PMID- 33508830 OWN - NLM STAT- Publisher LR - 20210128 IS - 1421-9964 (Electronic) IS - 1015-3837 (Linking) DP - 2021 Jan 28 TI - Quantification of Posterior Risk Related to Intrapartum FIGO 2015 Criteria for Cardiotocography in the Second Stage of Labor. PG - 1-9 LID - 10.1159/000512658 [doi] AB - INTRODUCTION: Intrapartum cardiotocography (CTG) was used for several decades to detect a stressed fetus so that delivery can be expedited to prevent birth asphyxia. The main aim of the study was to calculate the risk of neonatal acidemia (pH ≤ 7.10) according to duration of the 2nd stage of labor and occurrence of the International Federation of Gynecology and Obstetrics (FIGO) 2015 CTG classification parameters. MATERIALS AND METHODS: This was a retrospective case-control study on 552 pregnancies receiving continuous CTG monitoring in labor and immediate hemogasanalysis at birth. Cases with umbilical artery (UA) pH ≤ 7.10 and controls with UA pH ≥ 7.10 were matched for parity and gestational age at delivery, with ratio 1:5. Logistic regression analysis, adjusted for the expected risk in the general population, was used to calculate the baseline risk of UA pH ≤ 7.10 in the absence of any CTG pathological feature and those associated with pathological CTG patterns occurring in the 2nd stage according to FIGO 2015. RESULTS: Seventy-three cases and 387 controls reached 2nd stage and were included in the analysis. For those reaching 2nd stage, the mean adjusted risk of acidemia associated with nonpathological CTG was 1.6%. Stratification of risk according to duration of the 2nd stage yielded risks of neonatal acidemia of 1.23, 2.08, 5.81, and 15.22% at 30, 60, 120, and 180 min, respectively. Bradycardia >10 min was associated with risk of neonatal acidemia of 9.9 and 15.8% for 2nd-stage durations of 30 and 60 min, respectively. Risks associated with 1 prolonged deceleration >5 min were 6.80, 11.08, 27.0, and 51.0% at 30, 60, 120, and 180 min, respectively. Repetitive late or prolonged decelerations >30 min were associated with risk of neonatal acidemia of 2.43, 4.14, 11.17, and 26.45% at 30, 60, 120, and 180 min, respectively. CONCLUSION: The risk of neonatal acidemia is directly proportional to duration of the 2nd stage, irrespective of the presence of CTG abnormalities, increasing 12-fold (1.2-15.3%) from 30 to 180 min. Occurrence of FIGO 2015 pathological CTG patterns showed a decreasing impact from bradycardia >10 min to decelerations >5 min, recurrent later or prolonged decelerations >30 min, and nonpathological CTG. CI - © 2021 S. Karger AG, Basel. FAU - Cavoretto, Paolo Ivo AU - Cavoretto PI AD - Gynecology and Obstetrics Department, I.R.C.C.S. San Raffaele Hospital, University Vita-Salute, Milan, Italy. FAU - Seidenari, Anna AU - Seidenari A AD - Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC), Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. FAU - Amodeo, Silvia AU - Amodeo S AD - Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC), Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. FAU - Della Gatta, Anna Nunzia AU - Della Gatta AN AD - Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC), Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. FAU - Nale, Roberta AU - Nale R AD - Gynecology and Obstetrics Department, I.R.C.C.S. San Raffaele Hospital, University Vita-Salute, Milan, Italy. FAU - Ismail, Yasmin Sara AU - Ismail YS AD - Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC), Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. FAU - Candiani, Massimo AU - Candiani M AD - Gynecology and Obstetrics Department, I.R.C.C.S. San Raffaele Hospital, University Vita-Salute, Milan, Italy. FAU - Farina, Antonio AU - Farina A AD - Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC), Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy, antonio.farina@unibo.it. LA - eng PT - Journal Article DEP - 20210128 PL - Switzerland TA - Fetal Diagn Ther JT - Fetal diagnosis and therapy JID - 9107463 SB - IM OTO - NOTNLM OT - Birth asphyxia OT - Childbirth OT - Fetal surveillance OT - Feto-neonatal pH OT - International Federation of Gynecology and Obstetrics 2015 cardiotocography classification OT - Intrapartum fetal monitoring OT - Logistic regression OT - Risk estimation cardiotocography EDAT- 2021/01/29 06:00 MHDA- 2021/01/29 06:00 CRDT- 2021/01/28 20:19 PHST- 2020/08/18 00:00 [received] PHST- 2020/10/28 00:00 [accepted] PHST- 2021/01/28 20:19 [entrez] PHST- 2021/01/29 06:00 [pubmed] PHST- 2021/01/29 06:00 [medline] AID - 000512658 [pii] AID - 10.1159/000512658 [doi] PST - aheadofprint SO - Fetal Diagn Ther. 2021 Jan 28:1-9. doi: 10.1159/000512658. PMID- 33494634 OWN - NLM STAT- Publisher LR - 20210126 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) DP - 2021 Jan 25 TI - Mid forceps did not cause "compromised babies" - "compromise" caused forceps: an approach toward safely lowering the cesarean delivery rate. PG - 1-9 LID - 10.1080/14767058.2021.1876657 [doi] AB - OBJECTIVE: Over 5 decades, Cesarean Delivery rates (CDR) have risen 6-fold while vaginal operative deliveries [VODs] decreased from >20% to ∼3%. Poor outcomes (HIE and cerebral palsy) haven't improved. Potentiating the virtual abandonment of forceps (F), particularly midforceps (Mid), were allegations about various poor neonatal outcomes. Here, we evaluate VOD and CDR outcomes controlling for prior fetal risk metrics (PR) ascertained an hour before birth. METHODS: Our 45-year-old database from a labor research unit of moderate/high risk laboring patients (288 NSVDs, 120 Lows, 30 Mids, and 32 CDs) had multiple fetal scalp samples for base excess (BE), pH, cord blood gases (CB), and umbilical artery bloods. ANOVA established relationships between birth methods and outcomes (Cord blood BE and pH and 1 and 5 min Apgar scores); correlations, and two-step multiple regression assessed PR for delivery method and neonatal outcomes. The main outcome measures were correlations of outcome measures with fetal scalp sample BE and pH up to an hour before delivery and fetal reserve index scores scored concurrently. RESULTS: NSVDs had the best immediate neonatal outcomes with significantly higher CB pH and BE as compared to forceps and CDs. However, controlling for PR revealed: (1) PR at 1 h before delivery correlated with delivery mode, i.e. the decrements in outcomes were already present before the delivery was performed; and (2) The presumed deleterious effects of interventional deliveries, per se, were significantly reduced, and (3) Fetal Reserve Index predicted neonatal outcomes better than fetal scalp sample BE, pH, or delivery mode. CONCLUSION: The historical belief that MF deliveries caused poorer outcomes than NSVDs seems mostly backwards. Appreciating PR's impact on delivery routes, and when appropriate, properly performing VODs could safely reduce CDR. If our approach lowered CDR by only ∼2%, in the United States about 80,000 CDs might be avoided, saving ∼$750 Million yearly. In the post pandemic world, safely apportioning medical expenses will be even more critical than previously. FAU - Evans, Mark I AU - Evans MI AUID- ORCID: 0000-0002-1705-799X AD - Comprehensive Genetics, Fetal Medicine Foundation of America, New York, NY, USA. AD - Department of Obstetrics & Gynecology, Icahn School of Medicine at Mt Sinai, Mt Sinai, NY, USA. FAU - Britt, David W AU - Britt DW AD - Comprehensive Genetics, Fetal Medicine Foundation of America, New York, NY, USA. FAU - Evans, Shara M AU - Evans SM AD - Comprehensive Genetics, Fetal Medicine Foundation of America, New York, NY, USA. AD - Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. LA - eng PT - Journal Article DEP - 20210125 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 SB - IM OTO - NOTNLM OT - ACOG Category system OT - Forceps OT - base excess OT - cardiotocography OT - cerebral palsy OT - electronic fetal monitoring OT - fetal reserve index OT - fetal scalp sampling OT - metabolic acidosis OT - pH OT - screening test EDAT- 2021/01/27 06:00 MHDA- 2021/01/27 06:00 CRDT- 2021/01/26 05:27 PHST- 2021/01/26 05:27 [entrez] PHST- 2021/01/27 06:00 [pubmed] PHST- 2021/01/27 06:00 [medline] AID - 10.1080/14767058.2021.1876657 [doi] PST - aheadofprint SO - J Matern Fetal Neonatal Med. 2021 Jan 25:1-9. doi: 10.1080/14767058.2021.1876657. PMID- 33484945 OWN - NLM STAT- Publisher LR - 20210201 IS - 1879-0534 (Electronic) IS - 0010-4825 (Linking) VI - 130 DP - 2021 Jan 14 TI - Cardiotocography signal abnormality classification using time-frequency features and Ensemble Cost-sensitive SVM classifier. PG - 104218 LID - S0010-4825(21)00012-3 [pii] LID - 10.1016/j.compbiomed.2021.104218 [doi] AB - BACKGROUND: Cardiotocography (CTG) signal abnormality classification plays an important role in the diagnosis of abnormal fetuses. This classification problem is made difficult by the non-stationary nature of CTG and the dataset imbalance. This paper introduces a novel application of Time-frequency (TF) features and Ensemble Cost-sensitive Support Vector Machine (ECSVM) classifier to tackle these problems. METHODS: Firstly, CTG signals are converted into TF-domain representations by Continuous Wavelet Transform (CWT), Wavelet Coherence (WTC), and Cross-wavelet Transform (XWT). From these representations, a novel image descriptor is used to extract the TF features. Then, the linear feature is derived from the time-domain representation of the CTG signal. The linear and TF features are fed to the ECSVM classifier for prediction and classification of fetal outcome. RESULTS: The TF features show the significant difference (p-value<0.05) in distinguishing abnormal CTG signals, but not for traditional nonlinear features. In ECSVM abnormality classification, using only linear features, the sensitivity, specificity, and quality index are 59.3%, 78.3%, and 68.1%, respectively, whereas more effective results (sensitivity: 85.2%, specificity: 66.1%, and quality index: 75.0%) are obtained using a combination of linear and TF features, with a performance improvement index of 10.1%. Especially, the area under the receiver operating characteristic curve (0.77 vs. 0.64) is significantly increased with the ECSVM vs. SVM. CONCLUSION: Our method can greatly improve the classification results, especially for sensitivity. It improves the true positive rate of CTG abnormality classification and reduces the false positive rate, which may help detect and treat abnormal fetuses during labor. CI - Copyright © 2021 Elsevier Ltd. All rights reserved. FAU - Zeng, Rongdan AU - Zeng R AD - Department of Electronic Engineering, College of Information Science and Technology, Jinan University, Guangzhou, China. FAU - Lu, Yaosheng AU - Lu Y AD - Department of Electronic Engineering, College of Information Science and Technology, Jinan University, Guangzhou, China. FAU - Long, Shun AU - Long S AD - Department of Computer Science, College of Information Science and Technology, Jinan University, Guangzhou, China. FAU - Wang, Chuan AU - Wang C AD - Department of Electronic Engineering, College of Information Science and Technology, Jinan University, Guangzhou, China. FAU - Bai, Jieyun AU - Bai J AD - Department of Electronic Engineering, College of Information Science and Technology, Jinan University, Guangzhou, China. Electronic address: bai_jieyun@126.com. LA - eng PT - Journal Article DEP - 20210114 PL - United States TA - Comput Biol Med JT - Computers in biology and medicine JID - 1250250 SB - IM OTO - NOTNLM OT - Abnormality classification OT - Cardiotocography OT - Fetal heart rate OT - Time-frequency representation OT - Wavelet EDAT- 2021/01/24 06:00 MHDA- 2021/01/24 06:00 CRDT- 2021/01/23 20:09 PHST- 2020/09/29 00:00 [received] PHST- 2021/01/10 00:00 [revised] PHST- 2021/01/11 00:00 [accepted] PHST- 2021/01/24 06:00 [pubmed] PHST- 2021/01/24 06:00 [medline] PHST- 2021/01/23 20:09 [entrez] AID - S0010-4825(21)00012-3 [pii] AID - 10.1016/j.compbiomed.2021.104218 [doi] PST - aheadofprint SO - Comput Biol Med. 2021 Jan 14;130:104218. doi: 10.1016/j.compbiomed.2021.104218. PMID- 33438340 OWN - NLM STAT- Publisher LR - 20210119 IS - 1447-0756 (Electronic) IS - 1341-8076 (Linking) DP - 2021 Jan 12 TI - iPREFACE score: Integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring. LID - 10.1111/jog.14652 [doi] AB - AIM: Cardiotocography is used worldwide to evaluate fetal well-being during pregnancy and labor. In past guidelines, the management plan was determined based on the assessment of the most severe waveform. There are no guidelines for evaluating the integrated recurrent decelerations; however, we believe their assessment to be essential for predicting the status of the fetus. The objective of this study was to propose an indicator for performing medical interventions during labor by creating a scoring system that reflects integrated recurrent decelerations. METHODS: In this retrospective cohort study, we included data for only full-term single fetus births from vaginal deliveries. The score named the iPREFACE score (integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring) was calculated using cardiotocography findings from continuing 30 min before delivery. We examined the iPREFACE score and fetal acidemia association and calculated the cut-off iPREFACE scores for acidemia using receiver operating characteristic curves. RESULTS: The study included 469 delivery cases. Their iPREFACE scores exhibited a significant negative correlation with the umbilical artery blood pH (correlation coefficient; -0.43). The cut-off iPREFACE scores for the umbilical artery blood with pH <7.20, <7.10 and <7.0 were 44, 46 and 67, respectively (the areas under the curve were 0.776, 0.962 and 0.996, respectively). CONCLUSION: The iPREFACE score may predict fetal acidemia and could be used as an indicator for timely medical interventions during labor. Because assessments using a cardiotocography are quick and easy to perform, the iPREFACE score could be a valuable tool in clinical practice. CI - © 2021 The Authors. Journal of Obstetrics and Gynaecology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Obstetrics and Gynecology. FAU - Ito, Ayumu AU - Ito A AD - Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan. AD - Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan. AD - Department of Obstetrics and Gynecology, Ageo Central General Hospital, Ageo-shi, Japan. FAU - Hayata, Eijiro AU - Hayata E AD - Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan. FAU - Nakata, Masahiko AU - Nakata M AD - Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan. AD - Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan. FAU - Oji, Ayako AU - Oji A AD - Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan. FAU - Furukawa, Takamasa AU - Furukawa T AD - Department of Obstetrics and Gynecology, Ageo Central General Hospital, Ageo-shi, Japan. FAU - Nakakuma, Masahito AU - Nakakuma M AD - Department of Obstetrics and Gynecology, Ageo Central General Hospital, Ageo-shi, Japan. FAU - Morita, Mineto AU - Morita M AD - Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan. AD - Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan. LA - eng PT - Journal Article DEP - 20210112 PL - Australia TA - J Obstet Gynaecol Res JT - The journal of obstetrics and gynaecology research JID - 9612761 SB - IM OTO - NOTNLM OT - CTG OT - cardiotocography OT - electronic fetal monitoring OT - hypoxic-ischemic encephalopathy OT - umbilical artery blood pH EDAT- 2021/01/14 06:00 MHDA- 2021/01/14 06:00 CRDT- 2021/01/13 06:19 PHST- 2020/10/13 00:00 [received] PHST- 2020/12/10 00:00 [revised] PHST- 2020/12/26 00:00 [accepted] PHST- 2021/01/14 06:00 [pubmed] PHST- 2021/01/14 06:00 [medline] PHST- 2021/01/13 06:19 [entrez] AID - 10.1111/jog.14652 [doi] PST - aheadofprint SO - J Obstet Gynaecol Res. 2021 Jan 12. doi: 10.1111/jog.14652. PMID- 33406946 OWN - NLM STAT- Publisher LR - 20210107 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) DP - 2021 Jan 6 TI - Impaired validity of the new FIGO and Swedish CTG classification templates to identify fetal acidosis in the first stage of labor. PG - 1-8 LID - 10.1080/14767058.2020.1869931 [doi] AB - INTRODUCTION: Cardiotocography (CTG) is the main method of intrapartum fetal surveillance. In 2015 a new guideline was introduced by the International Federation of Gynecology and Obstetrics (FIGO), FIGO-15. In Sweden it was adjusted to SWE-17, replacing the previous national template, SWE-09. This study, conducted at one university hospital and one regional hospital in southern Sweden, evaluated the diagnostic validity of these three templates to detect fetal acidosis during the first stage of labor. MATERIAL AND METHODS: A total of 73 neonates with pH <7.1 in umbilical cord artery or vein at cesarean delivery during the first stage of labor were identified retrospectively. For each acidotic neonate, three non-acidemic neonates, with a pH ≥7.2 in cord artery and vein, and Apgar scores ≥9 at five and ten minutes, in all 219 neonates, were selected. The CTG tracings before birth in acidemic neonates, and tracings at the same cervical dilatation in the non-acidemic neonates, were independently assessed by three professionals from the obstetric staff, blinded to group and clinical data. Based on their categorizations of the included variables (baseline, variability, accelerations, decelerations and contraction rate), each CTG tracing was systematically classified according to the three templates. The sensitivity and specificity to identify acidemia by the classification pathological were determined for each template. Interobserver agreement in the assessments of tracings as pathological or not was analyzed, using free-marginal Kappa index. RESULTS: The sensitivity for patterns classified as pathological to identify acidemia was similar for FIGO-15 (71%) and SWE-17 (77%, p = .13), and the specificity was 97% for both. SWE-09 had a significantly higher sensitivity (95%, p < .001) albeit with a lower specificity (90%, p < .001) than the other two templates. Among acidemic neonates, the fraction of tracings classified as normal was higher with SWE-17 (9.6%) than with SWE-09 (0%; p = .01) and FIGO-15 (1.4%; p = .06). For tracings from neonates with acidemia, agreement for three independent assessors was strong (κ 0.85) with SWE-09, and weak for FIGO-15 (κ 0.47), and SWE-17 (κ 0.51). For tracings from neonates without acidemia, the agreement was almost perfect for FIGO-15 (κ 0.91), strong withSWE-17 (κ 0.90) and moderate with SWE-09 (κ 0.78). CONCLUSIONS: The ability of FIGO-15 and SWE-17 to identify fetal acidosis is considered insufficient. The combination of a high sensitivity and a high specificity makes SWE-09 the most discriminatory template during the first stage of labor. FAU - Ekengård, Frida AU - Ekengård F AD - Department of Obstetrics, and Gynecology, Skåne University Hospital, Institution of Clinical Sciences Lund University, Lund, Sweden. FAU - Cardell, Monika AU - Cardell M AD - Department of Obstetrics, and Gynecology, Skåne University Hospital, Institution of Clinical Sciences Lund University, Lund, Sweden. FAU - Herbst, Andreas AU - Herbst A AD - Department of Obstetrics, and Gynecology, Skåne University Hospital, Institution of Clinical Sciences Lund University, Lund, Sweden. LA - eng PT - Journal Article DEP - 20210106 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 SB - IM OTO - NOTNLM OT - Electronic fetal monitoring OT - acidosis OT - cardiotocography OT - classification OT - fetal heart rate EDAT- 2021/01/08 06:00 MHDA- 2021/01/08 06:00 CRDT- 2021/01/07 05:41 PHST- 2021/01/07 05:41 [entrez] PHST- 2021/01/08 06:00 [pubmed] PHST- 2021/01/08 06:00 [medline] AID - 10.1080/14767058.2020.1869931 [doi] PST - aheadofprint SO - J Matern Fetal Neonatal Med. 2021 Jan 6:1-8. doi: 10.1080/14767058.2020.1869931. PMID- 32777997 OWN - NLM STAT- In-Process LR - 20210106 IS - 1654-9880 (Electronic) IS - 1654-9716 (Print) IS - 1654-9880 (Linking) VI - 13 IP - 1 DP - 2020 Dec 31 TI - Investigation of stillbirth causes in Suriname: application of the WHO ICD-PM tool to national-level hospital data. PG - 1794105 LID - 10.1080/16549716.2020.1794105 [doi] LID - 1794105 AB - BACKGROUND: Suriname has one of the highest stillbirth rates in Latin America and the Caribbean. To facilitate data comparison of perinatal deaths, the World Health Organization developed the International Classification of Diseases-10 Perinatal Mortality (ICD-PM). OBJECTIVE: We aimed to (1) assess characteristics and risk indicators of women with a stillbirth, (2) determine the timing and causes of stillbirths according to the ICD-PM with critical evaluation of its application and (3) propose recommendations for the reduction of stillbirths in Suriname. METHODS: A hospital-based, nation-wide, cross-sectional study was conducted in all hospitals within Suriname during one-year (2017). The medical files of stillbirths (gestation ≥28 weeks/birth weight ≥1000 grams) were reviewed and classified using ICD-PM. We used descriptive statistics and multiple logistic regression analyses. RESULTS: The stillbirth rate in Suriname was 14.4/1000 births (n=131 stillbirths, n=9089 total births). Medical files were available for 86% (n=113/131) of stillbirths. Women of African descent had the highest stillbirth rate and two times the odds of stillbirth (OR 2.1, 95%CI 1.4-3.1) compared to women of other ethnicities. One third (33%, n=37/113) of stillbirths occurred after hospital admission. The timing was antepartum in 85% (n=96/113), intrapartum in 11% (n=12/113) and unknown in 4% (n=5/113). Antepartum stillbirths were caused by hypoxia in 46% (n=44/96). In 41% (n=39/96) the cause was unspecified. Maternal medical and surgical conditions were present in 50% (n=57/113), mostly hypertensive disorders. CONCLUSION: Stillbirth reduction strategies in Suriname call for targeting ethnic disparities, improving antenatal services, implementing perinatal death audits and improving diagnostic post-mortem investigations. ICD-PM limited the formulation of recommendations due to many stillbirths of 'unspecified' causes. Based on our study findings, we also recommend addressing some challenges with applying the ICD-PM. ABBREVIATIONS: CTG: Cardiotocography; ENAP: Every Newborn Action Plan (ENAP); ICD-PM: The WHO application of ICD-10 to deaths during the perinatal period - perinatal mortality; SBR: Stillbirth rate; SGA: Small for gestational age; WHO: World Health Organization; LMIC: Low- and middle-income countries; FHR: foetal heart rate. FAU - Prüst, Zita D AU - Prüst ZD AUID- ORCID: 0000-0003-4087-7424 AD - Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht University , Utrecht, The Netherlands. FAU - Verschueren, Kim J C AU - Verschueren KJC AUID- ORCID: 0000-0003-1170-6132 AD - Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht University , Utrecht, The Netherlands. FAU - Bhikha-Kori, Gieta A A AU - Bhikha-Kori GAA AUID- ORCID: 0000-0003-3487-9626 AD - Department of Obstetrics and Gynaecology, Academical Hospital Paramaribo (AZP) , Paramaribo, Suriname. FAU - Kodan, Lachmi R AU - Kodan LR AUID- ORCID: 0000-0003-2129-9796 AD - Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht University , Utrecht, The Netherlands. AD - Department of Obstetrics and Gynaecology, Academical Hospital Paramaribo (AZP) , Paramaribo, Suriname. FAU - Bloemenkamp, Kitty W M AU - Bloemenkamp KWM AUID- ORCID: 0000-0002-1377-4625 AD - Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht University , Utrecht, The Netherlands. FAU - Browne, Joyce L AU - Browne JL AUID- ORCID: 0000-0001-7048-3245 AD - Julius Global Health, The Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University , Utrecht, The Netherlands. FAU - Rijken, Marcus J AU - Rijken MJ AUID- ORCID: 0000-0003-0914-5508 AD - Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht University , Utrecht, The Netherlands. AD - Julius Global Health, The Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University , Utrecht, The Netherlands. LA - eng PT - Journal Article TA - Glob Health Action JT - Global health action JID - 101496665 SB - IM PMC - PMC7480654 OTO - NOTNLM OT - *ICD-PM OT - *Stillbirths OT - *classification OT - *foetal death OT - *middle-income country OT - *perinatal mortality COIS- No potential conflict of interest was reported by the authors. EDAT- 2020/08/12 06:00 MHDA- 2020/08/12 06:00 CRDT- 2020/08/12 06:00 PHST- 2020/08/12 06:00 [entrez] PHST- 2020/08/12 06:00 [pubmed] PHST- 2020/08/12 06:00 [medline] AID - 1794105 [pii] AID - 10.1080/16549716.2020.1794105 [doi] PST - ppublish SO - Glob Health Action. 2020 Dec 31;13(1):1794105. doi: 10.1080/16549716.2020.1794105. PMID- 33369871 OWN - NLM STAT- Publisher LR - 20210126 IS - 1471-0528 (Electronic) IS - 1470-0328 (Linking) DP - 2020 Dec 28 TI - Deceleration area and capacity during labour-like umbilical cord occlusions identify evolving hypotension: a controlled study in fetal sheep. LID - 10.1111/1471-0528.16638 [doi] AB - OBJECTIVE: Cardiotocography is widely used to assess fetal well-being during labour. The positive predictive value of current clinical algorithms to identify hypoxia-ischaemia is poor. In experimental studies, fetal hypotension is the strongest predictor of hypoxic-ischaemic injury. Cohort studies suggest that deceleration area and deceleration capacity of the fetal heart rate trace correlate with fetal acidaemia, but it is not known whether they are indices of fetal arterial hypotension. DESIGN: Prospective, controlled study. SETTING: Laboratory. SAMPLE: Near-term fetal sheep. METHODS: One minute of complete umbilical cord occlusions (UCOs) every 5 minutes (1:5 min, n = 6) or every 2.5 minutes (1:2.5 min, n = 12) for 4 hours or until fetal mean arterial blood pressure fell <20 mmHg. MAIN OUTCOME MEASURES: Deceleration area and capacity during the UCO series were related to evolving hypotension. RESULTS: The 1:5 min group developed only mild metabolic acidaemia, without hypotension. By contrast, 10/12 fetuses in the 1:2.5-min group progressively developed severe metabolic acidaemia and hypotension, reaching 16.8 ± 0.9 mmHg after 71.2 ± 6.7 UCOs. Deceleration area and capacity remained unchanged throughout the UCO series in the 1:5-min group, but progressively increased in the 1:2.5-min group. The severity of hypotension was closely correlated with both deceleration area (P < 0.001, R(2)  = 0.66, n = 18) and capacity (P < 0.001, R(2)  = 0.67, n = 18). Deceleration area and capacity predicted development of hypotension at a median of 103 and 123 minutes before the final occlusion, respectively. CONCLUSIONS: Both deceleration area and capacity were strongly associated with developing fetal hypotension, supporting their potential to improve identification of fetuses at risk of hypotension leading to hypoxic-ischaemic injury during labour. TWEETABLE ABSTRACT: Deceleration area and capacity of fetal heart rate identify developing hypotension during labour-like hypoxia. CI - © 2021 John Wiley & Sons Ltd. FAU - Georgieva, A AU - Georgieva A AUID- ORCID: 0000-0002-5543-6683 AD - Nuffield Department of Women's and Reproductive Health, The John Radcliffe Hospital, University of Oxford, Oxford, UK. FAU - Lear, C A AU - Lear CA AUID- ORCID: 0000-0002-8937-0846 AD - Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand. FAU - Westgate, J A AU - Westgate JA AD - Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand. FAU - Kasai, M AU - Kasai M AUID- ORCID: 0000-0002-4400-8288 AD - Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand. AD - The Department of Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan. FAU - Miyagi, E AU - Miyagi E AUID- ORCID: 0000-0002-5492-0844 AD - The Department of Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan. FAU - Ikeda, T AU - Ikeda T AUID- ORCID: 0000-0003-1489-4810 AD - Department of Obstetrics and Gynecology, Mie University, Mie, Japan. FAU - Gunn, A J AU - Gunn AJ AUID- ORCID: 0000-0003-0656-7035 AD - Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand. FAU - Bennet, L AU - Bennet L AUID- ORCID: 0000-0002-4336-7596 AD - Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand. LA - eng GR - 17/601/Health Research Council of New Zealand/ GR - 1108004/Auckland Medical Research Foundation/ GR - CDF-2016-09-004/UK National Institute for Health Research/ PT - Journal Article DEP - 20201228 PL - England TA - BJOG JT - BJOG : an international journal of obstetrics and gynaecology JID - 100935741 SB - AIM SB - IM OTO - NOTNLM OT - Asphyxia OT - cardiotocography OT - computerised fetal heart rate monitoring OT - deceleration area OT - deceleration capacity OT - hypotension OT - hypoxia-ischaemia OT - phase-rectified signal averaging EDAT- 2020/12/29 06:00 MHDA- 2020/12/29 06:00 CRDT- 2020/12/28 13:19 PHST- 2020/12/18 00:00 [accepted] PHST- 2020/12/29 06:00 [pubmed] PHST- 2020/12/29 06:00 [medline] PHST- 2020/12/28 13:19 [entrez] AID - 10.1111/1471-0528.16638 [doi] PST - aheadofprint SO - BJOG. 2020 Dec 28. doi: 10.1111/1471-0528.16638. PMID- 33314025 OWN - NLM STAT- Publisher LR - 20210127 IS - 1600-0412 (Electronic) IS - 0001-6349 (Linking) DP - 2020 Dec 14 TI - Fetal heart rate nadir during bradycardia and umbilical artery acidemia at birth. LID - 10.1111/aogs.14061 [doi] AB - INTRODUCTION: Fetal bradycardia due to sentinel events such as placental abruption, cord prolapse or uterine rupture is associated with an increased risk of acidemia at birth. In the absence of a sentinel event, data regarding neonatal prognosis are scarce, and it seems plausible that the depth of bradycardia might be associated with an increased risk of acidosis at birth. The objective was to determine whether the depth of bradycardia is associated with a higher risk of umbilical artery acidemia at birth in term singleton pregnancies requiring cesarean delivery during labor. MATERIAL AND METHODS: A retrospective comparative study of all cesarean deliveries for bradycardia in an academic tertiary center in the 6-year period of 2013-2018, among term singleton pregnancies. Bradycardia associated with a sentinel event such as placental abruption, cord prolapse or uterine rupture, were excluded. The nadir of the bradycardia was defined as the lowest fetal heart rate baseline lasting at least 3 minutes during bradycardia. Women who delivered an infant with an umbilical pH at birth <7.00 (acidosis group) were compared with women who delivered an infant with an umbilical pH at birth ≥7.00 (non-acidosis group). RESULTS: Among 111 eligible cases, 32 women in the acidosis group were compared with 79 in the non-acidosis group. The median nadir of the bradycardia was lower in the acidosis than in the non-acidosis group (60 bpm, interquartile range [56-65] vs 70 [60-76], P < .01). A bradycardia nadir <60 bpm emerged as the optimal threshold for predicting acidemia and was more frequently observed in the acidosis than in the non-acidosis group (10 [31%] vs 10 [13%], P = .02). In the multivariable analysis, a nadir <60 bpm was independently associated with an umbilical artery pH <7.00 (adjusted OR 3.16, 95% CI 1.10-9.04). CONCLUSIONS: A bradycardia nadir <60 bpm was associated with a tripled risk of umbilical artery acidemia at birth. CI - © 2020 Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). Published by John Wiley & Sons Ltd. FAU - Lepercq, Jacques AU - Lepercq J AUID- ORCID: 0000-0002-0574-3749 AD - Department of Obstetrics and Gynecology of Port Royal, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France. FAU - Nghiem, My-Anh AU - Nghiem MA AD - Department of Obstetrics and Gynecology of Port Royal, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France. FAU - Goffinet, François AU - Goffinet F AD - Department of Obstetrics and Gynecology of Port Royal, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France. AD - INSERM Unit 953, Epidemiological Research Unit on Perinatal Health and Women's Health, Paris, France. LA - eng PT - Journal Article DEP - 20201214 PL - United States TA - Acta Obstet Gynecol Scand JT - Acta obstetricia et gynecologica Scandinavica JID - 0370343 SB - IM OTO - NOTNLM OT - acidemia OT - cardiotocography OT - cesarean delivery OT - intrapartum fetal heart rate OT - labor OT - obstetric care OT - perinatal asphyxia EDAT- 2020/12/15 06:00 MHDA- 2020/12/15 06:00 CRDT- 2020/12/14 11:04 PHST- 2020/10/07 00:00 [received] PHST- 2020/12/04 00:00 [revised] PHST- 2020/12/09 00:00 [accepted] PHST- 2020/12/15 06:00 [pubmed] PHST- 2020/12/15 06:00 [medline] PHST- 2020/12/14 11:04 [entrez] AID - 10.1111/aogs.14061 [doi] PST - aheadofprint SO - Acta Obstet Gynecol Scand. 2020 Dec 14. doi: 10.1111/aogs.14061. PMID- 33249820 OWN - NLM STAT- Publisher LR - 20201130 IS - 1827-1650 (Electronic) IS - 0026-4784 (Linking) DP - 2020 Nov 30 TI - STAN: a reappraisal of its clinical usefulness. LID - 10.23736/S0026-4784.20.04690-0 [doi] AB - The automatic analysis of fetal ECG in labor has been introduced as an adjunct of traditional cardiotocography with the aim to improve the identification of fetuses with intrapartum hypoxia. Several randomized controlled trials and meta-analyses have produced conflicting results, with the most recent randomized controlled trial not demonstrating any improvement in either neonatal outcomes or reduction in operative birth rates. The objective of this review article is to present the state of art about the use of STAN technology in labor ward. FAU - Cagninelli, Greta AU - Cagninelli G AD - Department of Obstetrics and Gynecology of Parma, University of Parma, Parma, Italy. FAU - Dall'Asta, Andrea AU - Dall'Asta A AD - Department of Obstetrics and Gynecology of Parma, University of Parma, Parma, Italy. FAU - Di Pasquo, Elvira AU - Di Pasquo E AD - Department of Obstetrics and Gynecology of Parma, University of Parma, Parma, Italy. FAU - Morganelli, Giovanni AU - Morganelli G AD - Department of Obstetrics and Gynecology of Parma, University of Parma, Parma, Italy. FAU - Degennaro, Valentina A AU - Degennaro VA AD - Department of Obstetrics and Gynecology of Parma, University of Parma, Parma, Italy. FAU - Fieni, Stefania AU - Fieni S AD - Department of Obstetrics and Gynecology of Parma, University of Parma, Parma, Italy. FAU - Frusca, Tiziana AU - Frusca T AD - Department of Obstetrics and Gynecology of Parma, University of Parma, Parma, Italy. FAU - Ghi, Tullio AU - Ghi T AD - Department of Obstetrics and Gynecology of Parma, University of Parma, Parma, Italy - tullio.ghi@unipr.it. LA - eng PT - Journal Article DEP - 20201130 PL - Italy TA - Minerva Ginecol JT - Minerva ginecologica JID - 0400731 SB - IM EDAT- 2020/12/01 06:00 MHDA- 2020/12/01 06:00 CRDT- 2020/11/30 04:35 PHST- 2020/11/30 04:35 [entrez] PHST- 2020/12/01 06:00 [pubmed] PHST- 2020/12/01 06:00 [medline] AID - S0026-4784.20.04690-0 [pii] AID - 10.23736/S0026-4784.20.04690-0 [doi] PST - aheadofprint SO - Minerva Ginecol. 2020 Nov 30. doi: 10.23736/S0026-4784.20.04690-0. PMID- 33238664 OWN - NLM STAT- Publisher LR - 20201126 IS - 1827-1650 (Electronic) IS - 0026-4784 (Linking) DP - 2020 Nov 26 TI - Fetal heart rate monitoring in labor: from pattern recognition to fetal physiology. LID - 10.23736/S0026-4784.20.04666-3 [doi] AB - The journey of human labour involves hypoxic and mechanical stresses as a result of progressively increasing frequency, duration and strength of uterine contractions and resultant compression of umbilical cord. In addition, occlusion of the spiral arteries during myometrial contractions also leads to repetitive interruptions in the utero-placental circulation, predisposing a fetus to progressively worsening hypoxic stress as the labour progresses. The vast majority of fetuses are equipped with compensatory mechanisms to withstand these hypoxic and mechanical stresses. They emerge unharmed at birth. However, some fetuses may sustain an antenatal injury or experience a chronic utero-placental insufficiency prior to the onset of labour. These may impair the fetus to compensate for the ongoing hypoxic stress secondary to ongoing uterine contractions. Non-hypoxic pathways of neurological damage such as chorioamnionitis, fetal anaemia or an acute fetal hypovolemia may potentiate fetal neurological injury, especially if in the presence of a superimposed, additional hypoxic stress. The use of utero-tonic agents to induce or augment labour may increase the risk of hypoxic-ischaemic injury. Clinicians need to move away from "pattern recognition" guidelines ("Normal", "Suspicious", "Pathological"), and apply the knowledge of fetal physiology to differentiate fetal compensation from decompensation. Individualization of care is essential to optimize outcomes. FAU - Oikonomou, Maria AU - Oikonomou M AD - Clinical Fellow in Obstetrics & Gynaecology, Watford General Hospital, Watford, UK - mariadoikonomou@gmail.com. FAU - Chandraharan, Edwin AU - Chandraharan E AD - Global Academy of Medical Education & Training, London, Intrapartum Care, Basildon & Thurrock University Hospital NHS Foundation Trust, Nethermayne, UK. LA - eng PT - Journal Article DEP - 20201126 PL - Italy TA - Minerva Ginecol JT - Minerva ginecologica JID - 0400731 SB - IM EDAT- 2020/11/27 06:00 MHDA- 2020/11/27 06:00 CRDT- 2020/11/26 03:06 PHST- 2020/11/26 03:06 [entrez] PHST- 2020/11/27 06:00 [pubmed] PHST- 2020/11/27 06:00 [medline] AID - S0026-4784.20.04666-3 [pii] AID - 10.23736/S0026-4784.20.04666-3 [doi] PST - aheadofprint SO - Minerva Ginecol. 2020 Nov 26. doi: 10.23736/S0026-4784.20.04666-3. PMID- 33319210 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201216 IS - 2590-1613 (Electronic) IS - 2590-1613 (Linking) VI - 9 DP - 2021 Jan TI - Low sensitivity of the new FIGO classification system for electronic fetal monitoring to identify fetal acidosis in the second stage of labor. PG - 100120 LID - 10.1016/j.eurox.2020.100120 [doi] LID - 100120 AB - OBJECTIVE: In 2015, new FIGO guidelines for CTG interpretation were presented (FIGO-15). In 2017, the previous Swedish guidelines (SWE-09) were replaced with guidelines adapted to FIGOs (SWE-17). The performance of these three templates had not been scientifically evaluated before its clinical implementation. The objective of this study was to compare the sensitivity and specificity to detect fetal acidosis at birth using these three templates during the second stage of labor. STUDY DESIGN: This case-control study included 295 neonates with cord blood pH < 7.05 and 591 controls with pH ≥ 7.15, born 2012-2017. Tracings from the last 30-80 min of labor were classified independently by three assessors (midwives, residents and obstetricians), blinded to group and outcome. RESULTS: The classification pathological using FIGO-15 had a sensitivity of 50 % and specificity of 88 % in detecting fetuses with acidosis. For SWE-17, the sensitivity was 62 % and the specificity 85 %. For SWE-09 the sensitivity was 87 % and the specificity 56 %.By combining suspicious and pathological patterns the sensitivity for FIGO-15 increased to 97 %, and for SWE-17 to 83 %, whereas the specificity decreased to 23 % and 68 % respectively. CONCLUSIONS: The FIGO classification seemed to be insufficiently discriminative in the second stage of labor; most patterns in acidotic cases were classified as merely suspicious with this template, and the sensitivity of pathological patterns was low at 50 %. Combined pathological and suspicious patterns detected fetal acidosis at a specificity that was too low to be useful (23 %). SWE-09 showed the best ability to detect acidosis with pathological patterns (sensitivity 87 %). SWE-17 reached almost the same sensitivity (83 %) with the combination of suspicious and pathological patterns, and at a higher specificity (68 %). CI - © 2020 The Authors. FAU - Ekengård, Frida AU - Ekengård F AD - Department of Obstetrics and Gynecology Skåne University Hospital, Institution of Clinical Sciences Lund University, Lund, Sweden. FAU - Cardell, Monika AU - Cardell M AD - Department of Obstetrics and Gynecology Skåne University Hospital, Institution of Clinical Sciences Lund University, Lund, Sweden. FAU - Herbst, Andreas AU - Herbst A AD - Department of Obstetrics and Gynecology Skåne University Hospital, Institution of Clinical Sciences Lund University, Lund, Sweden. LA - eng PT - Journal Article DEP - 20201125 TA - Eur J Obstet Gynecol Reprod Biol X JT - European journal of obstetrics & gynecology and reproductive biology: X JID - 101750520 PMC - PMC7724159 OTO - NOTNLM OT - Asphyxia OT - CTG, cardiotocography OT - Cardiotocograpy OT - Delivery OT - FIGO, International Federation of Gynecology and Obstetrics OT - FIGO-15, FIGO classification system from 2015 OT - Fetal heart rate OT - Fetal monitoring OT - SWE-09, the Swedish classification guidelines of CTG from 2009 OT - SWE-17, the Swedish classification guidelines of CTG from 2017 COIS- The authors declare that they have no competing financial interest that have influenced the work reported in this paper. Andreas Herbst has contributed in the development of the Swedish classification systems from 2009 and 2017. EDAT- 2020/12/16 06:00 MHDA- 2020/12/16 06:01 CRDT- 2020/12/15 06:06 PHST- 2020/08/19 00:00 [received] PHST- 2020/11/20 00:00 [revised] PHST- 2020/11/24 00:00 [accepted] PHST- 2020/12/15 06:06 [entrez] PHST- 2020/12/16 06:00 [pubmed] PHST- 2020/12/16 06:01 [medline] AID - S2590-1613(20)30014-4 [pii] AID - 100120 [pii] AID - 10.1016/j.eurox.2020.100120 [doi] PST - epublish SO - Eur J Obstet Gynecol Reprod Biol X. 2020 Nov 25;9:100120. doi: 10.1016/j.eurox.2020.100120. eCollection 2021 Jan. PMID- 33210630 OWN - NLM STAT- In-Process LR - 20201119 IS - 1999-6217 (Electronic) IS - 1727-5482 (Linking) VI - 18 IP - 3 DP - 2020 Nov 13 TI - Role of Modified Biophysical Profile in High Risk Pregnancy in Predicting Fetal Outcome. PG - 401-405 LID - 10.33314/jnhrc.v18i3.2513 [doi] AB - BACKGROUND: High risk pregnant women have increased risk of maternal and neonatal morbidity and mortality. Antepartum surveillance is important and should be effective in such conditions. Modified biophysical profile is the method of antepartum surveillance which comprises of cardiotocography and amniotic fluid index. METHODS: A cross-sectional study was carried out in Paropakar Maternity and Women's Hospital from February 2019 to January 2020 to determine the effectiveness of modified biophysical profile. Cardiotocography was interpreted as reactive, equivocal and non-reactive. AFI was considered normal if it was 5 to 24 cm. In the study 172 high risk cases at term and not in labor were included. Each case was subjected to cardiotocography then amniotic fluid index was obtained using real time sonography where it was measured from all four quadrants. Modified biophysical results were obtained and then were divided into 2 arms as normal modified biophysical profile and abnormal modified biophysical profile then analysis was done. RESULTS: Of 172 cases, there were 97 (56.4%) cases in normal modified biophysical profile and remaining 75 (43.6%) in abnormal modified biophysical profile group. The rate of cesarean section increased when there was abnormal modified biophysical profile.  Neonatal resuscitation and admission was increased in abnormal modified biophysical profile. CONCLUSIONS: Normal modified biophysical profile in high risk pregnancy had more cases of vaginal delivery and less adverse fetal outcome like low APGAR score, neonatal resuscitation and neonatal intensive care admission. FAU - Jha, Santosh AU - Jha S AD - Department of Obstetrics and Gynecology, Paropakar Maternity and Womens Hospital, Kathmandu, Nepal. FAU - Dangal, Ganesh AU - Dangal G AD - Department of Obstetrics and Gynecology, Kathmandu Model Hospital, Nepal. LA - eng PT - Journal Article DEP - 20201113 PL - Nepal TA - J Nepal Health Res Counc JT - Journal of Nepal Health Research Council JID - 101292936 SB - IM OTO - NOTNLM OT - Amniotic fluid index; cardiotocography; fetal surveillance; modified biophysical profile. EDAT- 2020/11/20 06:00 MHDA- 2020/11/20 06:00 CRDT- 2020/11/19 08:47 PHST- 2020/02/09 00:00 [received] PHST- 2020/11/13 00:00 [accepted] PHST- 2020/11/19 08:47 [entrez] PHST- 2020/11/20 06:00 [pubmed] PHST- 2020/11/20 06:00 [medline] AID - 10.33314/jnhrc.v18i3.2513 [doi] PST - epublish SO - J Nepal Health Res Counc. 2020 Nov 13;18(3):401-405. doi: 10.33314/jnhrc.v18i3.2513. PMID- 33166876 OWN - NLM STAT- Publisher LR - 20201120 IS - 1532-3102 (Electronic) IS - 0143-4004 (Linking) VI - 103 DP - 2020 Nov 5 TI - Placental histology of acute versus continuous meconium exposure - Association with obstetric and neonatal outcomes. PG - 214-219 LID - S0143-4004(20)30378-7 [pii] LID - 10.1016/j.placenta.2020.10.002 [doi] AB - OBJECTIVE: We aimed to compare obstetric and neonatal outcomes of deliveries complicated by meconium stained amniotic fluid (MSAF), according to placental histology of continuous vs. acute meconium associated changes. METHODS: This was a retrospective cohort study of singleton deliveries complicated by MSAF at a single university-affiliated medical center during 2008-2018. Obstetric and neonatal outcomes were compared between cases with placental acute vs. continuous meconium exposure associated changes (columnar epithelial changes and meconium-laden macrophages, respectively). Regression analysis was used to identify independent associations with adverse neonatal outcomes. RESULTS: The medical records of 294 deliveries at our institution were reviewed, along with medical records of the neonates and the histopathological reports of their placentas. Ninety-two cases were classified as an acute placental reaction to meconium (acute exposure group) and 200 as continuous placental exposure (continuous exposure group). Patient demographics did not differ between groups. Placentas from the continuous exposure to meconium were associated with a higher rate of placental weight <10th percentile (p = 0.03) while the acute exposure group was associated with a shorter time between rupture of membranes and delivery (p = 0.02). and higher rates of non-reassuring fetal heart rate in labor (p = 0.003), and of adverse neonatal outcome (p = 0.02). In multivariable analysis adverse neonatal outcome was associated with acute histologic exposure to meconium independent of background confounders (aOR = 1.51, 95% CI 1.12-3.67). CONCLUSIONS: Acute histological changes of MSAF were independently associated with adverse neonatal outcomes as compared to continuous histologic MSAF. CI - Copyright © 2020 Elsevier Ltd. All rights reserved. FAU - Tamayev, Liliya AU - Tamayev L AD - Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Mor, Liat AU - Mor L AD - Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Herman, Hadas Ganer AU - Herman HG AD - Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Schreiber, Letizia AU - Schreiber L AD - Department of Pathology, The Edith Wolfson Medical Center, Holon, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Kovo, Michal AU - Kovo M AD - Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Bar, Jacob AU - Bar J AD - Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Weiner, Eran AU - Weiner E AD - Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: masolbarak@gmail.com. LA - eng PT - Journal Article DEP - 20201105 PL - Netherlands TA - Placenta JT - Placenta JID - 8006349 SB - IM OTO - NOTNLM OT - Meconium OT - Meconium aspiration syndrome (MAS) OT - Meconium-stained amniotic fluid (MSAF) OT - Obstetric complications OT - Placental histopathology EDAT- 2020/11/10 06:00 MHDA- 2020/11/10 06:00 CRDT- 2020/11/09 20:18 PHST- 2020/07/18 00:00 [received] PHST- 2020/09/20 00:00 [revised] PHST- 2020/10/01 00:00 [accepted] PHST- 2020/11/10 06:00 [pubmed] PHST- 2020/11/10 06:00 [medline] PHST- 2020/11/09 20:18 [entrez] AID - S0143-4004(20)30378-7 [pii] AID - 10.1016/j.placenta.2020.10.002 [doi] PST - aheadofprint SO - Placenta. 2020 Nov 5;103:214-219. doi: 10.1016/j.placenta.2020.10.002. PMID- 33155452 OWN - NLM STAT- In-Data-Review LR - 20201115 IS - 1560-2281 (Electronic) IS - 1083-3668 (Print) IS - 1083-3668 (Linking) VI - 25 IP - 11 DP - 2020 Nov TI - Evaluation of the human placenta optical scattering properties using continuous wave and frequency-domain diffuse reflectance spectroscopy. LID - 10.1117/1.JBO.25.11.116001 [doi] LID - 116001 AB - SIGNIFICANCE: Placenta is an essential organ for fetal development and successful reproduction. Placental insufficiency can lead to fetal hypoxia and, in extreme cases anoxia, leading to fetal death. Of the 145 million deliveries per year worldwide, ∼15 million neonates are small for gestational age and, therefore, at risk for antepartum and intrapartum hypoxia. Clinical methods to assess placental function largely rely on the assessment of fetal heart rate changes but do not assess placental oxygenation. Near-infrared spectroscopy (NIRS) allows non-invasive, real-time assessment of tissue oxygenation in intact organs, which can be used to assess placental oxygenation. However, tissue optical properties can affect the accuracy of methods to measure tissue oxygenation. AIM: This study was performed to estimate the scattering coefficient of the human placenta. We have computed the scattering coefficients of the human placenta for the range of 659 to 840 nm using two methods of diffuse reflectance spectroscopy (DRS). APPROACH: Measurements were performed using an in-house DRS device and a well-established frequency-domain diffuse optical spectroscopic system (DOSI). Measurements were performed in eight placentas obtained after cesarean deliveries. Placentas were perfused with normal saline to minimize the effects of absorption due to blood. Three sites per placenta were measured. Absorption and scattering coefficients were then calculated from the measured reflectance using the random walk theory for DRS and frequency-domain algorithm for DOSI. RESULTS: Average reduced scattering coefficient (μs  '  ) was 0.943  ±  0.015  mm  -  1 at 760 nm and 0.831  ±  0.009  mm  -  1 at 840 nm, and a power function μs  '    =  1.6619 (λ/500  nm)  -  1.426 was derived for the human placental scattering coefficient. CONCLUSION: We report for the first time the scattering coefficient of the human placenta. This information can be used to assess baseline scattering and improve measurements of placental oxygen saturation with NIRS. FAU - Khare, Siddharth M AU - Khare SM AD - National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, M, United States. FAU - Nguyen, Thien AU - Nguyen T AD - National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, M, United States. FAU - Anderson, Afrouz A AU - Anderson AA AD - National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, M, United States. FAU - Hill, Brian AU - Hill B AD - National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, M, United States. FAU - Romero, Roberto AU - Romero R AD - U.S. Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Hea, United States. AD - University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, Michigan, United States. AD - Michigan State University, Department of Epidemiology and Biostatistics, East Lansing, Michigan, United States. FAU - Gandjbakhche, Amir H AU - Gandjbakhche AH AD - National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, M, United States. LA - eng GR - HHSN275201300006C/HD/NICHD NIH HHS/United States PT - Journal Article TA - J Biomed Opt JT - Journal of biomedical optics JID - 9605853 SB - IM PMC - PMC7644416 OTO - NOTNLM OT - diffuse optical spectroscopic system OT - near-infrared spectroscopy OT - power function OT - random walk theory OT - scattering coefficient OT - tissue oxygenation EDAT- 2020/11/07 06:00 MHDA- 2020/11/07 06:00 CRDT- 2020/11/06 06:05 PHST- 2020/08/04 00:00 [received] PHST- 2020/10/14 00:00 [accepted] PHST- 2020/11/06 06:05 [entrez] PHST- 2020/11/07 06:00 [pubmed] PHST- 2020/11/07 06:00 [medline] AID - JBO-200250LRR [pii] AID - 200250LRR [pii] AID - 10.1117/1.JBO.25.11.116001 [doi] PST - ppublish SO - J Biomed Opt. 2020 Nov;25(11):116001. doi: 10.1117/1.JBO.25.11.116001. PMID- 33106065 OWN - NLM STAT- Publisher LR - 20201027 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) DP - 2020 Oct 26 TI - Performance of the Kleihauer Betke test in the prediction of neonatal anemia. PG - 1-7 LID - 10.1080/14767058.2020.1837768 [doi] AB - OBJECTIVES: The aim of this study was to correlate antenatal Kleihauer (KT) test results with fetal hemoglobin at birth to find a threshold for predicting severe fetal anemia. The secondary objectives were to assess the impact of KT on obstetric management and to study the correlation between the middle cerebral artery peack systolic velocity and fetal anemia. RESULTS: One thousand forty-six KT were positive over the 10-year period, but only 147 were included from 88 patients, of which 17 fetuses were anemic. Demographic and obstetric characteristics were similar between anemic and non-anemic groups. As regards new-born, there was a higher risk of prematurity among anemic as long as a lower birth rate in accordance. While a negative correlation was observed between KT and hemoglobin at birth, no KT upper threshold could be found that was both sensitive and specific. In addition, there was no case of fetal anemia when KT was repeated, even though it increased. KT showed little usefulness in obstetrics management to help improving neonatal care for anemia. Conversely, the MCA PSV demonstrated good performance in this matter and the ROC curve area was 0.91 (figure). DISCUSSION: Feto-maternal hemorrhage is a rare but grave pathology which could lead to anemia. The most common clinical sign is reduced fetal movement and it was the main indication to perform a KT. Cardiotocography patterns suggestive of anemia are sinusoidal, micro-oscillatory and non-reactive monitoring. Ultrasound features were polyhydramnios, hydrop fetalis and increased MCA peack systolic velocity. KT was correlated with MCA PSV and with hemoglobin level at birth. However, the latter showed a better diagnostic performance. MCA PSV measurement is a powerful test to screen for fetal anemia, and should be part of the regular training of obstetricians. Indeed, this technic gives immediate and reliable results, while those of KT are delayed. CONCLUSION: The KT should not be used as a tool to screen for fetal anemia but rather as a test to explain a fetal anemia. However, the MCA PSV is reliable in this matter and give immediate result, thus obstetrician should be trained to routinely perform it. FAU - Bataille, Pauline AU - Bataille P AD - La Roche Sur Yon Hospital, boulevard Stéphane Moreau, La Roche Sur Yon, France. FAU - Petit, Laurent AU - Petit L AD - Sainte Thérèse Private Hospital, Paris, France. FAU - Winer, Norbert AU - Winer N AD - Nantes University Hospital, Nantes, France. LA - eng PT - Journal Article DEP - 20201026 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 SB - IM OTO - NOTNLM OT - Fetal anemia OT - Kleihauer test OT - fetal doppler OT - fetomaternal hemorrhage OT - middle cerebral artery pick systolic velocity EDAT- 2020/10/28 06:00 MHDA- 2020/10/28 06:00 CRDT- 2020/10/27 05:34 PHST- 2020/10/27 05:34 [entrez] PHST- 2020/10/28 06:00 [pubmed] PHST- 2020/10/28 06:00 [medline] AID - 10.1080/14767058.2020.1837768 [doi] PST - aheadofprint SO - J Matern Fetal Neonatal Med. 2020 Oct 26:1-7. doi: 10.1080/14767058.2020.1837768. PMID- 32957140 OWN - NLM STAT- Publisher LR - 20200921 IS - 1098-8785 (Electronic) IS - 0735-1631 (Linking) DP - 2020 Sep 21 TI - Decision to Incision and Risk for Fetal Acidemia, Low Apgar Scores, and Hypoxic Ischemic Encephalopathy. LID - 10.1055/s-0040-1717068 [doi] AB - OBJECTIVE:  This study aimed to assess risk for fetal acidemia, low Apgar scores, and hypoxic ischemic encephalopathy based on decision-to-incision time interval in the setting of emergency cesarean delivery. STUDY DESIGN:  This unplanned secondary analysis of the Maternal-Fetal Medicine Units prospective observational cesarean registry dataset evaluated risk for hypoxic ischemic encephalopathy, umbilical cord pH ≤7.0, and Apgar score ≤4 at 5 minutes based on decision-to-incision time for emergency cesarean deliveries. Cesarean occurring for nonreassuring fetal heart rate monitoring, bleeding previa, nonreassuring antepartum testing, placental abruption, or cord prolapse was classified as emergent. Decision-to-incision time was categorized as <10 minutes, 10 to <20 minutes, 20 to <30 minutes, 30 to <50 minutes, or ≥50 minutes. As secondary outcomes umbilical cord pH ≤7.1, umbilical artery pH ≤7.0, and Apgar score ≤5 at 5 minutes were analyzed. RESULTS:  Of 5,784 women included in the primary analysis, 12.4% had a decision-to-incision interval ≤10 minutes, 20.2% 11 to 20 minutes, 14.9% 21 to 30 minutes, 18.2% 31 to 50 minutes, and 16.5% >50 minutes. Risk for umbilical cord pH ≤7.0 was highest at ≤10 and 11 to 20 minutes (10.2 and 7.9%, respectively), and lowest at 21 to 30 minutes (3.9%), 31 to 50 minutes (3.9%), and >50 minutes (3.5%) (p < 0.01). Risk for Apgar scores ≤4 at 5 minutes was also higher with decision-to-incision intervals ≤10 and 11 to 20 minutes (4.3 and 4.4%, respectively) compared with intervals of 21 to 30 minutes (1.7%), 31 to 50 minutes (2.1%), and >50 minutes (2.0%) (p < 0.01). Hypoxic ischemic encephalopathy occurred in 1.5 and 1.0% of women with decision-to-incision intervals of ≤10 and 11 to 20 minutes compared with 0.3 and 0.5% for women with decision-to-incision intervals of 21 to 30 minutes and 31 to 50 minutes (p = 0.04). Risk for secondary outcomes was also higher with shorter decision-to-incision intervals. CONCLUSION:  Shorter decision-to-incision times were associated with increased risk for adverse outcomes in the setting of emergency cesarean. KEY POINTS: · Shorter intervals likely occur with higher risk cases.. · Shorter intervals were associated with higher neonatal risk.. · Shorter intervals were associated with low cord pH.. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Bousleiman, Sabine AU - Bousleiman S AD - Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York. FAU - Rouse, Dwight J AU - Rouse DJ AD - Division of Research, Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School at Brown University, Providence, Rhode Island. FAU - Gyamfi-Bannerman, Cynthia AU - Gyamfi-Bannerman C AD - Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York. FAU - Huang, Yongmei AU - Huang Y AD - Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York. FAU - D'Alton, Mary E AU - D'Alton ME AD - Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York. FAU - Siddiq, Zainab AU - Siddiq Z AD - Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York. FAU - Wright, Jason D AU - Wright JD AD - Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York. FAU - Friedman, Alexander M AU - Friedman AM AD - Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York City, New York. LA - eng GR - Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health/K08HD082287/ PT - Journal Article DEP - 20200921 PL - United States TA - Am J Perinatol JT - American journal of perinatology JID - 8405212 SB - IM COIS- None declared. EDAT- 2020/09/22 06:00 MHDA- 2020/09/22 06:00 CRDT- 2020/09/21 20:22 PHST- 2020/09/21 20:22 [entrez] PHST- 2020/09/22 06:00 [pubmed] PHST- 2020/09/22 06:00 [medline] AID - 10.1055/s-0040-1717068 [doi] PST - aheadofprint SO - Am J Perinatol. 2020 Sep 21. doi: 10.1055/s-0040-1717068. PMID- 33015176 OWN - NLM STAT- In-Process LR - 20201006 IS - 2314-6141 (Electronic) IS - 2314-6133 (Print) VI - 2020 DP - 2020 TI - Proportion and Associated Factors of Nonreassuring Fetal Heart Rate Patterns in Finote Selam Primary Hospital, North West Ethiopia. PG - 6948972 LID - 10.1155/2020/6948972 [doi] LID - 6948972 AB - INTRODUCTION: Nonreassuring fetal heart rate patterns (NRFHRP) suggest fetal conciliation or a deteriorating ability to handle the stress of labor. Nearly half of stillbirths occurring worldwide are due to hypoxia which is primarily manifested by NRFHRP. Hence, this study assessed the proportion and associated factors of NRFHRP in the Finote Selam primary hospital, North West Ethiopia. METHODS: An institution-based retrospective cross-sectional study was conducted from March 1 to April 1, 2019, on 364 charts of mothers who gave birth from January 2017 to January 2018 at the Finote Selam primary hospital. A computer-based simple random sampling technique was used to select charts. A secondary data was collected using a structured questionnaire adapted from different literatures. The data was entered and analyzed using Epi Info version 7 and Statistical Package for the Social Sciences (SPSS) version 23.0. Binary logistic regression was executed, and all explanatory variables with p value < 0.2 were entered into multivariable logistic regressions. Multivariable logistic regression was used to control the effect of confounding variables and to identify factors affecting NRFHRP. Odds ratios with 95% confidence intervals were computed, and statistical significance was declared if p < 0.05. RESULT: Out of 364 total deliveries, NRFHRP was detected on 55 (15.1%) fetuses, and the commonest NRFHRP detected was bradycardia 44 (80%). Most NRFHRP (38.18%) occurred on the deceleration phase of labor. There was no identified possible cause for NRFHRP on 34.5% of cases. Referral from nearby health institutions [AOR = 2.832 (95% CI 1.457, 5.503)], primigravida [AOR = 2.722 (95% CI 1.377, 5.381)], augmentation of labor [AOR = 3.664 (95% CI 1.782, 7.534)], and meconium-stained amniotic fluid [AOR = 6.491 (95% CI 3.198, 13.173)] were significantly associated with NRFHRP. CONCLUSION: The proportion of NRFHRP is high. Referral from nearby health institutions, primigravida mothers, augmentation of labor, and meconium-stained amniotic fluid were significantly associated with NRFHRP. Implementing a better referral link and close monitoring during follow-up could minimize NHFHRP. CI - Copyright © 2020 Eden Asmare Kassahun et al. FAU - Kassahun, Eden Asmare AU - Kassahun EA AUID- ORCID: 0000-0002-3278-1193 AD - Midwifery Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia. FAU - Aweke, Amlaku Mulat AU - Aweke AM AUID- ORCID: 0000-0002-1064-4585 AD - Midwifery Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia. FAU - Getu, Almaz Aklilu AU - Getu AA AD - Midwifery Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia. FAU - Gela, Getahun Belay AU - Gela GB AD - Midwifery Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia. FAU - Limenih, Simachew Kassa AU - Limenih SK AD - Midwifery Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia. FAU - Mekonnen, Mesafint Ewnetu AU - Mekonnen ME AD - Midwifery Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia. FAU - Abtie, Tilksew Ayalew AU - Abtie TA AUID- ORCID: 0000-0001-8294-1020 AD - Nursing Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia. LA - eng PT - Journal Article DEP - 20200919 TA - Biomed Res Int JT - BioMed research international JID - 101600173 SB - IM PMC - PMC7525310 COIS- The authors declare that they have no competing interests. EDAT- 2020/10/06 06:00 MHDA- 2020/10/06 06:00 CRDT- 2020/10/05 06:22 PHST- 2020/02/04 00:00 [received] PHST- 2020/07/19 00:00 [revised] PHST- 2020/08/19 00:00 [accepted] PHST- 2020/10/05 06:22 [entrez] PHST- 2020/10/06 06:00 [pubmed] PHST- 2020/10/06 06:00 [medline] AID - 10.1155/2020/6948972 [doi] PST - epublish SO - Biomed Res Int. 2020 Sep 19;2020:6948972. doi: 10.1155/2020/6948972. eCollection 2020. PMID- 32939941 OWN - NLM STAT- In-Process LR - 20210107 IS - 1447-0756 (Electronic) IS - 1341-8076 (Linking) VI - 47 IP - 1 DP - 2021 Jan TI - Accuracy of predicting neonatal distress using a five-level classification of fetal heart rate monitoring. PG - 254-261 LID - 10.1111/jog.14490 [doi] AB - AIM: To assess the accuracy of neonatal distress prediction using the five-level classification of fetal heart rate (FHR) and management protocol of the Japan Society of Obstetrics and Gynecology (JSOG). METHODS: A case-control study was conducted. Vertex singleton pregnant women who delivered after 37 weeks' gestation from 2013 to 2015 were enrolled. The participants were categorized into two groups; controls were levels 1-3 (n = 1184), whereas cases were levels 4-5 (n = 117) group. Neonatal distress was defined as Apgar score < 8 points at 5 min or umbilical cord artery pH < 7.1. RESULTS: There were 117 cases (9.0%). The frequency of the neonatal distress was observed in 1.3% controls and 6.8% cases (P < 0.01). Diagnostic accuracy of neonatal distress for cases showed a 6.8% positive-predictive value, 34.8% sensitivity, 91.5% specificity and 98.7% negative-predictive value. Among various obstetrical conditions, high sensitivity (100%) for prediction of neonatal distress was observed in women with chromosome abnormalities, placental abruption, umbilical cord abnormalities and excessive labor pain. Conversely, relatively low specificity (<50%) was observed in cases with oligohydramnios and excessive labor pain. CONCLUSION: The five-level classification scheme was efficient for neonatal distress prediction. However, depending on the obstetric condition, the FHR findings and neonatal condition might be independent. CI - © 2020 Japan Society of Obstetrics and Gynecology. FAU - Furuya, Natsumi AU - Furuya N AD - Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan. FAU - Hasegawa, Junichi AU - Hasegawa J AD - Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan. FAU - Imai, Haruka AU - Imai H AD - Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan. FAU - Homma, Chika AU - Homma C AD - Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan. FAU - Kurasaki, Akiko AU - Kurasaki A AD - Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan. FAU - Kondo, Haruhiro AU - Kondo H AD - Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan. FAU - Suzuki, Nao AU - Suzuki N AD - Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan. LA - eng PT - Journal Article DEP - 20200916 PL - Australia TA - J Obstet Gynaecol Res JT - The journal of obstetrics and gynaecology research JID - 9612761 SB - IM OTO - NOTNLM OT - cardiotocogram OT - fetal heart rate monitoring OT - neonatal distress OT - nonreassuring fetal status EDAT- 2020/09/18 06:00 MHDA- 2020/09/18 06:00 CRDT- 2020/09/17 05:49 PHST- 2020/05/11 00:00 [received] PHST- 2020/08/09 00:00 [revised] PHST- 2020/09/02 00:00 [accepted] PHST- 2020/09/18 06:00 [pubmed] PHST- 2020/09/18 06:00 [medline] PHST- 2020/09/17 05:49 [entrez] AID - 10.1111/jog.14490 [doi] PST - ppublish SO - J Obstet Gynaecol Res. 2021 Jan;47(1):254-261. doi: 10.1111/jog.14490. Epub 2020 Sep 16. PMID- 32925496 OWN - NLM STAT- Publisher LR - 20200914 IS - 1530-0315 (Electronic) IS - 0195-9131 (Linking) DP - 2020 Sep 11 TI - Elite Athletes and Pregnancy Outcomes: A Systematic Review and Meta-analysis. LID - 10.1249/MSS.0000000000002510 [doi] AB - PURPOSE: The purpose of this systematic review was to evaluate fetal and maternal pregnancy outcomes of elite athletes who had participated in competitive sport immediately prior to conception. METHODS: Online databases were searched up to March 24, 2020. Studies of any design and language were eligible if they contained information on the relevant population (pregnant women), exposure (engaged in elite sport immediately prior to pregnancy), and outcomes (birthweight, low birthweight, macrosomia, preterm birth, fetal heart rate and pulse index, cesarean sections, instrumental deliveries, episiotomies, duration of labor, perineal tears, pregnancy induced low back pain, pelvic girdle pain, urinary incontinence, miscarriages, prenatal weight gain, inadequate/excess prenatal weight gain, maternal depression or anxiety). RESULTS: Eleven unique studies (n = 2,256 women) were included. We identified 'low' certainty evidence demonstrating lower rates of low back pain in elite athletes compared to active/sedentary controls (n = 248; OR 0.38; 95%CI [0.20, 0.73], I= 0%;); and 'very low' certainty evidence indicating an increased odds of excessive prenatal weight gain in elite athletes versus active/sedentary controls (n = 1,763; OR 2.47; 95%CI [1.26, 4.85], I= 0%). 'Low' certainty evidence from two studies (n=7) indicated three episodes of fetal bradycardia following high intensity exercise that resolved within 10 minutes of cessation of activity. No studies reported inadequate gestational weight gain or maternal depression or anxiety. There were no differences between elite athletes and controls for all other outcomes. CONCLUSION: There is 'low' certainty of evidence that elite athletes have reduced odds of experiencing pregnancy-related low back pain and 'very low' certainty of evidence that elite athletes have increased odds of excessive weight gain compared to active/sedentary controls. More research is needed to provide strong evidence of how elite competitive sport prior to pregnancy impacts maternal and fetal outcomes. PROSPERO registration (CRD42020167382). FAU - Wowdzia, Jenna B AU - Wowdzia JB AD - Program for Pregnancy and Postpartum Health. Faculty of Kinesiology, Sports and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, AB, CANADA. FAU - McHugh, Tara-Leigh AU - McHugh TL AD - Faculty of Kinesiology, Sports, and Recreation, University of Alberta, Edmonton, AB, CANADA. FAU - Thornton, Jane AU - Thornton J AD - Fowler Kennedy Sports Medicine Clinic. Department of Family Medicine, Schulich School of Medicine and Dentistry. Department of Epidemiology, and Biostatistics, Schulich School of Medicine and Dentistry. Western University, London, ON, CANADA. FAU - Sivak, Allison AU - Sivak A AD - University of Alberta Libraries, University of Alberta, Edmonton, AB, CANADA. FAU - Mottola, Michelle F AU - Mottola MF AD - R. Samuel McLaughlin Foundation - Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Children's Health Research Institute, Western University, London, ON, CANADA. FAU - Davenport, Margie H AU - Davenport MH AD - Program for Pregnancy and Postpartum Health. Faculty of Kinesiology, Sports and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, AB, CANADA. LA - eng PT - Journal Article DEP - 20200911 PL - United States TA - Med Sci Sports Exerc JT - Medicine and science in sports and exercise JID - 8005433 SB - IM EDAT- 2020/09/15 06:00 MHDA- 2020/09/15 06:00 CRDT- 2020/09/14 15:44 PHST- 2020/09/14 15:44 [entrez] PHST- 2020/09/15 06:00 [pubmed] PHST- 2020/09/15 06:00 [medline] AID - 10.1249/MSS.0000000000002510 [doi] PST - aheadofprint SO - Med Sci Sports Exerc. 2020 Sep 11. doi: 10.1249/MSS.0000000000002510. PMID- 32870345 OWN - NLM STAT- Publisher LR - 20200901 IS - 1432-0711 (Electronic) IS - 0932-0067 (Linking) DP - 2020 Sep 1 TI - Intrapartum fetal monitoring and perinatal risk factors of neonatal hypoxic-ischemic encephalopathy. LID - 10.1007/s00404-020-05757-2 [doi] AB - BACKGROUND: Neonatal hypoxic-ischemic encephalopathy (HIE) in term infants, is a major cause of neonatal mortality and severe neurologic disability. OBJECTIVES: To identify in labor fetal monitoring characteristic patterns and perinatal factors associated with neonatal HIE. STUDY DESIGN: Single-center retrospective case-control study between 2010 and 2017. Cases clinically diagnosed with neonatal HIE treated by therapeutic hypothermia according to strict criteria (HIE-TH) were compared to a group of neonates born in the same period, gestational age-matched diagnosed with fetal distress according to fetal monitoring interpretation that was followed by prompt delivery, without subsequent HIE or therapeutic hypothermia (No-HIE). The primary outcome of the study was the electronic fetal monitoring (EFM) pattern during 60 min prior to delivery; the secondary outcome was the identification of perinatal associated factors. RESULTS: 54 neonates with HIE were treated by therapeutic hypothermia. EFM parameters most predictive of HIE-TH were indeterminate baseline heart rate OR = 47.297, 95% (8.17-273.76) p < 0.001, bradycardia OR = 15.997 95% (4.18-61.18) p < 0.001, low variability OR = 10.224, 95% (2.71-38.45) p < 0.001, higher baseline of the fetal heart rate calculated for each increment of 1 BPM OR = 1.0547, 95% (1.001-1.116) p = 0.047. Rupture of a previous uterine cesarean scar and placental abruption were characteristic of the HIE-TH group 14.8% vs. 1% p < 0.05; and 16.7% vs. 6% p < 0.05, respectively. Adverse neonatal outcomes also differed significantly: HIE-TH had a higher rate of neonatal seizures 46.2% vs. 0% p < 0.001 and mortality 7.7% vs. 0% p < 0.001. CONCLUSIONS: Characteristic fetal monitoring pattern prior to delivery together with acute obstetric emergency events are associated with neonatal HIE, neurological morbidity, and mortality. FAU - Michaeli, Jennia AU - Michaeli J AD - Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Affiliated with the Hebrew University Hadassah School of Medicine, 12 Shmuel Bait St, P.O. Box 3235, 9103102, Jerusalem, Israel. FAU - Srebnik, Naama AU - Srebnik N AUID- ORCID: 0000-0003-0488-9313 AD - Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Affiliated with the Hebrew University Hadassah School of Medicine, 12 Shmuel Bait St, P.O. Box 3235, 9103102, Jerusalem, Israel. srebnik@gmail.com. FAU - Zilberstein, Zvi AU - Zilberstein Z AD - Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Affiliated with the Hebrew University Hadassah School of Medicine, 12 Shmuel Bait St, P.O. Box 3235, 9103102, Jerusalem, Israel. FAU - Rotem, Reut AU - Rotem R AD - Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Affiliated with the Hebrew University Hadassah School of Medicine, 12 Shmuel Bait St, P.O. Box 3235, 9103102, Jerusalem, Israel. FAU - Bin-Nun, Alona AU - Bin-Nun A AD - Department of Neonatology, Shaare Zedek Medical Center Affiliated with the Hebrew University Hadassah School of Medicine, Jerusalem, Israel. FAU - Grisaru-Granovsky, Sorina AU - Grisaru-Granovsky S AD - Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Affiliated with the Hebrew University Hadassah School of Medicine, 12 Shmuel Bait St, P.O. Box 3235, 9103102, Jerusalem, Israel. LA - eng PT - Journal Article DEP - 20200901 PL - Germany TA - Arch Gynecol Obstet JT - Archives of gynecology and obstetrics JID - 8710213 SB - IM OTO - NOTNLM OT - Bradycardia OT - Indeterminate baseline heart OT - Low variability OT - Obstetric emergency OT - Perinatal hypoxia OT - Placental abruption OT - Tachysystole OT - Uterine rupture EDAT- 2020/09/02 06:00 MHDA- 2020/09/02 06:00 CRDT- 2020/09/02 06:00 PHST- 2019/10/05 00:00 [received] PHST- 2020/08/24 00:00 [accepted] PHST- 2020/09/02 06:00 [entrez] PHST- 2020/09/02 06:00 [pubmed] PHST- 2020/09/02 06:00 [medline] AID - 10.1007/s00404-020-05757-2 [pii] AID - 10.1007/s00404-020-05757-2 [doi] PST - aheadofprint SO - Arch Gynecol Obstet. 2020 Sep 1. doi: 10.1007/s00404-020-05757-2. PMID- 32649322 OWN - NLM STAT- In-Process LR - 20210121 IS - 1532-5520 (Electronic) IS - 0009-9201 (Linking) VI - 63 IP - 3 DP - 2020 Sep TI - Management of the Category II Fetal Heart Rate Tracing. PG - 659-667 LID - 10.1097/GRF.0000000000000551 [doi] AB - Management of the category II fetal heart rate (FHR) tracing presents a common challenge in obstetrics. Up to 80% of women will have a category II FHR tracing at some point during labor. Here we propose a management algorithm to identify specific features of the FHR tracing that correlate with risk for fetal acidemia, target interventions to address FHR decelerations, and guide clinicians about when to proceed toward operative vaginal delivery or cesarean to achieve delivery before there is a high risk for significant fetal acidemia with potential for neurological injury or death. FAU - Eller, Alexandra G AU - Eller AG AD - Women and Newborns, Intermountain Healthcare, Department of OBGYN. FAU - Esplin, M Sean AU - Esplin MS AD - Department of Maternal Fetal Medicine, Intermountain Healthcare. AD - Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah. LA - eng PT - Journal Article PL - United States TA - Clin Obstet Gynecol JT - Clinical obstetrics and gynecology JID - 0070014 SB - IM EDAT- 2020/07/11 06:00 MHDA- 2020/07/11 06:00 CRDT- 2020/07/11 06:00 PHST- 2020/07/11 06:00 [pubmed] PHST- 2020/07/11 06:00 [medline] PHST- 2020/07/11 06:00 [entrez] AID - 00003081-202009000-00023 [pii] AID - 10.1097/GRF.0000000000000551 [doi] PST - ppublish SO - Clin Obstet Gynecol. 2020 Sep;63(3):659-667. doi: 10.1097/GRF.0000000000000551. PMID- 32534466 OWN - NLM STAT- In-Process LR - 20201002 IS - 1442-200X (Electronic) IS - 1328-8067 (Linking) VI - 62 IP - 9 DP - 2020 Sep TI - Differences in rate and medical indication of caesarean section between Germany and Japan. PG - 1086-1093 LID - 10.1111/ped.14340 [doi] AB - BACKGROUND: There are growing concerns about the increasing rate of caesarean section (CS) worldwide. Various strategies have been implemented to reduce the proportion of CS to a reasonable level. Most research on medical indications for CS focuses on nationwide evaluations. Comparative research between different countries is sparse. The aim of this study was to evaluate differences in the rate and indications for CS between Japan and Germany in 2012 and 2013. METHODS: Comparison of the overall rate and medical indications for CS in two cohort studies from Germany and Japan. We used data from the German Perinatal Survey and the Japan Environment and Children's Study (JECS). RESULTS: We analyzed data of 1 335 150 participants from the German perinatal survey and of 62 533 participants from JECS and found significant differences between the two countries in CS rate (30.6% vs 20.6%) and main medical indications: cephalopelvic disproportion (3.2% vs 1.3%; OR: 2.4 [95% CI: 2.2-2.6]), fetal distress (7.3% vs 2.3%; OR: 3.4 [95%-CI: 3.2-3.6]), and past uterine surgery/repeat CS (8.4% vs 8.8%; OR: 0.9 [95%-CI: 0.9-1]). CONCLUSION: There are differences in the rate and medical indications for CS between Germany and Japan at the population level. Fetal distress was identified as a medical indication for CS more often Germany than in Japan. Considering the substantial diagnostic uncertainty of electronic fetal monitoring (EFM) as the major indicator for fetal distress, it would seem to be reasonable to rethink CS decision algorithms. CI - © 2020 The Authors. Pediatrics International published by John Wiley & Sons Australia, Ltd on behalf of Japan Pediatric Society. FAU - Fröhlich, Matthias AU - Fröhlich M AUID- ORCID: 0000-0002-9256-262X AD - Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany. FAU - Koga, Chie AU - Koga C AD - Center for Preventive Medical Sciences, Chiba University, Chiba, Japan. FAU - Bührer, Christoph AU - Bührer C AD - Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany. FAU - Mori, Chisato AU - Mori C AD - Center for Preventive Medical Sciences, Chiba University, Chiba, Japan. AD - Department of Sustainable Health Science, Center of Preventive Medical Sciences, Chiba University, Chiba, Japan. FAU - Yamamoto, Midori AU - Yamamoto M AD - Center for Preventive Medical Sciences, Chiba University, Chiba, Japan. FAU - Sakurai, Kenichi AU - Sakurai K AD - Center for Preventive Medical Sciences, Chiba University, Chiba, Japan. FAU - Hinkson, Larry AU - Hinkson L AD - Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany. CN - Japan Environment, Children's Study Group LA - eng PT - Journal Article PL - Australia TA - Pediatr Int JT - Pediatrics international : official journal of the Japan Pediatric Society JID - 100886002 SB - IM OTO - NOTNLM OT - birth mode OT - caesarean section OT - epidemiology OT - indication OT - neonates EDAT- 2020/06/14 06:00 MHDA- 2020/06/14 06:00 CRDT- 2020/06/14 06:00 PHST- 2020/03/16 00:00 [received] PHST- 2020/05/28 00:00 [revised] PHST- 2020/06/05 00:00 [accepted] PHST- 2020/06/14 06:00 [pubmed] PHST- 2020/06/14 06:00 [medline] PHST- 2020/06/14 06:00 [entrez] AID - 10.1111/ped.14340 [doi] PST - ppublish SO - Pediatr Int. 2020 Sep;62(9):1086-1093. doi: 10.1111/ped.14340. PMID- 32516155 OWN - NLM STAT- In-Process LR - 20210121 IS - 1532-5520 (Electronic) IS - 0009-9201 (Linking) VI - 63 IP - 3 DP - 2020 Sep TI - Identification of the Fetus at Risk for Metabolic Acidemia Using Continuous Fetal Heart Rate Monitoring. PG - 616-624 LID - 10.1097/GRF.0000000000000546 [doi] AB - The fetal heart rate can be used to assess the current metabolic state of the fetus and predict the risk of the evolution of metabolic acidemia through the course of labor. In this chapter, we will present the pathophysiology of the development of fetal acidemia and provide an organized approach to identifying the risk of worsening acidemia using changes noted in the fetal heart rate pattern to allow for interventions that might alter this course. FAU - Esplin, M Sean AU - Esplin MS AD - Department of Maternal Fetal Medicine, Intermountain Healthcare. AD - Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah. LA - eng PT - Journal Article PL - United States TA - Clin Obstet Gynecol JT - Clinical obstetrics and gynecology JID - 0070014 SB - IM EDAT- 2020/06/10 06:00 MHDA- 2020/06/10 06:00 CRDT- 2020/06/10 06:00 PHST- 2020/06/10 06:00 [pubmed] PHST- 2020/06/10 06:00 [medline] PHST- 2020/06/10 06:00 [entrez] AID - 00003081-202009000-00019 [pii] AID - 10.1097/GRF.0000000000000546 [doi] PST - ppublish SO - Clin Obstet Gynecol. 2020 Sep;63(3):616-624. doi: 10.1097/GRF.0000000000000546. PMID- 32516154 OWN - NLM STAT- In-Process LR - 20210121 IS - 1532-5520 (Electronic) IS - 0009-9201 (Linking) VI - 63 IP - 3 DP - 2020 Sep TI - The Goal of Continuous Fetal Heart Rate Monitoring During Labor: Have We Been Successful? PG - 601-606 LID - 10.1097/GRF.0000000000000543 [doi] AB - Despite its ubiquitous use, fetal heart rate (FHR) monitoring has not resulted in a significant reduction in hypoxic-ischemic encephalopathy following delivery. This manuscript reviews the reasons for this failure including limitations of FHR to accurately predict hypoxia, low prevalence of hypoxic-ischemic encephalopathy, and lack of standardization of interpretation and intervention. We propose an alternative goal for FHR monitoring during labor to provide optimal care by early identification of truly concerning features, initiation of appropriate interventions, clear documentation of concerns and plans, and clear communication between team members on labor and delivery, including initiation of the chain of command as needed. FAU - Esplin, M Sean AU - Esplin MS AD - Department of Maternal Fetal Medicine, Intermountain Healthcare. AD - Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah. LA - eng PT - Journal Article PL - United States TA - Clin Obstet Gynecol JT - Clinical obstetrics and gynecology JID - 0070014 SB - IM EDAT- 2020/06/10 06:00 MHDA- 2020/06/10 06:00 CRDT- 2020/06/10 06:00 PHST- 2020/06/10 06:00 [pubmed] PHST- 2020/06/10 06:00 [medline] PHST- 2020/06/10 06:00 [entrez] AID - 00003081-202009000-00017 [pii] AID - 10.1097/GRF.0000000000000543 [doi] PST - ppublish SO - Clin Obstet Gynecol. 2020 Sep;63(3):601-606. doi: 10.1097/GRF.0000000000000543. PMID- 32984215 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201001 IS - 2296-2360 (Print) IS - 2296-2360 (Electronic) IS - 2296-2360 (Linking) VI - 8 DP - 2020 TI - Electronic Fetal Monitoring-Prevention or Rescue? PG - 503 LID - 10.3389/fped.2020.00503 [doi] LID - 503 FAU - Schifrin, Barry S AU - Schifrin BS AD - Department of Obstetrics & Gynecology, Western University of Health Sciences, Pomona, CA, United States. LA - eng PT - Journal Article DEP - 20200827 TA - Front Pediatr JT - Frontiers in pediatrics JID - 101615492 PMC - PMC7481352 OTO - NOTNLM OT - EFM OT - classification of FHR patterns OT - defensive medicine OT - fetal acidemia OT - malpractice awards OT - obstetrical malpractice EDAT- 2020/09/29 06:00 MHDA- 2020/09/29 06:01 CRDT- 2020/09/28 05:45 PHST- 2020/04/06 00:00 [received] PHST- 2020/07/16 00:00 [accepted] PHST- 2020/09/28 05:45 [entrez] PHST- 2020/09/29 06:00 [pubmed] PHST- 2020/09/29 06:01 [medline] AID - 10.3389/fped.2020.00503 [doi] PST - epublish SO - Front Pediatr. 