocography had positive impacts on maternal emotion. Small differences were determined between the three groups related to their feelings before and following delivery. Prevalent feelings were: love, happiness, responsibility, anxiety and fear. Guilt was frequent among adolescents in the maternity wards. Mothers' perception of babies, their evaluation of postnatal care and caregivers were the same for adult and adolescent mothers. In both maternity wards mothers and caregivers related well, mothers were happy with the neonatal care they were receiving and with their caregivers; however breast feeding was not valued enough and few mothers knew who their doctors were. CONCLUSIONS: a more humane approach for mothers and newborns is taking place at the university hospital but some aspects could be improved on specially pertaining to focus on breastfeeding and a more personal contact between doctors and patients.

  16. Concordância entre a percepção materna dos movimentos fetais e a visualização pela ultrassonografia Agreement between maternal perception of fetal movements and visualization by ultrasound

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    Roseli Mieko Yamamoto Nomura

    2013-02-01

    Full Text Available OBJETIVO: Verificar, em gestantes de baixo risco, a concordância entre a percepção materna dos movimentos fetais e os movimentos constatados simultaneamente pela ultrassonografia. MÉTODOS: Foram avaliadas 20 gestantes com os seguintes critérios de inclusão: feto único e vivo; idade materna entre 18 e 35 anos; idade gestacional entre 36 e 40 semanas completas; morfologia fetal normal ao exame ultrassonográfico; ausência de morbidades clínicas ou obstétricas. A gestante foi avaliada por dez minutos, período em que foi monitorada com aparelho de cardiotocografia para registro dos movimentos fetais acionados com o marcador de eventos, com a velocidade do papel ajustada para 3 cm/min. Simultaneamente foi realizada observação dos movimentos fetais pela ultrassonografia. RESULTADOS: A análise de concordância interobservador pela análise de kappa obteve o índice de 0,62, caracterizando boa concordância (IC95% 0,45 - 0,79. O coeficiente de correlação intraclasse foi de 0,82 (IC95% 0,61 - 0,92. A análise pelo gráfico de Bland & Altman indicou boa concordância. A análise pela regressão linear demonstrou correlação significativa entre a percepção materna (x e a observação pela ultrassonografia (y (r²=0,71; pPURPOSE: To determine the agreement between maternal perception of fetal movements and the movements recorded simultaneously by ultrasound in low-risk pregnancies. METHODS: Twenty pregnant women were evaluated with the following inclusion criteria: single pregnancy, alive fetus, maternal age between 18 and 35 years; between 36 and 40 weeks gestation; normal fetal morphology at ultrasound, and absence of maternal comorbidities. The pregnant women were evaluated for 10 minutes, during which cardiotocography was used to record fetal movements triggered with the event marker, with the paper speed set at 3 cm/min. At the same time, fetal movements were observed by ultrasonography. RESULTS: The kappa index for interobserver

  17. Low Apgar scores at 5 minutes in a low risk population: maternal and obstetrical factors and postnatal outcome Baixos índices de Apgar no quinto minuto de vida em população de baixo risco: fatores maternos e obstétricos e resultados pós-natais

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    Eugenia Maria Assunção Salustiano

    2012-10-01

    Full Text Available OBJECTIVE: To evaluate the association between Apgar scores of less than seven at five minutes (AS5min 7 at 5 minutes who were randomly selected by a computer program. The main outcomes were neonatal death, newborn respiratory distress, need for orotracheal intubation and neonatal intensive care unit (NICU, and hypoxic-ischemic-encephalopathy. RESULTS: After multiple regression analysis, repeated late decelerations on cardiotocography (OR: 2.4; 95% CI: 1.4-4.1 and prolonged second stage of labor (OR: 3.3; 95% CI: 1.3-8.3 were associated with AS5min 0.05. CONCLUSION: Repeated late decelerations and prolonged second stage of labor in the low-risk population are predictors of AS5min OBJETIVO: Avaliar a associação entre índice de Apgar menor que sete no 5º minuto, os fatores pré-natais e resultados pós-natais. MÉTODOS: Trata-se de estudo retrospectivo com 27.252 recém-nascidos em maternidade escola com população de baixo risco obstétrico, de janeiro de 2003 a dezembro de 2010. Prontuários de todos os casos com índice de Apgar 7 no 5º minuto, escolhidos ao acaso, foram revisados. Os principais desfechos estudados foram: óbito neonatal, insuficiência respiratória neonatal, necessidade de intubação orotraqueal e de unidade terapia intensiva (UTI neonatal e encefalopatia hipóxico-isquêmica. RESULTADOS: Após análise de regressão múltipla, desacelerações tardias (DIP II (OR: 2,4; IC95%: 1,4-4,1 e período expulsivo prolongado (OR: 3,3; IC 95%: 1,3-8,3 se associaram com Apgar < 7 no 5º minuto; assim como com insuficiência respiratória ao nascimento (OR: 3,0; IC 95%: 1,3-6,9, intubação traqueal (OR: 2,5; IC 95%: 1,2-4,8, necessidade de UTI neonatal (OR: 9,5; IC 95%: 6,7-16,8 e encefalopatia hipóxico-isquêmica (OR: 14,1; IC 95%: 3,6-54,7. Nenhuma outra variável prénatal se associou com Apgar < 7 no 5º minuto (p < 0,05. CONCLUSÃO: DIP II e período expulsivo prolongado estão associados com Apgar < 7 no 5º minuto em

