Intrapartum Fetal Electrocardiogram in Small- and Large-for-Gestational Age Fetuses

Objective This study aimed to evaluate whether intrapartum fetal electrocardiogram (ECG) tracings with ST-elevation or depression occur more frequently in each stage of labor in small-for-gestational age (SGA) or large-for-gestational age (LGA), as compared with appropriate-for-gestational age (AGA) fetuses. Study Design We conducted a secondary analysis of a large, multicenter trial in which laboring patients underwent fetal ECG waveform-analysis. We excluded participants with diabetes mellitus and major fetal anomalies. Birth weight was categorized as SGA (<10th percentile), LGA (>90th percentile), or AGA (10–90th percentile) by using a gender and race/ethnicity specific nomogram. In adjusted analyses, the frequency of ECG tracings with ST-depression or ST-elevation without depression was compared according to birthweight categories and labor stage. Results Our study included 4,971 laboring patients in the first stage and 4,074 in the second stage. During the first stage of labor, there were no differences in the frequency of ST-depression in SGA fetuses compared with AGA fetuses (6.7 vs. 5.5%; adjusted odds ratio [aOR]: 1.41, 95% confidence interval [CI]: 0.93–2.13), or in ST-elevation without depression (35.8 vs. 34.1%; aOR: 1.17, 95% CI: 0.94–1.46). During the second stage, there were no differences in the frequency of ST-depression in SGA fetuses compared with AGA fetuses (1.6 vs. 2.0%; aOR: 0.69, 95% CI: 0.27–1.73), or in ST-elevation without depression (16.2 vs. 18.1%; aOR: 0.90, 95% CI: 0.67–1.22). During the first stage of labor, there were no differences in the frequency of ST-depression in LGA fetuses compared with AGA fetuses (6.3 vs. 5.5%; aOR: 0.97, 95% CI: 0.60–1.57), or in ST-elevation without depression (33.1 vs. 34.1%; aOR: 0.80, 95% CI: 0.62–1.03); during the second stage of labor, the frequency of ST-depression in LGA compared with AGA fetuses (2.5 vs. 2.0%, aOR: 1.36, 95% CI: 0.61–3.03), and in ST-elevation without depression (15.5 vs. 18.1%; aOR: 0.83, 95% CI: 0.58–1.18) were similar as well. Conclusion The frequency of intrapartum fetal ECG tracings with ST-events is similar among SGA, AGA, and LGA fetuses. Key Points

Download Full-text

1403-P: Functional Data Analysis Reveals Differences in Temporal Glucose Profiles Associated with Large for Gestational Age: A Secondary Analysis of the CONCEPTT Study

Diabetes ◽

10.2337/db19-1403-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 1403-P

Author(s):

ELEANOR M. SCOTT ◽

HELEN R. MURPHY ◽

DENICE FEIG ◽

GRAHAM LAW

Keyword(s):

Data Analysis ◽

Functional Data Analysis ◽

Gestational Age ◽

Functional Data ◽

Secondary Analysis ◽

Large For Gestational Age ◽

Glucose Profiles

Download Full-text

Locked twins—remote from term: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02725-5 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Abraham Fessehaye ◽

Ferid A. Abubeker ◽

Mekdes Daba

Keyword(s):

Gestational Age ◽

Twin Pregnancy ◽

Caesarian Section ◽

Obstetric Complication ◽

Second Stage ◽

Case Summary ◽

History Of ◽

Twin Pregnancies ◽

Abdominal Delivery ◽

First Stage Of Labor

Abstract Background Locked twins is a rare and hazardous obstetric complication, which occurs in approximately 1:100 twin pregnancies. One of the known etiologic factors for locked twins is size of the twins. We report a case of chin-to-chin locked twins that occurred at gestational age of 30 weeks pus 6 days. Case summary A 27 years-old primigravida Oromo mother presented with a history of pushing down pain and passage of liquor of 6 hours duration at gestational age of 30 weeks plus 6 days. With a diagnosis of twin pregnancy (first twin non-vertex), abdominal delivery was decided in latent first stage of labor but mother refused caesarian delivery and she was allowed to labor with the hope of achieving a vaginal delivery. In second stage, interlocking twin was encountered and a low vertical cesarean section was done to effect delivery of twins without the need to decapitate the first twin. Conclusion Locked twin is a rare obstetric complication. Whenever it is encountered, successful delivery can be achieved without the need to have decapitation of the first twin during caesarian section.

Download Full-text

First stage of labor progression in women with large-for-gestational age infants

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2019.06.042 ◽

2019 ◽

Vol 221 (6) ◽

pp. 640.e1-640.e11

Author(s):

Stephanie A. Blankenship ◽

Candice L. Woolfolk ◽

Nandini Raghuraman ◽

Molly J. Stout ◽

George A. Macones ◽

...

