A Handbook of Pre-natal Paediatrics for Obstetricians and Paediatricians, edited by Gifford F. Batstone, M.B., B.S., Alastair W. Blair, M.B., Ch.B., M.R.C.P.E., D.C.H., and Jack M. Slater, M.B., Ch.B., M.R.C.O.G. Philadelphia: J. B. Lippincott, 1971, 225 pp., $10.00

PEDIATRICS ◽  
1972 ◽  
Vol 50 (5) ◽  
pp. 835-835
Author(s):  
John C. Hobbins
Keyword(s):  
Heart Rate ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Fetal Monitoring ◽  
Pertinent Information

The British authors have chosen to call this a "handbook." It may be a handbook in size but not in content. It contains more pertinent information relating to the expanding field of perinatology than most of the bulkier texts on my shelf. Although detail and filigree have been sacrificed, the book is far from dry. In the early chapters the reader is given a concise account of fetal monitoring by interpretation of continuous fetal heart rate patterns and information obtained from scalp sampling.

Effect of Oligohydramnios on Fetal Heart Rate Patterns during Term Labor Induction

2018 ◽  
Vol 36 (07) ◽  
pp. 715-722
Author(s):  
Janine S. Rhoades ◽  
Molly J. Stout ◽  
George A. Macones ◽  
Alison G. Cahill
Keyword(s):  
Heart Rate ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Secondary Analysis ◽  
Neonatal Morbidity ◽  
Fetal Monitoring ◽  
Secondary Outcome ◽  
Significant Difference ◽  
Electronic Fetal Monitoring ◽  
Consecutive Term

Objective To estimate the effect of oligohydramnios on fetal heart rate (FHR) patterns in patients undergoing induction of labor (IOL) at term. Study Design Secondary analysis of a prospective cohort study of consecutive term, singleton deliveries from 2010 to 2015. We included all patients who underwent IOL. Our primary outcomes were electronic fetal monitoring (EFM) characteristics in the 2 hours preceding delivery. Outcomes were compared between those induced with oligohydramnios and those induced without a diagnosis of oligohydramnios. Our secondary outcome was composite neonatal morbidity. Logistic regression was used to control for confounders. Results Of 3,787 patients who underwent IOL, 147 had a diagnosis of oligohydramnios and 3,640 were included in the no oligohydramnios group. There was no significant difference in EFM characteristics between the two groups. There was no difference in composite neonatal morbidity. In patients with oligohydramnios, EFM patterns with baseline tachycardia for 30 minutes or greater were significantly associated with composite neonatal morbidity (31.3 vs. 5.3% adjusted odds ratio 8.63, 95% confidence interval 2.18, 34.1]). Conclusion Term patients undergoing IOL with oligohydramnios had EFM patterns that did not differ from their induced peers.

scholarly journals Non-invasive Fetal Electrocardiography for Intrapartum Cardiotocography

2020 ◽  
Vol 8 ◽  
Author(s):  
Rik Vullings ◽  
Judith O. E. H. van Laar
Keyword(s):  
Heart Rate ◽  
Doppler Ultrasound ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Fetal Monitoring ◽  
Irreversible Damage ◽  
Scalp Electrode ◽  
Non Invasive ◽  
Electrophysiological Measurements ◽  
Fetal Electrocardiography

Fetal monitoring is important to diagnose complications that can occur during pregnancy. If detected timely, these complications might be resolved before they lead to irreversible damage. Current fetal monitoring mainly relies on cardiotocography, the simultaneous registration of fetal heart rate and uterine activity. Unfortunately, the technology to obtain the cardiotocogram has limitations. In current clinical practice the fetal heart rate is obtained via either an invasive scalp electrode, that poses risks and can only be applied during labor and after rupture of the fetal membranes, or via non-invasive Doppler ultrasound technology that is inaccurate and suffers from loss of signal, in particular in women with high body mass, during motion, or in preterm pregnancies. In this study, transabdominal electrophysiological measurements are exploited to provide fetal heart rate non-invasively and in a more reliable manner than Doppler ultrasound. The performance of the fetal heart rate detection is determined by comparing the fetal heart rate to that obtained with an invasive scalp electrode during intrapartum monitoring. The performance is gauged by comparing it to performances mentioned in literature on Doppler ultrasound and on two commercially-available devices that are also based on transabdominal fetal electrocardiography.