  18. The Condition of Thyroid and Fetoplacental Systems in Pregnant Women with Clinically Euthyroid Goiter

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    V N Petrova

    2007-03-01

    Full Text Available The aim is to study a condition of thyroid and fetoplacental systems at pregnant women with clinically euthyroid goiter. Materials and methods: 116 pregnant women have been included in the basic group with clinically euthyroid goiter. The control group was made by 60 pregnant women with physiologically proceeding pregnancy, not having anamnestic and the clinical data on diseases of the thyroid. Inspection included: definition of concentration thyroid-stimulating hormone (TSH and free thyroxine (fT4 by a radio-immunologic method, sets “RIA-gnost” (France and the maintenance of antibodies to thyroid peroxydase (anti-TPO by a method hard phase immune-enzyme analysis; ultrasonic assessment of a thyroid with the help of device SONOACE 8800 “GAIA MT”; ultrasonic fetometry, placentography, measurement of amniotic fluid volume, doppler ultrasound examination of the blood flow, an estimation of a functional condition of a fetus on parameters of its biophysical profile (BP and cardiotocography (CTG, carried out on device “Oxford Sonicaid Team S8000”. Results: At studying hormonal function thyroid systems at 25 pregnant (21.6% with euthyroid goiter in the third trimester of pregnancy a level fT4 norms were lower and had values from 4.5 up to 6.9 ng/ml, therefore an average level fT4 at pregnant women of the basic group was authentically lower, than in control (8.26 ± 0.30 and 10.71 ± 0.52 ng/ml, accordingly. At the retrospective analysis it is established, that only at 5 of 116 (4.3% pregnant women with a goiter were not complications pregnancy, at the others — 111 (95.7% took place a combination various obstetric complications: an anemia — at 72 (62.0%, threat noncarrying of pregnancy — at 75 (64.6 %, an early toxicosis — at 45 (38.6%, a gestosis — at 47 (40.5% which frequency authentically is higher, than in control group: 20.0%, 25.0%, 16.6%. 20.0%, accordingly, р < 0.05. Average Estimation CTG at patients of the basic group is

  19. Fatores que influenciam a transmissão vertical do vírus da imunodeficiência humana tipo 1 Risk factors for vertical transmission of the human immunodeficiency virus type 1

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    Geraldo Duarte

    2005-11-01

    ões mamilares, que podem ser resumidos no contexto da amamentação natural.One of the most important advances in the control of the spread of infection with type 1 human immunodeficiency virus (HIV-1 occurred within the context of vertical transmission (VT, with a reduction from levels of more than 40% to levels of less than 3%. Technological progress together with a better physiopathological understanding of this infection has permitted the determination of the situations and factors that increase the rates of perinatal transmission of the virus, indicating which interventions are most adequate for its control. The situations of higher risk for VT of HIV involve maternal, adnexal, obstetrical, fetal, viral, and postnatal factors. Among maternal factors, particularly important is viral load, the major indicator of the risk of this form of transmission. However, despite its relevance, viral load is not the only variable in this equation, with the following factors also playing important roles: use of illicit drugs, multiple sex partners and unprotected sex, malnutrition, smoking habit, advanced maternal disease, and lack af access or compliance with antiretroviral drugs. Among the adnexal factors are prolonged chorion-amniorrhexis, loss of placental integrity, and the expression of secondary receptors in placental tissue. Among the obstetrical factors, it should be remembered that invasive interventions in the fetus or amniotic chamber, internal cardiotocography, type of delivery, and contact of the fetus/newborn infant with maternal blood are also important elements to be controlled. Among the fetal factors are the expression of secondary HIV-1 receptors, genetic susceptibility, reduced cytotoxic T-lymphocyte function, and prematurity. Among the viral factors, mutations and syncytium-inducing strains are believed to be risk factors for VT. Finally, there are postnatal factors represented by an elevated viral load in maternal milk, a low antibody concentration in this fluid