2020 Aug 27;8:503. doi: 10.3389/fped.2020.00503. eCollection 2020. PMID- 32874404 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200928 IS - 1930-0433 (Print) IS - 1930-0433 (Electronic) IS - 1930-0433 (Linking) VI - 15 IP - 10 DP - 2020 Oct TI - Rectus sheath hematoma in pregnancy: a case report. PG - 2022-2025 LID - 10.1016/j.radcr.2020.08.001 [doi] AB - This clinical study reports a case of rectus sheath hematoma in a 32-year-old woman with a pregnancy at 33 weeks of gestation, who developed acute right-sided abdominal pain following anticoagulant administration for pulmonary embolism. The rectus sheath hematoma was identified during an emergency cesarean section initiated due to severe fetal bradycardia. The present case would have been easy to manage prenatally if the presence of rectus sheath hematoma had been added as a differential diagnosis. For future cases, timely recognition and therapy could help prevent premature cesarean delivery. CI - Crown Copyright © 2020 Published by Elsevier Inc. on behalf of University of Washington. FAU - Anwari, Lida AU - Anwari L AD - Department of Obstetrics & Gynaecology, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, United Kingdom. LA - eng PT - Case Reports DEP - 20200825 TA - Radiol Case Rep JT - Radiology case reports JID - 101467888 PMC - PMC7452068 OTO - NOTNLM OT - Abdominal pain OT - Cardiotocography OT - Cesarean section OT - Computed tomography OT - Rectus sheath hematoma OT - Ultrasound EDAT- 2020/09/03 06:00 MHDA- 2020/09/03 06:01 CRDT- 2020/09/03 06:00 PHST- 2020/06/29 00:00 [received] PHST- 2020/07/31 00:00 [revised] PHST- 2020/08/01 00:00 [accepted] PHST- 2020/09/03 06:00 [entrez] PHST- 2020/09/03 06:00 [pubmed] PHST- 2020/09/03 06:01 [medline] AID - S1930-0433(20)30394-0 [pii] AID - 10.1016/j.radcr.2020.08.001 [doi] PST - epublish SO - Radiol Case Rep. 2020 Aug 25;15(10):2022-2025. doi: 10.1016/j.radcr.2020.08.001. eCollection 2020 Oct. PMID- 32839938 OWN - NLM STAT- In-Process LR - 20201203 IS - 1865-8652 (Electronic) IS - 0741-238X (Linking) VI - 37 IP - 10 DP - 2020 Oct TI - Prolonged Fetal Heart Rate Decelerations in Labor: Can We Reduce Unplanned Primary Cesarean Sections in This Group? PG - 4325-4335 LID - 10.1007/s12325-020-01468-x [doi] AB - INTRODUCTION: Non-reassuring fetal tracing is the second leading cause of primary cesarean delivery in the United States. Prolonged fetal heart rate decelerations are non-reassuring fetal heart rate characteristics, which do not uniformly predict poor fetal outcome but can prompt obstetricians to proceed with cesarean delivery. The objective of this manuscript is to identify a strategy to reduce the primary cesarean section rate in patients with prolonged fetal heart rate decelerations in labor. METHODS: This is a retrospective cohort study over a 5-year period at an academic medical center, including patients undergoing primary cesarean section following labor induction, augmentation, or spontaneous labor who were noted to have prolonged fetal heart rate deceleration(s) in the 1 h prior to the time of delivery. Two groups were compared: "crash" cesarean sections versus "emergent" cesarean sections. The primary outcome was if fetal heart tones were rechecked in the operating room prior to cesarean section incision. Secondary outcomes included maternal-fetal monitoring versus Doppler fetal heart tones in the operating room, return to baseline noted in the operating room, fetal outcomes, fetal monitoring characteristics, and anesthesia type between crash versus emergent groups. RESULTS: Of 1969 term singleton cesarean sections, 119 patients met our inclusion criteria (emergent group n = 80) (crash group n = 39), which accounted for 13.9% of all primary cesarean sections during the study period. The emergent group had a significantly higher rate of reassessment of fetal heart tones in the operating room n = 61 (76.2%) versus the crash group n = 15 (38.4%) (p ≤ 0.0001). There were no statistically significant differences regarding fetal outcomes between the two groups. The crash group had a higher rate of category 1 fetal heart rate tracing prior to the prolonged deceleration, a longer median prolonged deceleration, and a deeper median nadir of the prolonged deceleration; these differences were statistically significant. The prolonged-to-delivery interval was significantly shorter in the crash group (median = 15 min) than tin he emergent group (median = 33 min) (p ≤ 0.0001). The crash group also had a higher rate of general anesthesia (n = 11, 28.2%) than the emergent group (n = 6, 7.5%) (p = 0.002). The crash group was specifically investigated. Of the 15 patients with fetal heart tones rechecked in the crash group, 7 had returned to baseline in the operating room, but underwent cesarean section without fetal monitoring. CONCLUSION: Our results indicate that the practice of placing patients on fetal monitor upon arrival to the operating room prior to performing crash cesarean delivery could reduce the rate of primary cesarean deliveries performed for prolonged decelerations in labor. When fetal heart tones have returned to baseline upon arrival in the operating room, the decision to proceed with cesarean delivery can be reconsidered. However, many clinical factors must be taken into consideration, and the decision to proceed is ultimately at the discretion of the obstetrics provider. FAU - Morgan, John A AU - Morgan JA AD - Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Shreveport, LA, USA. FAU - Hankins, Miriam E AU - Hankins ME AD - Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Shreveport, LA, USA. FAU - Wang, Yuping AU - Wang Y AD - Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Shreveport, LA, USA. FAU - Hutchinson, Donna AU - Hutchinson D AD - Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Shreveport, LA, USA. FAU - Sams, Hannah L AU - Sams HL AD - Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Shreveport, LA, USA. FAU - Voltz, John H AU - Voltz JH AD - Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Shreveport, LA, USA. FAU - McCathran, Charles E AU - McCathran CE AD - Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Shreveport, LA, USA. FAU - Kaye, Alan D AU - Kaye AD AD - Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Shreveport, LA, USA. akaye@lsuhsc.edu. FAU - Lewis, David F AU - Lewis DF AD - Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Shreveport, LA, USA. LA - eng PT - Journal Article DEP - 20200824 PL - United States TA - Adv Ther JT - Advances in therapy JID - 8611864 SB - T OTO - NOTNLM OT - *Crash OT - *Deceleration OT - *Electronic fetal monitoring OT - *Emergent OT - *Labor OT - *Primary cesarean section OT - *Prolonged EDAT- 2020/08/26 06:00 MHDA- 2020/08/26 06:00 CRDT- 2020/08/26 06:00 PHST- 2020/06/22 00:00 [received] PHST- 2020/08/26 06:00 [pubmed] PHST- 2020/08/26 06:00 [medline] PHST- 2020/08/26 06:00 [entrez] AID - 10.1007/s12325-020-01468-x [pii] AID - 10.1007/s12325-020-01468-x [doi] PST - ppublish SO - Adv Ther. 2020 Oct;37(10):4325-4335. doi: 10.1007/s12325-020-01468-x. Epub 2020 Aug 24. PMID- 32745099 OWN - NLM STAT- MEDLINE DCOM- 20201013 LR - 20201013 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 15 IP - 8 DP - 2020 TI - Is short-term-variation of fetal-heart-rate a better predictor of fetal acidaemia in labour? A feasibility study. PG - e0236982 LID - 10.1371/journal.pone.0236982 [doi] LID - e0236982 AB - BACKGROUND: Continuous intrapartum fetal monitoring is challenging and its clinical benefits are debated. The project evaluated whether short-term-variation (STV) and other computerised fetal heart rate (FHR) parameters (baseline FHR, long-term-variation, accelerations and decelerations) predicted acidaemia at birth. The aims of the study were to assess the changes in FHR pattern during labour and determine the feasibility of undertaking a definitive trial by reporting the practicalities of using the monitoring device, participant recruitment, data collection and staff training. METHODS: 200 high-risk women carrying a term singleton, non-anomalous fetus, requiring continuous FHR monitoring in labour were consented to participate from the Jessop Wing maternity unit, Sheffield, UK. The trans-abdominal fetal ECG monitor was placed as per clinical protocol. During the monitoring session, clinicians were blinded to the computerised FHR parameters. We analysed the last hour of the FHR and its ability to predict umbilical arterial blood pH <7.20 using receiver operator characteristics (ROC) curves. RESULTS: Of 200 women, 137 cases were excluded as either the monitor did not work from the onset of labour (n = 30), clinical staff did not return or used the monitor on another patient (n = 37), umbilical cord blood not obtained (n = 25), FHR data not recorded within an hour of birth (n = 34) and other reasons (n = 11). In 63 cases included in the final analysis, the computer-derived FHR parameters did not show significant correlation with umbilical artery cord pH <7.20. Labour was associated with a significant increase in short and long term variation of FHR and number of deceleration (P<0.001). However, baseline FHR decreased significantly before delivery (P<0.001). CONCLUSIONS: The project encountered a number of challenges, with learning points crucial to informing the design of a large study to evaluate the potential place of intrapartum computerised FHR parameters, using abdominal fetal ECG monitor before its clinical utility and more widespread adoption can be ascertained. FAU - Kapaya, Habiba AU - Kapaya H AUID- ORCID: 0000-0001-6218-1781 AD - Sheffield Teaching Hospitals, NHS Foundation Trust, Tree Root Walk, Sheffield, United Kingdom. FAU - Jacques, Richard AU - Jacques R AD - Medical Statistics Group, School of Health and Related Research (ScHARR), University of Sheffield, United Kingdom. FAU - Almond, Thomas AU - Almond T AD - Obstetrics and Gynaecology, Sheffield Teaching Hospitals, NHS Foundation Trust, Tree Root Walk, Sheffield, United Kingdom. FAU - Rosser, Miss Hilary AU - Rosser MH AD - Obstetrics and Gynaecology, Sheffield Teaching Hospitals, NHS Foundation Trust, Tree Root Walk, Sheffield, United Kingdom. FAU - Anumba, Dilly AU - Anumba D AD - Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, Tree Root Walk, Sheffield, United Kingdom. LA - eng GR - PB-PG-1215-20010/DH_/Department of Health/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20200803 TA - PLoS One JT - PloS one JID - 101285081 SB - IM MH - Acidosis/physiopathology MH - Adult MH - Cardiotocography MH - Electrocardiography MH - Electroencephalography/*instrumentation MH - Feasibility Studies MH - Female MH - Fetal Blood MH - Fetal Diseases/physiopathology MH - Fetal Monitoring/*methods MH - Fetus/physiopathology MH - Heart Rate, Fetal/*physiology MH - Humans MH - Hydrogen-Ion Concentration MH - Labor, Obstetric MH - Pregnancy PMC - PMC7398510 COIS- The authors have declared that no competing interests exist. EDAT- 2020/08/04 06:00 MHDA- 2020/10/21 06:00 CRDT- 2020/08/04 06:00 PHST- 2020/05/12 00:00 [received] PHST- 2020/07/18 00:00 [accepted] PHST- 2020/08/04 06:00 [entrez] PHST- 2020/08/04 06:00 [pubmed] PHST- 2020/10/21 06:00 [medline] AID - PONE-D-20-14044 [pii] AID - 10.1371/journal.pone.0236982 [doi] PST - epublish SO - PLoS One. 2020 Aug 3;15(8):e0236982. doi: 10.1371/journal.pone.0236982. eCollection 2020. PMID- 32735438 OWN - NLM STAT- MEDLINE DCOM- 20201204 LR - 20201214 IS - 1532-0650 (Electronic) IS - 0002-838X (Linking) VI - 102 IP - 3 DP - 2020 Aug 1 TI - Intrapartum Fetal Monitoring. PG - 158-167 AB - Continuous electronic fetal monitoring was developed to screen for signs of hypoxic-ischemic encephalopathy, cerebral palsy, and impending fetal death during labor. Because these events have a low prevalence, continuous electronic fetal monitoring has a false-positive rate of 99%. The widespread use of continuous electronic fetal monitoring has increased operative and cesarean delivery rates without improved neonatal outcomes, but its use is appropriate in high-risk labor. Structured intermittent auscultation is an underused form of fetal monitoring; when employed during low-risk labor, it can lower rates of operative and cesarean deliveries with neonatal outcomes similar to those of continuous electronic fetal monitoring. However, structured intermittent auscultation remains difficult to implement because of barriers in nurse staffing and physician oversight. The National Institute of Child Health and Human Development terminology is used when reviewing continuous electronic fetal monitoring and delineates fetal risk by three categories. Category I tracings reflect a lack of fetal acidosis and do not require intervention. Category II tracings are indeterminate, are present in the majority of laboring patients, and can encompass monitoring predictive of clinically normal to rapidly developing acidosis. Presence of moderate fetal heart rate variability and accelerations with absence of recurrent pathologic decelerations provides reassurance that acidosis is not present. Category II tracing abnormalities can be addressed by treating reversible causes and providing intrauterine resuscitation, which includes stopping uterine-stimulating agents, fetal scalp stimulation and/or maternal repositioning, intravenous fluids, or oxygen. Recurrent deep variable decelerations can be corrected with amnioinfusion. Category III tracings are highly concerning for fetal acidosis, and delivery should be expedited if immediate interventions do not improve the tracing. FAU - Arnold, James J AU - Arnold JJ AD - Eglin Family Medicine Residency, Eglin Air Force Base, FL, USA. FAU - Gawrys, Breanna L AU - Gawrys BL AD - Saint Louis University Family Medicine Residency Program, Scott Air Force Base, IL, USA. LA - eng PT - Journal Article PL - United States TA - Am Fam Physician JT - American family physician JID - 1272646 SB - AIM SB - IM MH - Adult MH - Cardiotocography/*standards MH - *Curriculum MH - *Education, Medical, Continuing MH - Female MH - Fetal Monitoring/*standards MH - Health Personnel/education MH - Humans MH - Male MH - Middle Aged MH - Perinatal Care/*standards MH - *Practice Guidelines as Topic MH - Pregnancy MH - Risk Assessment/*standards MH - United States EDAT- 2020/08/01 06:00 MHDA- 2020/12/15 06:00 CRDT- 2020/08/01 06:00 PHST- 2020/08/01 06:00 [entrez] PHST- 2020/08/01 06:00 [pubmed] PHST- 2020/12/15 06:00 [medline] AID - d14859 [pii] PST - ppublish SO - Am Fam Physician. 2020 Aug 1;102(3):158-167. PMID- 32503518 OWN - NLM STAT- In-Process LR - 20200609 IS - 1471-2393 (Electronic) IS - 1471-2393 (Linking) VI - 20 IP - 1 DP - 2020 Jun 5 TI - Effectiveness of fetal scalp stimulation test in assessing fetal wellbeing during labor, a retrospective cohort study. PG - 347 LID - 10.1186/s12884-020-03030-7 [doi] LID - 347 AB - BACKGROUND: It is discussed whether fetal scalp stimulation (FSS) test is a reliable complimentary tool to cardiotocography (CTG) to assess fetal wellbeing during labor. The test is based on the assumption that a well-oxygenated fetus, in contrast to the depressed fetus, will respond to a certain stimulus. The aim of this study was to investigate the effectiveness of the FSS-test. METHODS: A retrospective observational study carried out Copenhagen University Hospital, Herlev, Denmark. Laboring women with singleton pregnancies in cephalic presentation after gestation week 33 and indication for fetal blood sampling (FBS) were eligible for inclusion. The FSS-test was classified as positive when an acceleration was absent at the time of FBS and negative when an acceleration was present. Lactate in scalp blood was measured by the point-of-care device LactatePro™ and pH in artery umbilical cord blood by the stationary blood gas analyzer ABL800. Lactate level < 4.2 mmol/L in scalp blood and arterial cord pH > 7.1 were cut-offs for normality. RESULTS: Three hundred eighty-five women were included. The cohort was divided by the FBS-to-delivery time: Group 1 (n = 128) ≤ 20 min, Group 2 (n = 117) 21-59 min and Group 3 (n = 140) ≥ 60 min. The proportion of FSS-positive tests differed significantly between the groups (p < 0.000). In Group 1 the sensitivity, specificity and likelihoods for scalp lactate ≥4.2 mmol/L were 81.5 (95% CI 67-90.1), 13.3 18.5 (95% CI 5.9-24.6), LHR+ 0.94 (95% CI 0.8-1.1) and LHR - 1.4 (95% CI 0.6-3.2) and for umbilical artery pH ≤ 7.10 the values were 82.6% (95% CI 61.2-95.1), 16% (95% CI 9.4-24.7), 1.0 (95% CI 0.8-1.2) and 1.1 (95% CI 0.4-3) respectively. Regardless of the FBS-to-delivery time the LHR+ for lactate ≥4.2 mmol/L increased to 1.38 (95% CI 1.2-1.6). CONCLUSION: The effectiveness of scalp stimulation test was poor for both ruling in and out fetal hypoxia during labor. Absence of a provoked acceleration seems to be a normal phenomenon in the second stage of labor. FAU - Shakouri, Farzaneh AU - Shakouri F AD - Department of Gynecology and Obstetrics, Sjælland University Hospital, Roskilde, Denmark. FAU - Iorizzo, Linda AU - Iorizzo L AUID- ORCID: 0000-0002-5840-4062 AD - Department of Clinical Sciences Lund, Lund University, Lund, Sweden. linda.iorizzo@med.lu.se. AD - Department of Gynecology and Obstetrics, Helsingborg Hospital, Helsingborg, Sweden. linda.iorizzo@med.lu.se. FAU - Edwards, Hellen Mc Kinnon AU - Edwards HMK AD - Department of Gynecology and Obstetrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark. FAU - Vinter, Christina Anne AU - Vinter CA AD - Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark. AD - Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. FAU - Kristensen, Karl AU - Kristensen K AD - Department of Clinical Sciences Lund, Gynecology and Obstetrics, Lund University, Faculty of Medicine, Lund, Sweden. FAU - Isberg, Per-Erik AU - Isberg PE AD - Department of Statistics, Lund University, Lund, Sweden. FAU - Wiberg, Nana AU - Wiberg N AD - Department of Clinical Sciences Lund, Gynecology and Obstetrics, Lund University, Faculty of Medicine, Lund, Sweden. AD - Department of Gynecology and Obstetrics, Skåne University Hospital, Ystad, Sweden. LA - eng GR - 823551/Region Skåne/ PT - Journal Article DEP - 20200605 TA - BMC Pregnancy Childbirth JT - BMC pregnancy and childbirth JID - 100967799 SB - IM PMC - PMC7275571 OTO - NOTNLM OT - Acidemia OT - Cardiotocography OT - Fetal monitoring OT - Fetal scalp blood lactate OT - Fetal scalp stimulation OT - Hypoxia OT - Umbilical cord blood COIS- None. EDAT- 2020/06/07 06:00 MHDA- 2020/06/07 06:00 CRDT- 2020/06/07 06:00 PHST- 2020/03/19 00:00 [received] PHST- 2020/05/22 00:00 [accepted] PHST- 2020/06/07 06:00 [entrez] PHST- 2020/06/07 06:00 [pubmed] PHST- 2020/06/07 06:00 [medline] AID - 10.1186/s12884-020-03030-7 [pii] AID - 3030 [pii] AID - 10.1186/s12884-020-03030-7 [doi] PST - epublish SO - BMC Pregnancy Childbirth. 2020 Jun 5;20(1):347. doi: 10.1186/s12884-020-03030-7. PMID- 32497609 OWN - NLM STAT- MEDLINE DCOM- 20210104 LR - 20210104 IS - 1097-6868 (Electronic) IS - 0002-9378 (Linking) VI - 223 IP - 6 DP - 2020 Dec TI - Fetal heart rate pattern in term or near-term cerebral palsy: a nationwide cohort study. PG - 907.e1-907.e13 LID - S0002-9378(20)30615-3 [pii] LID - 10.1016/j.ajog.2020.05.059 [doi] AB - BACKGROUND: It is crucial to interpret fetal heart rate patterns with a focus on the pattern evolution during labor to estimate the relationship between cerebral palsy and delivery. However, nationwide data are not available. OBJECTIVE: The aim of our study was to demonstrate the features of fetal heart rate pattern evolution and estimate the timing of fetal brain injury during labor in cerebral palsy cases. STUDY DESIGN: In this longitudinal study, 1069 consecutive intrapartum fetal heart rate strips from infants with severe cerebral palsy at or beyond 34 weeks of gestation, were analyzed. They were categorized as follows: (1) continuous bradycardia (Bradycardia), (2) persistently nonreassuring, (3) reassuring-prolonged deceleration, (4) Hon's pattern, and (5) persistently reassuring. The clinical factors underlying cerebral palsy in each group were assessed. RESULTS: Hypoxic brain injury during labor (those in the reassuring-prolonged deceleration and Hon's pattern groups) accounted for 31.5% of severe cerebral palsy cases and at least 30% of those developed during the antenatal period. Of the 1069 cases, 7.86% were classified as continuous bradycardia (n=84), 21.7% as persistently nonreassuring (n=232), 15.6% as reassuring-prolonged deceleration (n=167), 15.9% as Hon's pattern (n=170), 19.8% as persistently reassuring (n=212), and 19.1% were unclassified (n=204). The overall interobserver agreement was moderate (kappa 0.59). Placental abruption was the most common cause (31.9%) of cerebral palsy, accounting for almost 90% of cases in the continuous bradycardia group (64 of 73). Among the cases in the Hon's pattern group (n=67), umbilical cord abnormalities were the most common clinical factor for cerebral palsy development (29.9%), followed by placental abruption (20.9%), and inappropriate operative vaginal delivery (13.4%). CONCLUSION: Intrapartum hypoxic brain injury accounted for approximately 30% of severe cerebral palsy cases, whereas a substantial proportion of the cases were suspected to have either a prenatal or postnatal onset. Up to 16% of cerebral palsy cases may be preventable by placing a greater focus on the earlier changes seen in the Hon's fetal heart rate progression. CI - Copyright © 2020 Elsevier Inc. All rights reserved. FAU - Nakao, Masahiro AU - Nakao M AD - Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan; Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan. Electronic address: hiro.nakao1987@gmail.com. FAU - Okumura, Asumi AU - Okumura A AD - Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan; Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan. FAU - Hasegawa, Junichi AU - Hasegawa J AD - Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan. FAU - Toyokawa, Satoshi AU - Toyokawa S AD - Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of Public Health, the University of Tokyo, Tokyo, Japan. FAU - Ichizuka, Kiyotake AU - Ichizuka K AD - Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan. FAU - Kanayama, Naohiro AU - Kanayama N AD - Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Shizuoka, Japan. FAU - Satoh, Shoji AU - Satoh S AD - Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Maternal and Perinatal Care Center, Oita Prefectural Hospital, Oita, Japan. FAU - Tamiya, Nanako AU - Tamiya N AD - Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. FAU - Nakai, Akihito AU - Nakai A AD - Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan. FAU - Fujimori, Keiya AU - Fujimori K AD - Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan. FAU - Maeda, Tsugio AU - Maeda T AD - Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Maeda Clinic, Incorporated Association Anzu-kai, Shizuoka, Japan. FAU - Suzuki, Hideaki AU - Suzuki H AD - Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan. FAU - Iwashita, Mitsutoshi AU - Iwashita M AD - Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan. FAU - Ikeda, Tomoaki AU - Ikeda T AD - Recurrence Prevention Committee, the Japan Obstetric Compensation System for Cerebral Palsy, Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan; Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan. LA - eng PT - Journal Article DEP - 20200601 PL - United States TA - Am J Obstet Gynecol JT - American journal of obstetrics and gynecology JID - 0370476 SB - AIM SB - IM MH - Adult MH - Bradycardia/*physiopathology MH - Cardiotocography MH - *Cerebral Palsy MH - Cohort Studies MH - Female MH - Fetal Blood MH - Fetal Distress/*physiopathology MH - Fetal Hypoxia/*physiopathology MH - *Heart Rate, Fetal MH - Humans MH - Hypoxia, Brain/*physiopathology MH - Infant, Newborn MH - Male MH - Nuchal Cord/epidemiology/*physiopathology MH - Obstetric Labor Complications/*physiopathology MH - Pregnancy MH - Umbilical Cord/abnormalities OTO - NOTNLM OT - *brain injuries OT - *cerebral palsy OT - *fetal heart rate EDAT- 2020/06/05 06:00 MHDA- 2021/01/05 06:00 CRDT- 2020/06/05 06:00 PHST- 2020/02/22 00:00 [received] PHST- 2020/05/20 00:00 [revised] PHST- 2020/05/29 00:00 [accepted] PHST- 2020/06/05 06:00 [pubmed] PHST- 2021/01/05 06:00 [medline] PHST- 2020/06/05 06:00 [entrez] AID - S0002-9378(20)30615-3 [pii] AID - 10.1016/j.ajog.2020.05.059 [doi] PST - ppublish SO - Am J Obstet Gynecol. 2020 Dec;223(6):907.e1-907.e13. doi: 10.1016/j.ajog.2020.05.059. Epub 2020 Jun 1. PMID- 32490069 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200928 IS - 2352-3409 (Electronic) IS - 2352-3409 (Linking) VI - 31 DP - 2020 Aug TI - Annotation dataset of the cardiotocographic recordings constituting the "CTU-CHB intra-partum CTG database". PG - 105690 LID - 10.1016/j.dib.2020.105690 [doi] LID - 105690 AB - The proposed dataset provides annotations for the 552 cardiotocographic (CTG) recordings included in the publicly available "CTU-CHB intra-partum CTG database" from Physionet (https://physionet.org/content/ctu-uhb-ctgdb/1.0.0/). Each CTG recording is composed by two simultaneously acquired signals: i) the fetal heart rate (FHR) and ii) the maternal tocogram (representing uterine activity). Annotations consist in the detection of starting and ending points of specific CTG events on both FHR signal and maternal tocogram. Annotated events for the FHR signal are the bradycardia, tachycardia, acceleration and deceleration episodes. Annotated events for the maternal tocogram are the uterine contractions. The dataset also reports classification of each deceleration as early, late, variable or prolonged, in relation to the presence of a uterine contraction. Annotations were obtained by an expert gynecologist with the support of CTG Analyzer, a dedicated software application for automatic analysis of digital CTG recordings. These annotations can be useful in the development, testing and comparison of algorithms for the automatic analysis of digital CTG recordings, which can make CTG interpretation more objective and independent from clinician's experience. CI - © 2020 The Authors. FAU - Romagnoli, Sofia AU - Romagnoli S AD - Cardiovascular Bioengineering Lab, Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy. FAU - Sbrollini, Agnese AU - Sbrollini A AD - Cardiovascular Bioengineering Lab, Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy. FAU - Burattini, Luca AU - Burattini L AD - Obstetric and Gynecology Clinic, Ospedali Riuniti di Ancona (Salesi Hospital), Ancona, Italy. FAU - Marcantoni, Ilaria AU - Marcantoni I AD - Cardiovascular Bioengineering Lab, Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy. FAU - Morettini, Micaela AU - Morettini M AD - Cardiovascular Bioengineering Lab, Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy. FAU - Burattini, Laura AU - Burattini L AD - Cardiovascular Bioengineering Lab, Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy. LA - eng PT - Journal Article DEP - 20200519 TA - Data Brief JT - Data in brief JID - 101654995 PMC - PMC7256311 OTO - NOTNLM OT - Cardiotocography OT - Childbirth OT - Electronic fetal monitoring OT - Fetal distress OT - Fetal heart rate OT - Labor OT - Uterine contractions COIS- The authors declare that they have no known competing financial interests or personal relationships which have, or could be perceived to have, influenced the work reported in this article. EDAT- 2020/06/04 06:00 MHDA- 2020/06/04 06:01 CRDT- 2020/06/04 06:00 PHST- 2020/02/27 00:00 [received] PHST- 2020/04/09 00:00 [revised] PHST- 2020/05/04 00:00 [accepted] PHST- 2020/06/04 06:00 [entrez] PHST- 2020/06/04 06:00 [pubmed] PHST- 2020/06/04 06:01 [medline] AID - S2352-3409(20)30584-9 [pii] AID - 105690 [pii] AID - 10.1016/j.dib.2020.105690 [doi] PST - epublish SO - Data Brief. 2020 May 19;31:105690. doi: 10.1016/j.dib.2020.105690. eCollection 2020 Aug. PMID- 32421437 OWN - NLM STAT- MEDLINE DCOM- 20201109 LR - 20201109 IS - 1941-3084 (Electronic) IS - 1941-3149 (Print) IS - 1941-3084 (Linking) VI - 13 IP - 5 DP - 2020 May TI - Complex and Novel Arrhythmias Precede Stillbirth in Fetuses With De Novo Long QT Syndrome. PG - e008082 LID - 10.1161/CIRCEP.119.008082 [doi] AB - BACKGROUND: Long QT syndrome (LQTS) is a leading cause of sudden cardiac death in early life and has been implicated in ≈10% of sudden infant deaths and unexplained stillbirths. The purpose of our study was to use fetal magnetocardiography to characterize the electrophysiology and rhythm phenotypes of fetuses with de novo and inherited LQTS variants and identify risk factors for sudden death before birth. METHODS: We reviewed the fetal magnetocardiography database from the University of Wisconsin Biomagnetism Laboratory for fetuses with confirmed LQTS. We assessed waveform intervals, heart rate, and rhythm, including the signature LQTS rhythms: functional 2° atrioventricular block, T-wave alternans, and torsade de pointes (TdP). RESULTS: Thirty-nine fetuses had pathogenic variants in LQTS genes: 27 carried the family variant, 11 had de novo variants, and 1 was indeterminate. De novo variants, especially de novo SCN5A variants, were strongly associated with a severe rhythm phenotype and perinatal death: 9 (82%) showed signature LQTS rhythms, 6 (55%) showed TdP, 5 (45%) were stillborn, and 1 (9%) died in infancy. Those that died exhibited novel fetal rhythms, including atrioventricular block with 3:1 conduction ratio, QRS alternans in 2:1 atrioventricular block, long-cycle length TdP, and slow monomorphic ventricular tachycardia. Premature ventricular contractions were also strongly associated with TdP and perinatal death. Fetuses with familial variants showed a lower incidence of signature LQTS rhythm (6/27=22%), including TdP (3/27=11%). All were live born. CONCLUSIONS: The malignancy of de novo LQTS variants was remarkably high and demonstrate that these mutations are a significant cause of stillbirth. Their ability to manifest rhythms not known to be associated with LQTS increases the difficulty of echocardiographic diagnosis and decreases the likelihood that a resultant fetal loss is attributed to LQTS. Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT03047161. FAU - Strand, Sarah AU - Strand S AD - Department of Medical Physics, University of Wisconsin-Madison (S.S. R.T.W.). FAU - Strasburger, Janette F AU - Strasburger JF AD - Division of Cardiology, Department of Pediatrics, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee (J.F.S.). FAU - Cuneo, Bettina F AU - Cuneo BF AD - Division of Cardiology, Department of Pediatrics (B.F.C.), Children's Hospital Colorado & University of Colorado School of Medicine, Aurora. AD - The Colorado Fetal Care Center (B.F.C), Children's Hospital Colorado & University of Colorado School of Medicine, Aurora. FAU - Wakai, Ronald T AU - Wakai RT AD - Department of Medical Physics, University of Wisconsin-Madison (S.S. R.T.W.). LA - eng SI - ClinicalTrials.gov/NCT03047161 GR - R01 HL063174/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20200518 TA - Circ Arrhythm Electrophysiol JT - Circulation. Arrhythmia and electrophysiology JID - 101474365 SB - IM MH - Cause of Death MH - Databases, Factual MH - Female MH - Fetal Heart/*physiopathology MH - Genetic Predisposition to Disease MH - Gestational Age MH - *Heart Rate, Fetal MH - Heredity MH - Humans MH - Long QT Syndrome/*diagnosis/genetics/mortality/physiopathology MH - *Magnetocardiography MH - Mutation MH - Phenotype MH - Predictive Value of Tests MH - Pregnancy MH - Prenatal Diagnosis/*methods MH - Risk Assessment MH - Risk Factors MH - *Stillbirth PMC - PMC7241276 MID - NIHMS1570032 OTO - NOTNLM OT - *atrioventricular block OT - *heart rate OT - *long QT syndrome OT - *magnetocardiography OT - *stillbirth EDAT- 2020/05/19 06:00 MHDA- 2020/11/11 06:00 PMCR- 2021/05/18 CRDT- 2020/05/19 06:00 PHST- 2021/05/18 00:00 [pmc-release] PHST- 2020/05/19 06:00 [entrez] PHST- 2020/05/19 06:00 [pubmed] PHST- 2020/11/11 06:00 [medline] AID - 10.1161/CIRCEP.119.008082 [doi] PST - ppublish SO - Circ Arrhythm Electrophysiol. 2020 May;13(5):e008082. doi: 10.1161/CIRCEP.119.008082. Epub 2020 May 18. PMID- 31909523 OWN - NLM STAT- In-Data-Review LR - 20200504 IS - 1469-0705 (Electronic) IS - 0960-7692 (Linking) VI - 55 IP - 5 DP - 2020 May TI - Ultrasound features prior to 11 weeks' gestation and first-trimester maternal factors in prediction of hypertensive disorders of pregnancy. PG - 629-636 LID - 10.1002/uog.21962 [doi] AB - OBJECTIVES: Maternal hypertensive disorders (MHD), including pregnancy-induced hypertension and pre-eclampsia, are estimated to occur in 7-10% of pregnancies worldwide and have significant short- and long-term implications for both mother and fetus. This study aimed to determine the association of conventional and novel early first-trimester ultrasound measures with MHD and whether these ultrasound measures, combined with maternal characteristics and biochemistry, improve the prediction of MHD. METHODS: This was a prospective cohort study of consecutive women with a singleton pregnancy, attending for an early (5 + 1 to 11 + 0 weeks' gestation) ultrasound examination at a private obstetric ultrasound practice between February 2016 and August 2018. Recorded ultrasound measurements included mean sac diameter, yolk sac diameter, crown-rump length, fetal heart rate (FHR), trophoblast thickness, trophoblast volume (TV) and mean uterine artery pulsatility index. Maternal biochemistry was assessed at 10-14 weeks and included beta-human chorionic gonadotropin, pregnancy-associated plasma protein-A (PAPP-A), placental growth factor (PlGF) and maternal serum alpha-fetoprotein. Regression models were fitted for each ultrasound parameter and multiples of the median (MoM) were calculated. All measures were compared between women who had a normotensive outcome and those who subsequently developed MHD. Logistic regression analysis was used to create a prediction model for MHD based on maternal characteristics, ultrasound measurements at 5 + 1 to 11 + 0 weeks' gestation and maternal biochemistry at 10-14 weeks. RESULTS: In total, 1141 women were included in the analysis, of whom 1086 (95.2%) were normotensive at delivery and 55 (4.8%) developed MHD. Women who developed MHD weighed significantly more than did normotensive women (P < 0.0001). Mean MoM values for TV (P = 0.006), PAPP-A (P = 0.031) and PlGF (P = 0.044) were decreased significantly in pregnancies that subsequently developed MHD. The proposed logistic regression model includes maternal weight and height and MoM values for TV, FHR and PlGF, resulting in an area under the receiver-operating-characteristics curve of 0.80 (95% CI, 0.75-0.86). CONCLUSION: The combination of maternal weight and height, TV and FHR, measured prior to 11 weeks' gestation, and first-trimester PlGF appears to have good predictive value for development of MHD later in pregnancy. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd. CI - Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd. FAU - Hanchard, T J AU - Hanchard TJ AUID- ORCID: 0000-0002-9545-2813 AD - South Coast Ultrasound for Women, Wollongong, NSW, Australia. AD - Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia. FAU - de Vries, B S AU - de Vries BS AD - Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia. AD - RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. FAU - Quinton, A E AU - Quinton AE AUID- ORCID: 0000-0001-6585-7468 AD - Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia. AD - School of Health, Medical and Applied Science, Central Queensland University, Sydney, NSW, Australia. FAU - Sinosich, M AU - Sinosich M AD - Prenatal Testing DHM Pathology, Sonic Healthcare, Macquarie Park, NSW, Australia. FAU - Hyett, J A AU - Hyett JA AD - Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia. AD - RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. LA - eng GR - Dr Albert S McKern Research Scholarship; Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney/ PT - Journal Article PL - England TA - Ultrasound Obstet Gynecol JT - Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology JID - 9108340 SB - IM OTO - NOTNLM OT - first trimester OT - logistic regression OT - pre-eclampsia OT - pregnancy-induced hypertension OT - trophoblast OT - ultrasound EDAT- 2020/01/08 06:00 MHDA- 2020/01/08 06:00 CRDT- 2020/01/08 06:00 PHST- 2019/10/05 00:00 [received] PHST- 2019/12/25 00:00 [revised] PHST- 2019/12/31 00:00 [accepted] PHST- 2020/01/08 06:00 [pubmed] PHST- 2020/01/08 06:00 [medline] PHST- 2020/01/08 06:00 [entrez] AID - 10.1002/uog.21962 [doi] PST - ppublish SO - Ultrasound Obstet Gynecol. 2020 May;55(5):629-636. doi: 10.1002/uog.21962. PMID- 32298307 OWN - NLM STAT- MEDLINE DCOM- 20200727 LR - 20200727 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 15 IP - 4 DP - 2020 TI - Near-infrared spectroscopy of the placenta for monitoring fetal oxygenation during labour. PG - e0231461 LID - 10.1371/journal.pone.0231461 [doi] LID - e0231461 AB - Although being the golden standard for intrapartum fetal surveillance, cardiotocography (CTG) has been shown to have poor specificity for detecting fetal acidosis. Non-invasive near-infrared-spectroscopy (NIRS) monitoring of placental oxygenation during labour has not been studied yet. The objective of the study was to determine whether changes in placental NIRS values during labour could identify intrapartum fetal hypoxia and resulting acidosis. We included 43 healthy women in active stage of labour at term. CTG and NIRS parameters in groups with vs. without neonatal umbilical artery pH ≤ 7.20 were compared using Mann-Whitney-U. Receiver-operating-characteristics (ROC) curves were used to estimate predictive value of CTG and NIRS parameters for neonatal pH ≤ 7.20. A computer-based statistical classification was also performed to further evaluate predictive values of CTG and NIRS for neonatal acidosis. Ten (23%) neonates were born with umbilical artery pH ≤ 7.20. Compared to group with pH > 7.20, fetal acidosis was associated with more episodes of placental NIRS deoxygenation (9 (range 2-37) vs. 2 (range 0-65); p<0.001), higher velocity of placental NIRS deoxygenation (2.31 (range 0-22) vs. 1 (range 0-49) %/s; p = 0.03), more decelerations on CTG (25 (range 3-91) vs. 10 (range 10-60); p = 0.02), and more prolonged decelerations on CTG (2 (range 0-4) vs. 1 (range 0-3); p = 0.04). Number of placental deoxygenations had the highest prognostic value for fetal/neonatal acidosis (area under the ROC curve 0.85 (95% confidence interval 0.70-0.99). Computer-based classification also identified number of placental deoxygenations as the most accurate classifier, with 25% false positive and 93% true positive rate in the training dataset, with 100% accuracy when applied to the testing dataset. Placental deoxygenations during labour measured by NIRS are associated with fetal/neonatal acidosis. Predictive value of placental NIRS for neonatal acidosis was superior to that of CTG. FAU - Ražem, Katja AU - Ražem K AD - Division of Obstetrics and Gynecology, Department of Perinatology, UniversityMedical Centre Ljubljana, Ljubljana, Slovenia. FAU - Kocijan, Juš AU - Kocijan J AUID- ORCID: 0000-0002-1221-946X AD - Department of Systems and Control, Jožef Štefan Institute, Ljubljana, Slovenia. AD - School of Engineering and Management, University of Nova Gorica, Nova Gorica, Slovenia. FAU - Podbregar, Matej AU - Podbregar M AD - Department of Intensive Internal Medicine, General Hospital Celje, Celje, Slovenia. AD - Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia. FAU - Lučovnik, Miha AU - Lučovnik M AD - Division of Obstetrics and Gynecology, Department of Perinatology, UniversityMedical Centre Ljubljana, Ljubljana, Slovenia. AD - Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20200416 TA - PLoS One JT - PloS one JID - 101285081 RN - S88TT14065 (Oxygen) SB - IM EIN - PLoS One. 2020 May 21;15(5):e0233830. PMID: 32437430 MH - Adolescent MH - Adult MH - Cardiotocography/*methods MH - Female MH - Fetus/*blood supply MH - Humans MH - *Labor, Obstetric/physiology MH - Middle Aged MH - Oxygen/metabolism MH - Placenta/metabolism/*physiology MH - Pregnancy MH - Spectroscopy, Near-Infrared/*methods MH - Young Adult PMC - PMC7162483 COIS- The authors have declared that no competing interests exist. EDAT- 2020/04/17 06:00 MHDA- 2020/07/28 06:00 CRDT- 2020/04/17 06:00 PHST- 2019/09/06 00:00 [received] PHST- 2020/03/24 00:00 [accepted] PHST- 2020/04/17 06:00 [entrez] PHST- 2020/04/17 06:00 [pubmed] PHST- 2020/07/28 06:00 [medline] AID - PONE-D-19-25139 [pii] AID - 10.1371/journal.pone.0231461 [doi] PST - epublish SO - PLoS One. 2020 Apr 16;15(4):e0231461. doi: 10.1371/journal.pone.0231461. eCollection 2020. PMID- 32283958 OWN - NLM STAT- Publisher LR - 20200414 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) DP - 2020 Apr 14 TI - Prelabor short-term variability in fetal heart rate by computerized cardiotocogram and maternal fetal doppler indices for the prediction of labor outcomes. PG - 1-10 LID - 10.1080/14767058.2020.1752657 [doi] AB - Objectives: To investigate (i) the association between pre-labor maternal-fetal Dopplers and fetal heart rate short-term variability (FHR STV) with arterial cord blood pH and (ii) the potential value of pre-labor maternal-fetal Dopplers, FHR STV and Dawes-Redman criteria in predicting composite neonatal morbidity at term in a cohort of unselected women.Method: A prospective study in 218 women with term singleton pregnancy in latent phase of labor or due to undergo induction of labor. Data on maternal characteristics, maternal-fetal Dopplers indices and computerized cardiotocography (CTG) findings of FHR STV and Dawes-Redman criteria were collected. Pearson correlation analysis was used to determine the relationship between maternal-fetal Dopplers and FHR STV and arterial cord blood pH. Logistic regression analysis was used to determine which factors amongst maternal characteristics, labor onset, indication of labor induction, estimated fetal weight (EFW), maternal-fetal Dopplers, FHR STV and Dawes-Redman criteria were significant predictors of composite neonatal morbidity and arterial cord blood pH less than 7.2.Result: Of the 218 cases, 12 (5.5%) women were delivered by emergency operative delivery for pathological CTG, and 42 babies (19.3%) had composite neonatal morbidities. Arterial cord blood pH was not associated with maternal-fetal Doppler indices and FHR STV, but rather it was associated with maternal age and body mass index. The composite neonatal morbidity and arterial cord blood pH less than 7.2 were not significantly associated with maternal characteristics, labor onset, indication of labor induction, pre-labor assessment of EFW, maternal-fetal Doppler indices, FHR STV and Dawes-Redman criteria by computerized CTG.Conclusion: In unselected women in latent phase of labor or undergoing induction of labor at term, admission maternal-fetal Doppler indices, FHR STV and Dawes-Redman criteria are not predictive of composite neonatal morbidity. FAU - Lam, Michelle S N AU - Lam MSN AD - Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR. FAU - Chaemsaithong, Piya AU - Chaemsaithong P AD - Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR. FAU - Kwan, Angel H W AU - Kwan AHW AD - Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR. FAU - Wong, Sani T K AU - Wong STK AD - Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR. FAU - Tse, Ada W T AU - Tse AWT AUID- ORCID: 0000-0003-3439-4338 AD - Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR. FAU - Sahota, Daljit S AU - Sahota DS AD - Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR. FAU - Leung, Tak Yeung AU - Leung TY AD - Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR. FAU - Poon, Liona C AU - Poon LC AUID- ORCID: 0000-0002-3944-4130 AD - Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR. LA - eng PT - Journal Article DEP - 20200414 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 SB - IM OTO - NOTNLM OT - Dawes-Redman criteria OT - Uterine artery pulsatility index OT - computerized cardiotocography OT - fetal heart rate short-term variability OT - middle cerebral artery pulsatility index OT - umbilical artery pulsatility index EDAT- 2020/04/15 06:00 MHDA- 2020/04/15 06:00 CRDT- 2020/04/15 06:00 PHST- 2020/04/15 06:00 [entrez] PHST- 2020/04/15 06:00 [pubmed] PHST- 2020/04/15 06:00 [medline] AID - 10.1080/14767058.2020.1752657 [doi] PST - aheadofprint SO - J Matern Fetal Neonatal Med. 2020 Apr 14:1-10. doi: 10.1080/14767058.2020.1752657. PMID- 32292825 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210110 IS - 2398-502X (Print) IS - 2398-502X (Electronic) IS - 2398-502X (Linking) VI - 5 DP - 2020 TI - A protocol for an observational cohort study of heat strain and its effect on fetal wellbeing in pregnant farmers in The Gambia. PG - 32 LID - 10.12688/wellcomeopenres.15731.2 [doi] LID - 32 AB - Introduction: Climate change predictions indicate that global temperatures are likely to exceed those seen in the last 200,000 years, rising by around 4°C above pre-industrial levels by 2100 (without effective mitigation of current emission rates). In regions of the world set to experience extreme temperatures, women often work outside in agriculture even during pregnancy. The implications of heat strain in pregnancy on maternal health and pregnancy outcome are not well understood. This protocol describes a study to assess the physiological response of pregnant women to environmental heat stress and the immediate effect this has on fetal wellbeing. Methods and analysis: The study will be performed in West Kiang district, The Gambia; a semi-arid zone in West Africa with daily maximum temperatures ranging from approximately 32 to 40°C. We will recruit 125 pregnant women of all ages who perform agricultural work during their pregnancy. Participants will be followed every two months until delivery. At each study visit fetal growth will be measured by ultrasound scan. During the course of their working day we will take the following measurements: continuous maternal physiological measurements (heart rate, respiratory rate, chest skin temperature and tri-axis accelerometer data); intermittent maternal tympanic core temperature, four point skin temperature, blood pressure; intermittent fetal heart rate and, if eligible, umbilical artery doppler; intermittent environmental measurements of air temperature, humidity, solar radiation and wind speed. Venous blood and urine will be collected at beginning and end of day for biomarkers of heat strain or fetal distress and hydration status. CI - Copyright: © 2020 Bonell A et al. FAU - Bonell, Ana AU - Bonell A AUID- ORCID: 0000-0001-5981-762X AD - Medical Research Council Gambia @ London School of Hygiene and Tropical Medicine, Fajara, The Gambia. FAU - Hirst, Jane AU - Hirst J AUID- ORCID: 0000-0002-0176-2651 AD - Nuffield Department of Women's and Reproductive Health and the George Institute for Global Health, University of Oxford, Oxford, UK. FAU - Vicedo-Cabrera, Ana M AU - Vicedo-Cabrera AM AD - Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. AD - Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland. FAU - Haines, Andy AU - Haines A AUID- ORCID: 0000-0002-8053-4605 AD - Department of Public Health, Environment and Society; Department of Population health, London School of Hygiene and Tropical Medicine, London, UK. FAU - Prentice, Andrew M AU - Prentice AM AD - Medical Research Council Gambia @ London School of Hygiene and Tropical Medicine, Fajara, The Gambia. FAU - Maxwell, Neil S AU - Maxwell NS AD - Environmental Extremes Laboratory, University of Brighton, Brighton, UK. LA - eng PT - Journal Article DEP - 20200331 TA - Wellcome Open Res JT - Wellcome open research JID - 101696457 PMC - PMC7141168 OTO - NOTNLM OT - climate change OT - heat stress OT - maternal OT - pregnancy OT - subsistence farmer COIS- No competing interests were disclosed. EDAT- 2020/04/23 06:00 MHDA- 2020/04/23 06:01 CRDT- 2020/04/23 06:00 PHST- 2020/03/26 00:00 [accepted] PHST- 2020/04/23 06:00 [entrez] PHST- 2020/04/23 06:00 [pubmed] PHST- 2020/04/23 06:01 [medline] AID - 10.12688/wellcomeopenres.15731.2 [doi] PST - epublish SO - Wellcome Open Res. 2020 Mar 31;5:32. doi: 10.12688/wellcomeopenres.15731.2. eCollection 2020. PMID- 32228514 OWN - NLM STAT- MEDLINE DCOM- 20201216 LR - 20201216 IS - 1471-2393 (Electronic) IS - 1471-2393 (Linking) VI - 20 IP - 1 DP - 2020 Mar 30 TI - Is perinatal asphyxia predictable? PG - 186 LID - 10.1186/s12884-020-02876-1 [doi] LID - 186 AB - BACKGROUND: The objective of our study was to evaluate the association between perinatal asphyxia and hypoxic-ischemic encephalopathy (HIE) with the presence of ante and intrapartum risk factors and/or abnormal fetal heart rate (FHR) findings, in order to improve maternal and neonatal management. METHODS: We did a prospective observational cohort study from a network of four hospitals (one Hub center with neonatal intensive care unit and three level I Spoke centers) between 2014 and 2016. Neonates of gestational age ≥ 35 weeks, birthweight ≥1800 g, without lethal malformations were included if diagnosed with perinatal asphyxia, defined as pH ≤7.0 or Base Excess (BE) ≤ - 12 mMol/L in Umbical Artery (UA) or within 1 h, 10 min Apgar < 5, or need for resuscitation > 10 min. FHR monitoring was classified in three categories according to the American College of Obstetricians and Gynecologists (ACOG). Pregnancies were divided into four classes: 1) low risk; 2) antepartum risk; 3) intrapartum risk; 4) and both ante and intrapartum risk. In the first six hours of life asphyxiated neonates were evaluated using the Thomson score (TS): if TS ≥ 5 neonates were transferred to Hub for further assessment; if TS ≥ 7 hypothermia was indicated. RESULTS: Perinatal asphyxia occurred in 21.5‰ cases (321/14,896) and HIE in 1.1‰ (16/14,896). The total study population was composed of 281 asphyxiated neonates: 68/5152 (1.3%) born at Hub and 213/9744 (2.2%) at Spokes (p < 0.001, OR 0.59, 95% CI 0.45-0.79). 32/213 (15%) neonates were transferred from Spokes to Hub. Overall, 12/281 were treated with hypothermia. HIE occurred in 16/281 (5.7%) neonates: four grade I, eight grade II and four grade III. Incidence of HIE was not different between Hub and Spokes. Pregnancies resulting in asphyxiated neonates were classified as class 1) 1.1%, 2) 52.3%, 3) 3.2%, and 4) 43.4%. Sentinel events occurred in 23.5% of the cases and FHR was category II or III in 50.5% of the cases. 40.2% cases of asphyxia and 18.8% cases of HIE were not preceded by sentinel events or abnormal FHR. CONCLUSIONS: We identified at least one risk factor associated with all cases of HIE and with most cases of perinatal asphyxia. In absence of risk factors, the probability of developing perinatal asphyxia resulted extremely low. FHR monitoring alone is not a reliable tool for detecting the probability of eventual asphyxia. FAU - Locatelli, Anna AU - Locatelli A AD - Department of Obstetrics and Gynecology, ASST Vimercate, Carate B.za Hospital, University of Milano-Bicocca, Monza, Italy. anna.locatelli@unimib.it. FAU - Lambicchi, Laura AU - Lambicchi L AD - Department of Obstetrics and Gynecology, Fondazione MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy. FAU - Incerti, Maddalena AU - Incerti M AD - Department of Obstetrics and Gynecology, Fondazione MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy. FAU - Bonati, Francesca AU - Bonati F AD - Department of Obstetrics and Gynecology, ASST Vimercate, Carate B.za Hospital, University of Milano-Bicocca, Monza, Italy. FAU - Ferdico, Massimo AU - Ferdico M AD - Department of Obstetrics and Gynecology, ASST Vimercate, Vimercate Hospital, Vimercate, Italy. FAU - Malguzzi, Silvia AU - Malguzzi S AD - Neonatal Intensive Care Unit, Fondazione MBBM, San Gerardo Hospital, Monza, Italy. FAU - Torcasio, Ferruccio AU - Torcasio F AD - Department of Pediatrics, ASST Vimercate, Carate B.za Hospital, Vimercate, Italy. FAU - Calzi, Patrizia AU - Calzi P AD - Department of Pediatrics, ASST Vimercate, Vimercate Hospital, Vimercate, Italy. FAU - Varisco, Tiziana AU - Varisco T AD - Department of Pediatrics, ASST Monza, Desio Hospital, Desio, Italy. FAU - Paterlini, Giuseppe AU - Paterlini G AD - Neonatal Intensive Care Unit, Fondazione MBBM, San Gerardo Hospital, Monza, Italy. LA - eng GR - 14291 2015/Università degli Studi di Milano-Bicocca/ PT - Journal Article PT - Observational Study DEP - 20200330 TA - BMC Pregnancy Childbirth JT - BMC pregnancy and childbirth JID - 100967799 SB - IM MH - Apgar Score MH - Asphyxia Neonatorum/*epidemiology MH - Female MH - Heart Rate, Fetal MH - Humans MH - Hypoxia-Ischemia, Brain/*epidemiology MH - Incidence MH - Infant MH - Infant, Newborn MH - Italy/epidemiology MH - Male MH - Pregnancy MH - Probability MH - Prospective Studies MH - Risk Factors PMC - PMC7106720 OTO - NOTNLM OT - Fetal heart rate monitoring OT - Hypoxic-ischemic encephalopathy; asphyxia; sentinel events OT - Nulliparity OT - Umbilical artery pH COIS- The authors declare that they have no competing interests. EDAT- 2020/04/02 06:00 MHDA- 2020/12/17 06:00 CRDT- 2020/04/02 06:00 PHST- 2019/09/11 00:00 [received] PHST- 2020/03/16 00:00 [accepted] PHST- 2020/04/02 06:00 [entrez] PHST- 2020/04/02 06:00 [pubmed] PHST- 2020/12/17 06:00 [medline] AID - 10.1186/s12884-020-02876-1 [pii] AID - 2876 [pii] AID - 10.1186/s12884-020-02876-1 [doi] PST - epublish SO - BMC Pregnancy Childbirth. 2020 Mar 30;20(1):186. doi: 10.1186/s12884-020-02876-1. PMID- 32223647 OWN - NLM STAT- MEDLINE DCOM- 20210106 LR - 20210106 IS - 1473-2300 (Electronic) IS - 0300-0605 (Print) IS - 0300-0605 (Linking) VI - 48 IP - 3 DP - 2020 Mar TI - Factors related to morbidity and maternal and perinatal outcomes of umbilical cord torsion. PG - 300060520905421 LID - 10.1177/0300060520905421 [doi] LID - 0300060520905421 AB - OBJECTIVE: This study analyzed factors influencing umbilical cord torsion, measured the umbilical coiling index (UCI) postnatally, and analyzed the association of umbilical cord torsion with maternal and perinatal outcomes. METHODS: In total, 845 antenatal women who went into labor at the Fujian Provincial Maternity and Children’s Hospital from January 2016 to January 2017 were retrospectively studied. The patients were divided into those with and without umbilical cord torsion. Possible influencing factors and the UCI were noted, and maternal and perinatal outcomes were compared. RESULTS: Higher morbidity in the presence of umbilical cord torsion was affected by multiparous pregnancy and a long cord. The area under the curve was 0.666 for the UCI to predict fetal distress and 0.505 for the umbilical artery peak systolic to end diastolic flow velocity ratio (S/D ratio) to predict fetal distress. Umbilical cord torsion was associated with higher rates of fetal distress, forceps-assisted delivery, cesarean sections, fetal heart rate abnormalities, amniotic fluid meconium staining, neonatal intensive care unit admission, and small for gestational age. CONCLUSIONS: Multiparous status and longer umbilical cord length were highly associated with umbilical cord torsion. The UCI is a better predictor of fetal distress than is the umbilical artery S/D ratio. FAU - Chen, Rongxin AU - Chen R AD - Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China. FAU - Yan, Jianying AU - Yan J AUID- ORCID: 0000-0002-3897-3209 AD - Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China. FAU - Han, Qing AU - Han Q AD - Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China. FAU - Zheng, Lianghui AU - Zheng L AD - Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China. LA - eng PT - Journal Article TA - J Int Med Res JT - The Journal of international medical research JID - 0346411 SB - IM MH - Adolescent MH - Adult MH - Female MH - Humans MH - Infant, Newborn MH - Logistic Models MH - Middle Aged MH - Morbidity MH - Multivariate Analysis MH - Pregnancy MH - *Pregnancy Outcome MH - ROC Curve MH - Risk Factors MH - Torsion Abnormality/*epidemiology MH - Umbilical Cord/*pathology MH - Young Adult PMC - PMC7133088 OTO - NOTNLM OT - Umbilical cord torsion OT - color Doppler ultrasonography OT - maternal outcome OT - perinatal outcome OT - umbilical coiling index OT - umbilical cord EDAT- 2020/04/01 06:00 MHDA- 2021/01/07 06:00 CRDT- 2020/04/01 06:00 PHST- 2020/04/01 06:00 [entrez] PHST- 2020/04/01 06:00 [pubmed] PHST- 2021/01/07 06:00 [medline] AID - 10.1177_0300060520905421 [pii] AID - 10.1177/0300060520905421 [doi] PST - ppublish SO - J Int Med Res. 2020 Mar;48(3):300060520905421. doi: 10.1177/0300060520905421. PMID- 32109464 OWN - NLM STAT- MEDLINE DCOM- 20200831 LR - 20200831 IS - 1097-6868 (Electronic) IS - 0002-9378 (Linking) VI - 223 IP - 2 DP - 2020 Aug TI - Prediction of pregnancy loss by early first trimester ultrasound characteristics. PG - 242.e1-242.e22 LID - S0002-9378(20)30213-1 [pii] LID - 10.1016/j.ajog.2020.02.025 [doi] AB - BACKGROUND: Pregnancy loss prediction based on routinely measured ultrasound characteristics is generally aimed toward distinguishing nonviability. Physicians also use ultrasound indicators for patient counseling, and in some cases to decide upon the frequency of follow-up sonograms. To improve clinical utility, allocation of cut-points should be based on clinical data for multiple sonographic characteristics, be specific to gestational week, and be determined by methods that optimize prediction. OBJECTIVES: To identify routinely measured features of the early first trimester ultrasound and the gestational age-specific cut-points that are most predictive of pregnancy loss. MATERIALS AND METHODS: This was a secondary analysis of 617 pregnant women enrolled in the Effects of Aspirin in Gestation and Reproduction (EAGeR) trial; all women had 1-2 previous pregnancy losses and no documented infertility. Each participant had a single ultrasound with a detectable fetal heartbeat between 6 weeks 0 days and 8 weeks 6 days. Cut-points for low fetal heart rate and small crown-rump length were separately defined for gestational weeks 6, 7, and 8 to optimize prediction. Identity and log-binomial regression models were used to estimate absolute and relative risks, respectively, and 95% confidence intervals between jointly categorized low fetal heart rate, small crown-rump length, and clinical pregnancy loss. Adjusted models accounted for gestational age at ultrasound in weeks. Missing data were addressed using multiple imputation. RESULTS: A total of 64 women experienced a clinical pregnancy loss following the first ultrasound (10.4%), 7 were lost to follow-up (1.1%), and 546 women (88.5%) had a live birth. Low fetal heart rate and small crown-rump length (≤122, 123, and 158 bpm; ≤6.0, 8.5, and 10.9 mm for gestational weeks 6, 7, and 8, respectively) were independent predictors of clinical pregnancy loss, with greatest risks observed for pregnancies having both characteristics (relative risk, 2.08; 95% confidence interval, 1.24-2.91). The combination of low fetal heart rate and small crown-rump length was linked to a 16% (95% confidence interval, 9.1-23%) adjusted absolute increase in risk of subsequent loss, from 5.0% (95% confidence interval, 1.5-8.5%) to 21% (95% confidence interval, 15-27%). Abnormal yolk sac diameter or the presence of a subchorionic hemmhorage did not improve prediction of clinical pregnancy loss. CONCLUSION: Identified cut-points can be used by physicians for patient counseling, and in some cases to decide upon the frequency of follow-up sonograms. The specified criteria should not be used to diagnose nonviability. CI - Copyright © 2020. Published by Elsevier Inc. FAU - DeVilbiss, Elizabeth A AU - DeVilbiss EA AD - Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD. FAU - Mumford, Sunni L AU - Mumford SL AD - Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD. FAU - Sjaarda, Lindsey A AU - Sjaarda LA AD - Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD. FAU - Connell, Matthew T AU - Connell MT AD - Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD. FAU - Plowden, Torie C AU - Plowden TC AD - Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Howard University Hospital, Washington, DC. FAU - Andriessen, Victoria C AU - Andriessen VC AD - Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD. FAU - Perkins, Neil J AU - Perkins NJ AD - Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD. FAU - Hill, Micah J AU - Hill MJ AD - Howard University Hospital, Washington, DC; Program in Reproductive and Adult Endocrinology, National Institutes of Health, Bethesda, MD. FAU - Silver, Robert M AU - Silver RM AD - Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT. FAU - Schisterman, Enrique F AU - Schisterman EF AD - Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD. Electronic address: schistee@mail.nih.gov. LA - eng PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20200225 PL - United States TA - Am J Obstet Gynecol JT - American journal of obstetrics and gynecology JID - 0370476 SB - AIM SB - IM MH - Abortion, Spontaneous/*epidemiology MH - Adult MH - Bradycardia/diagnostic imaging/*epidemiology MH - Chorion/diagnostic imaging MH - Clinical Decision Rules MH - *Crown-Rump Length MH - Female MH - Fetal Growth Retardation/diagnostic imaging/*epidemiology MH - Gestational Age MH - *Heart Rate, Fetal MH - Humans MH - Pregnancy MH - *Pregnancy Trimester, First MH - Risk Assessment MH - *Ultrasonography, Prenatal MH - Yolk Sac/diagnostic imaging MH - Young Adult OTO - NOTNLM OT - *fetal loss OT - *miscarriage OT - *sonogram OT - *sonographic EDAT- 2020/02/29 06:00 MHDA- 2020/09/01 06:00 CRDT- 2020/02/29 06:00 PHST- 2019/05/08 00:00 [received] PHST- 2020/01/24 00:00 [revised] PHST- 2020/02/19 00:00 [accepted] PHST- 2020/02/29 06:00 [pubmed] PHST- 2020/09/01 06:00 [medline] PHST- 2020/02/29 06:00 [entrez] AID - S0002-9378(20)30213-1 [pii] AID - 10.1016/j.ajog.2020.02.025 [doi] PST - ppublish SO - Am J Obstet Gynecol. 2020 Aug;223(2):242.e1-242.e22. doi: 10.1016/j.ajog.2020.02.025. Epub 2020 Feb 25. PMID- 31960411 OWN - NLM STAT- MEDLINE DCOM- 20201013 LR - 20201013 IS - 1600-0412 (Electronic) IS - 0001-6349 (Linking) VI - 99 IP - 7 DP - 2020 Jul TI - Reduced fetal movements at term in singleton low risk pregnancies-Is there an association with placental histopathological findings? PG - 884-890 LID - 10.1111/aogs.13810 [doi] AB - INTRODUCTION: Maternal perception of fetal movements has long been considered an indicator of fetal well-being. A sudden decrease in the number of fetal movements is suggestive of fetal compromise. We aimed to determine whether the maternal perception of reduced fetal movements (RFM) is associated with placental pathological lesions in a low-risk term population. MATERIAL AND METHODS: Our study was a case-control study that was performed in a single university center. Placental histopathology, maternal demographics, labor characteristics, and neonatal outcomes of term, singleton pregnancies with maternal perception of RFM during the 2 weeks prior to delivery were collected. To isolate the effect of RFM on placental pathology, we excluded cases complicated by preterm birth, hypertensive disorders, diabetes mellitus, small-for-gestational-age and congenital/genetic anomalies. We compared pregnancy outcomes and placental pathology between the RFM group and a control group matched for gestational age and mode of delivery. Placental lesions were classified according to the "Amsterdam" criteria. Composite adverse neonatal outcome was defined as one or more of the following: sepsis, transfusion, hypoglycemia, phototherapy, respiratory morbidity, cerebral morbidity, necrotizing enterocolitis and fetal/neonatal death. Multivariable regression analysis was performed to identify independent associations with adverse neonatal outcome. RESULTS: We included patients who gave birth from January 2008 until May 2019. The study group included 203 term pregnancies with RFM during the 2 weeks prior to delivery, which was matched with 203 controls. The RFM group was characterized by a higher rate of placental weight <10th percentile (22.6% vs. 3.9%, P < .001), a higher rate of maternal vascular malperfusion lesions (30.5% vs. 18.7%, P = .007) and lesions of maternal inflammatory response (43.3% vs. 29.5%, P = .005). At delivery, the RFM group had higher rates of cesarean delivery due to non-reassuring fetal heart rate monitoring (P = .01), 5-minute Apgar score ≤7 (P = .03), neonatal intensive care unit admissions (P < .001) and composite adverse neonatal outcomes (P = .007). Using multivariable analysis, RFM (adjusted odds ratio [aOR] 1.7, 95% confidence interval [CI] 1.1-4.8), and placental maternal vascular malperfusion lesions (aOR 1.2, 95% CI 1.0-2.9) were independently associated with adverse neonatal outcome. CONCLUSIONS: After excluding important placental-related morbidities, RFM was associated with a higher rate of placental weight <10th percentile and placental maternal vascular malperfusion lesions vs. controls. This study suggests a placental involvement in the association between RFM at term and adverse pregnancy outcomes. CI - © 2020 Nordic Federation of Societies of Obstetrics and Gynecology. FAU - Levy, Michal AU - Levy M AUID- ORCID: 0000-0003-2915-3732 AD - Departments of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel. AD - Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Kovo, Michal AU - Kovo M AD - Departments of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel. AD - Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Izaik, Yakira AU - Izaik Y AD - Departments of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel. AD - Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Luwisch Cohen, Isca AU - Luwisch Cohen I AD - Departments of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel. AD - Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Schreiber, Letizia AU - Schreiber L AD - Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. AD - Department of Pathology, Edith Wolfson Medical Center, Holon, Israel. FAU - Ganer Herman, Hadas AU - Ganer Herman H AD - Departments of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel. AD - Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Barda, Giulia AU - Barda G AUID- ORCID: 0000-0003-1742-7396 AD - Departments of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel. AD - Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Bar, Jacob AU - Bar J AD - Departments of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel. AD - Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Weiner, Eran AU - Weiner E AD - Departments of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel. AD - Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. LA - eng PT - Journal Article DEP - 20200214 PL - United States TA - Acta Obstet Gynecol Scand JT - Acta obstetricia et gynecologica Scandinavica JID - 0370343 SB - IM MH - Adult MH - Case-Control Studies MH - Female MH - Fetal Death MH - Fetal Diseases/*pathology MH - *Fetal Movement MH - Humans MH - Infant, Newborn MH - Mothers/*psychology MH - Perinatal Death MH - Placenta/*pathology MH - Pregnancy MH - Pregnancy Outcome OTO - NOTNLM OT - *malperfusion lesions OT - *neonatal outcome OT - *placental pathology OT - *reduced fetal movements OT - *term pregnancy EDAT- 2020/01/22 06:00 MHDA- 2020/10/21 06:00 CRDT- 2020/01/22 06:00 PHST- 2019/11/13 00:00 [received] PHST- 2019/12/20 00:00 [revised] PHST- 2020/01/12 00:00 [accepted] PHST- 2020/01/22 06:00 [pubmed] PHST- 2020/10/21 06:00 [medline] PHST- 2020/01/22 06:00 [entrez] AID - 10.1111/aogs.13810 [doi] PST - ppublish SO - Acta Obstet Gynecol Scand. 2020 Jul;99(7):884-890. doi: 10.1111/aogs.13810. Epub 2020 Feb 14. PMID- 32089884 OWN - NLM STAT- MEDLINE DCOM- 20200803 LR - 20200803 IS - 2090-2735 (Electronic) IS - 2090-2727 (Print) IS - 2090-2727 (Linking) VI - 2020 DP - 2020 TI - Solving the Obstetrical Paradox: The FETAL Technique-A Step toward Noninvasive Evaluation of Fetal pH. PG - 7801039 LID - 10.1155/2020/7801039 [doi] LID - 7801039 AB - Every year, about 85 percent of the approximately 5 million births in North America are evaluated with the electronic fetal monitoring (EFM). Clinicians use the EFM as a proxy to assess fetal oxygenation status, fetal well-being, and potential compromise. Despite the widespread use of this technology, neonatal hypoxia and acidosis continue to make up a high proportion of neonatal morbidity at term. Indeed, though the fetal heart rhythm is inextricably linked to fetal acid-base status, EFM has not been shown to reliably predict neonatal pH status nor has it reduced adverse maternal or neonatal outcomes. As a consequence, the high false-positive rate of EFM for predicting adverse neonatal outcomes has led to an increase in the rate of operative vaginal and cesarean delivery, with elevated rates of associated maternal and neonatal morbidity. This fact invariably leads to a paradox we have henceforth defined as the "obstetrical paradox." Herein, we explore the potential solutions to this paradox and introduce a novel noninvasive technique to assess fetal acid-base status in utero known as the "FETAL technique" (Fourier Evaluation of Tracings and Acidosis in Labour). The FETAL technique, currently under investigation, applies the discrete Fourier transformation to EFM tracings to determine the spectral frequency distribution of the fetal heart rate. These specific frequency distributions correlate with specific umbilical pH values and may provide the missing link between fetal heat rate patterns and acid-base status at birth. As we work toward realizing the full potential benefits of EFM, finding the best assessment strategies to evaluate fetal pH in real time remains a key goal in obstetrics. CI - Copyright © 2020 Jacques Balayla and Guy Shrem. FAU - Balayla, Jacques AU - Balayla J AUID- ORCID: 0000-0002-0783-8063 AD - Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada. FAU - Shrem, Guy AU - Shrem G AD - Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada. LA - eng PT - Journal Article PT - Review DEP - 20200208 TA - J Pregnancy JT - Journal of pregnancy JID - 101553823 SB - IM MH - Cardiotocography/*methods MH - Female MH - Fetal Blood MH - Heart Rate, Fetal MH - Humans MH - *Hydrogen-Ion Concentration MH - Obstetrics MH - Pregnancy PMC - PMC7031714 COIS- Neither author has any relevant financial, personal, political, intellectual, or religious interests to declare. EDAT- 2020/02/25 06:00 MHDA- 2020/08/04 06:00 CRDT- 2020/02/25 06:00 PHST- 2019/09/20 00:00 [received] PHST- 2020/01/28 00:00 [accepted] PHST- 2020/02/25 06:00 [entrez] PHST- 2020/02/25 06:00 [pubmed] PHST- 2020/08/04 06:00 [medline] AID - 10.1155/2020/7801039 [doi] PST - epublish SO - J Pregnancy. 2020 Feb 8;2020:7801039. doi: 10.1155/2020/7801039. eCollection 2020. PMID- 32071962 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200928 IS - 2352-3409 (Electronic) IS - 2352-3409 (Linking) VI - 29 DP - 2020 Apr TI - Dataset on linear and non-linear indices for discriminating healthy and IUGR fetuses. PG - 105164 LID - 10.1016/j.dib.2020.105164 [doi] LID - 105164 AB - The presented collection of data comprises of a set of 12 linear and nonlinear indices computed at different time scales and extracted from Fetal Heart Rate (FHR) traces acquired through Hewlett Packard CTG fetal monitors (series 1351A), connected to a PC. The sampling frequency of the recorded FHR signal is equal 2 Hz. The recorded populations consist of two groups of fetuses: 60 healthy and 60 Intra Uterine Growth Restricted (IUGR) fetuses. IUGR condition is a fetal condition defined as the abnormal rate of fetal growth. In clinical practice, diagnosis is confirmed at birth and may only be suspected during pregnancy. The pathology is a documented cause of fetal and neonatal morbidity and mortality. The described database was employed in a set of machine learning approaches for the early detection of the IUGR condition: "Integrating machine learning techniques and physiology based heart rate features for antepartum fetal monitoring" [1]. The added value of the proposed indices is their interpretability and close connection to physiological and pathological aspect of FHR regulation. Additional information on data acquisition, feature extraction and potential relevance in clinical practice are discussed in [1]. CI - © 2020 The Author(s). FAU - Signorini, Maria G AU - Signorini MG AD - Department of Electronics, Information and Bioengineering (DEIB), Politecnico Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy. FAU - Pini, Nicolò AU - Pini N AD - Department of Electronics, Information and Bioengineering (DEIB), Politecnico Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy. FAU - Malovini, Alberto AU - Malovini A AD - IRCCS Fondazione S. Maugeri, Via Maugeri 10, 27100 Pavia, Italy. FAU - Bellazzi, Riccardo AU - Bellazzi R AD - Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Via Ferrata 5, 27100 Pavia, Italy. FAU - Magenes, Giovanni AU - Magenes G AD - Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Via Ferrata 5, 27100 Pavia, Italy. LA - eng PT - Journal Article DEP - 20200129 TA - Data Brief JT - Data in brief JID - 101654995 PMC - PMC7015997 OTO - NOTNLM OT - Cardiotocography OT - Fetal heart rate monitoring OT - Intra uterine growth restricted OT - Multivariate analysis OT - Physiology-based features OT - Predictive analytics EDAT- 2020/02/20 06:00 MHDA- 2020/02/20 06:01 CRDT- 2020/02/20 06:00 PHST- 2019/12/21 00:00 [received] PHST- 2020/01/13 00:00 [revised] PHST- 2020/01/14 00:00 [accepted] PHST- 2020/02/20 06:00 [entrez] PHST- 2020/02/20 06:00 [pubmed] PHST- 2020/02/20 06:01 [medline] AID - S2352-3409(20)30058-5 [pii] AID - 105164 [pii] AID - 10.1016/j.dib.2020.105164 [doi] PST - epublish SO - Data Brief. 2020 Jan 29;29:105164. doi: 10.1016/j.dib.2020.105164. eCollection 2020 Apr. PMID- 32028142 OWN - NLM STAT- MEDLINE DCOM- 20201204 LR - 20201214 IS - 1872-7654 (Electronic) IS - 0301-2115 (Linking) VI - 246 DP - 2020 Mar TI - Autonomic response to fetal acidosis using an experimental sheep model. PG - 151-155 LID - S0301-2115(20)30026-9 [pii] LID - 10.1016/j.ejogrb.2020.01.018 [doi] AB - BACKGROUND: The autonomic nervous system has a major role in fetal adaptation to hypoxia. Its activity might be assessed using heart rate variability and heart rate deceleration analyses. OBJECTIVE: To evaluate the ability of different heart rate variability and morphological deceleration analyses to predict fetal acidosis during labor in an experimental fetal sheep model. STUDY DESIGN: Repeated 1-minute total umbilical cord occlusions were performed at mild (1minute every 5 min), moderate (1 min every 3 min), and severe (1 min every 2 min) umbilical cord occlusion periodicities until arterial pH reached 7.10. Hemodynamic,blood gas analysis, morphological analysis of decelerations (magnitude, slope, and area ofdecelerations), and heart rate variability parameters were recorded throughout the experiment.Heart rate variability analysis included temporal analysis (root mean square of successivedifferences between adjacent RR intervals, standard deviation of normal to normal RR intervals, short term variability), spectral analysis (low frequencies, high frequencies,normalized high frequencies), and a new index developed by our team, the Fetal Stress Index.We defined and compared three pH groups: >7.20, 7.10-7.20, and <7.10. RESULTS: Eleven experiments were performed. Repetitive umbilical cord occlusions resulted in progressive fetal acidosis. Fetal Stress Index was correlated with pH and lactate (p < 0.05) and increased with acidosis. There were no significant correlations between pH, lactate, and other indices (spectral analysis, temporal analysis, or morphological analysis of decelerations). CONCLUSION: This protocol allowed us to identify the progressive onset of fetal acidosis in an experimental model close to labor. Fetal Stress Index is a heart rate variability method that varies with acidosis and indicates an increase in parasympathetic nervous system activity in response to fetal acidosis. CI - Copyright © 2020 Elsevier B.V. All rights reserved. FAU - Vanspranghels, Roxane AU - Vanspranghels R AD - University of Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France. FAU - De Jonckheere, Julien AU - De Jonckheere J AD - University of Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, CIC-IT 1403, F-59000 Lille, France. FAU - Drumez, Elodie AU - Drumez E AD - University of. Lille, CHU Lille, EA 2694 - Public Health: Epidemiology and Quality of Care, Department of Biostatistics, F-59000 Lille, France. FAU - Lauriot Dit Prevost, Arthur AU - Lauriot Dit Prevost A AD - University of Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Pediatric Surgery, F-59000 Lille, France. FAU - Sharma, Dyuti AU - Sharma D AD - University of Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Pediatric Surgery, F-59000 Lille, France. FAU - Ghesquiere, Louise AU - Ghesquiere L AD - University of Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France. FAU - Storme, Laurent AU - Storme L AD - University of Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Neonatology, F-59000 Lille, France. FAU - Houfflin-Debarge, Véronique AU - Houfflin-Debarge V AD - University of Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France. FAU - Garabedian, Charles AU - Garabedian C AD - University of Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France. Electronic address: charles.garabedian@chru-lille.fr. LA - eng PT - Journal Article DEP - 20200123 PL - Ireland TA - Eur J Obstet Gynecol Reprod Biol JT - European journal of obstetrics, gynecology, and reproductive biology JID - 0375672 RN - 33X04XA5AT (Lactic Acid) SB - IM MH - Acidosis/metabolism/*physiopathology MH - Animals MH - Autonomic Nervous System/*physiology/physiopathology MH - Blood Gas Analysis MH - Constriction MH - Female MH - Fetal Monitoring MH - Heart Rate, Fetal/*physiology MH - Hydrogen-Ion Concentration MH - Hypoxia/metabolism/*physiopathology MH - Labor, Obstetric MH - Lactic Acid/metabolism MH - Pregnancy MH - Sheep MH - Sheep, Domestic MH - Umbilical Cord OTO - NOTNLM OT - Acidosis OT - Autonomic nervous system OT - Fetal sheep OT - Heart rate variability OT - Labor monitoring EDAT- 2020/02/07 06:00 MHDA- 2020/12/15 06:00 CRDT- 2020/02/07 06:00 PHST- 2019/11/05 00:00 [received] PHST- 2020/01/11 00:00 [revised] PHST- 2020/01/15 00:00 [accepted] PHST- 2020/02/07 06:00 [pubmed] PHST- 2020/12/15 06:00 [medline] PHST- 2020/02/07 06:00 [entrez] AID - S0301-2115(20)30026-9 [pii] AID - 10.1016/j.ejogrb.2020.01.018 [doi] PST - ppublish SO - Eur J Obstet Gynecol Reprod Biol. 2020 Mar;246:151-155. doi: 10.1016/j.ejogrb.2020.01.018. Epub 2020 Jan 23. PMID- 32046394 OWN - NLM STAT- MEDLINE DCOM- 20201130 LR - 20201130 IS - 1933-7205 (Electronic) IS - 1933-7191 (Linking) VI - 27 IP - 1 DP - 2020 Jan TI - Real-time Monitoring of Hypoxic-Ischemic Brain Damage in Neonatal Rats Using Diffuse Light Reflectance Spectroscopy. PG - 172-181 LID - 10.1007/s43032-019-00020-9 [doi] AB - Obstetric management to prevent hypoxic ischemic encephalopathy (HIE) during labor is important to reduce the cerebral palsy incidence in neonates. A novel approach to monitor or predict fetal brain damage during labor is required. Diffuse reflectance spectroscopy is a noninvasive method routinely used to assess the intrinsic characteristics of tissues. This study investigated the time course of diffuse reflectance signals during an early stage of cerebral cortical damage in a neonatal rat HIE model (Vannucci's model). In the model, an HIE lesion was induced by hypoxic exposure following ligation of the left common carotid artery. Using this model, we established an experimental system to detect diffuse light reflectance signals at time points of interest. Quantitative monitoring of total hemoglobin, oxygen saturation, and scattering amplitude was conducted to examine the basis of the diffused reflectance signals. During hypoxic exposure, which induced HIE damage in the left hemisphere after ligation, the oxygen saturation level decreased, but the difference between the two hemispheres was relatively small. During this period, total hemoglobin was increased in both hemispheres, but the change in the left hemisphere was significantly greater than that in the right, which is attributable to a vigorous compensation response. During hypoxia, scattering amplitude, which reflects cellular/subcellular morphology, revealed a remarkable difference between the two hemispheres. We confirmed that scattering amplitude levels negatively correlated with the extent of edema. These findings suggest that simultaneous monitoring of the scattering amplitude, in addition to hemodynamic parameters, is useful for detecting brain tissue alterations leading to HIE. FAU - Kinoshita, Sakiko AU - Kinoshita S AD - Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. FAU - Kawauchi, Satoko AU - Kawauchi S AD - Division of Biomedical Information Sciences, National Defense Medical College Research Institute, Saitama, Japan. FAU - Nagamatsu, Takeshi AU - Nagamatsu T AD - Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. tnag-tky@umin.ac.jp. FAU - Nishidate, Izumi AU - Nishidate I AD - Graduate School of Bio-Application and Systems Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan. FAU - Fujii, Tomoyuki AU - Fujii T AD - Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. FAU - Sato, Shunichi AU - Sato S AD - Division of Biomedical Information Sciences, National Defense Medical College Research Institute, Saitama, Japan. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20200101 PL - United States TA - Reprod Sci JT - Reproductive sciences (Thousand Oaks, Calif.) JID - 101291249 SB - IM MH - Animals MH - Animals, Newborn MH - Brain/*diagnostic imaging/pathology MH - Disease Models, Animal MH - Hypoxia-Ischemia, Brain/*diagnostic imaging/pathology MH - Rats MH - Rats, Sprague-Dawley MH - Spectrum Analysis/*methods OTO - NOTNLM OT - *Cerebral palsy OT - *Diffuse light reflectance spectroscopy OT - *Hypoxic ischemic encephalopathy OT - *Scattering amplitude a EDAT- 2020/02/13 06:00 MHDA- 2020/12/01 06:00 CRDT- 2020/02/13 06:00 PHST- 2019/02/03 00:00 [received] PHST- 2019/03/20 00:00 [accepted] PHST- 2020/02/13 06:00 [pubmed] PHST- 2020/12/01 06:00 [medline] PHST- 2020/02/13 06:00 [entrez] AID - 10.1007/s43032-019-00020-9 [pii] AID - 10.1007/s43032-019-00020-9 [doi] PST - ppublish SO - Reprod Sci. 2020 Jan;27(1):172-181. doi: 10.1007/s43032-019-00020-9. Epub 2020 Jan 1. PMID- 31802494 OWN - NLM STAT- In-Process LR - 20210110 IS - 1469-7793 (Electronic) IS - 0022-3751 (Linking) VI - 598 IP - 2 DP - 2020 Jan TI - First evidence that intrinsic fetal heart rate variability exists and is affected by hypoxic pregnancy. PG - 249-263 LID - 10.1113/JP278773 [doi] AB - KEY POINTS: We introduce a technique to test whether intrinsic fetal heart rate variability (iFHRV) exists and we show the utility of the technique by testing the hypothesis that iFHRV is affected by chronic fetal hypoxia, one of the most common adverse outcomes of human pregnancy complicated by fetal growth restriction. Using an established late gestation ovine model of fetal development under chronic hypoxic conditions, we identify iFHRV in isolated fetal hearts and show that it is markedly affected by hypoxic pregnancy. Therefore, the isolated fetal heart has intrinsic variability and carries a memory of adverse intrauterine conditions experienced during the last third of pregnancy. ABSTRACT: Fetal heart rate variability (FHRV) emerges from influences of the autonomic nervous system, fetal body and breathing movements, and from baroreflex and circadian processes. We tested whether intrinsic heart rate variability (iHRV), devoid of any external influences, exists in the fetal period and whether it is affected by chronic fetal hypoxia. Chronically catheterized ewes carrying male singleton fetuses were exposed to normoxia (n = 6) or hypoxia (10% inspired O(2) , n = 9) for the last third of gestation (105-138 days of gestation (dG); term ∼145 dG) in isobaric chambers. At 138 dG, isolated hearts were studied using a Langendorff preparation. We calculated basal intrinsic FHRV (iFHRV) indices reflecting iFHRV's variability, predictability, temporal symmetry, fractality and chaotic behaviour, from the systolic peaks within 15 min segments in each heart. Significance was assumed at P < 0.05. Hearts of fetuses isolated from hypoxic pregnancy showed approximately 4-fold increases in the Grid transformation as well as the AND similarity index (sgridAND) and a 4-fold reduction in the scale-dependent Lyapunov exponent slope. We also detected a 2-fold reduction in the Recurrence quantification analysis, percentage of laminarity (pL) and recurrences, maximum and average diagonal line (dlmax, dlmean) and the Multiscale time irreversibility asymmetry index. The iHRV measures dlmax, dlmean, pL and sgridAND correlated with left ventricular end-diastolic pressure across both groups (average R(2)  = 0.38 ± 0.03). This is the first evidence that iHRV originates in fetal life and that chronic fetal hypoxia significantly alters it. Isolated fetal hearts from hypoxic pregnancy exhibit a time scale-dependent higher complexity in iFHRV. CI - © 2019 The Authors. The Journal of Physiology © 2019 The Physiological Society. FAU - Frasch, Martin G AU - Frasch MG AUID- ORCID: 0000-0003-3159-6321 AD - Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA. FAU - Herry, Christophe L AU - Herry CL AD - Dynamical Analysis Laboratory, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. FAU - Niu, Youguo AU - Niu Y AD - Department of Physiology Development & Neuroscience, University of Cambridge, Cambridge, UK. FAU - Giussani, Dino A AU - Giussani DA AUID- ORCID: 0000-0002-1308-1204 AD - Department of Physiology Development & Neuroscience, University of Cambridge, Cambridge, UK. LA - eng GR - RG/17/8/32924/BHF_/British Heart Foundation/United Kingdom GR - CIHR/Canada PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20200109 PL - England TA - J Physiol JT - The Journal of physiology JID - 0266262 SB - IM OTO - NOTNLM OT - *FHRV OT - *HRV OT - *IUGR OT - *Langendorff OT - *fetus OT - *hypoxia OT - *sheep EDAT- 2019/12/06 06:00 MHDA- 2019/12/06 06:00 CRDT- 2019/12/06 06:00 PHST- 2019/08/08 00:00 [received] PHST- 2019/11/11 00:00 [accepted] PHST- 2019/12/06 06:00 [pubmed] PHST- 2019/12/06 06:00 [medline] PHST- 2019/12/06 06:00 [entrez] AID - 10.1113/JP278773 [doi] PST - ppublish SO - J Physiol. 2020 Jan;598(2):249-263. doi: 10.1113/JP278773. Epub 2020 Jan 9. PMID- 31335010 STAT- Publisher CTDT- 20200823 PB - StatPearls Publishing DP - 2020 Jan TI - Stages of Labor. BTI - StatPearls AB - Labor is the process through which a fetus and placenta are delivered from the uterus through the vagina. Human labor divides into three stages. The first stage is further divided into two phases. Successful labor involves three factors, which include maternal efforts and uterine contractions, fetal characteristics, and pelvic anatomy. This triad is classically referred to as the passenger, power, and passage. Labor is typically monitored by multiple modalities. Serial cervical examinations are used to determine cervical dilation, effacement, and fetal position, also known as the station. Fetal heart monitoring is employed nearly continuously to asses fetal well-being throughout labor. Cardiotocography is used to monitor the frequency and adequacy of contractions. Medical professionals use the information they obtain from monitoring and cervical exams to determine the stage of labor of the patient and to monitor labor progression. Initial Evaluation and Presentation of Labor Women will often self-present to obstetrical triage with concern for the onset of labor. Common chief complaints include painful contractions, vaginal bleeding/bloody show, and leakage of fluid from the vagina. It is up to the clinician to determine if the patient is in labor, defined as regular, clinically significant contractions with an objective change in cervical dilation and/or effacement. When women first present to the labor and delivery unit, vital signs, including temperature, heart rate, oxygen saturation, respiratory rate, and blood pressure, should be obtained and reviewed for any abnormalities. The patient should be placed on continuous cardiotocographic monitoring to ensure fetal wellbeing. The patient's prenatal record, including obstetric history, surgical history, medical history, laboratory, and imaging data, should undergo review. Finally, a history of present illness, review of systems, and physical exam, including a sterile speculum exam, will need to take place. During the sterile speculum exam, clinicians will look for signs of rupture of membranes such as amniotic fluid pooling in the posterior vaginal canal. If the clinician is unsure about whether or not a rupture of membranes has occurred additional testing such as pH testing, microscopic exam looking for ferning of the fluid, or laboratory testing of the fluid can be the next step. Amniotic fluid has a pH of 7.0 to 7.5, which is more basic than that of normal vaginal pH. A sterile gloved exam should be done to determine the degree of cervical dilation and effacement. The measurement of cervical dilation is made by locating the external cervical os and spreading one's fingers in a ‘V’ shape and estimating the distance in centimeters between the two fingers. Effacement is measured by estimating the percentage remaining of the length of the thinned cervix compared to the uneffaced cervix. During the cervical exam, confirmation of the presenting fetal part is also necessary. Bedside ultrasound can be employed to confirm the presentation and position of the fetal presenting part. Particular mention should be noted in the case of breech presentation due to its increased risks regarding fetal morbidity and mortality compared with the cephalic presenting fetus.  Management of Normal Labor Labor is a natural process, but it can suffer interruption by complicating factors, which at times necessitate clinical intervention. The management of low-risk labor is a delicate balance between allowing the natural process to proceed while limiting any potential complications. During labor, cardiotocographic monitoring is often employed to monitor uterine contractions and fetal heart rate over time. Clinicians monitor fetal heart tracings to evaluate for any signs of fetal distress that would warrant intervention as well as the adequacy or inadequacy of contractions. Vital signs of the mother are taken at regular intervals and whenever there is a concern for change in clinical status. Laboratory testing often includes the hemoglobin, hematocrit, and platelet count and are sometimes repeated following delivery if significant blood loss occurs. Cervical exams are usually performed every 2 to 3 hours unless concerns arise and warrant more frequent exams. Frequent cervical exams are associated with a higher risk of infection, especially if a rupture of membranes has occurred. Women should be allowed to ambulated freely and change positions if desired. An intravenous catheter is typically inserted in case it is necessary to administer medications or fluids. Oral intake should not be withheld. If the patient remains without food or drink for a prolonged period of time intravenous fluids should be considered to help replace losses, but do not need to be used continuously on all laboring patients. Analgesia is offered in the form of intravenous opioids, inhaled nitrous oxide, and neuraxial analgesia in those who are appropriate candidates. Amniotomy is considered as needed for fetal scalp monitoring or labor augmentation, but its routine use should be discouraged.  Oxytocin may be initiated to augment contractions found to be inadequate. First Stage of Labor The first stage of labor begins when labor starts and ends with full cervical dilation to 10 centimeters. Labor often begins spontaneously or may be induced medically for a variety of maternal or fetal indications. Methods of inducing labor include cervical ripening with prostaglandins, membrane stripping, amniotomy, and intravenous oxytocin. Although precisely determining when labor starts may be inexact, labor is generally defined as beginning when contractions become strong and regularly spaced at approximately 3 to 5 minutes apart. Throughout pregnancy, women may experience painful contractions that do not lead to cervical dilation or effacement, referred to as false labor. Thus, defining the onset of labor often relies on retrospective or subjective data. Friedman et al were some of the first to study labor progress and defined the beginning of labor as starting when women felt significant and regular contractions. He graphed cervical dilation over time and determined that normal labor has a sigmoidal shape. Based on the analysis from his labor graphs, he proposed that labor has three divisions. First, a preparatory stage marked by slow cervical dilation, with large biochemical and structural changes. This is also known as the latent phase of the first stage of labor. Second, a much shorter and rapid dilational phase, which is also known as the active phase of the first stage of labor. Third, a pelvic division phase, which takes place during the second stage of labor. The first stage of labor is further subdivides into two phases, which are defined by the degree of cervical dilation. The latent phase is commonly defined as the 0 to 6 cm, while the active phase commences from 6 cm to full cervical dilation. The presenting fetal part also begins the process of engagement into the pelvis during the first stage. Throughout the first stage of labor, serial cervical exams are done to determine the position of the fetus, cervical dilation, and cervical effacement. Cervical effacement refers to the cervical length in the anterior-posterior plane. When the cervix is completely thinned out and no length is left, this is referred to as 100 percent effacement. The station of the fetus is defined relative to its position in the maternal pelvis.  When the bony fetal presenting part is aligned with the maternal ischial spine, the fetus is 0 station. Proximal to the ischial spines are stations -1 centimeter to -5 centimeters, and distal to the ischial spines is +1 to +5 station. The first stage of labor contains a latent phase and an active phase. During the latent phase, the cervix dilates slowly to approximately 6 centimeters. The latent phase is generally considerably longer and less predictable with regard to the rate of cervical change than is observed in the active phase. A normal latent phase can last up to 20 hours and 14 hours in nulliparous and multiparous women respectively, without being considered prolonged. Sedation can increase the duration of the latent phase of labor. In the active phase, the cervix changes more rapidly and predictably until it reaches 10 centimeters and cervical dilation and effacement are complete. Active labor with more rapid cervical dilation generally starts around 6 centimeters of dilation. During the active phase, the cervix typically dilates at a rate of 1.2 to 1.5 centimeters per hour. Multiparas, or women with a history of prior vaginal delivery, tend to demonstrate more rapid cervical dilation. The absence of cervical change for greater than 4 hours in the presence of adequate contractions or six hours with inadequate contractions is considered the arrest of labor and may warrant clinical intervention.  Second Stage of Labor The second stage of labor commences with complete cervical dilation to 10 centimeters and ends with the delivery of the neonate. This was also defined as the pelvic division phase by Friedman. After cervical dilation is complete, the fetus descends into the vaginal canal with or without maternal pushing efforts. The fetus passes through the birth canal via 7 movements known as the cardinal movements.  These include engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion. In women who have delivered vaginally previously, whose bodies have acclimated to delivering a fetus, the second stage may only require a brief trial, whereas a longer duration may be required for a nulliparous female. In parturients without neuraxial anesthesia, the second stage of labor typically lasts less than three hours in nulliparous women and less than two hours in multiparous women. In women who receive neuraxial anesthesia, the second stage of labor typically lasts less than four hours in nulliparous women and less than three hours in multiparous women. If the second stage of labor lasts longer than these parameters, then the second stage is considered prolonged. Several elements may influence the duration of the second stage of labor including fetal factors such as fetal size and position, or maternal factors such as pelvis shape, the magnitude of expulsive efforts, comorbidities such as hypertension or diabetes, age, and history of previous deliveries.  Third Stage of Labor The third stage of labor commences when the fetus is delivered and concludes with the delivery of the placenta. Separation of the placenta from the uterine interface is hallmarked by three cardinal signs including a gush of blood at the vagina, lengthening of the umbilical cord, and a globular shaped uterine fundus on palpation. Spontaneous expulsion of the placenta typically takes between 5 to 30 minutes. A delivery time of greater than 30 minutes is associated with a higher risk of postpartum hemorrhage and may be an indication for manual removal or other intervention. Management of the third stage of labor involves placing traction on the umbilical cord with simultaneous fundal pressure to effect faster placental delivery.  