Keyword(s):

Gestational Age ◽

Large For Gestational Age ◽

First Stage Of Labor

Download Full-text

765: Intrapartum fetal electrocardiogram (ECG) in small and large-for-gestational age fetuses

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2018.11.788 ◽

2019 ◽

Vol 220 (1) ◽

pp. S501

Author(s):

Lena Braginsky

Keyword(s):

Gestational Age ◽

Large For Gestational Age ◽

Fetal Electrocardiogram ◽

Electrocardiogram Ecg

Download Full-text

Existing Fetal ECG Monitoring Methods

International Journal of Innovative Technology and Exploring Engineering - Special Issue ◽

10.35940/ijitee.b1147.1292s219 ◽

2019 ◽

Vol 9 (2S2) ◽

pp. 905-911

Keyword(s):

Comparative Study ◽

Gestational Age ◽

Congenital Heart ◽

Ecg Monitoring ◽

Monitoring Methods ◽

Fetal Electrocardiogram ◽

Fetal Ecg

Fetal electrocardiogram (FECG) signal holds highly precise indispensable particulars, which potentially support physicians to diagnosis the existence of congenital heart syndromes and make instantaneous assessment if required. There are several FECG examination procedures applied to have precise fetal ECG, but unflatteringly some methods have certain snags. The goal of this study paper is to exemplify the range of existing observation techniques to offer proficient and effectual means of understanding along with their mode of examination at different gestational age. A comparative study has been accomplished to demonstrate the best approach.

Download Full-text

A Non-invasive Methodology for Fetal Monitoring during Pregnancy

Methods of Information in Medicine ◽

10.3414/me09-01-0041 ◽

2010 ◽

Vol 49 (03) ◽

pp. 238-253 ◽

Cited By ~ 11

Author(s):

E. C. Karvounis ◽

M. G. Tsipouras ◽

C. Papaloukas ◽

D. G. Tsalikakis ◽

K. K. Naka ◽

...

Keyword(s):

Fetal Monitoring ◽

Waveform Analysis ◽

The Novel ◽

Automated Identification ◽

Ecg Signals ◽

Cardiac Health ◽

Non Invasive ◽

Second Stage ◽

Fetal Ecg

Summary Objectives: This paper describes a methodology for the monitoring of the fetal cardiac health status during pregnancy, through the effective and non-invasive monitoring of the abdominal ECG signals (abdECG) of the mother. Methods: For this purpose, a three-stage methodology has been developed. In the first stage, the fetal heart rate (fHR) is extracted from the abdECG signals, using nonlinear analysis. Also, the eliminated ECG (eECG) is calculated, which is the abdECG after the maternal QRSs elimination. In the second stage, a blind source separation technique is applied to the eECG signals and the fetal ECG (fECG) is obtained. Finally, monitoring of the fetus is implemented using features extracted from the fHR and f ECG, such as the T/QRS ratio and the characterization of the fetal ST waveforms. Results: The methodology is evaluated using a dataset of simulated multichannel abdECG signals: 94.79% accuracy for fHR extraction, 92.49% accuracy in T/QRS ratio calculation and 79.87% in ST waveform classification. Conclusions: The novel non-invasive proposed methodology is advantageous since it offers automated identification of fHR and fECG and automated ST waveform analysis, exhibiting a high diagnostic accuracy.

Download Full-text

Infants Born Large for Gestational Age and Developmental Attainment in Early Childhood

International Journal of Pediatrics ◽

10.1155/2018/9181497 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Cairina E. Frank ◽

Kathy N. Speechley ◽

Jennifer J. Macnab ◽

M. Karen Campbell

Keyword(s):

Gestational Age ◽

Social Factors ◽

Secondary Analysis ◽

Verbal Ability ◽

Children And Youth ◽

Large For Gestational Age ◽

Behaviour Problems ◽

Peabody Picture Vocabulary ◽

Increased Risk ◽

Externalizing Behaviour

Objectives. To investigate if an association exists between being born large for gestational age (LGA) and verbal ability or externalizing behaviour problems at ages 4-5 years. Method. A secondary analysis was conducted using the National Longitudinal Survey of Children and Youth, including singleton births in 2004-2005 followed till 4-5 years (n=1685). LGA was defined as a birth weight > 90th percentile. Outcomes included poor verbal ability (scoring < 15th percentile on the Revised Peabody Picture Vocabulary Test) and externalizing behaviour problems (scoring > 90th percentile on externalizing behaviour scales). Multivariable logistic regression with longitudinal standardized funnel weights and bootstrapping estimation were used. Results. Infants born LGA were not found to be at increased risk for poor verbal ability (aOR: 1.16 [0.49,2.72] and aOR: 0.83 [0.37,1.87] for girls and boys, resp.) or externalizing behaviour problems (aOR: 1.24 [0.52,2.93] and aOR: 1.24 [0.66,2.36] for girls and boys, resp.). Social factors were found to impact developmental attainment. Maternal smoking led to an increased risk for externalizing behaviour problems (aOR: 3.33 [1.60,6.94] and aOR: 2.12 [1.09,4.13] for girls and boys, resp.). Conclusion. There is no evidence to suggest that infants born LGA are at increased risk for poor verbal ability or externalizing behaviour problems.

Download Full-text