  20. Prolonged and post-term pregnancies: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF).

    Science.gov (United States)

    Vayssière, Christophe; Haumonte, Jean-Baptiste; Chantry, Anne; Coatleven, Frédéric; Debord, Marie Pascal; Gomez, Conchita; Le Ray, Camille; Lopez, Emmanuel; Salomon, Laurent J; Senat, Marie Victoire; Sentilhes, Loïc; Serry, Aurelie; Winer, Norbert; Grandjean, Hélène; Verspyck, Eric; Subtil, Damien

    2013-07-01

    pregnancy began is defined by the date of oocyte retrieval (Professional consensus). From 37(0-6) to 43(0-6) weeks, the risk of perinatal mortality increases regularly and there is no threshold at which a clear increase in perinatal mortality becomes visible. Fetal monitoring by cardiotocography (CTG) that begins at 41(+0) weeks would cover approximately 20% of women and reduce perinatal morbidity compared with monitoring that begins at 42(+0) weeks (grade C). The frequency recommended for this monitoring ranges between two and three times a week (Professional consensus). For ultrasonography assessment, measurement of the largest fluid pocket is recommended, because measurement of the amniotic fluid index (that is, the sum of the four quadrants) is accompanied by more diagnoses of oligohydramnios, inductions of labor, and cesareans for fetal distress without any improvement in neonatal prognosis (grade A). The practice of assessing the Manning biophysical score increases the number of diagnoses of oligohydramnios and fetal heart rage (FHR) abnormalities and generates an increase in the rates of inductions and cesareans without improving neonatal prognosis. The use of this biophysical score in monitoring prolonged pregnancies is therefore not recommended (grade B). In the absence of a specific disorder, induction of labor can be proposed in patients between 41(+0) and 42(+6) weeks (grade B). Nonetheless, the choice of prolongation beyond above 42(+0) weeks appears to involve an increase in fetal risk, which must be explained to the patient and balanced against the potential disadvantages of induction (Professional consensus). Stripping the membranes can reduce the duration of pregnancy by increasing the number of patients going into labor spontaneously during the week afterward (grade B). Compared to an expectant approach, it does not increase the cesarean section rate (grade A). It reduces recourse to induction by 41% at 41(+0) weeks and by 72% at 42(+0) weeks (grade B

  1. Evolução e prognóstico materno-fetal da cirurgia cardíaca durante a gravidez Evolución y pronóstico materno-fetal de la cirugía cardiaca durante el embarazo Maternal-fetal outcome and prognosis of cardiac surgery during pregnancy

    Directory of Open Access Journals (Sweden)

    Walkiria Samuel Ávila

    2009-07-01

    edad gestacional superior a 20 semanas. RESULTADOS: El promedio de edad materna fue de 27,8 ± 7,6 años, con predominio de valvulopatía reumática (87,8%, y 15 de ellas (41,6% se sometieron a reoperación, debido a disfunción de prótesis valvular. El promedio del tiempo de circulación extracorpórea fue de 87,4 ± 43,6 min, y se utilizó la hipotermia en 27 casos (67,5%. Trece madres (31,7% no presentaron intercurrencias y tuvieron sus recién nacidos vivos y sanos. La evolución postoperatoria de las demás 28 gestaciones (68,3% reveló: 17 complicaciones maternas (41,5%; tres óbitos (7,3%; 12 pérdidas fetales (29,2% y 4 casos de malformación neurológica (10%, dos de los cuales evolucionaron para óbito tardío. Hubo una pérdida de seguimiento tras la cirugía. Se operaron a nueve pacientes (21,9% en carácter de emergencia, situación que influenció (p BACKGROUND: Cardiac surgery improves the maternal prognosis in cases refractory to medical therapy. However, it is associated with risks to the fetus when performed during pregnancy. OBJECTIVE: To analyze maternal-fetal outcome and prognosis related to cardiac surgery performed during pregnancy and puerperium. METHODS: The outcome of 41 gestations of women undergoing cardiac surgery during pregnancy and puerperium was studied. Fetal cardiotocography was performed throughout the procedure in patients with gestational age above 20 weeks. RESULTS: Mean maternal age was 27.8 ± 7.6 years; there was a predominance of patients with rheumatic valve disease (87.8%, of whom 15 (41.6% underwent reoperation due to prosthetic valve dysfunction. Mean extracorporeal circulation time was 87.4± 43.6min and hypothermia was used in 27 (67.5% cases. Thirteen (31.7% mothers experienced no events and gave birth to live healthy newborns. Postoperative outcome of the remaining 28 (68.3% pregnancies showed: 17 (41.5% maternal complications and three (7.3% deaths; 12 (29.2% fetal losses, and four (10% cases of neurological