CI - Copyright © 2020, StatPearls Publishing LLC. FAU - Hutchison, Julia AU - Hutchison J AD - Kaiser Permanente School of Medicine FAU - Mahdy, Heba AU - Mahdy H FAU - Hutchison, Justin AU - Hutchison J AD - Kaiser Modesto LA - eng PT - Review PT - Book Chapter PL - Treasure Island (FL) EDAT- 2020/08/23 00:00 CRDT- 2020/08/23 00:00 AID - NBK544290 [bookaccession] PMID- 30725808 STAT- Publisher CTDT- 20200810 PB - StatPearls Publishing DP - 2020 Jan TI - Prenatal Non-stress Test. BTI - StatPearls AB - Prenatal non-stress test, popularly known as NST, is a method used to test fetal wellbeing before the onset of labor. A prenatal non-stress test functions in overall antepartum surveillance with ultrasound as a part or component of the biophysical profile. The presence of fetal movements and fetal heart rate acceleration is the most critical feature of the non-stress test. It is a non-invasive test used for the surveillance of high-risk pregnancies when the fetus is judged clinically to be at risk for hypoxemia or increased risk of death. Trained and certified nurses, midwives and physicians should read and interpret the non-stress test. The NST readings are as reactive and none reactive. The non-stress tests can initiate at 26 to 28 weeks. The NST is reactive from 32 weeks. The Non-Stress Test (NST) is an assessment tool used from 32 weeks of gestation to term to evaluate fetal health through the use of electric fetal monitors that continuously record the fetal heart rate (FHR). The test is used to determine if a fetus is at risk for intrauterine death or neonatal complications, usually secondary to high-risk pregnancies or suspected fetal hypoxemia. The frequency of use is based on clinical judgment, but is common because it is non-invasive and presents a low maternal and fetal risk; however, the test does not hold predictive value and only indicates fetal hypoxemia at time of the test. The presence of fetal heart rate acceleration with fetal movement is the principle behind the non-stress test. The NST recognizes the coupling of fetal neurological status to cardiovascular reflex responses. It is one of the factors that tends to disappear earliest during progressive fetal compromise. Interpretation of the nonstress test follows a systematic approach to include: the baseline fetal heart rate, baseline fetal heart rate variability, presence of accelerations, decelerations, and contractions. CI - Copyright © 2020, StatPearls Publishing LLC. FAU - Umana, Otto D AU - Umana OD AD - Cape Fear Valley Hospital, Campbell Unversity FAU - Siccardi, Marco A AU - Siccardi MA AD - San Paolo Hospital Savona LA - eng PT - Review PT - Book Chapter PL - Treasure Island (FL) EDAT- 2020/08/10 00:00 CRDT- 2020/08/10 00:00 AID - NBK537123 [bookaccession] PMID- 32118472 OWN - NLM STAT- MEDLINE DCOM- 20200821 LR - 20200821 IS - 1802-9973 (Electronic) IS - 0862-8408 (Linking) VI - 68 IP - Suppl 4 DP - 2019 Dec 30 TI - Laboratory options for risk assessment of pregnancy pathologies. PG - S415-S425 AB - The most effective method of screening for chromosomal abnormalities and evaluating the risk of pregnancy pathologies in the first trimester is combined screening. The algorithm of screening is based on the combination of maternal age, measuring of the nuchal translucency and the fetal heart rate and analysis of the placental products of free ß-hCG and PAPP-A. For the screening of preeclampsia, placental growth factor (PlGF) is added. To distinguish between preeclampsia and other pathologies caused by placental dysfunction it is recommended to also extend the screening with selected immunological markers. We concluded that elevated biochemical and immunological markers can help to predict the threat of preeclampsia in the third trimester. Some markers can probably predict the development of particularly severe pathological conditions. FAU - Kestlerová, A AU - Kestlerová A AD - Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University, Prague, Czech Republic. 1andrea1@centrum.cz. FAU - Krofta, L AU - Krofta L FAU - Žufić, A AU - Žufić A FAU - Hamplová Běhávková, K AU - Hamplová Běhávková K FAU - Račko, J AU - Račko J FAU - Beneš, J AU - Beneš J FAU - Feyereisl, J AU - Feyereisl J LA - eng PT - Journal Article PT - Review PL - Czech Republic TA - Physiol Res JT - Physiological research JID - 9112413 RN - 0 (Biomarkers) SB - IM MH - Biomarkers/*blood MH - *Chromosome Aberrations MH - Female MH - Humans MH - Hypertension, Pregnancy-Induced/*diagnosis MH - Pregnancy MH - Pregnancy Trimester, First MH - *Prenatal Diagnosis MH - Risk Assessment EDAT- 2020/03/03 06:00 MHDA- 2020/08/22 06:00 CRDT- 2020/03/03 06:00 PHST- 2020/03/03 06:00 [entrez] PHST- 2020/03/03 06:00 [pubmed] PHST- 2020/08/22 06:00 [medline] AID - 934376 [pii] AID - 10.33549/physiolres.934376 [doi] PST - ppublish SO - Physiol Res. 2019 Dec 30;68(Suppl 4):S415-S425. doi: 10.33549/physiolres.934376. PMID- 31888592 OWN - NLM STAT- MEDLINE DCOM- 20200522 LR - 20200522 IS - 1472-6947 (Electronic) IS - 1472-6947 (Linking) VI - 19 IP - 1 DP - 2019 Dec 30 TI - DeepFHR: intelligent prediction of fetal Acidemia using fetal heart rate signals based on convolutional neural network. PG - 286 LID - 10.1186/s12911-019-1007-5 [doi] LID - 286 AB - BACKGROUND: Fetal heart rate (FHR) monitoring is a screening tool used by obstetricians to evaluate the fetal state. Because of the complexity and non-linearity, a visual interpretation of FHR signals using common guidelines usually results in significant subjective inter-observer and intra-observer variability. OBJECTIVE: Therefore, computer aided diagnosis (CAD) systems based on advanced artificial intelligence (AI) technology have recently been developed to assist obstetricians in making objective medical decisions. METHODS: In this work, we present an 8-layer deep convolutional neural network (CNN) framework to automatically predict fetal acidemia. After signal preprocessing, the input 2-dimensional (2D) images are obtained using the continuous wavelet transform (CWT), which provides a better way to observe and capture the hidden characteristic information of the FHR signals in both the time and frequency domains. Unlike the conventional machine learning (ML) approaches, this work does not require the execution of complex feature engineering, i.e., feature extraction and selection. In fact, 2D CNN model can self-learn useful features from the input data with the prerequisite of not losing informative features, representing the tremendous advantage of deep learning (DL) over ML. RESULTS: Based on the test open-access database (CTU-UHB), after comprehensive experimentation, we achieved better classification performance using the optimal CNN configuration compared to other state-of-the-art methods: the averaged ten-fold cross-validation of the accuracy, sensitivity, specificity, quality index defined as the geometric mean of the sensitivity and specificity, and the area under the curve yielded results of 98.34, 98.22, 94.87, 96.53 and 97.82%, respectively CONCLUSIONS: Once the proposed CNN model is successfully trained, the corresponding CAD system can be served as an effective tool to predict fetal asphyxia objectively and accurately. FAU - Zhao, Zhidong AU - Zhao Z AUID- ORCID: 0000-0001-6659-3732 AD - College of Electronics and Information, Hangzhou Dianzi University, Hangzhou, China. zhaozd@hdu.edu.cn. AD - Hangdian Smart City Research Center of Zhejiang Province, Hangzhou Dianzi University, Hangzhou, China. zhaozd@hdu.edu.cn. FAU - Deng, Yanjun AU - Deng Y AD - College of Electronics and Information, Hangzhou Dianzi University, Hangzhou, China. FAU - Zhang, Yang AU - Zhang Y AD - School of Communication Engineering, Hangzhou Dianzi University, Hangzhou, China. FAU - Zhang, Yefei AU - Zhang Y AD - College of Electronics and Information, Hangzhou Dianzi University, Hangzhou, China. FAU - Zhang, Xiaohong AU - Zhang X AD - College of Electronics and Information, Hangzhou Dianzi University, Hangzhou, China. FAU - Shao, Lihuan AU - Shao L AD - College of Electronics and Information, Hangzhou Dianzi University, Hangzhou, China. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20191230 TA - BMC Med Inform Decis Mak JT - BMC medical informatics and decision making JID - 101088682 SB - IM MH - Acidosis/*diagnosis/etiology MH - Cardiotocography MH - Databases, Factual MH - *Deep Learning MH - Diagnosis, Computer-Assisted/methods MH - Female MH - Fetal Diseases/*diagnosis MH - Fetal Hypoxia/complications/diagnosis MH - *Heart Rate, Fetal MH - Humans MH - *Neural Networks, Computer MH - Pregnancy MH - Sensitivity and Specificity PMC - PMC6937790 OTO - NOTNLM OT - *Computer aided diagnosis system OT - *Continuous wavelet transform OT - *Convolutional neural network OT - *Fetal acidemia OT - *Fetal heart rate COIS- The authors declare that they have no competing interests. EDAT- 2020/01/01 06:00 MHDA- 2020/05/23 06:00 CRDT- 2020/01/01 06:00 PHST- 2019/01/31 00:00 [received] PHST- 2019/12/16 00:00 [accepted] PHST- 2020/01/01 06:00 [entrez] PHST- 2020/01/01 06:00 [pubmed] PHST- 2020/05/23 06:00 [medline] AID - 10.1186/s12911-019-1007-5 [pii] AID - 1007 [pii] AID - 10.1186/s12911-019-1007-5 [doi] PST - epublish SO - BMC Med Inform Decis Mak. 2019 Dec 30;19(1):286. doi: 10.1186/s12911-019-1007-5. PMID- 31883047 OWN - NLM STAT- MEDLINE DCOM- 20200702 LR - 20200702 IS - 1432-0711 (Electronic) IS - 0932-0067 (Linking) VI - 301 IP - 1 DP - 2020 Jan TI - Intrapartum PRSA: a new method to predict fetal acidosis?-a case-control study. PG - 137-142 LID - 10.1007/s00404-019-05419-y [doi] AB - PURPOSE: Phase-rectified signal averaging method (PRSA) represents an analysis method which applied on fetal cardiotocography (CTG) allows the quantification of the speed of fetal heart rate changes. By calculating the average deceleration capacity (ADC) an assessment of the fetal autonomic nervous system (ANS) is possible. The objective of this study was to test its ability to predict perinatal acidosis. METHODS: A case-control study was performed at a University Hospital in Munich. All intrapartum CTG heart rate tracings saved during a 7-year period were considered for analysis. All neonates born with an umbilical arterial blood pH ≤ 7.10 were considered as cases. Controls were defined as healthy fetuses born with a pH ≥ 7.25. The main matching criteria were gestational age at delivery, parity, birth mode, and birth weight percentile. Exclusion criteria were a planned caesarean section, fetal malformations, and multiple pregnancies. ADC and STV were then calculated during the last 60, the last 45, and the last 30 min intervals prior to delivery. RESULTS: Of all stored birth CTG recordings, 227 cases met the inclusion criteria and were studied. ADC was significantly higher in fetuses born with acidemia (4.85 bpm ± 3.0) compared to controls (3.36 bpm ± 2.2). The area under ROC curve was 0.659 (95% CI 0.608-0.710) for ADC and 0.566 (0.512-0.620) for STV (p = 0.013). CONCLUSIONS: This study confirms that the assessment of ADC using PRSA represents a good additional tool for the prediction of acute fetal acidosis during delivery. FAU - Weyrich, Joy AU - Weyrich J AUID- ORCID: 0000-0002-5711-8603 AD - Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, E81675, Munich, Germany. joy.weyrich@tum.de. FAU - Ortiz, Javier U AU - Ortiz JU AD - Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, E81675, Munich, Germany. FAU - Müller, Alexander AU - Müller A AD - Department of Internal Medicine I - Cardiology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany. FAU - Schmidt, Georg AU - Schmidt G AD - Department of Internal Medicine I - Cardiology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany. FAU - Brambs, Christine E AU - Brambs CE AD - Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, E81675, Munich, Germany. FAU - Graupner, Oliver AU - Graupner O AD - Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, E81675, Munich, Germany. FAU - Kuschel, Bettina AU - Kuschel B AD - Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, E81675, Munich, Germany. FAU - Lobmaier, Silvia M AU - Lobmaier SM AD - Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, E81675, Munich, Germany. LA - eng PT - Journal Article DEP - 20191227 PL - Germany TA - Arch Gynecol Obstet JT - Archives of gynecology and obstetrics JID - 8710213 SB - IM MH - Acidosis/*blood MH - Cardiotocography/*methods MH - Case-Control Studies MH - Female MH - Fetal Blood/*chemistry/cytology MH - Fetal Diseases/blood/*diagnosis MH - Heart Rate, Fetal/physiology MH - Humans MH - Male MH - Pregnancy OTO - NOTNLM OT - *Acute fetal hypoxia OT - *Average acceleration capacity OT - *Average deceleration capacity OT - *Fetal heart rate variability OT - *PRSA OT - *STV EDAT- 2019/12/29 06:00 MHDA- 2020/07/03 06:00 CRDT- 2019/12/29 06:00 PHST- 2019/03/26 00:00 [received] PHST- 2019/12/13 00:00 [accepted] PHST- 2019/12/29 06:00 [pubmed] PHST- 2020/07/03 06:00 [medline] PHST- 2019/12/29 06:00 [entrez] AID - 10.1007/s00404-019-05419-y [pii] AID - 10.1007/s00404-019-05419-y [doi] PST - ppublish SO - Arch Gynecol Obstet. 2020 Jan;301(1):137-142. doi: 10.1007/s00404-019-05419-y. Epub 2019 Dec 27. PMID- 31199757 OWN - NLM STAT- MEDLINE DCOM- 20200406 LR - 20200408 IS - 1862-278X (Electronic) IS - 0013-5585 (Linking) VI - 64 IP - 6 DP - 2019 Dec 18 TI - Fetal cardiotocography monitoring using Legendre neural networks. PG - 669-675 LID - 10.1515/bmt-2018-0074 [doi] AB - A new technique for electronic fetal monitoring (EFM) using an efficient structure of neural networks based on the Legendre series is presented in this paper. Such a structure is achieved by training a Legendre series-based neural network (LNN) to classify the different fetal states based on recorded cardiotocographic (CTG) data sets given by others. These data sets consist of measurements of fetal heart rate (FHR) and uterine contraction (UC). The applied LNN utilizes a Legendre series expansion for the input vectors and, hence, has the capability to produce explicit equations describing multi-input multi-output systems. Simulations of the proposed technique in EFM demonstrate its high efficiency. Training the LNN requires a few number of iterations (5-10 epochs). The applied technique makes the classification of the fetal state available through equations combining the trained LNN weights and the current measured CTG record. A comparison of performance between the proposed LNN and other popular neural network techniques such as the Volterra neural network (VNN) in EFM is provided. The comparison shows that, the LNN outperforms the VNN in case of less computational requirements and fast convergence with a lower mean square error. FAU - Alsayyari, Abdulaziz AU - Alsayyari A AD - Computer Engineering Department, Shaqra University, Dawadmi 11911, Ar Riyadh, Saudi Arabia. LA - eng PT - Journal Article PL - Germany TA - Biomed Tech (Berl) JT - Biomedizinische Technik. Biomedical engineering JID - 1262533 SB - IM MH - Cardiotocography/*methods MH - Female MH - Heart Rate, Fetal/*physiology MH - Humans MH - Neural Networks, Computer MH - Pregnancy OTO - NOTNLM OT - Legendre neural networks OT - biomedical engineering OT - cardiotocography OT - electronic fetal monitoring EDAT- 2019/06/15 06:00 MHDA- 2020/04/09 06:00 CRDT- 2019/06/15 06:00 PHST- 2018/05/12 00:00 [received] PHST- 2018/10/18 00:00 [accepted] PHST- 2019/06/15 06:00 [pubmed] PHST- 2020/04/09 06:00 [medline] PHST- 2019/06/15 06:00 [entrez] AID - /j/bmte.ahead-of-print/bmt-2018-0074/bmt-2018-0074.xml [pii] AID - 10.1515/bmt-2018-0074 [doi] PST - ppublish SO - Biomed Tech (Berl). 2019 Dec 18;64(6):669-675. doi: 10.1515/bmt-2018-0074. PMID- 31842798 OWN - NLM STAT- MEDLINE DCOM- 20200515 LR - 20200515 IS - 1471-2393 (Electronic) IS - 1471-2393 (Linking) VI - 19 IP - 1 DP - 2019 Dec 16 TI - Unrecognized maternal heart rate artefact in cases of perinatal mortality reported to the United States Food and Drug Administration from 2009 to 2019: a critical patient safety issue. PG - 501 LID - 10.1186/s12884-019-2660-5 [doi] LID - 501 AB - BACKGROUND: Maternal heart rate artefact is a signal processing error whereby the fetal heart rate is masked by the maternal pulse, potentially leading to danger by failure to recognize an abnormal fetal heart rate or a pre-existing fetal death. Maternal heart rate artefact may be exacerbated by autocorrelation algorithms in modern fetal monitors due to smooth transitions between maternal and fetal heart rates rather than breaks in the tracing. In response, manufacturers of cardiotocography monitors recommend verifying fetal life prior to monitoring and have developed safeguards including signal ambiguity detection technologies to simultaneously and continuously monitor the maternal and fetal heart rates. However, these safeguards are not emphasized in current cardiotocography clinical practice guidelines, potentially leading to a patient safety gap. METHODS: The United States Food and Drug Administration Manufacturer and User Facility Device Experience database was reviewed for records with event type "Death" for the time period March 31, 2009 to March 31, 2019, in combination with search terms selected to capture all cases reported involving cardiotocography devices. Records were reviewed to determine whether maternal heart rate artefact was probable and/or whether the report contained a recommendation from the device manufacturer regarding maternal heart rate artefact. RESULTS: Forty-seven cases of perinatal mortality were identified with probable maternal heart rate artefact including 14 with antepartum fetal death prior to initiation of cardiotocography, 14 with intrapartum fetal death or neonatal death after initiation of cardiotocography, and 19 where the temporal relationship between initiation of cardiotocography and death cannot be definitively established from the report. In 29 cases, there was a recommendation from the manufacturer regarding diagnosis and/or management of maternal heart rate artefact. CONCLUSIONS: This case series indicates a recurring problem with undetected maternal heart rate artefact leading to perinatal mortality and, in cases of pre-existing fetal death, healthcare provider confusion. In response, manufacturers frequently recommend safeguards which are found in their device's instructions for use but not in major intrapartum cardiotocography guidelines. Cardiotocography guidelines should be updated to include the latest safeguards against the risks of maternal heart rate artefact. An additional file summarizing key points for clinicians is included. FAU - Kiely, Daniel J AU - Kiely DJ AUID- ORCID: 0000-0001-5661-7825 AD - Department of Obstetrics and Gynecology, Hôpital de Thetford Mines, 1717 rue Notre Dame Est, Thetford Mines, Québec, G6G 2V4, Canada. danieljameskiely@gmail.com. FAU - Oppenheimer, Lawrence W AU - Oppenheimer LW AD - Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, 501 Smyth Road, Box 804, Ottawa, Ontario, K1H 8L6, Canada. FAU - Dornan, James C AU - Dornan JC AD - Department of Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Queens University Belfast (rtrd) and Chair Health and Life Sciences, Ulster University, York Street, Belfast, County Antrim, Belfast, Northern Ireland, BT15 1ED. LA - eng PT - Journal Article DEP - 20191216 TA - BMC Pregnancy Childbirth JT - BMC pregnancy and childbirth JID - 100967799 SB - IM CIN - J Obstet Gynaecol Can. 2020 Aug;42(8):939-942. PMID: 32736857 MH - *Artifacts MH - Cardiotocography/methods/*mortality MH - Female MH - Heart Rate, Fetal MH - Humans MH - Infant, Newborn MH - Perinatal Death/*etiology MH - *Perinatal Mortality MH - Pregnancy MH - Signal Processing, Computer-Assisted MH - United States/epidemiology MH - United States Food and Drug Administration PMC - PMC6915916 OTO - NOTNLM OT - Brain hypoxia-ischemia OT - Cardiotocography OT - Fetal distress OT - Fetal heart rate OT - Fetal monitoring OT - Obstetrics OT - Perinatal death OT - Pregnancy OT - Product recalls and withdrawals OT - Stillbirth COIS- The authors have no financial or non-financial competing interests. EDAT- 2019/12/18 06:00 MHDA- 2020/05/16 06:00 CRDT- 2019/12/18 06:00 PHST- 2019/05/19 00:00 [received] PHST- 2019/12/03 00:00 [accepted] PHST- 2019/12/18 06:00 [entrez] PHST- 2019/12/18 06:00 [pubmed] PHST- 2020/05/16 06:00 [medline] AID - 10.1186/s12884-019-2660-5 [pii] AID - 2660 [pii] AID - 10.1186/s12884-019-2660-5 [doi] PST - epublish SO - BMC Pregnancy Childbirth. 2019 Dec 16;19(1):501. doi: 10.1186/s12884-019-2660-5. PMID- 31781889 OWN - NLM STAT- MEDLINE DCOM- 20200723 LR - 20200723 IS - 1432-0711 (Electronic) IS - 0932-0067 (Linking) VI - 301 IP - 2 DP - 2020 Feb TI - Fetal heart rate variability responsiveness to maternal stress, non-invasively detected from maternal transabdominal ECG. PG - 405-414 LID - 10.1007/s00404-019-05390-8 [doi] AB - PURPOSE: Prenatal stress (PS) during pregnancy affects in utero- and postnatal child brain-development. Key systems affected are the hypothalamic-pituitary-adrenal axis and the autonomic nervous system (ANS). Maternal- and fetal ANS activity can be gauged non-invasively from transabdominal electrocardiogram (taECG). We propose a novel approach to assess couplings between maternal (mHR) and fetal heart rate (fHR) as a new biomarker for PS based on bivariate phase-rectified signal averaging (BPRSA). We hypothesized that PS exerts lasting impact on fHR. METHODS: Prospective case-control study matched for maternal age, parity, and gestational age during the third trimester using the Cohen Perceived Stress Scale (PSS-10) questionnaire with PSS-10 over or equal 19 classified as stress group (SG). Women with PSS-10 < 19 served as control group (CG). Fetal electrocardiograms were recorded by a taECG. Coupling between mHR and fHR was analyzed by BPRSA resulting in fetal stress index (FSI). Maternal hair cortisol, a memory of chronic stress exposure for 2-3 months, was measured at birth. RESULTS: 538/1500 pregnant women returned the questionnaire, 55/538 (10.2%) mother-child pairs formed SG and were matched with 55/449 (12.2%) consecutive patients as CG. Maternal hair cortisol was 86.6 (48.0-169.2) versus 53.0 (34.4-105.9) pg/mg (p = 0.029). At 36 + 5 weeks, FSI was significantly higher in fetuses of stressed mothers when compared to controls [0.43 (0.18-0.85) versus 0.00 (- 0.49-0.18), p < 0.001]. CONCLUSION: Prenatal maternal stress affects the coupling between maternal and fetal heart rate detectable non-invasively a month prior to birth. Lasting effects on neurodevelopment of affected offspring should be studied. TRIAL REGISTRATION: Clinical trial registration: NCT03389178. FAU - Lobmaier, Silvia M AU - Lobmaier SM AUID- ORCID: 0000-0002-5696-6686 AD - Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany. silvia.lobmaier@tum.de. FAU - Müller, A AU - Müller A AD - Innere Medizin I, Department of Cardiology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany. FAU - Zelgert, C AU - Zelgert C AD - Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany. FAU - Shen, C AU - Shen C AD - Department of Mathematics, Duke University, Durham, NC, 27705, USA. FAU - Su, P C AU - Su PC AD - Department of Mathematics, Duke University, Durham, NC, 27705, USA. FAU - Schmidt, G AU - Schmidt G AD - Innere Medizin I, Department of Cardiology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany. FAU - Haller, B AU - Haller B AD - Institute of Medical Informatics, Statistics and Epidemiology, Buenos Aires, Argentina. FAU - Berg, G AU - Berg G AD - Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas Y Técnicas (CONICET), Facultad de Farmacia Y Bioquímica, Buenos Aires, Argentina. FAU - Fabre, B AU - Fabre B AD - Facultad de Farmacia Y Bioquímica. Instituto de Fisiopatología Y Bioquímica Clínica (INFIBIOC), Universidad de Buenos Aires, Buenos Aires, Argentina. FAU - Weyrich, J AU - Weyrich J AD - Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany. FAU - Wu, H T AU - Wu HT AD - Department of Mathematics, Duke University, Durham, NC, 27705, USA. AD - Department of Statistical Science, Duke University, Durham, NC, 27705, USA. AD - Mathematics Division, National Center for Theoretical Sciences, Taipei, Taiwan. FAU - Frasch, M G AU - Frasch MG AD - Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA. FAU - Antonelli, M C AU - Antonelli MC AUID- ORCID: 0000-0002-7785-8748 AD - Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany. AD - Instituto de Biología Celular Y Neurociencia "Prof. E. De Robertis", Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina. LA - eng SI - ClinicalTrials.gov/NCT03389178 PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20191128 PL - Germany TA - Arch Gynecol Obstet JT - Archives of gynecology and obstetrics JID - 8710213 RN - WI4X0X7BPJ (Hydrocortisone) SB - IM MH - Adult MH - Anxiety/*physiopathology MH - Autonomic Nervous System/*physiology MH - Case-Control Studies MH - Electrocardiography MH - Female MH - Fetal Movement/*physiology MH - Gestational Age MH - Heart Rate, Fetal/*physiology MH - Humans MH - Hydrocortisone/analysis MH - Hypothalamo-Hypophyseal System MH - Mothers/*psychology MH - Pituitary-Adrenal System MH - Pregnancy MH - Pregnancy Complications/*psychology MH - Pregnancy Trimester, Third MH - Prospective Studies MH - Stress, Psychological/complications/*physiopathology OTO - NOTNLM OT - *ANS OT - *BPRSA OT - *Bivariate phase-rectified signal averaging OT - *FSI OT - *Fetal autonomic nervous system OT - *Fetal heart rate OT - *Fetal stress index OT - *PS OT - *Prenatal stress EDAT- 2019/11/30 06:00 MHDA- 2020/07/24 06:00 CRDT- 2019/11/30 06:00 PHST- 2019/07/14 00:00 [received] PHST- 2019/11/14 00:00 [accepted] PHST- 2019/11/30 06:00 [pubmed] PHST- 2020/07/24 06:00 [medline] PHST- 2019/11/30 06:00 [entrez] AID - 10.1007/s00404-019-05390-8 [pii] AID - 10.1007/s00404-019-05390-8 [doi] PST - ppublish SO - Arch Gynecol Obstet. 2020 Feb;301(2):405-414. doi: 10.1007/s00404-019-05390-8. Epub 2019 Nov 28. PMID- 32007313 OWN - NLM STAT- In-Process LR - 20201005 IS - 1558-075X (Electronic) IS - 0146-0005 (Linking) VI - 44 IP - 2 DP - 2020 Mar TI - Response to category II tracings: Does anything help? PG - 151217 LID - S0146-0005(19)30154-5 [pii] LID - 10.1016/j.semperi.2019.151217 [doi] AB - Electronic fetal monitoring (EFM) is the most commonly used tool to screen for intrapartum fetal hypoxia. Category II EFM is present in over 80% of laboring patients and poses a unique challenge to management given the breadth of EFM features that fall within this category. Certain Category II patterns, such as recurrent late or recurrent variable decelerations, are more predictive of neonatal acidemia than others. A key feature among many published algorithms for Category II management is the use of intrauterine fetal resuscitation techniques including maternal oxygen administration, amnioinfusion, intravenous fluid bolus, discontinuation of oxytocin, and tocolytic administration. The goal of intrauterine resuscitation is to prevent or reverse fetal hypoxia. This is most likely to be successful if the etiology of the Category II EFM pattern is identified and targeted resuscitative measures are performed. CI - Copyright © 2019 Elsevier Inc. All rights reserved. FAU - Raghuraman, Nandini AU - Raghuraman N AD - Department of Obstetrics and Gynecology, Washington University School of Medicine in St Louis, Center for Outpatient Health, 10th floor, 4901 Forest Park Ave, St Louis, MO 63110, United States. Electronic address: nraghuraman@wustl.edu. LA - eng PT - Journal Article PT - Review DEP - 20191123 PL - United States TA - Semin Perinatol JT - Seminars in perinatology JID - 7801132 SB - IM OTO - NOTNLM OT - Category II OT - Elecronic fetal monitoring OT - Fetal hypoxia OT - Intrauterine resuscitation EDAT- 2020/02/03 06:00 MHDA- 2020/02/03 06:00 CRDT- 2020/02/03 06:00 PHST- 2020/02/03 06:00 [pubmed] PHST- 2020/02/03 06:00 [medline] PHST- 2020/02/03 06:00 [entrez] AID - S0146-0005(19)30154-5 [pii] AID - 10.1016/j.semperi.2019.151217 [doi] PST - ppublish SO - Semin Perinatol. 2020 Mar;44(2):151217. doi: 10.1016/j.semperi.2019.151217. Epub 2019 Nov 23. PMID- 31733202 OWN - NLM STAT- MEDLINE DCOM- 20200424 LR - 20200424 IS - 1097-6868 (Electronic) IS - 0002-9378 (Linking) VI - 222 IP - 3 DP - 2020 Mar TI - Scientific pathophysiology of intrapartum fetal hypoxemia and cardiotocography pattern recognition-realignment is a basic prerequisite! PG - 282-283 LID - S0002-9378(19)32623-7 [pii] LID - 10.1016/j.ajog.2019.10.106 [doi] FAU - Sholapurkar, Shashikant L AU - Sholapurkar SL AD - Department of Obstetrics and Gynaecology, Royal United Hospital Bath NHS Trust, Bath, United Kingdom. Electronic address: s.sholapurkar172@gmail.com. LA - eng PT - Comment PT - Letter DEP - 20191113 PL - United States TA - Am J Obstet Gynecol JT - American journal of obstetrics and gynecology JID - 0370476 SB - AIM SB - IM CON - Am J Obstet Gynecol. 2020 Jan;222(1):17-26. PMID: 31351061 CIN - Am J Obstet Gynecol. 2020 Mar;222(3):283-284. PMID: 31733204 MH - *Cardiotocography MH - Female MH - *Fetal Monitoring MH - Heart Rate, Fetal MH - Humans MH - Hypoxia MH - Parturition MH - Pregnancy EDAT- 2019/11/17 06:00 MHDA- 2020/04/25 06:00 CRDT- 2019/11/17 06:00 PHST- 2019/09/23 00:00 [received] PHST- 2019/10/26 00:00 [accepted] PHST- 2019/11/17 06:00 [pubmed] PHST- 2020/04/25 06:00 [medline] PHST- 2019/11/17 06:00 [entrez] AID - S0002-9378(19)32623-7 [pii] AID - 10.1016/j.ajog.2019.10.106 [doi] PST - ppublish SO - Am J Obstet Gynecol. 2020 Mar;222(3):282-283. doi: 10.1016/j.ajog.2019.10.106. Epub 2019 Nov 13. PMID- 31711710 OWN - NLM STAT- MEDLINE DCOM- 20200608 LR - 20200608 IS - 1879-3231 (Electronic) IS - 0093-691X (Linking) VI - 142 DP - 2020 Jan 15 TI - Pulsoximetric monitoring of fetal arterial oxygen saturation and fetal pulse at stage II of labor to predict acidosis in newborn Holstein Friesian calves. PG - 303-309 LID - S0093-691X(19)30481-9 [pii] LID - 10.1016/j.theriogenology.2019.10.027 [doi] AB - During stage II of parturition, the bovine fetus is at risk of oxygen deficiency caused by insufficient gas exchange between the dam and the fetus. The early detection of this critical condition, followed by assistance at calving, can help to improve the vitality of the newborn calf, or even prevent it from being born dead. By using pulse oximetry, the arterial oxygen saturation, as well as the pulse rate, can be continuously and non-invasively measured. The aim of our study was to identify critical thresholds for the parameters 'arterial oxygen saturation (FSpO(2))' and 'pulse rate (PR)' that indicate a severe postnatal risk for calves to suffer from acidosis. FSpO(2) and PR from 40 bovine fetuses were recorded during the last 25 min of calving with a commercially available pulse oximeter (Radius-7, Masimo Corporation, Irvine, USA). The calves were tested immediately after birth for acidosis by analyzing their blood with a portable blood gas analyzer (VetScan iStat1, Abaxis Inc., Union City, USA). Retrospectively, the pulsoximetric data were scanned for predefined patterns. The validity of these patterns to predict acidosis in newborn calves was analyzed by using receiver operating characteristics (ROC) curve analyses. In general, PR was a stronger predictive parameter for acidosis than FSpO(2), with the greatest area under the curve (AUC) for the PR criteria 'Pulse rate > 120 beats per minute (bpm) for at least 2 min', with an AUC of 0.764, in contrast to an AUC of 0.613 for the best FSpO(2) criteria 'FSpO2 < 40% for at least 50% of the measurement'. Further studies should investigate whether vitality after calving can be improved and fetal death rate can be reduced when obstetric assistance is performed as soon as one of these criteria apply to the bovine fetus. For more practical implementation in the field, improvement of the device's hardware would be necessary. CI - Copyright © 2019 Elsevier Inc. All rights reserved. FAU - Kanz, P AU - Kanz P AD - Clinical Unit for Herd Health Management in Ruminants, University Clinic for Ruminants, Department for Farm Animals and Veterinary Public Health, University of Veterinary Medicine Vienna, Kremesberg 12, 2563, Pottenstein, Austria. FAU - Gusterer, E AU - Gusterer E AD - Clinical Unit for Herd Health Management in Ruminants, University Clinic for Ruminants, Department for Farm Animals and Veterinary Public Health, University of Veterinary Medicine Vienna, Kremesberg 12, 2563, Pottenstein, Austria. FAU - Krieger, S AU - Krieger S AD - Clinical Unit for Herd Health Management in Ruminants, University Clinic for Ruminants, Department for Farm Animals and Veterinary Public Health, University of Veterinary Medicine Vienna, Kremesberg 12, 2563, Pottenstein, Austria. FAU - Schweinzer, V AU - Schweinzer V AD - Clinical Unit for Herd Health Management in Ruminants, University Clinic for Ruminants, Department for Farm Animals and Veterinary Public Health, University of Veterinary Medicine Vienna, Kremesberg 12, 2563, Pottenstein, Austria. FAU - Süss, D AU - Süss D AD - Clinical Unit for Herd Health Management in Ruminants, University Clinic for Ruminants, Department for Farm Animals and Veterinary Public Health, University of Veterinary Medicine Vienna, Kremesberg 12, 2563, Pottenstein, Austria. FAU - Drillich, M AU - Drillich M AD - Clinical Unit for Herd Health Management in Ruminants, University Clinic for Ruminants, Department for Farm Animals and Veterinary Public Health, University of Veterinary Medicine Vienna, Kremesberg 12, 2563, Pottenstein, Austria. FAU - Iwersen, M AU - Iwersen M AD - Clinical Unit for Herd Health Management in Ruminants, University Clinic for Ruminants, Department for Farm Animals and Veterinary Public Health, University of Veterinary Medicine Vienna, Kremesberg 12, 2563, Pottenstein, Austria. Electronic address: Michael.Iwersen@vetmeduni.ac.at. LA - eng PT - Journal Article DEP - 20191031 PL - United States TA - Theriogenology JT - Theriogenology JID - 0421510 RN - S88TT14065 (Oxygen) SB - IM MH - Acidosis/*diagnosis/veterinary MH - Animals MH - Animals, Newborn MH - Arteries/*chemistry MH - Cattle MH - Cattle Diseases/diagnosis MH - Female MH - Fetal Diseases/*diagnosis/veterinary MH - *Fetal Monitoring/methods/veterinary MH - *Heart Rate, Fetal MH - Labor, Obstetric/physiology MH - Male MH - *Oximetry/methods/veterinary MH - Oxygen/analysis/*blood MH - Predictive Value of Tests MH - Pregnancy MH - Prognosis MH - Pulmonary Gas Exchange/physiology MH - Reproducibility of Results MH - Retrospective Studies OTO - NOTNLM OT - Acidosis OT - Monitoring OT - Newborn calf OT - Pulse oximetry EDAT- 2019/11/13 06:00 MHDA- 2020/06/09 06:00 CRDT- 2019/11/13 06:00 PHST- 2019/05/22 00:00 [received] PHST- 2019/09/25 00:00 [revised] PHST- 2019/10/28 00:00 [accepted] PHST- 2019/11/13 06:00 [pubmed] PHST- 2020/06/09 06:00 [medline] PHST- 2019/11/13 06:00 [entrez] AID - S0093-691X(19)30481-9 [pii] AID - 10.1016/j.theriogenology.2019.10.027 [doi] PST - ppublish SO - Theriogenology. 2020 Jan 15;142:303-309. doi: 10.1016/j.theriogenology.2019.10.027. Epub 2019 Oct 31. PMID- 31698240 OWN - NLM STAT- MEDLINE DCOM- 20200922 LR - 20200922 IS - 1879-0534 (Electronic) IS - 0010-4825 (Linking) VI - 115 DP - 2019 Dec TI - Use of automated fetal heart rate analysis to identify risk factors for umbilical cord acidosis at birth. PG - 103525 LID - S0010-4825(19)30384-1 [pii] LID - 10.1016/j.compbiomed.2019.103525 [doi] AB - OBJECTIVE: To identify clinical parameters and intrapartum fetal heart rate parameters associated with a risk of umbilical cord acidosis at birth, using an automated analysis method based on empirical mode decomposition. METHODS: Our single-center study included 381 cases (arterial cord blood pH at birth pHa ≤7.15) and 1860 controls (pHa ≥7.25) extracted from a database comprising 8,383 full datasets for over-18 mothers after vaginal or caesarean non-twin, non-breech deliveries at term (>37 weeks of amenorrhea). The analysis of a 120-min period of the FHR recording (before maternal pushing or the decision to perform a caesarean section during labor) led to the extraction of morphological, frequency-related, and long- and short-term heart rate variability variables. After univariate analyses, sparse partial least square selection and logistic regression were applied. RESULTS: Several clinical factors were predictive of fetal acidosis in a multivariate analysis: nulliparity (odds ratio (OR) 95% confidence interval (CI)]: 1.769 [1.362-2.300]), a male fetus (1.408 [1.097-1.811]), and the term of the pregnancy (1.333 [1.189-1.497]). The risk of acidosis increased with the time interval between the end of the FHR recording and the delivery (OR [95%CI] for a 1-min increment: 1.022 [1.012-1.031]). The risk factors related to the FHR signal were mainly the difference between the mean baseline and the mean FHR (OR [95%CI]: 1.292 [1.174-1.424]), the baseline range (1.027 [1.014-1.040]), fetal bradycardia (1.038 [1.003-1.075]) and the late deceleration area (1.002 [1.000-1.005]). The area under the curve for the multivariate model was 0.79 [0.76; 0.81]. CONCLUSION: In addition to clinical predictors, the automated FHR analysis highlighted other significant predictors, such as the baseline range, the instability of the FHR signal and the late deceleration area. This study further extends the routine application of automated FHR analysis during labor and, ultimately, contributes to the development of predictive scores for fetal acidosis. CI - Copyright © 2019 Elsevier Ltd. All rights reserved. FAU - Houzé de l'Aulnoit, A AU - Houzé de l'Aulnoit A AD - Univ. Lille, EA 2694, Santé Publique, épidémiologie et Qualité des Soins, F-59000, Lille, France; Department of Obstetrics, Lille Catholic Hospital, Lille Catholic University, F-59020, Lille, France. Electronic address: ahouzedelaulnoit@yahoo.fr. FAU - Génin, M AU - Génin M AD - Univ. Lille, EA 2694, Santé Publique, épidémiologie et Qualité des Soins, F-59000, Lille, France. FAU - Boudet, S AU - Boudet S AD - Biomedical Signal Processing Unit (UTSB), Lille Catholic University, F-59800, Lille, France. FAU - Demailly, R AU - Demailly R AD - Department of Obstetrics, Lille Catholic Hospital, Lille Catholic University, F-59020, Lille, France. FAU - Ternynck, C AU - Ternynck C AD - Univ. Lille, EA 2694, Santé Publique, épidémiologie et Qualité des Soins, F-59000, Lille, France. FAU - Babykina, G AU - Babykina G AD - Univ. Lille, EA 2694, Santé Publique, épidémiologie et Qualité des Soins, F-59000, Lille, France. FAU - Houzé de l'Aulnoit, D AU - Houzé de l'Aulnoit D AD - Department of Obstetrics, Lille Catholic Hospital, Lille Catholic University, F-59020, Lille, France. FAU - Beuscart, R AU - Beuscart R AD - Univ. Lille, EA 2694, Santé Publique, épidémiologie et Qualité des Soins, F-59000, Lille, France. LA - eng PT - Clinical Trial PT - Journal Article DEP - 20191031 PL - United States TA - Comput Biol Med JT - Computers in biology and medicine JID - 1250250 SB - IM MH - *Acidosis/blood/diagnosis/physiopathology MH - Female MH - *Heart Rate, Fetal MH - Humans MH - Hydrogen-Ion Concentration MH - Infant, Newborn MH - *Infant, Newborn, Diseases/blood/diagnosis/physiopathology MH - Pregnancy MH - Risk Factors MH - *Umbilical Cord/metabolism/physiopathology OTO - NOTNLM OT - *Cardiotocography OT - *Computer-assisted OT - *Cord blood gas analysis OT - *Fetal hypoxia OT - *Fetal monitoring OT - *Intrapartum risk factors OT - *Neonatal acidaemia OT - *Neonatal acidosis OT - *Neonatal outcome EDAT- 2019/11/08 06:00 MHDA- 2020/09/23 06:00 CRDT- 2019/11/08 06:00 PHST- 2019/05/31 00:00 [received] PHST- 2019/10/14 00:00 [revised] PHST- 2019/10/27 00:00 [accepted] PHST- 2019/11/08 06:00 [pubmed] PHST- 2020/09/23 06:00 [medline] PHST- 2019/11/08 06:00 [entrez] AID - S0010-4825(19)30384-1 [pii] AID - 10.1016/j.compbiomed.2019.103525 [doi] PST - ppublish SO - Comput Biol Med. 2019 Dec;115:103525. doi: 10.1016/j.compbiomed.2019.103525. Epub 2019 Oct 31. PMID- 31630599 OWN - NLM STAT- Publisher LR - 20191021 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) DP - 2019 Oct 21 TI - Cumulative deceleration area: a simplified predictor of metabolic acidemia. PG - 1-8 LID - 10.1080/14767058.2019.1678130 [doi] AB - Objective: Fetal monitoring, ubiquitous in obstetrics is used to predict and prevent intrapartum fetal injury. Despite decades of education and nomenclature revision, clinicians show low agreement on key elements, including the types of deceleration and hence their presumed etiology. Cumulative deceleration area is not dependent on deceleration type and could potentially mitigate this problem. Although deceleration area has shown promise as a marker of acidemia, no reports have shown how deceleration area evolves in late labor. Advances in computerization allow for direct measurement of deceleration area and standard fetal heart rate (FHR) patterns. The objective of this study was to compare the evolution and discrimination performance of deceleration area and other FHR patterns in late labor in term neonates with metabolic acidemia (MA) and in those with normal cord gases. Methods: This retrospective cohort study included women with a term singleton (≥37 weeks) in cephalic presentation with cord gas data and FHR tracings available for analysis. MA included neonates with an umbilical artery base deficit >12 mmol/L (n = 132). Controls included those with normal cord gases (base deficit <8 mmol/L) and a 5-minute Apgar score of >6 (n = 1498). Deceleration area and other FHR patterns were summarized and compared in 30-minute segments over the last five hours. Receiver-operating characteristic curves were constructed and AUCs compared. Results: Deceleration area had the highest AUC (0.702, 95% CI 0.655-0.749) and was a superior marker of MA compared to baseline (AUC 0.588, 95% CI 0.530-0.645), baseline variability (AUC 0.611, 95% CI 0.558-0.663), and number of late decelerations (AUC 0.582, 95% CI 0.527-0.637). Conclusion: Cumulative deceleration area reduces the necessity to determine deceleration type. In a single number, it objectively quantifies three important aspects of decelerations; frequency, depth and duration and was a superior marker of MA compared to baseline level, baseline variability and number of late decelerations. The acidemia group had higher deceleration area over the last two hours prior to delivery. This result indicates that the cumulative area and persistence of repetitive decelerations is important clinically. FAU - Furukawa, Abby AU - Furukawa A AD - Department of Obstetrics and Gynecology, Legacy Health System , Portland , OR , USA. FAU - Neilson, Duncan AU - Neilson D AD - Women's Services, Legacy Health System , Portland , OR , USA. FAU - Hamilton, Emily AU - Hamilton E AD - Department of Obstetrics and Gynecology, McGill University , Montreal , Canada. LA - eng PT - Journal Article DEP - 20191021 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 SB - IM OTO - NOTNLM OT - Deceleration area OT - fetal heart rate monitoring OT - neonatal metabolic acidemia OT - variable decelerations EDAT- 2019/10/22 06:00 MHDA- 2019/10/22 06:00 CRDT- 2019/10/22 06:00 PHST- 2019/10/22 06:00 [entrez] PHST- 2019/10/22 06:00 [pubmed] PHST- 2019/10/22 06:00 [medline] AID - 10.1080/14767058.2019.1678130 [doi] PST - aheadofprint SO - J Matern Fetal Neonatal Med. 2019 Oct 21:1-8. doi: 10.1080/14767058.2019.1678130. PMID- 31678794 OWN - NLM STAT- MEDLINE DCOM- 20210106 LR - 20210106 IS - 1872-7565 (Electronic) IS - 0169-2607 (Linking) VI - 185 DP - 2020 Mar TI - Integrating machine learning techniques and physiology based heart rate features for antepartum fetal monitoring. PG - 105015 LID - S0169-2607(19)30810-7 [pii] LID - 10.1016/j.cmpb.2019.105015 [doi] AB - BACKGROUND AND OBJECTIVES: Intrauterine Growth Restriction (IUGR) is a fetal condition defined as the abnormal rate of fetal growth. The pathology is a documented cause of fetal and neonatal morbidity and mortality. In clinical practice, diagnosis is confirmed at birth and may only be suspected during pregnancy. Therefore, designing an accurate model for the early and prompt identification of pathology in the antepartum period is crucial in view of pregnancy management. METHODS: We tested the performance of 15 machine learning techniques in discriminating healthy versus IUGR fetuses. The various models were trained with a set of 12 physiology based heart rate features extracted from a single antepartum CardioTocographic (CTG) recording. The reason for the utilization of time, frequency, and nonlinear indices is based on their standalone documented ability to describe several physiological and pathological fetal conditions. RESULTS: We validated our approach on a database of 60 healthy and 60 IUGR fetuses. The machine learning methodology achieving the best performance was Random Forests. Specifically, we obtained a mean classification accuracy of 0.911 [0.860, 0.961 (0.95 confidence interval)] averaged over 10 test sets (10 Fold Cross Validation). Similar results were provided by Classification Trees, Logistic Regression, and Support Vector Machines. A features ranking procedure highlighted that nonlinear indices showed the highest capability to discriminate between the considered fetal conditions. Nevertheless, is the combination of features investigating CTG signal in different domains, that contributes to an increase in classification accuracy. CONCLUSIONS: We provided validation of an accurate artificially intelligence framework for the diagnosis of IUGR condition in the antepartum period. The employed physiology based heart rate features constitute an interpretable link between the machine learning results and the quantitative estimators of fetal wellbeing. CI - Copyright © 2019. Published by Elsevier B.V. FAU - Signorini, Maria G AU - Signorini MG AD - Department of Electronics, Information and Bioengineering (DEIB), Politecnico Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy. Electronic address: mariagabriella.signorini@polimi.it. FAU - Pini, Nicolò AU - Pini N AD - Department of Electronics, Information and Bioengineering (DEIB), Politecnico Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy. Electronic address: nicolo.pini@polimi.it. FAU - Malovini, Alberto AU - Malovini A AD - IRCCS Fondazione S. Maugeri, Via Maugeri 10, 27100 Pavia, Italy. Electronic address: alberto.malovini@unipv.it. FAU - Bellazzi, Riccardo AU - Bellazzi R AD - Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Via Ferrata 5, 27100 Pavia, Italy. Electronic address: riccardo.bellazzi@unipv.it. FAU - Magenes, Giovanni AU - Magenes G AD - Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Via Ferrata 5, 27100 Pavia, Italy. Electronic address: giovanni.magenes@unipv.it. LA - eng PT - Journal Article DEP - 20191017 PL - Ireland TA - Comput Methods Programs Biomed JT - Computer methods and programs in biomedicine JID - 8506513 SB - IM MH - Cardiotocography/*methods MH - Female MH - Fetal Monitoring/*methods MH - *Heart Rate, Fetal MH - Humans MH - *Machine Learning MH - Pregnancy MH - Reproducibility of Results MH - *Systems Integration OTO - NOTNLM OT - Fetal Heart Rate monitoring OT - Machine learning and statistical models OT - Multivariate analysis OT - Physiology-based features OT - Predictive analytics COIS- Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2019/11/05 06:00 MHDA- 2021/01/07 06:00 CRDT- 2019/11/04 06:00 PHST- 2019/05/26 00:00 [received] PHST- 2019/07/17 00:00 [revised] PHST- 2019/08/04 00:00 [accepted] PHST- 2019/11/05 06:00 [pubmed] PHST- 2021/01/07 06:00 [medline] PHST- 2019/11/04 06:00 [entrez] AID - S0169-2607(19)30810-7 [pii] AID - 10.1016/j.cmpb.2019.105015 [doi] PST - ppublish SO - Comput Methods Programs Biomed. 2020 Mar;185:105015. doi: 10.1016/j.cmpb.2019.105015. Epub 2019 Oct 17. PMID- 31612740 OWN - NLM STAT- In-Process LR - 20200626 IS - 1364-6893 (Electronic) IS - 0144-3615 (Linking) VI - 40 IP - 5 DP - 2020 Jul TI - Types of intrapartum hypoxia on the cardiotocograph (CTG): do they have any relationship with the type of brain injury in the MRI scan in term babies? PG - 688-693 LID - 10.1080/01443615.2019.1652576 [doi] AB - Electronic foetal monitoring using cardiotocography is aimed at the timely recognition and management of foetal hypoxia. The primary objective of this study was to examine whether a relationship exists between the types of foetal hypoxia (acute, subacute, evolving, chronic), as identified on cardiotocography and the nature of hypoxic ischaemic encephalopathy, as observed on MRI scans after birth. We conducted a retrospective study of 16 babies born (out of 52,187 births) at St George's Hospital in London during 2006-2017 with a postnatal diagnosis of HIE. Of the 16 babies, only 11 had both MRI scans and CTG traces available. Of those, 9 showed evidence of intrapartum hypoxia on CTG, but only 6 demonstrated evidence of HIE on MRI. Those with acute hypoxia showed abnormalities in the basal ganglia and thalami. A gradually evolving hypoxia or subacute hypoxia was associated with lesions in myelination and cerebral cortex.Impact StatementWhat is already known on this subject? It has been reported that inter-observer agreement for CTG interpretation is low (30%) when pattern recognition based guidelines are used (Rhöse et al. 2014; Reif et al. 2016), even amongst 'experts' (Hruban et al. 2015). Furthermore, it has been shown that CTG traces do not reliably predict neonatal encephalopathy (Spencer et al. 1997).What do the results of this study add? Our study indicates that if 'types of intrapartum hypoxia' are used for interpretation, then inter-observer agreement increases to 81%, from the reported 30% when traces are classified into 'normal, suspicious and pathological' using guidelines based on 'pattern recognition'. Furthermore, our study shows a good correlation between the type of intrapartum hypoxia observed on CTG trace and the nature of injury observed on the MRI.What are the implications of these findings for clinical practise and/or further research? Improving inter-observer agreement of CTGs with the use of pattern recognition in combination with the good correlation to MRI scan findings ultimately leads to better management and post-natal outcomes. This is evidenced by the fact that after the introduction of physiology-based CTG interpretation and mandatory competency testing on CTG interpretation for all staff in 2010, St. George's Maternity Unit has half the nationally reported rate of cerebral palsy. FAU - Yatham, Swetha S AU - Yatham SS AUID- ORCID: 0000-0002-3336-966X AD - St. Georges University of London Medical School, London, UK. FAU - Whelehan, Virginia AU - Whelehan V AD - Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK. FAU - Archer, Abigail AU - Archer A AD - Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK. FAU - Chandraharan, Edwin AU - Chandraharan E AUID- ORCID: 0000-0002-5711-8515 AD - Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK. LA - eng PT - Journal Article DEP - 20191015 PL - England TA - J Obstet Gynaecol JT - Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology JID - 8309140 SB - IM OTO - NOTNLM OT - APGAR scores OT - CTG OT - MRI OT - cord gases OT - foetal monitoring OT - hypoxic ischaemic encephalopathy EDAT- 2019/10/16 06:00 MHDA- 2019/10/16 06:00 CRDT- 2019/10/16 06:00 PHST- 2019/10/16 06:00 [pubmed] PHST- 2019/10/16 06:00 [medline] PHST- 2019/10/16 06:00 [entrez] AID - 10.1080/01443615.2019.1652576 [doi] PST - ppublish SO - J Obstet Gynaecol. 2020 Jul;40(5):688-693. doi: 10.1080/01443615.2019.1652576. Epub 2019 Oct 15. PMID- 31590294 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210110 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 8 IP - 10 DP - 2019 Oct 4 TI - Preeclampsia: Risk Factors, Diagnosis, Management, and the Cardiovascular Impact on the Offspring. LID - 10.3390/jcm8101625 [doi] LID - 1625 AB - Hypertensive disorders of pregnancy affect up to 10% of pregnancies worldwide, which includes the 3%-5% of all pregnancies complicated by preeclampsia. Preeclampsia is defined as new onset hypertension after 20 weeks' gestation with evidence of maternal organ or uteroplacental dysfunction or proteinuria. Despite its prevalence, the risk factors that have been identified lack accuracy in predicting its onset and preventative therapies only moderately reduce a woman's risk of preeclampsia. Preeclampsia is a major cause of maternal morbidity and is associated with adverse foetal outcomes including intra-uterine growth restriction, preterm birth, placental abruption, foetal distress, and foetal death in utero. At present, national guidelines for foetal surveillance in preeclamptic pregnancies are inconsistent, due to a lack of evidence detailing the most appropriate assessment modalities as well as the timing and frequency at which assessments should be conducted. Current management of the foetus in preeclampsia involves timely delivery and prevention of adverse effects of prematurity with antenatal corticosteroids and/or magnesium sulphate depending on gestation. Alongside the risks to the foetus during pregnancy, there is also growing evidence that preeclampsia has long-term adverse effects on the offspring. In particular, preeclampsia has been associated with cardiovascular sequelae in the offspring including hypertension and altered vascular function. FAU - Fox, Rachael AU - Fox R AD - Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK. AD - University of Melbourne, Victoria 3010, Australia. FAU - Kitt, Jamie AU - Kitt J AD - Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK. FAU - Leeson, Paul AU - Leeson P AD - Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK. FAU - Aye, Christina Y L AU - Aye CYL AD - Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK. AD - Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK. FAU - Lewandowski, Adam J AU - Lewandowski AJ AD - Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK. adam.lewandowski@cardiov.ox.ac.uk. LA - eng GR - FS/19/7/34148/BHF_/British Heart Foundation/United Kingdom GR - FS/18/3/33292/BHF_/British Heart Foundation/United Kingdom PT - Journal Article PT - Review DEP - 20191004 TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC6832549 OTO - NOTNLM OT - developmental origins of disease OT - foetal diseases OT - foetus OT - non-communicable disease OT - preeclampsia OT - pregnancy OT - prevention OT - treatment COIS- The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. EDAT- 2019/10/09 06:00 MHDA- 2019/10/09 06:01 CRDT- 2019/10/09 06:00 PHST- 2019/09/08 00:00 [received] PHST- 2019/09/22 00:00 [revised] PHST- 2019/10/02 00:00 [accepted] PHST- 2019/10/09 06:00 [entrez] PHST- 2019/10/09 06:00 [pubmed] PHST- 2019/10/09 06:01 [medline] AID - jcm8101625 [pii] AID - jcm-08-01625 [pii] AID - 10.3390/jcm8101625 [doi] PST - epublish SO - J Clin Med. 2019 Oct 4;8(10):1625. doi: 10.3390/jcm8101625. PMID- 31681548 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201001 IS - 2229-516X (Print) IS - 2248-9606 (Electronic) IS - 2229-516X (Linking) VI - 9 IP - 4 DP - 2019 Oct-Dec TI - Use of Machine Learning Algorithms for Prediction of Fetal Risk using Cardiotocographic Data. PG - 226-230 LID - 10.4103/ijabmr.IJABMR_370_18 [doi] AB - BACKGROUND: A major contributor to under-five mortality is the death of children in the 1(st) month of life. Intrapartum complications are one of the major causes of perinatal mortality. Fetal cardiotocograph (CTGs) can be used as a monitoring tool to identify high-risk women during labor. AIM: The objective of this study was to study the precision of machine learning algorithm techniques on CTG data in identifying high-risk fetuses. METHODS: CTG data of 2126 pregnant women were obtained from the University of California Irvine Machine Learning Repository. Ten different machine learning classification models were trained using CTG data. Sensitivity, precision, and F1 score for each class and overall accuracy of each model were obtained to predict normal, suspect, and pathological fetal states. Model with best performance on specified metrics was then identified. RESULTS: Determined by obstetricians' interpretation of CTGs as gold standard, 70% of them were normal, 20% were suspect, and 10% had a pathological fetal state. On training data, the classification models generated by XGBoost, decision tree, and random forest had high precision (>96%) to predict the suspect and pathological state of the fetus based on the CTG tracings. However, on testing data, XGBoost model had the highest precision to predict a pathological fetal state (>92%). CONCLUSION: The classification model developed using XGBoost technique had the highest prediction accuracy for an adverse fetal outcome. Lay health-care workers in low- and middle-income countries can use this model to triage pregnant women in remote areas for early referral and further management. CI - Copyright: © 2019 International Journal of Applied and Basic Medical Research. FAU - Hoodbhoy, Zahra AU - Hoodbhoy Z AD - Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan. FAU - Noman, Mohammad AU - Noman M AD - Department of Artificial Intelligence, Ephlux Pvt Ltd., Karachi, Pakistan. FAU - Shafique, Ayesha AU - Shafique A AD - Department of Artificial Intelligence, Ephlux Pvt Ltd., Karachi, Pakistan. FAU - Nasim, Ali AU - Nasim A AD - Department of Artificial Intelligence, Ephlux Pvt Ltd., Karachi, Pakistan. FAU - Chowdhury, Devyani AU - Chowdhury D AD - Cardiology Care for Children, Pennsylvania, USA. FAU - Hasan, Babar AU - Hasan B AD - Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan. LA - eng PT - Journal Article DEP - 20191011 TA - Int J Appl Basic Med Res JT - International journal of applied & basic medical research JID - 101579831 PMC - PMC6822315 OTO - NOTNLM OT - Fetal cardiotocography OT - machine learning OT - perinatal risk COIS- There are no conflicts of interest. EDAT- 2019/11/05 06:00 MHDA- 2019/11/05 06:01 CRDT- 2019/11/05 06:00 PHST- 2018/11/11 00:00 [received] PHST- 2019/03/29 00:00 [revised] PHST- 2019/08/01 00:00 [accepted] PHST- 2019/11/05 06:00 [entrez] PHST- 2019/11/05 06:00 [pubmed] PHST- 2019/11/05 06:01 [medline] AID - IJABMR-9-226 [pii] AID - 10.4103/ijabmr.IJABMR_370_18 [doi] PST - ppublish SO - Int J Appl Basic Med Res. 2019 Oct-Dec;9(4):226-230. doi: 10.4103/ijabmr.IJABMR_370_18. Epub 2019 Oct 11. PMID- 31592995 OWN - NLM STAT- MEDLINE DCOM- 20200106 LR - 20201001 IS - 1536-1004 (Electronic) IS - 0899-3459 (Print) IS - 0899-3459 (Linking) VI - 28 IP - 5 DP - 2019 Oct TI - Placental MRI: Developing Accurate Quantitative Measures of Oxygenation. PG - 285-297 LID - 10.1097/RMR.0000000000000221 [doi] AB - The Human Placenta Project has focused attention on the need for noninvasive magnetic resonance imaging (MRI)-based techniques to diagnose and monitor placental function throughout pregnancy. The hope is that the management of placenta-related pathologies would be improved if physicians had more direct, real-time measures of placental health to guide clinical decision making. As oxygen alters signal intensity on MRI and oxygen transport is a key function of the placenta, many of the MRI methods under development are focused on quantifying oxygen transport or oxygen content of the placenta. For example, measurements from blood oxygen level-dependent imaging of the placenta during maternal hyperoxia correspond to outcomes in twin pregnancies, suggesting that some aspects of placental oxygen transport can be monitored by MRI. Additional methods are being developed to accurately quantify baseline placental oxygenation by MRI relaxometry. However, direct validation of placental MRI methods is challenging and therefore animal studies and ex vivo studies of human placentas are needed. Here we provide an overview of the current state of the art of oxygen transport and quantification with MRI. We suggest that as these techniques are being developed, increased focus be placed on ensuring they are robust and reliable across individuals and standardized to enable predictive diagnostic models to be generated from the data. The field is still several years away from establishing the clinical benefit of monitoring placental function in real time with MRI, but the promise of individual personalized diagnosis and monitoring of placental disease in real time continues to motivate this effort. FAU - Abaci Turk, Esra AU - Abaci Turk E AD - Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA. FAU - Stout, Jeffrey N AU - Stout JN AD - Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA. FAU - Ha, Christopher AU - Ha C AD - Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA. FAU - Luo, Jie AU - Luo J AD - School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China. FAU - Gagoski, Borjan AU - Gagoski B AD - Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA. FAU - Yetisir, Filiz AU - Yetisir F AD - Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA. FAU - Golland, Polina AU - Golland P AD - Computer Science and Artificial Intelligence Laboratory (CSAIL), Massachusetts Institute of Technology, Cambridge, MA. AD - Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA. FAU - Wald, Lawrence L AU - Wald LL AD - Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA. FAU - Adalsteinsson, Elfar AU - Adalsteinsson E AD - Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA. AD - Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA. FAU - Robinson, Julian N AU - Robinson JN AD - Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA. FAU - Roberts, Drucilla J AU - Roberts DJ AD - Department of Pathology, Massachusetts General Hospital, Boston, MA. FAU - Barth, William H Jr AU - Barth WH Jr AD - Maternal-Fetal Medicine, Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA. FAU - Grant, P Ellen AU - Grant PE AD - Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA. LA - eng GR - P41 EB015902/EB/NIBIB NIH HHS/United States GR - R01 EB017337/EB/NIBIB NIH HHS/United States GR - U01 HD087211/HD/NICHD NIH HHS/United States PT - Journal Article PT - Review TA - Top Magn Reson Imaging JT - Topics in magnetic resonance imaging : TMRI JID - 8913523 RN - S88TT14065 (Oxygen) SB - IM MH - Animals MH - Female MH - Humans MH - Hyperoxia/*diagnostic imaging/*pathology MH - Magnetic Resonance Imaging/*methods MH - Oxygen/*blood MH - Placenta/*diagnostic imaging/*pathology MH - Pregnancy PMC - PMC7323862 MID - NIHMS1538238 EDAT- 2019/10/09 06:00 MHDA- 2020/01/07 06:00 CRDT- 2019/10/09 06:00 PHST- 2019/10/09 06:00 [entrez] PHST- 2019/10/09 06:00 [pubmed] PHST- 2020/01/07 06:00 [medline] AID - 00002142-201910000-00006 [pii] AID - 10.1097/RMR.0000000000000221 [doi] PST - ppublish SO - Top Magn Reson Imaging. 2019 Oct;28(5):285-297. doi: 10.1097/RMR.0000000000000221. PMID- 31575300 OWN - NLM STAT- Publisher LR - 20191002 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) DP - 2019 Oct 1 TI - Fetal ST baseline T/QRS rise in normal CTG does not predict neonatal acidemia. PG - 1-6 LID - 10.1080/14767058.2019.1670802 [doi] AB - Purpose: Analysis of the ST segment of the fetal electrocardiogram (ECG) waveform is a relatively new adjunct to support the cardiotocograph in assessing the risk of significant intrapartum fetal acidosis. The use of ST analysis (STAN) combined with cardiotocography (CTG) was reported to significantly lower the incidence of metabolic acidosis. We aimed to assess the role of "baseline T/QRS rise" associated with a normal CTG on the risk of neonatal acidemia. Study design: This is a prospective cohort study performed at the Division of Perinatal Medicine of Policlinico Abano Terme, Italy. Women in labor with a singleton fetus in cephalic position beyond 36 weeks of gestation were monitored with STAN and CTG. Patients and methods: The relationship between "baseline T/QRS rise" and neonatal cord arterial acidemia and hypoxic distress were assessed using a linear mixed-model analysis. Magnitude of "baseline T/QRS rise", neonatal cord blood acidemia, electrolytes, lactacidemia, and glycemia levels were measured. Results: "Baseline T/QRS rise" was not associated with neonatal acidemia in the presence of normal CTG, regardless of the magnitude of the T/QRS rise. However, in a linear mixed-model analysis, cord blood sodium levels were negatively (p = .033) associated with T/QRS ratio magnitude. Conclusions: In the presence of a normal CTG, "baseline T/QRS rise" does not predict neonatal acidemia or biochemical derangement. Greater knowledge of fetal ECG parameters including "baseline T/QRS rise" and their associations with normal, intermediary, and abnormal CTG tracing, is required in assessing the performance of the STAN. FAU - Vettore, Michela AU - Vettore M AD - Division of Perinatal Medicine, Policlinico Abano Terme , Abano Terme , Italy. FAU - Straface, Gianluca AU - Straface G AD - Division of Perinatal Medicine, Policlinico Abano Terme , Abano Terme , Italy. FAU - Tortora, Domenico AU - Tortora D AD - Neuroradiology Unit, IRCCS Istituto Giannina Gaslini , Genova , Italy. FAU - Parotto, Matteo AU - Parotto M AD - Department of Anesthesia, University of Toronto , Toronto , Canada. FAU - Greco, Pantaleo AU - Greco P AD - Department of Obstetrics and Gynecology, Ferrara University , Ferrara , Italy. FAU - Ugwumadu, Austin AU - Ugwumadu A AD - Department of Obstetrics and Gynecology, St. George's University of London , London , UK. FAU - Zanardo, Vincenzo AU - Zanardo V AD - Division of Perinatal Medicine, Policlinico Abano Terme , Abano Terme , Italy. LA - eng PT - Journal Article DEP - 20191001 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 SB - IM OTO - NOTNLM OT - Acidosis OT - CTG OT - STAN OT - baseline T/QRS rise OT - neonate EDAT- 2019/10/03 06:00 MHDA- 2019/10/03 06:00 CRDT- 2019/10/03 06:00 PHST- 2019/10/03 06:00 [entrez] PHST- 2019/10/03 06:00 [pubmed] PHST- 2019/10/03 06:00 [medline] AID - 10.1080/14767058.2019.1670802 [doi] PST - aheadofprint SO - J Matern Fetal Neonatal Med. 2019 Oct 1:1-6. doi: 10.1080/14767058.2019.1670802. PMID- 31486225 OWN - NLM STAT- MEDLINE DCOM- 20190909 LR - 20190909 IS - 1471-0528 (Electronic) IS - 1470-0328 (Linking) VI - 126 IP - 11 DP - 2019 Oct TI - Computerising the intrapartum continuous cardiotocography does not add to its predictive value: FOR: Computer analysis does not add to intrapartum continuous cardiotocography predictive value. PG - 1363 LID - 10.1111/1471-0528.15575 [doi] FAU - Silver, Robert M AU - Silver RM AD - Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA. LA - eng PT - Comment PT - Journal Article PL - England TA - BJOG JT - BJOG : an international journal of obstetrics and gynaecology JID - 100935741 SB - AIM SB - IM CON - BJOG. 2019 Oct;126(11):1354-1361. PMID: 30461166 MH - *Cardiotocography MH - Female MH - Fetal Distress MH - Fetal Hypoxia MH - *Heart Rate, Fetal MH - Humans MH - Infant MH - Parturition MH - Pregnancy EDAT- 2019/09/06 06:00 MHDA- 2019/09/10 06:00 CRDT- 2019/09/06 06:00 PHST- 2019/09/06 06:00 [entrez] PHST- 2019/09/06 06:00 [pubmed] PHST- 2019/09/10 06:00 [medline] AID - 10.1111/1471-0528.15575 [doi] PST - ppublish SO - BJOG. 2019 Oct;126(11):1363. doi: 10.1111/1471-0528.15575. PMID- 31511259 OWN - NLM STAT- MEDLINE DCOM- 20200210 LR - 20200806 IS - 1757-790X (Electronic) IS - 1757-790X (Linking) VI - 12 IP - 9 DP - 2019 Sep 11 TI - Birth asphyxia following delayed recognition and response to abnormal labour progress and fetal distress in a 31-year-old multiparous Malawian woman. LID - 10.1136/bcr-2018-227973 [doi] LID - e227973 AB - Reducing neonatal mortality is one of the targets of Sustainable Development Goal 3 on good health and well-being. The highest rates of neonatal death occur in sub-Saharan Africa. Birth asphyxia is one of the major preventable causes. Early detection and timely management of abnormal labour progress and fetal compromise are critical to reduce the global burden of birth asphyxia. Labour progress, maternal and fetal well-being are assessed using the WHO partograph and intermittent fetal heart rate monitoring. However, in low-resource settings adherence to labour guidelines and timely response to arising labour complications is generally poor. Reasons for this are multifactorial and include lack of resources and skilled health care staff. This case study in a Malawian hospital illustrates how delayed recognition of abnormal labour and prolonged decision-to-delivery interval contributed to birth asphyxia, as an example of many delivery rooms in low-income country settings. CI - © BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Löwensteyn, Yvette N AU - Löwensteyn YN AD - Department of Vrouw & Baby, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands. FAU - Housseine, Natasha AU - Housseine N AD - Department of Vrouw & Baby, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands. AD - Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, United Republic of Tanzania. FAU - Masina, Thokozani AU - Masina T AD - Department of Medicine, University of Malawi College of Medicine, Blantyre, Malawi. FAU - Browne, Joyce L AU - Browne JL AD - Julius Global Health, Julius Centre for Health Sciences and Primary Care, Utrecht, The Netherlands. FAU - Rijken, Marcus J AU - Rijken MJ AD - Department of Vrouw & Baby, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands. AD - Julius Global Health, Julius Centre for Health Sciences and Primary Care, Utrecht, The Netherlands. LA - eng PT - Case Reports PT - Journal Article DEP - 20190911 TA - BMJ Case Rep JT - BMJ case reports JID - 101526291 SB - IM MH - Adult MH - Asphyxia Neonatorum/*etiology MH - Delayed Diagnosis MH - *Developing Countries MH - Dystocia/*diagnosis MH - Female MH - Fetal Distress/complications/*diagnosis MH - Humans MH - Indonesia MH - Infant, Newborn MH - Male MH - Practice Guidelines as Topic MH - Pregnancy PMC - PMC6738677 OTO - NOTNLM OT - global health OT - healthcare improvement and patient safety OT - neonatal health OT - obstetrics and gynaecology COIS- Competing interests: None declared. EDAT- 2019/09/13 06:00 MHDA- 2020/02/11 06:00 PMCR- 2021/09/11 CRDT- 2019/09/13 06:00 PHST- 2021/09/11 00:00 [pmc-release] PHST- 2019/09/13 06:00 [entrez] PHST- 2019/09/13 06:00 [pubmed] PHST- 2020/02/11 06:00 [medline] AID - 12/9/e227973 [pii] AID - bcr-2018-227973 [pii] AID - 10.1136/bcr-2018-227973 [doi] PST - epublish SO - BMJ Case Rep. 2019 Sep 11;12(9):e227973. doi: 10.1136/bcr-2018-227973. PMID- 31464638 OWN - NLM STAT- MEDLINE DCOM- 20200210 LR - 20200225 IS - 1745-6215 (Electronic) IS - 1745-6215 (Linking) VI - 20 IP - 1 DP - 2019 Aug 29 TI - Comparing the effect of STan (cardiotocographic electronic fetal monitoring (CTG) plus analysis of the ST segment of the fetal electrocardiogram) with CTG alone on emergency caesarean section rates: study protocol for the STan Australian Randomised controlled Trial (START). PG - 539 LID - 10.1186/s13063-019-3640-9 [doi] LID - 539 AB - BACKGROUND: Cardiotocography is almost ubiquitous in its use in intrapartum care. Although it has been demonstrated that there is some benefit from continuous intrapartum fetal monitoring using cardiotocography, there is also an increased risk of caesarean section which is accompanied by short-term and long-term risks to the mother and child. There is considerable potential to reduce unnecessary operative delivery with up to a 60% false positive diagnosis of fetal distress using cardiotocography alone. ST analysis of the fetal electrocardiogram is a promising adjunct to cardiotocography alone, and permits detection of metabolic acidosis of the fetus, potentially reducing false positive diagnosis of fetal distress. METHODS: This study will be a single-centre, parallel-group, randomised controlled trial, conducted over 3 years. The primary hypothesis will be that the proportion of women with an emergency caesarean section on ST analysis will not equal that for women on cardiotocography monitoring alone. Participants will be recruited at the Women's and Children's Hospital, a high-risk specialty facility with approximately 5000 deliveries per annum. A total of 1818 women will be randomised to the treatment or conventional arm with an allocation ratio of 1:1, stratified by parity. The primary outcome is emergency caesarean section (yes/no). Statistical analysis will follow standard methods for randomised trials and will be performed on an intention-to-treat basis. Secondary maternal and neonatal outcomes will also be analysed. Additional study outcomes include psychosocial outcomes, patient preferences and cost-effectiveness. DISCUSSION: Approximately 20% of Australian babies are delivered by emergency caesarean section. This will be the first Australian trial to examine ST analysis of the fetal electrocardiogram as an adjunct to cardiotocography as a potential method for reducing this proportion. The trial will be among the first to comprehensively examine ST analysis, taking into account the impact on psychosocial well-being as well as cost-effectiveness. This research will provide Australian evidence for clinical practice and guideline development as well as for policy-makers and consumers to make informed, evidence-based choices about care in labour. TRIAL REGISTRATION: ANZCTR, ACTRN1261800006268 . Registered on 19 January 2018. FAU - Turnbull, D AU - Turnbull D AD - School of Psychology, University of Adelaide, Adelaide, South Australia, Australia. FAU - Salter, A AU - Salter A AD - School of Public Health, University of Adelaide, Adelaide, South Australia, Australia. FAU - Simpson, B AU - Simpson B AUID- ORCID: 0000-0001-7750-4168 AD - Women's and Children's Hospital, Adelaide, South Australia, Australia. FAU - Mol, B W AU - Mol BW AD - Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia. FAU - Chandraharan, E AU - Chandraharan E AD - NHS Foundation Trust, St George's University Hospitals, London, UK. FAU - McPhee, A AU - McPhee A AD - Women's and Children's Hospital, Adelaide, South Australia, Australia. FAU - Symonds, I AU - Symonds I AD - Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia. FAU - Benton, M AU - Benton M AD - School of Psychology, University of Adelaide, Adelaide, South Australia, Australia. FAU - Kuah, S AU - Kuah S AD - Women's and Children's Hospital, Adelaide, South Australia, Australia. FAU - Matthews, G AU - Matthews G AD - Women's and Children's Hospital, Adelaide, South Australia, Australia. FAU - Howard, K AU - Howard K AD - School of Public Health, The University of Sydney, Sydney, New South Wales, Australia. FAU - Wilkinson, C AU - Wilkinson C AD - Women's and Children's Hospital, Adelaide, South Australia, Australia. chris.wilkinson@sa.gov.au. LA - eng GR - 1129648/National Health and Medical Research Council/ PT - Clinical Trial Protocol PT - Journal Article DEP - 20190829 TA - Trials JT - Trials JID - 101263253 SB - IM MH - *Cardiotocography MH - *Cesarean Section MH - Clinical Decision-Making MH - *Electrocardiography MH - Emergencies MH - Female MH - *Heart Rate, Fetal MH - Humans MH - *Parturition MH - Patient Selection MH - Predictive Value of Tests MH - Pregnancy MH - Randomized Controlled Trials as Topic MH - Reproducibility of Results MH - *Signal Processing, Computer-Assisted MH - South Australia PMC - PMC6716809 OTO - NOTNLM OT - Caesarean section OT - Cardiotocography OT - Continuous electronic fetal monitoring OT - Randomised controlled trial OT - ST analysis OT - START COIS- The authors declare that they have no competing interests. EDAT- 2019/08/30 06:00 MHDA- 2020/02/11 06:00 CRDT- 2019/08/30 06:00 PHST- 2019/05/05 00:00 [received] PHST- 2019/08/08 00:00 [accepted] PHST- 2019/08/30 06:00 [entrez] PHST- 2019/08/30 06:00 [pubmed] PHST- 2020/02/11 06:00 [medline] AID - 10.1186/s13063-019-3640-9 [pii] AID - 3640 [pii] AID - 10.1186/s13063-019-3640-9 [doi] PST - epublish SO - Trials. 2019 Aug 29;20(1):539. doi: 10.1186/s13063-019-3640-9. PMID- 31437178 OWN - NLM STAT- MEDLINE DCOM- 20200226 LR - 20200226 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 14 IP - 8 DP - 2019 TI - Why -aVF can be used in STAN as a proxy for scalp electrode-derived signal; reply to comments by Kjellmer et al. PG - e0221220 LID - 10.1371/journal.pone.0221220 [doi] LID - e0221220 AB - The conclusion of our recent paper that performance of the STAN device in clinical practice is potentially limited by high false-negative and high false-positive STAN-event rates and loss of ST waveform assessment capacity during severe hypoxemia, evoked comments by Kjellmer, Lindecrantz and Rosén. These comments can be summarized as follows: 1) STAN analysis is based on a unipolar lead but the authors used a negative aVF lead, and they did not validate this methodology; 2) The fetuses used in the study were too young to display the signals that the authors were trying to detect. In response to these comments we now provide both a theoretical and an experimental underpinning of our approach. In an in vivo experiment in human we placed several electrodes over the head (simulating different places of a scalp electrode), simultaneously recorded Einthoven lead I and II, and constructed -aVF from these two frontal leads. Irrespective of scalp electrode placement, the correlation between any of unipolar scalp electrode-derived signals and constructed-aVF was excellent (≥ 0.92). In response to the second comment we refer to a study which demonstrated that umbilical cord occlusion resulted in rapid increase in T/QRS ratio that coincided with initial hypertension and bradycardia at all gestational ages which were tested from 0.6-0.8 gestation. The animals of our study were in this gestational range and, hence, our experimental setup can be used to assess STAN's quality to detect fetal hypoxia. In conclusion, we have clearly demonstrated the appropriateness of using-aVF as a proxy for a scalp electrode-derived signal in STAN in these preterm lambs. Investigation why STAN could not detect relevant ST-changes and instead produced erroneous alarms in our experimental setup is hampered by the fact that the exact STAN algorithm (signal processing and analysis) is not in the public domain. FAU - Delhaas, Tammo AU - Delhaas T AUID- ORCID: 0000-0001-6897-9700 AD - Department of Biomedical Engineering, Maastricht University, Maastricht, the Netherlands. AD - CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands. FAU - Andriessen, Peter AU - Andriessen P AD - Department of Pediatrics, Máxima Medical Centre, Veldhoven, the Netherlands. AD - Department of Pediatrics, Maastricht University Medical Centre, Maastricht, the Netherlands. FAU - van Laar, Judith Oeh AU - van Laar JO AD - Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, the Netherlands. FAU - Vullings, Rik AU - Vullings R AD - Signal Processing Systems Group, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands. FAU - Hermans, Ben Jm AU - Hermans BJ AD - Department of Biomedical Engineering, Maastricht University, Maastricht, the Netherlands. AD - CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands. FAU - Niemarkt, Hendrik J AU - Niemarkt HJ AD - Department of Pediatrics, Máxima Medical Centre, Veldhoven, the Netherlands. FAU - Jellema, Reint K AU - Jellema RK AD - Department of Pediatrics, Máxima Medical Centre, Veldhoven, the Netherlands. AD - Department of Pediatrics, Maastricht University Medical Centre, Maastricht, the Netherlands. FAU - Ophelders, Daan Rmg AU - Ophelders DR AD - Department of Pediatrics, Maastricht University Medical Centre, Maastricht, the Netherlands. AD - School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands. FAU - Wolfs, Tim Gam AU - Wolfs TG AD - Department of Biomedical Engineering, Maastricht University, Maastricht, the Netherlands. AD - Department of Pediatrics, Maastricht University Medical Centre, Maastricht, the Netherlands. AD - School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands. FAU - Kramer, Boris W AU - Kramer BW AD - Department of Pediatrics, Maastricht University Medical Centre, Maastricht, the Netherlands. AD - School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands. FAU - Zwanenburg, Alex AU - Zwanenburg A AD - Department of Biomedical Engineering, Maastricht University, Maastricht, the Netherlands. AD - CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands. AD - School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands. LA - eng PT - Comment PT - Journal Article DEP - 20190822 TA - PLoS One JT - PloS one JID - 101285081 SB - IM CON - PLoS One. 2018 Apr 16;13(4):e0195978. PMID: 29659625 CON - PLoS One. 2019 Aug 22;14(8):e0221210. PMID: 31437186 MH - Animals MH - *Electrocardiography MH - Electrodes MH - Female MH - Fetus MH - Humans MH - Hypoxia MH - Pregnancy MH - *Scalp MH - Sheep MH - Umbilical Cord PMC - PMC6705853 COIS- The authors reconfirm and declare that no competing interests exist. Although Rik Vullings is scientific director and shareholder of Nemo Healthcare (Veldhoven, the Netherlands), a company that develops innovative technology for improved pregnancy monitoring, this does not alter our adherence to PLOS ONE policies on sharing data and materials. EDAT- 2019/08/23 06:00 MHDA- 2020/02/27 06:00 CRDT- 2019/08/23 06:00 PHST- 2019/05/17 00:00 [received] PHST- 2019/07/31 00:00 [accepted] PHST- 2019/08/23 06:00 [entrez] PHST- 2019/08/23 06:00 [pubmed] PHST- 2020/02/27 06:00 [medline] AID - PONE-D-19-13774 [pii] AID - 10.1371/journal.pone.0221220 [doi] PST - epublish SO - PLoS One. 2019 Aug 22;14(8):e0221220. doi: 10.1371/journal.pone.0221220. eCollection 2019. PMID- 31435480 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201201 IS - 2047-2501 (Print) IS - 2047-2501 (Electronic) IS - 2047-2501 (Linking) VI - 7 IP - 1 DP - 2019 Dec TI - Prediction of intrapartum fetal hypoxia considering feature selection algorithms and machine learning models. PG - 17 LID - 10.1007/s13755-019-0079-z [doi] LID - 17 AB - INTRODUCTION: Cardiotocography (CTG) consists of two biophysical signals that are fetal heart rate (FHR) and uterine contraction (UC). In this research area, the computerized systems are usually utilized to provide more objective and repeatable results. MATERIALS AND METHODS: Feature selection algorithms are of great importance regarding the computerized systems to not only reduce the dimension of feature set but also to reveal the most relevant features without losing too much information. In this paper, three filters and two wrappers feature selection methods and machine learning models, which are artificial neural network (ANN), k-nearest neighbor (kNN), decision tree (DT), and support vector machine (SVM), are evaluated on a high dimensional feature set obtained from an open-access CTU-UHB intrapartum CTG database. The signals are divided into two classes as normal and hypoxic considering umbilical artery pH value (pH < 7.20) measured after delivery. A comprehensive diagnostic feature set forming the features obtained from morphological, linear, nonlinear, time-frequency and image-based time-frequency domains is generated first. Then, combinations of the feature selection algorithms and machine learning models are evaluated to achieve the most effective features as well as high classification performance. RESULTS: The experimental results show that it is possible to achieve better classification performance using lower dimensional feature set that comprises of more related features, instead of the high-dimensional feature set. The most informative feature subset was generated by considering the frequency of selection of the features by feature selection algorithms. As a result, the most efficient results were produced by selected only 12 relevant features instead of a full feature set consisting of 30 diagnostic indices and SVM model. Sensitivity and specificity were achieved as 77.40% and 93.86%, respectively. CONCLUSION: Consequently, the evaluation of multiple feature selection algorithms resulted in achieving the best results. FAU - Cömert, Zafer AU - Cömert Z AD - Department of Software Engineering, Samsun University, Samsun, Turkey. FAU - Şengür, Abdulkadir AU - Şengür A AD - 2Department of Electrical and Electronics Engineering, Technology Faculty, Firat University, Elazig, Turkey. ISNI: 0000 0004 0574 1529. GRID: grid.411320.5 FAU - Budak, Ümit AU - Budak Ü AUID- ORCID: 0000-0003-4082-383X AD - 3Department of Electrical and Electronics Engineering, Bitlis Eren University, Bitlis, Turkey. ISNI: 0000 0004 0399 2965. GRID: grid.448551.9 FAU - Kocamaz, Adnan Fatih AU - Kocamaz AF AD - 4Department of Computer Engineering, İnönü University, Malatya, Turkey. ISNI: 0000 0001 0024 1937. GRID: grid.411650.7 LA - eng PT - Journal Article DEP - 20190820 TA - Health Inf Sci Syst JT - Health information science and systems JID - 101638060 PMC - PMC6702252 OTO - NOTNLM OT - Biomedical signal processing OT - Classification OT - Feature selection OT - Fetal heart rate OT - Machine learning COIS- Conflicts of interestThe authors declare that there is no conflict to interest related to this paper. EDAT- 2019/08/23 06:00 MHDA- 2019/08/23 06:01 CRDT- 2019/08/23 06:00 PHST- 2019/05/26 00:00 [received] PHST- 2019/08/12 00:00 [accepted] PHST- 2019/08/23 06:00 [entrez] PHST- 2019/08/23 06:00 [pubmed] PHST- 2019/08/23 06:01 [medline] AID - 79 [pii] AID - 10.1007/s13755-019-0079-z [doi] PST - epublish SO - Health Inf Sci Syst. 2019 Aug 20;7(1):17. doi: 10.1007/s13755-019-0079-z. eCollection 2019 Dec. PMID- 31071684 OWN - NLM STAT- MEDLINE DCOM- 20200421 LR - 20200703 IS - 1361-6579 (Electronic) IS - 0967-3334 (Print) IS - 0967-3334 (Linking) VI - 40 IP - 6 DP - 2019 Jul 3 TI - Heart rate variability categories of fluctuation amplitude and complexity: diagnostic markers of fetal development and its disturbances. PG - 064002 LID - 10.1088/1361-6579/ab205f [doi] AB - OBJECTIVE: In fetal diagnosis the myriad and diversity of heart rate variability (HRV) indices prevents a comparable routine evaluation of disturbances in fetal development and well-being. The work aims at the extraction of a small set of HRV key indices that could help to establish a universal, overarching tool to screen for any disturbance. APPROACH: HRV indices were organized in categories of short-term (prefix s) and long-term (prefix l) amplitude fluctuations (AMP), complexity (COMP), and patterns (PATTERN) and common representatives for each category were extracted. This procedure was done with respect to the diagnostic value in the evaluation of the maturation age throughout the second and complete third trimester of pregnancy as well as to potential differences associated with maternal life-style factors (physical exercise, smoking), nutrient intervention (docosahexaenoic acid (DHA) supplementation), and complications of pregnancy (gestational diabetes mellitus (GDM), intra-uterine growth restriction (IUGR)). MAIN RESULTS: We found a comprehensive minimal set that includes [lAMP: short term variation (STV), initially introduced in cardiotocography, sAMP: heart rate increase across one interbeat interval of phase rectified averaged signal - acceleration capacity (ACst1), lCOMP: scale 4 multi-scale entropy (MSE4), PATTERN: skewness] for the maturation age prediction, and partly overlapping [lAMP: STV, sAMP: ACst1, sCOMP: Lempel Ziv complexity (LZC)] for the discrimination of the deviations. SIGNIFICANCE: The minimal set of category-based HRV representatives allows for a screening of fetal development and well-being. These results are an important step towards a universal and comparable diagnostic tool for the early identification of developmental disturbances. Novelty & Significance Fetal development and its disturbances have been reported to be associated with a multiplicity of HRV indices. Furthermore, these HRV indices change with maturation. We propose the abstraction of HRV categories defined by short- and long-term fluctuation amplitude, complexity, and pattern indices that cover all relevant aspects of maturational age, behavioral influences and a series of pathological disturbances. The study data are provided by multiple centers. Our approach is an important step towards the goal of a standardized diagnostic tool for early identification of fetal developmental disturbances with respect to the reduction of serious complications in the later life. FAU - Hoyer, Dirk AU - Hoyer D AD - Hans Berger Department of Neurology, Biomagnetic Center, Jena University Hospital, Jena 07747, Germany. FAU - Schmidt, Alexander AU - Schmidt A FAU - Gustafson, Kathleen M AU - Gustafson KM FAU - Lobmaier, Silvia M AU - Lobmaier SM FAU - Lakhno, Igor AU - Lakhno I FAU - van Leeuwen, Peter AU - van Leeuwen P FAU - Cysarz, Dirk AU - Cysarz D FAU - Preisl, Hubert AU - Preisl H FAU - Schneider, Uwe AU - Schneider U LA - eng SI - ClinicalTrials.gov/NCT01007110 GR - P20 GM103418/GM/NIGMS NIH HHS/United States GR - R21 HD059019/HD/NICHD NIH HHS/United States GR - U54 HD090216/HD/NICHD NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20190703 TA - Physiol Meas JT - Physiological measurement JID - 9306921 RN - 0 (Biomarkers) SB - IM MH - Area Under Curve MH - Biomarkers/*metabolism MH - Female MH - Fetal Development/*physiology MH - Gestational Age MH - Heart Rate, Fetal/*physiology MH - Humans MH - Linear Models MH - Pregnancy PMC - PMC7020698 MID - NIHMS1068712 EDAT- 2019/05/10 06:00 MHDA- 2020/04/22 06:00 CRDT- 2019/05/10 06:00 PHST- 2019/05/10 06:00 [pubmed] PHST- 2020/04/22 06:00 [medline] PHST- 2019/05/10 06:00 [entrez] AID - 10.1088/1361-6579/ab205f [doi] PST - epublish SO - Physiol Meas. 2019 Jul 3;40(6):064002. doi: 10.1088/1361-6579/ab205f. PMID- 31947209 OWN - NLM STAT- MEDLINE DCOM- 20200615 LR - 20200928 IS - 2694-0604 (Electronic) IS - 2375-7477 (Linking) VI - 2019 DP - 2019 Jul TI - Influence of averaged fetal heart rate in heart rate variability analysis. PG - 5979-5982 LID - 10.1109/EMBC.2019.8856803 [doi] AB - In high-income countries, fetal hypoxia affects 3 to 8 newborns per 1000 live births with subsequent moderate or severe Hypoxic-Ischemic Encephalopathy (HIE) in 0.5 to 1 per 1000 live births. Visual interpretation of FHR signal issued from a Doppler ultrasound cardiotocography is the gold standard to monitor fetal condition. Unfortunately, its analysis presents a high rate of inter-observer variability and a low specificity to predict poor neonatal outcomes. Under hypoxia, the fetus develops several adaptive mechanisms regulated by the autonomic nervous system inducing changes in the fetal heart rate variability. Though fetal heart rate variability methods demonstrated abilities to predict perinatal asphyxia, most of the Doppler ultrasound technologies used in clinical practice do not provide sufficiently accurate fetal heart rate signals for heart rate variability analysis. Indeed, Doppler ultrasound cardiotocography usually provides fetal heart rate values averaged over 2 or 3 beats which can constitute a limitation for spectral analysis. We developed a fetal heart