The Factor Time in Fetal Heart Rate Monitoring and the Detection of Acidosis Using the WAS Score

2014 ◽  
Vol 218 (02) ◽  
pp. 80-86
Author(s):  
V. Roemer ◽  
R. Walden
Keyword(s):  
Heart Rate ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Oscillation Amplitude ◽  
Fetal Monitoring ◽  
Significant Loss ◽  
Fetal Heart Rate Monitoring ◽  
Mean Frequency ◽  
Ph Values ◽  
Umbilical Blood

Abstract Background: Using the naked eye evaluation of fetal heart rate (fhr) patterns remains difficult and is not complete. Computer-aided analysis of the fhr offers the opportunity to analyze fhr patterns completely and to detect all changes due to hypoxia and acidosis. It was the goal of this study to analyze the factor time in fetal monitoring and to evaluate the association between the fhr and the actual pH values in arterial umbilical blood. Methods: During a period of 11 years the FHR signals (i. e., the R-R interval of the F-ECG) of 646 fetuses were recorded with a CTG and simultaneously by a computer. The computer files were analyzed thereafter, i. e., the results did not influence our clinical management. To enter the study, all fetuses must have been delivered by the vaginal route – in consequence without a significant loss of fhr signals. During forceps and/or vacuum deliveries recordings were continued. If necessary a new electrode was inserted. In this study recordings of fetuses with chorioamnionitis, tracings of malformed neonates and tracings shorter than 30 min were excluded. Thus 484 recordings were left. We used our own computer programs written in MATLAB (USA). 3 parameters were determined electronically: 1) the mean fetal frequency [fhf, (bpm)], 2) the number of turning points (N/min) in the fhr, which we called ‘microfluctuation’ (micro) and 3) the oscillation amplitude, oamp (bpm). Measurements of the acid-base variables from arterial (UA) and venous (UV) blood were performed using RADIOMETER equipment (ABL500) and trained personnel. However, only the actual pHUA values were used in this study. To detect the influence of hypoxia and acidosis, all 484 cases were separated into 7 groups according to the actual pHUA value: 55 fetuses lying in a small non-acidotic “pH-window” (pHUA=7.290–7.310, mean=7.300±0.008) were used as ‘controls’. Results: In humans fhf, micro and the oamp behave differently during the last 30 min of delivery and with different fetal pHUA values: micro is early (at 0 min) decreased with fetal acidemia and is steadily deceasing (68–40 N/min) during vaginal delivery; the oamp – mainly due to decelerations – is increased from 35 up to 70 bpm during the last 30 min. Hypoxia and acidosis increase the amplitude and duration of decelerations; finally fhf shows only an insignificant reaction to acidemia but is decreased (from 135 to 110 bpm) overall with the course of time. Therefore the 3 characteristics of the fhr might be ranged according to their decreasing sensitivity to acidemia as follows: 1) fetal microfluctuation, 2) oscillation amplitude and 3) mean frequency. The 3 components of the fhr were used to invent and apply a score named the WAS score. This score increases the association between the actual pHUA values and the activity of the fetal heart. The 3 variables of the fhr mentioned above were rated differently; the 3 factors necessary to achieve this were computed electronically using an optimization program. The result is the WAS score: WAS=mean [frq*ff(vj) * micro*fm (vj)/oamp*fa(vj)]j=1,30. Using the last 30 min of delivery the correlation coefficient r of this score with pHUA reaches 0.645, P<< 0.001. The regression is linear in our 484 cases. Conclusions: Microfluctuation is the most sensible variable of the fetal heart followed by the oscillation amplitude and mean frequency. The WAS score offers the best correlation with the actual pH values measured in arterial umbilical blood.

scholarly journals Use of Continuous Electronic Fetal Monitoring in a Preterm Fetus: Clinical Dilemmas and Recommendations for Practice

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Karolina Afors ◽  
Edwin Chandraharan
Keyword(s):  
Heart Rate ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Scientific Evidence ◽  
Preterm Births ◽  
Fetal Monitoring ◽  
National Guidelines ◽  
Physiological Control ◽  
Electronic Fetal Monitoring ◽  
Continuous Electronic Fetal Monitoring

The aim of intrapartum continuous electronic fetal monitoring using a cardiotocograph (CTG) is to identify a fetus exposed to intrapartum hypoxic insults so that timely and appropriate action could be instituted to improve perinatal outcome. Features observed on a CTG trace reflect the functioning of somatic and autonomic nervous systems and the fetal response to hypoxic or mechanical insults during labour. Although, National Guidelines on electronic fetal monitoring exist for term fetuses, there is paucity of recommendations based on scientific evidence for monitoring preterm fetuses during labour. Lack of evidence-based recommendations may pose a clinical dilemma as preterm births account for nearly 8% (1 in 13) live births in England and Wales. 93% of these preterm births occur after 28 weeks, 6% between 22–27 weeks, and 1% before 22 weeks. Physiological control of fetal heart rate and the resultant features observed on the CTG trace differs in the preterm fetus as compared to a fetus at term making interpretation difficult. This review describes the features of normal fetal heart rate patterns at different gestations and the physiological responses of a preterm fetus compared to a fetus at term. We have proposed an algorithm “ACUTE” to aid management.