  2. Monitorização materno-fetal durante procedimento odontológico em portadora de cardiopatia valvar Monitoreo maternofetal durante procedimiento odontológico en portadora de cardiopatía valvular Maternal-fetal monitoring during dental procedure in patients with heart valve disease

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    Itamara Lucia Itagiba Neves

    2009-11-01

    , electrocardiografía ambulatoria materna y cardiotocografía de 31 portadoras de cardiopatía reumática, entre la 28ª y la 37ª semana de gestación, divididas en dos grupos según la presencia o no del vasoconstrictor. RESULTADOS: Se observó reducción significativa de los valores de frecuencia cardíaca materna en los dos grupos, durante el procedimiento, al compararlo con los demás períodos (p 0,05. Lo mismo ocurrió (p > 0,05 con el número de contracciones uterinas, nivel de variabilidad de la línea de base y número de aceleraciones de la frecuencia cardíaca fetal. CONCLUSIÓN: El uso de 1,8 ml de lidocaína 2% asociado a la adrenalina se mostró seguro y eficaz en procedimiento odontológico restaurador durante la gestación de mujeres con cardiopatía valvular reumática.BACKGROUND: The effects of local dental anesthesia with lidocaine and epinephrine on cardiovascular parameters of pregnant women with heart valve diseases and their fetuses are not fully understood. OBJECTIVES: To assess and analyze cardiotocographic, blood pressure and electrocardiographic parameters of pregnant women with rheumatic heart valve disease undergoing local anesthesia with 1.8mL of lidocaine 2% with or without epinephrine 1:100,000 during restorative dental treatment. METHODS: Maternal ambulatory blood pressure and electrocardiographic monitoring as well as cardiotocography of 31 patients with rheumatic heart disease were performed between the 28th and 37th week of gestation. The patients were divided into two groups, those with or without vasoconstrictor. RESULTS: A significant reduction in maternal heart rate was shown in both groups during the procedure in comparison with the other periods (p0.05. The same occurred (p>0.05 with the number of uterine contractions, baseline level and variability, and number of accelerations of fetal heart rate. CONCLUSION: The use of 1.8mL of lidocaine 2% in combination with epinephrine was safe and efficient in restorative dental procedures during

  3. Comparação dos padrões da frequência cardíaca fetal no segundo e terceiro trimestres da gestação Comparison of fetal heart rate patterns in the second and third trimesters of pregnancy

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    Roseli Mieko Yamamoto Nomura

    2010-09-01

    criteria were: singleton pregnancy, live fetus, pregnant women without clinical or obstetrical complications, no fetal malformation, gestational age between 24 and 27 weeks (2nd trimester - 2T or between 36 and 40 weeks (3rd trimester - 3T. Computerized cardiotocography (System 8002 - Sonicaid was performed for 30 minutes and the fetal biophysical profile was obtained. System 8002 analyzes the FHR tracings for periods of 3.75 seconds (1/16 minutes. During each period, the mean duration of the time intervals between successive fetal heart beats is determined in milliseconds (ms; the mean FHR and also the differences between adjacent periods are calculated for each period. The parameters included: basal FHR, FHR accelerations, duration of high variation episodes, duration of low variation episodes and short-term variation. The dataset was analyzed by the Student t test, chi-square test and Fisher's exact test. Statistical significance was set at p 10 bpm (3.7 bpm versus 8.4 bpm, p 15 bpm (mean, 0.9 bpm versus 5.4 bpm, p <0.001, mean duration of high variation episodes (8.4 min versus 15.4 min, p=0.008 and mean short - term variation (8.0 ms versus 10.9 ms, p=0.01. The fetal biophysical profile showed normal results in all pregnancies. CONCLUSION: the present study shows significant differences in the FHR characteristics when the 2nd and 3rd trimesters of pregnancy are compared and confirms the influence of autonomic nervous system maturation on FHR regulation.