rate variability analysis method: the Fetal Stress Index (FSI). The objective of this study was to investigate the influence of averaged fetal heart rate on this new index in order to check the feasibility of computing the FSI from the signal issued from Doppler ultrasound cardiotocography. FAU - Jonckheere, J De AU - Jonckheere J FAU - Garabedian, C AU - Garabedian C FAU - Charlier, P AU - Charlier P FAU - Storme, L AU - Storme L FAU - Debarge, V AU - Debarge V FAU - Logier, R AU - Logier R LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Annu Int Conf IEEE Eng Med Biol Soc JT - Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference JID - 101763872 SB - IM MH - *Cardiotocography MH - Female MH - Fetal Hypoxia/*diagnosis MH - Fetus MH - *Heart Rate, Fetal MH - Humans MH - Pregnancy MH - *Ultrasonography, Doppler EDAT- 2020/01/18 06:00 MHDA- 2020/06/17 06:00 CRDT- 2020/01/18 06:00 PHST- 2020/01/18 06:00 [entrez] PHST- 2020/01/18 06:00 [pubmed] PHST- 2020/06/17 06:00 [medline] AID - 10.1109/EMBC.2019.8856803 [doi] PST - ppublish SO - Annu Int Conf IEEE Eng Med Biol Soc. 2019 Jul;2019:5979-5982. doi: 10.1109/EMBC.2019.8856803. PMID- 31947151 OWN - NLM STAT- MEDLINE DCOM- 20200608 LR - 20200928 IS - 2694-0604 (Electronic) IS - 2375-7477 (Linking) VI - 2019 DP - 2019 Jul TI - An Efficient Algorithm for the Extraction of Fetal ECG from Standard and Non-Standard Multi Abdominal Maternal Leads. PG - 5717-5720 LID - 10.1109/EMBC.2019.8858152 [doi] AB - The importance of fetal surveillance during pregnancy is worldwide accepted since its peculiar ability to anticipate fetal distress under a variety of conditions. The novel frontier in the field of remote fetal monitoring relies on a continuous and everyday-monitoring of fetal wellbeing. As a consequence, fECG monitoring systems have seen a net increase in popularity in the recent years. In this paper, we propose a novel algorithm for the detection of fECG and we validated its performances by testing it on an open source collection of 75 annotated fECG traces. Our results show the reliability of the proposed methodology in extracting fECG and deriving an estimate of fHR. FAU - Pini, Nicolo AU - Pini N FAU - Magenes, Giovanni AU - Magenes G FAU - Fanelli, Andrea AU - Fanelli A FAU - Signorini, Maria G AU - Signorini MG LA - eng PT - Journal Article PL - United States TA - Annu Int Conf IEEE Eng Med Biol Soc JT - Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference JID - 101763872 SB - IM MH - *Algorithms MH - *Electrocardiography MH - Female MH - *Fetal Monitoring MH - Humans MH - Pregnancy MH - Reproducibility of Results MH - *Signal Processing, Computer-Assisted EDAT- 2020/01/18 06:00 MHDA- 2020/06/09 06:00 CRDT- 2020/01/18 06:00 PHST- 2020/01/18 06:00 [entrez] PHST- 2020/01/18 06:00 [pubmed] PHST- 2020/06/09 06:00 [medline] AID - 10.1109/EMBC.2019.8858152 [doi] PST - ppublish SO - Annu Int Conf IEEE Eng Med Biol Soc. 2019 Jul;2019:5717-5720. doi: 10.1109/EMBC.2019.8858152. PMID- 31946265 OWN - NLM STAT- MEDLINE DCOM- 20200422 LR - 20200928 IS - 2694-0604 (Electronic) IS - 2375-7477 (Linking) VI - 2019 DP - 2019 Jul TI - The Influence of Vectorcardiogram Orientation on the T/QRS Ratio Obtained Via Non-Invasive Fetal ECG. PG - 1883-1886 LID - 10.1109/EMBC.2019.8857284 [doi] AB - Non-invasive fetal electrocardiography (NI-FECG) is an emerging technology that demonstrates potential for providing novel physiological information compared to traditional ultrasound-based cardiotocography (CTG). However, few studies have investigated the reliability of signal features derived via this technique for diagnostic use. One feature of NI-FECG recordings proposed for the purpose of identifying fetal distress is the T/QRS ratio, which has been indicated to change in response to fetal hypoxia. As the T/QRS ratio measures characteristics of the heart's electrical activity in 3D space (represented as the vectorcardiogram), it is critical to understand how changes in the vectorcardiogram orientation may influence the reliability of this feature. To study this influence, this work simulates NI-FECG recordings using eight finite element models of the maternal-fetal anatomy and calculates the T/QRS ratio for a range of vector-cardiogram orientations and sensor positions. To quantify the potential for T/QRS ratio estimation error in real world data, these results are compared to those observed in a homogeneous volume conductor model, as assumed by many existing signal processing techniques. Our results demonstrate that the fetal vectorcardiogram orientation has a significant influence on the reliability of the T/QRS ratio obtained via NI-FECG. Varying the vectorcardiogram orientation through a range of -30 to +30 degrees along each coordinate axis results in the potential for the T/QRS ratio to be underestimated by up to 94% and overestimated by up to 240% if a homogeneous volume conductor model is assumed. Furthermore, we find that the sensor positioning on the maternal abdomen strongly affects the range of the T/QRS ratio estimation error. These results confirm that further study must be undertaken to determine the relationship between the physiological and signal processing domains before utilizing the T/QRS ratio obtained via NI-FECG for diagnostic purposes. FAU - Keenan, Emerson AU - Keenan E FAU - Karmakar, Chandan Kumar AU - Karmakar CK FAU - Palaniswami, Marimuthu AU - Palaniswami M LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Annu Int Conf IEEE Eng Med Biol Soc JT - Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference JID - 101763872 SB - IM MH - Cardiotocography MH - *Electrocardiography MH - Female MH - Fetal Monitoring/*methods MH - Fetus MH - Finite Element Analysis MH - *Heart Rate, Fetal MH - Humans MH - Pregnancy MH - Reproducibility of Results MH - Signal Processing, Computer-Assisted EDAT- 2020/01/18 06:00 MHDA- 2020/04/23 06:00 CRDT- 2020/01/18 06:00 PHST- 2020/01/18 06:00 [entrez] PHST- 2020/01/18 06:00 [pubmed] PHST- 2020/04/23 06:00 [medline] AID - 10.1109/EMBC.2019.8857284 [doi] PST - ppublish SO - Annu Int Conf IEEE Eng Med Biol Soc. 2019 Jul;2019:1883-1886. doi: 10.1109/EMBC.2019.8857284. PMID- 31945828 OWN - NLM STAT- MEDLINE DCOM- 20200220 LR - 20200928 IS - 2694-0604 (Electronic) IS - 2375-7477 (Linking) VI - 2019 DP - 2019 Jul TI - Comparison of Single- and Multi-reference QRD-RLS adaptive filter for non-invasive fetal electrocardiography. PG - 1-5 LID - 10.1109/EMBC.2019.8856824 [doi] AB - Non-invasive fetal electrocardiography (ECG) would allow accessing very relevant information on fetal cardiac function, especially for arrhythmias. However, the signal-to-noise ratio is significantly low, since fetal ECG is embedded in instrumental noise and spectrally overlapping maternal electrophysiological interferences. Among the different techniques proposed in the scientific literature, some variants of adaptive filters have been proposed for maternal ECG cancellation and fetal QRS complex enhancement. Such techniques encompass approaches using one or more reference signals, which is an important aspect for the development of accurate and unobtrusive monitoring systems.In this work, this aspect is systematically analyzed by comparing single- and multi-reference implementations of the QRD-RLS adaptive filter, and by challenging them in the fetal ECG enhancement on three abdominal leads differently oriented in space. The performance is assessed on real data in terms of signal-to-interference ratio, detection of fetal QRS complexes and maternal ECG attenuation. Multi-reference implementation reveals its superiority, whereas the single-reference implementation suffers from the electrodes positioning and cannot be trustily used even for the fetal heart rate only on the adopted dataset. FAU - Sulas, Eleonora AU - Sulas E FAU - Urru, Monica AU - Urru M FAU - Tumbarello, Roberto AU - Tumbarello R FAU - Raffo, Luigi AU - Raffo L FAU - Pani, Danilo AU - Pani D LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Annu Int Conf IEEE Eng Med Biol Soc JT - Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference JID - 101763872 SB - IM MH - *Algorithms MH - *Electrocardiography MH - Female MH - Fetal Monitoring MH - Fetus MH - Heart Rate, Fetal MH - Humans MH - Pregnancy MH - *Signal Processing, Computer-Assisted EDAT- 2020/01/18 06:00 MHDA- 2020/02/23 06:00 CRDT- 2020/01/18 06:00 PHST- 2020/01/18 06:00 [entrez] PHST- 2020/01/18 06:00 [pubmed] PHST- 2020/02/23 06:00 [medline] AID - 10.1109/EMBC.2019.8856824 [doi] PST - ppublish SO - Annu Int Conf IEEE Eng Med Biol Soc. 2019 Jul;2019:1-5. doi: 10.1109/EMBC.2019.8856824. PMID- 31228414 OWN - NLM STAT- MEDLINE DCOM- 20200318 LR - 20200318 IS - 1097-6868 (Electronic) IS - 0002-9378 (Linking) VI - 221 IP - 6 DP - 2019 Dec TI - Randomized comparison of a reduced-visit prenatal care model enhanced with remote monitoring. PG - 638.e1-638.e8 LID - S0002-9378(19)30810-5 [pii] LID - 10.1016/j.ajog.2019.06.034 [doi] AB - BACKGROUND: Standard prenatal care, consisting of 12-14 visits per pregnancy, is expensive and resource intensive, with limited evidence supporting the structure, rhythm, or components of care. Some studies suggest a reduced-frequency prenatal care model is as safe as the standard model of care for low-risk pregnant women, but evidence is limited. We developed and evaluated an innovative, technology-enhanced, reduced prenatal visit model (OB Nest). OBJECTIVE: To evaluate the acceptability and effectiveness of OB Nest, a reduced-frequency prenatal care model enhanced with remote home monitoring devices and nursing support. STUDY DESIGN: A single-center randomized controlled trial, composed of pregnant women, aged 18-36 years, recruited from an outpatient obstetric tertiary academic center in the Midwest United States. OB Nest care consisted of 8 onsite appointments with an obstetric provider; 6 virtual visits consisting of phone or online communication with an assigned nurse, supplemented with fetal Doppler and sphygmomanometer home monitoring devices; and access to an online community of pregnant women. Usual care consisted of 12 prescheduled prenatal clinic appointments with obstetric providers. Acceptability of OB Nest was measured by validated surveys of patient satisfaction with care at 36 weeks; perception of stress at 14, 24, and 36 weeks; and perceived quality of care at 36 weeks of gestation. Effectiveness was analyzed by comparing adherence to the American College of Obstetricians and Gynecologists recommended routine prenatal and ancillary services, maternal and fetal safety outcomes, and healthcare utilization. RESULTS: Three hundred pregnant women at <13 weeks of gestation were recruited and randomized to OB Nest or usual care (150 in each arm) using a minimization algorithm. Demographic characteristics were similar between groups. Compared to usual care, patients in OB Nest had higher satisfaction on a 100-point validated modified Littlefield and Adams Satisfaction scale (OB Nest = 93.9% vs usual care = 78.9%, P < .01). Pregnancy-related stress, measured, on a 0-2 point PreNatal Maternal Stress validated scale, with higher scores indicating higher levels of stress, was lower among OB Nest participants at 14 weeks (OB Nest = 0.32 vs usual care = 0.41, P < .01) and at 36 weeks of gestation (OB Nest = 0.34 vs usual care = 0.40, P < .03). There was no statistical difference in perceived quality of care. Adherence to the provision of American College of Obstetricians and Gynecologists prenatal services was similar in both arms. Maternal and fetal clinical outcomes were similar between groups. Total reported nursing time was higher in OB Nest (OB Nest = 171.2 minutes vs usual care = 108.2 minutes, 95% confidence interval, 48.7-77.4). CONCLUSION: OB Nest is an innovative, acceptable, and effective reduced-frequency prenatal care model. Compared to routine prenatal care, OB Nest resulted in higher patient satisfaction and lower prenatal stress, while reducing the number of appointments with clinicians and maintaining care standards for pregnant women. This program is a step toward evidence-driven prenatal care that improves patient satisfaction. CI - Copyright © 2019 Elsevier Inc. All rights reserved. FAU - Butler Tobah, Yvonne S AU - Butler Tobah YS AD - Division of Obstetrics, Department of Obstetrics and Gynecology Mayo Clinic, Rochester, MN. Electronic address: ButlerTobah.Yvonne@mayo.edu. FAU - LeBlanc, Annie AU - LeBlanc A AD - Knowledge and Evaluation Research Unit at Mayo Clinic, Rochester, MN; Department of Family and Emergency, Laval University, Quebec, Canada. FAU - Branda, Megan E AU - Branda ME AD - Mayo Clinic Health Sciences Research, Rochester, MN. FAU - Inselman, Jonathan W AU - Inselman JW AD - Mayo Clinic Health Sciences Research, Rochester, MN. FAU - Morris, Megan A AU - Morris MA AD - Mayo Clinic Health Sciences Research, Rochester, MN. FAU - Ridgeway, Jennifer L AU - Ridgeway JL AD - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic, Rochester, MN. FAU - Finnie, Dawn M AU - Finnie DM AD - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic, Rochester, MN. FAU - Theiler, Regan AU - Theiler R AD - Division of Obstetrics, Department of Obstetrics and Gynecology Mayo Clinic, Rochester, MN. FAU - Torbenson, Vanessa E AU - Torbenson VE AD - Division of Obstetrics, Department of Obstetrics and Gynecology Mayo Clinic, Rochester, MN. FAU - Brodrick, Ellen M AU - Brodrick EM AD - Division of Obstetrics, Department of Obstetrics and Gynecology Mayo Clinic, Rochester, MN. FAU - Meylor de Mooij, Marnie AU - Meylor de Mooij M AD - Mayo Clinic Center for Innovation, Rochester, MN. FAU - Gostout, Bobbie AU - Gostout B AD - Division of Obstetrics, Department of Obstetrics and Gynecology Mayo Clinic, Rochester, MN. FAU - Famuyide, Abimbola AU - Famuyide A AD - Division of Obstetrics, Department of Obstetrics and Gynecology Mayo Clinic, Rochester, MN. LA - eng SI - ClinicalTrials.gov/NCT02082275 PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20190619 PL - United States TA - Am J Obstet Gynecol JT - American journal of obstetrics and gynecology JID - 0370476 SB - AIM SB - IM MH - Adult MH - *Blood Pressure Determination MH - Delivery of Health Care/*methods MH - Female MH - *Heart Rate, Fetal MH - Humans MH - Obstetric Nursing/methods MH - Obstetrics/methods MH - Patient Acceptance of Health Care MH - Patient Satisfaction MH - Pregnancy MH - Prenatal Care/*methods MH - Quality of Health Care MH - Self Care/*methods MH - Sphygmomanometers MH - Stress, Psychological/psychology MH - Telemedicine/*methods MH - Ultrasonography, Doppler OTO - NOTNLM OT - *alternative prenatal care OT - *connected prenatal care OT - *innovative prenatal care OT - *low-risk prenatal care OT - *prenatal telemedicine OT - *reduced prenatal visits OT - *remote prenatal care OT - *telehealth and pregnancy OT - *telehealth obstetric care OT - *virtual prenatal care EDAT- 2019/06/23 06:00 MHDA- 2020/03/19 06:00 CRDT- 2019/06/23 06:00 PHST- 2018/12/01 00:00 [received] PHST- 2019/06/05 00:00 [revised] PHST- 2019/06/13 00:00 [accepted] PHST- 2019/06/23 06:00 [pubmed] PHST- 2020/03/19 06:00 [medline] PHST- 2019/06/23 06:00 [entrez] AID - S0002-9378(19)30810-5 [pii] AID - 10.1016/j.ajog.2019.06.034 [doi] PST - ppublish SO - Am J Obstet Gynecol. 2019 Dec;221(6):638.e1-638.e8. doi: 10.1016/j.ajog.2019.06.034. Epub 2019 Jun 19. PMID- 31081113 OWN - NLM STAT- MEDLINE DCOM- 20200318 LR - 20210109 IS - 1600-0412 (Electronic) IS - 0001-6349 (Print) IS - 0001-6349 (Linking) VI - 98 IP - 9 DP - 2019 Sep TI - Computer-based intrapartum fetal monitoring and beyond: A review of the 2nd Workshop on Signal Processing and Monitoring in Labor (October 2017, Oxford, UK). PG - 1207-1217 LID - 10.1111/aogs.13639 [doi] AB - The second Signal Processing and Monitoring in Labor workshop gathered researchers who utilize promising new research strategies and initiatives to tackle the challenges of intrapartum fetal monitoring. The workshop included a series of lectures and discussions focusing on: new algorithms and techniques for cardiotocogoraphy (CTG) and electrocardiogram acquisition and analyses; the results of a CTG evaluation challenge comparing state-of-the-art computerized methods and visual interpretation for the detection of arterial cord pH <7.05 at birth; the lack of consensus about the role of intrapartum acidemia in the etiology of fetal brain injury; the differences between methods for CTG analysis "mimicking" expert clinicians and those derived from "data-driven" analyses; a critical review of the results from two randomized controlled trials testing the former in clinical practice; and relevant insights from modern physiology-based studies. We concluded that the automated algorithms performed comparably to each other and to clinical assessment of the CTG. However, the sensitivity and specificity urgently need to be improved (both computerized and visual assessment). Data-driven CTG evaluation requires further work with large multicenter datasets based on well-defined labor outcomes. And before first tests in the clinic, there are important lessons to be learnt from clinical trials that tested automated algorithms mimicking expert CTG interpretation. In addition, transabdominal fetal electrocardiogram monitoring provides reliable CTG traces and variability estimates; and fetal electrocardiogram waveform analysis is subject to promising new research. There is a clear need for close collaboration between computing and clinical experts. We believe that progress will be possible with multidisciplinary collaborative research. CI - © 2019 Nordic Federation of Societies of Obstetrics and Gynecology. FAU - Georgieva, Antoniya AU - Georgieva A AUID- ORCID: 0000-0002-5543-6683 AD - Nuffield Department of Women's and Reproductive Health, Big Data Institute, University of Oxford, Oxford, UK. FAU - Abry, Patrice AU - Abry P AD - University of Lyon, Ens de Lyon, University Claude Bernard, CNRS, Laboratoire de Physique, Lyon, France. FAU - Chudáček, Václav AU - Chudáček V AD - CIIRC, Czech Technical University in Prague, Prague, Czech Republic. FAU - Djurić, Petar M AU - Djurić PM AD - Electrical and Computer Engineering, Stony Brook University, Stony Brook, NY, USA. FAU - Frasch, Martin G AU - Frasch MG AD - Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA. FAU - Kok, René AU - Kok R AD - Nemo Healthcare, Veldhoven, the Netherlands. FAU - Lear, Christopher A AU - Lear CA AUID- ORCID: 0000-0002-8937-0846 AD - Department of Physiology, University of Auckland, Auckland, New Zealand. FAU - Lemmens, Sebastiaan N AU - Lemmens SN AD - Nemo Healthcare, Veldhoven, the Netherlands. FAU - Nunes, Inês AU - Nunes I AD - Department of Obstetrics and Gynecology, Centro Materno-Infantil do Norte-Centro Hospitalar do Porto, Instituto de Ciências Biomédicas Abel Salazar, Centro de Investigação em Tecnologias e Serviços de Saúde, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal. FAU - Papageorghiou, Aris T AU - Papageorghiou AT AD - Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK. FAU - Quirk, Gerald J AU - Quirk GJ AD - Department of Obstetrics and Gynecology at Stony Brook University Medical Center, Stony Brook, NY, USA. FAU - Redman, Christopher W G AU - Redman CWG AD - Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK. FAU - Schifrin, Barry AU - Schifrin B AD - Encino, California, USA. FAU - Spilka, Jiri AU - Spilka J AD - CIIRC, Czech Technical University in Prague, Prague, Czech Republic. FAU - Ugwumadu, Austin AU - Ugwumadu A AD - Department of Obstetrics & Gynecology, St. George's University of London, London, UK. FAU - Vullings, Rik AU - Vullings R AD - Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands. LA - eng GR - 17/601/Health Research Council of New Zealand/International GR - Canadian Institutes of Health Research (CIHR)/International GR - R01 HD097188/HD/NICHD NIH HHS/United States GR - R21 HD080025/HD/NICHD NIH HHS/United States GR - CDF-2016-09-004/DH_/Department of Health/United Kingdom GR - CDF-2016-09-004/National Institute of Health Research (NIHR)/International GR - 719500/European Union Horizon/International GR - Institute of Human Development, Child and Youth Health/International PT - Congress PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20190618 TA - Acta Obstet Gynecol Scand JT - Acta obstetricia et gynecologica Scandinavica JID - 0370343 SB - IM MH - Acidosis/diagnosis MH - *Algorithms MH - Cardiotocography/methods MH - Electrocardiography/methods MH - Female MH - Fetal Monitoring/*methods MH - Humans MH - Pregnancy MH - Prenatal Diagnosis MH - Signal Processing, Computer-Assisted MH - United Kingdom PMC - PMC7135636 MID - NIHMS1029417 OTO - NOTNLM OT - *artificial intelligence OT - *cardiotocography OT - *electronic fetal monitoring OT - *health data OT - *hypoxic-ischemic encephalopathy OT - *intrapartum care OT - *sensitivity OT - *specificity COIS- Conflicts of interest B.N.L. and R. V. are shareholders in Nemo Healthcare BV, the Netherlands. R.K. is employed by Nemo Healthcare BV; M.G. F. is an inventor of related patent application entitled “EEG Monitor of Fetal Health” including U.S. Patent 9,215,999. M.G.F. co-filed a patent for the aECG method referred to in this article. The remaining authors report no conflict of interest. EDAT- 2019/05/14 06:00 MHDA- 2020/03/19 06:00 CRDT- 2019/05/14 06:00 PHST- 2019/03/08 00:00 [received] PHST- 2019/05/08 00:00 [accepted] PHST- 2019/05/14 06:00 [pubmed] PHST- 2020/03/19 06:00 [medline] PHST- 2019/05/14 06:00 [entrez] AID - 10.1111/aogs.13639 [doi] PST - ppublish SO - Acta Obstet Gynecol Scand. 2019 Sep;98(9):1207-1217. doi: 10.1111/aogs.13639. Epub 2019 Jun 18. PMID- 31214775 OWN - NLM STAT- MEDLINE DCOM- 20200420 LR - 20200420 IS - 1432-0711 (Electronic) IS - 0932-0067 (Linking) VI - 300 IP - 3 DP - 2019 Sep TI - Correlation of short-term variation and Doppler parameters with adverse perinatal outcome in small-for-gestational age fetuses at term. PG - 575-581 LID - 10.1007/s00404-019-05216-7 [doi] AB - OBJECTIVE: To evaluate the association of short-term variation (STV) and Doppler parameters with adverse perinatal outcome in small-for-gestational-age (SGA) fetuses at term. METHODS: In this retrospective single-center study 97 patients with singleton SGA fetuses at term (≥ 37 + 0 weeks' gestation) were examined. Inclusion criteria were a birth weight < 10th centile, cephalic presentation and planned vaginal birth. Only cases with available Doppler measurements of umbilical artery (UA) and middle cerebral artery (MCA) with calculated cerebroplacental ratio (CPR) in combination with a computerized CTG (cCTG) and STV 72 h prior to delivery were eligible for analysis. Pulsatility indices (PI) were converted into multiples of median (MoM), adjusted for gestational age. The association between Doppler indices and STV values with mode of delivery [secondary cesarean delivery (CD), operative vaginal delivery (OVD), as well as secondary CD and OVD due to fetal distress] and neonatal outcome [UA blood pH ≤ 7.15 and the need of admission to the neonatal intensive care unit (NICU)] was analyzed using logistic regression analysis. RESULTS: There was a significant association between UA PI MoM and the rate of CD. CD due to fetal distress, OVD and OVD due to fetal distress did not show a correlation with the evaluated Doppler parameters. Furthermore, we did not find an association between low UA birth pH and Doppler parameters while neonates with the need of admission to NICU had significant higher UA PI MoM and significant lower MCA PI MoM and CPR MoM. Regarding STV, a significant effect of low STV on NICU admission was found while none of the other assessed outcome parameters were significantly associated with STV. CONCLUSION: STV and Doppler parameters in SGA fetuses at term are significantly associated to the rate of NICU admission. FAU - Stumpfe, Florian M AU - Stumpfe FM AUID- ORCID: 0000-0002-1865-5369 AD - Department of Obstetrics and Gynecology, University Hospital of Erlangen, Universitätsstraße 21/23, 91054, Erlangen, Germany. florian.stumpfe@uk-erlangen.de. FAU - Faschingbauer, Florian AU - Faschingbauer F AD - Department of Obstetrics and Gynecology, University Hospital of Erlangen, Universitätsstraße 21/23, 91054, Erlangen, Germany. FAU - Kehl, Sven AU - Kehl S AD - Department of Obstetrics and Gynecology, University Hospital of Erlangen, Universitätsstraße 21/23, 91054, Erlangen, Germany. FAU - Pretscher, Jutta AU - Pretscher J AD - Department of Obstetrics and Gynecology, University Hospital of Erlangen, Universitätsstraße 21/23, 91054, Erlangen, Germany. FAU - Stelzl, Patrick AU - Stelzl P AD - Department of Obstetrics and Gynecology, University Hospital of Erlangen, Universitätsstraße 21/23, 91054, Erlangen, Germany. FAU - Mayr, Andreas AU - Mayr A AD - Department of Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Bonn, Bonn, Germany. FAU - Schild, Ralf L AU - Schild RL AD - Department of Obstetrics and Perinatal Medicine, Perinatalzentrum Hannover, Diakovere Krankenhaus gGmbH, Hannover, Germany. FAU - Schmid, Matthias AU - Schmid M AD - Department of Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Bonn, Bonn, Germany. FAU - Beckmann, Matthias W AU - Beckmann MW AD - Department of Obstetrics and Gynecology, University Hospital of Erlangen, Universitätsstraße 21/23, 91054, Erlangen, Germany. FAU - Schneider, Michael O AU - Schneider MO AD - Department of Obstetrics and Gynecology, University Hospital of Erlangen, Universitätsstraße 21/23, 91054, Erlangen, Germany. LA - eng PT - Journal Article DEP - 20190617 PL - Germany TA - Arch Gynecol Obstet JT - Archives of gynecology and obstetrics JID - 8710213 SB - IM MH - Cardiotocography MH - Delivery, Obstetric MH - Female MH - Fetal Distress/*diagnostic imaging MH - Gestational Age MH - Humans MH - Infant, Newborn MH - *Infant, Small for Gestational Age MH - Intensive Care Units, Neonatal MH - Middle Cerebral Artery/diagnostic imaging MH - Predictive Value of Tests MH - Pregnancy MH - Pregnancy Outcome MH - Retrospective Studies MH - *Ultrasonography, Doppler MH - *Ultrasonography, Prenatal MH - Umbilical Arteries/*diagnostic imaging/embryology OTO - NOTNLM OT - *Cardiotocography OT - *Cerebroplacental ratio OT - *Computerized CTG OT - *Doppler OT - *Fetal distress OT - *SGA OT - *Short-term variation OT - *small-for-gestational age EDAT- 2019/06/20 06:00 MHDA- 2020/04/21 06:00 CRDT- 2019/06/20 06:00 PHST- 2019/01/24 00:00 [received] PHST- 2019/06/07 00:00 [accepted] PHST- 2019/06/20 06:00 [pubmed] PHST- 2020/04/21 06:00 [medline] PHST- 2019/06/20 06:00 [entrez] AID - 10.1007/s00404-019-05216-7 [pii] AID - 10.1007/s00404-019-05216-7 [doi] PST - ppublish SO - Arch Gynecol Obstet. 2019 Sep;300(3):575-581. doi: 10.1007/s00404-019-05216-7. Epub 2019 Jun 17. PMID- 31229725 OWN - NLM STAT- MEDLINE DCOM- 20200211 LR - 20200211 IS - 1872-7654 (Electronic) IS - 0301-2115 (Linking) VI - 240 DP - 2019 Sep TI - Evaluating the value of intrapartum fetal scalp blood sampling to predict adverse neonatal outcomes: A UK multicentre observational study. PG - 62-67 LID - S0301-2115(19)30298-2 [pii] LID - 10.1016/j.ejogrb.2019.06.012 [doi] AB - OBJECTIVE: To evaluate the value of fetal scalp blood sampling (FBS) as an adjunct test to cardiotocography, to predict adverse neonatal outcomes. STUDY DESIGN: A multicentre service evaluation observational study in forty-four maternity units in the UK. We collected data retrospectively on pregnant women with singleton pregnancy who received FBS in labour using a standardised data collection tool. The primary outcome was prediction of neonatal acidaemia diagnosed as umbilical cord arterial pH < 7.05, the secondary outcomes were the prediction of Apgar scores<7 at 1st and 5th minutes and admission to the neonatal intensive care unit (NICU). We evaluated the correlation between the last FBS blood gas before birth and the umbilical cord blood and adjusted for time intervals. We constructed 2 × 2 tables to calculate the sensitivity, specificity, positive (PPV) and negative predictive value (NPV) and generated receiver operating curves to report on the Area Under the Curve (AUC). RESULTS: In total, 1422 samples were included in the analysis; pH values showed no correlation (r = 0.001, p = 0.9) in samples obtained within an hour (n = 314), or within half an hour from birth (n = 115) (r=-0.003, p = 0.9). A suboptimal FBS pH value (<7.25) had a poor sensitivity (22%) and PPV (4.9%) to predict neonatal acidaemia with high specificity (87.3%) and NPV (97.4%). Similar performance was noted to predict Apgar scores <7 at 1st (sensitivity 14.5%, specificity 87.5%, PPV 23.4%, NPV 79.6%) and 5th minute (sensitivity 20.3%, specificity 87.4%, PPV 7.6%, NPV 95.6%), and admission to NICU (sensitivity 20.3%, specificity 87.5%, PPV 13.3%, NPV 92.1%). The AUC for FBS pH to predict neonatal acidaemia was 0.59 (95%CI 0.59-0.68, p = 0.3) with similar performance to predict Apgar scores<7 at 1st minute (AUC 0.55, 95%CI 0.51-0.59, p = 0.004), 5th minute (AUC 0.55, 95%CI 0.48-0.62, p = 0.13), and admission to NICU (AUC 0.58, 95%CI 0.52-0.64, p = 0.002). Forty-one neonates had acidaemia (2.8%, 41/1422) at birth. There was no significant correlation in pH values between the FBS and the umbilical cord blood in this subgroup adjusted for sampling time intervals (r = 0.03, p = 0.83). CONCLUSIONS: As an adjunct tool to cardiotocography, FBS offered limited value to predict neonatal acidaemia, low Apgar Scores and admission to NICU. CI - Copyright © 2019 Elsevier B.V. All rights reserved. FAU - Al Wattar, Bassel H AU - Al Wattar BH AD - Warwick Medical School, The University of Warwick, Coventry CV4 7AJ, UK. Electronic address: dr.basselwa@gmail.com. FAU - Lakhiani, Aarti AU - Lakhiani A AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Sacco, Adalina AU - Sacco A AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Siddharth, Aditi AU - Siddharth A AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Bain, Alexandra AU - Bain A AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Calvia, Alexandra AU - Calvia A AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Kamran, Atiyah AU - Kamran A AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Tiong, Bing AU - Tiong B AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Warwick, Bethan AU - Warwick B AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - MacMahon, Caroline AU - MacMahon C AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Marcus, Diana AU - Marcus D AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Long, Emma AU - Long E AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Coyle, Gillian AU - Coyle G AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Lever, Gillian Elizabeth AU - Lever GE AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Michel, Gina AU - Michel G AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Gopal, Gomathy AU - Gopal G AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Baig, Hana AU - Baig H AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Price, Hannah Louise AU - Price HL AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Badri, Hawra AU - Badri H AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Stevenson, Helen AU - Stevenson H AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Hoyte, Helene AU - Hoyte H AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Malik, Humaira AU - Malik H AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Edwards, Jade AU - Edwards J AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Hartley, Jennifer AU - Hartley J AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Hemers, Jennifer AU - Hemers J AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Tamblyn, Jennifer AU - Tamblyn J AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Dalton, John Alexander William AU - Dalton JAW AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Frost, Jonathan AU - Frost J AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Subba, Kamana AU - Subba K AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Baxter, Kathryn AU - Baxter K AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Sivakumar, Kavitha AU - Sivakumar K AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Murphy, Kelly AU - Murphy K AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Papadakis, Konstantinos AU - Papadakis K AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Bladon, Laura Rachel AU - Bladon LR AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Kasaven, Lorraine AU - Kasaven L AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Manning, Louisa AU - Manning L AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Prior, Mathew AU - Prior M AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Ghosh, Mausumi AU - Ghosh M AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Couch, Melanie AU - Couch M AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Altunel, Melis AU - Altunel M AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Pearce, Melissa AU - Pearce M AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Cocker, Michael AU - Cocker M AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Stephanou, Michael AU - Stephanou M AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Jie, Michelle AU - Jie M AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Mistry, Minesh AU - Mistry M AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Wahby, Mohammed Osama AU - Wahby MO AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Saidi, Nabila Shahid AU - Saidi NS AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Ramshaw, Nicola Louise AU - Ramshaw NL AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Tempest, Nicola AU - Tempest N AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Parker, Nina AU - Parker N AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Tan, Phoebe L AU - Tan PL AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Johnson, Racheal Louise AU - Johnson RL AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Harris, Rachel AU - Harris R AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Tildesley, Rachel AU - Tildesley R AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Ram, Ramya AU - Ram R AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Painuly, Ritu AU - Painuly R AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Cuffolo, Romana AU - Cuffolo R AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Bugeja, Roberta AU - Bugeja R AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Ngadze, Rose AU - Ngadze R AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Grainger, Rosie AU - Grainger R AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Gurung, Sabitra AU - Gurung S AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Mak, Sammy AU - Mak S AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Farrell, Sara AU - Farrell S AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Cowey, Sarah AU - Cowey S AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Neary, Sarah AU - Neary S AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Quinn, Sarah AU - Quinn S AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Nijjar, Simrit Kaur AU - Nijjar SK AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Kenyon, Sophie AU - Kenyon S AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Lamb, Stephanie AU - Lamb S AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Tracey, Susan AU - Tracey S AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Lee, Tara AU - Lee T AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Kinsella, Therese AU - Kinsella T AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Davidson, Trecia AU - Davidson T AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Corr, Trent AU - Corr T AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Sampson, Uzo AU - Sampson U AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - McQueen, Victoria AU - McQueen V AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Smith, William Parry AU - Smith WP AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. FAU - Castling, Zora AU - Castling Z AD - The UK trainee Audit and Research Collaborative in Obstetrics and Gynaecology. CN - AB-FAB study group LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study DEP - 20190615 PL - Ireland TA - Eur J Obstet Gynecol Reprod Biol JT - European journal of obstetrics, gynecology, and reproductive biology JID - 0375672 SB - IM MH - Acidosis/blood/*diagnosis MH - Blood Gas Analysis MH - Female MH - Fetal Blood MH - Fetal Distress/blood/*diagnosis MH - Humans MH - Hydrogen-Ion Concentration MH - Infant, Newborn MH - Labor, Obstetric MH - Male MH - Pregnancy MH - *Pregnancy Outcome MH - Retrospective Studies MH - Scalp MH - United Kingdom OTO - NOTNLM OT - Accuracy OT - Acidaemia OT - Asphyxia OT - Blood sampling OT - Fetal scalp OT - Intrapartum EDAT- 2019/06/24 06:00 MHDA- 2020/02/12 06:00 CRDT- 2019/06/24 06:00 PHST- 2019/02/20 00:00 [received] PHST- 2019/05/26 00:00 [revised] PHST- 2019/06/11 00:00 [accepted] PHST- 2019/06/24 06:00 [pubmed] PHST- 2020/02/12 06:00 [medline] PHST- 2019/06/24 06:00 [entrez] AID - S0301-2115(19)30298-2 [pii] AID - 10.1016/j.ejogrb.2019.06.012 [doi] PST - ppublish SO - Eur J Obstet Gynecol Reprod Biol. 2019 Sep;240:62-67. doi: 10.1016/j.ejogrb.2019.06.012. Epub 2019 Jun 15. PMID- 31094790 OWN - NLM STAT- MEDLINE DCOM- 20200122 LR - 20200529 IS - 1526-7598 (Electronic) IS - 0003-2999 (Linking) VI - 128 IP - 6 DP - 2019 Jun TI - Point-of-Care Ultrasound Abnormalities in Late-Onset Severe Preeclampsia: Prevalence and Association With Serum Albumin and Brain Natriuretic Peptide. PG - 1208-1216 LID - 10.1213/ANE.0000000000003759 [doi] AB - BACKGROUND: Pilot studies applying point-of-care ultrasound (POCUS) in preeclampsia indicate the presence of pulmonary interstitial edema, cerebral edema, and cardiac dysfunction. Laboratory markers of oncotic pressure (albumin) and cardiac dysfunction (brain natriuretic peptide [BNP]) may be abnormal, but the clinical application remains unclear. We investigated the prevalence of pulmonary interstitial syndrome (PIS), cardiac dysfunction, and increased optic nerve sheath diameter (ONSD) in late-onset preeclampsia with severe features. The primary aim was to examine the association between PIS or ONSD and maternal serum albumin level. The secondary aims were to explore the association between cardiac dysfunction and PIS, ONSD, BNP, and serum albumin level and between POCUS-derived parameters and a suspicious or pathological cardiotocograph. METHODS: Ninety-five women were enrolled in this prospective observational cohort study. A POCUS examination of lungs, heart, and ONSD was performed. PIS was defined as a bilateral B-line pattern on lung ultrasound and diastolic dysfunction according to an algorithm of the American Society of Echocardiography. ONSD >5.8 mm was interpreted as compatible with raised intracranial pressure (>20 mm Hg). Serum BNP and albumin levels were also measured. RESULTS: PIS, diastolic dysfunction, systolic dysfunction, and raised left ventricular end-diastolic pressure (LVEDP) were present in 23 (24%), 31 (33%), 9 (10%), and 20 (25%) women, respectively. ONSD was increased in 27 (28%) women. Concerning the primary outcome, there was no association between albumin level and PIS (P = .4) or ONSD (P = .63). With respect to secondary outcomes, there was no association between albumin level and systolic dysfunction (P = .21) or raised LVEDP (P = .44). PIS was associated with diastolic dysfunction (P = .02) and raised LVEDP (P = .009; negative predictive value, 85%). BNP level was associated with systolic (P < .001) and diastolic dysfunction (P = .003) and LVEDP (P = .007). No association was found between POCUS abnormalities and a suspicious/pathological cardiotocograph (P = .07). CONCLUSIONS: PIS, diastolic dysfunction, and increased ONSD were common in preeclampsia with severe features. Cardiac ultrasound abnormalities may be more useful than albumin levels in predicting PIS. The absence of PIS may exclude raised LVEDP. The further clinical relevance of PIS and raised ONSD remains to be established. BNP level was associated with cardiac ultrasound abnormalities. Although this study was not designed to directly influence clinical management, the findings suggest that POCUS may serve as a useful adjunct to clinical examination for the obstetric anesthesiologist managing these complex patients. FAU - Ortner, Clemens M AU - Ortner CM AD - From the Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria. FAU - Krishnamoorthy, Vijay AU - Krishnamoorthy V AD - Department of Anesthesiology, Duke University, Durham, North Carolina. AD - Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington. FAU - Neethling, Elmari AU - Neethling E AD - Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, Western Cape, South Africa. FAU - Flint, Margot AU - Flint M AD - Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, Western Cape, South Africa. FAU - Swanevelder, Justiaan L AU - Swanevelder JL AD - Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, Western Cape, South Africa. FAU - Lombard, Carl AU - Lombard C AD - Biostatistics Unit, South African Medical Research Council, Cape Town, Western Cape, South Africa. AD - School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa. FAU - Fawcus, Susan AU - Fawcus S AD - Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, Western Cape, South Africa. FAU - Dyer, Robert A AU - Dyer RA AD - Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, Western Cape, South Africa. LA - eng SI - ClinicalTrials.gov/NCT02721771 PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't PL - United States TA - Anesth Analg JT - Anesthesia and analgesia JID - 1310650 RN - 0 (Serum Albumin) RN - 114471-18-0 (Natriuretic Peptide, Brain) SB - AIM SB - IM MH - Adult MH - Algorithms MH - Cardiotocography MH - Echocardiography MH - Female MH - Heart/*diagnostic imaging MH - Heart Defects, Congenital/blood MH - Heart Ventricles MH - Humans MH - Incidence MH - Intracranial Pressure MH - Lung/diagnostic imaging MH - Lung Diseases/blood MH - Natriuretic Peptide, Brain/*blood MH - Observer Variation MH - Optic Nerve/pathology MH - *Point-of-Care Systems MH - Pre-Eclampsia/*blood MH - Predictive Value of Tests MH - Pregnancy MH - Prevalence MH - Prospective Studies MH - Serum Albumin/*analysis MH - *Ultrasonography, Prenatal MH - Ventricular Dysfunction, Left/physiopathology EDAT- 2019/05/17 06:00 MHDA- 2020/01/23 06:00 CRDT- 2019/05/17 06:00 PHST- 2019/05/17 06:00 [entrez] PHST- 2019/05/17 06:00 [pubmed] PHST- 2020/01/23 06:00 [medline] AID - 00000539-201906000-00028 [pii] AID - 10.1213/ANE.0000000000003759 [doi] PST - ppublish SO - Anesth Analg. 2019 Jun;128(6):1208-1216. doi: 10.1213/ANE.0000000000003759. PMID- 31005952 OWN - NLM STAT- MEDLINE DCOM- 20191213 LR - 20191217 IS - 1619-3997 (Electronic) IS - 0300-5577 (Linking) VI - 47 IP - 4 DP - 2019 May 27 TI - Computerized fetal cardiotocography analysis in early preterm fetal growth restriction - a quantitative comparison of two applications. PG - 439-447 LID - 10.1515/jpm-2018-0412 [doi] AB - Background We developed an open-source software for the computerized analysis of antenatal fetal cardiotocography (CTG) without limitation of duration of the registration, enabling batch processing and adaptation to any digital storage system. Methods STVcalc was developed based on literature about the FetalCare system (Huntleigh Healthcare Ltd, Cardiff, UK). For comparison with FetalCare, we selected the CTGs of all women who delivered in 2011 a small-for-gestational-age (SGA) fetus between 24 and 31 weeks by cesarean section (CS) for fetal distress, or had fetal death, before labor onset. Results In 471 CTGs from 39 women, the agreement was 99% for a short-term variation (STV) cut-off of 2.6 ms below 29 weeks and 3.0 ms thereafter, and 95% for 3.5 and 4.0 ms, respectively. In 18 (4%) cases, the proportional difference in STV between FetalCare and STVcalc was more than 10%. Conclusion As only slight differences were observed between the proposed feature-rich application and the FetalCare system, it can be considered valuable for clinical practice and research purposes. FAU - Wolf, Hans AU - Wolf H AD - Department of Obstetrics, Amsterdam University Medical CenterAmsterdam, The Netherlands. FAU - Bruin, Claartje AU - Bruin C AD - Department of Obstetrics, Amsterdam University Medical CenterAmsterdam, The Netherlands. FAU - Dobbe, Johannes G G AU - Dobbe JGG AD - Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands. FAU - Gordijn, Sanne J AU - Gordijn SJ AD - Department of Obstetrics, University Medical Center Groningen, Groningen, The Netherlands. FAU - Ganzevoort, Wessel AU - Ganzevoort W AD - Department of Obstetrics, Amsterdam University Medical CenterAmsterdam, The Netherlands. LA - eng PT - Comparative Study PT - Journal Article PL - Germany TA - J Perinat Med JT - Journal of perinatal medicine JID - 0361031 SB - IM MH - *Cardiotocography MH - Female MH - *Fetal Growth Retardation MH - Humans MH - *Software OTO - NOTNLM OT - fetal cardiotocography OT - fetal growth restriction OT - fetal heart rate OT - short-term variation EDAT- 2019/04/22 06:00 MHDA- 2019/12/18 06:00 CRDT- 2019/04/22 06:00 PHST- 2018/12/10 00:00 [received] PHST- 2019/02/08 00:00 [accepted] PHST- 2019/04/22 06:00 [pubmed] PHST- 2019/12/18 06:00 [medline] PHST- 2019/04/22 06:00 [entrez] AID - /j/jpme.ahead-of-print/jpm-2018-0412/jpm-2018-0412.xml [pii] AID - 10.1515/jpm-2018-0412 [doi] PST - ppublish SO - J Perinat Med. 2019 May 27;47(4):439-447. doi: 10.1515/jpm-2018-0412. PMID- 31099119 OWN - NLM STAT- MEDLINE DCOM- 20200114 LR - 20200114 IS - 1447-0756 (Electronic) IS - 1341-8076 (Linking) VI - 45 IP - 7 DP - 2019 Jul TI - Fetal heart rate monitoring and neonatal outcome in a population of early- and late-onset intrauterine growth restriction. PG - 1343-1351 LID - 10.1111/jog.13981 [doi] AB - AIM: The early-onset intrauterine growth restriction (IUGR) is associated with severe placental insufficiency and Doppler abnormalities. The late-onset IUGR is associated with mild placental insufficiency and normal Doppler velocimetry. The computerized cardiotocographic (cCTG) monitoring is used to evaluate the fetal well-being in pregnancies complicated by IUGR. Our aim was to investigate the cardiotocographic characteristics of IUGR fetuses and to identify every cCTG difference between Healthy and IUGR fetuses. METHODS: Four hundred thirty pregnant women were enrolled starting from the 28th week of gestation until the time of delivery: 200 healthy and 230 IUGR fetuses. Fetal heart rate (FHR) baseline (FHR), short-term variability (STV), long-term irregularity (LTI), delta, interval index (II), approximate entropy (ApEn), high frequency (HF), low frequency (LF), movement frequency (MF), LF/(HF + MF) ratio (LF/(HF + MF)) and number of decelerations were examined. Newborn baby data were also collected. RESULTS: The parameters of short- and medium-term variability discriminate between IUGR and healthy fetuses before 36 weeks including FHR, STV, LTI and delta discriminate between each subgroup of IUGR were compared to each one of the other two (P < 0.05). CONCLUSION: cCTG is a useful tool for the evaluation of chronic hypoxemia, which causes a delay in the maturation of all components of the autonomic and central nervous system. However, cCTG requires integration with fetal ultrasound and Doppler vessels evaluation to improve the ability to predict the neonatal outcome. CI - © 2019 Japan Society of Obstetrics and Gynecology. FAU - Esposito, Francesca G AU - Esposito FG AD - Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy. FAU - Tagliaferri, Salvatore AU - Tagliaferri S AD - Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy. FAU - Giudicepietro, Antonia AU - Giudicepietro A AD - Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy. FAU - Giuliano, Natascia AU - Giuliano N AD - Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy. FAU - Maruotti, Giuseppe M AU - Maruotti GM AD - Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy. FAU - Saccone, Gabriele AU - Saccone G AD - Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy. FAU - Signorini, Maria G AU - Signorini MG AD - Department of Electronics, Information and Bioengineering (DEIB), Politecnico of Milan, Milan, Italy. FAU - Magenes, Giovanni AU - Magenes G AD - Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy. FAU - Campanile, Marta AU - Campanile M AD - Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy. FAU - Zullo, Fulvio AU - Zullo F AD - Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy. LA - eng PT - Evaluation Study PT - Journal Article DEP - 20190516 PL - Australia TA - J Obstet Gynaecol Res JT - The journal of obstetrics and gynaecology research JID - 9612761 SB - IM MH - Adult MH - Cardiotocography/methods/*statistics & numerical data MH - Female MH - Fetal Growth Retardation/*diagnostic imaging/*physiopathology MH - Gestational Age MH - *Heart Rate, Fetal MH - Humans MH - Hypoxia/*diagnostic imaging/embryology/physiopathology MH - Infant, Newborn MH - Pregnancy MH - Pregnancy Outcome MH - Ultrasonography, Doppler/methods/statistics & numerical data MH - Ultrasonography, Prenatal/methods/statistics & numerical data OTO - NOTNLM OT - antepartum fetal monitoring OT - computerized cardiotocography OT - early-onset growth restriction OT - fetal heart rate OT - late-onset growth restriction EDAT- 2019/05/18 06:00 MHDA- 2020/01/15 06:00 CRDT- 2019/05/18 06:00 PHST- 2018/10/24 00:00 [received] PHST- 2019/04/06 00:00 [accepted] PHST- 2019/05/18 06:00 [pubmed] PHST- 2020/01/15 06:00 [medline] PHST- 2019/05/18 06:00 [entrez] AID - 10.1111/jog.13981 [doi] PST - ppublish SO - J Obstet Gynaecol Res. 2019 Jul;45(7):1343-1351. doi: 10.1111/jog.13981. Epub 2019 May 16. PMID- 31085380 OWN - NLM STAT- MEDLINE DCOM- 20200728 LR - 20200728 IS - 1879-0534 (Electronic) IS - 0010-4825 (Linking) VI - 109 DP - 2019 Jun TI - On the prediction of foetal acidaemia: A spectral analysis-based approach. PG - 235-241 LID - S0010-4825(19)30149-0 [pii] LID - 10.1016/j.compbiomed.2019.04.041 [doi] AB - A computational analysis of physiological systems has been used to support the understanding of how these systems work, and in the case of foetal heart rate, many different approaches have been developed in the last decades. Our objective was to apply a new method of classification, which is based on spectral analysis, in foetal heart rate (FHR) traces to predict foetal acidosis diagnosed with umbilical arterial blood pH ≤ 7.05. Fast Fourier transform was applied to a real database for the classification approach. To evaluate the models, sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve were used. Sensitivity equal to 1, specificity equal to 0.85 and an area under the ROC curve of 0.94 were found. In addition, when the definition of metabolic acidosis of umbilical arterial blood pH ≤ 7.05 and base excess ≤ -10 mmol/L was used, the proposed methodology obtained sensitivity = 1, specificity = 0.97 and area under the ROC curve = 0.98. The proposed methodology relies exclusively on the spectral frequency decomposition of the FHR signal. After further successful validation in more datasets, this approach can be incorporated easily in clinical practice due to its simple implementation. Likewise, the incorporation of this novel technique in an intrapartum monitoring station should be straightforward, thus enabling the assistance of labour professionals in the anticipated detection of acidaemia. CI - Copyright © 2019. Published by Elsevier Ltd. FAU - Zarmehri, Mohammad Nozari AU - Zarmehri MN AD - INESC TEC, Porto, Portugal. FAU - Castro, Luísa AU - Castro L AD - INESC TEC, Porto, Portugal; Center for Health Technology and Services Research - CINTESIS, University of Porto, Porto, Portugal. Electronic address: luisacastro@med.up.pt. FAU - Santos, João AU - Santos J AD - Center for Health Technology and Services Research - CINTESIS, University of Porto, Porto, Portugal. FAU - Bernardes, João AU - Bernardes J AD - Center for Health Technology and Services Research - CINTESIS, University of Porto, Porto, Portugal; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Portugal. FAU - Costa, Antónia AU - Costa A AD - Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Portugal. FAU - Santos, Cristina Costa AU - Santos CC AD - Center for Health Technology and Services Research - CINTESIS, University of Porto, Porto, Portugal; Health Information and Decision Sciences Department - MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20190504 PL - United States TA - Comput Biol Med JT - Computers in biology and medicine JID - 1250250 SB - IM MH - *Acidosis/blood/physiopathology MH - Cardiotocography MH - Female MH - Fetal Blood/*metabolism MH - *Fetal Diseases/blood/physiopathology MH - *Heart Rate, Fetal MH - Humans MH - Predictive Value of Tests MH - Pregnancy MH - Spectrum Analysis OTO - NOTNLM OT - *Acidaemia OT - *Base excess OT - *Foetal heart rate OT - *Power spectral analysis OT - *Variability EDAT- 2019/05/16 06:00 MHDA- 2020/07/29 06:00 CRDT- 2019/05/16 06:00 PHST- 2018/10/24 00:00 [received] PHST- 2019/04/30 00:00 [revised] PHST- 2019/04/30 00:00 [accepted] PHST- 2019/05/16 06:00 [pubmed] PHST- 2020/07/29 06:00 [medline] PHST- 2019/05/16 06:00 [entrez] AID - S0010-4825(19)30149-0 [pii] AID - 10.1016/j.compbiomed.2019.04.041 [doi] PST - ppublish SO - Comput Biol Med. 2019 Jun;109:235-241. doi: 10.1016/j.compbiomed.2019.04.041. Epub 2019 May 4. PMID- 30974475 OWN - NLM STAT- MEDLINE DCOM- 20200604 LR - 20200604 IS - 1439-1651 (Electronic) IS - 0948-2393 (Linking) VI - 224 IP - 1 DP - 2020 Feb TI - Alterations of the Short-Term Variation of the Fetal Heart Rate after Antenatal Maternal Betamethasone Administration: Validation with Two Different Computational Algorithms. PG - 26-30 LID - 10.1055/a-0873-2058 [doi] AB - INTRODUCTION: Antenatal betamethasone administration in the context of foetal lung maturity enhancement has a transient impact on the short-term variation (STV) of the foetal heart rate. There are currently various algorithms for computing the STV, each one resulting in different STV values. We studied the results of betamethasone administration on the STV using 2 different algorithms in order to investigate whether the effects of steroids on the STV depend on the algorithm used or not. MATERIALS AND METHODS: In the context of a larger, single-centre, prospective, observational study, we gathered CTG traces under and without the influence of steroids in order to study their effect on the STV using 2 different computational algorithms (STV240 and STV16). RESULTS: A total of 285 CTGs were registered and subsequently analysed with both algorithms. When compared to the STV240 and STV16 without or at least 72 h after the first intramuscular corticosteroid administration, a transient increase of both the STV240 and STV16 was documented in the first 24 h, followed by a transient decrease of both the STV240 and STV16 between 24 h and 72 h after the first intramuscular corticosteroid injection. CONCLUSION: Our results confirmed that betamethasone administration has a transient but significant effect on the STV independently of the algorithm used. These observations stress once again the fact that a decreased STV within the first 72 h after maternal bethametasone administration should not be an indication for early delivery. CI - © Georg Thieme Verlag KG Stuttgart · New York. FAU - Kouskouti, Christina AU - Kouskouti C AD - Klinik Hallerwiese, Department of Obstetrics and Perinatal Medicine, Nurnberg. FAU - Jonas, Hella AU - Jonas H AD - Klinik Hallerwiese, Department of Obstetrics and Perinatal Medicine, Nurnberg. FAU - Levidou, Georgia AU - Levidou G AD - Paracelsus Universität Nurnberg, Institute for Pathology, Nurnberg. FAU - Regner, Kerstin AU - Regner K AD - Klinik Hallerwiese, Department of Obstetrics and Perinatal Medicine, Nurnberg. FAU - Kainer, Franz AU - Kainer F AD - Klinik Hallerwiese, Department of Obstetrics and Perinatal Medicine, Nurnberg. LA - eng PT - Journal Article PT - Observational Study TT - Änderungen der Kurzzeitvariation der fetalen Herzfrequenz nach antepartaler maternaler Betamethason-Gabe: Validierung mit zwei unterschiedlichen Berechnungsalgorithmen. DEP - 20190411 PL - Germany TA - Z Geburtshilfe Neonatol JT - Zeitschrift fur Geburtshilfe und Neonatologie JID - 9508901 RN - 9842X06Q6M (Betamethasone) SB - IM MH - Algorithms MH - Betamethasone/*pharmacology MH - Cardiotocography MH - Female MH - Fetal Development/*drug effects MH - Fetal Heart/*physiology MH - Fetal Movement/*drug effects MH - Heart Rate, Fetal/*drug effects/*physiology MH - Humans MH - Pregnancy MH - Pregnancy Outcome MH - Prospective Studies MH - Respiration/drug effects COIS- Christina Kouskouti declares paid consultancy from Philips Medizinsystem Böblingen in the past. All other autors declare no relevant conflict of interest. EDAT- 2019/04/12 06:00 MHDA- 2020/06/05 06:00 CRDT- 2019/04/12 06:00 PHST- 2019/04/12 06:00 [pubmed] PHST- 2020/06/05 06:00 [medline] PHST- 2019/04/12 06:00 [entrez] AID - 10.1055/a-0873-2058 [doi] PST - ppublish SO - Z Geburtshilfe Neonatol. 2020 Feb;224(1):26-30. doi: 10.1055/a-0873-2058. Epub 2019 Apr 11. PMID- 31346581 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200930 IS - 2475-0328 (Electronic) IS - 2475-0328 (Linking) VI - 3 IP - 4 DP - 2019 Jul TI - Cancer-associated fibroblasts show heterogeneous gene expression and induce vascular endothelial growth factor A (VEGFA) in response to environmental stimuli. PG - 416-425 LID - 10.1002/ags3.12249 [doi] AB - AIM: Cancer-associated fibroblasts (CAF) play a crucial role in angiogenesis in the complex tumor microenvironment. However, fibroblasts show extensive heterogeneity and their dynamic functions against stressors remain largely unknown. METHODS: We collected patient-derived CAF and carried out perturbation-based monitoring of the dynamic functions. Clinically relevant experimental stimuli were defined as follows: hypoxia, cisplatin, fluorouracil, coculture with cancer spheroids (interaction through paracrine signals). We selected 18 marker genes that encode components for fibroblast activation, intracellular communication, and extracellular matrix remodeling. Quantitative reverse transcription polymerase chain reaction was carried out for data collection and statistical analyses were carried out using SPSS software. RESULTS: Kruskal-Wallis multivariate analysis of variance showed that variations in expression of 11 marker genes were explained, in part, by a difference in tissue of origin. Friedman and two-sided Wilcoxon signed rank tests detected significant perturbations in expression of marker genes. Paracrine signal from cancer spheroids induced vascular endothelial growth factor A (VEGFA) in CAF but not in fetal lung fibroblasts. CONCLUSION: We have established perturbation-based monitoring of patients' CAF. Further data collection and individual patient follow up is ongoing to identify critical determinants of disease outcome. FAU - Inoue, Ken-Ichi AU - Inoue KI AUID- ORCID: 0000-0001-9532-1867 AD - Center for Research Support Dokkyo Medical University Mibu Japan. AD - Center for Regenerative Medicine Dokkyo Medical University Hospital Mibu Japan. FAU - Kishimoto, Satoko AU - Kishimoto S AD - Center for Research Support Dokkyo Medical University Mibu Japan. FAU - Akimoto, Kazumi AU - Akimoto K AD - Center for Research Support Dokkyo Medical University Mibu Japan. FAU - Sakuma, Masashi AU - Sakuma M AD - Department for Cardiovascular Medicine Dokkyo Medical University Mibu Japan. FAU - Toyoda, Shigeru AU - Toyoda S AD - Department for Cardiovascular Medicine Dokkyo Medical University Mibu Japan. FAU - Inoue, Teruo AU - Inoue T AD - Center for Research Support Dokkyo Medical University Mibu Japan. AD - Center for Regenerative Medicine Dokkyo Medical University Hospital Mibu Japan. AD - Department for Cardiovascular Medicine Dokkyo Medical University Mibu Japan. FAU - Yoshida, Ken-Ichiro AU - Yoshida KI AD - Center for Regenerative Medicine Dokkyo Medical University Hospital Mibu Japan. FAU - Shimoda, Mitsugi AU - Shimoda M AUID- ORCID: 0000-0003-1954-9880 AD - Department of Gastroenterological Surgery Ibaraki Medical Center Tokyo Medical University Tokyo Japan. FAU - Suzuki, Shuji AU - Suzuki S AD - Department of Gastroenterological Surgery Ibaraki Medical Center Tokyo Medical University Tokyo Japan. LA - eng PT - Journal Article DEP - 20190409 TA - Ann Gastroenterol Surg JT - Annals of gastroenterological surgery JID - 101718062 PMC - PMC6635680 OTO - NOTNLM OT - VEGF‐A OT - cancer‐associated fibroblast OT - complex system OT - heterogeneity OT - perturbation EDAT- 2019/07/28 06:00 MHDA- 2019/07/28 06:01 CRDT- 2019/07/27 06:00 PHST- 2018/11/05 00:00 [received] PHST- 2019/03/05 00:00 [revised] PHST- 2019/03/15 00:00 [accepted] PHST- 2019/07/27 06:00 [entrez] PHST- 2019/07/28 06:00 [pubmed] PHST- 2019/07/28 06:01 [medline] AID - AGS312249 [pii] AID - 10.1002/ags3.12249 [doi] PST - epublish SO - Ann Gastroenterol Surg. 2019 Apr 9;3(4):416-425. doi: 10.1002/ags3.12249. eCollection 2019 Jul. PMID- 30870055 OWN - NLM STAT- Publisher LR - 20191120 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) DP - 2019 Mar 27 TI - Umbilical cord coiling index for the prediction of adverse pregnancy outcomes: a meta-analysis and sequential analysis. PG - 1-8 LID - 10.1080/14767058.2019.1594187 [doi] AB - PURPOSE: To evaluate the potential association of abnormal cord coiling with adverse pregnancy outcomes. MATERIALS AND METHODS: We used the Medline (1966-2018), Scopus (2004-2018), Clinicaltrials.gov (2008-2018), Embase (1980-2018), Cochrane Central Register of Controlled Trials CENTRAL (1999-2018), and Google Scholar (2004-2018) databases. The date of last search was set on 31 May 2018. Language, country, or date restrictions were not applied during the literature research to prevent bias. All observational (both prospective and retrospective) studies that reported maternal and neonatal antenatal and perinatal outcomes based on the umbilical coiling index (UCI) status were considered as eligible for inclusion. Meta-analysis of the risk ratio (RR) and mean differences (MD) among hypocoiled/hypercoiled and normocoiled cases was performed with RevMan 5.3 software. Univariate metaregression and leave-one-out meta-analysis was performed with Open Meta-Analyst statistical software. Trial sequential analysis was performed with the trial sequential analysis (TSA) software. RESULTS: Twenty four studies were finally included that involved 9553 pregnant women. Umbilical cord coiling was evaluated with the use of the umbilical coiling index (UCI). Values of the UCI below the 10th percentile were evaluated as hypocoiled and above the 90th percentile as hypercoiled. Hypocoiled cords were significantly associated with increased prevalence of preterm birth < 37 weeks, need for interventional delivery due to fetal distress, meconium stained liquor, Apgar scores < 7 at 5 min, small for gestational age (SGA) neonates, fetal anomalies, need for admission in the neonatal intensive care unit (NICU), fetal heart rate abnormalities, and fetal death. Hypercoiled cords were significantly associated with increased prevalence of preterm birth < 37 weeks, need for interventional delivery due to fetal distress, meconium stained liquor, Apgar scores < 7 at 5 min, small for gestational age (SGA) neonates, fetal anomalies, fetal growth restriction fetal heart rate abnormalities, fetal acidosis, and fetal death. CONCLUSIONS: The findings of our meta-analysis underline the correlation of UCI abnormalities with antenatal and perinatal pathology. More studies are needed, however, to elucidate whether antenatal assessment of the UCI can be used as routine in clinical practice as well as its value in uncomplicated pregnancies. FAU - Pergialiotis, Vasilios AU - Pergialiotis V AD - a Third Department of Obstetrics and Gynecology, Attikon University Hospital , National and Kapodistrian University of Athens , Athens , Greece. FAU - Kotrogianni, Paraskevi AU - Kotrogianni P AD - a Third Department of Obstetrics and Gynecology, Attikon University Hospital , National and Kapodistrian University of Athens , Athens , Greece. FAU - Koutaki, Diamanto AU - Koutaki D AD - a Third Department of Obstetrics and Gynecology, Attikon University Hospital , National and Kapodistrian University of Athens , Athens , Greece. FAU - Christopoulos-Timogiannakis, Evangelos AU - Christopoulos-Timogiannakis E AD - a Third Department of Obstetrics and Gynecology, Attikon University Hospital , National and Kapodistrian University of Athens , Athens , Greece. FAU - Papantoniou, Nikolaos AU - Papantoniou N AD - a Third Department of Obstetrics and Gynecology, Attikon University Hospital , National and Kapodistrian University of Athens , Athens , Greece. FAU - Daskalakis, Georgios AU - Daskalakis G AD - b First Department of Obstetrics and Gynecology, Alexandra Hospital , National and Kapodistrian University of Athens , Athens , Greece. LA - eng PT - Journal Article DEP - 20190327 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 OTO - NOTNLM OT - Antenatal screening OT - coiling OT - meta-analysis OT - perinatal outcomes OT - umbilical cord EDAT- 2019/03/15 06:00 MHDA- 2019/03/15 06:00 CRDT- 2019/03/15 06:00 PHST- 2019/03/15 06:00 [pubmed] PHST- 2019/03/15 06:00 [medline] PHST- 2019/03/15 06:00 [entrez] AID - 10.1080/14767058.2019.1594187 [doi] PST - aheadofprint SO - J Matern Fetal Neonatal Med. 2019 Mar 27:1-8. doi: 10.1080/14767058.2019.1594187. PMID- 30910324 OWN - NLM STAT- MEDLINE DCOM- 20190501 LR - 20200225 IS - 1474-547X (Electronic) IS - 0140-6736 (Print) IS - 0140-6736 (Linking) VI - 393 IP - 10181 DP - 2019 Apr 20 TI - Three-dimensional visualisation of the fetal heart using prenatal MRI with motion-corrected slice-volume registration: a prospective, single-centre cohort study. PG - 1619-1627 LID - S0140-6736(18)32490-5 [pii] LID - 10.1016/S0140-6736(18)32490-5 [doi] AB - BACKGROUND: Two-dimensional (2D) ultrasound echocardiography is the primary technique used to diagnose congenital heart disease before birth. There is, however, a longstanding need for a reliable form of secondary imaging, particularly in cases when more detailed three-dimensional (3D) vascular imaging is required, or when ultrasound windows are of poor diagnostic quality. Fetal MRI, which is well established for other organ systems, is highly susceptible to fetal movement, particularly for 3D imaging. The objective of this study was to investigate the combination of prenatal MRI with novel, motion-corrected 3D image registration software, as an adjunct to fetal echocardiography in the diagnosis of congenital heart disease. METHODS: Pregnant women carrying a fetus with known or suspected congenital heart disease were recruited via a tertiary fetal cardiology unit. After initial validation experiments to assess the general reliability of the approach, MRI data were acquired in 85 consecutive fetuses, as overlapping stacks of 2D images. These images were then processed with a bespoke open-source reconstruction algorithm to produce a super-resolution 3D volume of the fetal thorax. These datasets were assessed with measurement comparison with paired 2D ultrasound, structured anatomical assessment of the 2D and 3D data, and contemporaneous, archived clinical fetal MRI reports, which were compared with postnatal findings after delivery. FINDINGS: Between Oct 8, 2015, and June 30, 2017, 101 patients were referred for MRI, of whom 85 were eligible and had fetal MRI. The mean gestational age at the time of MRI was 32 weeks (range 24-36). High-resolution (0·50-0·75 mm isotropic) 3D datasets of the fetal thorax were generated in all 85 cases. Vascular measurements showed good overall agreement with 2D echocardiography in 51 cases with paired data (intra-class correlation coefficient 0·78, 95% CI 0·68-0·84), with fetal vascular structures more effectively visualised with 3D MRI than with uncorrected 2D MRI (657 [97%] of 680 anatomical areas identified vs 358 [53%] of 680 areas; p<0·0001). When a structure of interest was visualised in both 2D and 3D data (n=358), observers gave a higher diagnostic quality score for 3D data in 321 (90%) of cases, with 37 (10%) scores tied with 2D data, and no lower scores than for 2D data (Wilcoxon signed rank test p<0·0001). Additional anatomical features were described in ten cases, of which all were confirmed postnatally. INTERPRETATION: Standard fetal MRI with open-source image processing software is a reliable method of generating high-resolution 3D imaging of the fetal vasculature. The 3D volumes produced show good spatial agreement with ultrasound, and significantly improved visualisation and diagnostic quality compared with source 2D MRI data. This freely available combination requires minimal infrastructure, and provides safe, powerful, and highly complementary imaging of the fetal cardiovascular system. FUNDING: Wellcome Trust/EPSRC Centre for Medical Engineering, National Institute for Health Research. CI - Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved. FAU - Lloyd, David F A AU - Lloyd DFA AD - School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK; Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. FAU - Pushparajah, Kuberan AU - Pushparajah K AD - School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK; Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. FAU - Simpson, John M AU - Simpson JM AD - Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. FAU - van Amerom, Joshua F P AU - van Amerom JFP AD - School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK. FAU - van Poppel, Milou P M AU - van Poppel MPM AD - School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK. FAU - Schulz, Alexander AU - Schulz A AD - School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK. FAU - Kainz, Bernard AU - Kainz B AD - School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK; Department of Computing (BioMedIA), Imperial College London, London, UK. FAU - Deprez, Maria AU - Deprez M AD - School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK. FAU - Lohezic, Maelene AU - Lohezic M AD - School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK. FAU - Allsop, Joanna AU - Allsop J AD - School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK. FAU - Mathur, Sujeev AU - Mathur S AD - Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. FAU - Bellsham-Revell, Hannah AU - Bellsham-Revell H AD - Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. FAU - Vigneswaran, Trisha AU - Vigneswaran T AD - Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. FAU - Charakida, Marietta AU - Charakida M AD - Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. FAU - Miller, Owen AU - Miller O AD - Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. FAU - Zidere, Vita AU - Zidere V AD - Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. FAU - Sharland, Gurleen AU - Sharland G AD - Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. FAU - Rutherford, Mary AU - Rutherford M AD - School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK. FAU - Hajnal, Joseph V AU - Hajnal JV AD - School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK. FAU - Razavi, Reza AU - Razavi R AD - School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, UK; Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. Electronic address: reza.razavi@kcl.ac.uk. LA - eng GR - Wellcome Trust/United Kingdom PT - Journal Article DEP - 20190322 TA - Lancet JT - Lancet (London, England) JID - 2985213R SB - AIM SB - IM CIN - Lancet. 2019 Apr 20;393(10181):1574-1576. PMID: 30910326 CIN - Nat Rev Cardiol. 2019 Jul;16(7):386. PMID: 30948785 MH - Cardiotocography/*methods MH - Female MH - Fetal Heart/*diagnostic imaging/pathology MH - Gestational Age MH - Heart Defects, Congenital/diagnosis MH - Humans MH - Image Processing, Computer-Assisted/*methods MH - Imaging, Three-Dimensional/*methods MH - *Magnetic Resonance Imaging MH - Pregnancy MH - Prospective Studies MH - Ultrasonography, Prenatal PMC - PMC6484696 EDAT- 2019/03/27 06:00 MHDA- 2019/05/02 06:00 CRDT- 2019/03/27 06:00 PHST- 2018/07/11 00:00 [received] PHST- 2018/09/13 00:00 [revised] PHST- 2018/10/02 00:00 [accepted] PHST- 2019/03/27 06:00 [pubmed] PHST- 2019/05/02 06:00 [medline] PHST- 2019/03/27 06:00 [entrez] AID - S0140-6736(18)32490-5 [pii] AID - 10.1016/S0140-6736(18)32490-5 [doi] PST - ppublish SO - Lancet. 2019 Apr 20;393(10181):1619-1627. doi: 10.1016/S0140-6736(18)32490-5. Epub 2019 Mar 22. PMID- 31164209 OWN - NLM STAT- MEDLINE DCOM- 20200427 LR - 20200427 IS - 1873-2860 (Electronic) IS - 0933-3657 (Linking) VI - 96 DP - 2019 May TI - Prediction of fetal state from the cardiotocogram recordings using neural network models. PG - 33-44 LID - S0933-3657(18)30482-2 [pii] LID - 10.1016/j.artmed.2019.03.005 [doi] AB - The combination of machine vision and soft computing approaches in the clinical decisions, using training data, can improve medical decisions and treatments. The cardiotocography (CTG) monitoring and uterine activity (UA) provides useful information about the condition of the fetus and the cesarean or natural delivery. The visual assessment by the pathologists takes a lot of time and may be incompatible. Therefore, creating a computer intelligent method to assess fetal wellbeing before the mother labour is very important. In this study, many diverse approaches are suggested for predicting fetal state classes based on artificial intelligence. The various topologies of multi-layer architecture of a sub-adaptive neuro fuzzy inference system (MLA-ANFIS) using multiple input features, neural networks (NN), deep stacked sparse auto-encoders (DSSAEs), and deep-ANFIS models are implemented on a CTG data set. Experimental results contributing to DSSAE are more accurate than other suggested techniques to predict fetal state. The proposed method achieved a sensitivity of 99.716, specificity of 97.500 and geometric mean of 98.602 with accuracy of 99.503. CI - Copyright © 2019 Elsevier B.V. All rights reserved. FAU - Iraji, Mohammad Saber AU - Iraji MS AD - Faculty Member of Department of Computer Engineering and Information Technology, Payame Noor University (PNU), Iran. Electronic address: iraji.ms@gmail.com. LA - eng PT - Journal Article DEP - 20190319 PL - Netherlands TA - Artif Intell Med JT - Artificial intelligence in medicine JID - 8915031 SB - IM MH - Artificial Intelligence MH - Cardiotocography/*methods MH - *Deep Learning MH - Female MH - Fuzzy Logic MH - Humans MH - Neural Networks, Computer MH - Pregnancy MH - Uterine Contraction/physiology OTO - NOTNLM OT - *Adaptive neuro fuzzy inference network OT - *Deep stacked sparse auto-encoders OT - *Fetal state OT - *Neural network EDAT- 2019/06/06 06:00 MHDA- 2020/04/28 06:00 CRDT- 2019/06/06 06:00 PHST- 2018/08/09 00:00 [received] PHST- 2019/02/02 00:00 [revised] PHST- 2019/03/17 00:00 [accepted] PHST- 2019/06/06 06:00 [entrez] PHST- 2019/06/06 06:00 [pubmed] PHST- 2020/04/28 06:00 [medline] AID - S0933-3657(18)30482-2 [pii] AID - 10.1016/j.artmed.2019.03.005 [doi] PST - ppublish SO - Artif Intell Med. 2019 May;96:33-44. doi: 10.1016/j.artmed.2019.03.005. Epub 2019 Mar 19. PMID- 30885507 OWN - NLM STAT- MEDLINE DCOM- 20200811 LR - 20200811 IS - 1701-2163 (Print) IS - 1701-2163 (Linking) VI - 41 IP - 11 DP - 2019 Nov TI - Prediction of Hypoxic Acidemia in Last 2 Hours of Labour in Low-Risk Women. PG - 1564-1570 LID - S1701-2163(18)31037-5 [pii] LID - 10.1016/j.jogc.2018.12.015 [doi] AB - OBJECTIVE: Prediction of hypoxic acidemia in neonates using cardiotocogram (CTG) features continues to be challenging. The objective of this study was to explore the association between contraction frequency and fetal heart rate characteristics with hypoxic acidemia in low-risk women in labour. METHODS: Cases were singleton, vertex, in labour with umbilical artery pH ≤7.05. Controls were the next consecutive birth with pH ≥7.15, matched for gestational age, maternal age, and parity. Obstetrical complications and maternal comorbidities were excluded. CTG features were tabulated for the last 2 hours of labour. "Cut-off points" above which acidemia is more likely were calculated for significant variables (Canadian Task Force Classification II-2). RESULTS: A total of 190 case-control pairs were included. Among cases we observed greater marked variability, tachycardia, variable and late decelerations, and fewer accelerations and early decelerations. A conditional logistic regression model included tachycardia, accelerations, total decelerations, and contractions. Tachycardia and total decelerations (variable, late) were significant. Tachycardia was most specific in predicting neonatal acidemia, whereas total (variable, late) decelerations were most sensitive. Late decelerations alone and total (variable, late) decelerations were similarly predictive for detecting neonatal acidemia using receiver-operating characteristic analysis; tachycardia was least discriminatory. Acidemic neonates were more likely to have CTGs with ≥11 late decelerations, ≥15 total decelerations (variable, late), and at least 80 minutes of tachycardia in the last 2 hours of labour. CONCLUSION: Tachycardia, late decelerations, and total (variable, late) decelerations were associated with acidosis in our population. Identifying "cut-off" points for the frequency of significant CTG features should be explored as a potential screening tool for neonatal acidemia. CI - Copyright © 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved. FAU - Toomey, Patricia C AU - Toomey PC AD - Department of Obstetrics and Gynecology, Winchester District Memorial Hospital, Winchester, ON. Electronic address: ptoom050@uottawa.ca. FAU - Oppenheimer, Lawrence AU - Oppenheimer L AD - Department of Maternal and Fetal Medicine, The Ottawa Hospital, Ottawa, ON. LA - eng PT - Evaluation Study PT - Journal Article PT - Multicenter Study DEP - 20190315 PL - Netherlands TA - J Obstet Gynaecol Can JT - Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC JID - 101126664 SB - IM MH - Adult MH - *Cardiotocography MH - Case-Control Studies MH - Databases, Factual MH - Female MH - Fetal Hypoxia/blood/*diagnosis/physiopathology MH - Heart Rate, Fetal MH - Humans MH - Male MH - Obstetric Labor Complications/*diagnosis/physiopathology MH - Ontario MH - Predictive Value of Tests MH - Pregnancy MH - Pregnancy Outcome MH - *Prenatal Diagnosis MH - ROC Curve OTO - NOTNLM OT - Labour OT - acidosis OT - cardiotocogram OT - fetal heart rate OT - fetal monitoring OT - hypoxica EDAT- 2019/03/20 06:00 MHDA- 2020/08/12 06:00 CRDT- 2019/03/20 06:00 PHST- 2018/08/21 00:00 [received] PHST- 2018/12/04 00:00 [revised] PHST- 2018/12/06 00:00 [accepted] PHST- 2019/03/20 06:00 [pubmed] PHST- 2020/08/12 06:00 [medline] PHST- 2019/03/20 06:00 [entrez] AID - S1701-2163(18)31037-5 [pii] AID - 10.1016/j.jogc.2018.12.015 [doi] PST - ppublish SO - J Obstet Gynaecol Can. 2019 Nov;41(11):1564-1570. doi: 10.1016/j.jogc.2018.12.015. Epub 2019 Mar 15. PMID- 30914973 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201001 IS - 1664-042X (Print) IS - 1664-042X (Electronic) IS - 1664-042X (Linking) VI - 10 DP - 2019 TI - Computer-Aided Diagnosis System of Fetal Hypoxia Incorporating Recurrence Plot With Convolutional Neural Network. PG - 255 LID - 10.3389/fphys.2019.00255 [doi] LID - 255 AB - Background: Electronic fetal monitoring (EFM) is widely applied as a routine diagnostic tool by clinicians using fetal heart rate (FHR) signals to prevent fetal hypoxia. However, visual interpretation of the FHR usually leads to significant inter-observer and intra-observer variability, and false positives become the main cause of unnecessary cesarean sections. Goal: The main aim of this study was to ensure a novel, consistent, robust, and effective model for fetal hypoxia detection. Methods: In this work, we proposed a novel computer-aided diagnosis (CAD) system integrated with an advanced deep learning (DL) algorithm. For a 1-dimensional preprocessed FHR signal, the 2-dimensional image was transformed using recurrence plot (RP), which is considered to greatly capture the non-linear characteristics. The ultimate image dataset was enriched by changing several parameters of the RP and was then used to feed the convolutional neural network (CNN). Compared to conventional machine learning (ML) methods, a CNN can self-learn useful features from the input data and does not perform complex manual feature engineering (i.e., feature extraction and selection). Results: Finally, according to the optimization experiment, the CNN model obtained the average performance using optimal configuration across 10-fold: accuracy = 98.69%, sensitivity = 99.29%, specificity = 98.10%, and area under the curve = 98.70%. Conclusion: To the best of our knowledge, this approached achieved better classification performance in predicting fetal hypoxia using FHR signals compared to the other state-of-the-art works. Significance: In summary, the satisfied result proved the effectiveness of our proposed CAD system for assisting obstetricians making objective and accurate medical decisions based on RP and powerful CNN algorithm. FAU - Zhao, Zhidong AU - Zhao Z AD - Hangdian Smart City Research Center of Zhejiang Province, Hangzhou Dianzi University, Hangzhou, China. FAU - Zhang, Yang AU - Zhang Y AD - School of Communication Engineering, Hangzhou Dianzi University, Hangzhou, China. FAU - Comert, Zafer AU - Comert Z AD - Department of Computer Engineering, Bitlis Eren University, Bitlis, Turkey. FAU - Deng, Yanjun AU - Deng Y AD - College of Electronics and Information, Hangzhou Dianzi University, Hangzhou, China. LA - eng PT - Journal Article DEP - 20190312 TA - Front Physiol JT - Frontiers in physiology JID - 101549006 PMC - PMC6422985 OTO - NOTNLM OT - computer-aided diagnosis system OT - convolutional neural network OT - fetal heart rate signal OT - optimization experiment OT - recurrence plot EDAT- 2019/03/28 06:00 MHDA- 2019/03/28 06:01 CRDT- 2019/03/28 06:00 PHST- 2018/08/22 00:00 [received] PHST- 2019/02/25 00:00 [accepted] PHST- 2019/03/28 06:00 [entrez] PHST- 2019/03/28 06:00 [pubmed] PHST- 2019/03/28 06:01 [medline] AID - 10.3389/fphys.2019.00255 [doi] PST - epublish SO - Front Physiol. 2019 Mar 12;10:255. doi: 10.3389/fphys.2019.00255. eCollection 2019. PMID- 30884338 OWN - NLM STAT- MEDLINE DCOM- 20191206 LR - 20191217 IS - 1872-7654 (Electronic) IS - 0301-2115 (Linking) VI - 236 DP - 2019 May TI - Factors associated with neonatal hypoxic ischemic encephalopathy in infants with an umbilical artery pH less than 7.00. PG - 69-74 LID - S0301-2115(19)30076-4 [pii] LID - 10.1016/j.ejogrb.2019.02.009 [doi] AB - OBJECTIVE: Our objective was to identify factors associated with hypoxic-ischemic encephalopathy (HIE) among newborns with an umbilical pH < 7.00. STUDY DESIGN: Case-control study during a four-year study period in a single academic tertiary-center, including all neonates ≥35 weeks with an umbilical pH < 7.00. Cases were neonates with HIE, regardless of Sarnat classification, and controls were neonates without signs of HIE. We used univariate and multivariate analysis to compare the maternal, obstetric, and neonatal characteristics of cases and controls. RESULTS: Among 21,211 births, 179 neonates≥35 weeks (0.84%) had an umbilical pH < 7.00. One hundred and forty-seven(82.1%) newborns had severe asphyxia without HIE, 32(17.9%) had HIE and 21(11.7%) needed therapeutic hypothermia. Neonates with HIE were significantly more likely to have 5-minute Apgar score<7(75% versus 15.7% P < 0.01), together with a lower mean umbilical arterial pH (6.84 versus 6.95, P < 0.01) and lower mean base deficits (-17.0 versus -12.7, P < 0.01). Factors significantly associated with HIE were the mother being overweight(28.1% for cases versus 14.3% for controls, adjusted OR=4.6[1.4-15.2]) or obese(25.0% versus 13.6%, aOR=15.5[1.1-12.5]), smoking(18.7% versus 5.4%, aOR=5.8[1.6-21.2]), a sentinel event as cord prolaps or placenta abruption (34.4% versus 13.6%, aOR=2.7[1.1-7.2]), and decreased fetal heart rate variability(68.7% versus 44.2%, aOR=2.8[1.1-6.9]). CONCLUSION: Among neonates with an umbilical cord pH < 7.00, those with HIE had a more severe metabolic acidosis. Maternal factors associated with HIE among newborns with an umbilical pH < 7.00, were being overweight or obese, and smoking, and the associated obstetric factors were a sentinel event and decreased fetal heart rate variability. CI - Copyright © 2019 Elsevier B.V. All rights reserved. FAU - Barrois, Mathilde AU - Barrois M AD - Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, DHU Risks in Pregnancy, Paris Descartes University, Paris, France. Electronic address: mathilde.barrois@aphp.fr. FAU - Patkai, Juliana AU - Patkai J AD - Neonatal Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, DHU Risks in Pregnancy, Paris Descartes University, Paris, France. FAU - Delorme, Pierre AU - Delorme P AD - Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; INSERM UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), France. FAU - Chollat, Clément AU - Chollat C AD - Neonatal Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, DHU Risks in Pregnancy, Paris Descartes University, Paris, France. FAU - Goffinet, François AU - Goffinet F AD - Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; INSERM UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), France. FAU - Le Ray, Camille AU - Le Ray C AD - Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; INSERM UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), France. LA - eng PT - Journal Article DEP - 20190312 PL - Ireland TA - Eur J Obstet Gynecol Reprod Biol JT - European journal of obstetrics, gynecology, and reproductive biology JID - 0375672 SB - IM MH - Acidosis/*complications MH - Case-Control Studies MH - Female MH - France/epidemiology MH - Humans MH - Hydrogen-Ion Concentration MH - Hypoxia-Ischemia, Brain/*epidemiology/etiology MH - Infant, Newborn MH - Male MH - Risk Factors MH - Umbilical Arteries OTO - NOTNLM OT - Association OT - Fetal asphyxia OT - Hypoxic-ischemic encephalopathy OT - Neonatal encephalopathy OT - Severe acidosis OT - Umbilical pH EDAT- 2019/03/19 06:00 MHDA- 2019/12/18 06:00 CRDT- 2019/03/19 06:00 PHST- 2018/07/29 00:00 [received] PHST- 2019/02/01 00:00 [revised] PHST- 2019/02/06 00:00 [accepted] PHST- 2019/03/19 06:00 [pubmed] PHST- 2019/12/18 06:00 [medline] PHST- 2019/03/19 06:00 [entrez] AID - S0301-2115(19)30076-4 [pii] AID - 10.1016/j.ejogrb.2019.02.009 [doi] PST - ppublish SO - Eur J Obstet Gynecol Reprod Biol. 2019 May;236:69-74. doi: 10.1016/j.ejogrb.2019.02.009. Epub 2019 Mar 12. PMID- 30887787 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20191120 IS - 1001-5515 (Print) IS - 1001-5515 (Linking) VI - 36 IP - 1 DP - 2019 Feb 25 TI - [Intelligent fetal state assessment based on genetic algorithm and least square support vector machine]. PG - 131-139 LID - 10.7507/1001-5515.201804046 [doi] AB - Cardiotocography (CTG) is a commonly used technique of electronic fetal monitoring (EFM) for evaluating fetal well-being, which has the disadvantage of lower diagnostic rate caused by subjective factors. To reduce the rate of misdiagnosis and assist obstetricians in making accurate medical decisions, this paper proposed an intelligent assessment approach for analyzing fetal state based on fetal heart rate (FHR) signals. First, the FHR signals from the public database of the Czech Technical University-University Hospital in Brno (CTU-UHB) was preprocessed, and the comprehensive features were extracted. Then the optimal feature subset based on the k-nearest neighbor (KNN) genetic algorithm (GA) was selected. At last the classification using least square support vector machine (LS-SVM) was executed. The experimental results showed that the classification of fetal state achieved better performance using the proposed method in this paper: the accuracy is 91%, sensitivity is 89%, specificity is 94%, quality index is 92%, and area under the receiver operating characteristic curve is 92%, which can assist clinicians in assessing fetal state effectively. FAU - Zhang, Yang AU - Zhang Y AD - The School of Communication Engineering, Hangzhou Dianzi University, Hangzhou 310018, P.R.China. FAU - Zhao, Zhidong AU - Zhao Z AD - The Smart City Research Center, Hangzhou Dianzi Unviersity, Hangzhou 310018, P.R.China.zhaozd@hdu.edu.cn. FAU - Ye, Haihui AU - Ye H AD - The Women's Hospital School of Medicine Zhejiang University, Hangzhou 310006, P.R.China. LA - chi PT - English Abstract PT - Journal Article PL - China TA - Sheng Wu Yi Xue Gong Cheng Xue Za Zhi JT - Sheng wu yi xue gong cheng xue za zhi = Journal of biomedical engineering = Shengwu yixue gongchengxue zazhi JID - 9426398 OTO - NOTNLM OT - cardiotocography OT - feature extraction OT - fetal heart rate OT - genetic algorithm OT - least square support vector machine EDAT- 2019/03/20 06:00 MHDA- 2019/03/20 06:01 CRDT- 2019/03/20 06:00 PHST- 2019/03/20 06:00 [entrez] PHST- 2019/03/20 06:00 [pubmed] PHST- 2019/03/20 06:01 [medline] AID - 10.7507/1001-5515.201804046 [doi] PST - ppublish SO - Sheng Wu Yi Xue Gong Cheng Xue Za Zhi. 2019 Feb 25;36(1):131-139. doi: 10.7507/1001-5515.201804046. PMID- 30782951 OWN - NLM STAT- MEDLINE DCOM- 20200325 LR - 20200325 IS - 2044-6055 (Electronic) IS - 2044-6055 (Linking) VI - 9 IP - 2 DP - 2019 Feb 19 TI - Implementation of the WHO manual for Robson classification: an example from Sri Lanka using a local database for developing quality improvement recommendations. PG - e027317 LID - 10.1136/bmjopen-2018-027317 [doi] LID - e027317 AB - OBJECTIVES: This study aimed at describing the use of a prospective database on hospital deliveries for analysing caesarean section (CS) practices according to the WHO manual for Robson classification, and for developing recommendations for improving the quality of care (QoC). DESIGN: Observational study. SETTING: University Obstetric Unit at De Soysa Hospital for Women, the largest maternity unit in Sri Lanka. DATA COLLECTION AND ANALYSIS: For each childbirth, 150 variables were routinely collected in a standardised form and entered into a database. Data were routinely monitored for ensuring quality. Information on deliveries occurring from July 2015 to June 2017 were analysed according the WHO Robson classification manual. Findings were discussed internally to develop quality improvement recommendations. RESULTS: 7504 women delivered in the hospital during the study period and at least one maternal or fetal pathological condition was reported in 2845 (37.9%). The CS rate was 30.0%, with 11.9% CS being performed prelabour. According to the Robson classification, Group 3 and Group 1 were the most represented groups (27.0% and 23.1% of population, respectively). The major contributors to the CS rate were group 5 (29.6%), group 1 (14.0%), group 2a (13.3%) and group 10 (11.5%). The most commonly reported indications for CS included abnormal cardiotocography/suspected fetal distress, past CS and failed progress of labour or failed induction. These suggested the need for further discussion on CS practices. Overall, 18 recommendations were agreed on. Besides updating protocols and hands-on training, activities agreed on included monitoring and supervision, criterion-based audits, risk management meetings and appropriate information for patients, and recommendations to further improve the quality of data. CONCLUSIONS: This study provides an example on how the WHO manual for Robson classification can be used in an action-oriented manner for developing recommendations for improving the QoC, and the quality of data collected. CI - © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Senanayake, Hemantha AU - Senanayake H AD - University Obstetrics Unit, De Soysa Hospital for Women, Colombo, Sri Lanka. AD - Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Colombo, Colombo, Sri Lanka. FAU - Piccoli, Monica AU - Piccoli M AD - WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy. FAU - Valente, Emanuelle Pessa AU - Valente EP AUID- ORCID: 0000-0002-4741-4628 AD - WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy. FAU - Businelli, Caterina AU - Businelli C AD - WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy. FAU - Mohamed, Rishard AU - Mohamed R AD - University Obstetrics Unit, De Soysa Hospital for Women, Colombo, Sri Lanka. AD - Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Colombo, Colombo, Sri Lanka. FAU - Fernando, Roshini AU - Fernando R AD - Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Colombo, Colombo, Sri Lanka. FAU - Sakalasuriya, Anshumalie AU - Sakalasuriya A AD - Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Colombo, Colombo, Sri Lanka. FAU - Ihsan, Fathima Reshma AU - Ihsan FR AD - Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Colombo, Colombo, Sri Lanka. FAU - Covi, Benedetta AU - Covi B AD - WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy. FAU - Wanzira, Humphrey AU - Wanzira H AD - WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy. FAU - Lazzerini, Marzia AU - Lazzerini M AD - WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy. LA - eng GR - CIHR/Canada PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20190219 TA - BMJ Open JT - BMJ open JID - 101552874 SB - IM MH - Cesarean Section/*classification/statistics & numerical data MH - Databases, Factual MH - Female MH - Health Planning Guidelines MH - Hospitals, University/statistics & numerical data MH - Humans MH - Pregnancy MH - Quality Improvement/*organization & administration MH - Sri Lanka MH - World Health Organization PMC - PMC6411254 OTO - NOTNLM OT - *caesarean section OT - *health information system OT - *quality of care OT - *robson clasification COIS- Competing interests: None declared. EDAT- 2019/02/21 06:00 MHDA- 2020/03/26 06:00 CRDT- 2019/02/21 06:00 PHST- 2019/02/21 06:00 [entrez] PHST- 2019/02/21 06:00 [pubmed] PHST- 2020/03/26 06:00 [medline] AID - bmjopen-2018-027317 [pii] AID - 10.1136/bmjopen-2018-027317 [doi] PST - epublish SO - BMJ Open. 2019 Feb 19;9(2):e027317. doi: 10.1136/bmjopen-2018-027317. PMID- 30760224 OWN - NLM STAT- MEDLINE DCOM- 20190603 LR - 20200225 IS - 1471-2393 (Electronic) IS - 1471-2393 (Linking) VI - 19 IP - 1 DP - 2019 Feb 13 TI - Using fetal scalp stimulation with Doppler ultrasonography to enhance intermittent auscultation in low-resource settings: a diagnostic trial from Tanzania. PG - 71 LID - 10.1186/s12884-019-2212-z [doi] LID - 71 AB - BACKGROUND: Hypoxia during labor contributes to 2.2 million intrapartum and early neonatal deaths each year. An additional 0.6-1.0 million cases of life-long disability occur because of fetal hypoxia during labor. It is known that fetal heart rate changes in labor correspond to hypoxia and neurologic compromise, but a reliable, low-cost method for detecting these changes is not available. In this study we sought to compare the ability of a handheld Doppler device to detect accelerations as part of the fetal scalp stimulation test and to compare the diagnostic performance of routine intermittent auscultation with auscultation that is augmented with fetal scalp stimulation. METHODS: This non-randomized, pre- and post-diagnostic trial was conducted with 568 maternal-fetus pairs at Kilimanjaro Christian Medical Center in Moshi, Tanzania. The first objective was to determine whether a handheld Doppler device could detect fetal accelerations in labor with reasonable accuracy as compared with a cardiotocography machine. We performed the fetal scalp stimulation test on 50 fetuses during labor using both a handheld Doppler and a cardiotocography machine and compared the outcomes for correlation using the kappa correlation coefficient. During the second objective, two groups of laboring women were monitored either with intermittent auscultation alone per routine protocol (N = 251) or with intermittent auscultation augmented with fetal scalp stimulation per study protocol(N = 267). Diagnostic accuracy of the monitoring method was determined by comparing umbilical cord blood gases immediately after birth with the predicted state of the baby based on monitoring. The analyses included sensitivity, specificity, and positive and negative predictive values. RESULTS: The prevalence of fetal acidemia ranged from 15 to 20%. Adding the fetal scalp stimulation test to intermittent auscultation protocols improved the performance of intermittent auscultation for detecting severe acidemia (pH < 7.0) from 27 to 70% (p = 0.032). The negative predictive value of intermittent auscultation augmented with the fetal scalp stimulation test ranged from 88 to 99% for mild (pH < 7.2) to severe fetal acidemia. CONCLUSIONS: The fetal scalp stimulation test, conducted with a handheld Doppler, is feasible and accurate in a limited resource setting. It is a low-cost solution that merits further evaluation to reduce intrapartum stillbirth and neonatal death in low-income countries. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT02862925 ). FAU - Goodman, David M AU - Goodman DM AD - Hubert-Yeargan Center for Global Health, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA. david.goodman@orlandohealth.com. AD - Department of Obstetrics and Gynecology, Orlando Health, Winnie Palmer Hospital for Women and Babies, 83 West Miller Street, Orlando, FL, 32806, USA. david.goodman@orlandohealth.com. FAU - Mlay, Pendo AU - Mlay P AD - Kilimanjaro Christian Medical Centre, Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania. FAU - Thielman, Nathan AU - Thielman N AD - Hubert-Yeargan Center for Global Health, Department of Internal Medicine: Infectious Diseases, Duke University Medical Center, Durham, NC, USA. FAU - Small, Maria J AU - Small MJ AD - Hubert-Yeargan Center for Global Health, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA. FAU - Schmitt, John W AU - Schmitt JW AD - Hubert-Yeargan Center for Global Health, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA. LA - eng SI - ClinicalTrials.gov/NCT02862925 GR - R25 TW009337/TW/FIC NIH HHS/United States GR - R25TW009337/Fogarty International Center/ PT - Clinical Trial PT - Journal Article DEP - 20190213 TA - BMC Pregnancy Childbirth JT - BMC pregnancy and childbirth JID - 100967799 SB - IM MH - Echocardiography, Doppler/methods MH - Female MH - Fetal Hypoxia/*diagnosis MH - Fetal Monitoring/*methods MH - Heart Auscultation/*methods MH - Heart Rate, Fetal/*physiology MH - Humans MH - Labor, Obstetric/physiology MH - Pregnancy MH - Scalp MH - Tanzania MH - Ultrasonography, Doppler/*instrumentation PMC - PMC6374908 OTO - NOTNLM OT - Acidemia OT - Cardiotocography OT - Cesarean delivery OT - Doppler OT - Fetal monitoring OT - Fetal scalp stimulation OT - Intermittent auscultation OT - Neonatal mortality OT - Sub-Saharan Africa OT - Tanzania OT - Validation COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: Ethical approval for this study was obtained from Duke University Medical Center, KCMC Ethics Committee, Tanzania’s National Institute of Medical Research, and was registered with ClinicalTrials.gov (NCT02862925) prior to patient enrollment. All patients provided written consent in their heart language after being counselled by CITI-trained study nurses who are native Swahili speakers. CONSENT FOR PUBLICATION: Approved by Tanzania's National Institute for Medical Research. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER’S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2019/02/15 06:00 MHDA- 2019/06/04 06:00 CRDT- 2019/02/15 06:00 PHST- 2018/09/20 00:00 [received] PHST- 2019/02/01 00:00 [accepted] PHST- 2019/02/15 06:00 [entrez] PHST- 2019/02/15 06:00 [pubmed] PHST- 2019/06/04 06:00 [medline] AID - 10.1186/s12884-019-2212-z [pii] AID - 2212 [pii] AID - 10.1186/s12884-019-2212-z [doi] PST - epublish SO - BMC Pregnancy Childbirth. 2019 Feb 13;19(1):71. doi: 10.1186/s12884-019-2212-z. PMID- 30681540 OWN - NLM STAT- MEDLINE DCOM- 20191115 LR - 20191115 IS - 1873-233X (Electronic) IS - 0029-7844 (Linking) VI - 133 IP - 2 DP - 2019 Feb TI - ACOG Committee Opinion No. 766 Summary: Approaches to Limit Intervention During Labor and Birth. PG - 406-408 LID - 10.1097/AOG.0000000000003081 [doi] AB - Obstetrician-gynecologists, in collaboration with midwives, nurses, patients, and those who support them in labor, can help women meet their goals for labor and birth by using techniques that require minimal interventions and have high rates of patient satisfaction. Many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor. For women who are in latent labor and are not admitted to the labor unit, a process of shared decision making is recommended to create a plan for self-care activities and coping techniques. Admission during the latent phase of labor may be necessary for a variety of reasons, including pain management or maternal fatigue. Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor. Data suggest that for women with normally progressing labor and no evidence of fetal compromise, routine amniotomy need not be undertaken unless required to facilitate monitoring. The widespread use of continuous electronic fetal monitoring has not been shown to significantly affect such outcomes as perinatal death and cerebral palsy when used for women with low-risk pregnancies. Multiple nonpharmacologic and pharmacologic techniques can be used to help women cope with labor pain. Women in spontaneously progressing labor may not require routine continuous infusion of intravenous fluids. For most women, no one position needs to be mandated or proscribed. Obstetrician-gynecologists and other obstetric care providers should be familiar with and consider using low-interventional approaches, when appropriate, for the intrapartum management of low-risk women in spontaneous labor. Birthing units should carefully consider adding family-centric interventions that are otherwise not already considered routine care and that can be safely offered, given available environmental resources and staffing models. These family-centric interventions should be provided in recognition of the value of inclusion in the birthing process for many women and their families, irrespective of delivery mode. This Committee Opinion has been revised to incorporate new evidence for risks and benefits of several of these techniques and, given the growing interest on the topic, to incorporate information on a family-centered approach to cesarean birth. LA - eng PT - Editorial PL - United States TA - Obstet Gynecol JT - Obstetrics and gynecology JID - 0401101 SB - AIM SB - IM MH - *Delivery, Obstetric MH - Female MH - Humans MH - *Labor, Obstetric MH - Parturition MH - Pregnancy MH - *Unnecessary Procedures EDAT- 2019/01/27 06:00 MHDA- 2019/11/16 06:00 CRDT- 2019/01/26 06:00 PHST- 2019/01/26 06:00 [entrez] PHST- 2019/01/27 06:00 [pubmed] PHST- 2019/11/16 06:00 [medline] AID - 00006250-201902000-00037 [pii] AID - 10.1097/AOG.0000000000003081 [doi] PST - ppublish SO - Obstet Gynecol. 2019 Feb;133(2):406-408. doi: 10.1097/AOG.0000000000003081. PMID- 30575638 OWN - NLM STAT- MEDLINE DCOM- 20191115 LR - 20191115 IS - 1873-233X (Electronic) IS - 0029-7844 (Linking) VI - 133 IP - 2 DP - 2019 Feb TI - ACOG Committee Opinion No. 766: Approaches to Limit Intervention During Labor and Birth. PG - e164-e173 LID - 10.1097/AOG.0000000000003074 [doi] AB - Obstetrician-gynecologists, in collaboration with midwives, nurses, patients, and those who support them in labor, can help women meet their goals for labor and birth by using techniques that require minimal interventions and have high rates of patient satisfaction. Many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor. For women who are in latent labor and are not admitted to the labor unit, a process of shared decision making is recommended to create a plan for self-care activities and coping techniques. Admission during the latent phase of labor may be necessary for a variety of reasons, including pain management or maternal fatigue. Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor. Data suggest that for women with normally progressing labor and no evidence of fetal compromise, routine amniotomy need not be undertaken unless required to facilitate monitoring. The widespread use of continuous electronic fetal monitoring has not been shown to significantly affect such outcomes as perinatal death and cerebral palsy when used for women with low-risk pregnancies. Multiple nonpharmacologic and pharmacologic techniques can be used to help women cope with labor pain. Women in spontaneously progressing labor may not require routine continuous infusion of intravenous fluids. For most women, no one position needs to be mandated or proscribed. Obstetrician-gynecologists and other obstetric care providers should be familiar with and consider using low-interventional approaches, when appropriate, for the intrapartum management of low-risk women in spontaneous labor. Birthing units should carefully consider adding family-centric interventions that are otherwise not already considered routine care and that can be safely offered, given available environmental resources and staffing models. These family-centric interventions should be provided in recognition of the value of inclusion in the birthing process for many women and their families, irrespective of delivery mode. This Committee Opinion has been revised to incorporate new evidence for risks and benefits of several of these techniques and, given the growing interest on the topic, to incorporate information on a family-centered approach to cesarean birth. LA - eng PT - Editorial PL - United States TA - Obstet Gynecol JT - Obstetrics and gynecology JID - 0401101 SB - AIM SB - IM MH - Amniotomy MH - Cardiotocography MH - *Contraindications, Procedure MH - Family Nursing MH - Female MH - Humans MH - *Labor, Obstetric MH - Pain Management MH - *Parturition MH - Posture MH - Pregnancy MH - *Unnecessary Procedures EDAT- 2018/12/24 06:00 MHDA- 2019/11/16 06:00 CRDT- 2018/12/22 06:00 PHST- 2018/12/24 06:00 [pubmed] PHST- 2019/11/16 06:00 [medline] PHST- 2018/12/22 06:00 [entrez] AID - 10.1097/AOG.0000000000003074 [doi] PST - ppublish SO - Obstet Gynecol. 2019 Feb;133(2):e164-e173. doi: 10.1097/AOG.0000000000003074. PMID- 30682365 OWN - NLM STAT- MEDLINE DCOM- 20191216 LR - 20191217 IS - 1097-6868 (Electronic) IS - 0002-9378 (Linking) VI - 220 IP - 4 DP - 2019 Apr TI - Automated early detection of obstetric complications: theoretic and methodologic considerations. PG - 297-307 LID - S0002-9378(19)30237-6 [pii] LID - 10.1016/j.ajog.2019.01.208 [doi] AB - Compared with adults who are admitted to general medical-surgical wards, women who are admitted to labor and delivery services are at much lower risk of experiencing unexpected critical illness. Nonetheless, critical illness and other complications that put either the mother or fetus at risk do occur. One potential approach to prevention is to use automated early warning systems, such as those used for nonpregnant adults. Predictive models that use data extracted in real time from electronic records constitute the cornerstone of such systems. This article addresses several issues that are involved in the development of such predictive models: specification of temporal characteristics, choice of denominator, selection of outcomes for model calibration, potential uses of existing adult severity of illness scores, approaches to data processing, statistical considerations, validation, and options for instantiation. These have not been addressed explicitly in the obstetrics literature, which has focused on the use of manually assigned scores. In addition, this article provides some results from work in progress to develop 2 obstetric predictive models with the use of data from 262,071 women who were admitted to a labor and delivery service at 15 Kaiser Permanente Northern California hospitals between 2010 and 2017. CI - Copyright © 2019 Elsevier Inc. All rights reserved. FAU - Escobar, Gabriel J AU - Escobar GJ AD - Division of Research, Systems Research Initiative, Kaiser Permanente Northern California, Oakland, CA. Electronic address: Gabriel.Escobar@kp.org. FAU - Gupta, Neeru R AU - Gupta NR AD - Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, Oakland, CA. FAU - Walsh, Eileen M AU - Walsh EM AD - Division of Research, Perinatal Research Unit, Kaiser Permanente Northern California, Oakland, CA. FAU - Soltesz, Lauren AU - Soltesz L AD - Division of Research, Systems Research Initiative, Kaiser Permanente Northern California, Oakland, CA. FAU - Terry, Stephanie M AU - Terry SM AD - Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, San Francisco, CA. FAU - Kipnis, Patricia AU - Kipnis P AD - Division of Research, Systems Research Initiative, Kaiser Permanente Northern California, Oakland, CA; Decision Support, Kaiser Foundation Hospitals, Inc, Oakland, CA. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20190122 PL - United States TA - Am J Obstet Gynecol JT - American journal of obstetrics and gynecology JID - 0370476 SB - AIM SB - IM MH - Automation MH - Cardiotocography MH - Critical Illness MH - *Early Diagnosis MH - Early Warning Score MH - Eclampsia/diagnosis/epidemiology/prevention & control MH - Electronic Data Processing/*methods MH - *Electronic Health Records MH - Embolism/diagnosis/epidemiology/prevention & control MH - Female MH - Fetal Death MH - Humans MH - Hypoxia-Ischemia, Brain/diagnosis/epidemiology/prevention & control MH - Maternal Death MH - Obstetric Labor Complications/diagnosis/*epidemiology/prevention & control MH - Obstetrics MH - Postpartum Hemorrhage/diagnosis/epidemiology/prevention & control MH - Pre-Eclampsia/diagnosis/epidemiology/prevention & control MH - Pregnancy MH - Pregnancy Complications/diagnosis/epidemiology/prevention & control MH - Puerperal Disorders/diagnosis/*epidemiology/prevention & control MH - Risk Assessment MH - Severity of Illness Index MH - Time Factors MH - Uterine Hemorrhage/diagnosis/epidemiology/prevention & control MH - Uterine Rupture/diagnosis/epidemiology/prevention & control OTO - NOTNLM OT - *early warning system OT - *electronic medical record OT - *obstetrics OT - *predictive model OT - *severity of illness EDAT- 2019/01/27 06:00 MHDA- 2019/12/18 06:00 CRDT- 2019/01/26 06:00 PHST- 2018/10/12 00:00 [received] PHST- 2018/12/20 00:00 [revised] PHST- 2019/01/10 00:00 [accepted] PHST- 2019/01/27 06:00 [pubmed] PHST- 2019/12/18 06:00 [medline] PHST- 2019/01/26 06:00 [entrez] AID - S0002-9378(19)30237-6 [pii] AID - 10.1016/j.ajog.2019.01.208 [doi] PST - ppublish SO - Am J Obstet Gynecol. 2019 Apr;220(4):297-307. doi: 10.1016/j.ajog.2019.01.208. Epub 2019 Jan 22. PMID- 33305748 OWN - NLM STAT- MEDLINE DCOM- 20201214 LR - 20201215 IS - 1812-2078 (Electronic) IS - 1812-2027 (Linking) VI - 17 IP - 67 DP - 2019 Jul-Sept. TI - Admission Cardiotocography in Predicting Perinatal Outcome. PG - 201-205 AB - Background Antepartum assessment of the fetus is very important to prevent intra-uterine demise, birth asphyxia, neurological defect of newborns and neonatal mortality. Cardiotocography is the best indicator for fetal surveillance during labour in low resource country. Objective To assess on admission cardiotocography and predict perinatal outcome of antenatal mothers admitted to labour room for delivery at Dhulikhel Hospital, Kathmandu University Hospital. Method A prospective, observational study was conducted from 1st January 2016 to 31st December 2017. Antenatal mothers were evaluated in admission cardiotocography for 20 minutes. Cardiotocography studies were interpreted and categorized according to the classification proposed by National Institute of Clinical Excellence (NICE)- clinical guidelines 2007. Result Total 204 mothers were enrolled, the mean age is 24.06±4.331. Cardiotocography interpretation shows, 81.4% of Normal, 13.7% suspected and only 4.9% accounts pathological. Mother having CTG of pathological had more operative delivery 80% compare to normal and suspicious (0.0001). Similarly, more meconium stained liquor fall in pathological group with p value of 0.002. Fetal distress in labour is seen in all groups, showing 13.3% in normal, 32.1% in suspicious and 80% in pathological with p value 0.000. The duration of on admission cardiotocography to occurrence of fetal distress found to be mean hour of 9.57. Conclusion The admission cardiotocography test is useful to detect fetal distress which is already present at the time of test and can predict fetal wellbeing during the next few hours of labour. This test might lead to higher incidence of operative delivery at low resource countries because of lack of fetal blood sampling test to confirm fetal hypoxia during labour. FAU - Shrestha, S AU - Shrestha S AD - Department of Nursing, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. FAU - Shrestha, I AU - Shrestha I AD - Department of Nursing, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. LA - eng PT - Journal Article PT - Observational Study PL - Nepal TA - Kathmandu Univ Med J (KUMJ) JT - Kathmandu University medical journal (KUMJ) JID - 101215359 SB - IM MH - *Cardiotocography MH - Female MH - Fetal Distress/diagnosis MH - Heart Rate, Fetal MH - Humans MH - Infant, Newborn MH - *Labor, Obstetric MH - Pregnancy MH - Pregnancy Outcome MH - Prospective Studies EDAT- 2019/07/01 00:00 MHDA- 2020/12/15 06:00 CRDT- 2020/12/11 08:38 PHST- 2020/12/11 08:38 [entrez] PHST- 2019/07/01 00:00 [pubmed] PHST- 2020/12/15 06:00 [medline] PST - ppublish SO - Kathmandu Univ Med J (KUMJ). 2019 Jul-Sept.;17(67):201-205. PMID- 30562910 OWN - NLM STAT- MEDLINE DCOM- 20191216 LR - 20191217 IS - 1878-7401 (Electronic) IS - 0928-7329 (Linking) VI - 27 IP - 3 DP - 2019 TI - A novel modular fetal ECG STAN and HRV analysis: Towards robust hypoxia detection. PG - 257-287 LID - 10.3233/THC-181375 [doi] AB - This paper introduces a comprehensive fetal Electrocardiogram (fECG) Signal Extraction and Analysis Virtual Instrument that integrates various methods for detecting the R-R Intervals (RRIs) as a means to determine the fetal Heart Rate (fHR) and therefore facilitates fetal Heart Rate Variability (HRV) signal analysis. Moreover, it offers the capability to perform advanced morphological fECG signal analysis called ST segment Analysis (STAN) as it seamlessly allows the determination of the T-wave to QRS complex ratio (also called T/QRS) in the fECG signal. The integration of these signal processing and analytical modules could help clinical researchers and practitioners to noninvasively monitor and detect the life threatening hypoxic conditions that may arise in different stages of pregnancy and more importantly during delivery and could therefore lead to the reduction of unnecessary C-sections. In our experiments we used real recordings from a Fetal Scalp Electrode (FSE) as well as maternal abdominal electrodes. This Virtual Instrument (Toolbox) not only serves as a desirable platform for comparing various fECG extraction signal processing methods, it also provides an effective means to perform STAN and HRV signal analysis based on proven ECG morphological as well as Autonomic Nervous System (ANS) indices to detect hypoxic conditions. FAU - Martinek, Radek AU - Martinek R AD - Department of Cybernetics and Biomedical Engineering, VSB-Technical University of Ostrava, Ostrava 70833, Czech Republic. FAU - Kahankova, Radana AU - Kahankova R AD - Department of Cybernetics and Biomedical Engineering, VSB-Technical University of Ostrava, Ostrava 70833, Czech Republic. FAU - Martin, Boris AU - Martin B AD - Polytech Grenoble, Saint-Martin-d'Hres 38400, France. FAU - Nedoma, Jan AU - Nedoma J AD - Department of Telecommunications, VSB-Technical University of Ostrava, Ostrava 70833, Czech Republic. FAU - Fajkus, Marcel AU - Fajkus M AD - Department of Telecommunications, VSB-Technical University of Ostrava, Ostrava 70833, Czech Republic. LA - eng PT - Journal Article PL - Netherlands TA - Technol Health Care JT - Technology and health care : official journal of the European Society for Engineering and Medicine JID - 9314590 SB - IM MH - Electrocardiography/*methods MH - Female MH - Fetal Monitoring/*methods MH - Fetus/*physiology MH - Heart Rate, Fetal/*physiology MH - Humans MH - Hypoxia/*diagnosis/*physiopathology MH - Male MH - Pregnancy MH - Signal Processing, Computer-Assisted OTO - NOTNLM OT - Fetal ECG (fECG) OT - STAN analysis (T:QRS ratio) OT - abdominal ECG (aECG) OT - feature extraction OT - fetal Heart Rate (fHR) OT - fetal Heart Rate Variability (HRV) OT - maternal ECG (mECG) EDAT- 2018/12/20 06:00 MHDA- 2019/12/18 06:00 CRDT- 2018/12/20 06:00 PHST- 2018/12/20 06:00 [pubmed] PHST- 2019/12/18 06:00 [medline] PHST- 2018/12/20 06:00 [entrez] AID - THC181375 [pii] AID - 10.3233/THC-181375 [doi] PST - ppublish SO - Technol Health Care. 2019;27(3):257-287. doi: 10.3233/THC-181375. PMID- 30040750 OWN - NLM STAT- MEDLINE DCOM- 20190924 LR - 20190925 IS - 1878-4429 (Electronic) IS - 1878-4429 (Linking) VI - 12 IP - 1 DP - 2019 TI - Association between clinical chorioamnionitis and histological funisitis at term. PG - 37-40 LID - 10.3233/NPM-17155 [doi] AB - To predict the presence of histological funisitis at term, we examined the symptoms of clinical chorioamnionitis in 251 cases of maternal fever of 38 degrees or higher during labor at term. The examined symptoms in this study were clinical maternal findings (uterine fundal tenderness, maternal tachycardia, purulent or foul amniotic fluid or cervical discharge, and maternal white blood cell count) and fetal tachycardia. In these cases, microscopic histopathological analysis of the placenta was performed after delivery. The positive predictive value for histological funisitis in cases of maternal fever of 38 degrees or higher was only 15.5%. In cases of maternal fever with uterine fundal tenderness and purulent or foul amniotic fluid or cervical discharge at term, the positive predictive value for histological chorioamnionitis was 100%. Therefore, uterine fundal tenderness and amniotic fluid or cervical discharge with a foul odor are important symptoms to predict the presence of funisitis in cases of maternal fever of 38 degrees or higher. FAU - Suzuki, S AU - Suzuki S AD - Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan. LA - eng PT - Journal Article PL - Netherlands TA - J Neonatal Perinatal Med JT - Journal of neonatal-perinatal medicine JID - 101468335 SB - IM MH - Adult MH - Amniotic Fluid/chemistry/*microbiology MH - Chorioamnionitis/*diagnosis/microbiology/pathology MH - Female MH - Fever/*microbiology MH - Heart Rate, Fetal MH - Humans MH - Infant, Newborn MH - Placenta/*microbiology/pathology MH - Predictive Value of Tests MH - Pregnancy MH - Pregnancy Complications, Infectious/*microbiology/pathology MH - Retrospective Studies MH - Term Birth OTO - NOTNLM OT - Clinical chorioamnionitis OT - histological funisitis OT - purulent or foul amniotic fluid or cervical discharge OT - uterine fundal tenderness EDAT- 2018/07/25 06:00 MHDA- 2019/09/26 06:00 CRDT- 2018/07/25 06:00 PHST- 2018/07/25 06:00 [pubmed] PHST- 2019/09/26 06:00 [medline] PHST- 2018/07/25 06:00 [entrez] AID - NPM17155 [pii] AID - 10.3233/NPM-17155 [doi] PST - ppublish SO - J Neonatal Perinatal Med. 2019;12(1):37-40. doi: 10.3233/NPM-17155. PMID- 30594567 OWN - NLM STAT- MEDLINE DCOM- 20191119 LR - 20191119 IS - 1097-6868 (Electronic) IS - 0002-9378 (Linking) VI - 220 IP - 3 DP - 2019 Mar TI - Computerized analysis of cardiotocograms and ST signals is associated with significant reductions in hypoxic-ischemic encephalopathy and cesarean delivery: an observational study in 38,466 deliveries. PG - 269.e1-269.e8 LID - S0002-9378(18)32288-9 [pii] LID - 10.1016/j.ajog.2018.12.037 [doi] AB - BACKGROUND: Intrapartum cardiotocography is widely used in high-resource countries and remains at the center of fetal monitoring and the decision to intervene, but there is ample evidence of poor reliability in visual interpretation as well as limited accuracy in identifying fetal hypoxia. Combined monitoring of intrapartum cardiotocography and ST segment signals was developed to increase specificity, but analysis relies heavily on intrapartum cardiotocography interpretation and is therefore also affected by the previously referred problems. Computerized analysis was developed to overcome these limitations, aiding in the quantification of parameters that are difficult to evaluate visually, such as variability, integrating the complex guidelines of combined intrapartum cardiotocography and ST analysis, and using visual and sound alerts to prompt health care professionals to reevaluate features associated with fetal hypoxia. OBJECTIVE: The objective of the study was to evaluate the effect of introducing a central fetal monitoring system with computerized analysis of intrapartum cardiotocography and ST signals into the labor ward of a tertiary care university hospital in which all women are continuously monitored with intrapartum cardiotocography. The incidence of adverse perinatal outcomes and intervention rates was evaluated over time. STUDY DESIGN: In this retrospective cohort study, yearly rates of hypoxic-ischemic encephalopathy, instrumental vaginal delivery, overall cesarean delivery, and urgent cesarean delivery were obtained from the hospital's clinical databases. The rates occurring in the period from January 2001 to December 2003, before the introduction of the central monitoring system with computerized analysis of intrapartum cardiotocography and ST signals (Omniview-SisPorto), were compared with those occurring from January 2004 to December 2014, after the introduction of the system. All rates were calculated with 95% confidence intervals. RESULTS: A total of 38,466 deliveries occurred during this period. After introduction of the system, there was a significant decrease in the number of hypoxic-ischemic encephalopathy cases per 1000 births (5.3%, 95% confidence interval [4.0-7.0] vs 2.2%, 95% confidence interval [1.7-2.8]; relative risk, 0.42, 95% confidence interval [0.29-0.61]), overall cesarean delivery rates (29.9%, 95% confidence interval [28.9-30.8] vs 28.3%, 95% confidence interval [27.8-28.8]; relative risk, 0.96, 95% confidence interval [0.92-0.99]), and urgent cesarean deliveries (21.6%, 95% confidence interval [20.7-22.4] vs 19.2%, 95% confidence interval [18.8-19.7]; relative risk, 0.91, 95% confidence interval [0.87-0.95]). The instrumental vaginal delivery rate increased (19.5%, 95% confidence interval [18.7-20.3] vs 21.4%, 95% confidence interval [21.0-21.9; relative risk, 1.07, 95% confidence interval 1.02-1.13]. CONCLUSION: Introduction of computerized analysis of intrapartum cardiotocography and ST signals in a tertiary care hospital was associated with a significant reduction in the incidence of hypoxic-ischemic encephalopathy and a modest reduction in cesarean deliveries. CI - Copyright © 2019 Elsevier Inc. All rights reserved. FAU - Lopes-Pereira, Joana AU - Lopes-Pereira J AD - Department of Obstetrics and Gynecology, University of Porto School of Medicine, and Centro Hospitalar, S. João, Portugal. Electronic address: joanaslopespereira@gmail.com. FAU - Costa, Antónia AU - Costa A AD - Department of Obstetrics and Gynecology, University of Porto School of Medicine, and Centro Hospitalar, S. João, Portugal; Institute of Biomedical Engineering, University of Porto School of Medicine, Porto, Portugal. Electronic address: cosantonia@gmail.com. FAU - Ayres-De-Campos, Diogo AU - Ayres-De-Campos D AD - Institute of Biomedical Engineering, University of Porto School of Medicine, Porto, Portugal; Department of Health Information and Decision Sciences and Center for Research in Health Technology and Services, University of Porto School of Medicine, Porto, Portugal; Department of Obstetrics, Gynecology, and Reproductive Medicine, Santa Maria Hospital, University of Lisbon School of Medicine, Lisbon, Portugal. FAU - Costa-Santos, Cristina AU - Costa-Santos C AD - Department of Health Information and Decision Sciences and Center for Research in Health Technology and Services, University of Porto School of Medicine, Porto, Portugal. FAU - Amaral, Joana AU - Amaral J AD - Department of Obstetrics and Gynecology, University of Porto School of Medicine, and Centro Hospitalar, S. João, Portugal. FAU - Bernardes, João AU - Bernardes J AD - Department of Obstetrics and Gynecology, University of Porto School of Medicine, and Centro Hospitalar, S. João, Portugal; Institute of Biomedical Engineering, University of Porto School of Medicine, Porto, Portugal. LA - eng PT - Journal Article PT - Observational Study DEP - 20181227 PL - United States TA - Am J Obstet Gynecol JT - American journal of obstetrics and gynecology JID - 0370476 SB - AIM SB - IM MH - Cardiotocography/*methods MH - Cesarean Section/*statistics & numerical data MH - Female MH - Humans MH - Hypoxia-Ischemia, Brain/epidemiology/*prevention & control MH - Image Interpretation, Computer-Assisted/*methods MH - Incidence MH - Infant, Newborn MH - Pregnancy MH - Retrospective Studies MH - Treatment Outcome OTO - NOTNLM OT - *central monitoring OT - *electronic fetal monitoring OT - *fetal distress OT - *fetal heart rate OT - *intrapartum surveillance OT - *neonatal acidemia OT - *neonatal asphyxia OT - *neonatal encephalopathy OT - *nonreassuring heart rate tracings OT - *real-time alerts EDAT- 2018/12/31 06:00 MHDA- 2019/11/20 06:00 CRDT- 2018/12/31 06:00 PHST- 2018/05/20 00:00 [received] PHST- 2018/11/29 00:00 [revised] PHST- 2018/12/20 00:00 [accepted] PHST- 2018/12/31 06:00 [pubmed] PHST- 2019/11/20 06:00 [medline] PHST- 2018/12/31 06:00 [entrez] AID - S0002-9378(18)32288-9 [pii] AID - 10.1016/j.ajog.2018.12.037 [doi] PST - ppublish SO - Am J Obstet Gynecol. 2019 Mar;220(3):269.e1-269.e8. doi: 10.1016/j.ajog.2018.12.037. Epub 2018 Dec 27. PMID- 30563786 OWN - NLM STAT- MEDLINE DCOM- 20191206 LR - 20191217 IS - 2468-7189 (Electronic) IS - 2468-7189 (Linking) VI - 47 IP - 1 DP - 2019 Jan TI - [Per-partum risk factors of neonatal acidemia in planned vaginal delivery for fetuses in breech presentation]. PG - 11-17 LID - S2468-7189(18)30310-6 [pii] LID - 10.1016/j.gofs.2018.10.036 [doi] AB - OBJECTIVES: Delivery mode of term breech presentation is debated because of higher rate of neonatal acidosis (pH<7.15) in planned vaginal delivery than in planned caesarean section. The objective was to evaluate per-partum risk factors of neonatal acidosis in vaginal delivery for podalic fetuses. METHODS: It was a single-centre, case-control retrospective study that included planned vaginal delivery in singleton term breech presentation between 2012 and 2016. The "case" group defined by neonatal pH≤7.10 and the "control" group defined by neonatal pH≥7.20 were matched. The maternal, labor, and neonatal characteristics were noted. RESULTS: One hundred and thirty-two patients were included: each of 44 patients in "case" group, has been matched according to breech type (legs position) to 2 patients in the "control" group, so 88. In multivariate analysis, significant risk factors identified were oxytocin use [ORa=5.663 (95% CI=1.844-17.397)], "high risk" fetal heart rate (FHR) abnormalities according to FIGO classification [ORa=10.997 (95% CI=1.864-64.866)] and FHR abnormalities during expulsion, Melchior 2 [ORa=8.088 (95% CI=1.192-54.875)] and Melchior 4 [ORa=12.705 (95% CI=1.157-139.541)]. CONCLUSIONS: These risk factors of neonatal acidemia have to be known to improve the labor management in case of breech planned vaginal delivery. CI - Copyright © 2018 Elsevier Masson SAS. All rights reserved. FAU - Vannerum, M AU - Vannerum M AD - Clinique d'obstétrique, CHU de Lille, avenue Eugène-Avinée, 59000 Lille, France; EA 4489, faculté de médecine Henri-Warembourg, université de Lille, 2, avenue Eugène-Avinée, 59120 Loos, France. Electronic address: melvannerum@gmail.com. FAU - Subtil, D AU - Subtil D AD - Clinique d'obstétrique, CHU de Lille, avenue Eugène-Avinée, 59000 Lille, France; EA 4489, faculté de médecine Henri-Warembourg, université de Lille, 2, avenue Eugène-Avinée, 59120 Loos, France. FAU - Drumez, E AU - Drumez E AD - EA 2694 - santé publique : épidémiologie et qualité des soins, département de biostatistiques, université de Lille, CHU de Lille, 6, rue du Professeur-Laguesse, 59037 Lille, France. FAU - Brochot, C AU - Brochot C AD - Maternité, centre hospitalier d'Arras, 3, boulevard Georges-Besnier, 62000 Arras, France. FAU - Houfflin-Debarge, V AU - Houfflin-Debarge V AD - Clinique d'obstétrique, CHU de Lille, avenue Eugène-Avinée, 59000 Lille, France; EA 4489, faculté de médecine Henri-Warembourg, université de Lille, 2, avenue Eugène-Avinée, 59120 Loos, France. FAU - Garabedian, C AU - Garabedian C AD - Clinique d'obstétrique, CHU de Lille, avenue Eugène-Avinée, 59000 Lille, France; EA 4489, faculté de médecine Henri-Warembourg, université de Lille, 2, avenue Eugène-Avinée, 59120 Loos, France. LA - fre PT - Journal Article TT - Facteurs de risque per-partum d’acidose néonatale en cas de tentative d’accouchement voie basse chez les fœtus en présentation podalique. DEP - 20181215 PL - France TA - Gynecol Obstet Fertil Senol JT - Gynecologie, obstetrique, fertilite & senologie JID - 101693805 RN - 50-56-6 (Oxytocin) SB - IM MH - Acidosis/*epidemiology MH - Adult MH - Breech Presentation/*physiopathology/therapy MH - Case-Control Studies MH - Cesarean Section MH - Delivery, Obstetric/*methods MH - Female MH - Heart Rate, Fetal MH - Humans MH - Hydrogen-Ion Concentration MH - Infant, Newborn MH - Oxytocin/administration & dosage/adverse effects MH - Pregnancy MH - Retrospective Studies MH - Risk Factors OTO - NOTNLM OT - *Accouchement voie basse OT - *Acidose néonatale OT - *Breech OT - *Facteurs de risque OT - *Neonatal acidosis OT - *Per-partum OT - *Risk factors OT - *Siège OT - *Vaginal delivery EDAT- 2018/12/20 06:00 MHDA- 2019/12/18 06:00 CRDT- 2018/12/20 06:00 PHST- 2018/06/05 00:00 [received] PHST- 2018/12/20 06:00 [pubmed] PHST- 2019/12/18 06:00 [medline] PHST- 2018/12/20 06:00 [entrez] AID - S2468-7189(18)30310-6 [pii] AID - 10.1016/j.gofs.2018.10.036 [doi] PST - ppublish SO - Gynecol Obstet Fertil Senol. 2019 Jan;47(1):11-17. doi: 10.1016/j.gofs.2018.10.036. Epub 2018 Dec 15. PMID- 30461166 OWN - NLM STAT- MEDLINE DCOM- 20190923 LR - 20210109 IS - 1471-0528 (Electronic) IS - 1470-0328 (Linking) VI - 126 IP - 11 DP - 2019 Oct TI - Computerised analysis of intrapartum fetal heart rate patterns and adverse outcomes in the INFANT trial. PG - 1354-1361 LID - 10.1111/1471-0528.15535 [doi] AB - OBJECTIVE: To assess if a computerised decision support system reliably identified abnormal fetal heart rate (FHR) patterns in fetuses with adverse neonatal outcomes in the INFANT trial, and whether its use reduced substandard care. DESIGN: Prospective cohort study within a randomised controlled trial. SETTING: Twenty-four maternity units in the UK and Ireland. POPULATION OR SAMPLE: A total of 46 614 labours between January 6 2010 and August 31 2013 in the INFANT trial. METHODS: Panel review of intrapartum and neonatal care in infants with adverse outcome, and an assessment of the effectiveness of computerised interpretation of fetal heart rate in reducing substandard care. Descriptive analysis of other factors associated with adverse outcome. MAIN OUTCOME MEASURES: Incidence and detection rate of abnormal fetal heart rate patterns, other characteristics associated with perinatal adverse outcome, and frequency of substandard care. RESULTS: Computer interpretation of FHR patterns was deemed to be completely valid in only 24 of 71 (33.8%) cases of adverse outcome. On a scale of 0-10 (completely invalid to completely valid), 28 cases (39.4%) had a score of 6 or less, mainly due to lack of recognition of decelerations (15 cases), or reduced variability (seven cases), or failure to recognise tachysystole (five cases). There were multiple associated factors that modified the clinical assessment of FHR patterns. There was substandard care in 45/71 cases (63%). CONCLUSION: A significant proportion of abnormal fetal heart rate patterns were not detected accurately by computer analysis, and its use did not reduce the incidence of substandard care. FUNDING: UK National Institute for Health Research Health Technology Assessment Programme (project number 06.38.01). TWEETABLE ABSTRACT: Improved recognition of abnormal fetal heart rate patterns is insufficient to reduce the incidence of substandard care. CI - © 2018 Royal College of Obstetricians and Gynaecologists. FAU - Steer, P J AU - Steer PJ AD - Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK. AD - Faculty of Medicine, Imperial College, London, UK. FAU - Kovar, I AU - Kovar I AD - Faculty of Medicine, Imperial College, London, UK. AD - Department of Paediatrics, Chelsea and Westminster Hospital, London, UK. FAU - McKenzie, C AU - McKenzie C AD - McKenzie Consulting, Glasgow, UK. FAU - Griffin, M AU - Griffin M AD - Department of Midwifery, Chelsea and Westminster Hospital, London, UK. FAU - Linsell, L AU - Linsell L AD - National Perinatal Epidemiology Unit, Oxford, UK. LA - eng GR - 06/38/01/DH_/Department of Health/United Kingdom GR - NIHR Collaboration for Leadership in Applied Health Research and Care West Midlands/ GR - UK Medical Research Council/ PT - Journal Article PT - Randomized Controlled Trial PT - Video-Audio Media DEP - 20181207 PL - England TA - BJOG JT - BJOG : an international journal of obstetrics and gynaecology JID - 100935741 SB - AIM SB - IM CIN - BJOG. 2019 Oct;126(11):1363. PMID: 31486225 CIN - BJOG. 2020 Mar;127(4):523-524. PMID: 31916384 MH - Adult MH - *Cardiotocography MH - Decision Support Systems, Clinical MH - Female MH - Fetal Distress/*diagnostic imaging MH - *Fetal Monitoring MH - Heart Rate, Fetal/*physiology MH - Humans MH - *Image Processing, Computer-Assisted MH - Infant, Newborn MH - Intensive Care Units, Neonatal MH - Ireland MH - Pregnancy MH - Prospective Studies MH - United Kingdom OTO - NOTNLM OT - Adverse outcome OT - intrapartum fetal heart rate monitoring OT - risk factors OT - suboptimal care EDAT- 2018/11/22 06:00 MHDA- 2019/09/24 06:00 CRDT- 2018/11/22 06:00 PHST- 2018/10/14 00:00 [accepted] PHST- 2018/11/22 06:00 [pubmed] PHST- 2019/09/24 06:00 [medline] PHST- 2018/11/22 06:00 [entrez] AID - 10.1111/1471-0528.15535 [doi] PST - ppublish SO - BJOG. 2019 Oct;126(11):1354-1361. doi: 10.1111/1471-0528.15535. Epub 2018 Dec 7. PMID- 30463080 OWN - NLM STAT- MEDLINE DCOM- 20200213 LR - 20200213 IS - 1421-9964 (Electronic) IS - 1015-3837 (Linking) VI - 46 IP - 3 DP - 2019 TI - Refining the Prediction and Prevention of Emergency Operative Deliveries with the Fetal Reserve Index. PG - 159-165 LID - 10.1159/000494617 [doi] AB - Electronic fetal monitoring (EFM) is a poor predictor of outcomes attributable to delivery problems. Contextualizing EFM by adding maternal, obstetrical, and fetal risk-related information to create an index called the Fetal Reserve Index (FRI) improves the predictive capacity and facilitates the timing of interventions. Here, we test critical assumptions of FRI as a clinical tool. Our conceptualization implies that the earlier one reaches the red zone (FRI ≤25) and the longer one spends in the red zone, the greater the likelihood of emergency operative deliveries (EOD). METHODS: We analyzed 1,402 patients using logistic regression predicting the probability of EOD and employed qualitative methodology techniques to refine predictive capabilities. RESULTS: Reaching the red zone early and staying there > 1 h increases the probability of EOD. When these risk factors are paired with intrauterine resuscitation (IR) in Stage 1, the reduction of EOD is substantial. CONCLUSION: FRI is a capable predictor of EOD because it accurately identifies the level of malleable risk. FRI analysis increases the risk of using IR in Stage 1. Matching risk and resources dramatically reduces the chances of EOD. Earlier IR improves the outcomes if the calculated risk is high. CI - © 2018 S. Karger AG, Basel. FAU - Britt, David W AU - Britt DW AD - Fetal Medicine Foundation of America, New York, New York, USA. FAU - Evans, Mark I AU - Evans MI AD - Fetal Medicine Foundation of America, New York, New York, USA. AD - Comprehensive Genetics, PLLC/Department of Obstetrics and Gynecology, Mt. Sinai School of Medicine, New York, New York, USA. FAU - Schifrin, Barry S AU - Schifrin BS AD - Fetal Medicine Foundation of America, New York, New York, USA. FAU - Eden, Robert D AU - Eden RD AD - Fetal Medicine Foundation of America, New York, New York, USA. LA - eng PT - Journal Article DEP - 20181121 PL - Switzerland TA - Fetal Diagn Ther JT - Fetal diagnosis and therapy JID - 9107463 SB - IM MH - Adult MH - *Cardiotocography MH - Cerebral Palsy/*prevention & control MH - *Cesarean Section MH - Delivery, Obstetric/*methods MH - Female MH - Fetal Distress MH - Heart Rate, Fetal MH - Humans MH - Infant, Newborn MH - Pregnancy MH - Risk Factors OTO - NOTNLM OT - ACOG monitoring classification system OT - Cerebral palsy OT - Electronic fetal monitoring OT - Fetal Reserve Index OT - Intrauterine resuscitation OT - Neonatal encephalopathy EDAT- 2018/11/22 06:00 MHDA- 2020/02/14 06:00 CRDT- 2018/11/22 06:00 PHST- 2018/08/24 00:00 [received] PHST- 2018/10/17 00:00 [accepted] PHST- 2018/11/22 06:00 [pubmed] PHST- 2020/02/14 06:00 [medline] PHST- 2018/11/22 06:00 [entrez] AID - 000494617 [pii] AID - 10.1159/000494617 [doi] PST - ppublish SO - Fetal Diagn Ther. 2019;46(3):159-165. doi: 10.1159/000494617. Epub 2018 Nov 21. PMID- 30397231 OWN - NLM STAT- MEDLINE DCOM- 20191021 LR - 20191105 IS - 2045-2322 (Electronic) IS - 2045-2322 (Linking) VI - 8 IP - 1 DP - 2018 Nov 5 TI - EEG sharp waves are a biomarker of striatal neuronal survival after hypoxia-ischemia in preterm fetal sheep. PG - 16312 LID - 10.1038/s41598-018-34654-7 [doi] LID - 16312 AB - The timing of hypoxia-ischemia (HI) in preterm infants is often uncertain and there are few biomarkers to determine whether infants are in a treatable stage of injury. We evaluated whether epileptiform sharp waves recorded from the parietal cortex could provide early prediction of neuronal loss after HI. Preterm fetal sheep (0.7 gestation) underwent acute HI induced by complete umbilical cord occlusion for 25 minutes (n = 6) or sham occlusion (control, n = 6). Neuronal survival was assessed 7 days after HI by immunohistochemistry. Sharp waves were quantified manually and using a wavelet-type-2-fuzzy-logic-system during the first 4 hours of recovery. HI resulted in significant subcortical neuronal loss. Sharp waves counted by the automated classifier in the first 30 minutes after HI were associated with greater neuronal survival in the caudate nucleus (r = 0.80), whereas sharp waves between 2-4 hours after HI were associated with reduced neuronal survival (r = -0.83). Manual and automated counts were closely correlated. This study suggests that automated quantification of sharp waves may be useful for early assessment of HI injury in preterm infants. However, the pattern of evolution of sharp waves after HI was markedly affected by the severity of neuronal loss, and therefore early, continuous monitoring is essential. FAU - Abbasi, Hamid AU - Abbasi H AUID- ORCID: 0000-0003-1136-3280 AD - Department of Engineering Science, The University of Auckland, Auckland, New Zealand. FAU - Drury, Paul P AU - Drury PP AD - Department of Physiology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand. FAU - Lear, Christopher A AU - Lear CA AUID- ORCID: 0000-0002-8937-0846 AD - Department of Physiology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand. FAU - Gunn, Alistair J AU - Gunn AJ AUID- ORCID: 0000-0003-0656-7035 AD - Department of Physiology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand. FAU - Davidson, Joanne O AU - Davidson JO AD - Department of Physiology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand. FAU - Bennet, Laura AU - Bennet L AD - Department of Physiology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand. FAU - Unsworth, Charles P AU - Unsworth CP AD - Department of Engineering Science, The University of Auckland, Auckland, New Zealand. c.unsworth@auckland.ac.nz. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20181105 TA - Sci Rep JT - Scientific reports JID - 101563288 RN - 0 (Biomarkers) SB - IM MH - Animals MH - Biomarkers/metabolism MH - Cell Count MH - Cell Survival MH - *Electroencephalography MH - Fuzzy Logic MH - Hemodynamics MH - Hypoxia-Ischemia, Brain/metabolism/*pathology/*physiopathology MH - Infant, Premature MH - Neurons/*pathology MH - Sheep MH - *Signal Processing, Computer-Assisted MH - Survival Analysis MH - Wavelet Analysis PMC - PMC6218488 COIS- The authors declare no competing interests. EDAT- 2018/11/07 06:00 MHDA- 2019/10/23 06:00 CRDT- 2018/11/07 06:00 PHST- 2017/11/10 00:00 [received] PHST- 2018/10/16 00:00 [accepted] PHST- 2018/11/07 06:00 [entrez] PHST- 2018/11/07 06:00 [pubmed] PHST- 2019/10/23 06:00 [medline] AID - 10.1038/s41598-018-34654-7 [pii] AID - 34654 [pii] AID - 10.1038/s41598-018-34654-7 [doi] PST - epublish SO - Sci Rep. 2018 Nov 5;8(1):16312. doi: 10.1038/s41598-018-34654-7. PMID- 30235166 OWN - NLM STAT- MEDLINE DCOM- 20190620 LR - 20190620 IS - 1361-6579 (Electronic) IS - 0967-3334 (Linking) VI - 39 IP - 10 DP - 2018 Nov 1 TI - The effects of asymmetric volume conductor modeling on non-invasive fetal ECG extraction. PG - 105013 LID - 10.1088/1361-6579/aae305 [doi] AB - OBJECTIVE: Non-invasive fetal electrocardiography (NI-FECG) shows promise for capturing novel physiological information that may indicate signs of fetal distress. However, significant deterioration in NI-FECG signal quality occurs during the presence of a highly non-conductive layer known as vernix caseosa which forms on the fetal body surface beginning in approximately the 28th week of gestation. This work investigates asymmetric modeling of vernix caseosa and other maternal-fetal tissues in accordance with clinical observations and assesses their impacts for NI-FECG signal processing. APPROACH: We develop a process for simulating dynamic maternal-fetal abdominal ECG mixtures using a synthetic cardiac source model embedded in a finite element volume conductor. Using this process, changes in NI-FECG signal morphology are assessed in an extensive set of finite element models including spatially variable distributions of vernix caseosa. MAIN RESULTS: Our simulations show that volume conductor asymmetry can result in over 70% error in the observed T/QRS ratio and significant changes to signal morphology compared to a homogeneous volume conductor model. Volume conductor effects must be considered when analyzing T/QRS ratios obtained via NI-FECG and should be considered in future algorithm benchmarks using simulated data. SIGNIFICANCE: This work shows that without knowledge of the influence of volume conductor effects, clinical evaluation of the T/QRS ratio derived via NI-FECG should be avoided. FAU - Keenan, Emerson AU - Keenan E AD - Department of Electrical and Electronic Engineering, The University of Melbourne, Melbourne, VIC 3010, Australia. FAU - Karmakar, Chandan Kumar AU - Karmakar CK FAU - Palaniswami, Marimuthu AU - Palaniswami M LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20181101 PL - England TA - Physiol Meas JT - Physiological measurement JID - 9306921 SB - IM MH - Computer Simulation MH - Electrocardiography/*methods MH - Female MH - Fetal Monitoring/*methods MH - Finite Element Analysis MH - Humans MH - *Models, Biological MH - Pregnancy MH - Signal Processing, Computer-Assisted EDAT- 2018/09/21 06:00 MHDA- 2019/06/21 06:00 CRDT- 2018/09/21 06:00 PHST- 2018/09/21 06:00 [pubmed] PHST- 2019/06/21 06:00 [medline] PHST- 2018/09/21 06:00 [entrez] AID - 10.1088/1361-6579/aae305 [doi] PST - epublish SO - Physiol Meas. 2018 Nov 1;39(10):105013. doi: 10.1088/1361-6579/aae305. PMID- 30376679 OWN - NLM STAT- MEDLINE DCOM- 20190626 LR - 20190626 IS - 1806-9339 (Electronic) IS - 0100-7203 (Linking) VI - 40 IP - 12 DP - 2018 Dec TI - Umbilical Cord Blood Gas Analysis, Obstetric Performance and Perinatal Outcome. PG - 740-748 LID - 10.1055/s-0038-1675187 [doi] AB - OBJECTIVE:  To analyze if umbilical artery pH (pH(ua)) ≤7.00 and umbilical artery blood deficit (BD(ua)) ≥12.00 mmol/L are good predictors of adverse neonatal outcomes. METHODS:  This was an observational, longitudinal and retrospective cohort study, conducted at the department of obstetrics and gynecology of Centro Hospitalar Tondela Viseu between September 2013 and September 2015. Total cohort and subgroup analysis were performed: group A-women with umbilical cord blood gas analysis (UCBGA) performed for non-reassuring fetal cardiotocographic patterns, placental abruption, or shoulder dystocia; and group B-all the others. Assays were made with the software SPSS for Windows, Versions 20.0 and 21.0 (IBM Corp., Armonk, NY, USA). RESULTS:  A total of 428 UCBGAs met the inclusion criteria. The group analysis revealed an association between group A and pHua ≤7.00, as well as between BDua ≥12.00 mmol/L and 1st minute Apgar score ≤4 (p = 0.011). After the application of the logistic regression models in the total cohort analysis, pH(ua) ≤7.00 had an impact in the occurrence of acute neonatal hypoxia (odds ratio [OR]: 6.71; 95% confidence interval [CI]: 1.21-37.06; p = 0.029); multiparous women had a higher risk of delivering a newborn with first minute Apgar score ≤4 and acute neonatal hypoxia (OR: 5.38; 95% CI: 1.35-21.43; p = 0.017; and OR: 2.66; 95% CI: 1.03-6.89, p = 0.043, respectively); women who had urologic problems during pregnancy had a higher risk of delivering a newborn with 5th minute Apgar score ≤7 (OR: 15.17; 95% CI: 1.29-177.99; p = 0.030); and shoulder dystocia represented a 15 times higher risk of acute neonatal hypoxia (OR: 14.82; 95% CI: 2.20-99.60; p = 0.006). CONCLUSION:  The pH(ua) and the BD(ua) are predictors of adverse neonatal outcome, and UCBGA is a useful tool for screening newborns at risk. Universal UCBGA should be considered for all deliveries, as it is an accurate screening test for neonatal hypoxia. CI - Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil. FAU - Ferreira, Cátia Sofia AU - Ferreira CS AD - Department of Obstetrics and Gynecology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal. FAU - Melo, Ângela AU - Melo  AD - Department of Obstetrics and Gynecology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal. FAU - Fachada, Ana Helena AU - Fachada AH AD - Department of Obstetrics and Gynecology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal. FAU - Solheiro, Helena AU - Solheiro H AD - Department of Obstetrics and Gynecology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal. FAU - Nogueira Martins, Nuno AU - Nogueira Martins N AD - Department of Obstetrics and Gynecology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal. LA - eng PT - Journal Article PT - Observational Study TT - Gasometria do cordão umbilical, atuação obstétrica e desfecho neonatal. DEP - 20181030 PL - Brazil TA - Rev Bras Ginecol Obstet JT - Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia JID - 9214757 SB - IM MH - Adolescent MH - Adult MH - Blood Gas Analysis MH - Female MH - Fetal Blood/*chemistry MH - Humans MH - Hydrogen-Ion Concentration MH - Infant, Newborn MH - Longitudinal Studies MH - Pregnancy MH - *Pregnancy Outcome MH - Retrospective Studies MH - Risk Factors MH - Young Adult COIS- The authors have no conflicts of interests to disclose. EDAT- 2018/10/31 06:00 MHDA- 2019/06/27 06:00 CRDT- 2018/10/31 06:00 PHST- 2018/10/31 06:00 [pubmed] PHST- 2019/06/27 06:00 [medline] PHST- 2018/10/31 06:00 [entrez] AID - 10.1055/s-0038-1675187 [doi] PST - ppublish SO - Rev Bras Ginecol Obstet. 2018 Dec;40(12):740-748. doi: 10.1055/s-0038-1675187. Epub 2018 Oct 30. PMID- 30405441 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200930 IS - 1664-042X (Print) IS - 1664-042X (Electronic) IS - 1664-042X (Linking) VI - 9 DP - 2018 TI - Intrapartum Fetal Heart Rate: A Possible Predictor of Neonatal Acidemia and APGAR Score. PG - 1489 LID - 10.3389/fphys.2018.01489 [doi] LID - 1489 AB - Background: Predicting perinatal outcomes based on patterns of fetal heart rate (FHR) remains a challenge. The aim of this study was to evaluate intrapartum FHR variability as predictor for neonatal acidemia and APGAR score. Methods: This was a retrospective observational study of 552 childbirths. Multivariable linear regression models were used to assess the association between FHR variability and each of the following outcomes: arterial cord blood pH and base deficit, Apgar 1, and 5 scores. Variables used for adjustment were maternal age, comorbidities (gestational diabetes, preeclampsia, maternal fever, and hypertension), parity, gravidity, uterine contractions, and newborn gestational age, and weight at birth. Results: The following factors were associated with an increased risk of metabolic acidosis and low Apgar scores at birth: increased mean and coefficient of variation (CV) of the FHR, type of delivery and decreased parity. Each 10-beat/min increase in the FHR was associated with an increase of 0.43 mEq/L in the base deficit, and a decrease of 0.01 in the pH, 0.2 in the Apgar 1, and 0.14 in the Apgar 5 scores. Each 10% increase in the CV of the FHR was associated with an increase of 4.05 mEq/L in the base deficit and a decrease of 0.13 in the pH, 1.31 in the Apgar 1, and 0.86 in the Apgar 5 scores. Conclusion: These data suggest the intrapartum FHR variability is physiologically relevant and can be used for predicting the acidemia and Apgar scores at birth of the newborn infants without severe cases of morbidity and from uncomplicated pregnancies. FAU - Medeiros, Thâmila Kamila de Souza AU - Medeiros TKS AD - Center of Innovation, Technology and Education at Anhembi Morumbi University - Laureate International Universities, São José dos Campos, Brazil. AD - School of Health Sciences at Anhembi Morumbi University - Laureate International Universities, São José dos Campos, Brazil. FAU - Dobre, Mirela AU - Dobre M AD - Division of Nephrology and Hypertension, University Hospitals, Cleveland, OH, United States. FAU - da Silva, Daniela Monteiro Baptista AU - da Silva DMB AD - Center of Innovation, Technology and Education at Anhembi Morumbi University - Laureate International Universities, São José dos Campos, Brazil. AD - School of Health Sciences at Anhembi Morumbi University - Laureate International Universities, São José dos Campos, Brazil. FAU - Brateanu, Andrei AU - Brateanu A AD - Medicine Institute, Cleveland Clinic, Cleveland, OH, United States. FAU - Baltatu, Ovidiu Constantin AU - Baltatu OC AD - Center of Innovation, Technology and Education at Anhembi Morumbi University - Laureate International Universities, São José dos Campos, Brazil. AD - School of Health Sciences at Anhembi Morumbi University - Laureate International Universities, São José dos Campos, Brazil. FAU - Campos, Luciana Aparecida AU - Campos LA AD - Center of Innovation, Technology and Education at Anhembi Morumbi University - Laureate International Universities, São José dos Campos, Brazil. AD - School of Health Sciences at Anhembi Morumbi University - Laureate International Universities, São José dos Campos, Brazil. LA - eng PT - Journal Article DEP - 20181022 TA - Front Physiol JT - Frontiers in physiology JID - 101549006 PMC - PMC6204407 OTO - NOTNLM OT - APGAR OT - fetal monitoring OT - heart rate OT - neonatal acidemia OT - noninvasive prenatal diagnosis OT - perinatal outcome EDAT- 2018/11/09 06:00 MHDA- 2018/11/09 06:01 CRDT- 2018/11/09 06:00 PHST- 2018/07/08 00:00 [received] PHST- 2018/10/02 00:00 [accepted] PHST- 2018/11/09 06:00 [entrez] PHST- 2018/11/09 06:00 [pubmed] PHST- 2018/11/09 06:01 [medline] AID - 10.3389/fphys.2018.01489 [doi] PST - epublish SO - Front Physiol. 2018 Oct 22;9:1489. doi: 10.3389/fphys.2018.01489. eCollection 2018. PMID- 29945485 OWN - NLM STAT- MEDLINE DCOM- 20200604 LR - 20200604 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) VI - 33 IP - 3 DP - 2020 Feb TI - Identifying newborns with umbilical cord blood metabolic acidosis by intrapartum cardiotography combined with fetal ECG ST analysis (STAN): comparison of the new and old FIGO systems to classify cardiotocograms. PG - 404-409 LID - 10.1080/14767058.2018.1494148 [doi] AB - Introduction: The intrapartum cardiotocography (CTG) classification system by FIGO in 2015 (FIGO2015) was introduced to simplify CTG interpretation, but it is not harmonized with the fetal ECG ST analysis (STAN) algorithm from 2007 (STAN2007), which is based on the FIGO CTG system from 1987. The study aimed to determine time courses and sensitivity between the systems in classifying CTG + ST events to indicate metabolic acidosis at birth.Material and methods: Forty-four cases with umbilical cord artery metabolic acidosis were retrieved from a European multicenter database. CTG patterns and timing of the first occurring significant ST events were evaluated post hoc in consensus by an expert panel and sensitivity statistics were performed. Wilcoxon's matched-pairs signed-ranks test and McNemar's test were used with a two-tailed p < .05 regarded significant.Results: STAN2007 had a higher sensitivity (73 versus 43%, p = .0002) and alarmed for metabolic acidosis in mean 34 min earlier than the FIGO2015 system did (p = .002). In every fourth case, the time difference was ≥20 min.Conclusions: In this simulation study, surveillance with STAN2007 combined with fetal ECG ST analysis had a significantly higher sensitivity and would have alarmed for metabolic acidosis significantly earlier than the new FIGO system would have. FAU - Olofsson, Per AU - Olofsson P AD - Institution of Clinical Sciences, Lund University, Malmö, Sweden. FAU - Norén, Håkan AU - Norén H AD - Department of Obstetrics and Gynecology, Sahlgren's University Hospital, University of Gothenburg, Gothenburg, Sweden. FAU - Carlsson, Ann AU - Carlsson A AD - Department of Obstetrics and Gynecology, Sahlgren's University Hospital, University of Gothenburg, Gothenburg, Sweden. FAU - Rosén, Karl G AU - Rosén KG AD - Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. LA - eng PT - Comparative Study PT - Evaluation Study PT - Journal Article DEP - 20181012 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 SB - IM MH - Acidosis/blood/*diagnosis MH - *Cardiotocography MH - Electrocardiography MH - Female MH - Fetal Blood/chemistry MH - Humans MH - Infant, Newborn MH - Male OTO - NOTNLM OT - Birth OT - cardiotocography (CTG) OT - delivery OT - fetal heart rate (FHR) OT - fetal monitoring OT - hypoxia EDAT- 2018/06/28 06:00 MHDA- 2020/06/05 06:00 CRDT- 2018/06/28 06:00 PHST- 2018/06/28 06:00 [pubmed] PHST- 2020/06/05 06:00 [medline] PHST- 2018/06/28 06:00 [entrez] AID - 10.1080/14767058.2018.1494148 [doi] PST - ppublish SO - J Matern Fetal Neonatal Med. 2020 Feb;33(3):404-409. doi: 10.1080/14767058.2018.1494148. Epub 2018 Oct 12. PMID- 30455754 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200930 IS - 1857-9655 (Print) IS - 1857-9655 (Electronic) IS - 1857-9655 (Linking) VI - 6 IP - 10 DP - 2018 Oct 25 TI - Impact of Maternal Obesity and Mobile Phone Use on Fetal Cardiotocography Pattern. PG - 1813-1817 LID - 10.3889/oamjms.2018.405 [doi] AB - BACKGROUND: The fetal heart rate (FHR) is a good marker of fetal well-being during labour. Cardiotocography is used to record the FHR and uterine contractions and can detect possible fetal hypoxia. Mobile phones use, and obesity is suggested to influence the FHR and cardiovascular development. AIM: The present study aimed to study the differences in FHR pattern between fetuses of obese vs non-obese groups when using a mobile phone. METHODS: We conducted a clinical trial to test the impact of mobile phone use on FHR using a single mobile phone with Specific Absorption Rate rating of 0.99 W/kg for 10 minutes. Data from this clinical trial were analysed to compare the FHR pattern between fetuses of obese women (exposed group) vs those of non-obese women (control group). The two study groups (obese vs non-obese) were compared regarding four. FHR PATTERNS: baseline FHR, variability, acceleration and deceleration scores. Data were analysed by SPSS software version 23.0 using the independent-samples t-tests. RESULTS: Sixty-nine women were included in the final analysis (obese group: n = 22 and non-obese group: n = 47). Fetuses of the obese women had significantly higher baseline FHR and less FHR variability scores when compared with fetuses of the non-obese women (mean difference 2.9 and 3.18, respectively). CONCLUSION: Fetuses of obese women had abnormal FHR pattern compared with fetuses of non-obese women. The use of mobile phone slightly influenced the FHR variability score. These results highlight the importance of proper management of obesity in women within the childbearing period. FAU - Saadia, Zaheera AU - Saadia Z AD - Department of Obstetrics and Gynecology, Qassim University, College of Medicine, Al-Qassim, Saudi Arabia. LA - eng PT - Journal Article DEP - 20181001 TA - Open Access Maced J Med Sci JT - Open access Macedonian journal of medical sciences JID - 101662294 PMC - PMC6236027 OTO - NOTNLM OT - Body Mass Index OT - Fetal Heart Rate OT - Mobile Phone OT - Pregnancy EDAT- 2018/11/21 06:00 MHDA- 2018/11/21 06:01 CRDT- 2018/11/21 06:00 PHST- 2018/07/23 00:00 [received] PHST- 2018/09/18 00:00 [revised] PHST- 2018/09/19 00:00 [accepted] PHST- 2018/11/21 06:00 [entrez] PHST- 2018/11/21 06:00 [pubmed] PHST- 2018/11/21 06:01 [medline] AID - OAMJMS-6-1813 [pii] AID - 10.3889/oamjms.2018.405 [doi] PST - epublish SO - Open Access Maced J Med Sci. 2018 Oct 1;6(10):1813-1817. doi: 10.3889/oamjms.2018.405. eCollection 2018 Oct 25. PMID- 30269624 OWN - NLM STAT- MEDLINE DCOM- 20210118 LR - 20210118 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) VI - 33 IP - 9 DP - 2020 May TI - Safely lowering the emergency Cesarean and operative vaginal delivery rates using the Fetal Reserve Index. PG - 1473-1479 LID - 10.1080/14767058.2018.1519799 [doi] AB - Objective: The cardiotocograph (CTG) or electronic fetal monitoring (EFM) was developed to prevent fetal asphyxia and subsequent neurological injury. From a public health perspective, it has failed these objectives while increasing emergency operative deliveries (emergency operative deliveries (EODs) - emergency cesarean delivery or operative vaginal delivery) for newborns, who in retrospect, actually did not require the assistance. EODs increase the risks of complications and stress for patients, families, and medical personnel. A safe reduction in the need for EOD will likely reduce both the overall Cesarean section rate as well as the risk of fetal neurological injury during labor to which it is related. We have developed the fetal reserve index (FRI), which is more comprehensive than CTG as a new screening method for early identification of the fetus at-risk of both neurological harm and the need to "rescue" by means of an EOD. Here, we compare prospectively the need for EOD in two groups of parturients undergoing a trial of labor at term. One group was managed conventionally, the other by the principles of the FRI.Study design: We compared the need for EOD of 800 parturients with singleton cases undergoing a trial of labor at term entering with normal CTG patterns (ACOG category 1). Patients were either treated routinely (400 - "early cases") or in a second group seen later actively managed using the principles of the FRI (400 - "late cases"). The FRI includes measurements of five components of the CTG: rate, variability, decelerations, accelerations, and abnormal uterine activity combined with the presence of medical, obstetrical, and fetal risk factors. The 8-point metric categorizes cases as "green", "yellow", and "red" with the latter being at risk.Results: All 800 patients delivered babies, who were discharged in the usual time course with no untoward outcomes noted. The incidence of red zone scores was comparable in the two groups (≈25%), but the use of intrauterine resuscitation (IR) when reaching the red zone in the late group (47%) was more than double the incidence in the early group (20%) (p < .001). Despite (or because of) this, EODs were significantly reduced in the late group, from 17.3 to 4.0% (p < .001). Further, the late group spent less time in the red zone without increasing overall time in labor. Overall, EOD cases averaged >1 h in the red zone versus 0.5 h for non-EODs.Conclusions: The FRI may provide a metric to reduce EODs and by extension also reduce the risks of both cesarean delivery and adverse fetal/neonatal outcomes. The safe avoidance of EOD would seem to be an important metric to assess the quality of intrapartum management. This study represents the first attempt to apply the principles of the FRI "live" for the concurrent management of patients during labor. These promising results, if confirmed, in larger sample sizes, set the stage for our computerization of the FRI for widespread study. Benefits appear to come from identification and early, conservative management of fetal deterioration before the need to "rescue" the fetus by EOD. FAU - Eden, Robert D AU - Eden RD AD - Fetal Medicine Foundation of America, New York, NY, USA. FAU - Evans, Mark I AU - Evans MI AD - Fetal Medicine Foundation of America, New York, NY, USA. AD - Comprehensive Genetics, PLLC, New York, NY, USA. AD - Department of Obstetrics and Gynecology, Mt. Sinai School of Medicine, New York, NY, USA. FAU - Britt, David W AU - Britt DW AD - Fetal Medicine Foundation of America, New York, NY, USA. FAU - Evans, Shara M AU - Evans SM AD - Fetal Medicine Foundation of America, New York, NY, USA. FAU - Schifrin, Barry S AU - Schifrin BS AD - Fetal Medicine Foundation of America, New York, NY, USA. LA - eng PT - Journal Article DEP - 20181001 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 SB - IM MH - Cardiotocography/*methods MH - Case-Control Studies MH - Cesarean Section/statistics & numerical data MH - Female MH - Fetal Distress/*classification MH - Heart Rate, Fetal/physiology MH - Humans MH - Infant, Newborn MH - Pregnancy MH - Prospective Studies MH - Risk Factors MH - Time Factors MH - Trial of Labor OTO - NOTNLM OT - ACOG monitoring classification system OT - cerebral palsy OT - electronic fetal monitoring OT - fetal reserve index OT - intrauterine resuscitation OT - neonatal encephalopathy EDAT- 2018/10/03 06:00 MHDA- 2021/01/20 06:00 CRDT- 2018/10/02 06:00 PHST- 2018/10/03 06:00 [pubmed] PHST- 2021/01/20 06:00 [medline] PHST- 2018/10/02 06:00 [entrez] AID - 10.1080/14767058.2018.1519799 [doi] PST - ppublish SO - J Matern Fetal Neonatal Med. 2020 May;33(9):1473-1479. doi: 10.1080/14767058.2018.1519799. Epub 2018 Oct 1. PMID- 30188581 OWN - NLM STAT- MEDLINE DCOM- 20190618 LR - 20190618 IS - 1097-0223 (Electronic) IS - 0197-3851 (Linking) VI - 38 IP - 12 DP - 2018 Nov TI - Placental volume at 11 to 14 gestational weeks in pregnancies complicated with fetal growth restriction and preeclampsia. PG - 928-935 LID - 10.1002/pd.5356 [doi] AB - OBJECTIVE: The study aims to evaluate the predictive value of first trimester placental volume in pregnancies destined to develop fetal growth restriction (FGR) and preeclampsia (PE). METHODS: Prospective observational study including placentas from 34 FGR, 12 PE, 15 GH (gestational hypertension) pregnancies, and 265 controls. Placental volume (PV) was obtained using VOCAL technique, and a z score was calculated (z-PV). The association of PV with other first trimester variables and maternal characteristics was assessed with Spearman's correlation. RESULTS: PV increased exponentially with crown-rump length (CRL) and was unrelated to maternal factors (weight, age, parity, and smoking status) as well as first trimester uterine artery Doppler, free β-hCG, nuchal translucency, or fetal heart rate. However, PV was positively associated with maternal height, CRL, PAPP-A, and birth weight. z-PV was a strong predictor for FGR with abnormal fetal Dopplers (AUC = 0.9472, P < 0.001). z-PV provided moderate prediction of FGR with normal fetal Dopplers (AUC = 0.8396, P < 0.001), PE (AUC = 0.8312, P < 0.001), and GH (AUC = 0.7640, P < 0.001). The addition of maternal weight, PAPP-A, β-hCG, and uterine artery Doppler improved our models. CONCLUSION: At 11 to 14 weeks, PV is an independent predictor of pregnancy complications related to placental insufficiency, and the predictive ability is greater for FGR pregnancies with abnormal fetal Dopplers. CI - © 2018 John Wiley & Sons, Ltd. FAU - Papastefanou, Ioannis AU - Papastefanou I AUID- ORCID: 0000-0002-7969-1435 AD - Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, Athens Medical School, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece. FAU - Chrelias, Charalambos AU - Chrelias C AD - Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, Athens Medical School, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece. FAU - Siristatidis, Charalambos AU - Siristatidis C AD - Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, Athens Medical School, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece. FAU - Kappou, Dimitra AU - Kappou D AUID- ORCID: 0000-0003-1141-4738 AD - Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK. FAU - Eleftheriades, Makarios AU - Eleftheriades M AD - 2nd Department of Obstetrics and Gynecology, University of Athens Medical School, Aretaieio Hospital, Athens, Greece. FAU - Kassanos, Dimitrios AU - Kassanos D AD - Fetal Medicine Unit, 3rd Department of Obstetrics and Gynaecology, Athens Medical School, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece. LA - eng PT - Journal Article PT - Observational Study DEP - 20180926 PL - England TA - Prenat Diagn JT - Prenatal diagnosis JID - 8106540 SB - IM MH - Adult MH - Case-Control Studies MH - Female MH - Fetal Growth Retardation/etiology/*pathology MH - Humans MH - Imaging, Three-Dimensional MH - Organ Size MH - Placenta/diagnostic imaging/*pathology MH - Placenta Diseases/pathology MH - Placental Insufficiency/*pathology MH - Pre-Eclampsia/etiology/*pathology MH - Predictive Value of Tests MH - Pregnancy MH - Pregnancy Trimester, First MH - Prospective Studies MH - Registries MH - Ultrasonography, Prenatal MH - Uterine Artery/diagnostic imaging EDAT- 2018/09/07 06:00 MHDA- 2019/06/19 06:00 CRDT- 2018/09/07 06:00 PHST- 2018/05/12 00:00 [received] PHST- 2018/08/26 00:00 [revised] PHST- 2018/08/29 00:00 [accepted] PHST- 2018/09/07 06:00 [pubmed] PHST- 2019/06/19 06:00 [medline] PHST- 2018/09/07 06:00 [entrez] AID - 10.1002/pd.5356 [doi] PST - ppublish SO - Prenat Diagn. 2018 Nov;38(12):928-935. doi: 10.1002/pd.5356. Epub 2018 Sep 26. PMID- 30189283 OWN - NLM STAT- MEDLINE DCOM- 20191104 LR - 20200309 IS - 1872-678X (Electronic) IS - 0165-0270 (Print) IS - 0165-0270 (Linking) VI - 309 DP - 2018 Nov 1 TI - Ensuring signal quality of cerebral near infrared spectroscopy during continuous longterm monitoring. PG - 147-152 LID - S0165-0270(18)30269-3 [pii] LID - 10.1016/j.jneumeth.2018.09.003 [doi] AB - BACKGROUND: Near infrared spectroscopy (NIRS) derived hemoglobin difference (HbD: oxygenated [HbO2] - reduced hemoglobin [Hb]) and total hemoglobin (HbT: HbO2+Hb) have been used as surrogate measures of cerebral blood flow and volume, respectively. Statistically, a lack of HbD-blood pressure (BP) or negative HbT-BP association is regarded as a state of intact cerebral pressure autoregulation (CPA). In contrast, a co-variation of HbD/HbT and systemic blood pressure (BP) in the same direction is thought of as a failure of CPA. If the quality of one (NIRS/BP) or both signals is compromised, the reliability of the results may be adversely affected. In this work, we develop an analytic approach to assess the quality of the NIRS signals. NEW METHOD: Given that cardiac pulses cause hemodynamic changes that are transmitted through the peripheral vasculature, cerebral NIRS signals should exhibit cyclical changes at the pulse frequency. Therefore, we propose that an association between HbD/HbT and electrocardiogram (EKG) signals would be an indicator of NIRS quality. We demonstrate the application of this approach with data collected from six newborns undergoing therapeutic hypothermia for neonatal encephalopathy. RESULTS: We observed an intermittent lack of association between NIRS signals and EKG data over the course of several hours of continuous records, indicating a loss in the strength in NIRS signals. COMPARISON WITH EXISTING METHOD: Existing CPA characterization suffers from Type-II error which the current preprocessing approach can mitigate. CONCLUSIONS: The proposed approach will allow for real-time assessment of NIRS signal quality that is essential for accurate CPA monitoring. CI - Copyright © 2018 Elsevier B.V. All rights reserved. FAU - Govindan, R B AU - Govindan RB AD - Division of Fetal and Transitional Medicine, Children's National Health System, 111 Michigan Ave, NW, Washington, DC', 20010, USA. Electronic address: rgovinda@childrensnational.org. FAU - Massaro, A N AU - Massaro AN AD - Division of Fetal and Transitional Medicine, Children's National Health System, 111 Michigan Ave, NW, Washington, DC', 20010, USA; Division of Neonatology, Children's National Health System, 111 Michigan Ave, NW, Washington, DC, 20010, USA. FAU - du Plessis, Adre AU - du Plessis A AD - Division of Fetal and Transitional Medicine, Children's National Health System, 111 Michigan Ave, NW, Washington, DC', 20010, USA. LA - eng GR - KL2 RR031987/RR/NCRR NIH HHS/United States GR - U54 HD090257/HD/NICHD NIH HHS/United States GR - UL1 TR000075/TR/NCATS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20180904 TA - J Neurosci Methods JT - Journal of neuroscience methods JID - 7905558 SB - IM MH - Cerebral Cortex/blood supply/*diagnostic imaging MH - Electrocardiography/methods MH - Humans MH - Infant, Newborn MH - Monitoring, Physiologic/instrumentation/*methods MH - Reproducibility of Results MH - *Signal Processing, Computer-Assisted MH - Spectroscopy, Near-Infrared/*methods PMC - PMC6323003 MID - NIHMS1506312 OTO - NOTNLM OT - *Cerebral pressure autoregulation OT - *Electrocardiogram OT - *Near infrared spectroscopy OT - *Spectral coherence EDAT- 2018/09/07 06:00 MHDA- 2019/11/05 06:00 CRDT- 2018/09/07 06:00 PHST- 2018/05/28 00:00 [received] PHST- 2018/08/18 00:00 [revised] PHST- 2018/09/02 00:00 [accepted] PHST- 2018/09/07 06:00 [pubmed] PHST- 2019/11/05 06:00 [medline] PHST- 2018/09/07 06:00 [entrez] AID - S0165-0270(18)30269-3 [pii] AID - 10.1016/j.jneumeth.2018.09.003 [doi] PST - ppublish SO - J Neurosci Methods. 2018 Nov 1;309:147-152. doi: 10.1016/j.jneumeth.2018.09.003. Epub 2018 Sep 4. PMID- 30245882 OWN - NLM STAT- MEDLINE DCOM- 20190130 LR - 20190130 IS - 2090-2735 (Electronic) IS - 2090-2727 (Print) IS - 2090-2727 (Linking) VI - 2018 DP - 2018 TI - Can Obstetric Risk Factors Predict Fetal Acidaemia at Birth? A Retrospective Case-Control Study. PG - 2195965 LID - 10.1155/2018/2195965 [doi] LID - 2195965 AB - BACKGROUND: Despite major advances in perinatal medicine, intrapartum asphyxia remains a leading and potentially preventable cause of perinatal mortality and long-term morbidity. The umbilical cord pH is considered an essential criteria for the diagnosis of acute intrapartum hypoxic events. The purpose of this study was to evaluate whether obstetric risk factors are associated with fetal acidaemia at delivery. METHODOLOGY: In a case-control study, 294 women with term singleton pregnancies complicated by an umbilical artery cord pH < 7.20 at birth were individually matched by controls with umbilical artery cord pH > 7.20. Groups were compared for differences in maternal, obstetric, and fetal characteristics using logistic regression models presented as odds ratio (OR) with 95% confidence intervals (CI). RESULTS: The study showed pregestational diabetes (PGDM) [OR: 5.31, 95% CI: 1.15- 24.58, P = 0.018], urinary tract infection (UTI) [OR: 3.21, 95% CI: 1.61- 6.43, P < 0.001], and low Apgar scores to be significantly associated with acidaemia, whereas low maternal BMI [OR: 0.19, 95% CI: 0.04-0.87, P = 0.032], pyrexia in labour [OR 0.23; 95% CI 0.12-0.53; P < 0.001], electronic fetal monitoring (EFM) [OR 0.65; 95% CI 0.43-0.99; P = 0.042), and emergency caesarean section [OR 0.42; 95% CI 0.26-0.66; P < 0.001] were found to be protective of acidaemia. CONCLUSION: Certain obstetric risk factors before and during labour can identify newborns at risk of developing acidaemia. Further research is needed to gain quantitative insight into the predictive capacity of these risks that can inform obstetric clinical management for improved outcomes. FAU - Kapaya, Habiba AU - Kapaya H AUID- ORCID: 0000-0001-6218-1781 AD - Department of Oncology and Metabolism, Academic Unit of Reproductive & Developmental Medicine, 4th Floor Jessop Wing, Tree Root Walk, Sheffield S102SF, UK. FAU - Williams, Roslyn AU - Williams R AD - Department of Oncology and Metabolism, Academic Unit of Reproductive & Developmental Medicine, 4th Floor Jessop Wing, Tree Root Walk, Sheffield S102SF, UK. FAU - Elton, Grace AU - Elton G AD - Department of Oncology and Metabolism, Academic Unit of Reproductive & Developmental Medicine, 4th Floor Jessop Wing, Tree Root Walk, Sheffield S102SF, UK. FAU - Anumba, Dilly AU - Anumba D AUID- ORCID: 0000-0003-2502-3033 AD - Department of Oncology and Metabolism, Academic Unit of Reproductive & Developmental Medicine, 4th Floor Jessop Wing, Tree Root Walk, Sheffield S102SF, UK. LA - eng PT - Journal Article DEP - 20180902 TA - J Pregnancy JT - Journal of pregnancy JID - 101553823 SB - IM MH - Acidosis/*blood/epidemiology/*etiology MH - Adult MH - Apgar Score MH - Case-Control Studies MH - Chi-Square Distribution MH - Delivery, Obstetric/statistics & numerical data MH - Female MH - Fetal Blood/*chemistry MH - Humans MH - Infant, Newborn MH - Logistic Models MH - Pregnancy MH - Pregnancy Complications/*epidemiology MH - *Pregnancy Outcome/epidemiology MH - Retrospective Studies MH - Risk Factors MH - Young Adult PMC - PMC6139200 EDAT- 2018/09/25 06:00 MHDA- 2019/01/31 06:00 CRDT- 2018/09/25 06:00 PHST- 2018/06/04 00:00 [received] PHST- 2018/07/19 00:00 [revised] PHST- 2018/07/30 00:00 [accepted] PHST- 2018/09/25 06:00 [entrez] PHST- 2018/09/25 06:00 [pubmed] PHST- 2019/01/31 06:00 [medline] AID - 10.1155/2018/2195965 [doi] PST - epublish SO - J Pregnancy. 2018 Sep 2;2018:2195965. doi: 10.1155/2018/2195965. eCollection 2018. PMID- 30127256 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200930 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 7 IP - 8 DP - 2018 Aug 20 TI - A Comprehensive Feature Analysis of the Fetal Heart Rate Signal for the Intelligent Assessment of Fetal State. LID - 10.3390/jcm7080223 [doi] LID - 223 AB - Continuous monitoring of the fetal heart rate (FHR) signal has been widely used to allow obstetricians to obtain detailed physiological information about newborns. However, visual interpretation of FHR traces causes inter-observer and intra-observer variability. Therefore, this study proposed a novel computerized analysis software of the FHR signal (CAS-FHR), aimed at providing medical decision support. First, to the best of our knowledge, the software extracted the most comprehensive features (47) from different domains, including morphological, time, and frequency and nonlinear domains. Then, for the intelligent assessment of fetal state, three representative machine learning algorithms (decision tree (DT), support vector machine (SVM), and adaptive boosting (AdaBoost)) were chosen to execute the classification stage. To improve the performance, feature selection/dimensionality reduction methods (statistical test (ST), area under the curve (AUC), and principal component analysis (PCA)) were designed to determine informative features. Finally, the experimental results showed that AdaBoost had stronger classification ability, and the performance of the selected feature set using ST was better than that of the original dataset with accuracies of 92% and 89%, sensitivities of 92% and 89%, specificities of 90% and 88%, and F-measures of 95% and 92%, respectively. In summary, the results proved the effectiveness of our proposed approach involving the comprehensive analysis of the FHR signal for the intelligent prediction of fetal asphyxia accurately in clinical practice. FAU - Zhao, Zhidong AU - Zhao Z AD - Hangdian Smart City Research Center of Zhejiang Province, Hangzhou Dianzi University, 310018 Hangzhou, China. zhaozd@hdu.edu.cn. FAU - Zhang, Yang AU - Zhang Y AUID- ORCID: 0000-0002-7298-733X AD - Hangdian Smart City Research Center of Zhejiang Province, Hangzhou Dianzi University, 310018 Hangzhou, China. mynameiszhangyang@gmail.com. FAU - Deng, Yanjun AU - Deng Y AD - Hangdian Smart City Research Center of Zhejiang Province, Hangzhou Dianzi University, 310018 Hangzhou, China. dengyanjun79@gmail.com. LA - eng PT - Journal Article DEP - 20180820 TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC6111566 OTO - NOTNLM OT - classification OT - feature analysis OT - fetal heart rate OT - fetal state assessment COIS- The authors declare no conflict of interest. EDAT- 2018/08/22 06:00 MHDA- 2018/08/22 06:01 CRDT- 2018/08/22 06:00 PHST- 2018/07/16 00:00 [received] PHST- 2018/08/14 00:00 [revised] PHST- 2018/08/16 00:00 [accepted] PHST- 2018/08/22 06:00 [entrez] PHST- 2018/08/22 06:00 [pubmed] PHST- 2018/08/22 06:01 [medline] AID - jcm7080223 [pii] AID - jcm-07-00223 [pii] AID - 10.3390/jcm7080223 [doi] PST - epublish SO - J Clin Med. 2018 Aug 20;7(8):223. doi: 10.3390/jcm7080223. PMID- 30637063 OWN - NLM STAT- MEDLINE DCOM- 20190122 LR - 20200225 IS - 1937-8688 (Electronic) VI - 30 DP - 2018 TI - [Study of fetal heart rate abnormalities observed on cardiotocography in Lubumbashi: about a cases followed at the Lubumbashi University Clinic and the General Hospital of the Cinquantenaire]. PG - 278 LID - 10.11604/pamj.2018.30.278.13365 [doi] LID - 278 AB - Cardiotocography (CTG) has recently come into use in Lubumbashi but no thorough study has yet been conducted to identify its impact on perinatal morbi-mortality. This study aims to determine the frequency of fetal heart rate abnormalities (FHR)in order to identify the associated factors and to propose a suitable management. We conducted a cross-sectional, descriptive study of 411 women in labour over a period of 19 months (March 2015-December 2016). In patients with pathologic FHR abnormalities, sensitivity and positive predictive value of cardiotocography in the screening test for acute fetal distress were 82.95% and 45.35% respectively. FHR abnormalities were found in two women in labour out of five. Decelerations were the most frequent FHR abnormalities observed (50.8%) with a remarkable predominance of late decelerations (22.1% of all abnormalities). The factors associated with pathological FHR abnormalities were prolonged labor (OR = 14.64, CI = 3.91-54.81), chorioamnionitis (OR = 14.56, CI = 3.83-55.34), chronic maternal anemia (OR = 4.99, CI = 1.48-16.85), primiparity (OR = 2.69, CI = 1.49-4.85), prematurity (OR = 2.90, CI = 1.51-5.54) and prolonged pregnancy (OR = 3.22, CI = 1.38-7.52). Intrauterine growth retardation and arterial hypertension were mainly associated with flat lines and late decelerations (OR = 7.79, CI = 2.50-24.30 and OR=2.74, CI = 1.31-5.72). CTG is a screening tool for the identification of acute fetal distress but with high false-positive rate (55%); it should be associated with other second-line screening tests for acute fetal distress in order to reduce this rate. Factors associated with pathologic FHR abnormalities often cause acute fetal distress thus requiring a rigorous analysis of CTG traces. FAU - Mwansa, Joseph Chola AU - Mwansa JC AD - Département de Gynécologie-Obstétrique de la Faculté de Médecine de l'Université de Lubumbashi, Republique Démocratique du Congo. AD - Service de Gynécologie-Obstétrique de l'Hôpital Général du Cinquantenaire Karavia, Lubumbashi, Republique Démocratique du Congo. FAU - Tambwe, Albert Mwembo AU - Tambwe AM AD - Département de Gynécologie-Obstétrique de la Faculté de Médecine de l'Université de Lubumbashi, Republique Démocratique du Congo. FAU - Thaba, Jules Ngwe AU - Thaba JN AD - Département de Gynécologie-Obstétrique de la Faculté de Médecine de l'Université de Lubumbashi, Republique Démocratique du Congo. FAU - Ndoudule, Arthur Munkana AU - Ndoudule AM AD - Département de Gynécologie-Obstétrique de la Faculté de Médecine de l'Université de Lubumbashi, Republique Démocratique du Congo. FAU - Museba, Baudouin Yumba AU - Museba BY AD - Service de Gynécologie-Obstétrique de l'Hôpital Général du Cinquantenaire Karavia, Lubumbashi, Republique Démocratique du Congo. FAU - Thabu, Thérèse Mowa AU - Thabu TM AD - Service de Gynécologie-Obstétrique de l'Hôpital Général du Cinquantenaire Karavia, Lubumbashi, Republique Démocratique du Congo. FAU - Muenze, Prosper Kalenga AU - Muenze PK AD - Département de Gynécologie-Obstétrique de la Faculté de Médecine de l'Université de Lubumbashi, Republique Démocratique du Congo. AD - Service de Gynécologie-Obstétrique de l'Hôpital Général du Cinquantenaire Karavia, Lubumbashi, Republique Démocratique du Congo. LA - fre PT - Journal Article TT - Etude des anomalies du rythme cardiaque fœtal observées à l’examen cardiotocographique à Lubumbashi: cas suivis aux Cliniques Universitaires de Lubumbashi et à l’Hôpital Général du Cinquantenaire Karavia. DEP - 20180817 TA - Pan Afr Med J JT - The Pan African medical journal JID - 101517926 SB - IM MH - Adult MH - Cardiotocography/*methods MH - Cross-Sectional Studies MH - Democratic Republic of the Congo MH - Female MH - Fetal Distress/*diagnosis/epidemiology MH - Fetal Growth Retardation/diagnosis/epidemiology MH - Heart Rate, Fetal/*physiology MH - Hospitals, General MH - Humans MH - *Labor, Obstetric MH - Predictive Value of Tests MH - Pregnancy MH - Sensitivity and Specificity MH - Young Adult PMC - PMC6317385 OAB - Publisher: Abstract available from the publisher. OABL- fre OTO - NOTNLM OT - Cardiotocography OT - Lubumbashi OT - acute fetal distress OT - associated factors EDAT- 2019/01/15 06:00 MHDA- 2019/01/23 06:00 CRDT- 2019/01/15 06:00 PHST- 2017/07/15 00:00 [received] PHST- 2018/07/22 00:00 [accepted] PHST- 2019/01/15 06:00 [entrez] PHST- 2019/01/15 06:00 [pubmed] PHST- 2019/01/23 06:00 [medline] AID - PAMJ-30-278 [pii] AID - 10.11604/pamj.2018.30.278.13365 [doi] PST - epublish SO - Pan Afr Med J. 2018 Aug 17;30:278. doi: 10.11604/pamj.2018.30.278.13365. eCollection 2018. PMID- 30068417 OWN - NLM STAT- MEDLINE DCOM- 20181031 LR - 20181031 IS - 1469-2198 (Electronic) IS - 0954-5794 (Linking) VI - 30 IP - 3 DP - 2018 Aug TI - Predicting child temperament and behavior from the fetus. PG - 855-870 LID - 10.1017/S0954579418000482 [doi] AB - There remains little debate that the period before birth sets the stage for subsequent development, yet scant evidence exists showing continuity from characteristics of the individual fetus to characteristics of the child. This report examines, in two studies, whether baseline and evoked fetal neurobehavioral functioning are predictive of features of child temperament and behavior as reported by mothers when offspring were between 7 and 14 years old (M = 10.1 years). Study 1 utilizes data generated from 333 maternal-fetal pairs collected during an undisturbed condition during the second half of gestation in relation to the child temperament dimensions of behavioral inhibition and exuberance. Associations at 32 weeks gestation were detected between all features of fetal neurobehavior and behavioral inhibition. In adjusted models, slower fetal heart rate and less fetal movement were associated with significant unique variance in predicting higher levels of childhood behavioral inhibition. No associations were detected for exuberance. Study 2 focuses on the association of evoked fetal reactivity and recovery to induced maternal arousal with subsequent child behavioral difficulties in a subset of the full sample (n = 130). Greater recovery in fetal heart rate following maternal stimulation was predictive of fewer behavioral difficulties and more prosocial behavior in childhood. Results from both studies provide support for gestational origins of core individual differences that portend childhood outcomes with foundational reactivity and regulatory components. FAU - Dipietro, Janet A AU - Dipietro JA AD - Johns Hopkins University. FAU - Voegtline, Kristin M AU - Voegtline KM AD - Johns Hopkins University. FAU - Pater, Heather A AU - Pater HA AD - Johns Hopkins University. FAU - Costigan, Kathleen A AU - Costigan KA AD - Johns Hopkins University. LA - eng PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - United States TA - Dev Psychopathol JT - Development and psychopathology JID - 8910645 SB - IM MH - Adolescent MH - Adult MH - Anxiety Disorders/*physiopathology/psychology MH - Arousal/physiology MH - Brain/physiopathology MH - Child MH - Child Behavior Disorders/*physiopathology/psychology MH - Depressive Disorder/*physiopathology/psychology MH - Female MH - Fetal Movement MH - Gestational Age MH - Heart Rate, Fetal/physiology MH - Humans MH - Individuality MH - Male MH - Pregnancy MH - Prenatal Exposure Delayed Effects/*physiopathology/*psychology MH - Risk Factors MH - Stress, Psychological/complications/*physiopathology/psychology MH - Temperament/*physiology EDAT- 2018/08/03 06:00 MHDA- 2018/11/01 06:00 CRDT- 2018/08/03 06:00 PHST- 2018/08/03 06:00 [entrez] PHST- 2018/08/03 06:00 [pubmed] PHST- 2018/11/01 06:00 [medline] AID - S0954579418000482 [pii] AID - 10.1017/S0954579418000482 [doi] PST - ppublish SO - Dev Psychopathol. 