Multiparametric Investigation of Dynamics in Fetal Heart Rate Signals

In the field of electronic fetal health monitoring, computerized analysis of fetal heart rate (FHR) signals has emerged as a valid decision-support tool in the assessment of fetal wellbeing. Despite the availability of several approaches to analyze the variability of FHR signals (namely the FHRV), there are still shadows hindering a comprehensive understanding of how linear and nonlinear dynamics are involved in the control of the fetal heart rhythm. In this study, we propose a straightforward processing and modeling route for a deeper understanding of the relationships between the characteristics of the FHR signal. A multiparametric modeling and investigation of the factors influencing the FHR accelerations, chosen as major indicator of fetal wellbeing, is carried out by means of linear and nonlinear techniques, blockwise dimension reduction, and artificial neural networks. The obtained results show that linear features are more influential compared to nonlinear ones in the modeling of HRV in healthy fetuses. In addition, the results suggest that the investigation of nonlinear dynamics and the use of predictive tools in the field of FHRV should be undertaken carefully and limited to defined pregnancy periods and FHR mean values to provide interpretable and reliable information to clinicians and researchers.

importance of maternal ischemia modified albumin, non stress test and doppler ultrasonography in foreseeing perinatal asphyxia

Background: The aim of this study is to evaluate the importance of ischemia changed albumin, in foreseeing fetal asphyxia and comparing it between normal and preeclamptic pregnant. Method: We planned our study as a prospective case-controlled study between May 2011 and June 2013. We recruited 104 pregnant women complicated by preeclampsia and 110 healthy pregnant women in the study. Doppler ultrasonography, non-stress test and fetal biometric measurements were performed. Venous blood samples taken to measure ischemia modified albumin (IMA). The presence of fetal hypoxia/acidosis was analyzed by conducting post-natal cord blood gas examination and 1.-5. minutes APGAR scoring. Results: Women with preeclampsia had higher IMA compared to controls. The correlations between umbilical artery doppler systolic/diastolic (S/D) ratio, brain sparing effect, non stress test and IMA analyzed. We have found IMA statistically high when S/D ratio is above 2 standard deviations (preeclampsia; 11.83±1.33 vs 19.62±1.56 p<0.001, control; 10.28±1.57 vs 18.09±2.13 p<0.001) or brain sparing effect started (preeclampsia; 25.59±2.48 vs 9.16±1.99 p<0.001, control; 16.37±1.97 vs 6.72± 1.53 p<0.001) or abnormal NST findings occurred (preeclampsia; 10.69±1.92 vs 20.72±1.15 p<0.001, control; 7,42±1,94 vs 9,72±2,19 p<0.001). Conclusions: Maternal IMA levels are found high in preeclamptic pregnant women and it can be used as a biomarker for determining fetal wellbeing.

Púrpura trombocitopénica idiopática en el embarazo: a propósito de un caso

Idiopathic purple thrombocytopenia is a hemorrhagic pathology, characterized by a decrease in the platelet count during pregnancy, mediated by cells and anti-platelet antibodies, causing the premature destruction of platelets by the reticuloendothelial system, which during pregnancy could lead to a commitment to maternal fetal wellbeing in severe stages. This pathology occurs in 1 out of every 1,000 to 10,000 pregnancies, and corresponds to 3% of thrombocytopenic pregnancies. The goal of management is to maintain platelet counts within safe ranges, recommending starting harmacological management when a platelet count lower than 10,000 / uL is found at any time during pregnancy or 30,000 / uL in the second or third trimester. The case presented corresponds to a 40-yearold woman in the first trimester of pregnancy with a history of chronic idiopathic purple thrombocytopenic, with severe thrombocytopenia at the time of admission to the Hospital. Keywords: Idiopathic thrombocytopenic purpura. Pregnancy. Blood platlets.

Self-Fetal Wellbeing Monitoring and Ante-Natal Care during the COVID-19 Pandemic: A Qualitative Descriptive Study among Pregnant Women in Indonesia

Pregnant women are expected to have a high level of awareness when it comes to checking their fetal health and ensuring their welfare. This study explored the experiences of pregnant women in Indonesia who were monitoring their fetal wellbeing during the COVID-19 pandemic. A qualitativedescriptive study design with a constructivist paradigm was used. Twenty-two pregnant women were recruited and participated in a semi-structured interview. Analysis of the transcribed interviews used a content, thematic and comparative process. Three themes emerged from the analysis: feelingsand responses, changes to the ante natal care service during the COVID-19 pandemic, and the fetal wellbeing monitoring, tools, and methods used. Advice on how pregnant women should conduct fetal wellbeing monitoring during COVID-19 is urgently needed. The results of this study indicate there is a need for interventions to help pregnant women carry out self-fetal wellbeing monitoring in times where they have fewer contacts with health professionals such as during the COVID-19 pandemic.