scholarly journals Prevention of Cerebral Palsy and Fetal Demise with Hypoxia Index, FHR Score and Pathologic Sinusoidal FHR in Fetal Monitoring

2020 ◽  
pp. 1-3
Author(s):  
Kazuo Maeda
Keyword(s):  
Heart Rate ◽  
Cerebral Palsy ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Fetal Monitoring ◽  
Infantile Cerebral Palsy ◽  
Fetal Demise ◽  
Fetal Monitor

Although fetal deaths was decreased by intrapartum Fetal Heart Rate (FHR) monitoring, infantile cerebral palsy was not decreased in Dublin trials of Electric Fetal Monitor (EFM), thus, an analysis to reduce cerebral palsy was studied, where cerebral palsy is prevented by setting the threshold of hypoxia index at 24 or less, in the analysis of FHR deceleration.

ROLE OF FETAL MONITORING IN THE SECOND STAGE OF LABOR

2011 ◽  
pp. 125-136
Author(s):  
Van Phap Dang ◽  
Quang Vinh Truong ◽  
Vu Quoc Huy Nguyen ◽  
Cam An Bach ◽  
Dinh Hung Pham ◽  
...  
Keyword(s):  
Heart Rate ◽  
Apgar Score ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Total Duration ◽  
Fetal Monitoring ◽  
Second Stage Of Labor ◽  
Second Stage

Objectives: (1) to investigate the progression of the second stage of labor, (2) to evaluation of outcome of labor base on the form of the fetal monitoring. Materials and methods: Crosse sectional describe of 379 pregnant women with vertex presentation, singleton pregnancy, at term, normal pelvis, and the fetal weight was estimated to be medium according to Vietnamese size, applying the distribution in fetal heart form according to Melchior and the distribution in stage of labor according to PEOPLE. Study period: from June 2009 to December 2009. Results: The average of the age was 27.2 ± 12 years. Gestation age (weeks) was 39.1 ± 1.2. Nulliparous women was 55.67% (211 women), and multiparous women was 44.3% (168 women). 58.4% of those whose fetus was at 0 position according to Delle’s distribution. The position of the fetus was left occiput anterior which was majority, 68%. The total duration of second stage was 88 ± 25 minutes. Fetal heart rate: Type 1 was 33.7%, type 2 was 45.5%. In the type 1, when the active phase stretch to 90 minutes, the fetus was well response. In the type 2, the second stage cannot stretch as long as these, if it lasts longer then 60minutes, not even 83.37% but just also 28.5% was at good condition, should stopped labor immediately. The mean Apgar score will < 7 at 1st minutes, 40 % and 50% in type 3 and 4 respectively. Conclusions: Left occiput anterior was 68%. Total duration of the second stage of labor was 88 ± 25 minutes. Type 0, 1, 2, 3 and 4 of fetal heart rate were 3.3%; 33.7%; 45.5%; 12.1% and 7.4% respectively. Apgar score < 7 at 1st minutes with type 0, 3 and 4 after 30 minutes for the forceful, and with type 1 after 90 minutes for that.

scholarly journals A Comprehensive Review of Techniques for Processing and Analyzing Fetal Heart Rate Signals

Sensors ◽  
2021 ◽  
Vol 21 (18) ◽  
pp. 6136
Author(s):  
Alfonso Maria Ponsiglione ◽  
Carlo Cosentino ◽  
Giuseppe Cesarelli ◽  
Francesco Amato ◽  
Maria Romano
Keyword(s):  
Heart Rate ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
System Development ◽  
Fetal Monitoring ◽  
Frequency Domain Analysis ◽  
Nervous System Development ◽  
Autonomous Nervous System ◽  
Fetal Wellbeing ◽  
Future Direction

The availability of standardized guidelines regarding the use of electronic fetal monitoring (EFM) in clinical practice has not effectively helped to solve the main drawbacks of fetal heart rate (FHR) surveillance methodology, which still presents inter- and intra-observer variability as well as uncertainty in the classification of unreassuring or risky FHR recordings. Given the clinical relevance of the interpretation of FHR traces as well as the role of FHR as a marker of fetal wellbeing autonomous nervous system development, many different approaches for computerized processing and analysis of FHR patterns have been proposed in the literature. The objective of this review is to describe the techniques, methodologies, and algorithms proposed in this field so far, reporting their main achievements and discussing the value they brought to the scientific and clinical community. The review explores the following two main approaches to the processing and analysis of FHR signals: traditional (or linear) methodologies, namely, time and frequency domain analysis, and less conventional (or nonlinear) techniques. In this scenario, the emerging role and the opportunities offered by Artificial Intelligence tools, representing the future direction of EFM, are also discussed with a specific focus on the use of Artificial Neural Networks, whose application to the analysis of accelerations in FHR signals is also examined in a case study conducted by the authors.

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