  4. Ultrassonografia do colo uterino versus índice de Bishop como preditor do parto vaginal Cervical ultrasonography versus Bishop score as a predictor of vaginal delivery

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    José Richelmy Brazil Frota Aragão

    2011-11-01

    with Bishop’s score for the prediction of vaginal delivery after labor induction, with 25 mcg of misoprostol. METHODS: a prospective study for the validation of a diagnostic test was conducted on 126 pregnant women with indication for labor induction. The patients were evaluated by Bishop’s score and transvaginal ultrasonography for cervical measurement. They also undergone obstetric transabdominal ultrasound to evaluate static and fetal weight, as well as the amniotic fluid index, and basal cardiotocography for the evaluation of fetal vitality. Labor was induced with vaginal and sublingual misoprostol, one of the tablets containing 25 mcg of the drug and the other only placebo. The tablets were administered every six hours, with a maximum number of eight. Frequency tables were obtained, and measures of central tendency and dispersion were calculated. ROC curves were constructed for the evaluation of Bishop’s score and ultrasonographic measurement of the uterine cervix for the prediction of vaginal delivery. RESULTS: the area under the ROC curve was 0.5 (p=0.8 for the ultrasonographic measurement of the uterine cervix, and 0.6 (p=0.02 for Bishop’s score (cut point ³4. Bishop’s score had a sensitivity of 56.2% and specificity of 67.9% for prediction of vaginal delivery, with a positive likelihood ratio of 1.75 and a negative one of 0.65. CONCLUSIONS: ultrasonographic measurement of the uterine cervix was not a good predictor of evolution to vaginal delivery among patients with misoprostol-induced labor. Bishop’s score was a better predictor of vaginal delivery under these circumstances.

  5. Prolonged and post-term pregnancies: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF).

    Science.gov (United States)

    Vayssière, Christophe; Haumonte, Jean-Baptiste; Chantry, Anne; Coatleven, Frédéric; Debord, Marie Pascal; Gomez, Conchita; Le Ray, Camille; Lopez, Emmanuel; Salomon, Laurent J; Senat, Marie Victoire; Sentilhes, Loïc; Serry, Aurelie; Winer, Norbert; Grandjean, Hélène; Verspyck, Eric; Subtil, Damien

    2013-07-01

    pregnancy began is defined by the date of oocyte retrieval (Professional consensus). From 37(0-6) to 43(0-6) weeks, the risk of perinatal mortality increases regularly and there is no threshold at which a clear increase in perinatal mortality becomes visible. Fetal monitoring by cardiotocography (CTG) that begins at 41(+0) weeks would cover approximately 20% of women and reduce perinatal morbidity compared with monitoring that begins at 42(+0) weeks (grade C). The frequency recommended for this monitoring ranges between two and three times a week (Professional consensus). For ultrasonography assessment, measurement of the largest fluid pocket is recommended, because measurement of the amniotic fluid index (that is, the sum of the four quadrants) is accompanied by more diagnoses of oligohydramnios, inductions of labor, and cesareans for fetal distress without any improvement in neonatal prognosis (grade A). The practice of assessing the Manning biophysical score increases the number of diagnoses of oligohydramnios and fetal heart rage (FHR) abnormalities and generates an increase in the rates of inductions and cesareans without improving neonatal prognosis. The use of this biophysical score in monitoring prolonged pregnancies is therefore not recommended (grade B). In the absence of a specific disorder, induction of labor can be proposed in patients between 41(+0) and 42(+6) weeks (grade B). Nonetheless, the choice of prolongation beyond above 42(+0) weeks appears to involve an increase in fetal risk, which must be explained to the patient and balanced against the potential disadvantages of induction (Professional consensus). Stripping the membranes can reduce the duration of pregnancy by increasing the number of patients going into labor spontaneously during the week afterward (grade B). Compared to an expectant approach, it does not increase the cesarean section rate (grade A). It reduces recourse to induction by 41% at 41(+0) weeks and by 72% at 42(+0) weeks (grade B