Comparative study of intravaginal misoprostol versus dinoprostone gel for induction of labour in primigravida

Background: Labour is an inevitable consequence of pregnancy. The aim of the present research was to study the safety, efficacy and effect of intravaginal misoprostol and dinoprostone gel for induction of labour.Methods: 300 patients who required induction of labour in a tertiary care centre were included in this prospective randomized controlled study from August 2019 to August 2021 with a study duration of 12 months. 50% of cases received 25 µg of intravaginal misoprostol and repeated for a maximum of 6 doses every 4 hours as needed. 50% cases received 0.5 mg dinoprostone gel and repeated for maximum of 2 doses every 6 hours as needed. The patients selected were evaluated initially by modified Bishop’s score and admission test for fetal wellbeing. After drug insertion, patients were monitored for fetal heart rate, vital signs, progress of labour. A partogram was strictly maintained in all patients.Results: The highest number in both groups being below 40 weeks which were 74% and 76% in dinoprostone and misoprostol groups respectively. Rest were between 40.1-41.6 weeks. The mean induction delivery interval in dinoprostone was more (16.15±3.1) than in misoprostol (12.26±2.21). Requirement of oxytocin augmentation was less in misoprostol group than dinoprostone group. Caesarean section rate was less in misoprostol group. Maternal side effects were minimal in either groups and neonatal outcome was good in both the groups.Conclusions: Both misoprostol and dinoprostone gel are safe, effective for cervical ripening and induction but misoprostol is more cost effective and stable at room temperature.

Update in the prenatal management of sacrococcygeal teratomas and the outcome of the newborn – case report

Sacrococcygeal teratomas complicate approximatively 1 in 27,000 pregnancies, being the most common congenital germ cell tumors in infants. The diagnosis is suspected using ultrasonographic examination and confirmed after a pathology report is performed. The main issue complicating fetuses with sacrococcygeal teratomas is represented by the rapid growth and the great need of blood supply captured by the tumor that interferes with the fetal growth and fetal wellbeing, generating heart failure and, unfortunately, increasing neonatal mortality. Thus, ultrasonographic monitoring is fundamental, to diagnose, closely monitor the growth and vascularization of the tumor and to ameliorate the neonatal prognosis by establishing the proper time of birth. There are specialized healthcare centers that could perform in utero surgery with the aim to aid the normal growth and development of the fetus until term, when a curative surgery is performed to the newborn. In cases complicated with heart failure leading to fetal hydrops, pregnancy termination could be a valuable option for the mothers, as soon as the etiology and the stage of heart decompensation are known. We present a case of a fetal sacrococcygeal teratoma in a 36-year-old pregnant woman, an uninvestigated pregnancy that had a dreadful outcome with neonatal death.

Comparative efficacy of admission cardiotocography in high risk and low risk pregnancies in predicting neonatal outcome

Background: Admission cardiotocography (CTG) is a test of fetal wellbeing performed during labor. A normal CTG is for 20-30 minutes and ranges from 110-160 bpm with beat to beat variability, two accelerations and no decelerations with two contractions (as per NICE 2018 guidelines). To study comparative efficacy of admission CTG in predicting neonatal out in high risk, low risk and universally in all pregnancy.Methods: All high risk as well as low risk patients coming to labor room in labor were included in the study. CTG print was taken, and neonatal outcome as NICU admission were noted after taking written consent.Results: 189 cases were taken.138 were high risk cases, CTG was taken: 91were reassuring, 47were abnormal (non-reassuring +abnormal). In terms of NICU admission, 21 and 26 neonates were admitted. Out of 51 low risk cases, 33 had reassuring CTG, and18 had abnormal; 7and 6 was the number of NICU admission, respectively. When compared, highest sensitivity, specificity and positive predictive value of 55.31%, 77% and 55.3% was seen in high risk pregnancy, whereas negative predictive value (78.8%) was slightly higher in low risk cases.Conclusions: Admission CTG is a good predictor of neonatal outcome. Its predictive efficacy is more in high risk cases. It’s practicality in revealing poor neonatal outcome is more.

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

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.