2018 Aug;30(3):855-870. doi: 10.1017/S0954579418000482. PMID- 30098449 OWN - NLM STAT- MEDLINE DCOM- 20190129 LR - 20191210 IS - 1872-7654 (Electronic) IS - 0301-2115 (Linking) VI - 229 DP - 2018 Oct TI - Admission cardiotocography: A hospital based validation study. PG - 26-31 LID - S0301-2115(18)30343-9 [pii] LID - 10.1016/j.ejogrb.2018.07.016 [doi] AB - OBJECTIVE: Admission CTG is a short fetal heart rate (FHR) tracing recorded immediately at hospital admission to avoid unnecessary delay in action among pregnancies complicated by pre-existent fetal distress. There are different opinions regarding the value of the admission CTG, especially in low risk pregnancies. STUDY DESIGN: A retrospective validation study from Karolinska University Hospital, Jan 2011 to June 2015 (total number of deliveries = 40,061). All women who underwent emergency cesarean section within one hour of admittance due to suspected fetal distress were identified. We assessed whether an admission CTG was performed, if it was beneficial for the decision to perform emergent cesarean delivery and if there were objective signs of fetal compromise or if it was performed unnecessarily. The main outcome was the benefit of the admission CTG in the decision to perform emergency cesarean delivery. RESULTS: Eighty-eight cases (0.22%) fulfilled our inclusion criteria. Over 90% of these women (80/88) had objective evidence of compromised fetal well-being, i.e., indicating that emergent delivery was necessary. In 74% (54/73) of all cases was admission CTG determined to have been beneficial in the decision to perform cesarean delivery, equally effective of those classified as low- and high risk pregnancies before admission. In 28% (15/54) the CTG pathology was deemed difficult to identify by auscultation. CONCLUSION: Admission CTG was deemed beneficial in 74% of both low- and high-risk pregnancies that were delivered by emergent cesarean section within one hour of admittance due to suspected fetal distress. CI - Copyright © 2018 Elsevier B.V. All rights reserved. FAU - Parts, Lizza AU - Parts L AD - Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Huddinge, Sweden. FAU - Holzmann, Malin AU - Holzmann M AD - Department of Obstetrics and Gynecology, Karolinska University Hospital, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Sweden. FAU - Norman, Mikael AU - Norman M AD - Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Huddinge, Sweden; Department of Neonatology, Karolinska University Hospital, Huddinge, Sweden. FAU - Lindqvist, Pelle G AU - Lindqvist PG AD - Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Huddinge, Sweden; Department of Obstetrics and Gynecology, Sodersjukhuset, Stockholm, Sweden. Electronic address: pelle.lindqvist@ki.se. LA - eng PT - Journal Article PT - Validation Study DEP - 20180730 PL - Ireland TA - Eur J Obstet Gynecol Reprod Biol JT - European journal of obstetrics, gynecology, and reproductive biology JID - 0375672 SB - IM MH - *Cardiotocography MH - Cesarean Section MH - Early Diagnosis MH - Female MH - Fetal Distress/*diagnosis MH - Humans MH - Patient Admission MH - Pregnancy MH - Retrospective Studies OTO - NOTNLM OT - Asphyxia OT - CTG OT - Cesarean OT - Midwifery OT - Morbidity OT - Mortality OT - Severe outcome OT - Validation EDAT- 2018/08/12 06:00 MHDA- 2019/01/30 06:00 CRDT- 2018/08/12 06:00 PHST- 2018/06/03 00:00 [received] PHST- 2018/07/10 00:00 [revised] PHST- 2018/07/13 00:00 [accepted] PHST- 2018/08/12 06:00 [pubmed] PHST- 2019/01/30 06:00 [medline] PHST- 2018/08/12 06:00 [entrez] AID - S0301-2115(18)30343-9 [pii] AID - 10.1016/j.ejogrb.2018.07.016 [doi] PST - ppublish SO - Eur J Obstet Gynecol Reprod Biol. 2018 Oct;229:26-31. doi: 10.1016/j.ejogrb.2018.07.016. Epub 2018 Jul 30. PMID- 30096466 OWN - NLM STAT- MEDLINE DCOM- 20190129 LR - 20190129 IS - 1872-7654 (Electronic) IS - 0301-2115 (Linking) VI - 229 DP - 2018 Oct TI - The temporal effect of Category II fetal monitoring on neonatal outcomes. PG - 8-14 LID - S0301-2115(18)30357-9 [pii] LID - 10.1016/j.ejogrb.2018.07.030 [doi] AB - OBJECTIVE: To correlate the duration of Category II cardiotocograms (CTG) with adverse neonatal outcomes associated with perinatal asphyxia and determine the duration before fetal compromise. STUDY DESIGN: This retrospective, observational study used electronic medical record data from a cohort of 271 patients, delivered by C-section due to non-reassuring fetal heart rate, at a tertiary medical center, from 2015 through 2017. Duration of Category II CTG, variability, tachycardia and deceleration frequency were analyzed and correlated to immediate postnatal outcomes. including cord pH ≤ 7, cord base excess >12, 1- and 5-min Apgar scores ≤7, need for ventilation, need for chest compressions, NICU admission, hypoglycemia and convulsions. Intrapartum fever and meconium stained amniotic fluid were correlated to the same outcomes. Categorical and continuous variables were analyzed using chi-square and t-tests, respectively. P < 0.05 was considered significant. RESULTS: The mean duration of Category II CTG was 146 min (range 17-553). Longer duration did not result in increased rates of adverse neonatal outcomes. In contrast, reduced fetal heart rate (FHR) variability, fetal tachycardia and intrapartum fever did show increased rates of adverse neonatal outcomes, as follows: patients exhibiting reduced vs. normal (FHR) variability had 12.9% vs. 1.4% cord pH ≤ 7, P = 0.006 and 12.5% vs. 1.3% cord BE > 12, P = 0.004: patients with fetal tachycardia vs. normal baseline FHR exhibited 48% vs. 17.9% 1-minute Apgar score ≤7, P = 0.0004; 8% vs. 0.8% 5-minute Apgar score ≤7, P = 0.04; and 48% vs. 18.7% ventilation support, P < 0.001; patients with intrapartum fever vs. normal temperature, cord BE > 12 was seen in 9.7% vs. 1.7%, P = 0.035; 1-minute Apgar score was ≤7 in 35.5% vs. 18.7%, P = 0.03; 5-minute Apgar score ≤7 in 9.7% vs. 0.4%, P = 0.005; need for ventilation in 35.5% vs. 19.6%, P = 0.042; need for chest compressions in 6.45% vs. none, P = 0.013; and NICU admission in 12.9% vs. 2.5%, P = 0.018. CONCLUSIONS: Our results suggest that the duration of Category II CTG alone does not appear to predict perinatal asphyxia. Parameters associated with perinatal asphyxia are reduced FHR variability, fetal tachycardia and intrapartum fever. Therefore, when contemplating intervention during labor to avoid fetal asphyxia, these parameters should be strongly considered. CI - Copyright © 2018 Elsevier B.V. All rights reserved. FAU - Weissbach, Tal AU - Weissbach T AD - Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel(1). Electronic address: Ferbyt@gmail.com. FAU - Heusler, Ishai AU - Heusler I AD - Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel(1). FAU - Ovadia, Michal AU - Ovadia M AD - Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel(1). FAU - David, Liron AU - David L AD - Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel(1). FAU - Daykan, Yair AU - Daykan Y AD - Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel(1). FAU - Schreiber, Faye AU - Schreiber F AD - Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel(1). FAU - Biron-Shental, Tal AU - Biron-Shental T AD - Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel(1). LA - eng PT - Journal Article PT - Observational Study DEP - 20180730 PL - Ireland TA - Eur J Obstet Gynecol Reprod Biol JT - European journal of obstetrics, gynecology, and reproductive biology JID - 0375672 SB - IM MH - Adult MH - Asphyxia Neonatorum/*epidemiology MH - Cardiotocography/*statistics & numerical data MH - Female MH - Humans MH - Infant, Newborn MH - Israel/epidemiology MH - Pregnancy MH - Retrospective Studies OTO - NOTNLM OT - Category II cardiotocogram OT - Fetal heart rate monitoring OT - Non-reassuring fetal heart rate OT - Perinatal asphyxia OT - Three-tier classification system EDAT- 2018/08/11 06:00 MHDA- 2019/01/30 06:00 CRDT- 2018/08/11 06:00 PHST- 2018/06/05 00:00 [received] PHST- 2018/07/29 00:00 [accepted] PHST- 2018/08/11 06:00 [pubmed] PHST- 2019/01/30 06:00 [medline] PHST- 2018/08/11 06:00 [entrez] AID - S0301-2115(18)30357-9 [pii] AID - 10.1016/j.ejogrb.2018.07.030 [doi] PST - ppublish SO - Eur J Obstet Gynecol Reprod Biol. 2018 Oct;229:8-14. doi: 10.1016/j.ejogrb.2018.07.030. Epub 2018 Jul 30. PMID- 30441670 OWN - NLM STAT- MEDLINE DCOM- 20191030 LR - 20200928 IS - 2694-0604 (Electronic) IS - 2375-7477 (Linking) VI - 2018 DP - 2018 Jul TI - Deep Learning for Continuous Electronic Fetal Monitoring in Labor. PG - 5866-5869 LID - 10.1109/EMBC.2018.8513625 [doi] AB - Continuous electronic fetal monitoring (EFM) is used worldwide to visually assess whether a fetus is exhibiting signs of distress during labor, and may benefit from an emergency operative delivery (e.g. Cesarean section). Previously, computerized EFM assessment that mimics clinical experts showed no benefit in randomized clinical trials. However, as an example of routinely collected `big' data, EFM interpretation should benefit from data-driven computational approaches, such as deep learning, which allow automated evaluation based on large clinical datasets.Here we report our investigation of long short term memory (LSTM) and convolutional neural networks (CNN) in analyzing EFM traces from over 35,000 labors for the prediction of fetal compromise. Of these, 85% are used for training with crossvalidation and the remainder are set aside for testing. The results are compared with Clinical practice (reason for operative deliveryrecorded as fetal distress) and an earlier prototype system for computerized analysis of EFM (OxSys 1.5), developed on the same data. We demonstrate that CNN outperforms LSTM, Clinical practice, and OxSys 1.5 in predicting fetal compromise, with a sensitivity of 42% (30%, 34%, and 36% for the others, respectively), at comparable or lower false positive rates. We also show that increasing the size of the training set improves the sensitivity and stability of CNN's performance on the testing set. When tested on a small open-access external database, CNN moderately improves on the performance of published feature extraction based methods.We conclude that CNN could play an important role in the field of automated EFM analysis, but requires further work. FAU - Petrozziello, Alessio AU - Petrozziello A FAU - Jordanov, Ivan AU - Jordanov I FAU - Aris Papageorghiou, T AU - Aris Papageorghiou T FAU - Christopher Redman, W G AU - Christopher Redman WG FAU - Georgieva, Antoniya AU - Georgieva A LA - eng GR - CDF-2016-09-004/DH_/Department of Health/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Annu Int Conf IEEE Eng Med Biol Soc JT - Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference JID - 101763872 SB - IM MH - *Cardiotocography MH - *Deep Learning MH - Female MH - Fetal Distress/*diagnosis MH - Humans MH - *Labor, Obstetric MH - *Neural Networks, Computer MH - Pregnancy EDAT- 2018/11/18 06:00 MHDA- 2019/10/31 06:00 CRDT- 2018/11/17 06:00 PHST- 2018/11/17 06:00 [entrez] PHST- 2018/11/18 06:00 [pubmed] PHST- 2019/10/31 06:00 [medline] AID - 10.1109/EMBC.2018.8513625 [doi] PST - ppublish SO - Annu Int Conf IEEE Eng Med Biol Soc. 2018 Jul;2018:5866-5869. doi: 10.1109/EMBC.2018.8513625. PMID- 30440437 OWN - NLM STAT- MEDLINE DCOM- 20190924 LR - 20200928 IS - 2694-0604 (Electronic) IS - 2375-7477 (Linking) VI - 2018 DP - 2018 Jul TI - Automatic Identification and Classification of Fetal Heart-Rate Decelerations from Cardiotocographic Recordings. PG - 474-477 LID - 10.1109/EMBC.2018.8512432 [doi] AB - Cardiotocography (CTG) consists in the simultaneous recording of two distinct traces, the fetal heart rate (FHR; bpm) and the maternal uterine contractions (UCs; mmHg). CTG analysis consists in the evaluation of specific features of traces, among which fetal decelerations (DECs) are considered the "center-stage" since possibly related to fetal distress. DECs are classified based on their duration and occurrence in relation to UCs as prolonged, early, late and variable; each class associates to a specific status of the fetus health. Typically, CTG traces are visually interpreted; however, computerized CTG analysis may overcome subjectivity in CTG interpretation. Thus, this study proposes a new automatic algorithm for computerized identification and classification of DECs. The algorithm was tested on the 552 CTG recordings constituting the "CTU-CHB intra-partum CTG database" of Physionet. Of these, 470 (85.15%) were found suitable for automatic DECs identification and classification. Overall, 5888 DECs were identified, of which 3255 (55.28%) were classified while the other 2633 (44.72%) remained unclassified due to very strict preliminary classification criteria (now required for avoiding misclassifications). Among the classified DECs, 468 (14.38%) were classified as prolonged, 1498 (46.02%) as early, 32 (0.98%) as late, 1257 (38.62%) as variable. Thus, among the classified DECs, the most common are the early and the variable ones (overall 84.64%), the occurrence of which ranged from 0 to 14 DECs per recording. These findings are in agreement with what reported in literature. In conclusion, the proposed algorithm for automatic DECs identification and classification represents a useful tool for computerized CTG analysis. FAU - Sbrollini, Agnese AU - Sbrollini A FAU - Carnicelli, Amalia AU - Carnicelli A FAU - Massacci, Alessandra AU - Massacci A FAU - Tomaiuolo, Leonardo AU - Tomaiuolo L FAU - Zara, Tommaso AU - Zara T FAU - Marcantoni, Ilaria AU - Marcantoni I FAU - Burattini, Luca AU - Burattini L FAU - Morettini, Micaela AU - Morettini M FAU - Fioretti, Sandro AU - Fioretti S FAU - Burattini, Laura AU - Burattini L LA - eng PT - Journal Article PL - United States TA - Annu Int Conf IEEE Eng Med Biol Soc JT - Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference JID - 101763872 SB - IM MH - *Algorithms MH - *Cardiotocography MH - Databases, Factual MH - Deceleration MH - Female MH - Fetal Distress MH - Fetal Heart MH - *Heart Rate, Fetal MH - Humans MH - Pregnancy MH - Uterine Contraction EDAT- 2018/11/18 06:00 MHDA- 2019/09/26 06:00 CRDT- 2018/11/17 06:00 PHST- 2018/11/17 06:00 [entrez] PHST- 2018/11/18 06:00 [pubmed] PHST- 2019/09/26 06:00 [medline] AID - 10.1109/EMBC.2018.8512432 [doi] PST - ppublish SO - Annu Int Conf IEEE Eng Med Biol Soc. 2018 Jul;2018:474-477. doi: 10.1109/EMBC.2018.8512432. PMID- 30317293 OWN - NLM STAT- MEDLINE DCOM- 20190930 LR - 20190930 IS - 0030-9982 (Print) IS - 0030-9982 (Linking) VI - 68 IP - 7 DP - 2018 Jul TI - Predictability of intrapartum cardiotocography with meconium stained liquor and its correlation with perinatal outcome. PG - 1014-1018 AB - OBJECTIVE: To determine the relationship between the colour of liquor and the trace of cardiotocography to see whether it is reactive or non-reactive.. METHODS: This cross-sectional study was conducted at Obstetrics and Gynaecology department, Dar-ul-Sehat Hospital, Karachi from June 2015 to March 2016, and comprised women in labour who delivered singleton babies and had >37 weeks of gestation. Intrapartum monitoring by cardiotocography was conducted. The status of the amniotic membranes, colour and amount of liquor observed were recorded. Cardiotocography was performed for 30 minutes in the left lateral position on admission as well as a monitoring tool in labour at an interval of less than 4 hours. Foetal heart transducer and uterine pressure transducers were applied and the readings were recorded. SPSS 21 was used for statistical analysis. RESULTS: Of the total 200 subjects, 183(91.5%) were reactive and 17(8.5%) were non-reactive women. Overall mean age was 27.39±4.40 years. Most commonly noted risk factor were post-date 53(26.5%), anaemia 35(17.5%), premature rupture of membranes 28(14%) and pregnancy-induced hypertension 10(5%). Insignificant difference was observed in between Cardiotocography findings and risk factors of the women (p>0.05).. CONCLUSIONS: Significant change was seen in cardiotocography of clear liquor which needs more evaluation to rule out ongoing hypoxia. FAU - Husain, Ayesha AU - Husain A AD - Obstetrics and Gynecology Department, DarulSehat Hospital. FAU - Naseem, Aliya AU - Naseem A AD - Obstetrics and Gynecology Department, DarulSehat Hospital. FAU - Anjum, Sagheera AU - Anjum S AD - Obstetrics and Gynecology Department, DarulSehat Hospital. FAU - Imran, Sajida AU - Imran S AD - Obstetrics and Gynecology Department, DarulSehat Hospital. FAU - Arifuzzaman, Muhammad AU - Arifuzzaman M AD - Dow Institute of Radiology. FAU - Adil, Syed Omair AU - Adil SO AD - Department of Research, Dow University of Health Sciences, Karachi, Pakistan. LA - eng PT - Journal Article PL - Pakistan TA - J Pak Med Assoc JT - JPMA. The Journal of the Pakistan Medical Association JID - 7501162 SB - IM MH - Adult MH - Amniotic Fluid/*diagnostic imaging MH - Cardiotocography/*methods MH - Cross-Sectional Studies MH - Female MH - Fetal Distress/diagnosis/physiopathology MH - Heart Rate, Fetal/*physiology MH - Humans MH - Infant, Newborn MH - *Labor, Obstetric MH - Meconium/*diagnostic imaging MH - Predictive Value of Tests MH - Pregnancy MH - Pregnancy Complications/*diagnosis/physiopathology MH - Pregnancy Outcome MH - Prenatal Diagnosis/*methods MH - Retrospective Studies OTO - NOTNLM OT - CTG, Intrapartum, Amniotic fluid. EDAT- 2018/10/15 06:00 MHDA- 2019/10/01 06:00 CRDT- 2018/10/15 06:00 PHST- 2018/10/15 06:00 [entrez] PHST- 2018/10/15 06:00 [pubmed] PHST- 2019/10/01 06:00 [medline] AID - 8761 [pii] PST - ppublish SO - J Pak Med Assoc. 2018 Jul;68(7):1014-1018. PMID- 29799630 OWN - NLM STAT- MEDLINE DCOM- 20190326 LR - 20190326 IS - 1600-0412 (Electronic) IS - 0001-6349 (Linking) VI - 97 IP - 10 DP - 2018 Oct TI - Fetal heart rate short term variation during labor in relation to scalp blood lactate concentration. PG - 1274-1280 LID - 10.1111/aogs.13390 [doi] AB - INTRODUCTION: Fetal heart rate short term variation (STV) decreases with severe chronic hypoxia in the antenatal period. However, only limited research has been done on STV during labor. We have tested a novel algorithm for a valid baseline estimation and calculated STV. To explore the value of STV during labor, we compared STV with fetal scalp blood (FBS) lactate concentration, an early marker in the hypoxic process. MATERIAL AND METHODS: Software was developed which estimates baseline frequency using a novel algorithm and thereby calculates STV according to Dawes and Redman in up to four 30-minute blocks prior to each FBS. Cardiotocography traces from 1070 women in labor who had had FBS performed on 2134 occasions were analyzed. RESULTS: In acidemic cases (lactate >4.8 mmol/L; Lactate Pro™), median STV 30 minutes prior to FBS was 7.10 milliseconds compared with 6.09 milliseconds in the preacidemic (4.2-4.8 mmol/L) and 5.23 milliseconds in the normal (<4.2 mmol/L) groups (P < .05). There was a positive correlation between lactate and STV (rho = 0.16-0.24; P < .05). Median lactate concentration in cases with STV <3.0 milliseconds (n = 160) was 2.3 mmol/L. When 2 FBS were performed within 60 minutes the change rate of lactate correlated to STV (rho = 0.33; P < .001). Cases with increasing lactate concentration had a median STV of 5.29 milliseconds vs 4.41 milliseconds in those with decreasing lactate (P < .001). CONCLUSIONS: In the early stages of intrapartum hypoxia, STV increases, contrary to findings regarding chronic hypoxia in the antenatal period. The increase in the adrenergic surge is a likely explanation. CI - © 2018 Nordic Federation of Societies of Obstetrics and Gynecology. FAU - Lu, Ke AU - Lu K AD - School of Technology and Health, Royal Institute of Technology, Stockholm, Sweden. FAU - Holzmann, Malin AU - Holzmann M AUID- ORCID: 0000-0002-2640-0753 AD - Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. AD - Patient Area Pregnancy and Delivery Care, Karolinska University Hospital, Stockholm, Sweden. FAU - Abtahi, Fahrad AU - Abtahi F AD - Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. AD - Department of Clinical Physiology, Karolinska University Hospital Huddinge, Stockholm, Sweden. FAU - Lindecrantz, Kaj AU - Lindecrantz K AD - School of Technology and Health, Royal Institute of Technology, Stockholm, Sweden. AD - Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. FAU - Lindqvist, Pelle G AU - Lindqvist PG AUID- ORCID: 0000-0002-1652-8235 AD - Patient Area Pregnancy and Delivery Care, Karolinska University Hospital, Stockholm, Sweden. AD - Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. FAU - Nordstrom, Lennart AU - Nordstrom L AUID- ORCID: 0000-0002-7547-2569 AD - Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. AD - Patient Area Pregnancy and Delivery Care, Karolinska University Hospital, Stockholm, Sweden. LA - eng PT - Journal Article DEP - 20180612 PL - United States TA - Acta Obstet Gynecol Scand JT - Acta obstetricia et gynecologica Scandinavica JID - 0370343 SB - IM MH - Algorithms MH - Cardiotocography/*instrumentation MH - Fetal Blood/*chemistry MH - Fetal Hypoxia/*diagnosis/prevention & control MH - Heart Rate, Fetal/*physiology MH - Humans MH - *Scalp MH - Software OTO - NOTNLM OT - computer analysis OT - fetal heart rate monitoring OT - fetal scalp blood sampling OT - hypoxia OT - intrapartum OT - lactate OT - short-term variation EDAT- 2018/05/26 06:00 MHDA- 2019/03/27 06:00 CRDT- 2018/05/26 06:00 PHST- 2018/01/26 00:00 [received] PHST- 2018/05/22 00:00 [accepted] PHST- 2018/05/26 06:00 [pubmed] PHST- 2019/03/27 06:00 [medline] PHST- 2018/05/26 06:00 [entrez] AID - 10.1111/aogs.13390 [doi] PST - ppublish SO - Acta Obstet Gynecol Scand. 2018 Oct;97(10):1274-1280. doi: 10.1111/aogs.13390. Epub 2018 Jun 12. PMID- 29909268 OWN - NLM STAT- MEDLINE DCOM- 20181212 LR - 20181212 IS - 1872-7654 (Electronic) IS - 0301-2115 (Linking) VI - 228 DP - 2018 Sep TI - The relationship between intrapartum cerebroplacental ratio and adverse perinatal outcomes in term fetuses. PG - 82-86 LID - S0301-2115(18)30295-1 [pii] LID - 10.1016/j.ejogrb.2018.06.016 [doi] AB - OBJECTIVES: The cerebroplacental ratio (CPR) Doppler has been proposed as an instrument for predicting adverse perinatal outcomes particularly during antepartum period. Abnormal CPR is associated with non-reassuring fetal status requiring operative delivery, low Apgar score and neonatal complications. The aim of this study was to assess the role of CPR Doppler in the labor triage suite, so as to identify fetuses at risk for non-reassuring status as well as other adverse perinatal outcomes. METHODS: This was a prospective cohort study of term pregnancies who attended the labor room during the latent phase of labor. Both fetal Middle Cerebral Artery Pulsatility Index (MCA-PI) and Umbilical Artery Pulsatility Index (UA-PI) were measured and these values were converted to CPR values. Non-reassuring fetal status requiring operative delivery and other adverse perinatal outcomes were compared between women with normal and abnormal CPR values. Accuracy of CPR for predicting non-reassuring fetal status and abnormal fetal heart rate patterns were calculated. RESULTS: A total of 384 women were recruited. Lower CPR values were observed in women who underwent operative delivery for non-reassuring fetal status. However, when dividing women into normal and abnormal CPR groups, using 3 different cut-off values, the rate of non-reassuring fetal status was not significantly different between the groups. There was a significantly higher rate of abnormal fetal heart rate monitoring in fetuses with CPR < 5(th) percentile and CPR < 1. CPR appeared to have a low positive predictive value (PPV) for predicting non-reassuring fetal heart rate patterns, however, the negative predictive value (NPV) was high. CONCLUSIONS: In term fetuses, lower CPR is associated with non-reassuring fetal status. CPR measurement during the intrapartum period with currently available CPR cut-off values is not a good predictor for adverse perinatal outcomes, with the exception of abnormal fetal heart rate patterns. However, the high NPV may be used to stratify pregnant women who may benefit from continuous fetal heart rate monitoring. CI - Copyright © 2018 Elsevier B.V. All rights reserved. FAU - Chainarong, Natthicha AU - Chainarong N AD - Maternal and Fetal Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand. FAU - Petpichetchian, Chusana AU - Petpichetchian C AD - Maternal and Fetal Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand. Electronic address: chusana020@gmail.com. LA - eng PT - Journal Article PT - Observational Study DEP - 20180611 PL - Ireland TA - Eur J Obstet Gynecol Reprod Biol JT - European journal of obstetrics, gynecology, and reproductive biology JID - 0375672 SB - IM MH - Adult MH - Female MH - Fetal Distress/*diagnostic imaging MH - Humans MH - Middle Cerebral Artery/*diagnostic imaging MH - Pregnancy MH - Pregnancy Outcome MH - Prospective Studies MH - Ultrasonography, Prenatal/*methods MH - Umbilical Arteries/*diagnostic imaging OTO - NOTNLM OT - Adverse perinatal outcomes OT - Cerebroplacental ratio OT - Intrapartum OT - Term pregnancies EDAT- 2018/06/18 06:00 MHDA- 2018/12/13 06:00 CRDT- 2018/06/18 06:00 PHST- 2018/02/13 00:00 [received] PHST- 2018/06/05 00:00 [revised] PHST- 2018/06/10 00:00 [accepted] PHST- 2018/06/18 06:00 [pubmed] PHST- 2018/12/13 06:00 [medline] PHST- 2018/06/18 06:00 [entrez] AID - S0301-2115(18)30295-1 [pii] AID - 10.1016/j.ejogrb.2018.06.016 [doi] PST - ppublish SO - Eur J Obstet Gynecol Reprod Biol. 2018 Sep;228:82-86. doi: 10.1016/j.ejogrb.2018.06.016. Epub 2018 Jun 11. PMID- 29894897 OWN - NLM STAT- MEDLINE DCOM- 20190710 LR - 20190710 IS - 1879-0534 (Electronic) IS - 0010-4825 (Linking) VI - 99 DP - 2018 Aug 1 TI - Prognostic model based on image-based time-frequency features and genetic algorithm for fetal hypoxia assessment. PG - 85-97 LID - S0010-4825(18)30145-8 [pii] LID - 10.1016/j.compbiomed.2018.06.003 [doi] AB - Cardiotocography (CTG) is applied routinely for fetal monitoring during the perinatal period to decrease the rates of neonatal mortality and morbidity as well as unnecessary interventions. The analysis of CTG traces has become an indispensable part of present clinical practices; however, it also has serious drawbacks, such as poor specificity and variability in its interpretation. The automated CTG analysis is seen as the most promising way to overcome these disadvantages. In this study, a novel prognostic model is proposed for predicting fetal hypoxia from CTG traces based on an innovative approach called image-based time-frequency (IBTF) analysis comprised of a combination of short time Fourier transform (STFT) and gray level co-occurrence matrix (GLCM). More specifically, from a graphical representation of the fetal heart rate (FHR) signal, the spectrogram is obtained by using STFT. The spectrogram images are converted into 8-bit grayscale images, and IBTF features such as contrast, correlation, energy, and homogeneity are utilized for identifying FHR signals. At the final stage of the analysis, different subsets of the feature space are applied as the input to the least square support vector machine (LS-SVM) classifier to determine the most informative subset. For this particular purpose, the genetic algorithm is employed. The prognostic model was performed on the open-access intrapartum CTU-UHB CTG database. The sensitivity and specificity obtained using only conventional features were 57.33% and 67.24%, respectively, whereas the most effective results were achieved using a combination of conventional and IBTF features, with a sensitivity of 63.45% and a specificity of 65.88%. Conclusively, this study provides a new promising approach for feature extraction of FHR signals. In addition, the experimental outcomes showed that IBTF features provided an increase in the classification accuracy. CI - Copyright © 2018 Elsevier Ltd. All rights reserved. FAU - Cömert, Zafer AU - Cömert Z AD - Bitlis Eren University, Department of Computer Engineering, Bitlis, Turkey. Electronic address: zcomert@beu.edu.tr. FAU - Kocamaz, Adnan Fatih AU - Kocamaz AF AD - İnönü University, Department of Computer Engineering, Malatya, Turkey. Electronic address: fatih.kocamaz@inonu.edu.tr. FAU - Subha, Velappan AU - Subha V AD - Manonmaniam Sundaranar University, Department of Computer Science and Engineering, India. Electronic address: subha_velappan@msuniv.ac.in. LA - eng PT - Journal Article DEP - 20180606 PL - United States TA - Comput Biol Med JT - Computers in biology and medicine JID - 1250250 SB - IM MH - Adult MH - *Cardiotocography MH - Female MH - *Fetal Hypoxia/diagnosis/diagnostic imaging/physiopathology MH - *Heart Rate, Fetal MH - Humans MH - *Image Processing, Computer-Assisted MH - Pregnancy MH - Prognosis MH - *Support Vector Machine OTO - NOTNLM OT - *Biomedical signal processing OT - *Cardiotocography OT - *Classification OT - *Fetal heart rate OT - *Gray level Co-Occurrence matrix OT - *Image-based time-frequency analysis EDAT- 2018/06/13 06:00 MHDA- 2019/07/11 06:00 CRDT- 2018/06/13 06:00 PHST- 2018/02/20 00:00 [received] PHST- 2018/05/20 00:00 [revised] PHST- 2018/06/03 00:00 [accepted] PHST- 2018/06/13 06:00 [pubmed] PHST- 2019/07/11 06:00 [medline] PHST- 2018/06/13 06:00 [entrez] AID - S0010-4825(18)30145-8 [pii] AID - 10.1016/j.compbiomed.2018.06.003 [doi] PST - ppublish SO - Comput Biol Med. 2018 Aug 1;99:85-97. doi: 10.1016/j.compbiomed.2018.06.003. Epub 2018 Jun 6. PMID- 29859198 OWN - NLM STAT- In-Process LR - 20201218 IS - 1873-7528 (Electronic) IS - 0149-7634 (Linking) VI - 117 DP - 2020 Oct TI - Non-invasive biomarkers of fetal brain development reflecting prenatal stress: An integrative multi-scale multi-species perspective on data collection and analysis. PG - 165-183 LID - S0149-7634(18)30054-X [pii] LID - 10.1016/j.neubiorev.2018.05.026 [doi] AB - Prenatal stress (PS) impacts early postnatal behavioural and cognitive development. This process of 'fetal programming' is mediated by the effects of the prenatal experience on the developing hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS). We derive a multi-scale multi-species approach to devising preclinical and clinical studies to identify early non-invasively available pre- and postnatal biomarkers of PS. The multiple scales include brain epigenome, metabolome, microbiome and the ANS activity gauged via an array of advanced non-invasively obtainable properties of fetal heart rate fluctuations. The proposed framework has the potential to reveal mechanistic links between maternal stress during pregnancy and changes across these physiological scales. Such biomarkers may hence be useful as early and non-invasive predictors of neurodevelopmental trajectories influenced by the PS as well as follow-up indicators of success of therapeutic interventions to correct such altered neurodevelopmental trajectories. PS studies must be conducted on multiple scales derived from concerted observations in multiple animal models and human cohorts performed in an interactive and iterative manner and deploying machine learning for data synthesis, identification and validation of the best non-invasive detection and follow-up biomarkers, a prerequisite for designing effective therapeutic interventions. CI - Copyright © 2018 Elsevier Ltd. All rights reserved. FAU - Frasch, Martin G AU - Frasch MG AD - Department of Obstetrics and Gynecology, University of Washington, Seattle, USA. Electronic address: mfrasch@uw.edu. FAU - Lobmaier, Silvia M AU - Lobmaier SM AD - Frauenklinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. FAU - Stampalija, Tamara AU - Stampalija T AD - Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Mother and Child Health IRCCS Burlo Garofolo, Trieste, Italy. FAU - Desplats, Paula AU - Desplats P AD - University of California, Departments of Neurosciences and Pathology, San Diego, USA. FAU - Pallarés, María Eugenia AU - Pallarés ME AD - Instituto de Biología Celular y Neurociencia "Prof. Eduardo De Robertis", Facultad de Medicina, Universidad de Buenos Aires, Argentina. FAU - Pastor, Verónica AU - Pastor V AD - Instituto de Biología Celular y Neurociencia "Prof. Eduardo De Robertis", Facultad de Medicina, Universidad de Buenos Aires, Argentina. FAU - Brocco, Marcela A AU - Brocco MA AD - Instituto de Investigaciones Biotecnológicas - Instituto Tecnológico de Chascomús (IIB-INTECH), Universidad Nacional de San Martín - Consejo Nacional de Investigaciones Científicas y Técnicas (UNSAM-CONICET), San Martín, Buenos Aires, Argentina. FAU - Wu, Hau-Tieng AU - Wu HT AD - Department of Mathematics and Department of Statistical Science, Duke University, Durham, NC, USA; Mathematics Division, National Center for Theoretical Sciences, Taipei, Taiwan. FAU - Schulkin, Jay AU - Schulkin J AD - Department of Obstetrics and Gynecology, University of Washington, Seattle, USA. FAU - Herry, Christophe L AU - Herry CL AD - Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. FAU - Seely, Andrew J E AU - Seely AJE AD - Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. FAU - Metz, Gerlinde A S AU - Metz GAS AD - Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada. FAU - Louzoun, Yoram AU - Louzoun Y AD - Bar-Ilan University, Department of Applied Mathematics, Israel. FAU - Antonelli, Marta C AU - Antonelli MC AD - Instituto de Biología Celular y Neurociencia "Prof. Eduardo De Robertis", Facultad de Medicina, Universidad de Buenos Aires, Argentina. LA - eng PT - Journal Article PT - Review DEP - 20180530 PL - United States TA - Neurosci Biobehav Rev JT - Neuroscience and biobehavioral reviews JID - 7806090 SB - IM OTO - NOTNLM OT - *ANS OT - *Epigenetics OT - *Guinea pig OT - *HRV OT - *Human OT - *Machine learning OT - *Microbiome OT - *Omics OT - *Rat OT - *Sheep EDAT- 2018/06/03 06:00 MHDA- 2018/06/03 06:00 CRDT- 2018/06/03 06:00 PHST- 2018/02/09 00:00 [received] PHST- 2018/05/09 00:00 [revised] PHST- 2018/05/25 00:00 [accepted] PHST- 2018/06/03 06:00 [pubmed] PHST- 2018/06/03 06:00 [medline] PHST- 2018/06/03 06:00 [entrez] AID - S0149-7634(18)30054-X [pii] AID - 10.1016/j.neubiorev.2018.05.026 [doi] PST - ppublish SO - Neurosci Biobehav Rev. 2020 Oct;117:165-183. doi: 10.1016/j.neubiorev.2018.05.026. Epub 2018 May 30. PMID- 29843068 OWN - NLM STAT- MEDLINE DCOM- 20181018 LR - 20181018 IS - 1872-7654 (Electronic) IS - 0301-2115 (Linking) VI - 226 DP - 2018 Jul TI - When should foetal pH measurements be performed after a prolonged deceleration? An experimental study in a fetal sheep model. PG - 54-58 LID - S0301-2115(18)30253-7 [pii] LID - 10.1016/j.ejogrb.2018.05.031 [doi] AB - OBJECTIVE: The aim of fetal heart rate monitoring during labour is to identify and prevent foetal distress, but its evaluation is not perfect. Fetal scalp blood sampling for pH measurement is one of the second-line methods of monitoring when fetal heart rate is classified as suspicious. This study aims to determine when pH testing should be performed after a prolonged deceleration. STUDY DESIGN: This was an experimental study in a fetal sheep model. A partial umbilical cord occlusion was performed for seven minutes followed by a recuperation period of 30 min. Hemodynamic parameters (heart rate, mean blood pressure and intra-amniotic pressure) and blood gases were recorded before occlusion (T0), during occlusion (T4), just after the end of occlusion (T7), and then 10, 20 and 30 min after occlusion (T17, T27 and T37 respectively). RESULTS: Ten experiments were carried out. During partial cord occlusion, the fetal pH decreased significantly to acidosis. After a prolonged deceleration with fetal acidosis, the pH recovered to a normal value, defined by a pH greater than or equal to 7.25, after 20 min of recuperation. CONCLUSION: After a prolonged deceleration, fetal pH normalizes between 20 and 30 min thereafter. Thus, if a foetal blood sample is indicated, this delay must be respected in order to avoid inducing an unnecessary intervention decision. CI - Copyright © 2018 Elsevier B.V. All rights reserved. FAU - Dupuis, H AU - Dupuis H AD - Univ. Lille, EA 4489, Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France. Electronic address: dupuis.harmonie@outlook.fr. FAU - Ghesquière, L AU - Ghesquière L AD - Univ. Lille, EA 4489, Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France. FAU - De Jonckheere, Julien AU - De Jonckheere J AD - Univ. Lille, EA 4489, Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, CIC-IT 1403, MRRC, F-59000 Lille, France. FAU - Aubry, E AU - Aubry E AD - Univ. Lille, EA 4489, Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Pediatric Surgery, F-59000 Lille, France. FAU - Sharma, D AU - Sharma D AD - Univ. Lille, EA 4489, Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Pediatric Surgery, F-59000 Lille, France. FAU - Deruelle, P AU - Deruelle P AD - Univ. Lille, EA 4489, Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France. FAU - Storme, L AU - Storme L AD - Univ. Lille, EA 4489, Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Neonatology, F-59000 Lille, France. FAU - Houfflin-Debarge, V AU - Houfflin-Debarge V AD - Univ. Lille, EA 4489, Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France. FAU - Garabedian, C AU - Garabedian C AD - Univ. Lille, EA 4489, Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France. LA - eng PT - Journal Article DEP - 20180522 PL - Ireland TA - Eur J Obstet Gynecol Reprod Biol JT - European journal of obstetrics, gynecology, and reproductive biology JID - 0375672 SB - IM MH - Acidosis/blood/*diagnosis/physiopathology MH - Animals MH - Blood Gas Analysis MH - Deceleration MH - Female MH - Fetal Distress/blood/*diagnosis/physiopathology MH - Heart Rate, Fetal/*physiology MH - Hydrogen-Ion Concentration MH - *Labor, Obstetric MH - Pregnancy MH - Sheep OTO - NOTNLM OT - Acido-basic balance OT - Fetal scalp blood sampling OT - Fetal sheep OT - Partial umbilical cord occlusion OT - Prolonged deceleration EDAT- 2018/05/31 06:00 MHDA- 2018/10/20 06:00 CRDT- 2018/05/30 06:00 PHST- 2018/04/24 00:00 [received] PHST- 2018/05/21 00:00 [accepted] PHST- 2018/05/31 06:00 [pubmed] PHST- 2018/10/20 06:00 [medline] PHST- 2018/05/30 06:00 [entrez] AID - S0301-2115(18)30253-7 [pii] AID - 10.1016/j.ejogrb.2018.05.031 [doi] PST - ppublish SO - Eur J Obstet Gynecol Reprod Biol. 2018 Jul;226:54-58. doi: 10.1016/j.ejogrb.2018.05.031. Epub 2018 May 22. PMID- 29888259 OWN - NLM STAT- MEDLINE DCOM- 20181005 LR - 20181114 IS - 2314-6141 (Electronic) IS - 2314-6133 (Print) VI - 2018 DP - 2018 TI - A Comprehensive Evaluation of the Predictive Abilities of Fetal Electrocardiogram-Derived Parameters during Labor in Newborn Acidemia: Our Institutional Experience. PG - 3478925 LID - 10.1155/2018/3478925 [doi] LID - 3478925 AB - This study aimed to identify cardiotocography patterns that discriminate fetal acidemia newborns by comprehensively evaluating the parameters obtained from Holter monitoring during delivery. Between June 1, 2015, and August 1, 2016, a prospective observational study of 85 patients was conducted using fetal Holter monitoring at the Beijing Obstetrics and Gynecology Hospital, Capital Medical University, China. Umbilical cord blood was sampled immediately after delivery and fetal acidemia was defined as umbilical cord arterial blood pH < 7.20. Fetal electrocardiogram- (FECG-) derived parameters, including basal fetal heart rate (BFHR), short-term variation (STV), large acceleration (LA), deceleration capacity (DC), acceleration capacity (AC), proportion of episodes of high variation (PEHV), and proportion of episodes of low variation (PELV), were compared between 16 fetuses with acidemia and 47 without. The areas under the curve (AUC) of receiver operating characteristics (ROC) were calculated. Although all the computerized parameters showed predictive values for acidemia (all AUC > 0.50), STV (AUC = 0.84, P < 0.001), DC (AUC = 0.84, P < 0.001), AC (AUC = 0.80, P < 0.001), and PELV (AUC = 0.71, P = 0.012) were more strongly associated with fetal acidemia. Our institutional experience suggests that FECG-derived parameters from Holter monitoring are beneficial in reducing the incidence of neonatal acidemia. FAU - Tian, Ning AU - Tian N AD - Obstetrical Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China. FAU - Zhang, Weiyuan AU - Zhang W AUID- ORCID: 0000-0002-2014-7734 AD - Obstetrical Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China. LA - eng PT - Clinical Trial PT - Journal Article PT - Observational Study DEP - 20180517 TA - Biomed Res Int JT - BioMed research international JID - 101600173 SB - IM MH - Adult MH - *Electrocardiography MH - Female MH - *Fetus MH - Humans MH - Infant, Newborn MH - Male MH - Pregnancy MH - Prospective Studies PMC - PMC5985095 EDAT- 2018/06/12 06:00 MHDA- 2018/10/06 06:00 CRDT- 2018/06/12 06:00 PHST- 2017/11/28 00:00 [received] PHST- 2018/03/20 00:00 [revised] PHST- 2018/04/17 00:00 [accepted] PHST- 2018/06/12 06:00 [entrez] PHST- 2018/06/12 06:00 [pubmed] PHST- 2018/10/06 06:00 [medline] AID - 10.1155/2018/3478925 [doi] PST - epublish SO - Biomed Res Int. 2018 May 17;2018:3478925. doi: 10.1155/2018/3478925. eCollection 2018. PMID- 29724142 OWN - NLM STAT- MEDLINE DCOM- 20200121 LR - 20200121 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) VI - 32 IP - 22 DP - 2019 Nov TI - Interobserver agreement in analysis of cardiotocograms recorded during trial of labor after cesarean. PG - 3778-3783 LID - 10.1080/14767058.2018.1472225 [doi] AB - Introduction: To examine interobserver agreement in intrapartum cardiotocography (CTG) classification in women undergoing trial of labor after a cesarean section (TOLAC) at term with or without complete uterine rupture. Materials and methods: Nineteen blinded and independent Danish obstetricians assessed CTG tracings from 47 women (174 individual pages) with a complete uterine rupture during TOLAC and 37 women (133 individual pages) with no uterine rupture during TOLAC. Individual pages with CTG tracings lasting at least 20 min were evaluated by three different assessors and counted as an individual case. The tracings were analyzed according to the modified version of the Federation of Gynaecology and Obstetrics (FIGO) guidelines elaborated for the use of STAN (ST-analysis). Occurrence of defined abnormalities was recorded and the tracings were classified as normal, suspicious, pathological, or preterminal. The interobserver agreement was evaluated using Fleiss' kappa. Results: Agreement on classification of a preterminal CTG was almost perfect. The interobserver agreement on normal, suspicious or pathological CTG was moderate to substantial. Regarding the presence of severe variable decelerations, the agreement was moderate. No statistical difference was found in the interobserver agreement between classification of tracings from women undergoing TOLAC with and without complete uterine rupture. Conclusions: The interobserver agreement on classification of CTG tracings from high-risk deliveries during TOLAC is best for assessment of a preterminal CTG and the poorest for the identification of severe variable decelerations. FAU - Caning, M M AU - Caning MM AUID- ORCID: 0000-0001-6429-9492 AD - a Department of Obstetrics and Gynecology , University of Copenhagen, Holbaek Hospital , Holbaek, Denmark. FAU - Thisted, D L A AU - Thisted DLA AD - a Department of Obstetrics and Gynecology , University of Copenhagen, Holbaek Hospital , Holbaek, Denmark. AD - b Department of Obstetrics and Gynecology , University of Copenhagen, Slagelse Hospital , Slagelse , Denmark. FAU - Amer-Wählin, I AU - Amer-Wählin I AD - c Department of Women and Child Health , Karolinska Institute , Stockholm , Sweden. FAU - Laier, G H AU - Laier GH AD - d PFI (Production, Research and Innovation) , Region Zealand , Denmark. FAU - Krebs, L AU - Krebs L AD - a Department of Obstetrics and Gynecology , University of Copenhagen, Holbaek Hospital , Holbaek, Denmark. LA - eng PT - Evaluation Study PT - Journal Article DEP - 20180517 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 SB - IM MH - Acidosis/blood/diagnosis/epidemiology MH - Adult MH - Cardiotocography/*statistics & numerical data MH - Case-Control Studies MH - Female MH - Fetal Distress/blood/*diagnosis/epidemiology MH - Fetal Monitoring/methods/*statistics & numerical data MH - Heart Rate, Fetal/*physiology MH - Humans MH - Observer Variation MH - Predictive Value of Tests MH - Pregnancy MH - Retrospective Studies MH - Sensitivity and Specificity MH - *Trial of Labor MH - *Vaginal Birth after Cesarean/adverse effects/methods/statistics & numerical data OTO - NOTNLM OT - Cardiotocography OT - Fleiss’ kappa OT - interobserver agreement OT - trial of labor after cesarean (TOLAC) OT - uterine rupture EDAT- 2018/05/05 06:00 MHDA- 2020/01/22 06:00 CRDT- 2018/05/05 06:00 PHST- 2018/05/05 06:00 [pubmed] PHST- 2020/01/22 06:00 [medline] PHST- 2018/05/05 06:00 [entrez] AID - 10.1080/14767058.2018.1472225 [doi] PST - ppublish SO - J Matern Fetal Neonatal Med. 2019 Nov;32(22):3778-3783. doi: 10.1080/14767058.2018.1472225. Epub 2018 May 17. PMID- 29604064 OWN - NLM STAT- MEDLINE DCOM- 20191125 LR - 20210109 IS - 1469-7793 (Electronic) IS - 0022-3751 (Print) IS - 0022-3751 (Linking) VI - 596 IP - 23 DP - 2018 Dec TI - Altered autonomic control of heart rate variability in the chronically hypoxic fetus. PG - 6105-6119 LID - 10.1113/JP275659 [doi] AB - KEY POINTS: Fetal heart rate variability (FHRV) has long been recognised as a powerful predictor of fetal wellbeing, and a decrease in FHRV is associated with fetal compromise. However, the mechanisms by which FHRV is reduced in the chronically hypoxic fetus have yet to be established. The sympathetic and parasympathetic influences on heart rate mature at different rates throughout fetal life, and can be assessed by time domain and power spectral analysis of FHRV. In this study of chronically instrumented fetal sheep in late gestation, we analysed FHRV daily over a 16 day period towards term, and compared changes between fetuses of control and chronically hypoxic pregnancy. We show that FHRV in sheep is reduced by chronic hypoxia, predominantly due to dysregulation of the sympathetic control of the fetal heart rate. This presents a potential mechanism by which a reduction in indices of FHRV predicts fetuses at increased risk of neonatal morbidity and mortality in humans. Reduction in overall FHRV may therefore provide a biomarker that autonomic dysregulation of fetal heart rate control has taken place in a fetus where uteroplacental dysfunction is suspected. ABSTRACT: Although fetal heart rate variability (FHRV) has long been recognised as a powerful predictor of fetal wellbeing, the mechanisms by which it is reduced in the chronically hypoxic fetus have yet to be established. In particular, the physiological mechanism underlying the reduction of short term variation (STV) in fetal compromise remains unclear. In this study, we present a longitudinal study of the development of autonomic control of FHRV, assessed by indirect indices, time domain and power spectral analysis, in normoxic and chronically hypoxic, chronically catheterised, singleton fetal sheep over the last third of gestation. We used isobaric chambers able to maintain pregnant sheep for prolonged periods in hypoxic conditions (stable fetal femoral arterial PO2 10-12 mmHg), and a customised wireless data acquisition system to record beat-to-beat variation in the fetal heart rate. We determined in vivo longitudinal changes in overall FHRV and the sympathetic and parasympathetic contribution to FHRV in hypoxic (n = 6) and normoxic (n = 6) ovine fetuses with advancing gestational age. Normoxic fetuses show gestational age-related increases in overall indices of FHRV, and in the sympathetic nervous system contribution to FHRV (P < 0.001). Conversely, gestational age-related increases in overall FHRV were impaired by exposure to chronic hypoxia, and there was evidence of suppression of the sympathetic nervous system control of FHRV after 72 h of exposure to hypoxia (P < 0.001). This demonstrates that exposure to late gestation isolated chronic fetal hypoxia has the potential to alter the development of the autonomic nervous system control of FHRV in sheep. This presents a potential mechanism by which a reduction in indices of FHRV in human fetuses affected by uteroplacental dysfunction can predict fetuses at increased risk. CI - © 2018 The Authors. The Journal of Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society. FAU - Shaw, C J AU - Shaw CJ AUID- ORCID: 0000-0002-8002-2976 AD - Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK. AD - Institute of Reproductive and Developmental Biology, Imperial College London, London, UK. FAU - Allison, B J AU - Allison BJ AUID- ORCID: 0000-0002-1060-513X AD - Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK. FAU - Itani, N AU - Itani N AUID- ORCID: 0000-0001-6171-1349 AD - Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK. FAU - Botting, K J AU - Botting KJ AUID- ORCID: 0000-0003-4290-9821 AD - Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK. AD - Cambridge Cardiovascular Research Initiative, Addenbrooke's Hospital, Cambridge, UK. FAU - Niu, Y AU - Niu Y AUID- ORCID: 0000-0002-8843-9952 AD - Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK. AD - Cambridge Cardiovascular Research Initiative, Addenbrooke's Hospital, Cambridge, UK. FAU - Lees, C C AU - Lees CC AUID- ORCID: 0000-0002-2104-5561 AD - Institute of Reproductive and Developmental Biology, Imperial College London, London, UK. AD - Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium. FAU - Giussani, D A AU - Giussani DA AUID- ORCID: 0000-0002-1308-1204 AD - Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK. AD - Cambridge Cardiovascular Research Initiative, Addenbrooke's Hospital, Cambridge, UK. LA - eng GR - RG/11/16/29260/BHF_/British Heart Foundation/United Kingdom GR - RG/17/8/32924/BHF_/British Heart Foundation/United Kingdom GR - GN2052/Action Medical Research/International PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20180429 TA - J Physiol JT - The Journal of physiology JID - 0266262 SB - IM CIN - J Physiol. 2018 Dec;596(23):5507-5508. PMID: 29774552 MH - Animals MH - Autonomic Nervous System/physiopathology MH - Female MH - *Heart Rate, Fetal MH - Hypoxia/*physiopathology MH - Pregnancy MH - Sheep MH - Sympathetic Nervous System/physiopathology PMC - PMC6265555 OTO - NOTNLM OT - *Fetal Growth Restriction OT - *Fetal heart rate OT - *Fetal heart rate variability OT - *Intrauterine hypoxia OT - *Sympathetic nervous system EDAT- 2018/04/01 06:00 MHDA- 2019/11/26 06:00 CRDT- 2018/04/01 06:00 PHST- 2017/11/30 00:00 [received] PHST- 2018/03/19 00:00 [accepted] PHST- 2018/04/01 06:00 [pubmed] PHST- 2019/11/26 06:00 [medline] PHST- 2018/04/01 06:00 [entrez] AID - TJP12943 [pii] AID - 10.1113/JP275659 [doi] PST - ppublish SO - J Physiol. 2018 Dec;596(23):6105-6119. doi: 10.1113/JP275659. Epub 2018 Apr 29. PMID- 29514530 OWN - NLM STAT- MEDLINE DCOM- 20191224 LR - 20191224 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) VI - 32 IP - 17 DP - 2019 Sep TI - Accuracy of the fetal cerebroplacental ratio for the detection of intrapartum compromise in nonsmall fetuses(). PG - 2842-2852 LID - 10.1080/14767058.2018.1450380 [doi] AB - Objective: To study the accuracy of the cerebroplacental ratio (CPR) for the detection of intrapartum fetal compromise (IFC) in fetuses growing over the 10th centile. Methods: This was a prospective study of 569 nonsmall fetuses attending the day hospital unit of a tertiary hospital that underwent an ultrasound examination at 36-40 weeks, and were delivered within 4 weeks of examination. IFC was defined as a composite of abnormal intrapartum fetal heart rate or intrapartum fetal scalp pH <7.20 requiring cesarean section, neonatal umbilical cord pH <7.20, 5 min Apgar score <7 and postpartum admission to neonatal or pediatric intensive care units. The accuracy of CPR for the prediction of IFC was calculated alone and in combination with other perinatal parameters using univariate and multivariate logistic regression models, which alternatively included the onset of labor to evaluate the influence of induction of labor (IOL) on IFC, and a brief composite adverse outcome of two parameters to prove the strength of the approach. Results: The incidence of IFC was 17.9%. CPR sensitivity was 30.4% for a false positive rate (FFR) of 10 and 14.7% for an FPP of 5% (AUC = 0.62, p < .001). The multivariate analysis showed that only fetal gender and parity increased the predictive accuracy of CPR alone, although the improvement was poor (AUC = 0.67, p < .001). No differences were observed using any of the alternative models. Finally, IOL had no influence on IFC. Conclusions: Despite their apparent normality, a proportion of fetuses growing over the 10th centile suffer IFC. Some of them are suitable for detection by means of CPR. FAU - Morales-Roselló, José AU - Morales-Roselló J AD - a Servicio de Obstetricia , Hospital Universitario y Politécnico La Fe , Valencia , Spain. AD - b Departamento de Pediatría Obstetricia y Ginecología , Universidad de Valencia , Valencia , Spain. FAU - Khalil, Asma AU - Khalil A AD - c Fetal Medicine Unit, St. George's Hospital and St George's University , London , United Kingdom. FAU - Fornés-Ferrer, Victoria AU - Fornés-Ferrer V AD - d Unidad de Bioestadística, Instituto de Investigación Sanitaria La Fe , Valencia , Spain. FAU - Perales-Marín, Alfredo AU - Perales-Marín A AD - a Servicio de Obstetricia , Hospital Universitario y Politécnico La Fe , Valencia , Spain. AD - b Departamento de Pediatría Obstetricia y Ginecología , Universidad de Valencia , Valencia , Spain. LA - eng PT - Journal Article DEP - 20180321 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 SB - IM MH - Adult MH - Birth Weight MH - Female MH - Fetal Distress/*diagnosis/epidemiology MH - Gestational Age MH - Humans MH - Infant, Newborn MH - Male MH - Middle Cerebral Artery/diagnostic imaging/*embryology MH - Predictive Value of Tests MH - Pregnancy MH - Pregnancy Outcome/epidemiology MH - Prospective Studies MH - *Pulsatile Flow MH - Reproducibility of Results MH - Ultrasonography, Prenatal MH - Umbilical Arteries/diagnostic imaging/*embryology OTO - NOTNLM OT - Cerebroplacental ratio OT - fetal Doppler OT - fetal growth EDAT- 2018/03/09 06:00 MHDA- 2019/12/25 06:00 CRDT- 2018/03/09 06:00 PHST- 2018/03/09 06:00 [pubmed] PHST- 2019/12/25 06:00 [medline] PHST- 2018/03/09 06:00 [entrez] AID - 10.1080/14767058.2018.1450380 [doi] PST - ppublish SO - J Matern Fetal Neonatal Med. 2019 Sep;32(17):2842-2852. doi: 10.1080/14767058.2018.1450380. Epub 2018 Mar 21. PMID- 29447043 OWN - NLM STAT- MEDLINE DCOM- 20191126 LR - 20191126 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) VI - 32 IP - 15 DP - 2019 Aug TI - Re-engineering the interpretation of electronic fetal monitoring to identify reversible risk for cerebral palsy: a case control series. PG - 2561-2569 LID - 10.1080/14767058.2018.1441283 [doi] AB - BACKGROUND: Even key opinion leaders now concede that electronic fetal monitoring (EFM) cannot reliably identify fetal acidemia which many vouch as the only labor mediated pathophysiologic precursor for cerebral palsy (CP). We have developed the "Fetal Reserve Index" - an algorithm combining five dynamic components of EFM (1. Rate, 2. Variability, 3. Accelerations, 4. Decelerations, and 5. Excessive uterine activity) considered individually that are combined with the presence of: 6. maternal, 7. obstetrical, and 8. fetal risk factors. OBJECTIVE: Here, we compare this 8-point fetal reserve index (FRI) against the performance of ACOG monograph criteria and ACOG Category systems for predicting risk for both CP and the need for emergency operative delivery (EOD). We then studied how varied management for screen positives (Red zone-defined below) impacts the outcome of such cases. STUDY DESIGN: Four hundred twenty term patients were studied: all entered labor with normal EFMs and no apparent cause of harm except events of labor and delivery. Sixty subsequently developed CP, and 360 were apparently normal controls. An FRI, normal on all eight parameters scored 100%, 4 of the 8 was 50%, etc. We divided cases into Green zone >50%, Yellow 50-26%, and Red ≤25%. An FRI in the Red zone was considered a positive screen. We then compared performance metrics for the three evaluation schemes and differences between controls that reached Red against those controls whose worst scores were Green/Yellow. RESULTS: For detection of injury during labor, the FRI performed much better than the ACOG Category criteria (sensitivity 28%), and Category III (45%) (p < .001). All CP cases reached Red zone and were Red for a minimum of 2 hours (mean = 5.35 hours). Twenty-four% of controls reached Red, but were only Red for average of 1 hr. The incidence of low Apgar's, pH, FRI, and Lowest FRI increased progressively from Green/Yellow controls to red controls to CP cases. Irrespective, CP cases met ACOG Monograph criteria for labor injury less than 50% of the time. Only half of CP babies had umbilical artery pH values <7.00, and less than 50% showed Category III patterns. The earlier in labor the Red zone was reached, the more likely for a baby to develop CP or the mother to require an EOD regardless of fetal outcome. Successful intrauterine resuscitations (IR) diminished time spent in the Red zone and the need for EODs. CONCLUSIONS: FRI shows better discrimination for adverse fetal outcome and EOD than traditional EFM interpretation. The Category system is a very poor, subjective screening method as the vast majority of CP babies never reach the "action point" result of Category III. While reaching the Red zone does not ordain a bad outcome, how it is managed, does. Compared to CP cases, Red controls were delivered faster, had higher FRIs, and often had prompt management including IR maneuvers, which improved the FRI and lowered the risk of EODs even for cases with normal outcomes. With further study and validation, the quantitative FRI approach may replace the current, very subjective interpretation with a quantitative "lab test" approach. FAU - Evans, Mark I AU - Evans MI AD - a Fetal Medicine Foundation of America , New York , NY , USA. AD - b Comprehensive Genetics, PLLC/Department of Obstetrics & Gynecology , Mt. Sinai School of Medicine , New York , NY , USA. FAU - Eden, Robert D AU - Eden RD AD - a Fetal Medicine Foundation of America , New York , NY , USA. FAU - Britt, David W AU - Britt DW AD - a Fetal Medicine Foundation of America , New York , NY , USA. FAU - Evans, Shara M AU - Evans SM AD - a Fetal Medicine Foundation of America , New York , NY , USA. FAU - Schifrin, Barry S AU - Schifrin BS AD - a Fetal Medicine Foundation of America , New York , NY , USA. LA - eng PT - Journal Article DEP - 20180228 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 SB - IM MH - Adult MH - Algorithms MH - *Cardiotocography MH - Case-Control Studies MH - *Cerebral Palsy MH - Female MH - Humans MH - Pregnancy MH - Risk Assessment OTO - NOTNLM OT - ACOG monitoring classification system OT - Electronic fetal monitoring OT - cerebral palsy OT - fetal reserve index OT - intrauterine resuscitation OT - neonatal encephalopathy EDAT- 2018/02/16 06:00 MHDA- 2019/11/27 06:00 CRDT- 2018/02/16 06:00 PHST- 2018/02/16 06:00 [pubmed] PHST- 2019/11/27 06:00 [medline] PHST- 2018/02/16 06:00 [entrez] AID - 10.1080/14767058.2018.1441283 [doi] PST - ppublish SO - J Matern Fetal Neonatal Med. 2019 Aug;32(15):2561-2569. doi: 10.1080/14767058.2018.1441283. Epub 2018 Feb 28. PMID- 29350194 OWN - NLM STAT- MEDLINE DCOM- 20181231 LR - 20181231 IS - 1361-6579 (Electronic) IS - 0967-3334 (Linking) VI - 39 IP - 2 DP - 2018 Feb 28 TI - Detection rate of fetal distress using contraction-dependent fetal heart rate variability analysis. PG - 025008 LID - 10.1088/1361-6579/aaa925 [doi] AB - OBJECTIVE: Monitoring of the fetal condition during labor is currently performed by cardiotocograpy (CTG). Despite the use of CTG in clinical practice, CTG interpretation suffers from a high inter- and intra-observer variability and a low specificity. In addition to CTG, analysis of fetal heart rate variability (HRV) has been shown to provide information on fetal distress. However, fetal HRV can be strongly influenced by uterine contractions, particularly during the second stage of labor. Therefore, the aim of this study is to examine if distinguishing contractions from rest periods can improve the detection rate of HRV features for fetal distress during the second stage of labor. APPROACH: We used a dataset of 100 recordings, containing 20 cases of fetuses with adverse outcome. The most informative HRV features were selected by a genetic algorithm and classification performance was evaluated using support vector machines. MAIN RESULTS: Classification performance of fetal heart rate segments closest to birth improved from a geometric mean of 70% to 79%. If the classifier was used to indicate fetal distress over time, the geometric mean at 15 minutes before birth improved from 60% to 72%. SIGNIFICANCE: Our results show that combining contraction-dependent HRV features with HRV features calculated over the entire fetal heart rate signal improves the detection rate of fetal distress. FAU - Warmerdam, G J J AU - Warmerdam GJJ AD - Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands. FAU - Vullings, R AU - Vullings R FAU - Van Laar, J O E H AU - Van Laar JOEH FAU - Van der Hout-Van der Jagt, M B AU - Van der Hout-Van der Jagt MB FAU - Bergmans, J W M AU - Bergmans JWM FAU - Schmitt, L AU - Schmitt L FAU - Oei, S G AU - Oei SG LA - eng PT - Journal Article DEP - 20180228 PL - England TA - Physiol Meas JT - Physiological measurement JID - 9306921 SB - IM MH - Female MH - Fetal Distress/*physiopathology MH - Fetal Monitoring/*methods MH - *Heart Rate, Fetal MH - Humans MH - Pregnancy MH - Signal Processing, Computer-Assisted EDAT- 2018/01/20 06:00 MHDA- 2019/01/01 06:00 CRDT- 2018/01/20 06:00 PHST- 2018/01/20 06:00 [pubmed] PHST- 2019/01/01 06:00 [medline] PHST- 2018/01/20 06:00 [entrez] AID - 10.1088/1361-6579/aaa925 [doi] PST - epublish SO - Physiol Meas. 2018 Feb 28;39(2):025008. doi: 10.1088/1361-6579/aaa925. PMID- 29511418 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201001 IS - 1918-3003 (Print) IS - 1918-3011 (Electronic) IS - 1918-3003 (Linking) VI - 10 IP - 4 DP - 2018 Apr TI - Obstetrics at Decisive Crossroads Regarding Pattern-Recognition of Fetal Heart Rate Decelerations: Scientific Principles and Lessons From Memetics. PG - 302-308 LID - 10.14740/jocmr3307e [doi] AB - The survival of cardiotocography (CTG) as a tool for intrapartum fetal monitoring seems threatened somewhat unjustifiably and unwittingly despite the absence of better alternatives. Fetal heart rate (FHR) decelerations are center-stage (most important) in the interpretation of CTG with maximum impact on three-tier classification. The pattern-discrimination of FHR decelerations is inexorably linked to their nomenclature. Unscientific or flawed nomenclature of decelerations can explain the dysfunctional CTG interpretation leading to errors in detection of acidemic fetuses. There are three contrasting concepts about categorization of FHR decelerations: 1) all rapid decelerations (the vast majority) should be grouped as "variable" because they are predominantly due to cord-compression, 2) all decelerations are due to chemoreflex from fetal hypoxemia hence their timing is not important, and 3) FHR decelerations should be categorized into "early/late/variable" based primarily on their time relationship to contractions. These theoretical concepts are like memes (ideas/beliefs). Lessons from "memetics" are that the most popular, attractive or established beliefs may not necessarily be true, scientific, beneficial or even without harm. Decelerations coincident with contractions with trough corresponding to the peak of contractions cannot be explained by cord-compression or increasing hypoxia (from compromised uteroplacental perfusion, cord-compression or even cerebral hypoperfusion/anoxia purportedly conceivable from head-compression). Decelerations due to hypoxemia would be associated with delayed recovery of decelerations (lag phase). It is a scientific imperative to cast away disproven/falsified theories. Practices based on unscientific theories lead to patient harm. Clinicians should urgently adopt the categorization of FHR decelerations based primarily of the time relationship to contractions as originally proposed by Hon and Caldeyro-Barcia. This analytical review shows it to be underpinned by most robust physiological and scientific hypotheses unlike the other categorizations associated with untruthful hypotheses, irreconcilable fallacies and contradictions. Without truthful framework and meaningful pattern-recognition of FHR decelerations, the CTG will not fulfil its true potential. FAU - Sholapurkar, Shashikant L AU - Sholapurkar SL AD - Department of Obstetrics and Gynaecology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, UK. Email: s.sholapurkar@nhs.net. LA - eng PT - Journal Article PT - Review DEP - 20180218 TA - J Clin Med Res JT - Journal of clinical medicine research JID - 101538301 PMC - PMC5827914 OTO - NOTNLM OT - Cardiotocography OT - Cord compression OT - Fetal heart rate decelerations OT - Fetal hypoxemia OT - Head compression OT - Intrapartum fetal monitoring OT - Memetics COIS- The author has no conflict of interest to declare. The concepts presented are personal opinion only and do not necessarily reflect any practice. All the concepts were submitted to expert-groups on many occasions over the last decade. EDAT- 2018/03/08 06:00 MHDA- 2018/03/08 06:01 CRDT- 2018/03/08 06:00 PHST- 2017/12/08 00:00 [received] PHST- 2017/12/20 00:00 [accepted] PHST- 2018/03/08 06:00 [entrez] PHST- 2018/03/08 06:00 [pubmed] PHST- 2018/03/08 06:01 [medline] AID - 10.14740/jocmr3307e [doi] PST - ppublish SO - J Clin Med Res. 2018 Apr;10(4):302-308. doi: 10.14740/jocmr3307e. Epub 2018 Feb 18. PMID- 28294442 OWN - NLM STAT- MEDLINE DCOM- 20181001 LR - 20181001 IS - 1469-0705 (Electronic) IS - 0960-7692 (Linking) VI - 51 IP - 3 DP - 2018 Mar TI - Prediction of adverse perinatal outcome by cerebroplacental ratio adjusted for estimated fetal weight. PG - 381-386 LID - 10.1002/uog.17458 [doi] AB - OBJECTIVES: To evaluate the relationship between cerebroplacental ratio (CPR) and estimated fetal weight (EFW) in low- and high-risk singleton pregnancies. Furthermore, we evaluated the role of CPR in the prediction of adverse perinatal outcome and whether CPR measurements adjusted for EFW improve its predictive value. METHODS: This was a retrospective cohort study including pregnancies in which Doppler investigations of umbilical artery (UA) and fetal middle cerebral artery (MCA) were performed at ≥ 30 weeks' gestation. Pregnancies were allocated to one of three groups according to EFW centile: small-for-gestational age (SGA) with EFW < 10(th) centile, appropriate-for-gestational age (AGA) and large-for-gestational age (LGA) with EFW > 90(th) centile. CPR was calculated as the ratio between the UA pulsatility index (PI) and MCA-PI and converted to CPR multiples of the median (MoMs) according to the three EFW groups. Linear regression analysis was performed to evaluate the relationship between CPR-MoMs and EFW centiles in low-risk pregnancies. Furthermore, MoMs of CPR adjusted according to EFW centile (aCPR-MoMs) were calculated. Adverse perinatal outcome was defined as presence of pathological cardiotocography (CTG) trace, arterial cord blood pH < 7.1, 5-min Apgar score < 7 and presence of meconium-stained amniotic fluid (MSAF). RESULTS: A total of 3515 (3016 low risk and 499 high risk) pregnancies, delivered between January 2010 and March 2016, were included. Linear regression analysis revealed a significant positive correlation between EFW centile and CPR-MoM. Receiver-operating characteristics (ROC) curve analysis showed a significant association between CPR-MoM and pathological CTG trace (AUC, 0.539; SD, 0.014; P = 0.005) and low Apgar score (AUC, 0.609; SD, 0.041; P = 0.008), but not with low arterial pH or MSAF. There was a significant association between aCPR-MoM and pathological CTG trace (AUC, 0.540; SD, 0.014; P = 0.003), low arterial cord blood pH (AUC, 0.546; SD, 0.022; P = 0.035) and low Apgar score (AUC, 0.609; SD, 0.044; P = 0.008), but not with MSAF. However, detection rates for adverse perinatal outcomes by CPR-MoM and aCPR-MoM were low, ranging from 6.7% to 28.6% for SGA, 12.1% to 22.2% for AGA and 0% to 33.3% for LGA, for a false-positive rate of 10%. In a subgroup analysis of cases in which ultrasound examination was performed at ≥ 34 weeks of gestation and within 4 weeks of delivery (n = 1439), the ROC curves for aCPR-MoM were significantly associated with all four outcomes evaluated. CONCLUSIONS: CPR-MoM values are dependent on EFW centiles; therefore, we suggest that CPR-MoM should be adjusted for EFW centile. However, both CPR- and aCPR-MoM showed a low prediction rate for adverse perinatal outcome. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. CI - Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. FAU - Sirico, A AU - Sirico A AUID- ORCID: 0000-0002-0593-9063 AD - Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. AD - High Risk Pregnancy Centre-Department of Neurosciences, Reproductive and Dentistry Sciences, University Federico II, Naples, Italy. FAU - Diemert, A AU - Diemert A AUID- ORCID: 0000-0003-2546-5464 AD - Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. FAU - Glosemeyer, P AU - Glosemeyer P AD - Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. FAU - Hecher, K AU - Hecher K AUID- ORCID: 0000-0002-3172-1164 AD - Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. LA - eng PT - Journal Article DEP - 20180207 PL - England TA - Ultrasound Obstet Gynecol JT - Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology JID - 9108340 SB - IM MH - Adult MH - Female MH - Fetal Growth Retardation/*diagnostic imaging MH - Fetal Weight/*physiology MH - Fetus/blood supply MH - Gestational Age MH - Humans MH - Infant, Small for Gestational Age MH - Middle Cerebral Artery/*diagnostic imaging/embryology/physiopathology MH - Placenta/diagnostic imaging MH - Placental Insufficiency/*diagnostic imaging MH - Pregnancy MH - Pregnancy Complications/*diagnostic imaging MH - Pregnancy Trimester, Third/physiology MH - Pulsatile Flow/*physiology MH - ROC Curve MH - Retrospective Studies MH - Risk Assessment MH - Ultrasonography, Doppler MH - *Ultrasonography, Prenatal OTO - NOTNLM OT - Doppler OT - cerebroplacental ratio OT - estimated fetal weight OT - perinatal outcome OT - umbilical artery EDAT- 2017/03/16 06:00 MHDA- 2018/10/03 06:00 CRDT- 2017/03/16 06:00 PHST- 2016/09/14 00:00 [received] PHST- 2017/02/08 00:00 [revised] PHST- 2017/02/24 00:00 [accepted] PHST- 2017/03/16 06:00 [pubmed] PHST- 2018/10/03 06:00 [medline] PHST- 2017/03/16 06:00 [entrez] AID - 10.1002/uog.17458 [doi] PST - ppublish SO - Ultrasound Obstet Gynecol. 2018 Mar;51(3):381-386. doi: 10.1002/uog.17458. Epub 2018 Feb 7. PMID- 29408586 OWN - NLM STAT- MEDLINE DCOM- 20181127 LR - 20190501 IS - 1097-6868 (Electronic) IS - 0002-9378 (Print) IS - 0002-9378 (Linking) VI - 218 IP - 5 DP - 2018 May TI - A prospective cohort study of fetal heart rate monitoring: deceleration area is predictive of fetal acidemia. PG - 523.e1-523.e12 LID - S0002-9378(18)30075-9 [pii] LID - 10.1016/j.ajog.2018.01.026 [doi] AB - BACKGROUND: Intrapartum electronic fetal monitoring is the most commonly used tool in obstetrics in the United States; however, which electronic fetal monitoring patterns predict acidemia remains unclear. OBJECTIVE: This study was designed to describe the frequency of patterns seen in labor using modern nomenclature, and to test the hypothesis that visually interpreted patterns are associated with acidemia and morbidities in term infants. We further identified patterns prior to delivery, alone or in combination, predictive of acidemia and neonatal morbidity. STUDY DESIGN: This was a prospective cohort study of 8580 women from 2010 through 2015. Patients were all consecutive women laboring at ≥37 weeks' gestation with a singleton cephalic fetus. Electronic fetal monitoring patterns during the 120 minutes prior to delivery were interpreted in 10-minute epochs. Interpretation included the category system and individual electronic fetal monitoring patterns per the Eunice Kennedy Shriver National Institute of Child Health and Human Development criteria as well as novel patterns. The primary outcome was fetal acidemia (umbilical artery pH ≤7.10); neonatal morbidities were also assessed. Final regression models for acidemia adjusted for nulliparity, pregestational diabetes, and advanced maternal age. Area under the receiver operating characteristic curves were used to assess the test characteristics of individual models for acidemia and neonatal morbidity. RESULTS: Of 8580 women, 149 (1.7%) delivered acidemic infants. Composite neonatal morbidity was diagnosed in 757 (8.8%) neonates within the total cohort. Persistent category I, and 10-minute period of category III, were significantly associated with normal pH and acidemia, respectively. Total deceleration area was most discriminative of acidemia (area under the receiver operating characteristic curves, 0.76; 95% confidence interval, 0.72-0.80), and deceleration area with any 10 minutes of tachycardia had the greatest discriminative ability for neonatal morbidity (area under the receiver operating characteristic curves, 0.77; 95% confidence interval, 0.75-0.79). Once the threshold of deceleration area is reached the number of cesareans needed-to-be performed to potentially prevent 1 case of acidemia and morbidity is 5 and 6, respectively. CONCLUSION: Deceleration area is the most predictive electronic fetal monitoring pattern for acidemia, and combined with tachycardia for significant risk of morbidity, from the electronic fetal monitoring patterns studied. It is important to acknowledge that this study was performed in patients delivering ≥37 weeks, which may limit the generalizability to preterm populations. We also did not use computerized analysis of the electronic fetal monitoring patterns because human visual interpretation was the basis for the Eunice Kennedy Shriver National Institute of Child Health and Human Development categories, and importantly, it is how electronic fetal monitoring is used clinically. CI - Copyright © 2018 Elsevier Inc. All rights reserved. FAU - Cahill, Alison G AU - Cahill AG AD - Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO. Electronic address: cahilla@wustl.edu. FAU - Tuuli, Methodius G AU - Tuuli MG AD - Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO. FAU - Stout, Molly J AU - Stout MJ AD - Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO. FAU - López, Julia D AU - López JD AD - Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO. FAU - Macones, George A AU - Macones GA AD - Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO. LA - eng GR - R01 HD061619/HD/NICHD NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20180201 TA - Am J Obstet Gynecol JT - American journal of obstetrics and gynecology JID - 0370476 SB - AIM SB - IM CIN - Am J Obstet Gynecol. 2018 Nov;219(5):510-512. PMID: 29885303 MH - Acidosis/*diagnosis/physiopathology MH - Adult MH - *Cardiotocography MH - Deceleration MH - Female MH - Heart Rate, Fetal/*physiology MH - Humans MH - Infant, Newborn MH - *Labor, Obstetric MH - Pregnancy MH - Prospective Studies MH - Risk Factors MH - Young Adult PMC - PMC5916338 MID - NIHMS939463 OTO - NOTNLM OT - *acidemia OT - *deceleration area OT - *electronic fetal monitoring OT - *neonatal morbidity OT - *pregnancy OT - *term infants COIS- Conflict of Interest Statement: The authors report no conflicts of interest. EDAT- 2018/02/07 06:00 MHDA- 2018/11/28 06:00 CRDT- 2018/02/07 06:00 PHST- 2017/08/25 00:00 [received] PHST- 2018/01/12 00:00 [revised] PHST- 2018/01/22 00:00 [accepted] PHST- 2018/02/07 06:00 [pubmed] PHST- 2018/11/28 06:00 [medline] PHST- 2018/02/07 06:00 [entrez] AID - S0002-9378(18)30075-9 [pii] AID - 10.1016/j.ajog.2018.01.026 [doi] PST - ppublish SO - Am J Obstet Gynecol. 2018 May;218(5):523.e1-523.e12. doi: 10.1016/j.ajog.2018.01.026. Epub 2018 Feb 1. PMID- 29215160 OWN - NLM STAT- MEDLINE DCOM- 20181031 LR - 20210109 IS - 1600-0412 (Electronic) IS - 0001-6349 (Print) IS - 0001-6349 (Linking) VI - 97 IP - 2 DP - 2018 Feb TI - New FIGO and Swedish intrapartum cardiotocography classification systems incorporated in the fetal ECG ST analysis (STAN) interpretation algorithm: agreements and discrepancies in cardiotocography classification and evaluation of significant ST events. PG - 219-228 LID - 10.1111/aogs.13277 [doi] AB - INTRODUCTION: The updated intrapartum cardiotocography (CTG) classification system by FIGO in 2015 (FIGO2015) and the FIGO2015-approached classification by the Swedish Society of Obstetricians and Gynecologist in 2017 (SSOG2017) are not harmonized with the fetal ECG ST analysis (STAN) algorithm from 2007 (STAN2007). The study aimed to reveal homogeneity and agreement between the systems in classifying CTG and ST events, and relate them to maternal and perinatal outcomes. MATERIAL AND METHODS: Among CTG traces with ST events, 100 traces originally classified as normal, 100 as suspicious and 100 as pathological were randomly selected from a STAN database and classified by two experts in consensus. Homogeneity and agreement statistics between the CTG classifications were performed. Maternal and perinatal outcomes were evaluated in cases with clinically hidden ST data (n = 151). A two-tailed p < 0.05 was regarded as significant. RESULTS: For CTG classes, the heterogeneity was significant between the old and new systems, and agreements were moderate to strong (proportion of agreement, kappa index 0.70-0.86). Between the new classifications, heterogeneity was significant and agreements strong (0.90, 0.92). For significant ST events, heterogeneities were significant and agreements moderate to almost perfect (STAN2007 vs. FIGO2015 0.86, 0.72; STAN2007 vs. SSOG2017 0.92, 0.84; FIGO2015 vs. SSOG2017 0.94, 0.87). Significant ST events occurred more often combined with STAN2007 than with FIGO2015 classification, but not with SSOG2017; correct identification of adverse outcomes was not significantly different between the systems. CONCLUSION: There are discrepancies in the classification of CTG patterns and significant ST events between the old and new systems. The clinical relevance of the findings remains to be shown. CI - © 2017 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). FAU - Olofsson, Per AU - Olofsson P AUID- ORCID: 0000-0002-0792-1393 AD - Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden. FAU - Norén, Håkan AU - Norén H AD - Department of Obstetrics and Gynecology, Sahlgrenka University Hospital, Gothenburg, Sweden. FAU - Carlsson, Ann AU - Carlsson A AD - Department of Obstetrics and Gynecology, Sahlgrenka University Hospital, Gothenburg, Sweden. LA - eng PT - Journal Article TA - Acta Obstet Gynecol Scand JT - Acta obstetricia et gynecologica Scandinavica JID - 0370343 SB - IM MH - Adult MH - *Algorithms MH - Blood Gas Analysis/standards MH - Cardiotocography/methods/*standards MH - Electrocardiography/methods/*standards MH - Female MH - Fetal Hypoxia/*diagnosis MH - Fetal Monitoring/methods/*standards MH - Heart Rate, Fetal/*physiology MH - Humans MH - Pregnancy MH - Sweden MH - Young Adult PMC - PMC5887886 OTO - NOTNLM OT - FIGO OT - Cardiotocography OT - ST analysis OT - delivery OT - fetal ECG OT - fetal monitoring OT - fetal surveillance EDAT- 2017/12/08 06:00 MHDA- 2018/11/01 06:00 CRDT- 2017/12/08 06:00 PHST- 2017/04/10 00:00 [received] PHST- 2017/11/30 00:00 [accepted] PHST- 2017/12/08 06:00 [pubmed] PHST- 2018/11/01 06:00 [medline] PHST- 2017/12/08 06:00 [entrez] AID - AOGS13277 [pii] AID - 10.1111/aogs.13277 [doi] PST - ppublish SO - Acta Obstet Gynecol Scand. 2018 Feb;97(2):219-228. doi: 10.1111/aogs.13277. PMID- 29335781 OWN - NLM STAT- MEDLINE DCOM- 20190401 LR - 20190401 IS - 1432-0711 (Electronic) IS - 0932-0067 (Linking) VI - 297 IP - 4 DP - 2018 Apr TI - Peripartum events associated with severe neurologic morbidity and mortality among acidemic neonates. PG - 877-883 LID - 10.1007/s00404-018-4657-0 [doi] AB - PURPOSE: To identify peripartum events that may predict the development of short-term neurologic morbidity and mortality among acidemic neonates. METHODS: Retrospective case-control study conducted at a single-teaching hospital on data from January 2010 to December 2015. The study cohort group included all acidemic neonates (cord artery pH ≤ 7.1) born at ≥ 34 weeks. Primary outcome was a composite including any of the following: neonatal encephalopathy, convulsions, intra-ventricular hemorrhage, or neonatal death. The study cohort was divided to the cases group, i.e., acidemic neonates who had any component of the primary outcome, and a control group, i.e., acidemic neonates who did not experience any component of the primary outcome. RESULTS: Of all 24,311 neonates born ≥ 34 weeks during the study period, 568 (2.3%) had a cord artery pH ≤ 7.1 and composed the cohort study group. Twenty-one (3.7%) neonates composed the cases group. Multivariate logistic regression analysis revealed that cases were significantly more likely to have experienced placental abruption (OR 18.78; 95% CI 5.57-63.26), born ≤ 2500 g (OR 13.58; 95% CI 3.70-49.90), have meconium (OR 3.80; 95% CI 1.20-11.98) and cord entanglement (OR 5.99; 95% CI 1.79-20.06). The probability for developing the composite outcome rose from 3.7% with isolated acidemia to 97% among neonates who had all these peripartum events combined with intrapartum fetal heart rate tracing category 2 or 3. CONCLUSION: Neonatal acidemia carries a favorable outcome in the vast majority of cases. In association with particular antenatal and intrapartum events, the short-term outcome may be unfavorable. FAU - Zuarez-Easton, Sivan AU - Zuarez-Easton S AD - Department of Obstetrics and Gynecology, Emek Medical Center, 18101, Afula, Israel. FAU - Hosary, Sally AU - Hosary S AD - Rappaport Faculty of Medicine, Technion, Haifa, Israel. FAU - Zafran, Noah AU - Zafran N AD - Department of Obstetrics and Gynecology, Emek Medical Center, 18101, Afula, Israel. AD - Rappaport Faculty of Medicine, Technion, Haifa, Israel. FAU - Garmi, Gali AU - Garmi G AD - Department of Obstetrics and Gynecology, Emek Medical Center, 18101, Afula, Israel. AD - Rappaport Faculty of Medicine, Technion, Haifa, Israel. FAU - Felszer, Clari AU - Felszer C AD - Department of Neonatology, Emek Medical Center, Afula, Israel. FAU - Salim, Raed AU - Salim R AUID- ORCID: 0000-0002-3603-8452 AD - Department of Obstetrics and Gynecology, Emek Medical Center, 18101, Afula, Israel. salim_ra@clalit.org.il. AD - Rappaport Faculty of Medicine, Technion, Haifa, Israel. salim_ra@clalit.org.il. LA - eng PT - Journal Article DEP - 20180115 PL - Germany TA - Arch Gynecol Obstet JT - Archives of gynecology and obstetrics JID - 8710213 SB - IM MH - Abruptio Placentae MH - Acidosis/*blood/complications/congenital MH - Case-Control Studies MH - Cohort Studies MH - Female MH - Fetal Blood/*metabolism MH - Humans MH - Hydrogen-Ion Concentration MH - Infant MH - Infant Mortality MH - Infant, Newborn MH - Infant, Newborn, Diseases MH - Infant, Premature, Diseases/*blood MH - Meconium MH - Parturition MH - Peripartum Period MH - Pregnancy MH - Retrospective Studies MH - Seizures/blood OTO - NOTNLM OT - *Neonatal acidemia OT - *Neonatal mortality OT - *Neonatal neurological morbidity EDAT- 2018/01/18 06:00 MHDA- 2019/04/02 06:00 CRDT- 2018/01/17 06:00 PHST- 2017/11/03 00:00 [received] PHST- 2018/01/09 00:00 [accepted] PHST- 2018/01/18 06:00 [pubmed] PHST- 2019/04/02 06:00 [medline] PHST- 2018/01/17 06:00 [entrez] AID - 10.1007/s00404-018-4657-0 [pii] AID - 10.1007/s00404-018-4657-0 [doi] PST - ppublish SO - Arch Gynecol Obstet. 2018 Apr;297(4):877-883. doi: 10.1007/s00404-018-4657-0. Epub 2018 Jan 15. PMID- 29235940 OWN - NLM STAT- MEDLINE DCOM- 20181219 LR - 20200422 IS - 1559-2308 (Electronic) IS - 1559-2294 (Print) IS - 1559-2294 (Linking) VI - 13 IP - 1 DP - 2018 TI - SLC9B1 methylation predicts fetal intolerance of labor. PG - 33-39 LID - 10.1080/15592294.2017.1411444 [doi] AB - Fetal intolerance of labor is a common indication for delivery by Caesarean section. Diagnosis is based on the presence of category III fetal heart rate tracing, which is an abnormal heart tracing associated with increased likelihood of fetal hypoxia and metabolic acidemia. This study analyzed data from 177 unique women who, during their prenatal visits (7-15 weeks and/or 24-32 weeks) to Atlanta area prenatal care clinics, consented to provide blood samples for DNA methylation (HumanMethylation450 BeadChip) and gene expression (Human HT-12 v4 Expression BeadChip) analyses. We focused on 57 women aged 18-36 (mean 25.4), who had DNA methylation data available from their second prenatal visit. DNA methylation patterns at CpG sites across the genome were interrogated for associations with fetal intolerance of labor. Four CpG sites (P value <8.9 × 10(-9), FDR <0.05) in gene SLC9B1, a Na(+)/H(+) exchanger, were associated with fetal intolerance of labor. DNA methylation and gene expression were negatively associated when examined longitudinally during pregnancy using a linear mixed-effects model. Positive predictive values of methylation of these four sites ranged from 0.80 to 0.89, while negative predictive values ranged from 0.91 to 0.92. The four CpG sites were also associated with fetal intolerance of labor in an independent cohort (the Johns Hopkins Prospective PPD cohort). Therefore, fetal intolerance of labor could be accurately predicted from maternal blood samples obtained between 24-32 weeks gestation. Fetal intolerance of labor may be accurately predicted from maternal blood samples obtained between 24-32 weeks gestation by assessing DNA methylation patterns of SLC9B1. The identification of pregnant women at elevated risk for fetal intolerance of labor may allow for the development of targeted treatments or management plans. FAU - Knight, Anna K AU - Knight AK AUID- ORCID: 0000-0002-5809-050X AD - a Genetics and Molecular Biology Program , Emory University , 1462 Clifton Road, Atlanta , GA , 30322. FAU - Conneely, Karen N AU - Conneely KN AD - a Genetics and Molecular Biology Program , Emory University , 1462 Clifton Road, Atlanta , GA , 30322. AD - b Department of Human Genetics , Emory University , 615 Michael St NE, Atlanta , GA , 30322. FAU - Kilaru, Varun AU - Kilaru V AD - c Department of Gynecology and Obstetrics , Emory University , 101 Woodruff Circle NE, Atlanta , GA. FAU - Cobb, Dawayland AU - Cobb D AD - c Department of Gynecology and Obstetrics , Emory University , 101 Woodruff Circle NE, Atlanta , GA. FAU - Payne, Jennifer L AU - Payne JL AD - d Women's Mood Disorders Center , Johns Hopkins School of Medicine , 550 N. Broadway, Suite 305, Baltimore , MD 21205. FAU - Meilman, Samantha AU - Meilman S AD - d Women's Mood Disorders Center , Johns Hopkins School of Medicine , 550 N. Broadway, Suite 305, Baltimore , MD 21205. FAU - Corwin, Elizabeth J AU - Corwin EJ AD - e Nell Hodgson Woodruff School of Nursing , Emory University , 1520 Clifton Road, Atlanta , GA , 30322. FAU - Kaminsky, Zachary A AU - Kaminsky ZA AD - f Department of Psychiatry , Johns Hopkins School of Medicine , 720 Rutland Avenue, Baltimore , MD , 21205 ; Johns Hopkins Bloomberg School of Public Health , 615 N. Wolfe St, Baltimore , MD , 21205. FAU - Dunlop, Anne L AU - Dunlop AL AD - e Nell Hodgson Woodruff School of Nursing , Emory University , 1520 Clifton Road, Atlanta , GA , 30322. FAU - Smith, Alicia K AU - Smith AK AUID- ORCID: 0000-0002-8537-5156 AD - a Genetics and Molecular Biology Program , Emory University , 1462 Clifton Road, Atlanta , GA , 30322. AD - c Department of Gynecology and Obstetrics , Emory University , 101 Woodruff Circle NE, Atlanta , GA. AD - g Department of Psychiatry & Behavioral Sciences , Emory University , 101 Woodruff Circle NE, Atlanta , GA. LA - eng GR - R01 MD009064/MD/NIMHD NIH HHS/United States GR - R01 NR014800/NR/NINR NIH HHS/United States GR - T32 GM008490/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20180125 TA - Epigenetics JT - Epigenetics JID - 101265293 RN - 0 (SLC9B1 protein, human) RN - 0 (Sodium-Hydrogen Exchangers) SB - IM MH - Adolescent MH - Adult MH - *Cesarean Section MH - CpG Islands MH - *DNA Methylation MH - Female MH - Fetal Distress/genetics MH - Gene Expression Profiling MH - Gestational Age MH - Humans MH - Pregnancy MH - Pregnancy Trimester, Third/*genetics MH - Prenatal Care MH - Sodium-Hydrogen Exchangers/blood/*genetics PMC - PMC5837080 OTO - NOTNLM OT - *Biomarker, complication OT - *delivery OT - *fetal distress; NHEDC1; pregnancy; SLC9B1; sodium hydrogen exchanger EDAT- 2017/12/14 06:00 MHDA- 2018/12/20 06:00 CRDT- 2017/12/14 06:00 PHST- 2017/12/14 06:00 [pubmed] PHST- 2018/12/20 06:00 [medline] PHST- 2017/12/14 06:00 [entrez] AID - 1411444 [pii] AID - 10.1080/15592294.2017.1411444 [doi] PST - ppublish SO - Epigenetics. 2018;13(1):33-39. doi: 10.1080/15592294.2017.1411444. Epub 2018 Jan 25. PMID- 29312932 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200930 IS - 2296-4185 (Print) IS - 2296-4185 (Electronic) IS - 2296-4185 (Linking) VI - 5 DP - 2017 TI - Fetal Cardiac Doppler Signal Processing Techniques: Challenges and Future Research Directions. PG - 82 LID - 10.3389/fbioe.2017.00082 [doi] LID - 82 AB - The fetal Doppler Ultrasound (DUS) is commonly used for monitoring fetal heart rate and can also be used for identifying the event timings of fetal cardiac valve motions. In early-stage fetuses, the detected Doppler signal suffers from noise and signal loss due to the fetal movements and changing fetal location during the measurement procedure. The fetal cardiac intervals, which can be estimated by measuring the fetal cardiac event timings, are the most important markers of fetal development and well-being. To advance DUS-based fetal monitoring methods, several powerful and well-advanced signal processing and machine learning methods have recently been developed. This review provides an overview of the existing techniques used in fetal cardiac activity monitoring and a comprehensive survey on fetal cardiac Doppler signal processing frameworks. The review is structured with a focus on their shortcomings and advantages, which helps in understanding fetal Doppler cardiogram signal processing methods and the related Doppler signal analysis procedures by providing valuable clinical information. Finally, a set of recommendations are suggested for future research directions and the use of fetal cardiac Doppler signal analysis, processing, and modeling to address the underlying challenges. FAU - Alnuaimi, Saeed Abdulrahman AU - Alnuaimi SA AD - Department of Electrical and Computer Engineering, Khalifa University, Abu Dhabi, United Arab Emirates. FAU - Jimaa, Shihab AU - Jimaa S AD - Department of Electrical and Computer Engineering, Khalifa University, Abu Dhabi, United Arab Emirates. FAU - Khandoker, Ahsan H AU - Khandoker AH AD - Department of Biomedical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates. LA - eng PT - Journal Article PT - Review DEP - 20171222 TA - Front Bioeng Biotechnol JT - Frontiers in bioengineering and biotechnology JID - 101632513 PMC - PMC5743703 OTO - NOTNLM OT - fetal Doppler OT - fetal cardiac intervals OT - fetal cardiology OT - fetal heart rate OT - fetal monitoring OT - signal processing EDAT- 2018/01/10 06:00 MHDA- 2018/01/10 06:01 CRDT- 2018/01/10 06:00 PHST- 2017/05/21 00:00 [received] PHST- 2017/12/11 00:00 [accepted] PHST- 2018/01/10 06:00 [entrez] PHST- 2018/01/10 06:00 [pubmed] PHST- 2018/01/10 06:01 [medline] AID - 10.3389/fbioe.2017.00082 [doi] PST - epublish SO - Front Bioeng Biotechnol. 2017 Dec 22;5:82. doi: 10.3389/fbioe.2017.00082. eCollection 2017. PMID- 29183176 OWN - NLM STAT- MEDLINE DCOM- 20190523 LR - 20190523 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) VI - 32 IP - 10 DP - 2019 May TI - Incidence of maternal tachycardia during the second stage of labor: a prospective observational cohort study. PG - 1615-1619 LID - 10.1080/14767058.2017.1411476 [doi] AB - OBJECTIVE: To our knowledge, this is the largest prospective study reporting on maternal heart rate (MHR) levels in laboring women (30 patients), and maternal tachycardia that is a potential risk factor in fetal monitoring confusion. Our objective was to analyze a large population of contiguous laboring patients and to assess the MHR levels attained during the second stage. METHODS: We performed a prospective study that analyzed MHR levels of second-stage laboring patients evaluating numerous predisposing maternal conditions. Univariate and stepwise multivariate logistic regression analysis were performed. RESULTS: A total of 1105 contiguous patients were analyzed and 33.9% had a sustained MHR ≥100; 18.8% had an MHR ≥110; and 9.1% had an MHR ≥120. Multivariate analysis of all potential predisposing maternal conditions did not reveal any specific variable as uniformly significant for predicting maternal tachycardia across all levels of analysis. CONCLUSIONS: The incidence of maternal tachycardia in the second stage of labor is common. We recommend that if the MHR is ≥100 during labor, the simultaneous maternal and fetal heart rate (FHR) monitoring will be used to minimize the potential for fetal monitoring confusion and risking poor fetal outcome if the fetus is in distress. FAU - Towers, Craig V AU - Towers CV AD - a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Tennessee Medical Center , Knoxville , TN , USA. FAU - Trussell, John AU - Trussell J AD - a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Tennessee Medical Center , Knoxville , TN , USA. FAU - Heidel, Robert E AU - Heidel RE AD - a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Tennessee Medical Center , Knoxville , TN , USA. FAU - Chernicky, Lindsey AU - Chernicky L AD - a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Tennessee Medical Center , Knoxville , TN , USA. FAU - Howard, Bobby C AU - Howard BC AD - a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Tennessee Medical Center , Knoxville , TN , USA. LA - eng PT - Journal Article PT - Observational Study DEP - 20171210 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 SB - IM MH - Adult MH - Cardiotocography MH - Female MH - *Heart Rate MH - *Heart Rate, Fetal MH - Humans MH - Labor Stage, Second/physiology MH - Obstetric Labor Complications/diagnostic imaging/*epidemiology MH - Pregnancy MH - Prospective Studies MH - Tachycardia/diagnostic imaging/*epidemiology MH - Ultrasonography, Doppler MH - Young Adult OTO - NOTNLM OT - Fetal heart rate monitoring OT - maternal tachycardia OT - second-stage vital signs EDAT- 2017/12/01 06:00 MHDA- 2019/05/24 06:00 CRDT- 2017/11/30 06:00 PHST- 2017/12/01 06:00 [pubmed] PHST- 2019/05/24 06:00 [medline] PHST- 2017/11/30 06:00 [entrez] AID - 10.1080/14767058.2017.1411476 [doi] PST - ppublish SO - J Matern Fetal Neonatal Med. 2019 May;32(10):1615-1619. doi: 10.1080/14767058.2017.1411476. Epub 2017 Dec 10. PMID- 29245247 OWN - NLM STAT- MEDLINE DCOM- 20171221 LR - 20210112 IS - 1536-5964 (Electronic) IS - 0025-7974 (Print) IS - 0025-7974 (Linking) VI - 96 IP - 49 DP - 2017 Dec TI - Accuracy of intrapartum fetal blood gas analysis by scalp sampling: A retrospective cohort study. PG - e8839 LID - 10.1097/MD.0000000000008839 [doi] LID - e8839 AB - Fetal blood gas analysis (FBGA) using scalp blood is commonly used to identify serious fetal distress. However, there is a lack of data regarding its accuracy and reliability. The aim of this study was to determine the positive predictive value (PPV) and negative predictive value (NPV) of FBGA for predicting postpartum acidosis in case of nonreassuring fetal heart rate tracings (NRFHRT). To this end, we conducted a retrospective cohort study of singleton term deliveries with NRFHRT according to Fédération Internationale de Gynécologie et d'Obstétrique and Fisher cardiotocography scores undergoing FBGA in a university hospital. The PPV and NPV of FBGA regarding neonatal acidosis (defined as a pH value ≤ 7.15 in arterial or venous umbilical cord blood) and Apgar scores indicating neonatal depression (defined as a 5-min Apgar score ≤5) were evaluated. Multivariate analysis was used to determine the influence of cardiotocography variations and the time delay between FBGA and delivery on the accuracy of FBGA. We analyzed 343 deliveries with NRFHRT. In 32 (9%) of these cases, fetal acidosis was confirmed by a postpartum umbilical cord blood pH value ≤ 7.15. In 308/343 (90%) cases, FBGA identified NRFHRT as false positive (as confirmed by nonacidotic postpartum pH values) and thus avoided unnecessary interventions such as operative delivery. The overall test accuracy of FBGA was 91%. FBGA accurately predicted postpartum cord blood pH values with a margin of ±0.2 in 319/343 (93%) cases. On the other hand, the false negative rate of FBGA was 8% (29/343). The PPV and NPV of FBGA for predicting postpartum acidosis were 50% and 91%, respectively. The sensitivity was 9% and the specificity was 99%. In a multivariate logistic regression analysis, maternal body mass index (odds ratio [OR] 1.1; 95% confidence interval [CI] 1.01-1.17; P = .029) and cardiotocography variations (OR 0.80; 95% CI 0.66-0.98; P = .029) independently affected the predictive value of FBGA. The PPV of FBGA regarding neonatal depression according to Apgar scores was low with only 17%. We conclude that FBGA may be used in clinical practice to rule out, but not to rule in, neonatal acidosis in parturients with NRFHRT. It can avoid unnecessary interventions such as cesarean section or operative vaginal delivery in up to 90% of cases, but cannot reliably detect fetal acidosis. FAU - Hilal, Ziad AU - Hilal Z AD - Department of Obstetrics and Gynecology, Ruhr-Universität Bochum, Bochum, Germany. FAU - Mrkvicka, Jennifer AU - Mrkvicka J FAU - Rezniczek, Günther A AU - Rezniczek GA FAU - Dogan, Askin AU - Dogan A FAU - Tempfer, Clemens B AU - Tempfer CB LA - eng PT - Evaluation Study PT - Journal Article TA - Medicine (Baltimore) JT - Medicine JID - 2985248R SB - AIM SB - IM MH - Acidosis/blood/*diagnosis/embryology MH - Adult MH - Apgar Score MH - Blood Gas Analysis/methods MH - Cardiotocography MH - Female MH - Fetal Blood/*metabolism MH - Fetal Distress/blood/*diagnosis/embryology MH - Heart Rate, Fetal MH - Humans MH - Infant, Newborn MH - Predictive Value of Tests MH - Pregnancy MH - Prenatal Diagnosis/*methods MH - Reproducibility of Results MH - Retrospective Studies MH - Scalp/embryology/*metabolism PMC - PMC5728862 COIS- The authors have no funding and conflicts of interest to disclose. EDAT- 2017/12/17 06:00 MHDA- 2017/12/22 06:00 CRDT- 2017/12/17 06:00 PHST- 2017/12/17 06:00 [entrez] PHST- 2017/12/17 06:00 [pubmed] PHST- 2017/12/22 06:00 [medline] AID - 00005792-201712080-00036 [pii] AID - MD-D-17-02924 [pii] AID - 10.1097/MD.0000000000008839 [doi] PST - ppublish SO - Medicine (Baltimore). 2017 Dec;96(49):e8839. doi: 10.1097/MD.0000000000008839. PMID- 29241921 OWN - NLM STAT- MEDLINE DCOM- 20180801 LR - 20191210 IS - 1875-6263 (Electronic) IS - 1028-4559 (Linking) VI - 56 IP - 6 DP - 2017 Dec TI - Relationship between fetal heart rate patterns and a time course for evaluation of fetal well-being: "the 30 minutes rule" for decision of mechanical delivery. PG - 788-792 LID - S1028-4559(17)30254-1 [pii] LID - 10.1016/j.tjog.2017.10.015 [doi] AB - OBJECTIVE: To predict acidosis in fetus showing deceleration associated with non-reassuring fetal status during delivery, we examined the relationship between duration of the deceleration and umbilical arterial pH. MATERIALS AND METHODS: A total of 19,907 deliveries in eight facilities of the Juntendo Perinatal Care Group, 895 cases of vaginal deliveries with level 3 decelerations were selected for the subjects of this study. The cut-off point of time when the umbilical arterial pH fell below 7.20 in all cases of level 3 and for each deceleration type were examined. The explanatory variables were the pH and pO(2) of umbilical arterial gas and the time from onset of the level 3 pattern to delivery. From receiver operating characteristic (ROC) analysis using these variables, the critical point indicating low Apgar score was set at an umbilical arterial pH < 7.20. RESULTS: The cut-off point of time when the umbilical arterial pH fell below 7.2 was 33.5 min for all cases of level 3, and 604 cases of severe variable decelerations with normal baseline variability and normal baseline heart rates, the cut-off point was 33.5 min as well. For 108 cases of late decelerations, there was no significant cut-off point for either the mild or severe cases. Mild prolonged deceleration showed the cut-off point of 34.5 min. CONCLUSIONS: We confirmed the time indices for predicting and preventing acidosis in fetuses showing decelerations. To prevent fetal acidosis, the decision related to proper timing for performing assisted delivery by considering the time course is important. CI - Copyright © 2017. Published by Elsevier B.V. FAU - Makino, Shintaro AU - Makino S AD - Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Japan. Electronic address: shintaro@juntendo.ac.jp. FAU - Hirai, Chihiro AU - Hirai C AD - Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Japan. FAU - Takeda, Jun AU - Takeda J AD - Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Japan. FAU - Itakura, Atsuo AU - Itakura A AD - Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Japan. FAU - Takeda, Satoru AU - Takeda S AD - Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Japan. LA - eng PT - Evaluation Study PT - Journal Article PT - Multicenter Study PL - China (Republic : 1949- ) TA - Taiwan J Obstet Gynecol JT - Taiwanese journal of obstetrics & gynecology JID - 101213819 SB - IM MH - Acidosis/embryology/prevention & control MH - Apgar Score MH - Cardiotocography/*standards MH - Delivery, Obstetric/methods/*standards MH - Female MH - Fetal Blood/chemistry MH - Fetal Diseases/prevention & control MH - Fetal Distress/*diagnosis MH - Heart Rate, Fetal/*physiology MH - Humans MH - Hydrogen-Ion Concentration MH - Pregnancy MH - ROC Curve MH - Reference Values MH - Retrospective Studies MH - Time Factors MH - Time-to-Treatment/*standards OTO - NOTNLM OT - Cardiotocography OT - Fetal heart rate patterns OT - Time course EDAT- 2017/12/16 06:00 MHDA- 2018/08/02 06:00 CRDT- 2017/12/16 06:00 PHST- 2017/07/05 00:00 [accepted] PHST- 2017/12/16 06:00 [entrez] PHST- 2017/12/16 06:00 [pubmed] PHST- 2018/08/02 06:00 [medline] AID - S1028-4559(17)30254-1 [pii] AID - 10.1016/j.tjog.2017.10.015 [doi] PST - ppublish SO - Taiwan J Obstet Gynecol. 2017 Dec;56(6):788-792. doi: 10.1016/j.tjog.2017.10.015. PMID- 29078943 OWN - NLM STAT- MEDLINE DCOM- 20180709 LR - 20180709 IS - 1558-0474 (Electronic) IS - 0889-8545 (Linking) VI - 44 IP - 4 DP - 2017 Dec TI - Update on Fetal Monitoring: Overview of Approaches and Management of Category II Tracings. PG - 615-624 LID - S0889-8545(17)30117-1 [pii] LID - 10.1016/j.ogc.2017.08.007 [doi] AB - Electronic fetal monitoring (EFM) is widely used to assess fetal status in labor. Use of intrapartum continuous EFM is associated with a lower risk of neonatal seizures but a higher risk of cesarean or operative delivery. Category II fetal heart tracings (FHTs) are indeterminate in their ability to predict fetal acidemia. Certain patterns of decelerations and variability within this category may be predictive of neonatal morbidity. Adjunct tests of fetal well-being can be used during labor to further triage patients. Intrauterine resuscitation techniques should target the suspected etiology of intrapartum fetal hypoxia. Clinical factors play a role in the interpretation of EFM. CI - Copyright © 2017 Elsevier Inc. All rights reserved. FAU - Raghuraman, Nandini AU - Raghuraman N AD - Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, Maternity Building, 5th Floor, St Louis, MO 63110, USA. Electronic address: raghuramann@wudosis.wustl.edu. FAU - Cahill, Alison G AU - Cahill AG AD - Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, Maternity Building, 5th Floor, St Louis, MO 63110, USA. LA - eng PT - Journal Article PT - Review PL - United States TA - Obstet Gynecol Clin North Am JT - Obstetrics and gynecology clinics of North America JID - 8709551 SB - IM MH - Cardiotocography/*methods MH - *Delivery, Obstetric/adverse effects/methods MH - Female MH - Humans MH - Infant, Newborn MH - *Infant, Newborn, Diseases/etiology/prevention & control MH - Patient Care Management MH - Pregnancy MH - Safety Management OTO - NOTNLM OT - Category II OT - Electronic fetal monitoring OT - Intrauterine resuscitation OT - Management EDAT- 2017/10/29 06:00 MHDA- 2018/07/10 06:00 CRDT- 2017/10/29 06:00 PHST- 2017/10/29 06:00 [entrez] PHST- 2017/10/29 06:00 [pubmed] PHST- 2018/07/10 06:00 [medline] AID - S0889-8545(17)30117-1 [pii] AID - 10.1016/j.ogc.2017.08.007 [doi] PST - ppublish SO - Obstet Gynecol Clin North Am. 2017 Dec;44(4):615-624. doi: 10.1016/j.ogc.2017.08.007. PMID- 29137550 OWN - NLM STAT- MEDLINE DCOM- 20181108 LR - 20181108 IS - 1933-7205 (Electronic) IS - 1933-7191 (Linking) VI - 25 IP - 4 DP - 2018 Apr TI - Reengineering Electronic Fetal Monitoring Interpretation: Using the Fetal Reserve Index to Anticipate the Need for Emergent Operative Delivery. PG - 487-497 LID - 10.1177/1933719117737849 [doi] AB - OBJECTIVE: The near-ubiquitous use of electronic fetal monitoring has failed to lower the rates of both cerebral palsy and emergency operative deliveries (EODs). Its performance metrics have low sensitivity, specificity, and predictive values for both. There are many EODs, but the vast majority have normal outcomes. The EODs, however, cause serious disruption in the delivery suite routine with increased complications, anxiety, and concern for all. METHODS: We developed the fetal reserve index (FRI) as multicomponent algorithm including 4 FHR components (analyzed individually), uterine activity, and maternal, obstetrical, and fetal risk factors to assess risk of cerebral palsy and EOD. Scores were categorized into green, yellow, and red zones. Here, we studied 300 patients by the FRI, all of whom had normal neonatal outcomes. We attempted to distinguish the clinical course of those cases which required an EOD versus controls which did not. RESULTS: 51 cases with EOD had FRIs much lower than 249 non-EOD cases. The red zone was reached more frequently ( P < .001) and lasted longer (1.06 vs 0.05 hours; P < .001). Reaching the red zone had a sensitivity of 92% for EOD, with a positive predictive value of 64% and a false positive rate of 10.4%. CONCLUSIONS: Our data suggest the FRI can significantly lower the incidence of EODs by identifying the opportunity for intrauterine resuscitation. Our approach can reduce the disruptive effects of EODs and their concomitant increased risks of complications. The FRI may provide a metric that can refine labor management to reduce CP and EODs. FAU - Eden, Robert D AU - Eden RD AD - 1 Fetal Medicine Foundation of America, New York, NY, USA. FAU - Evans, Mark I AU - Evans MI AD - 1 Fetal Medicine Foundation of America, New York, NY, USA. AD - 2 Comprehensive Genetics, PLLC, New York, NY, USA. AD - 3 Department of Obstetrics & Gynecology, Mount Sinai School of Medicine, New York, NY, USA. FAU - Evans, Shara M AU - Evans SM AD - 1 Fetal Medicine Foundation of America, New York, NY, USA. FAU - Schifrin, Barry S AU - Schifrin BS AD - 1 Fetal Medicine Foundation of America, New York, NY, USA. LA - eng PT - Journal Article DEP - 20171114 PL - United States TA - Reprod Sci JT - Reproductive sciences (Thousand Oaks, Calif.) JID - 101291249 SB - IM MH - Cardiotocography/*methods MH - Cesarean Section/*methods MH - Emergency Treatment MH - Female MH - Humans MH - *Labor, Obstetric MH - Pregnancy OTO - NOTNLM OT - ACOG monitoring classification system OT - electronic fetal monitoring OT - emergency operative deliveries OT - fetal reserve index OT - intrauterine resuscitation OT - stat cesarean delivery EDAT- 2017/11/16 06:00 MHDA- 2018/11/09 06:00 CRDT- 2017/11/16 06:00 PHST- 2017/11/16 06:00 [pubmed] PHST- 2018/11/09 06:00 [medline] PHST- 2017/11/16 06:00 [entrez] AID - 10.1177/1933719117737849 [doi] PST - ppublish SO - Reprod Sci. 2018 Apr;25(4):487-497. doi: 10.1177/1933719117737849. Epub 2017 Nov 14. PMID- 29041923 OWN - NLM STAT- MEDLINE DCOM- 20180710 LR - 20181113 IS - 1471-2393 (Electronic) IS - 1471-2393 (Linking) VI - 17 IP - 1 DP - 2017 Oct 17 TI - Fetal heart rate abnormalities during and after external cephalic version: Which fetuses are at risk and how are they delivered? PG - 363 LID - 10.1186/s12884-017-1547-6 [doi] LID - 363 AB - BACKGROUND: Fetal heart rate abnormalities (FHR) during and after external cephalic version (ECV) are relatively frequent. They may raise concern about fetal wellbeing. Only occasionally they may lead to an emergency cesarean section. METHODS: Prospective cohort study in 980 women (> 34 weeks gestation) with a singleton fetus in breech presentation. During and after external cephalic version (ECV) FHR abnormalities were recorded. Obstetric variables and delivery outcome were evaluated. Primary outcome was to identify which fetuses are at risk for FHR abnormalities. Secondary outcome was to identify a possible relationship between FHR abnormalities during and after ECV and mode of delivery and fetal distress during subsequent labor. RESULTS: The overall success rate of ECV was 60% and in 9% of the attempts there was an abnormal FHR pattern. In two cases FHR abnormalities after ECV led to an emergency CS. Estimated fetal weight per 100 g (OR 0.90, CI: 0.87-0.94) and longer duration of the ECV-procedure (OR 1.13, CI: 1.05-1.21) were factors significantly associated with the occurrence of FHR abnormalities. FHR abnormalities were not associated with the mode of delivery or the occurrence of fetal distress during subsequent labor. CONCLUSIONS: FHR abnormalities during and after ECV are more frequent with lower estimated fetal weight and longer duration of the procedure. FHR abnormalities during and after ECV have no consequences for subsequent mode of delivery. They do not predict whether fetal distress will occur during labor. TRIAL REGISTRATION: The Eindhoven Breech Intervention Study, NCT00516555 . Date of registration: August 13, 2007. FAU - Kuppens, Simone M AU - Kuppens SM AD - Department of Obstetrics and Gynecology, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, the Netherlands. simone.kuppens@catharinaziekenhuis.nl. FAU - Smailbegovic, Ida AU - Smailbegovic I AD - Department of Obstetrics and Gynecology, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, the Netherlands. FAU - Houterman, Saskia AU - Houterman S AD - Department of Education and Research, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, the Netherlands. FAU - de Leeuw, Ingrid AU - de Leeuw I AD - Department of Obstetrics and Gynecology, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, the Netherlands. FAU - Hasaart, Tom H AU - Hasaart TH AD - Department of Obstetrics and Gynecology, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, the Netherlands. LA - eng SI - ClinicalTrials.gov/NCT00516555 PT - Journal Article PT - Observational Study DEP - 20171017 TA - BMC Pregnancy Childbirth JT - BMC pregnancy and childbirth JID - 100967799 SB - IM MH - Adult MH - Breech Presentation/physiopathology/*therapy MH - Delivery, Obstetric/methods/*statistics & numerical data MH - Female MH - Fetal Distress/*etiology/physiopathology MH - Gestational Age MH - *Heart Rate, Fetal MH - Humans MH - Pregnancy MH - Prospective Studies MH - Risk Factors MH - Version, Fetal/*adverse effects/methods PMC - PMC5646157 OTO - NOTNLM OT - Breech presentation OT - External cephalic version OT - Fetal distress OT - Fetal heart rate OT - Mode of delivery OT - Pregnancy COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The medical ethics review committee of the Catharina Hospital Eindhoven approved this research on March 15, 2007. Reference number: M06/1697. Written informed consent was obtained. CONSENT FOR PUBLICATION: Participants gave their consent for publication. Of all participants who were included in the study written informed consent was taken. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER’S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2017/10/19 06:00 MHDA- 2018/07/11 06:00 CRDT- 2017/10/19 06:00 PHST- 2016/09/14 00:00 [received] PHST- 2017/10/09 00:00 [accepted] PHST- 2017/10/19 06:00 [entrez] PHST- 2017/10/19 06:00 [pubmed] PHST- 2018/07/11 06:00 [medline] AID - 10.1186/s12884-017-1547-6 [pii] AID - 1547 [pii] AID - 10.1186/s12884-017-1547-6 [doi] PST - epublish SO - BMC Pregnancy Childbirth. 2017 Oct 17;17(1):363. doi: 10.1186/s12884-017-1547-6. PMID- 28962035 OWN - NLM STAT- MEDLINE DCOM- 20180606 LR - 20210109 IS - 1460-2407 (Electronic) IS - 1360-9947 (Print) IS - 1360-9947 (Linking) VI - 23 IP - 10 DP - 2017 Oct 1 TI - Immune cell and transcriptomic analysis of the human decidua in term and preterm parturition. PG - 708-724 LID - 10.1093/molehr/gax038 [doi] AB - STUDY QUESTION: Is labour, both at term and preterm, associated with alterations in decidual lymphocyte densities and widespread changes to the decidual transcriptome? SUMMARY ANSWER: The onset of parturition, both at term and preterm, is associated with widespread gene expression changes in the decidua, many of which are related to inflammatory signalling, but is not associated with changes in the number of any of the decidual lymphocyte populations examined. WHAT IS KNOWN ALREADY: Given its location, directly at the maternal-foetal interface, the decidua is likely to play a pivotal role in the onset of parturition, however, the molecular events occurring in the decidua in association with the onset of labour, both at term and preterm, remain relatively poorly defined. Using flow cytometry and microarray analysis, the present study aimed to investigate changes to the immune cell milieu of the decidua in association with the onset of parturition and define the decidual gene signature associated with term and preterm labour (PTL). STUDY DESIGN, SIZE, DURATION: This study used decidual samples collected from 36 women across four clinical groups: term (38-42 weeks of gestation) not in labour, TNL; term in labour, TL; preterm (<35 weeks of gestation)not in labour, PTNL; and preterm in labour, PTL. PARTICIPANTS/MATERIALS, SETTING, METHODS: Decidual lymphocytes were isolated from fresh decidual tissue collected from women in each of our four patient groups and stained with a panel of antibodies (CD45, CD3, CD19, CD56, CD4, CD8 and TCRVα24-Jα18) to investigate lymphocyte populations present in the decidua (TNL, n = 8; TL, n = 7; PTNL, n = 5; PTL, n = 5). RNA was extracted from decidual tissue and subjected to Illumina HT-12v4.0 BeadChip expression microarrays (TNL, n = 11; TL, n = 8; PTNL, n = 7; PTL, n = 10). Quantitative real-time PCR (qRT-PCR) was used to validate the microarray results. MAIN RESULTS AND THE ROLE OF CHANCE: The relative proportions of decidual lymphocytes (T cells, NK cells, B cells and invariant natural killer (iNKT) cells) were unaffected by either gestation or labour status. However, we found elevated expression of the non-classical MHC-protein, CD1D, in PTL decidua samples (P < 0.05), suggesting the potential for increased activation of decidual invariant NKT (iNKT) cells in PTL. Both term and PTL were associated with widespread gene expression changes, particularly related to inflammatory signalling. Up-regulation of candidate genes in TL (IL-6, PTGS2, ATF3, IER3 and TNFAIP3) and PTL (CXCL8, MARCO, LILRA3 and PLAU) were confirmed by qRT-PCR analysis. LARGE SCALE DATA: Microarray data are available at www.ebi.ac.uk/arrayexpress under accession number E-MTAB-5353. LIMITATIONS REASONS FOR CAUTION: Whilst no changes in lymphocyte number were observed across our patient samples, we did not investigate the activation state of any of the immune cell sub-populations examined, therefore, it is possible that the function of these cells may be altered in association with labour onset. Additionally, the results of our transcriptomic analyses are descriptive and at this stage, we cannot prove direct causal link with the up-regulation of any of the genes examined and the onset of either term or PTL. WIDER IMPLICATIONS OF THE FINDINGS: Our findings demonstrate that the onset of parturition is associated with widespread changes to the decidual transcriptome, and there are distinct gene expression changes associated with term and PTL. We confirmed that an inflammatory signature is present within the decidua, and we also report the up-regulation of several genes involved in regulating the inflammatory response. The identification of genes involved in regulating the inflammatory response may provide novel molecular targets for the development of new, more effective therapies for the prevention of preterm birth (PTB). Such targets are urgently required. STUDY FUNDING AND COMPETING INTEREST(S): This work was supported by Medical Research Council (grant number MR/L002657/1) and Tommy's, the baby charity. Jane Norman has had research grants from the charity Tommy's and from the National Institute for Health Research on PTB during the lifetime of this project. Jane Norman also sits on a data monitoring committee for GSK for a study on PTB prevention and her institution receives financial recompense for this. The other authors do not have any conflicts of interest to declare. CI - © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com FAU - Rinaldi, S F AU - Rinaldi SF AD - MRC Centre for Reproductive Health and Tommy's Centre for Maternal and Fetal Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK. FAU - Makieva, S AU - Makieva S AD - MRC Centre for Reproductive Health and Tommy's Centre for Maternal and Fetal Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK. FAU - Saunders, P T AU - Saunders PT AD - MRC Centre for Inflammation Research, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK. FAU - Rossi, A G AU - Rossi AG AD - MRC Centre for Inflammation Research, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK. FAU - Norman, J E AU - Norman JE AD - MRC Centre for Reproductive Health and Tommy's Centre for Maternal and Fetal Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK. LA - eng GR - G0700452/MRC_/Medical Research Council/United Kingdom GR - MR/L002647/1/MRC_/Medical Research Council/United Kingdom GR - MR/N022556/1/MRC_/Medical Research Council/United Kingdom GR - MR/L002657/1/MRC_/Medical Research Council/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't TA - Mol Hum Reprod JT - Molecular human reproduction JID - 9513710 RN - 0 (Antigens, CD) RN - 0 (Cytokines) SB - IM MH - Antigens, CD/genetics/immunology MH - Cell Lineage/genetics/*immunology MH - Cytokines/genetics/immunology MH - Decidua/cytology/*immunology MH - Female MH - Flow Cytometry MH - Gene Expression Profiling MH - Humans MH - Infant, Newborn MH - Labor, Obstetric/genetics/*immunology MH - Lymphocyte Count MH - Lymphocytes/classification/cytology/*immunology MH - Microarray Analysis MH - Obstetric Labor, Premature/genetics/*immunology/pathology MH - Pregnancy MH - Term Birth/immunology/metabolism MH - Transcriptome/*immunology PMC - PMC5909855 OTO - NOTNLM OT - *decidua OT - *immune OT - *inflammation OT - *microarray OT - *parturition OT - *preterm labour EDAT- 2017/09/30 06:00 MHDA- 2018/06/07 06:00 CRDT- 2017/09/30 06:00 PHST- 2016/12/19 00:00 [received] PHST- 2017/08/14 00:00 [accepted] PHST- 2017/09/30 06:00 [pubmed] PHST- 2018/06/07 06:00 [medline] PHST- 2017/09/30 06:00 [entrez] AID - 4084688 [pii] AID - gax038 [pii] AID - 10.1093/molehr/gax038 [doi] PST - ppublish SO - Mol Hum Reprod. 2017 Oct 1;23(10):708-724. doi: 10.1093/molehr/gax038. PMID- 28862738 OWN - NLM STAT- MEDLINE DCOM- 20171023 LR - 20181113 IS - 1600-0412 (Electronic) IS - 0001-6349 (Print) IS - 0001-6349 (Linking) VI - 96 IP - 11 DP - 2017 Nov TI - Doppler-based fetal heart rate analysis markers for the detection of early intrauterine growth restriction. PG - 1322-1329 LID - 10.1111/aogs.13228 [doi] AB - INTRODUCTION: One indicator for fetal risk of mortality is intrauterine growth restriction (IUGR). Whether markers reflecting the impact of growth restriction on the cardiovascular system, computed from a Doppler-derived heart rate signal, would be suitable for its detection antenatally was studied. MATERIAL AND METHODS: We used a cardiotocography archive of 1163 IUGR cases and 1163 healthy controls, matched for gestation and gender. We assessed the discriminative power of short-term variability and long-term variability of the fetal heart rate, computed over episodes of high and low variation aiming to separate growth-restricted fetuses from controls. Metrics characterizing the sleep state distribution within a trace were also considered for inclusion into an IUGR detection model. RESULTS: Significant differences in the risk markers comparing growth-restricted with healthy fetuses were found. When used in a logistic regression classifier, their performance for identifying IUGR was considerably superior before 34 weeks of gestation. Long-term variability in active sleep was superior to short-term variability [area under the receiver operator curve (AUC) of 72% compared with 71%]. Most predictive was the number of minutes in high variation per hour (AUC of 75%). A multivariate IUGR prediction model improved the AUC to 76%. CONCLUSION: We suggest that heart rate variability markers together with surrogate information on sleep states can contribute to the detection of early-onset IUGR. CI - © 2017 Nordic Federation of Societies of Obstetrics and Gynecology. FAU - Stroux, Lisa AU - Stroux L AUID- ORCID: 0000-0002-4724-1456 AD - Institute of Biomedical Engineering, Department of Ethics approval to use this database was givenEngineering Science, University of Oxford, Oxford, UK. FAU - Redman, Christopher W AU - Redman CW AD - Nuffield Department of Obstetrics & Gynecology, University of Oxford, Oxford, UK. FAU - Georgieva, Antoniya AU - Georgieva A AUID- ORCID: 0000-0002-5543-6683 AD - Nuffield Department of Obstetrics & Gynecology, University of Oxford, Oxford, UK. FAU - Payne, Stephen J AU - Payne SJ AD - Institute of Biomedical Engineering, Department of Ethics approval to use this database was givenEngineering Science, University of Oxford, Oxford, UK. FAU - Clifford, Gari D AU - Clifford GD AD - Departments of Biomedical Informatics and Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, USA. LA - eng GR - R21 HD084114/HD/NICHD NIH HHS/United States PT - Journal Article DEP - 20170927 TA - Acta Obstet Gynecol Scand JT - Acta obstetricia et gynecologica Scandinavica JID - 0370343 SB - IM MH - Cardiotocography MH - Case-Control Studies MH - Female MH - Fetal Growth Retardation/*diagnostic imaging MH - Gestational Age MH - *Heart Rate, Fetal MH - Humans MH - Male MH - Pregnancy MH - Risk Assessment MH - *Ultrasonography, Prenatal PMC - PMC5643243 MID - NIHMS902478 OTO - NOTNLM OT - Cardiotocography OT - Doppler OT - heart rate variability OT - intrauterine growth restriction OT - low-cost automated fetal monitoring COIS- Conflicts of Interest notification: The authors report no conflict of interest. EDAT- 2017/09/02 06:00 MHDA- 2017/10/24 06:00 CRDT- 2017/09/02 06:00 PHST- 2016/11/10 00:00 [received] PHST- 2017/08/25 00:00 [accepted] PHST- 2017/09/02 06:00 [pubmed] PHST- 2017/10/24 06:00 [medline] PHST- 2017/09/02 06:00 [entrez] AID - 10.1111/aogs.13228 [doi] PST - ppublish SO - Acta Obstet Gynecol Scand. 2017 Nov;96(11):1322-1329. doi: 10.1111/aogs.13228. Epub 2017 Sep 27. PMID- 28851241 OWN - NLM STAT- MEDLINE DCOM- 20190207 LR - 20190215 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) VI - 32 IP - 1 DP - 2019 Jan TI - Obesity's impact on intrapartum electronic fetal monitoring. PG - 92-94 LID - 10.1080/14767058.2017.1371696 [doi] AB - OBJECTIVE: The objective of this study is to evaluate the impact maternal obesity has on the percentage of unmonitored electronic fetal monitoring (EFM). STUDY DESIGN: Women undergoing induction of labor at term were categorized into three groups: Group 1 (body mass index (BMI) < 30 kg/m(2)), Group 2 (30 < BMI < 40 kg/m(2)), and Group 3 (BMI ≥ 40 kg/m(2)). External EFM tracings were reviewed from the time of induction of labor until amniotomy; the percentage of time off of EFM was calculated. Statistical analysis was performed using commercially available software. RESULTS: Three hundred and thirty-seven patients were stratified into the following groups: 104 patients in Group 1, 156 patients in Group 2, and 77 in Group 3. No significant differences were found between groups when analyzed for gestational age, bishop score, parity, race, and 5 min APGAR less than 7 or admission to the NICU. The mean percentage unmonitored by EFM was 5% for Group 1, 7% for Group 2 and 11% for Group 3. There was a significant association between percent of time unmonitored by EFM and BMI (r = 0.344 p < .0001). CONCLUSION: At term gestation, the fetuses of obese women spend more time unmonitored by external intrapartum EFM than non-obese women. This represents a disparity among a high-risk group that may result in poor pregnancy outcomes if fetal distress is present. FAU - Brocato, Brian AU - Brocato B AD - a Department of Obstetrics and Gynecology , University of South Alabama , Mobile , AL , USA. FAU - Lewis, David AU - Lewis D AD - b Department of Obstetrics and Gynecology , Louisiana State University - Shreveport , Shreveport , LA , USA. FAU - Mulekar, Madhuri AU - Mulekar M AD - c Department of Mathematics and Statistics , University of South Alabama , Mobile , AL , USA. FAU - Baker, Susan AU - Baker S AD - a Department of Obstetrics and Gynecology , University of South Alabama , Mobile , AL , USA. LA - eng PT - Journal Article DEP - 20170917 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 SB - IM MH - Adult MH - Cardiotocography/*statistics & numerical data MH - Female MH - Humans MH - *Obesity MH - Pregnancy MH - *Pregnancy Complications MH - Young Adult OTO - NOTNLM OT - Electronic fetal monitoring OT - induction of labor OT - obesity OT - term pregnancy EDAT- 2017/08/31 06:00 MHDA- 2019/02/08 06:00 CRDT- 2017/08/31 06:00 PHST- 2017/08/31 06:00 [pubmed] PHST- 2019/02/08 06:00 [medline] PHST- 2017/08/31 06:00 [entrez] AID - 10.1080/14767058.2017.1371696 [doi] PST - ppublish SO - J Matern Fetal Neonatal Med. 2019 Jan;32(1):92-94. doi: 10.1080/14767058.2017.1371696. Epub 2017 Sep 17. PMID- 28782450 OWN - NLM STAT- MEDLINE DCOM- 20190129 LR - 20190129 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) VI - 31 IP - 23 DP - 2018 Dec TI - Predictive value of fetal scalp pH and base excess for fetal acidosis and poor neonatal outcome. PG - 3166-3171 LID - 10.1080/14767058.2017.1365132 [doi] AB - OBJECTIVE: The objective of this study is to assess retrospectively the predictive value of fetal scalp pH and base excess (BE) for fetal acidosis and poor neonatal outcome in term, low-risk, spontaneous deliveries with suspicious or pathological intrapartum cardiotocography (CTG) tracings. METHODS: Umbilical artery pH and BE values obtained immediately after delivery and Apgar score were the outcomes under consideration. Statistics included receiver-operating characteristic curve (ROC) and multiple logistic regression analysis. RESULTS: Four hundred and six deliveries were included in the study. Scalp pH < 7.20 predicted umbilical pH ≤7.1 with 64.3% sensitivity and 92.9% specificity (p < .001). The corresponding positive-predictive value (PPV) was 24.3% and the negative-predictive value (NPV) was 98.6%. Scalp BE ≤ -7 mmol/l (a cut-off value provided by ROC curve analysis) predicted Apgar score ≤ 7 at 5 min with 61.9% sensitivity and 91.7% specificity (p < .001). The corresponding PPV and NPV were 29.5 and 97.7%, respectively. Neither scalp pH nor BE was significantly associated with umbilical BE values. Infants with intrapartum BE ≤ -7 mmol/l were 30 times on an average more likely to get a low Apgar score, independently of intrapartum pH values. CONCLUSION: Our study supports the consideration of both scalp pH and BE values, when fetal blood sampling (FBS) is used. FAU - Tsikouras, Panagiotis AU - Tsikouras P AD - a Department of Obstetrics and Gynecology , Democritus University of Thrace , Greece. FAU - Koukouli, Zacharoula AU - Koukouli Z AD - a Department of Obstetrics and Gynecology , Democritus University of Thrace , Greece. FAU - Niesigk, Barbara AU - Niesigk B AD - b Department of Obstetrics and Gynecology , Clinicum Aschaffenburg, Teaching Hospital of University of Würzburg , Germany. FAU - Manav, Bachar AU - Manav B AD - a Department of Obstetrics and Gynecology , Democritus University of Thrace , Greece. FAU - Farmakides, George AU - Farmakides G AD - a Department of Obstetrics and Gynecology , Democritus University of Thrace , Greece. FAU - Csorba, Roland AU - Csorba R AD - b Department of Obstetrics and Gynecology , Clinicum Aschaffenburg, Teaching Hospital of University of Würzburg , Germany. FAU - Galazios, Georgios AU - Galazios G AD - a Department of Obstetrics and Gynecology , Democritus University of Thrace , Greece. FAU - Teichmann, Alexander Tobias AU - Teichmann AT AD - b Department of Obstetrics and Gynecology , Clinicum Aschaffenburg, Teaching Hospital of University of Würzburg , Germany. LA - eng PT - Journal Article DEP - 20170817 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 SB - IM MH - Acidosis/blood/*diagnosis MH - Adult MH - *Apgar Score MH - Female MH - Fetal Blood/chemistry MH - Gestational Age MH - Humans MH - *Hydrogen-Ion Concentration MH - Infant, Newborn MH - Predictive Value of Tests MH - Pregnancy MH - ROC Curve MH - Retrospective Studies MH - Scalp/*blood supply MH - Sensitivity and Specificity MH - Young Adult OTO - NOTNLM OT - Apgar score OT - fetal blood sampling OT - fetal blood sampling (FBS) OT - fetal monitoring EDAT- 2017/08/08 06:00 MHDA- 2019/01/30 06:00 CRDT- 2017/08/08 06:00 PHST- 2017/08/08 06:00 [pubmed] PHST- 2019/01/30 06:00 [medline] PHST- 2017/08/08 06:00 [entrez] AID - 10.1080/14767058.2017.1365132 [doi] PST - ppublish SO - J Matern Fetal Neonatal Med. 2018 Dec;31(23):3166-3171. doi: 10.1080/14767058.2017.1365132. Epub 2017 Aug 17. PMID- 28743026 OWN - NLM STAT- MEDLINE DCOM- 20180713 LR - 20180713 IS - 1879-3231 (Electronic) IS - 0093-691X (Linking) VI - 102 DP - 2017 Oct 15 TI - Evaluation of the iVET(®) birth monitoring system in primiparous dairy heifers. PG - 44-47 LID - S0093-691X(17)30315-1 [pii] LID - 10.1016/j.theriogenology.2017.07.005 [doi] AB - The objective was to validate the iVET(®) birth monitoring system and to determine if it reduced fetal death in primiparous dairy heifers over a 1-y interval. There were 359 pregnant heifers enrolled; 167 heifers in the iVET(®) group were monitored electronically and the remaining 192 (controls) were monitored visually for onset of Stage 2 labor, according to routine farm management. In addition, as a reference, all heifers were observed throughout the study by two independent investigators. Calves born dead or that died within 24 h after birth were defined as stillborn. The interval from appearance of the chorioallantoic sac to recognition of onset of calving in the control group averaged 21 min longer than the iVET(®) signal (p = 0.0001) and rate of fetal death was numerically lower in the iVET(®) group (8.9%) than in the control group (10.4%, p = 0.65). Interestingly, dystocia occurred more often in the iVET(®) group (58.3%) than in the control group (40.9%, p = 0.001). The iVET(®) system detected onset of Stage 2 labor earlier than conventional monitoring by farm staff. However, the device was lacking in several aspects and should be improved before its use in primiparous heifers can be recommended. CI - Copyright © 2017 Elsevier Inc. All rights reserved. FAU - Henningsen, G AU - Henningsen G AD - Clinic for Cattle, University of Veterinary Medicine Hannover, Germany. Electronic address: g.henningsen@web.de. FAU - Marien, H AU - Marien H AD - Clinic for Cattle, University of Veterinary Medicine Hannover, Germany. FAU - Hasseler, W AU - Hasseler W AD - Joint Veterinary Practice, Papenburg, Germany. FAU - Feldmann, M AU - Feldmann M AD - Bovine Health Service, Vetsuisse-Faculty, University of Zurich, Switzerland. FAU - Schoon, H-A AU - Schoon HA AD - Institute of Veterinary Pathology, Faculty of Veterinary Medicine, University of Leipzig, Germany. FAU - Hoedemaker, M AU - Hoedemaker M AD - Clinic for Cattle, University of Veterinary Medicine Hannover, Germany. FAU - Herzog, K AU - Herzog K AD - Department for Animal Welfare Service, Lower Saxony State Office for Consumer Protection and Food Safety, Oldenburg, Germany. LA - eng PT - Journal Article DEP - 20170710 PL - United States TA - Theriogenology JT - Theriogenology JID - 0421510 SB - IM MH - Animals MH - Cattle/*physiology MH - Cattle Diseases/prevention & control MH - Female MH - *Labor, Obstetric MH - Monitoring, Physiologic/*veterinary MH - Parturition MH - Pregnancy MH - Stillbirth/*veterinary OTO - NOTNLM OT - Birth monitoring OT - Calving ease OT - Cattle OT - Fetal death EDAT- 2017/07/26 06:00 MHDA- 2018/07/14 06:00 CRDT- 2017/07/26 06:00 PHST- 2017/03/13 00:00 [received] PHST- 2017/07/03 00:00 [revised] PHST- 2017/07/09 00:00 [accepted] PHST- 2017/07/26 06:00 [pubmed] PHST- 2018/07/14 06:00 [medline] PHST- 2017/07/26 06:00 [entrez] AID - S0093-691X(17)30315-1 [pii] AID - 10.1016/j.theriogenology.2017.07.005 [doi] PST - ppublish SO - Theriogenology. 2017 Oct 15;102:44-47. doi: 10.1016/j.theriogenology.2017.07.005. Epub 2017 Jul 10. PMID- 28679415 OWN - NLM STAT- MEDLINE DCOM- 20180320 LR - 20181113 IS - 1475-925X (Electronic) IS - 1475-925X (Linking) VI - 16 IP - 1 DP - 2017 Jul 6 TI - Classification of caesarean section and normal vaginal deliveries using foetal heart rate signals and advanced machine learning algorithms. PG - 89 LID - 10.1186/s12938-017-0378-z [doi] LID - 89 AB - BACKGROUND: Visual inspection of cardiotocography traces by obstetricians and midwives is the gold standard for monitoring the wellbeing of the foetus during antenatal care. However, inter- and intra-observer variability is high with only a 30% positive predictive value for the classification of pathological outcomes. This has a significant negative impact on the perinatal foetus and often results in cardio-pulmonary arrest, brain and vital organ damage, cerebral palsy, hearing, visual and cognitive defects and in severe cases, death. This paper shows that using machine learning and foetal heart rate signals provides direct information about the foetal state and helps to filter the subjective opinions of medical practitioners when used as a decision support tool. The primary aim is to provide a proof-of-concept that demonstrates how machine learning can be used to objectively determine when medical intervention, such as caesarean section, is required and help avoid preventable perinatal deaths. METHODS: This is evidenced using an open dataset that comprises 506 controls (normal virginal deliveries) and 46 cases (caesarean due to pH ≤ 7.20-acidosis, n = 18; pH > 7.20 and pH < 7.25-foetal deterioration, n = 4; or clinical decision without evidence of pathological outcome measures, n = 24). Several machine-learning algorithms are trained, and validated, using binary classifier performance measures. RESULTS: The findings show that deep learning classification achieves sensitivity = 94%, specificity = 91%, Area under the curve = 99%, F-score = 100%, and mean square error = 1%. CONCLUSIONS: The results demonstrate that machine learning significantly improves the efficiency for the detection of caesarean section and normal vaginal deliveries using foetal heart rate signals compared with obstetrician and midwife predictions and systems reported in previous studies. FAU - Fergus, Paul AU - Fergus P AUID- ORCID: 0000-0002-7070-4447 AD - Applied Computing Research Group, Department of Computer Science, Faculty of Engineering and Technology, Liverpool John Moors University, Byron Street, Liverpool, L3 3AF, UK. p.fergus@ljmu.ac.uk. FAU - Hussain, Abir AU - Hussain A AD - Applied Computing Research Group, Department of Computer Science, Faculty of Engineering and Technology, Liverpool John Moors University, Byron Street, Liverpool, L3 3AF, UK. FAU - Al-Jumeily, Dhiya AU - Al-Jumeily D AD - Applied Computing Research Group, Department of Computer Science, Faculty of Engineering and Technology, Liverpool John Moors University, Byron Street, Liverpool, L3 3AF, UK. FAU - Huang, De-Shuang AU - Huang DS AD - Institute of Machine Learning and Systems Biology, Tongji University, No. 4800 Caoan Road, Shanghai, 201804, China. FAU - Bouguila, Nizar AU - Bouguila N AD - Concordia Institute for Information Systems Engineering, Concorida University, 1455 de Maisonneuve Blvd West, EV7.632, Montreal, QC, HJ3G 2W1, Canada. LA - eng PT - Journal Article DEP - 20170706 TA - Biomed Eng Online JT - Biomedical engineering online JID - 101147518 SB - IM MH - Adult MH - *Cardiotocography MH - Cesarean Section/*classification MH - Contraceptive Devices, Female/*classification MH - Discriminant Analysis MH - Female MH - *Heart Rate, Fetal MH - Humans MH - *Machine Learning MH - Nonlinear Dynamics MH - Pregnancy MH - *Signal Processing, Computer-Assisted MH - Young Adult PMC - PMC5498914 OTO - NOTNLM OT - Classification OT - Deep learning OT - Feature extraction and selection OT - Intrapartum cardiotocography OT - Machine learning OT - Random forest EDAT- 2017/07/07 06:00 MHDA- 2018/03/21 06:00 CRDT- 2017/07/07 06:00 PHST- 2017/02/11 00:00 [received] PHST- 2017/06/26 00:00 [accepted] PHST- 2017/07/07 06:00 [entrez] PHST- 2017/07/07 06:00 [pubmed] PHST- 2018/03/21 06:00 [medline] AID - 10.1186/s12938-017-0378-z [pii] AID - 378 [pii] AID - 10.1186/s12938-017-0378-z [doi] PST - epublish SO - Biomed Eng Online. 2017 Jul 6;16(1):89. doi: 10.1186/s12938-017-0378-z. PMID- 29060570 OWN - NLM STAT- MEDLINE DCOM- 20180821 LR - 20200928 IS - 2694-0604 (Electronic) IS - 2375-7477 (Linking) VI - 2017 DP - 2017 Jul TI - Statistical baseline assessment in cardiotocography. PG - 3166-3169 LID - 10.1109/EMBC.2017.8037529 [doi] AB - Cardiotocography (CTG) is the most common non-invasive diagnostic technique to evaluate fetal well-being. It consists in the recording of fetal heart rate (FHR; bpm) and maternal uterine contractions. Among the main parameters characterizing FHR, baseline (BL) is fundamental to determine fetal hypoxia and distress. In computerized applications, BL is typically computed as mean FHR±ΔFHR, with ΔFHR=8 bpm or ΔFHR=10 bpm, both values being experimentally fixed. In this context, the present work aims: to propose a statistical procedure for ΔFHR assessment; to quantitatively determine ΔFHR value by applying such procedure to clinical data; and to compare the statistically-determined ΔFHR value against the experimentally-determined ΔFHR values. To these aims, the 552 recordings of the "CTU-UHB intrapartum CTG database" from Physionet were submitted to an automatic procedure, which consisted in a FHR preprocessing phase and a statistical BL assessment. During preprocessing, FHR time series were divided into 20-min sliding windows, in which missing data were removed by linear interpolation. Only windows with a correction rate lower than 10% were further processed for BL assessment, according to which ΔFHR was computed as FHR standard deviation. Total number of accepted windows was 1192 (38.5%) over 383 recordings (69.4%) with at least an accepted window. Statistically-determined ΔFHR value was 9.7 bpm. Such value was statistically different from 8 bpm (P<;10(-19)) but not from 10 bpm (P=0.16). Thus, ΔFHR=10 bpm is preferable over 8 bpm because both experimentally and statistically validated. FAU - Agostinelli, Angela AU - Agostinelli A FAU - Braccili, Eleonora AU - Braccili E FAU - Marchegiani, Enrico AU - Marchegiani E FAU - Rosati, Riccardo AU - Rosati R FAU - Sbrollini, Agnese AU - Sbrollini A FAU - Burattini, Luca AU - Burattini L FAU - Morettini, Micaela AU - Morettini M FAU - Di Nardo, Francesco AU - Di Nardo F FAU - Fioretti, Sandro AU - Fioretti S FAU - Burattini, Laura AU - Burattini L LA - eng PT - Journal Article PL - United States TA - Annu Int Conf IEEE Eng Med Biol Soc JT - Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference JID - 101763872 SB - IM MH - *Cardiotocography MH - Female MH - Fetal Hypoxia MH - Heart Rate, Fetal MH - Humans MH - Pregnancy MH - Reproducibility of Results EDAT- 2017/10/25 06:00 MHDA- 2018/08/22 06:00 CRDT- 2017/10/25 06:00 PHST- 2017/10/25 06:00 [entrez] PHST- 2017/10/25 06:00 [pubmed] PHST- 2018/08/22 06:00 [medline] AID - 10.1109/EMBC.2017.8037529 [doi] PST - ppublish SO - Annu Int Conf IEEE Eng Med Biol Soc. 2017 Jul;2017:3166-3169. doi: 10.1109/EMBC.2017.8037529. PMID- 29060442 OWN - NLM STAT- MEDLINE DCOM- 20180816 LR - 20200928 IS - 2694-0604 (Electronic) IS - 2375-7477 (Linking) VI - 2017 DP - 2017 Jul TI - An ordinal classification approach for CTG categorization. PG - 2642-2645 LID - 10.1109/EMBC.2017.8037400 [doi] AB - Evaluation of cardiotocogram (CTG) is a standard approach employed during pregnancy and delivery. But, its interpretation requires high level expertise to decide whether the recording is Normal, Suspicious or Pathological. Therefore, a number of attempts have been carried out over the past three decades for development automated sophisticated systems. These systems are usually (multiclass) classification systems that assign a category to the respective CTG. However most of these systems usually do not take into consideration the natural ordering of the categories associated with CTG recordings. In this work, an algorithm that explicitly takes into consideration the ordering of CTG categories, based on binary decomposition method, is investigated. Achieved results, using as a base classifier the C4.5 decision tree classifier, prove that the ordinal classification approach is marginally better than the traditional multiclass classification approach, which utilizes the standard C4.5 algorithm for several performance criteria. FAU - Georgoulas, George AU - Georgoulas G FAU - Karvelis, Petros AU - Karvelis P FAU - Gavrilis, Dimitris AU - Gavrilis D FAU - Stylios, Chrysostomos D AU - Stylios CD FAU - Nikolakopoulos, George AU - Nikolakopoulos G LA - eng PT - Journal Article PL - United States TA - Annu Int Conf IEEE Eng Med Biol Soc JT - Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference JID - 101763872 SB - IM MH - Algorithms MH - *Cardiotocography MH - Decision Trees MH - Female MH - Humans MH - Pregnancy EDAT- 2017/10/25 06:00 MHDA- 2018/08/17 06:00 CRDT- 2017/10/25 06:00 PHST- 2017/10/25 06:00 [entrez] PHST- 2017/10/25 06:00 [pubmed] PHST- 2018/08/17 06:00 [medline] AID - 10.1109/EMBC.2017.8037400 [doi] PST - ppublish SO - Annu Int Conf IEEE Eng Med Biol Soc. 2017 Jul;2017:2642-2645. doi: 10.1109/EMBC.2017.8037400. PMID- 29060294 OWN - NLM STAT- MEDLINE DCOM- 20180808 LR - 20200928 IS - 2694-0604 (Electronic) IS - 2375-7477 (Linking) VI - 2017 DP - 2017 Jul TI - Influence of ECG sampling rate in fetal heart rate variability analysis. PG - 2027-2030 LID - 10.1109/EMBC.2017.8037250 [doi] AB - Fetal hypoxia results in a fetal blood acidosis (pH<;7.10). In such a situation, the fetus develops several adaptation mechanisms regulated by the autonomic nervous system. Many studies demonstrated significant changes in heart rate variability in hypoxic fetuses. So, fetal heart rate variability analysis could be of precious help for fetal hypoxia prediction. Commonly used fetal heart rate variability analysis methods have been shown to be sensitive to the ECG signal sampling rate. Indeed, a low sampling rate could induce variability in the heart beat detection which will alter the heart rate variability estimation. In this paper, we introduce an original fetal heart rate variability analysis method. We hypothesize that this method will be less sensitive to ECG sampling frequency changes than common heart rate variability analysis methods. We then compared the results of this new heart rate variability analysis method with two different sampling frequencies (250-1000 Hz). FAU - De Jonckheere, J AU - De Jonckheere J FAU - Garabedian, C AU - Garabedian C FAU - Charlier, P AU - Charlier P FAU - Champion, C AU - Champion C FAU - Servan-Schreiber, E AU - Servan-Schreiber E FAU - Storme, L AU - Storme L FAU - Debarge, V AU - Debarge V FAU - Jeanne, M AU - Jeanne M FAU - Logier, R AU - Logier R LA - eng PT - Journal Article PL - United States TA - Annu Int Conf IEEE Eng Med Biol Soc JT - Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference JID - 101763872 SB - IM MH - Acidosis MH - Autonomic Nervous System MH - Electrocardiography MH - Female MH - Fetal Heart MH - Fetal Hypoxia MH - *Heart Rate, Fetal MH - Humans MH - Pregnancy EDAT- 2017/10/25 06:00 MHDA- 2018/08/09 06:00 CRDT- 2017/10/25 06:00 PHST- 2017/10/25 06:00 [entrez] PHST- 2017/10/25 06:00 [pubmed] PHST- 2018/08/09 06:00 [medline] AID - 10.1109/EMBC.2017.8037250 [doi] PST - ppublish SO - Annu Int Conf IEEE Eng Med Biol Soc. 2017 Jul;2017:2027-2030. doi: 10.1109/EMBC.2017.8037250. PMID- 28761202 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200930 IS - 0253-0716 (Print) IS - 1735-3688 (Electronic) IS - 0253-0716 (Linking) VI - 42 IP - 4 DP - 2017 Jul TI - Admission Test and Pregnancy Outcome. PG - 362-368 AB - BACKGROUND: The admission test (AT) has been carried out for many years, but there are still debates about the prognostic value of the test. Therefore, we aimed to examine the value of the AT in predicting the adverse outcome in neonates. METHODS: In this cross-sectional study, 425 pregnant women with normal vaginal delivery were studied between2009 and 2014at Vali-e-Asr Hospital. Based on the results, the women were divided into 2groups of normal and abnormal ATs. All the patients were followed up until the birth of their baby, when the status of mother and neonate was determined. The main outcomes of the study were cesarean rate, neonatal intensive care unit (NICU) admission, fetus demise, neonatal acidosis, and Apgar score. The independent t-test, chi-square test, Fisher exact test, and logistic regression were used for statistical analysis. The data were analyzed using SPSS (version 17). RESULTS: Of 425 pregnant women studied, 142 (33.4%) had abnormal ATs with a mean age of 29 (±4.5) years. Multivariate analysis showed that an abnormal AT was able to predict the incidence of cesarean section, intrauterine growth restriction, turned cord, and Apgar<7, but it could not predict neonatal death and hypoxia. CONCLUSION: The AT was shown to be a useful screening test with risk factors such as oligohydramnios, bloody amniotic fluid, meconium amniotic fluid, intrauterine growth restriction, and turned cord. Additionally, the test was also able to predict NICU admission and the need for cesarean section, but it could not predict the occurrence of neonatal death. FAU - Akhavan, Setareh AU - Akhavan S AD - Department of Gynecology, Tehran University of Medical Sciences, Tehran, Iran. FAU - Lak, Parvaneh AU - Lak P AD - Department of Obstetrics and Gynaecology, Shaheed Chamran Hospital, Iran University of Medical Sciences, Tehran, Iran. FAU - Rahimi-Sharbaf, Fatemeh AU - Rahimi-Sharbaf F AD - Department of Gynecology, Tehran University of Medical Sciences, Tehran, Iran. FAU - Mohammadi, Seyed Rahim AU - Mohammadi SR AD - Tehran University of Medical Sciences, Tehran, Iran. FAU - Shirazi, Mahboobeh AU - Shirazi M AD - Maternal Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran. LA - eng PT - Journal Article TA - Iran J Med Sci JT - Iranian journal of medical sciences JID - 8104374 PMC - PMC5523043 OTO - NOTNLM OT - Admission test OT - Cardiotocography OT - Electronic fetal monitoring OT - Infant OT - Outcome EDAT- 2017/08/02 06:00 MHDA- 2017/08/02 06:01 CRDT- 2017/08/02 06:00 PHST- 2017/08/02 06:00 [entrez] PHST- 2017/08/02 06:00 [pubmed] PHST- 2017/08/02 06:01 [medline] AID - IJMS-42-362 [pii] PST - ppublish SO - Iran J Med Sci. 2017 Jul;42(4):362-368. PMID- 28668074 OWN - NLM STAT- MEDLINE DCOM- 20180420 LR - 20181113 IS - 1471-2393 (Electronic) IS - 1471-2393 (Linking) VI - 17 IP - 1 DP - 2017 Jul 1 TI - Evidence of lower oxygen reserves during labour in the growth restricted human foetus: a retrospective study. PG - 209 LID - 10.1186/s12884-017-1392-7 [doi] LID - 209 AB - BACKGROUND: The aim of the present study is to test the hypothesis that Growth Restricted foetuses (FGR) have the tendency to develop more pathological cardiotocograpic tracings during labour than do appropriate for gestational age foetuses and that there is a shorter time lapse from the beginning of labour and the advent of a pathological cardiotocograpic tracing. METHODS: The study was carried out at the Maternal-Foetal Medicine Unit of the Sant'Anna University Hospital, Turin, Italy. A total of 930 foetuses born at term between January and December 2012 were analysed: 355 small for gestational age (SGA) comprising both constitutional small for gestational age and growth restricted foetuses (cases group) and 575 Appropriate for Gestational Age (AGA) foetuses (control group). Tracings were evaluated independently by two obstetric consultants, according to the International Federation of Gynaecology and Obstetrics (FIGO) classification. The main outcomes considered were the incidence of pathological cardiotocograpic tracings and the time interval between the beginning of labour and the advent of pathological cardiotocograpic tracing. The Student's t-test, chi-square test and ANOVA were used for comparisons between cases and controls and amongst groups. Significance was set at <0.05. Univariate and multivariate odds-ratios were calculated. RESULTS: Foetuses with birthweight <3rd centile (growth restricted foetuses) more frequently presented pathological cardiotocograpic tracings in labour than did controls (43.8% vs. 21.6%; p < 0.001). Pathological cardiotocograpic tracing developed faster in the foetuses with birthweight <3rd centile group (53', 0'-277') than it did in the control group (170.5', 0'-550'; p < 0.05). A higher induction rate was observed in the cases (29.6%) than in the control group (17%), with statistical significance p < 0.001. To correct for this possible confounding factor a multivariate logistic regression analysis was performed. It confirmed a statistically significant increased risk of pathological cardiotocographic tracings in the FGR group (OR 1.63; CI 1.30-2.05). CONCLUSION: The results confirm the hypothesis that Growth Restricted foetuses (FGR) have fewer oxygen reserves to deal with labour. Our results underscore the importance of the prenatal detection of these foetuses and of their continuous cardiotocographic monitoring during labour. FAU - Parisi, Silvia AU - Parisi S AUID- ORCID: 0000-0002-2222-713X AD - Department of Obstetrics and Gynaecology, Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, Turin, Italy. silviucciap@hotmail.it. FAU - Monzeglio, Clara AU - Monzeglio C AD - Department of Obstetrics and Gynaecology, Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, Turin, Italy. FAU - Attini, Rossella AU - Attini R AD - Department of Obstetrics and Gynaecology, Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, Turin, Italy. FAU - Biolcati, Marilisa AU - Biolcati M AD - Department of Obstetrics and Gynaecology, Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, Turin, Italy. FAU - Masturzo, Bianca AU - Masturzo B AD - Department of Obstetrics and Gynaecology, Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, Turin, Italy. FAU - Mensa, Manuela AU - Mensa M AD - Department of Obstetrics and Gynaecology, Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, Turin, Italy. FAU - Mischinelli, Marina AU - Mischinelli M AD - Department of Obstetrics and Gynaecology, Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, Turin, Italy. FAU - Pilloni, Eleonora AU - Pilloni E AD - Department of Obstetrics and Gynaecology, Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, Turin, Italy. FAU - Todros, Tullia AU - Todros T AD - Department of Obstetrics and Gynaecology, Sant'Anna Hospital, University of Turin, Via Ventimiglia 3, Turin, Italy. LA - eng PT - Journal Article DEP - 20170701 TA - BMC Pregnancy Childbirth JT - BMC pregnancy and childbirth JID - 100967799 RN - 33X04XA5AT (Lactic Acid) RN - S88TT14065 (Oxygen) SB - IM MH - *Birth Weight MH - Cardiotocography MH - Female MH - Fetal Blood/chemistry MH - Fetal Distress/etiology/*physiopathology MH - Fetal Growth Retardation/*physiopathology MH - *Heart Rate, Fetal MH - Humans MH - Infant, Newborn MH - Infant, Small for Gestational Age/physiology MH - Labor, Induced/statistics & numerical data MH - Labor, Obstetric/*physiology MH - Lactic Acid/blood MH - Male MH - Oxygen/metabolism MH - Pregnancy MH - Retrospective Studies MH - Time Factors PMC - PMC5494130 OTO - NOTNLM OT - Cardiotocography OT - Foetal growth restriction OT - Hypoxia OT - Labour OT - Small for gestational age COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: Ethics approval was not requested as the study was based on retrospective review of medical records. According to Italian rules (DM 31/03/2008; Determinazione 20/03/2008), formal ethics approval wasn’t necessary. We required and obtained an administrative permission to access data. CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER’S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2017/07/03 06:00 MHDA- 2018/04/21 06:00 CRDT- 2017/07/03 06:00 PHST- 2016/04/06 00:00 [received] PHST- 2017/06/22 00:00 [accepted] PHST- 2017/07/03 06:00 [entrez] PHST- 2017/07/03 06:00 [pubmed] PHST- 2018/04/21 06:00 [medline] AID - 10.1186/s12884-017-1392-7 [pii] AID - 1392 [pii] AID - 10.1186/s12884-017-1392-7 [doi] PST - epublish SO - BMC Pregnancy Childbirth. 2017 Jul 1;17(1):209. doi: 10.1186/s12884-017-1392-7. PMID- 27484356 OWN - NLM STAT- MEDLINE DCOM- 20171121 LR - 20171128 IS - 1469-0705 (Electronic) IS - 0960-7692 (Linking) VI - 50 IP - 1 DP - 2017 Jul TI - Longitudinal study of computerized cardiotocography in early fetal growth restriction. PG - 71-78 LID - 10.1002/uog.17215 [doi] AB - OBJECTIVES: To explore whether, in early fetal growth restriction (FGR), the longitudinal pattern of fetal heart rate (FHR) short-term variation (STV) can be used to identify imminent fetal distress and whether abnormalities of FHR recordings are associated with 2-year infant outcome. METHODS: The original TRUFFLE study assessed whether, in early FGR, delivery based on ductus venosus (DV) Doppler pulsatility index (PI), in combination with safety-net criteria of very low STV on cardiotocography (CTG) and/or recurrent FHR decelerations, could improve 2-year infant survival without neurological impairment in comparison with delivery based on CTG monitoring only. This was a secondary analysis of women who delivered before 32 weeks and had consecutive STV data recorded > 3 days before delivery and known infant outcome at 2 years of age. Women who received corticosteroids within 3 days of delivery were excluded. Individual regression line algorithms of all STV values, except the last one before delivery, were calculated. Life tables and Cox regression analysis were used to calculate the daily risk for low STV or very low STV and/or FHR decelerations (below DV group safety-net criteria) and to assess which parameters were associated with this risk. Furthermore, it was assessed whether STV pattern, last STV value or recurrent FHR decelerations were associated with 2-year infant outcome. RESULTS: One hundred and forty-nine women from the original TRUFFLE study met the inclusion criteria. Using the individual STV regression lines, prediction of a last STV below the cut-off used by the CTG monitoring group had sensitivity of 42% and specificity of 91%. For each day after study inclusion, the median risk for low STV (CTG group cut-off) was 4% (interquartile range (IQR), 2-7%) and for very low STV and/or recurrent FHR decelerations (below DV group safety-net criteria) was 5% (IQR, 4-7%). Measures of STV pattern, fetal Doppler (arterial or venous), birth-weight multiples of the median and gestational age did not usefully improve daily risk prediction. There was no association of STV regression coefficients, a low last STV and/or recurrent FHR decelerations with short- or long-term infant outcomes. CONCLUSION: The TRUFFLE study showed that a strategy of DV monitoring with safety-net criteria of very low STV and/or recurrent FHR decelerations for delivery indication could increase 2-year infant survival without neurological impairment. This post-hoc analysis demonstrates that, in early FGR, the daily risk of abnormal CTG, as defined by the DV group safety-net criteria, is 5%, and that prediction is not possible. This supports the rationale for CTG monitoring more often than daily in these high-risk fetuses. Low STV and/or recurrent FHR decelerations were not associated with adverse infant outcome and it appears safe to delay intervention until such abnormalities occur, as long as DV-PI is within normal range. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. CI - Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. FAU - Wolf, H AU - Wolf H AUID- ORCID: 0000-0003-3924-2149 AD - Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands. FAU - Arabin, B AU - Arabin B AD - Center for Mother and Child of the Phillips University, Marburg, Germany. FAU - Lees, C C AU - Lees CC AUID- ORCID: 0000-0002-2104-5561 AD - Department of Surgery and Cancer, Imperial College London, London, UK. AD - Department of Development and Regeneration, KU Leuven, Leuven, Belgium. FAU - Oepkes, D AU - Oepkes D AD - Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands. FAU - Prefumo, F AU - Prefumo F AD - Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy. FAU - Thilaganathan, B AU - Thilaganathan B AD - Fetal Medicine Unit, St George's, University of London and St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK. FAU - Todros, T AU - Todros T AD - Department of Obstetrics and Gynaecology, University of Turin, Turin, Italy. FAU - Visser, G H A AU - Visser GHA AD - Department of Perinatal Medicine, University Medical Center, Utrecht, The Netherlands. FAU - Bilardo, C M AU - Bilardo CM AUID- ORCID: 0000-0003-1894-0626 AD - Department of Obstetrics and Gynaecology, University Medical Center, University of Groningen, Groningen, The Netherlands. FAU - Derks, J B AU - Derks JB AD - Department of Perinatal Medicine, University Medical Center, Utrecht, The Netherlands. FAU - Diemert, A AU - Diemert A AD - Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg, Eppendorf, Germany. FAU - Duvekot, J J AU - Duvekot JJ AD - Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands. FAU - Ferrazzi, E AU - Ferrazzi E AD - Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Italy. FAU - Frusca, T AU - Frusca T AD - Department of Obstetrics and Gynecology, Maggiore Hospital, University of Parma, Parma, Italy. FAU - Hecher, K AU - Hecher K AUID- ORCID: 0000-0002-3172-1164 AD - Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg, Eppendorf, Germany. FAU - Marlow, N AU - Marlow N AD - Department of Neonatology, Institute for Women's Health, University College Hospitals London, London, UK. FAU - Martinelli, P AU - Martinelli P AUID- ORCID: 0000-0003-1911-7762 AD - Department of Neuroscience, Dentistry and Reproductive Sciences, University of Naples Federico II, Naples, Italy. FAU - Ostermayer, E AU - Ostermayer E AD - Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany. FAU - Papageorghiou, A T AU - Papageorghiou AT AD - Fetal Medicine Unit, St George's, University of London and St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK. FAU - Scheepers, H C J AU - Scheepers HCJ AD - Department of Obstetrics, Maastricht University Medical Centre, Maastricht, The Netherlands. FAU - Schlembach, D AU - Schlembach D AD - Department of Obstetrics, Vivantes Clinic Neukölln, Berlin, Germany. FAU - Schneider, K T M AU - Schneider KTM AD - Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany. FAU - Valcamonico, A AU - Valcamonico A AD - Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy. FAU - van Wassenaer-Leemhuis, A AU - van Wassenaer-Leemhuis A AD - Department of Neonatology, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands. FAU - Ganzevoort, W AU - Ganzevoort W AUID- ORCID: 0000-0002-7243-2115 AD - Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands. CN - TRUFFLE group LA - eng GR - G9533539/Medical Research Council/United Kingdom PT - Journal Article PT - Randomized Controlled Trial PL - England TA - Ultrasound Obstet Gynecol JT - Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology JID - 9108340 SB - IM MH - Adult MH - Cardiotocography MH - Child, Preschool MH - Female MH - Fetal Growth Retardation/*diagnostic imaging/mortality/physiopathology MH - Fetal Heart/*physiology MH - Heart Rate, Fetal/*physiology MH - Humans MH - Infant MH - Infant, Newborn MH - Longitudinal Studies MH - Middle Cerebral Artery/*diagnostic imaging/physiology MH - Pregnancy MH - Pregnancy Outcome MH - Pulsatile Flow MH - Survival Analysis MH - Ultrasonography, Prenatal OTO - NOTNLM OT - cardiotocography OT - ductus venosus OT - fetal growth restriction OT - fetal monitoring OT - preterm OT - short-term variation FIR - Aktas, Ayse IR - Aktas A FIR - Borgione, Silvia IR - Borgione S FIR - Brezinka, Christoph IR - Brezinka C FIR - Calvert, Sandra IR - Calvert S FIR - Chaoui, Rabih IR - Chaoui R FIR - Cornette, Jerome M J IR - Cornette JMJ FIR - Diehl, Thilo IR - Diehl T FIR - van Eyck, Jim IR - van Eyck J FIR - Fratelli, Nicola IR - Fratelli N FIR - van Haastert, Inge-Lot IR - van Haastert IL FIR - Johnson, Samantha IR - Johnson S FIR - Lobmaier, Silvia IR - Lobmaier S FIR - Lopriore, Enrico IR - Lopriore E FIR - Mansi, Giuseppina IR - Mansi G FIR - Missfelder-Lobos, Hannah IR - Missfelder-Lobos H FIR - Martelli, Paola IR - Martelli P FIR - Maso, Gianpaolo IR - Maso G FIR - Maurer-Fellbaum, Ute IR - Maurer-Fellbaum U FIR - van Charante, Nico Mensing IR - van Charante NM FIR - De Tollenaer, Susanne Mulder IR - De Tollenaer SM FIR - Moore, Tamanna IR - Moore T FIR - Napolitano, Raffaele IR - Napolitano R FIR - Oberto, Manuela IR - Oberto M FIR - Ogge, Giovanna IR - Ogge G FIR - van der Post, Joris IR - van der Post J FIR - Preston, Lucy IR - Preston L FIR - Raimondi, Francesco IR - Raimondi F FIR - Reiss, Irwin K M IR - Reiss IKM FIR - Rigano, Serena IR - Rigano S FIR - Schuit, Ewoud IR - Schuit E FIR - Skabar, Aldo IR - Skabar A FIR - Spaanderman, Marc IR - Spaanderman M FIR - Weisglas-Kuperus, Nynke IR - Weisglas-Kuperus N FIR - Zimmermann, Andrea IR - Zimmermann A EDAT- 2016/08/04 06:00 MHDA- 2017/11/29 06:00 CRDT- 2016/08/04 06:00 PHST- 2016/05/16 00:00 [received] PHST- 2016/07/03 00:00 [revised] PHST- 2016/07/08 00:00 [accepted] PHST- 2016/08/04 06:00 [pubmed] PHST- 2017/11/29 06:00 [medline] PHST- 2016/08/04 06:00 [entrez] AID - 10.1002/uog.17215 [doi] PST - ppublish SO - Ultrasound Obstet Gynecol. 2017 Jul;50(1):71-78. doi: 10.1002/uog.17215. PMID- 28602043 OWN - NLM STAT- MEDLINE DCOM- 20180111 LR - 20180111 IS - 1879-3479 (Electronic) IS - 0020-7292 (Linking) VI - 138 IP - 3 DP - 2017 Sep TI - Efficacy of first-trimester ultrasound parameters for prediction of early spontaneous abortion. PG - 325-330 LID - 10.1002/ijgo.12231 [doi] AB - OBJECTIVE: To assess first-trimester ultrasound measurements for the prediction of early spontaneous abortion. METHODS: In a prospective observational study in Jamshedpur, India, women with singleton pregnancies of 42-76 days were enrolled between November 2014 and April 2016. Inclusion criteria were spontaneous conception, embryonic cardiac activity, and regular menstrual cycle. Fetal crown-to-rump length (CRL), gestational sac diameter (GSD), yolk sac diameter (YSD), and fetal heart rate (FHR) were measured by transvaginal ultrasonography. Ultrasonography was repeated at 12 weeks and beyond to determine pregnancy continuation. RESULTS: Among 800 women, 140 (17.5%) experienced early spontaneous abortion. CRL, GSD, and FHR values below the 5th percentile (odds ratio [OR] 26.48, 26.94, and 100.63, respectively), and YSD above the 95th percentile (OR 1.04) were predictors of early abortion. Normal YSD did not reduce the risk of abortion if the other three parameters were below the 5th percentile (OR 34.27). For every 10-bpm decrease in FHR below 130, there was 26.7% increased risk of abortion. GSD-CRL difference of less than 5 mm was associated with a higher likelihood of abortion (OR 4.88). CONCLUSION: First-trimester ultrasound measurements are predictors of early abortion. Risk assessment tables based on combinations of abnormal measures might improve prediction rates. CI - © 2017 International Federation of Gynecology and Obstetrics. FAU - Datta, Mamta Rath AU - Datta MR AD - Tata Main Hospital, Jamshedpur, Jharkhand, India. FAU - Raut, Ankush AU - Raut A AD - Tata Main Hospital, Jamshedpur, Jharkhand, India. LA - eng PT - Journal Article PT - Observational Study DEP - 20170630 PL - United States TA - Int J Gynaecol Obstet JT - International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics JID - 0210174 SB - IM MH - Abortion, Spontaneous/*diagnosis/diagnostic imaging MH - Crown-Rump Length MH - Female MH - Heart Rate, Fetal MH - Humans MH - India MH - Maternal Health Services MH - Predictive Value of Tests MH - Pregnancy MH - *Pregnancy Trimester, First MH - Prospective Studies MH - Risk Factors MH - *Ultrasonography, Prenatal OTO - NOTNLM OT - Early spontaneous abortion OT - Prediction OT - Transvaginal ultrasonography OT - Ultrasonography EDAT- 2017/06/12 06:00 MHDA- 2018/01/13 06:00 CRDT- 2017/06/12 06:00 PHST- 2017/02/16 00:00 [received] PHST- 2017/04/23 00:00 [revised] PHST- 2017/06/07 00:00 [accepted] PHST- 2017/06/12 06:00 [pubmed] PHST- 2018/01/13 06:00 [medline] PHST- 2017/06/12 06:00 [entrez] AID - 10.1002/ijgo.12231 [doi] PST - ppublish SO - Int J Gynaecol Obstet. 2017 Sep;138(3):325-330. doi: 10.1002/ijgo.12231. Epub 2017 Jun 30. PMID- 28591756 OWN - NLM STAT- MEDLINE DCOM- 20180827 LR - 20180827 IS - 1421-9964 (Electronic) IS - 1015-3837 (Linking) VI - 43 IP - 2 DP - 2018 TI - The "Fetal Reserve Index": Re-Engineering the Interpretation and Responses to Fetal Heart Rate Patterns. PG - 90-104 LID - 10.1159/000475927 [doi] AB - OBJECTIVE: Electronic fetal monitoring (EFM) correlates poorly with neonatal outcome. We present a new metric: the "Fetal Reserve Index" (FRI), formally incorporating EFM with maternal, obstetrical, fetal risk factors, and excessive uterine activity for assessment of risk for cerebral palsy (CP). METHODS: We performed a retrospective, case-control series of 50 term CP cases with apparent intrapartum neurological injury and 200 controls. All were deemed neurologically normal on admission. We compared the FRI against ACOG Category (I-III) system and long-term outcome parameters against ACOG monograph (NEACP) requirements for labor-induced fetal neurological injury. RESULTS: Abnormal FRI's identified 100% of CP cases and did so hours before injury. ACOG Category III identified only 44% and much later. Retrospective ACOG monograph criteria were found in at most 30% of intrapartum-acquired CP patients; only 27% had umbilical or neonatal pH <7.0. CONCLUSIONS: In this initial, retrospective trial, an abnormal FRI identified all cases of labor-related neurological injury more reliably and earlier than Category III, which may allow fetal therapy by intrauterine resuscitation. The combination of traditional EFM with maternal, obstetrical, and fetal risk factors creating the FRI performed much better as a screening test than EFM alone. Our quantified screening system needs further evaluation in prospective trials. CI - © 2017 S. Karger AG, Basel. FAU - Eden, Robert D AU - Eden RD AD - Fetal Medicine Foundation of America, New York, NY, USA. FAU - Evans, Mark I AU - Evans MI FAU - Evans, Shara M AU - Evans SM FAU - Schifrin, Barry S AU - Schifrin BS LA - eng PT - Journal Article DEP - 20170608 PL - Switzerland TA - Fetal Diagn Ther JT - Fetal diagnosis and therapy JID - 9107463 SB - IM MH - Adult MH - Cardiotocography/*methods/trends MH - Case-Control Studies MH - Cerebral Palsy/*diagnosis/*physiopathology MH - Female MH - Follow-Up Studies MH - Heart Rate, Fetal/*physiology MH - Humans MH - Maternal Health/trends MH - Pregnancy MH - Retrospective Studies MH - Risk Factors OTO - NOTNLM OT - ACOG monitoring classification system OT - Cerebral palsy OT - Electronic fetal monitoring OT - Fetal Reserve Index OT - Intrauterine resuscitation OT - Neonatal encephalopathy EDAT- 2017/06/08 06:00 MHDA- 2018/08/28 06:00 CRDT- 2017/06/08 06:00 PHST- 2016/11/23 00:00 [received] PHST- 2017/04/18 00:00 [accepted] PHST- 2017/06/08 06:00 [pubmed] PHST- 2018/08/28 06:00 [medline] PHST- 2017/06/08 06:00 [entrez] AID - 000475927 [pii] AID - 10.1159/000475927 [doi] PST - ppublish SO - Fetal Diagn Ther. 2018;43(2):90-104. doi: 10.1159/000475927. Epub 2017 Jun 8. PMID- 28545266 OWN - NLM STAT- MEDLINE DCOM- 20170731 LR - 20181202 IS - 0529-567X (Print) IS - 0529-567X (Linking) VI - 52 IP - 5 DP - 2017 May 25 TI - [Analysis of misssed diagnosis and misdiagnosis of 1 212 cases with placental abruption]. PG - 294-300 LID - 10.3760/cma.j.issn.0529-567X.2017.05.002 [doi] AB - Objective: To investigate the risk factors and clinical manifestations of placental abruption, and to analyze the causes of missed diagnosis and misdiagnosis. Methods: A retrospective analysis was conducted in 135 584 women who delivered in Women's Hospital, School of Medicine, Zhejiang University from January 2005 to December 2015. The diagnosis of placental abruption was made in 1 212 cases. According to the consistency of prenatal and postnatal diagnosis, they were divided into 3 groups. (1) The diagnosis was consistent prenatally and postnatally in 715 cases(58.99%, 715/1 212) as the diagnosis group. (2) In 312 cases (25.74%, 312/1 212), the diagnosis was made after birth as the missed diagnosis group. (3) In 185 cases (15.26%, 185/1 212), the diagnosis was made prenatally but excluded after birth as the misdiagnosis group. The disease classification was made, and the risk factors, clinical manifestations, lab results, the time of termination and perinatal outcomes were recorded in the 3 groups. The reasons of missed diagnosis and misdiagnosis were analyzed. Results: (1) In the 1 212 cases, the diagnosis of placental abruption was confirmed in 1 027 cases, with the incidence of 0.76% (1 027/135 584). The rate of missed diagnosis was 30.38% (312/1 027), and the rate of misdiagnosis was 0.14% (185/134 557) . (2) There were significant differences in the degree of placental abruption among the 3 groups (P<0.05). (3)Significant differences were found among the 3 groups regarding the ratio of hypertensive disorders, trauma, induced labor and advanced maternal age (all P<0.05). (4) There were statistically significant differences among the 3 groups regarding the incidence of vaginal bleeding, persistent abdominal pain and uterine tenderness, bloody amniotic fluid, increased uterine tension and stillbirth (all P<0.05). (5) There was no significant difference in the rate of abnormal fetal heart rate mornitoring among the 3 groups (P=0.22). The differences were statistically significant among the 3 groups when regarding the incidence of abnormal ultrasound finding and abnormal blood coagulation (P<0.01), with the highest incidence of abnormal ultrasound in the diagnosis group (68.1%) and the highest incidence of abnormal coagulation in the misdiagnosis group (24.9%). (6)There was statistically significant difference among the 3 groups when comparing the ratio of termination of pregnancy within 24 hours (P=0.01). (7) There were statistically significant differences among the 3 groups when the ratios of postpartum hemorrhage, DIC, neonatal asphyxia and perinatal death were compared (all P<0.05). The highest incidence of postpartum hemorrhage was in the diagnosis group (17.9%) and the lowest was in the misdiagnosis group (5.4%). The highest incidence of DIC was in the diagnosis group (3.9%) and the lowest was in the misdiagnosis group (0). The highest incidence of neonatal asphyxia was in the diagnosis group (30.6%) and the lowest was in the misdiagnosis group (7.6%). And for perinatal death, the highest incidence was in the diagnosis group (12.6%), the lowest was in the misdiagnosis group (2.2%). Conclusions: Placental abruption could be misdiagnosed when depending on risk factors, such as trauma. And it could be missed diagnosis during the induction of labor. Uterine contraction, abnormal fetal heart rate mornitoring, abnormal ultrasound and abnormal coagulation function are important in the diagnosis of placental abruption. FAU - Xu, D AU - Xu D AD - Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China. FAU - Liang, C AU - Liang C FAU - Xu, J W AU - Xu JW FAU - He, J AU - He J LA - chi PT - Journal Article PL - China TA - Zhonghua Fu Chan Ke Za Zhi JT - Zhonghua fu chan ke za zhi JID - 16210370R SB - IM MH - Abruptio Placentae/*diagnosis MH - *Diagnostic Errors MH - Female MH - Humans MH - Incidence MH - Maternal Age MH - Pregnancy MH - Pregnancy Outcome MH - Retrospective Studies MH - Risk Factors MH - Uterine Hemorrhage/epidemiology OTO - NOTNLM OT - Misdiagnosis OT - Missed diagnosis OT - Placental abruption EDAT- 2017/05/27 06:00 MHDA- 2017/08/02 06:00 CRDT- 2017/05/27 06:00 PHST- 2017/05/27 06:00 [entrez] PHST- 2017/05/27 06:00 [pubmed] PHST- 2017/08/02 06:00 [medline] AID - 10.3760/cma.j.issn.0529-567X.2017.05.002 [doi] PST - ppublish SO - Zhonghua Fu Chan Ke Za Zhi. 2017 May 25;52(5):294-300. doi: 10.3760/cma.j.issn.0529-567X.2017.05.002. PMID- 28534810 OWN - NLM STAT- MEDLINE DCOM- 20180531 LR - 20181202 IS - 1424-8220 (Electronic) IS - 1424-8220 (Linking) VI - 17 IP - 5 DP - 2017 May 19 TI - Non-Invasive Fetal Monitoring: A Maternal Surface ECG Electrode Placement-Based Novel Approach for Optimization of Adaptive Filter Control Parameters Using the LMS and RLS Algorithms. LID - 10.3390/s17051154 [doi] LID - 1154 AB - This paper is focused on the design, implementation and verification of a novel method for the optimization of the control parameters (such as step size μ and filter order N) of LMS and RLS adaptive filters used for noninvasive fetal monitoring. The optimization algorithm is driven by considering the ECG electrode positions on the maternal body surface in improving the performance of these adaptive filters. The main criterion for optimal parameter selection was the Signal-to-Noise Ratio (SNR). We conducted experiments using signals supplied by the latest version of our LabVIEW-Based Multi-Channel Non-Invasive Abdominal Maternal-Fetal Electrocardiogram Signal Generator, which provides the flexibility and capability of modeling the principal distribution of maternal/fetal ECGs in the human body. Our novel algorithm enabled us to find the optimal settings of the adaptive filters based on maternal surface ECG electrode placements. The experimental results further confirmed the theoretical assumption that the optimal settings of these adaptive filters are dependent on the ECG electrode positions on the maternal body, and therefore, we were able to achieve far better results than without the use of optimization. These improvements in turn could lead to a more accurate detection of fetal hypoxia. Consequently, our approach could offer the potential to be used in clinical practice to establish recommendations for standard electrode placement and find the optimal adaptive filter settings for extracting high quality fetal ECG signals for further processing. Ultimately, diagnostic-grade fetal ECG signals would ensure the reliable detection of fetal hypoxia. FAU - Martinek, Radek AU - Martinek R AD - Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, 17 Listopadu 15, 70833 Ostrava, Czech Republic. radek.martinek@vsb.cz. FAU - Kahankova, Radana AU - Kahankova R AD - Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, 17 Listopadu 15, 70833 Ostrava, Czech Republic. radana.kahankova@vsb.cz. FAU - Nazeran, Homer AU - Nazeran H AD - Department of Electrical and Computer Engineering, University of Texas El Paso, 500 W University Ave, El Paso, TX 79968, USA. hnazeran@utep.edu. FAU - Konecny, Jaromir AU - Konecny J AD - Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, 17 Listopadu 15, 70833 Ostrava, Czech Republic. jaromir.konecny@vsb.cz. FAU - Jezewski, Janusz AU - Jezewski J AD - Institute of Medical Technology and Equipment ITAM, 118 Roosevelt Str., 41-800 Zabrze, Poland. jezewski@itam.zabrze.pl. FAU - Janku, Petr AU - Janku P AD - Department of Obstetrics and Gynecology, Masaryk University and University Hospital Brno, Jihlavska 20, 625 00 Brno, Czech Republic. janku.petr@fnbrno.cz. FAU - Bilik, Petr AU - Bilik P AD - Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, 17 Listopadu 15, 70833 Ostrava, Czech Republic. petr.bilik@vsb.cz. FAU - Zidek, Jan AU - Zidek J AD - Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, 17 Listopadu 15, 70833 Ostrava, Czech Republic. jan.zidek@vsb.cz. FAU - Nedoma, Jan AU - Nedoma J AD - Department of Telecommunications, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, 17 Listopadu 15, 70833 Ostrava, Czech Republic. jan.nedoma@vsb.cz. FAU - Fajkus, Marcel AU - Fajkus M AD - Department of Telecommunications, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, 17 Listopadu 15, 70833 Ostrava, Czech Republic. marcel.fajkus@vsb.cz. LA - eng PT - Journal Article DEP - 20170519 TA - Sensors (Basel) JT - Sensors (Basel, Switzerland) JID - 101204366 SB - IM MH - Algorithms MH - Electrocardiography MH - Electrodes MH - Female MH - *Fetal Monitoring MH - Humans MH - Pregnancy MH - Signal Processing, Computer-Assisted PMC - PMC5470900 OTO - NOTNLM OT - Least Mean Squares (LMS) algorithm OT - Recursive Least Squares (RLS) algorithm OT - adaptive filtering OT - fetal ECG COIS- The authors declare no conflict of interest. EDAT- 2017/05/24 06:00 MHDA- 2018/06/01 06:00 CRDT- 2017/05/24 06:00 PHST- 2017/03/24 00:00 [received] PHST- 2017/05/05 00:00 [revised] PHST- 2017/05/12 00:00 [accepted] PHST- 2017/05/24 06:00 [entrez] PHST- 2017/05/24 06:00 [pubmed] PHST- 2018/06/01 06:00 [medline] AID - s17051154 [pii] AID - sensors-17-01154 [pii] AID - 10.3390/s17051154 [doi] PST - epublish SO - Sensors (Basel). 2017 May 19;17(5):1154. doi: 10.3390/s17051154. PMID- 28559852 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200929 IS - 1664-042X (Print) IS - 1664-042X (Electronic) IS - 1664-042X (Linking) VI - 8 DP - 2017 TI - Is Abdominal Fetal Electrocardiography an Alternative to Doppler Ultrasound for FHR Variability Evaluation? PG - 305 LID - 10.3389/fphys.2017.00305 [doi] LID - 305 AB - Great expectations are connected with application of indirect fetal electrocardiography (FECG), especially for home telemonitoring of pregnancy. Evaluation of fetal heart rate (FHR) variability, when determined from FECG, uses the same criteria as for FHR signal acquired classically-through ultrasound Doppler method (US). Therefore, the equivalence of those two methods has to be confirmed, both in terms of recognizing classical FHR patterns: baseline, accelerations/decelerations (A/D), long-term variability (LTV), as well as evaluating the FHR variability with beat-to-beat accuracy-short-term variability (STV). The research material consisted of recordings collected from 60 patients in physiological and complicated pregnancy. The FHR signals of at least 30 min duration were acquired dually, using two systems for fetal and maternal monitoring, based on US and FECG methods. Recordings were retrospectively divided into normal (41) and abnormal (19) fetal outcome. The complex process of data synchronization and validation was performed. Obtained low level of the signal loss (4.5% for US and 1.8% for FECG method) enabled to perform both direct comparison of FHR signals, as well as indirect one-by using clinically relevant parameters. Direct comparison showed that there is no measurement bias between the acquisition methods, whereas the mean absolute difference, important for both visual and computer-aided signal analysis, was equal to 1.2 bpm. Such low differences do not affect the visual assessment of the FHR signal. However, in the indirect comparison the inconsistencies of several percent were noted. This mainly affects the acceleration (7.8%) and particularly deceleration (54%) patterns. In the signals acquired using the electrocardiography the obtained STV and LTV indices have shown significant overestimation by 10 and 50% respectively. It also turned out, that ability of clinical parameters to distinguish between normal and abnormal groups do not depend on the acquisition method. The obtained results prove that the abdominal FECG, considered as an alternative to the ultrasound approach, does not change the interpretation of the FHR signal, which was confirmed during both visual assessment and automated analysis. FAU - Jezewski, Janusz AU - Jezewski J AD - Institute of Medical Technology and Equipment ITAMZabrze, Poland. FAU - Wrobel, Janusz AU - Wrobel J AD - Institute of Medical Technology and Equipment ITAMZabrze, Poland. FAU - Matonia, Adam AU - Matonia A AD - Institute of Medical Technology and Equipment ITAMZabrze, Poland. FAU - Horoba, Krzysztof AU - Horoba K AD - Institute of Medical Technology and Equipment ITAMZabrze, Poland. FAU - Martinek, Radek AU - Martinek R AD - Department of Cybernetics and Biomedical Engineering, VSB-Technical University of OstravaOstrava, Czechia. FAU - Kupka, Tomasz AU - Kupka T AD - Institute of Medical Technology and Equipment ITAMZabrze, Poland. FAU - Jezewski, Michal AU - Jezewski M AD - Institute of Electronics, Silesian University of TechnologyGliwice, Poland. LA - eng PT - Journal Article DEP - 20170516 TA - Front Physiol JT - Frontiers in physiology JID - 101549006 PMC - PMC5432618 OTO - NOTNLM OT - Doppler ultrasound OT - fetal electrocardiogram OT - fetal heart rate analysis OT - fetal outcome OT - fetal state assessment EDAT- 2017/06/01 06:00 MHDA- 2017/06/01 06:01 CRDT- 2017/06/01 06:00 PHST- 2017/03/20 00:00 [received] PHST- 2017/04/27 00:00 [accepted] PHST- 2017/06/01 06:00 [entrez] PHST- 2017/06/01 06:00 [pubmed] PHST- 2017/06/01 06:01 [medline] AID - 10.3389/fphys.2017.00305 [doi] PST - epublish SO - Front Physiol. 2017 May 16;8:305. doi: 10.3389/fphys.2017.00305. eCollection 2017. PMID- 28328593 OWN - NLM STAT- MEDLINE DCOM- 20171212 LR - 20171212 IS - 2325-7237 (Electronic) IS - 2325-7237 (Linking) VI - 8 IP - 10 DP - 2017 May 15 TI - Fetal Monitor as Precordial Doppler in Neuroanesthesia. PG - 276-277 LID - 10.1213/XAA.0000000000000483 [doi] FAU - Cormack, John R AU - Cormack JR AD - Department of Anaesthesia and Pain Management, St. Vincent's Hospital, Fitzroy, Melbourne, Australia, cormackj@ozemail.com.au. FAU - Mellios, Anastasia AU - Mellios A FAU - McGlade, Desmond AU - McGlade D LA - eng PT - Comparative Study PT - Letter PL - United States TA - A A Case Rep JT - A & A case reports JID - 101637720 SB - IM MH - *Anesthesia MH - Cardiotocography/*instrumentation MH - Echocardiography, Doppler/*instrumentation MH - Equipment Design MH - Fetal Heart/*diagnostic imaging/physiopathology MH - Humans MH - Monitoring, Intraoperative/*instrumentation MH - *Neurosurgical Procedures MH - Predictive Value of Tests MH - Ultrasonography, Prenatal/*instrumentation EDAT- 2017/03/23 06:00 MHDA- 2017/12/13 06:00 CRDT- 2017/03/23 06:00 PHST- 2017/03/23 06:00 [pubmed] PHST- 2017/12/13 06:00 [medline] PHST- 2017/03/23 06:00 [entrez] AID - 10.1213/XAA.0000000000000483 [doi] PST - ppublish SO - A A Case Rep. 2017 May 15;8(10):276-277. doi: 10.1213/XAA.0000000000000483. PMID- 28369712 OWN - NLM STAT- MEDLINE DCOM- 20170809 LR - 20210109 IS - 1600-0412 (Electronic) IS - 0001-6349 (Linking) VI - 96 IP - 7 DP - 2017 Jul TI - Computerized data-driven interpretation of the intrapartum cardiotocogram: a cohort study. PG - 883-891 LID - 10.1111/aogs.13136 [doi] AB - INTRODUCTION: Continuous intrapartum fetal monitoring remains a significant clinical challenge. We propose using cohorts of routinely collected data. We aim to combine non-classical (data-driven) and classical cardiotocography features with clinical features into a system (OxSys), which generates automated alarms for the fetus at risk of intrapartum hypoxia. We hypothesize that OxSys can outperform clinical diagnosis of "fetal distress", when optimized and tested over large retrospective data sets. MATERIAL AND METHODS: We studied a cohort of 22 790 women in labor (≥36 weeks of gestation). Paired umbilical blood analyses were available. Perinatal outcomes were defined by objective criteria (normal; severe, moderate or mild compromise). We used the data retrospectively to develop a prototype of OxSys, by relating its alarms to perinatal outcome, and comparing its performance against standards achieved by bedside diagnosis. RESULTS: OxSys1.5 triggers an alarm if the initial trace is nonreactive or the decelerative capacity (a nonclassical cardiotocography feature), exceeds a threshold, adjusted for preeclampsia and thick meconium. There were 187 newborns with severe, 613 with moderate and 3197 with mild compromise; and 18 793 with normal outcome. OxSys1.5 increased the sensitivity for compromise detection: 43.3% vs. 38.0% for severe (p = 0.3) and 36.1% vs. 31.0% for moderate (p = 0.06); and reduced the false-positive rate (14.4% vs. 16.3%, p < 0.001). CONCLUSIONS: Large historic cohorts can be used to develop and optimize computerized cardiotocography monitoring, combining clinical and cardiotocography risk factors. Our simple prototype has demonstrated the principle of using such data to trigger alarms, and compares well with clinical judgment. CI - © 2017 Nordic Federation of Societies of Obstetrics and Gynecology. FAU - Georgieva, Antoniya AU - Georgieva A AUID- ORCID: 0000-0002-5543-6683 AD - Nuffield Department of Obstetrics and Gynecology, University of Oxford, Women's Center, John Radcliffe Hospital, Oxford, UK. FAU - Redman, Christopher W G AU - Redman CWG AD - Nuffield Department of Obstetrics and Gynecology, University of Oxford, Women's Center, John Radcliffe Hospital, Oxford, UK. FAU - Papageorghiou, Aris T AU - Papageorghiou AT AD - Nuffield Department of Obstetrics and Gynecology, University of Oxford, Women's Center, John Radcliffe Hospital, Oxford, UK. LA - eng GR - CDF-2016-09-004/DH_/Department of Health/United Kingdom PT - Evaluation Study PT - Journal Article DEP - 20170505 PL - United States TA - Acta Obstet Gynecol Scand JT - Acta obstetricia et gynecologica Scandinavica JID - 0370343 SB - IM MH - Cardiotocography/*methods MH - Cohort Studies MH - *Decision Support Systems, Clinical MH - *Diagnosis, Computer-Assisted MH - Female MH - Fetal Blood/chemistry MH - Fetal Distress/*diagnosis/prevention & control MH - Humans MH - Labor Presentation MH - Predictive Value of Tests MH - Pregnancy MH - *Prenatal Care OTO - NOTNLM OT - Cardiotocography OT - computerized electronic fetal monitoring OT - intrapartum fetal monitoring OT - sensitivity OT - specificity EDAT- 2017/04/04 06:00 MHDA- 2017/08/10 06:00 CRDT- 2017/04/04 06:00 PHST- 2016/11/03 00:00 [received] PHST- 2017/03/19 00:00 [accepted] PHST- 2017/04/04 06:00 [pubmed] PHST- 2017/08/10 06:00 [medline] PHST- 2017/04/04 06:00 [entrez] AID - 10.1111/aogs.13136 [doi] PST - ppublish SO - Acta Obstet Gynecol Scand. 2017 Jul;96(7):883-891. doi: 10.1111/aogs.13136. Epub 2017 May 5. PMID- 28346664 OWN - NLM STAT- MEDLINE DCOM- 20171018 LR - 20171018 IS - 1879-3479 (Electronic) IS - 0020-7292 (Linking) VI - 138 IP - 1 DP - 2017 Jul TI - A cross-sectional comparison of three guidelines for intrapartum cardiotocography. PG - 89-93 LID - 10.1002/ijgo.12161 [doi] AB - OBJECTIVE: To compare the cardiotocography classification systems outlined by the International Federation of Gynecology and Obstetrics (FIGO) in 2015 and the UK National Institute for Health and Care Excellence (NICE) in 2007 and 2014. METHODS: A cross-sectional observational study of cardiotocography practices at a UK hospital was conducted among labor ward staff (n=21) from November 1 to November 31, 2015. All observers classified ten cardiotocography traces according to the three guidelines using a bespoke form. Outcome measures included interobserver agreement (κ values), percentage agreement, intervention rate, and perceived ease of use. RESULTS: The κ values were 0.38 (FIGO 2015), 0.37 (NICE 2007), and 0.34 (NICE 2014). The percentage agreement was identical across the three systems for both normal cardiotocography results (100.0%) and for intermediate or suspicious results (80.9%). By contrast, the percentage agreement for abnormal or pathological findings was 47.6% for NICE 2014, 76.2% for FIGO 2015, and 91.0% for NICE 2007 guidelines. Among 210 observations, intervention was deemed necessary for 48 (22.9%) for FIGO 2015, 29 (13.8%) for NICE 2014, and 56 (26.7%) for NICE 2007 guidelines. The FIGO 2015 system was considered the easiest to use by 13 (61.9%) observers. CONCLUSION: Interobserver agreement of cardiotocography classification is suboptimal. The FIGO 2015 system offered favorable agreement scores, perceived ease of use, and a moderate intervention rate. CI - © 2017 International Federation of Gynecology and Obstetrics. FAU - Bhatia, Meena AU - Bhatia M AD - Department of Obstetrics and Gynaecology, Buckinghamshire National Health Service Trust, Aylesbury, UK. FAU - Mahtani, Kamal R AU - Mahtani KR AD - Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK. FAU - Nunan, David AU - Nunan D AD - Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK. FAU - Reddy, Aparna AU - Reddy A AD - Department of Obstetrics and Gynaecology, Buckinghamshire National Health Service Trust, Aylesbury, UK. AD - Department of Obstetrics and Gynaecology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. LA - eng PT - Comparative Study PT - Journal Article PT - Observational Study DEP - 20170419 PL - United States TA - Int J Gynaecol Obstet JT - International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics JID - 0210174 SB - IM MH - Cardiotocography/classification/*standards MH - Cross-Sectional Studies MH - Female MH - Heart Rate, Fetal MH - Humans MH - Observer Variation MH - Practice Guidelines as Topic MH - Pregnancy/physiology MH - Pregnancy Outcome MH - United Kingdom OTO - NOTNLM OT - Cardiotocography OT - Ease of use OT - Interobserver agreement OT - Intervention rate OT - Percentage agreement score EDAT- 2017/03/28 06:00 MHDA- 2017/10/19 06:00 CRDT- 2017/03/28 06:00 PHST- 2016/09/26 00:00 [received] PHST- 2017/02/22 00:00 [revised] PHST- 2017/03/23 00:00 [accepted] PHST- 2017/03/28 06:00 [pubmed] PHST- 2017/10/19 06:00 [medline] PHST- 2017/03/28 06:00 [entrez] AID - 10.1002/ijgo.12161 [doi] PST - ppublish SO - Int J Gynaecol Obstet. 2017 Jul;138(1):89-93. doi: 10.1002/ijgo.12161. Epub 2017 Apr 19. PMID- 28410419 OWN - NLM STAT- MEDLINE DCOM- 20170426 LR - 20190208 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 12 IP - 4 DP - 2017 TI - The electrical heart axis and ST events in fetal monitoring: A post-hoc analysis following a multicentre randomised controlled trial. PG - e0175823 LID - 10.1371/journal.pone.0175823 [doi] LID - e0175823 AB - OBJECTIVE: Reducing perinatal morbidity and mortality is one of the major challenges in modern health care. Analysing the ST segment of the fetal electrocardiogram was thought to be the breakthrough in fetal monitoring during labour. However, its implementation in clinical practice yields many false alarms and ST monitoring is highly dependent on cardiotocogram assessment, limiting its value for the prediction of fetal distress during labour. This study aims to evaluate the relation between physiological variations in the orientation of the fetal electrical heart axis and the occurrence of ST events. METHODS: A post-hoc analysis was performed following a multicentre randomised controlled trial, including 1097 patients from two participating centres. All women were monitored with ST analysis during labour. Cases of fetal metabolic acidosis, poor signal quality, missing blood gas analysis, and congenital heart disease were excluded. The orientation of the fetal electrical heart axis affects the height of the initial T/QRS baseline, and therefore the incidence of ST events. We grouped tracings with the same initial baseline T/QRS value. We depicted the number of ST events as a function of the initial baseline T/QRS value with a linear regression model. RESULTS: A significant increment of ST events was observed with increasing height of the initial T/QRS baseline, irrespective of the fetal condition; correlation coefficient 0.63, p<0.001. The most frequent T/QRS baseline is 0.12. CONCLUSION: The orientation of the fetal electrical heart axis and accordingly the height of the initial T/QRS baseline should be taken into account in fetal monitoring with ST analysis. FAU - Vullings, Rik AU - Vullings R AD - Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands. FAU - Verdurmen, Kim M J AU - Verdurmen KMJ AD - Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands. FAU - Hulsenboom, Alexandra D J AU - Hulsenboom ADJ AD - Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands. FAU - Scheffer, Stephanie AU - Scheffer S AD - Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands. FAU - de Lau, Hinke AU - de Lau H AD - Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands. FAU - Kwee, Anneke AU - Kwee A AD - Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, the Netherlands. FAU - Wijn, Pieter F F AU - Wijn PFF AD - Department of Clinical Physics, Máxima Medical Centre, Veldhoven, the Netherlands. FAU - Amer-Wåhlin, Isis AU - Amer-Wåhlin I AD - Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden. FAU - van Laar, Judith O E H AU - van Laar JOEH AD - Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands. FAU - Oei, S Guid AU - Oei SG AD - Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands. AD - Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands. LA - eng PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial DEP - 20170414 TA - PLoS One JT - PloS one JID - 101285081 SB - IM MH - Adolescent MH - Adult MH - Cesarean Section MH - Electrocardiography MH - Female MH - Fetal Blood/chemistry MH - Fetal Diseases/physiopathology MH - *Fetal Monitoring MH - Gestational Age MH - Heart Rate, Fetal/*physiology MH - Humans MH - Hydrogen-Ion Concentration MH - Labor, Obstetric MH - Pregnancy MH - Young Adult PMC - PMC5391944 COIS- Competing Interests: Guid Oei is head of the research group "fundamental perinatology", which is a collaboration of the Eindhoven University of Technology and the Máxima Medical Centre. He was involved in the founding of Nemo Healthcare BV, that arose from this collaboration. Guid Oei is not a shareholder in this company. Rik Vullings is shareholder in Nemo Healthcare BV, the Netherlands. This does not alter our adherence to PLOS ONE policies on sharing data and materials. None of the other authors have any conflicts of interest. EDAT- 2017/04/15 06:00 MHDA- 2017/04/27 06:00 CRDT- 2017/04/15 06:00 PHST- 2016/11/06 00:00 [received] PHST- 2017/03/27 00:00 [accepted] PHST- 2017/04/15 06:00 [entrez] PHST- 2017/04/15 06:00 [pubmed] PHST- 2017/04/27 06:00 [medline] AID - PONE-D-16-44097 [pii] AID - 10.1371/journal.pone.0175823 [doi] PST - epublish SO - PLoS One. 2017 Apr 14;12(4):e0175823. doi: 10.1371/journal.pone.0175823. eCollection 2017. PMID- 28571214 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200929 IS - 2249-782X (Print) IS - 0973-709X (Electronic) IS - 0973-709X (Linking) VI - 11 IP - 4 DP - 2017 Apr TI - Segregation of Patients for Intrapartum Monitoring, using Robson's Classification. PG - QC15-QC18 LID - 10.7860/JCDR/2017/23115.9672 [doi] AB - INTRODUCTION: Monitoring labour by intermittent or continuous foetal heart rate monitoring has been discussed widely in literature. Robson's classification has categorized pregnant women in ten groups. The study proposes to examine in which patients one must recommend continuous or intermittent foetal heart rate monitoring. AIM: To study the effect of Continuous Electronic Foetal Monitoring (CEFM) on the overall rate of operative deliveries as well as the rate using Robson's classification and the neonatal outcome. MATERIALS AND METHODS: After Institutional Review Board approval, low risk parturients with a reactive foetal heart rate at arrival in labour were prospectively analysed. Women with a previous caesarean section, those requiring elective caesarean section and having high risk factors were excluded. Patient details, history, examination findings and the method of monitoring, whether continuous or intermittent was noted. 1803 women were monitored by CEFM and 2107 by intermittent auscultation. In both the groups of intrapartum monitoring, suspected foetal distress was followed by immediate intervention in the form of caesarean section or operative vaginal delivery without resorting to any other monitoring methods such as foetal scalp blood sampling, as per the institutional policy. Comparison was based on the need for operative deliveries in view of presumed foetal distress and the neonatal outcome between the two groups of monitoring and further in each Robson's class. Results were assessed using IBM(®) SPSS Version 22.0, Chi-square test, considering p<0.05 as significant. RESULTS: Operative deliveries in view of suspected foetal distress increased and the neonatal outcome was better with CEFM. Assessing in each Robson's class, only class 4A, 7A and 10A results were consistent with the overall outcome. In others (class 2A), women experienced reduced rate of operative deliveries and better neonatal outcome with CEFM. In yet others, there was no benefit with CEFM as there were increased operative deliveries without any difference in the neonatal outcome. CONCLUSION: Segregation of patients for intrapartum monitoring using Robson's classification would result in decreased operative deliveries and a better neonatal outcome. FAU - Kandhari, Khushboo Vikram AU - Kandhari KV AD - Resident, Department of Obstetrics and Gynaecology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India. FAU - Mayekar, Rahul Vishwanath AU - Mayekar RV AD - Associate Professor, Department of Obstetrics and Gynaecology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India. FAU - Bhosale, Archana Anilkumar AU - Bhosale AA AD - Assistant Professor, Department of Obstetrics and Gynaecology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India. FAU - Nandanwar, Yogeshwar Sadashiv AU - Nandanwar YS AD - Professor and Head, Department of Obstetrics and Gynaecology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India. LA - eng PT - Journal Article DEP - 20170401 TA - J Clin Diagn Res JT - Journal of clinical and diagnostic research : JCDR JID - 101488993 PMC - PMC5449860 OTO - NOTNLM OT - Continuous electronic heart rate monitoring OT - Foetal distress OT - Intermittent auscultation OT - Prospective studies EDAT- 2017/06/03 06:00 MHDA- 2017/06/03 06:01 CRDT- 2017/06/03 06:00 PHST- 2016/07/21 00:00 [received] PHST- 2016/11/28 00:00 [accepted] PHST- 2017/06/03 06:00 [entrez] PHST- 2017/06/03 06:00 [pubmed] PHST- 2017/06/03 06:01 [medline] AID - 10.7860/JCDR/2017/23115.9672 [doi] PST - ppublish SO - J Clin Diagn Res. 2017 Apr;11(4):QC15-QC18. doi: 10.7860/JCDR/2017/23115.9672. Epub 2017 Apr 1. PMID- 28277912 OWN - NLM STAT- MEDLINE DCOM- 20180806 LR - 20180806 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) VI - 31 IP - 7 DP - 2018 Apr TI - Fetal hemoglobin Bart's hydrops fetalis: pathophysiology, prenatal diagnosis and possibility of intrauterine treatment. PG - 946-957 LID - 10.1080/14767058.2017.1301423 [doi] AB - This review aimed at comprehensively summarizing current available reports regarding the ultrasound markers and biomarkers in predicting fetal Hb Bart's disease and evaluate the potential role of cardiac function assessment in a clinical practice. This review involves various methods in prenatal predicting fetal Hb Bart's disease or alpha-thalassemia major and attempts to provide valuable insights regarding the underlying mechanisms responsible for heart failure in Hb Bart's fetuses. Moreover, this information may be used to predict the cardiac function before the development of hydrops fetalis. Finally, the affected Hb Bart's fetus could be the best model of the study on cardiovascular response to fetal anemia, thus the cardiovascular ultrasound and molecular assessment may be helpful in predicting the prognosis or in making a choice in the management of the fetal anemia condition. In conclusion, ultrasound findings especially cardiomegaly and an increase in peak systolic velocity of the middle cerebral artery (MCA-PSV) are helpful in predicting the future hydrops fetalis and ultrasound assessment of fetal cardiac function is potentially helpful in clinical practice. Finally, this review highlights the pathogenesis of hydropic changes secondary to fetal anemia. FAU - Jatavan, Phudit AU - Jatavan P AD - a Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology , Chiang Mai University , Chiang Mai , Thailand. FAU - Chattipakorn, Nipon AU - Chattipakorn N AD - b Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University , Chiang Mai , Thailand. AD - c Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand. AD - d Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University , Chiang Mai , Thailand. FAU - Tongsong, Theera AU - Tongsong T AD - a Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology , Chiang Mai University , Chiang Mai , Thailand. LA - eng PT - Journal Article PT - Review DEP - 20170321 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 RN - 0 (Biomarkers) RN - 0 (Hemoglobins, Abnormal) RN - 0 (Peptide Fragments) RN - 0 (Troponin T) RN - 0 (pro-brain natriuretic peptide (1-76)) RN - 114471-18-0 (Natriuretic Peptide, Brain) RN - 9056-09-1 (hemoglobin Bart's) SB - IM MH - Abortion, Eugenic MH - Anemia/blood/diagnostic imaging MH - Biomarkers/blood MH - Cardiotocography MH - Female MH - Fetal Heart/*diagnostic imaging/pathology MH - Fetal Therapies/*methods MH - Heart Failure/embryology MH - Hemoglobins, Abnormal/*analysis MH - Humans MH - *Hydrops Fetalis/blood/diagnostic imaging/physiopathology/therapy MH - Middle Cerebral Artery/*diagnostic imaging MH - Natriuretic Peptide, Brain/blood MH - Peptide Fragments/blood MH - Predictive Value of Tests MH - Pregnancy MH - Troponin T/blood MH - Ultrasonography, Prenatal/*methods OTO - NOTNLM OT - Hb Bart’s OT - cardiac function OT - homozygous alpha thalassemia OT - intrauterine therapy OT - serum markers OT - ultrasound EDAT- 2017/03/10 06:00 MHDA- 2018/08/07 06:00 CRDT- 2017/03/10 06:00 PHST- 2017/03/10 06:00 [pubmed] PHST- 2018/08/07 06:00 [medline] PHST- 2017/03/10 06:00 [entrez] AID - 10.1080/14767058.2017.1301423 [doi] PST - ppublish SO - J Matern Fetal Neonatal Med. 2018 Apr;31(7):946-957. doi: 10.1080/14767058.2017.1301423. Epub 2017 Mar 21. PMID- 28301895 OWN - NLM STAT- MEDLINE DCOM- 20180430 LR - 20180507 IS - 1098-8785 (Electronic) IS - 0735-1631 (Linking) VI - 34 IP - 9 DP - 2017 Jul TI - Association of Fetal Heart Rate Baseline Change and Neonatal Outcomes. PG - 879-886 LID - 10.1055/s-0037-1600911 [doi] AB - Objective The objective of this study was to describe the incidence of baseline change within normal range during labor and its prediction of neonatal outcomes. Materials and Methods This was a prospective cohort of singleton, nonanomalous, term neonates with continuous electronic fetal monitoring and normal baseline fetal heart rate throughout the last 2 hours of labor. We determined baseline in 10-minute segments using Eunice Kennedy Shriver National Institute of Child Health and Human Development criteria. We evaluated baseline changes of ≥ 20 and ≥ 30 bpm for association with acidemia (umbilical cord arterial pH ≤ 7.10) and neonatal intensive care unit (NICU) admission. Finally, we performed a sensitivity analysis of normal neonates, excluding those with acidemia, NICU admission, or 5-minute Apgar < 4. Results Among all neonates (n = 3,021), 1,267 (41.9%) had change ≥ 20 bpm; 272 (9.0%) had ≥ 30 bpm. Among normal neonates (n = 2,939), 1,221 (41.5%) had change ≥20 bpm. Acidemia was not associated with baseline change of any direction or magnitude. NICU admission was associated with decrease ≥ 20 bpm (adjusted odds ratio [aOR]: 2.93; 95% confidence interval [CI]: 1.19 - 7.21) or any direction ≥ 20 bpm (aOR: 4.06; 95% CI: 1.46-11.29). For decrease ≥ 20 bpm, sensitivity and specificity were 40.0 and 81.7%; for any direction ≥ 20 bpm, 75.0 and 58.3%. Conclusion Changes of normal baseline are common in term labor and poorly predict morbidity, regardless of direction or magnitude. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Yang, Michael AU - Yang M AD - Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri. FAU - Stout, Molly J AU - Stout MJ AD - Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri. FAU - López, Julia D AU - López JD AD - Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri. FAU - Colvin, Ryan AU - Colvin R AD - Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri. FAU - Macones, George A AU - Macones GA AD - Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri. FAU - Cahill, Alison G AU - Cahill AG AD - Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri. LA - eng PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20170316 PL - United States TA - Am J Perinatol JT - American journal of perinatology JID - 8405212 SB - IM MH - Acidosis/*blood MH - Adult MH - Apgar Score MH - *Cardiotocography MH - Female MH - *Heart Rate, Fetal MH - Humans MH - Infant, Newborn MH - Intensive Care Units, Neonatal MH - *Labor, Obstetric MH - Linear Models MH - Logistic Models MH - Male MH - Predictive Value of Tests MH - Pregnancy MH - *Pregnancy Outcome MH - Prospective Studies MH - Risk Factors MH - Tertiary Care Centers MH - Young Adult COIS- Conflict of Interest: None. EDAT- 2017/03/17 06:00 MHDA- 2018/05/01 06:00 CRDT- 2017/03/17 06:00 PHST- 2017/03/17 06:00 [pubmed] PHST- 2018/05/01 06:00 [medline] PHST- 2017/03/17 06:00 [entrez] AID - 10.1055/s-0037-1600911 [doi] PST - ppublish SO - Am J Perinatol. 2017 Jul;34(9):879-886. doi: 10.1055/s-0037-1600911. Epub 2017 Mar 16. PMID- 32258602 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200928 IS - 2444-8672 (Electronic) IS - 2444-8664 (Print) IS - 2444-8664 (Linking) VI - 2 IP - 4 DP - 2017 Jul-Aug TI - Recognition of chronic hypoxia and pre-existing foetal injury on the cardiotocograph (CTG): Urgent need to think beyond the guidelines. PG - 124-129 LID - 10.1016/j.pbj.2017.01.004 [doi] AB - Chronic utero-placental insufficiency may result in progressive hypoxia culminating in fetal decompensation and acidosis and this is termed 'chronic' or 'long-standing' hypoxia. It is essential to recognise the features of chronic hypoxia on the CTG trace so as to institute timely and appropriate action. The current guidelines may not capture a fetus who starts labour already compromised or limited in its ability to compensate for hypoxic or mechanical stresses during labour. The aim of this short review is to explore the CTG features that allow the clinician to recognise a fetus who may present with an antenatal insult such as chronic hypoxia, anaemia, infection, fetal arrhythmias and preexisting non-hypoxic brain injury. CI - Copyright 2017 PBJ-Associação Porto Biomedical/Porto Biomedical Society. FAU - Pereira, Susana AU - Pereira S AD - Kingston Hospital NHS Foundation Trust, Galsworthy Road, Kingston upon Thames, Surrey, UK. FAU - Chandraharan, Edwin AU - Chandraharan E AD - St. George's University Hospitals NHS Foundation Trust & St George's University of London, Blackshaw Road, London, UK. LA - eng PT - Journal Article DEP - 20170301 TA - Porto Biomed J JT - Porto biomedical journal JID - 101707479 PMC - PMC6806963 OTO - NOTNLM OT - CTG monitoring OT - Cardiotocography OT - Chronic hypoxia OT - Fetal anaemia OT - Fetal stroke COIS- The authors declare no conflicts of interest. EDAT- 2017/07/01 00:00 MHDA- 2017/07/01 00:01 CRDT- 2020/04/08 06:00 PHST- 2016/11/14 00:00 [received] PHST- 2017/01/11 00:00 [accepted] PHST- 2020/04/08 06:00 [entrez] PHST- 2017/07/01 00:00 [pubmed] PHST- 2017/07/01 00:01 [medline] AID - 10.1016/j.pbj.2017.01.004 [doi] PST - ppublish SO - Porto Biomed J. 2017 Jul-Aug;2(4):124-129. doi: 10.1016/j.pbj.2017.01.004. Epub 2017 Mar 1. PMID- 28344957 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201001 IS - 2287-8572 (Print) IS - 2287-8580 (Electronic) IS - 2287-8572 (Linking) VI - 60 IP - 2 DP - 2017 Mar TI - Predicting factors for success of vaginal delivery in preterm induction with prostaglandin E(2). PG - 163-169 LID - 10.5468/ogs.2017.60.2.163 [doi] AB - OBJECTIVE: To evaluate the efficacy and safety of prostaglandin (PG) E(2) for preterm labor induction and to investigate the predictive factors for the success of vaginal delivery. METHODS: A retrospective cohort study was performed in women (n=155) at 24+0 to 36+6 weeks of gestation who underwent induction of labor using a PGE(2) vaginal pessary (10 mg, Propess) from January 2009 to December 2015. Success rates of vaginal delivery according to gestational age at induction and incidence of intrapartum complications such as tachysystole and nonreassuring fetal heart rate were investigated. Multivariable logistic regression analysis was performed to evaluate the predictive factors for success of labor induction. RESULTS: The vaginal delivery rate was 57% (n=89) and the rate of cesarean delivery after induction was 43% (n=66). According to gestational age, labor induction was successful in 16.7%, 50.0%, and 62.8% of patients at 24 to 31, 32 to 33, and 34 to 36 weeks, showing a stepwise increase (P=0.006). There were 18 cases (11%) of fetal distress, 9 cases (5.8%) of tachysystole, and 6 cases (3.8%) of massive postpartum bleeding (>1,000 mL). After adjusting for confounding factors, multiparity (odds ratio [OR], 8.47; 95% confidence interval [CI], 3.10 to 23.14), younger maternal age (OR, 0.84; 95% CI, 0.75 to 0.94), advanced gestational age at induction (OR, 1.06; 95% CI, 1.02 to 1.09), rupture of membranes (OR, 11.83; 95% CI, 3.55 to 39.40), and the Bishop score change after removal of PGE(2) (OR, 2.19; 95% CI, 1.0 to 4.8) were significant predictors of successful preterm vaginal delivery. CONCLUSION: An understanding of the principal predictive factors of successful preterm labor induction, as well as the safety of PGE(2), will provide useful information when clinicians consult with preterm pregnant women requiring premature delivery. FAU - Kim, Yoo Min AU - Kim YM AD - Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. FAU - Park, Ju Young AU - Park JY AD - Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. FAU - Sung, Ji-Hee AU - Sung JH AD - Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. FAU - Choi, Suk-Joo AU - Choi SJ AD - Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. FAU - Oh, Soo-Young AU - Oh SY AUID- ORCID: 0000-0003-3002-0048 AD - Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. FAU - Roh, Cheong-Rae AU - Roh CR AD - Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. FAU - Kim, Jong-Hwa AU - Kim JH AD - Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. LA - eng PT - Journal Article DEP - 20170316 TA - Obstet Gynecol Sci JT - Obstetrics & gynecology science JID - 101602614 PMC - PMC5364098 OTO - NOTNLM OT - Dinoprostone OT - Labor, induced OT - Premature birth OT - Vaginal delivery OT - Vaginal pessary COIS- Conflict of interest: No potential conflict of interest relevant to this article was reported. EDAT- 2017/03/28 06:00 MHDA- 2017/03/28 06:01 CRDT- 2017/03/28 06:00 PHST- 2016/05/30 00:00 [received] PHST- 2016/09/21 00:00 [revised] PHST- 2016/10/19 00:00 [accepted] PHST- 2017/03/28 06:00 [entrez] PHST- 2017/03/28 06:00 [pubmed] PHST- 2017/03/28 06:01 [medline] AID - 10.5468/ogs.2017.60.2.163 [doi] PST - ppublish SO - Obstet Gynecol Sci. 2017 Mar;60(2):163-169. doi: 10.5468/ogs.2017.60.2.163. Epub 2017 Mar 16. PMID- 28244331 OWN - NLM STAT- MEDLINE DCOM- 20170706 LR - 20170706 IS - 0236-6290 (Print) IS - 0236-6290 (Linking) VI - 65 IP - 1 DP - 2017 Mar TI - Applicability of fetal thoracic aortic diameter measurement in the prediction of birth weight in Holstein-Friesian cows - Short communication. PG - 60-65 LID - 10.1556/004.2017.006 [doi] AB - Transabdominal ultrasonography has been shown to be a useful and reliable method for assessing fetal well-being in horses and cattle. To test the applicability of fetal aortic diameter measurement in cattle, 44 late-term pregnant cows and heifers were examined 21 to 0 days prior to calving. Mean fetal aortic diameter was 2.07 ± 0.14 cm and mean fetal heart rate (FHR) was 109 ± 17 bpm. Three dead calves were dissected and their aortic diameter was measured in a water bath. The mean birth weight (n = 44) was 39.9 ± 5.8 kg. There was a significant negative correlation between FHR and fetal aortic diameter. However, although some studies have shown that fetal aortic diameter strongly correlates with birth weight in near-term horses and cattle, in this study there was no correlation between fetal aortic diameter and birth weight in Holstein-Friesian cows and heifers irrespective of whether the fetus was born alive or dead. FAU - Vincze, Boglárka AU - Vincze B AD - Unit of Animal Breeding and Genetics, Institution of Animal Breeding, Nutrition and Laboratory Animal Science, University of Veterinary Medicine , H-1078 Budapest , Hungary. AD - MTA-SZIE Large Animal Clinical Research Group , Hungary. FAU - Gáspárdy, András AU - Gáspárdy A AD - Unit of Animal Breeding and Genetics, Institution of Animal Breeding, Nutrition and Laboratory Animal Science, University of Veterinary Medicine , H-1078 Budapest , Hungary. FAU - Kovács, Levente AU - Kovács L AD - MTA-SZIE Large Animal Clinical Research Group , Hungary. FAU - Albert, Ervin AU - Albert E AD - MTA-SZIE Large Animal Clinical Research Group , Hungary. FAU - Kézér, Luca AU - Kézér L AD - MTA-SZIE Large Animal Clinical Research Group , Hungary. FAU - Baska, Ferenc AU - Baska F AD - Department of Pathology, University of Veterinary Medicine , Budapest , Hungary. FAU - Szenci, Ottó AU - Szenci O AD - MTA-SZIE Large Animal Clinical Research Group , Hungary. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - Hungary TA - Acta Vet Hung JT - Acta veterinaria Hungarica JID - 8406376 SB - IM MH - Animals MH - Aorta, Thoracic/*embryology MH - *Birth Weight MH - Cattle/*embryology/physiology MH - Female MH - Fetal Development/physiology MH - Fetus/physiology MH - Pregnancy MH - Ultrasonography, Prenatal/veterinary OTO - NOTNLM OT - *Fetal well-being OT - *aortic diameter OT - *cattle OT - *ultrasonography EDAT- 2017/03/01 06:00 MHDA- 2017/07/07 06:00 CRDT- 2017/03/01 06:00 PHST- 2017/03/01 06:00 [entrez] PHST- 2017/03/01 06:00 [pubmed] PHST- 2017/07/07 06:00 [medline] AID - 10.1556/004.2017.006 [doi] PST - ppublish SO - Acta Vet Hung. 2017 Mar;65(1):60-65. doi: 10.1556/004.2017.006. PMID- 28293198 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200929 IS - 1664-042X (Print) IS - 1664-042X (Electronic) IS - 1664-042X (Linking) VI - 8 DP - 2017 TI - Fetal Heart Rate Analysis for Automatic Detection of Perinatal Hypoxia Using Normalized Compression Distance and Machine Learning. PG - 113 LID - 10.3389/fphys.2017.00113 [doi] LID - 113 AB - Accurate identification of Perinatal Hypoxia from visual inspection of Fetal Heart Rate (FHR) has been shown to have limitations. An automated signal processing method for this purpose needs to deal with time series of different lengths, recording interruptions, and poor quality signal conditions. We propose a new method, robust to those issues, for automated detection of perinatal hypoxia by analyzing the FHR during labor. Our system consists of several stages: (a) time series segmentation; (b) feature extraction from FHR signals, including raw time series, moments, and usual heart rate variability indices; (c) similarity calculation with Normalized Compression Distance, which is the key element for dealing with FHR time series; and (d) a simple classification algorithm for providing the hypoxia detection. We analyzed the proposed system using a database with 32 fetal records (15 controls). Time and frequency domain and moment features had similar performance identifying fetuses with hypoxia. The final system, using the third central moment of the FHR, yielded 92% sensitivity and 85% specificity at 3 h before delivery. Best predictions were obtained in time intervals more distant from delivery, i.e., 4-3 h and 3-2 h. FAU - Barquero-Pérez, Óscar AU - Barquero-Pérez Ó AD - Department of Signal Theory and Communications, University Rey Juan Carlos Fuenlabrada, Spain. FAU - Santiago-Mozos, Ricardo AU - Santiago-Mozos R AD - Department of Signal Theory and Communications, University Rey Juan Carlos Fuenlabrada, Spain. FAU - Lillo-Castellano, José M AU - Lillo-Castellano JM AD - Department of Signal Theory and Communications, University Rey Juan Carlos Fuenlabrada, Spain. FAU - García-Viruete, Beatriz AU - García-Viruete B AD - Department of Signal Theory and Communications, University Rey Juan Carlos Fuenlabrada, Spain. FAU - Goya-Esteban, Rebeca AU - Goya-Esteban R AD - Department of Signal Theory and Communications, University Rey Juan Carlos Fuenlabrada, Spain. FAU - Caamaño, Antonio J AU - Caamaño AJ AD - Department of Signal Theory and Communications, University Rey Juan Carlos Fuenlabrada, Spain. FAU - Rojo-Álvarez, José L AU - Rojo-Álvarez JL AD - Department of Signal Theory and Communications, University Rey Juan Carlos Fuenlabrada, Spain. FAU - Martín-Caballero, Carlos AU - Martín-Caballero C AD - Department of Obstetrics and Gynaecology, Hospital Universitario Fundación de Alcorcón Madrid, Spain. LA - eng PT - Journal Article DEP - 20170228 TA - Front Physiol JT - Frontiers in physiology JID - 101549006 PMC - PMC5329001 OTO - NOTNLM OT - fetal heart rate OT - heart rate variability OT - information theory OT - normalized compression distance OT - perinatal hypoxia EDAT- 2017/03/16 06:00 MHDA- 2017/03/16 06:01 CRDT- 2017/03/16 06:00 PHST- 2016/11/25 00:00 [received] PHST- 2017/02/13 00:00 [accepted] PHST- 2017/03/16 06:00 [entrez] PHST- 2017/03/16 06:00 [pubmed] PHST- 2017/03/16 06:01 [medline] AID - 10.3389/fphys.2017.00113 [doi] PST - epublish SO - Front Physiol. 2017 Feb 28;8:113. doi: 10.3389/fphys.2017.00113. eCollection 2017. PMID- 28270884 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200930 IS - 1918-3003 (Print) IS - 1918-3011 (Electronic) IS - 1918-3003 (Linking) VI - 9 IP - 4 DP - 2017 Apr TI - Critical Imperative for the Reform of British Interpretation of Fetal Heart Rate Decelerations: Analysis of FIGO and NICE Guidelines, Post-Truth Foundations, Cognitive Fallacies, Myths and Occam's Razor. PG - 253-265 LID - 10.14740/jocmr2877e [doi] AB - Cardiotocography (CTG) has disappointingly failed to show good predictability for fetal acidemia or neonatal outcomes in several large studies. A complete rethink of CTG interpretation will not be out of place. Fetal heart rate (FHR) decelerations are the most common deviations, benign as well as manifestation of impending fetal hypoxemia/acidemia, much more commonly than FHR baseline or variability. Their specific nomenclature is important (center-stage) because it provides the basic concepts and framework on which the complex "pattern recognition" of CTG interpretation by clinicians depends. Unfortunately, the discrimination of FHR decelerations seems to be muddled since the British obstetrics adopted the concept of vast majority of FHR decelerations being "variable" (cord-compression). With proliferation of confusing waveform criteria, "atypical variables" became the commonest cause of suspicious/pathological CTG. However, National Institute for Health and Care Excellence (NICE) (2014) had to disband the "typical" and "atypical" terminology because of flawed classifying criteria. This analytical review makes a strong case that there are major and fundamental framing and confirmation fallacies (not just biases) in interpretation of FHR decelerations by NICE (2014) and International Federation of Gynecology and Obstetrics (FIGO) (2015), probably the biggest in modern medicine. This "post-truth" approach is incompatible with scientific practice. Moreover, it amounts to setting oneself for failure. The inertia to change could be best described as "backfire effect". There is abundant evidence that head-compression (and other non-hypoxic mediators) causes rapid rather than shallow/gradual decelerations. Currently, the vast majority of decelerations are attributed to unproven cord compression underpinned by flawed disproven pathophysiological hypotheses. Their further discrimination based on abstract, random, trial and error criteria remains unresolved suggesting a false premise to begin with. This is not surprising considering that the commonest pathophysiology of intrapartum hypoxemia is contraction-induced reduction in uteroplacental perfusion (sometimes already compromised) and not cord compression at all. This distorted categorization causes confusion, false-alarm fatigue and difficulty in focusing on real pathological decelerations making CTG interpretation dysfunctional ultimately compromising patient safety. Obstetricians/midwives should demand reverting to the previous more scientific British categorization of decelerations based solely on time relationship to contractions as advocated by the pioneers like Hon and Caldeyro-Barcia, rather than accepting the current "post-truth" scenario. FAU - Sholapurkar, Shashikant L AU - Sholapurkar SL AD - Department of Obstetrics and Gynaecology, Royal United Hospital Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG, UK. Email: s.sholapurkar@nhs.net. LA - eng PT - Journal Article PT - Review DEP - 20170221 TA - J Clin Med Res JT - Journal of clinical medicine research JID - 101538301 PMC - PMC5330767 OTO - NOTNLM OT - Cardiotocography OT - Confirmation bias OT - FIGO CTG guidelines OT - Fetal heart rate decelerations OT - Framing bias OT - Intermittent auscultation OT - Intrapartum fetal monitoring OT - NICE CTG guidelines EDAT- 2017/03/09 06:00 MHDA- 2017/03/09 06:01 CRDT- 2017/03/09 06:00 PHST- 2017/01/23 00:00 [accepted] PHST- 2017/03/09 06:00 [entrez] PHST- 2017/03/09 06:00 [pubmed] PHST- 2017/03/09 06:01 [medline] AID - 10.14740/jocmr2877e [doi] PST - ppublish SO - J Clin Med Res. 2017 Apr;9(4):253-265. doi: 10.14740/jocmr2877e. Epub 2017 Feb 21. PMID- 28196652 OWN - NLM STAT- MEDLINE DCOM- 20171211 LR - 20180330 IS - 1873-4030 (Electronic) IS - 1350-4533 (Linking) VI - 42 DP - 2017 Apr TI - Simulation of fetal heart rate variability with a mathematical model. PG - 55-64 LID - S1350-4533(17)30018-8 [pii] LID - 10.1016/j.medengphy.2017.01.016 [doi] AB - In the clinic, the cardiotocogram (CTG), the combined registration of fetal heart rate (FHR) and uterine contractions, is used to predict fetal well-being. Amongst others, fetal heart rate variability (FHRV) is an important indicator of fetal distress. In this study we add FHRV to our previously developed CTG simulation model, in order to improve its use as a research and educational tool. We implemented three sources of variability by applying either 1/f or white noise to the peripheral vascular resistance, baroreceptor output, or efferent vagal signal. Simulated FHR tracings were evaluated by visual inspection and spectral analysis. All power spectra showed a 1/f character, irrespective of noise type and source. The clinically observed peak near 0.1 Hz was only obtained by applying white noise to the different sources of variability. Similar power spectra were found when peripheral vascular resistance or baroreceptor output was used as source of variability. Sympathetic control predominantly influenced the low frequency power, while vagal control influenced both low and high frequency power. In contrast to clinical data, model results did not show an increase of FHRV during FHR decelerations. Still, addition of FHRV improves the applicability of the model as an educational and research tool. CI - Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved. FAU - Jongen, Germaine J L M AU - Jongen GJLM AD - Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands; Department of Gynecology and Obstetrics, Máxima Medical Center, PO Box 7777, 5500 MB Veldhoven, The Netherlands. Electronic address: g.j.l.m.jongen@tue.nl. FAU - van der Hout-van der Jagt, M Beatrijs AU - van der Hout-van der Jagt MB AD - Department of Gynecology and Obstetrics, Máxima Medical Center, PO Box 7777, 5500 MB Veldhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands. FAU - Oei, S Guid AU - Oei SG AD - Department of Gynecology and Obstetrics, Máxima Medical Center, PO Box 7777, 5500 MB Veldhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands. FAU - van de Vosse, Frans N AU - van de Vosse FN AD - Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands. FAU - Bovendeerd, Peter H M AU - Bovendeerd PHM AD - Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands. Electronic address: p.h.m.bovendeerd@tue.nl. LA - eng PT - Journal Article DEP - 20170211 PL - England TA - Med Eng Phys JT - Medical engineering & physics JID - 9422753 SB - IM MH - *Cardiotocography MH - Female MH - *Heart Rate, Fetal MH - Humans MH - *Models, Theoretical MH - Pregnancy MH - Signal Processing, Computer-Assisted MH - Signal-To-Noise Ratio OTO - NOTNLM OT - *Cardiotocogram OT - *Computer simulation model OT - *Fetal heart rate variability OT - *Fetal monitoring OT - *Spectral analysis EDAT- 2017/02/16 06:00 MHDA- 2017/12/12 06:00 CRDT- 2017/02/16 06:00 PHST- 2016/03/29 00:00 [received] PHST- 2016/12/23 00:00 [revised] PHST- 2017/01/17 00:00 [accepted] PHST- 2017/02/16 06:00 [pubmed] PHST- 2017/12/12 06:00 [medline] PHST- 2017/02/16 06:00 [entrez] AID - S1350-4533(17)30018-8 [pii] AID - 10.1016/j.medengphy.2017.01.016 [doi] PST - ppublish SO - Med Eng Phys. 2017 Apr;42:55-64. doi: 10.1016/j.medengphy.2017.01.016. Epub 2017 Feb 11. PMID- 27935627 OWN - NLM STAT- MEDLINE DCOM- 20170403 LR - 20191210 IS - 1600-0412 (Electronic) IS - 0001-6349 (Linking) VI - 96 IP - 3 DP - 2017 Mar TI - Clinical evaluation of Statstrip(®) Lactate for use in fetal scalp blood sampling. PG - 334-341 LID - 10.1111/aogs.13078 [doi] AB - INTRODUCTION: Point-of-care testing of fetal scalp blood lactate is used as an alternative to pH analysis in fetal scalp blood sampling (FBS) during labor. Lactate measurements are not standardized and values vary with each device used. The aim of this study was to evaluate StatStrip(®) Lactate (SSL) in the clinical setting in comparison with lactate (RLL) and pH (RLpH) using RapidLab(®) . MATERIAL AND METHODS: We obtained 323 FBS samples from 139 women. Parallel sampling of SSL and RLL/RLpH was performed in 247 samples. Outcome measures were the agreement and discrepancy rates between SSL, RLL and RLpH and the failure rate of all three methods. We constructed a Bland-Altman graph to assess the variability between the measurements across the range of values. The discrepancy rates between methods were compared using previously established cut-off values for SSL indicating reassurance (<5.7 mmol/L) and immediate delivery (>7.0 mmol/L) with those for RLpH (<7.20 and >7.25). RESULTS: SSL showed excellent agreement with RLL (R(2) = 0.742) and poor agreement with RLpH (R(2) = 0.204). Failure rates for SSL, RLL and RLpH were 7, 43 and 23%, respectively. Using the cut-off values for reassurance and immediate delivery, the discrepancy rates between SSL and RLpH were 14 and 5%, respectively. CONCLUSIONS: SSL is a reliable test to measure lactate in FBS with a low failure rate. As there are discrepancies between SSL and RLpH, and the cut-off values have not yet been evaluated prospectively regarding intervention rates and neonatal outcome, we recommend using SSL in addition to pH in FBS. CI - © 2016 Nordic Federation of Societies of Obstetrics and Gynecology. FAU - Heinis, Ayesha AU - Heinis A AD - Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands. FAU - van Dillen, Jeroen AU - van Dillen J AD - Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands. FAU - Oosting, Janine AU - Oosting J AD - Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, the Netherlands. FAU - Rhöse, Sarah AU - Rhöse S AD - Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands. FAU - Vandenbussche, Frank AU - Vandenbussche F AD - Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands. FAU - Van Drongelen, Joris AU - Van Drongelen J AD - Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands. LA - eng PT - Evaluation Study PT - Journal Article DEP - 20170203 PL - United States TA - Acta Obstet Gynecol Scand JT - Acta obstetricia et gynecologica Scandinavica JID - 0370343 RN - 33X04XA5AT (Lactic Acid) SB - IM MH - Adult MH - Female MH - Fetal Blood/*chemistry MH - Fetal Distress/*diagnosis MH - Fetal Monitoring/*instrumentation MH - Humans MH - *Labor, Obstetric MH - Lactic Acid/*analysis MH - *Point-of-Care Systems MH - Predictive Value of Tests MH - Pregnancy MH - Prospective Studies MH - Scalp/blood supply MH - Young Adult OTO - NOTNLM OT - *Fetal scalp blood sampling OT - *cardiotocography OT - *fetal distress OT - *lactate OT - *point-of-care-testing EDAT- 2016/12/10 06:00 MHDA- 2017/04/04 06:00 CRDT- 2016/12/10 06:00 PHST- 2016/04/14 00:00 [received] PHST- 2016/11/30 00:00 [accepted] PHST- 2016/12/10 06:00 [pubmed] PHST- 2017/04/04 06:00 [medline] PHST- 2016/12/10 06:00 [entrez] AID - 10.1111/aogs.13078 [doi] PST - ppublish SO - Acta Obstet Gynecol Scand. 2017 Mar;96(3):334-341. doi: 10.1111/aogs.13078. Epub 2017 Feb 3. PMID- 28403968 OWN - NLM STAT- MEDLINE DCOM- 20190731 LR - 20191210 IS - 2468-7847 (Electronic) IS - 2468-7847 (Linking) VI - 46 IP - 2 DP - 2017 Feb TI - Inter-observer reliability of 4 fetal heart rate classifications. PG - 131-135 LID - S2468-7847(16)30004-6 [pii] LID - 10.1016/j.jogoh.2016.11.002 [doi] AB - OBJECTIVE: Different classification of fetal heart rate (FHR) pattern have been proposed: FHR classified as either "reassuring" or "non-reassuring", the National Institute of Child Health and Human Development (NICHD) published in 2008 a 3-tier system, the French College of Gynecology and Obstetrics (CNGOF) recommended in 2013 a 5-tier system and recently in 2015, the Federation International of Gynecology and Obstetrics (FIGO) proposed a new classification based on a 3-tier system. Our objective was to assess the inter-observer reliability of these 4 existing classifications. STUDY DESIGN: Four observers reviewed 100 FHR without clinical information. FHR were obtained from term singleton pregnancies. Fetal heart rate patterns were classified by one 2-tier ("reassuring vs. non-reassuring"), two 3-tier (NICHD 2008 and FIGO 2015), and one 5-tier (CNGOF 2013) fetal heart classifications. RESULTS: The global agreement between observers was moderate for each classification: 0.58 (0.40-0.74) for the 2-tier, 0.48 (0.37-0.58) for the NICHD 2008, 0.58 (0.53-0.63) for the CNGOF 2013 and 0.59 (0.49-0.67) for the FIGO 2015 classification. When FHR was classified as reassuring, it was classified as normal in 85.5% for the NICHD 2008 and in 94.5% for the FIGO 2015. For the CNGOF 2013, 65.0% were classified as normal and 32.5% as quasi normal. There was strong concordance between FIGO category I and "reassuring" FHR (kappa=0.95). CONCLUSION: Inter-observer agreement of FHR interpretation is moderate whatever the classification used. To evaluate the superior interest of one classification, it will be interesting to compare their impact on need of second line techniques and on neonatal outcome. CI - Copyright © 2017 Elsevier Masson SAS. All rights reserved. FAU - Garabedian, C AU - Garabedian C AD - University of Lille North of France, EA4489 Perinatal growth and environment, 59000 Lille, France; CHU Lille, Jeanne de Flandre Hospital, Department of obstetrics, 59000 Lille, France. Electronic address: charles.garabedian@chru-lille.fr. FAU - Butruille, L AU - Butruille L AD - University of Lille North of France, EA4489 Perinatal growth and environment, 59000 Lille, France. FAU - Drumez, E AU - Drumez E AD - University of Lille North of France, EA 2694, Department of Biostatistics, 59000 Lille, France. FAU - Servan Schreiber, E AU - Servan Schreiber E AD - University of Lille North of France, EA4489 Perinatal growth and environment, 59000 Lille, France; CHU Lille, Jeanne de Flandre Hospital, Department of obstetrics, 59000 Lille, France. FAU - Bartolo, S AU - Bartolo S AD - CHU Lille, Jeanne de Flandre Hospital, Department of obstetrics, 59000 Lille, France. FAU - Bleu, G AU - Bleu G AD - University of Lille North of France, EA4489 Perinatal growth and environment, 59000 Lille, France; CHU Lille, Jeanne de Flandre Hospital, Department of obstetrics, 59000 Lille, France. FAU - Mesdag, V AU - Mesdag V AD - CHU Lille, Jeanne de Flandre Hospital, Department of obstetrics, 59000 Lille, France. FAU - Deruelle, P AU - Deruelle P AD - University of Lille North of France, EA4489 Perinatal growth and environment, 59000 Lille, France; CHU Lille, Jeanne de Flandre Hospital, Department of obstetrics, 59000 Lille, France. FAU - De Jonckheere, J AU - De Jonckheere J AD - University of Lille North of France, EA4489 Perinatal growth and environment, 59000 Lille, France. FAU - Houfflin-Debarge, V AU - Houfflin-Debarge V AD - University of Lille North of France, EA4489 Perinatal growth and environment, 59000 Lille, France; CHU Lille, Jeanne de Flandre Hospital, Department of obstetrics, 59000 Lille, France. LA - eng PT - Comparative Study PT - Evaluation Study PT - Journal Article DEP - 20170130 PL - France TA - J Gynecol Obstet Hum Reprod JT - Journal of gynecology obstetrics and human reproduction JID - 101701588 MH - *Cardiotocography/classification/standards/statistics & numerical data MH - Female MH - Fetal Distress/*classification/*diagnosis MH - *Fetal Monitoring/classification/standards/statistics & numerical data MH - Gestational Age MH - Heart Rate, Fetal/*physiology MH - Humans MH - Observer Variation MH - Pregnancy MH - Reproducibility of Results MH - Terminology as Topic OTO - NOTNLM OT - Agreement OT - Cardiotocography OT - Fetal heart rate OT - Fetal monitoring OT - Reliability EDAT- 2017/04/14 06:00 MHDA- 2019/08/01 06:00 CRDT- 2017/04/14 06:00 PHST- 2016/06/25 00:00 [received] PHST- 2016/11/03 00:00 [revised] PHST- 2016/11/09 00:00 [accepted] PHST- 2017/04/14 06:00 [entrez] PHST- 2017/04/14 06:00 [pubmed] PHST- 2019/08/01 06:00 [medline] AID - S2468-7847(16)30004-6 [pii] AID - 10.1016/j.jogoh.2016.11.002 [doi] PST - ppublish SO - J Gynecol Obstet Hum Reprod. 2017 Feb;46(2):131-135. doi: 10.1016/j.jogoh.2016.11.002. Epub 2017 Jan 30. PMID- 27869985 OWN - NLM STAT- MEDLINE DCOM- 20170221 LR - 20170817 IS - 1600-0412 (Electronic) IS - 0001-6349 (Linking) VI - 96 IP - 2 DP - 2017 Feb TI - Agreement and accuracy using the FIGO, ACOG and NICE cardiotocography interpretation guidelines. PG - 166-175 LID - 10.1111/aogs.13064 [doi] AB - INTRODUCTION: One of the limitations reported with cardiotocography is the modest interobserver agreement observed in tracing interpretation. This study compared agreement, reliability and accuracy of cardiotocography interpretation using the International Federation of Gynecology and Obstetrics, American College of Obstetrics and Gynecology and National Institute for Health and Care Excellence guidelines. MATERIAL AND METHODS: A total of 151 tracings were evaluated by 27 clinicians from three centers where International Federation of Gynecology and Obstetrics, American College of Obstetrics and Gynecology and National Institute for Health and Care Excellence guidelines were routinely used. Interobserver agreement was evaluated using the proportions of agreement and reliability with the κ statistic. The accuracy of tracings classified as "pathological/category III" was assessed for prediction of newborn acidemia. For all measures, 95% confidence interval were calculated. RESULTS: Cardiotocography classifications were more distributed with International Federation of Gynecology and Obstetrics (9, 52, 39%) and National Institute for Health and Care Excellence (30, 33, 37%) than with American College of Obstetrics and Gynecology (13, 81, 6%). The category with the highest agreement was American College of Obstetrics and Gynecology category II (proportions of agreement = 0.73, 95% confidence interval 0.70-76), and the ones with the lowest agreement were American College of Obstetrics and Gynecology categories I and III. Reliability was significantly higher with International Federation of Gynecology and Obstetrics (κ = 0.37, 95% confidence interval 0.31-0.43), and National Institute for Health and Care Excellence (κ = 0.33, 95% confidence interval 0.28-0.39) than with American College of Obstetrics and Gynecology (κ = 0.15, 95% confidence interval 0.10-0.21); however, all represent only slight/fair reliability. International Federation of Gynecology and Obstetrics and National Institute for Health and Care Excellence showed a trend towards higher sensitivities in prediction of newborn acidemia (89 and 97%, respectively) than American College of Obstetrics and Gynecology (32%), but the latter achieved a significantly higher specificity (95%). CONCLUSIONS: With American College of Obstetrics and Gynecology guidelines there is high agreement in category II, low reliability, low sensitivity and high specificity in prediction of acidemia. With International Federation of Gynecology and Obstetrics and National Institute for Health and Care Excellence guidelines there is higher reliability, a trend towards higher sensitivity, and lower specificity in prediction of acidemia. CI - © 2016 Nordic Federation of Societies of Obstetrics and Gynecology. FAU - Santo, Susana AU - Santo S AD - Department of Obstetrics and Gynecology, Santa Maria Hospital, Faculty of Medicine of Lisbon University, Lisbon, Portugal. FAU - Ayres-de-Campos, Diogo AU - Ayres-de-Campos D AD - Department of Obstetrics and Gynecology, Medical School, University of Porto, S. João Hospital, Institute of Biomedical Engineering, Porto, Portugal. FAU - Costa-Santos, Cristina AU - Costa-Santos C AD - Department of Medical Informatics, Medical School, University of Porto, Porto, Portugal. FAU - Schnettler, William AU - Schnettler W AD - Center for Maternal Cardiac Care, TriHealth, Good Samaritan Hospital, Cincinnati, OH, USA. FAU - Ugwumadu, Austin AU - Ugwumadu A AD - Department of Obstetrics & Gynecology, St George's Hospital, University of London, London, UK. FAU - Da Graça, Luís M AU - Da Graça LM AD - Department of Obstetrics and Gynecology, Santa Maria Hospital, Faculty of Medicine of Lisbon University, Lisbon, Portugal. CN - FM-Compare Collaboration LA - eng PT - Comparative Study PT - Journal Article PT - Multicenter Study DEP - 20170106 PL - United States TA - Acta Obstet Gynecol Scand JT - Acta obstetricia et gynecologica Scandinavica JID - 0370343 SB - IM MH - Acidosis/*diagnosis MH - Cardiotocography/*standards MH - Female MH - Fetal Blood/chemistry MH - Fetal Diseases/diagnosis MH - *Heart Rate, Fetal MH - Humans MH - *Practice Guidelines as Topic MH - Pregnancy MH - Reproducibility of Results MH - Sensitivity and Specificity OTO - NOTNLM OT - Agreement OT - cardiotocography OT - electronic fetal monitoring OT - guidelines OT - heart rate EDAT- 2016/11/22 06:00 MHDA- 2017/02/22 06:00 CRDT- 2016/11/22 06:00 PHST- 2016/07/29 00:00 [received] PHST- 2016/11/16 00:00 [accepted] PHST- 2016/11/22 06:00 [pubmed] PHST- 2017/02/22 06:00 [medline] PHST- 2016/11/22 06:00 [entrez] AID - 10.1111/aogs.13064 [doi] PST - ppublish SO - Acta Obstet Gynecol Scand. 2017 Feb;96(2):166-175. doi: 10.1111/aogs.13064. Epub 2017 Jan 6. PMID- 27926647 OWN - NLM STAT- MEDLINE DCOM- 20170614 LR - 20180312 IS - 1873-233X (Electronic) IS - 0029-7844 (Linking) VI - 129 IP - 1 DP - 2017 Jan TI - Central Fetal Monitoring With and Without Computer Analysis: A Randomized Controlled Trial. PG - 83-90 LID - 10.1097/AOG.0000000000001799 [doi] AB - OBJECTIVE: To evaluate whether intrapartum fetal monitoring with computer analysis and real-time alerts decreases the rate of newborn metabolic acidosis or obstetric intervention when compared with visual analysis. METHODS: A randomized clinical trial carried out in five hospitals in the United Kingdom evaluated women with singleton, vertex fetuses of 36 weeks of gestation or greater during labor. Continuous central fetal monitoring by computer analysis and online alerts (experimental arm) was compared with visual analysis (control arm). Fetal blood sampling and electrocardiographic ST waveform analysis were available in both arms. The primary outcome was incidence of newborn metabolic acidosis (pH less than 7.05 and base deficit greater than 12 mmol/L). Prespecified secondary outcomes included operative delivery, use of fetal blood sampling, low 5-minute Apgar score, neonatal intensive care unit admission, hypoxic-ischemic encephalopathy, and perinatal death. A sample size of 3,660 per group (N=7,320) was planned to be able to detect a reduction in the rate of metabolic acidosis from 2.8% to 1.8% (two-tailed α of 0.05 with 80% power). RESULTS: From August 2011 through July 2014, 32,306 women were assessed for eligibility and 7,730 were randomized: 3,961 to computer analysis and online alerts, and 3,769 to visual analysis. Baseline characteristics were similar in both groups. Metabolic acidosis occurred in 16 participants (0.40%) in the experimental arm and 22 participants (0.58%) in the control arm (relative risk 0.69 [0.36-1.31]). No statistically significant differences were found in the incidence of secondary outcomes. CONCLUSION: Compared with visual analysis, computer analysis of fetal monitoring signals with real-time alerts did not significantly reduce the rate of metabolic acidosis or obstetric intervention. A lower-than-expected rate of newborn metabolic acidosis was observed in both arms of the trial. CLINICAL TRIAL REGISTRATION: ISRCTN Registry, http://www.isrctn.com, ISRCTN42314164. FAU - Nunes, Inês AU - Nunes I AD - Medical School, University of Porto, S. João Hospital, and I3S, Instituto de Investigação e Inovação em Saúde-INEB: Institute of Biomedical Engineering, Porto, Portugal; and St. George's University Hospitals NHS Foundation Trust, London, University Hospital of Wales, Cardiff, Glan Clwyd Hospital, Rhyl, Ninewells Hospital, Dundee, and Leighton Hospital, Crewe, United Kingdom. FAU - Ayres-de-Campos, Diogo AU - Ayres-de-Campos D FAU - Ugwumadu, Austin AU - Ugwumadu A FAU - Amin, Pina AU - Amin P FAU - Banfield, Philip AU - Banfield P FAU - Nicoll, Antony AU - Nicoll A FAU - Cunningham, Simon AU - Cunningham S FAU - Sousa, Paulo AU - Sousa P FAU - Costa-Santos, Cristina AU - Costa-Santos C FAU - Bernardes, João AU - Bernardes J CN - Fetal Monitoring and Alert (FM-ALERT) Study Group LA - eng SI - ISRCTN/ISRCTN42314164 PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - United States TA - Obstet Gynecol JT - Obstetrics and gynecology JID - 0401101 SB - AIM SB - IM MH - Acidosis/blood/*diagnosis/*epidemiology/prevention & control MH - Adult MH - Apgar Score MH - Cesarean Section/statistics & numerical data MH - Clinical Alarms MH - *Decision Making, Computer-Assisted MH - Female MH - Fetal Distress/*diagnosis/surgery MH - Fetal Monitoring/*methods MH - Humans MH - Hypoxia-Ischemia, Brain/epidemiology MH - Incidence MH - Infant, Newborn MH - Intensive Care Units, Neonatal MH - Labor, Obstetric MH - Patient Admission/statistics & numerical data MH - Perinatal Death MH - Pregnancy MH - Signal Processing, Computer-Assisted MH - Young Adult EDAT- 2016/12/08 06:00 MHDA- 2017/06/15 06:00 CRDT- 2016/12/08 06:00 PHST- 2016/12/08 06:00 [pubmed] PHST- 2017/06/15 06:00 [medline] PHST- 2016/12/08 06:00 [entrez] AID - 10.1097/AOG.0000000000001799 [doi] PST - ppublish SO - Obstet Gynecol. 2017 Jan;129(1):83-90. doi: 10.1097/AOG.0000000000001799. PMID- 28715964 OWN - NLM STAT- MEDLINE DCOM- 20180423 LR - 20180609 IS - 1933-7205 (Electronic) IS - 1933-7191 (Linking) VI - 24 IP - 8 DP - 2017 Aug TI - Uterine and Abdominal Muscle Electromyographic Activities in Control and PCEA-Treated Nulliparous Women During the Second Stage of Labor. PG - 1214-1220 LID - 10.1177/1933719116682875 [doi] AB - OBJECTIVE: Patient-controlled epidural analgesia (PCEA), used to relieve pain during delivery, delays labor but the mechanism is unknown. The aim was to investigate the effects of PCEA on uterine and abdominal muscles electromyographic (EMG) activity during the second stage of labor. METHODS: This study included 45 nulliparous pregnant women without PCEA, 42 women with standard PCEA treatment given during the first stage of labor and stopped near the end of the first stage, and 22 women with standard PCEA treatment with continued use throughout the first and second stages of labor. The EMG signals were recorded from the abdominal surface using PowerLab hardware and LabChart software (ADInstruments, New South Wales, Australia) and filtered to separate uterine and abdominal EMG. Various EMG burst parameters were obtained. RESULTS: There are no differences ( P > .05) in the age, body mass index, fetal weight, and Apgar scores between the patients from the various groups. PCEA (both stopped and continued) inhibits ( P < .05) duration, number of bursts, and root mean square of uterine EMG. PCEA also produces statistically significant ( P < .001) reductions in abdominal EMG. The decrease in EMG activity is accompanied by a significant ( P < .001) prolongation of the second stage duration (PCEA continued = 95.08 ± 8.60 minutes, PCEA stopped = 79.39 ± 6.25 minutes, no PCEA = 61.00 ± 7.23 minutes). CONCLUSION: PCEA suppresses uterine and abdominal muscle EMG during the second stage of labor but inhibition depends upon the treatment schedule. PCEA prolongs the duration of labor by inhibition of uterine and abdominal muscle and neural activity. FAU - Qian, Xueya AU - Qian X AD - 1 Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China. FAU - Li, Pin AU - Li P AD - 1 Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China. FAU - Shi, Shao-Qing AU - Shi SQ AD - 1 Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China. FAU - Garfield, Robert E AU - Garfield RE AD - 1 Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China. FAU - Liu, Huishu AU - Liu H AD - 1 Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China. LA - eng PT - Journal Article DEP - 20161220 PL - United States TA - Reprod Sci JT - Reproductive sciences (Thousand Oaks, Calif.) JID - 101291249 RN - 0 (Anesthetics, Local) SB - IM MH - Abdominal Muscles/drug effects/*physiology MH - Adult MH - *Analgesia, Epidural MH - *Analgesia, Patient-Controlled MH - Anesthetics, Local/administration & dosage MH - Electromyography MH - Female MH - Humans MH - Labor Stage, Second/drug effects/*physiology MH - Myometrium/drug effects/*physiology MH - Pregnancy OTO - NOTNLM OT - *abdominal muscle OT - *electromyographic (EMG) activity OT - *labor contractions OT - *labor monitoring OT - *the second stage of labor EDAT- 2017/07/19 06:00 MHDA- 2018/04/24 06:00 CRDT- 2017/07/19 06:00 PHST- 2017/07/19 06:00 [entrez] PHST- 2017/07/19 06:00 [pubmed] PHST- 2018/04/24 06:00 [medline] AID - 10.1177/1933719116682875 [doi] PST - ppublish SO - Reprod Sci. 2017 Aug;24(8):1214-1220. doi: 10.1177/1933719116682875. Epub 2016 Dec 20. PMID- 27956203 OWN - NLM STAT- MEDLINE DCOM- 20170531 LR - 20180110 IS - 1097-6868 (Electronic) IS - 0002-9378 (Linking) VI - 216 IP - 4 DP - 2017 Apr TI - Syphilis during pregnancy: a preventable threat to maternal-fetal health. PG - 352-363 LID - S0002-9378(16)32167-6 [pii] LID - 10.1016/j.ajog.2016.11.1052 [doi] AB - Syphilis remains the most common congenital infection worldwide and has tremendous consequences for the mother and her developing fetus if left untreated. Recently, there has been an increase in the number of congenital syphilis cases in the United States. Thus, recognition and appropriate treatment of reproductive-age women must be a priority. Testing should be performed at initiation of prenatal care and twice during the third trimester in high-risk patients. There are 2 diagnostic algorithms available and physicians should be aware of which algorithm is utilized by their testing laboratory. Women testing positive for syphilis should undergo a history and physical exam as well as testing for other sexually transmitted infections, including HIV. Serofast syphilis can occur in patients with previous adequate treatment but persistent low nontreponemal titers (<1:8). Syphilis can infect the fetus in all stages of the disease regardless of trimester and can sometimes be detected with ultrasound >20 weeks. The most common findings include hepatomegaly and placentomegaly, but also elevated peak systolic velocity in the middle cerebral artery (indicative of fetal anemia), ascites, and hydrops fetalis. Pregnancies with ultrasound abnormalities are at higher risk of compromise during syphilotherapy as well as fetal treatment failure. Thus, we recommend a pretreatment ultrasound in viable pregnancies when feasible. The only recommended treatment during pregnancy is benzathine penicillin G and it should be administered according to maternal stage of infection per Centers for Disease Control and Prevention guidelines. Women with a penicillin allergy should be desensitized and then treated with penicillin appropriate for their stage of syphilis. The Jarisch-Herxheimer reaction occurs in up to 44% of gravidas and can cause contractions, fetal heart rate abnormalities, and even stillbirth in the most severely affected pregnancies. We recommend all viable pregnancies receive the first dose of benzathine penicillin G in a labor and delivery department under continuous fetal monitoring for at least 24 hours. Thereafter, the remaining benzathine penicillin G doses can be given in an outpatient setting. The rate of maternal titer decline is not tied to pregnancy outcomes. Therefore, after adequate syphilotherapy, maternal titers should be checked monthly to ensure they are not increasing four-fold, as this may indicate reinfection or treatment failure. CI - Copyright © 2016 Elsevier Inc. All rights reserved. FAU - Rac, Martha W F AU - Rac MW AD - Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX. Electronic address: Martha.Rac@bcm.edu. FAU - Revell, Paula A AU - Revell PA AD - Department of Pathology and Pediatrics, Baylor College of Medicine, Houston, TX. FAU - Eppes, Catherine S AU - Eppes CS AD - Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX. LA - eng PT - Journal Article PT - Review DEP - 20161209 PL - United States TA - Am J Obstet Gynecol JT - American journal of obstetrics and gynecology JID - 0370476 RN - 0 (Anti-Bacterial Agents) RN - RIT82F58GK (Penicillin G Benzathine) SB - AIM SB - IM MH - Algorithms MH - Anemia/etiology MH - Anti-Bacterial Agents/therapeutic use MH - Ascites/diagnostic imaging MH - Female MH - Hepatomegaly/diagnostic imaging MH - Humans MH - Hydrops Fetalis/diagnostic imaging MH - Penicillin G Benzathine/therapeutic use MH - Placenta Diseases/diagnostic imaging MH - Polyhydramnios/diagnostic imaging MH - Pregnancy MH - Pregnancy Complications, Infectious/*diagnosis/drug therapy/epidemiology MH - Syphilis/*diagnosis/drug therapy/epidemiology MH - Syphilis, Congenital/diagnostic imaging/*prevention & control MH - Ultrasonography, Prenatal OTO - NOTNLM OT - *congenital syphilis OT - *fetal syphilis OT - *syphilis during pregnancy EDAT- 2016/12/14 06:00 MHDA- 2017/06/01 06:00 CRDT- 2016/12/14 06:00 PHST- 2016/09/08 00:00 [received] PHST- 2016/11/17 00:00 [revised] PHST- 2016/11/30 00:00 [accepted] PHST- 2016/12/14 06:00 [pubmed] PHST- 2017/06/01 06:00 [medline] PHST- 2016/12/14 06:00 [entrez] AID - S0002-9378(16)32167-6 [pii] AID - 10.1016/j.ajog.2016.11.1052 [doi] PST - ppublish SO - Am J Obstet Gynecol. 2017 Apr;216(4):352-363. doi: 10.1016/j.ajog.2016.11.1052. Epub 2016 Dec 9. PMID- 27923290 OWN - NLM STAT- MEDLINE DCOM- 20171016 LR - 20171016 IS - 1364-6893 (Electronic) IS - 0144-3615 (Linking) VI - 37 IP - 3 DP - 2017 Apr TI - Computerised analysis of antepartum foetal heart parameters: New reference ranges. PG - 296-304 LID - 10.1080/01443615.2016.1239069 [doi] AB - We selected 4012 cCTG records (one trace for each patient) performed in healthy pregnancies from 30th to 42nd gestational week using foetal heart rate (FHR), short-term variability (STV), long-term irregularity (LTI), Delta, approximate entropy (ApEn), spectral components as low frequency (LF), median frequency (MF), high frequency (HF) and LF/(HF + MF) ratio were analysed. Reference nomograms were created and sensitivity and specificity for the prediction of foetal compromise were calculated which were 90% and 89%, respectively. Changes of cCTG parameters according to gestational week were evaluated: FHR (r = -.65) and LF (r = -.87) showed a statistically significant reduction (p < .05) with gestational age. STV (r = .59), LTI (r = .69), Delta (r = .67), and MF (r = .88) showed a statistically significant increase (p < .05) with gestational age. In contrast, for ApEn (r = -.098), HF (r = .14) and LF/(HF + MF) ratio (r = -.47) a non-statistically significant change was found (p > .05). The identification of reference ranges for cCTG indexes in according to gestational age could provide a more objective examination of cCTG trace. FAU - Giuliano, Natascia AU - Giuliano N AD - a Department of Obstetrical-Gynaecological, Urological Science and Reproductive Medicine , Federico II University , Naples , Italy. FAU - Annunziata, Maria Laura AU - Annunziata ML AD - a Department of Obstetrical-Gynaecological, Urological Science and Reproductive Medicine , Federico II University , Naples , Italy. FAU - Esposito, Francesca Giovanna AU - Esposito FG AD - a Department of Obstetrical-Gynaecological, Urological Science and Reproductive Medicine , Federico II University , Naples , Italy. FAU - Tagliaferri, Salvatore AU - Tagliaferri S AD - a Department of Obstetrical-Gynaecological, Urological Science and Reproductive Medicine , Federico II University , Naples , Italy. FAU - Di Lieto, Andrea AU - Di Lieto A AD - a Department of Obstetrical-Gynaecological, Urological Science and Reproductive Medicine , Federico II University , Naples , Italy. FAU - Magenes, Giovanni AU - Magenes G AD - b Department of Electrical, Computer and Biomedical Engineering , University of Pavia , Pavia , Italy. FAU - Signorini, Maria Gabriella AU - Signorini MG AD - c Department of Electronic, Information and Bioengineering , Politecnico of Milano , Milan , Italy. FAU - Campanile, Marta AU - Campanile M AD - a Department of Obstetrical-Gynaecological, Urological Science and Reproductive Medicine , Federico II University , Naples , Italy. FAU - Arduini, Domenico AU - Arduini D AD - d Department of Obstetrics and Gynaecology , Foetal Medicine Centre, University of Rome "Tor Vergata" , Rome , Italy. LA - eng PT - Journal Article DEP - 20161206 PL - England TA - J Obstet Gynaecol JT - Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology JID - 8309140 SB - IM MH - Cardiotocography/*methods MH - Female MH - Fetal Distress/diagnosis MH - Heart Rate, Fetal/*physiology MH - Humans MH - Infant, Newborn MH - Labor, Obstetric/*physiology MH - Pregnancy MH - Pregnancy Outcome MH - Prospective Studies MH - Reference Values MH - Sensitivity and Specificity OTO - NOTNLM OT - Computerised cardiotocography OT - antepartum foetal monitoring OT - foetal heart rate OT - gestational age OT - reference ranges EDAT- 2016/12/08 06:00 MHDA- 2017/10/17 06:00 CRDT- 2016/12/08 06:00 PHST- 2016/12/08 06:00 [pubmed] PHST- 2017/10/17 06:00 [medline] PHST- 2016/12/08 06:00 [entrez] AID - 10.1080/01443615.2016.1239069 [doi] PST - ppublish SO - J Obstet Gynaecol. 2017 Apr;37(3):296-304. doi: 10.1080/01443615.2016.1239069. Epub 2016 Dec 6. PMID- 27533904 OWN - NLM STAT- MEDLINE DCOM- 20170703 LR - 20180124 IS - 2163-0763 (Electronic) IS - 2163-0755 (Linking) VI - 81 IP - 6 DP - 2016 Dec TI - Computed tomographic imaging interpretation improves fetal outcomes after maternal trauma. PG - 1131-1135 AB - BACKGROUND: Computed tomography (CT) has been validated to identify and classify placental abruption following blunt trauma. The purpose of this study was to demonstrate improvement in fetal survival when delivery occurs by protocol at the first sign of class III fetal heart rate tracing in pregnant trauma patients with a viable fetus on arrival and CT evidence of placental perfusion 50% or less secondary to placental abruption. METHODS: This is a retrospective review of pregnant trauma patients at 26 weeks' gestation or greater who underwent abdominopelvic CT as part of their initial evaluation. Charts were reviewed for CT interpretation of placental pathology with classification of placental abruption based upon enhancement (Grade 1, >50% perfusion; Grade 2, 25%-50% perfusion; Grade 3, <25% perfusion), as well as need for delivery and fetal outcomes. RESULTS: Forty-one patients met inclusion criteria. Computed tomography revealed evidence of placental abruption in six patients (15%): Grade 1, one patient, Grade 2, one patient, and Grade 3, four patients. Gestational ages ranged from 26 to 39 weeks. All patients with placental abruption of Grade 2 or greater developed concerning fetal heart tracings and underwent delivery emergently at first sign. Abruption was confirmed intraoperatively in all cases. Each birth was viable, and Apgar scores at 10 minutes were greater than 7 in 80% of infants, all of whom were ultimately discharged home. The remaining infant was transferred to an outside facility. CONCLUSIONS: Delivery at first sign of nonreassuring fetal heart rate tracings in pregnant trauma patients (third trimester) with placental abruption of Grade 2 or greater can lead to improved fetal outcome. LEVEL OF EVIDENCE: Therapeutic/care management study, level III. FAU - Kopelman, Tammy R AU - Kopelman TR AD - From the Division of Burns, Trauma Surgery, and Surgical Critical Care, Department of Surgery(T.R.K., J.B., J.W., O.G., K.D., P.P., S.V., M.P.), and Department of Radiology(D.G.), Maricopa Medical Center, Phoenix, Arizona. FAU - Bogert, James N AU - Bogert JN FAU - Walters, Jarvis W AU - Walters JW FAU - Gridley, Daniel AU - Gridley D FAU - Guzman, Oscar AU - Guzman O FAU - Davis, Karole M AU - Davis KM FAU - Pieri, Paola G AU - Pieri PG FAU - Vail, Sydney J AU - Vail SJ FAU - Pressman, Melissa AU - Pressman M LA - eng PT - Journal Article PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 SB - AIM SB - IM MH - Abruptio Placentae/*diagnostic imaging/therapy MH - Adult MH - Clinical Protocols MH - *Delivery, Obstetric MH - Female MH - Heart Rate, Fetal MH - Humans MH - Infant, Newborn MH - Male MH - Pregnancy MH - Pregnancy Outcome MH - Retrospective Studies MH - *Tomography, X-Ray Computed MH - Wounds, Nonpenetrating/*diagnostic imaging/therapy EDAT- 2016/08/18 06:00 MHDA- 2017/07/04 06:00 CRDT- 2016/08/18 06:00 PHST- 2016/08/18 06:00 [pubmed] PHST- 2017/07/04 06:00 [medline] PHST- 2016/08/18 06:00 [entrez] AID - 10.1097/TA.0000000000001210 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2016 Dec;81(6):1131-1135. doi: 10.1097/TA.0000000000001210. PMID- 27819172 OWN - NLM STAT- MEDLINE DCOM- 20180517 LR - 20180517 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) VI - 30 IP - 21 DP - 2017 Nov TI - Deceleration area and fetal acidemia. PG - 2578-2584 LID - 10.1080/14767058.2016.1256993 [doi] AB - AIMS: To compare the predictive ability for neonatal acidemia of individual components of intrapartum cardiotocography (CTG) described by National Institute of Child Health and Human Development (NICHD) system and deceleration area. DESIGN: Case-control study. SETTING: Spanish tertiary obstetrical hospital. POPULATION: CTG patterns of 102 acidemic fetus (umbilical arterial cord gas pH ≤7.10, base deficit (BD) > 8) and 102 nonacidemic controls (umbilical arterial cord gas pH > 7.10). METHODS: Two reviewers blind to clinical and outcome data analyzed the last thirty minutes before delivery of 204 fetal heart rate (FHR) tracings, extracting those features defined by NICHD and certain measures of FHR decelerations, including deceleration area, not considered by this system. OUTCOME MEASURES: The primary outcome was the predictive ability of NICHD features and non-NICHD deceleration measures for fetal acidemia. The secondary outcome was the impact of deceleration area in the last 30 min of labor on gasometry components (pH, BD and lactate). RESULTS: Minimal variability (area under the curve (AUC) 0.74), total number of late (AUC: 0.75) and prolonged decelerations (0.77) were the three NICHD features with the greatest predictive ability for fetal acidemia in the last thirty minutes of labor. Total deceleration area demonstrated the highest discrimination power (AUC: 0.83) of all the analyzed elements. For each cm(2) the area increases in the last 30 min of labor, pH decreases 0.08 units, BD increases 0.272 mEq/L and lactate 0.183 mEq/L. CONCLUSIONS: Total deceleration area showed the greatest predictive ability for fetal acidemia and its measure could help to estimate intrapartum fetal acid-base status. FAU - Martí Gamboa, Sabina AU - Martí Gamboa S AUID- ORCID: 0000-0002-6767-9084 AD - a Obstetrics Department and. FAU - Lapresta Moros, Maria AU - Lapresta Moros M AUID- ORCID: 0000-0002-3493-3138 AD - a Obstetrics Department and. FAU - Pascual Mancho, Jara AU - Pascual Mancho J AUID- ORCID: 0000-0002-5869-4450 AD - a Obstetrics Department and. FAU - Lapresta Moros, Carlos AU - Lapresta Moros C AUID- ORCID: 0000-0002-7703-4060 AD - b Preventive Medicine Department , Miguel Servet University Hospital , Zaragoza , Spain. FAU - Castán Mateo, Sergio AU - Castán Mateo S AUID- ORCID: 0000-0001-5294-5709 AD - a Obstetrics Department and. LA - eng PT - Comparative Study PT - Journal Article DEP - 20161124 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 SB - IM MH - Acidosis/*diagnosis MH - Adult MH - *Cardiotocography MH - Deceleration MH - Female MH - Humans MH - Infant, Newborn MH - Male MH - Pregnancy MH - Retrospective Studies MH - Young Adult OTO - NOTNLM OT - Cardiotocography OT - deceleration area OT - fetal buffer system OT - fetal heart rate decelerations OT - neonatal acidemia EDAT- 2016/11/08 06:00 MHDA- 2018/05/18 06:00 CRDT- 2016/11/08 06:00 PHST- 2016/11/08 06:00 [pubmed] PHST- 2018/05/18 06:00 [medline] PHST- 2016/11/08 06:00 [entrez] AID - 10.1080/14767058.2016.1256993 [doi] PST - ppublish SO - J Matern Fetal Neonatal Med. 2017 Nov;30(21):2578-2584. doi: 10.1080/14767058.2016.1256993. Epub 2016 Nov 24. PMID- 27848142 OWN - NLM STAT- MEDLINE DCOM- 20180713 LR - 20181113 IS - 1573-2614 (Electronic) IS - 1387-1307 (Linking) VI - 31 IP - 6 DP - 2017 Dec TI - Parasympathetic tone variations according to umbilical cord pH at birth: a computerized fetal heart rate variability analysis. PG - 1197-1202 LID - 10.1007/s10877-016-9957-y [doi] AB - Non-reassuring fetal heart rate tracings reflect an imbalance between the parasympathetic and sympathetic nervous systems. In this situation, fetal asphyxia can be suspected and may be confirmed by metabolic measurements at birth like low pH or high base deficit values. The objective of this study was to determine whether fetal asphyxia during labor is related to parasympathetic nervous system activity. This is a retrospective study of a database collected in 5 centers. Two hundred and ninety-nine fetal heart rate tracings collected during labor were analyzed. Autonomic nervous system, especially the parasympathetic nervous system, was analyzed using an original index: the FSI (Fetal Stress Index). The FSI is a parasympathetic activity evaluation based on fetal heart rate variability analysis. Infants were grouped based on normal or low pH value at birth. FSI was measured during the last 30 min of labor before birth and compared between groups. The minimum value of the FSI during the last 30 min before delivery was significantly lower in the group with the lower umbilical cord arterial pH value. In this pilot study during labor, FSI was lower in the group of infants with low arterial pH at birth. FAU - Butruille, Laura AU - Butruille L AUID- ORCID: 0000-0001-5760-1489 AD - Faculté de médecine Pôle Recherche, EA 4489, Environnement Périnatal et Santé, 1, place de Verdun, 59045, Lille Cedex, France. laura.butruille@hotmail.fr. FAU - De Jonckheere, Julien AU - De Jonckheere J AD - Faculté de médecine Pôle Recherche, EA 4489, Environnement Périnatal et Santé, 1, place de Verdun, 59045, Lille Cedex, France. AD - Maison Régionale de la Recherche Clinique, INSERM CIC-IT 1403, Lille, France. FAU - Flocteil, Mathilde AU - Flocteil M AD - Maison Régionale de la Recherche Clinique, INSERM CIC-IT 1403, Lille, France. FAU - Garabedian, Charles AU - Garabedian C AD - Faculté de médecine Pôle Recherche, EA 4489, Environnement Périnatal et Santé, 1, place de Verdun, 59045, Lille Cedex, France. AD - Hôpital Jeanne de Flandre, Clinique de Gynécologie-Obstétrique, Lille, France. FAU - Houfflin-Debarge, Véronique AU - Houfflin-Debarge V AD - Faculté de médecine Pôle Recherche, EA 4489, Environnement Périnatal et Santé, 1, place de Verdun, 59045, Lille Cedex, France. AD - Hôpital Jeanne de Flandre, Clinique de Gynécologie-Obstétrique, Lille, France. FAU - Storme, Laurent AU - Storme L AD - Faculté de médecine Pôle Recherche, EA 4489, Environnement Périnatal et Santé, 1, place de Verdun, 59045, Lille Cedex, France. AD - Hôpital Jeanne de Flandre, Clinique de médecine néonatale, Lille, France. FAU - Deruelle, Philippe AU - Deruelle P AD - Faculté de médecine Pôle Recherche, EA 4489, Environnement Périnatal et Santé, 1, place de Verdun, 59045, Lille Cedex, France. AD - Hôpital Jeanne de Flandre, Clinique de Gynécologie-Obstétrique, Lille, France. FAU - Logier, Régis AU - Logier R AD - Maison Régionale de la Recherche Clinique, INSERM CIC-IT 1403, Lille, France. LA - eng PT - Journal Article DEP - 20161115 PL - Netherlands TA - J Clin Monit Comput JT - Journal of clinical monitoring and computing JID - 9806357 SB - IM MH - Adult MH - Autonomic Nervous System MH - Cardiology/*methods MH - Delivery, Obstetric MH - Female MH - Fetal Monitoring/*methods MH - *Heart Rate, Fetal MH - Humans MH - Hydrogen-Ion Concentration MH - Infant, Newborn MH - Labor, Obstetric MH - Models, Statistical MH - Parasympathetic Nervous System/*physiopathology MH - Pilot Projects MH - Pregnancy MH - Retrospective Studies MH - Signal Processing, Computer-Assisted MH - Software MH - Umbilical Cord/*pathology OTO - NOTNLM OT - Acidemia OT - Autonomic nervous system OT - Fetus OT - Heart rate variability OT - Umbilical cord pH EDAT- 2016/11/17 06:00 MHDA- 2018/07/14 06:00 CRDT- 2016/11/17 06:00 PHST- 2016/05/13 00:00 [received] PHST- 2016/11/08 00:00 [accepted] PHST- 2016/11/17 06:00 [pubmed] PHST- 2018/07/14 06:00 [medline] PHST- 2016/11/17 06:00 [entrez] AID - 10.1007/s10877-016-9957-y [pii] AID - 10.1007/s10877-016-9957-y [doi] PST - ppublish SO - J Clin Monit Comput. 2017 Dec;31(6):1197-1202. doi: 10.1007/s10877-016-9957-y. Epub 2016 Nov 15. PMID- 27862683 OWN - NLM STAT- MEDLINE DCOM- 20170425 LR - 20170425 IS - 1447-0756 (Electronic) IS - 1341-8076 (Linking) VI - 43 IP - 1 DP - 2017 Jan TI - Is the neonatal creatine phosphokinase level a reliable marker for fetal hypoxia? PG - 114-121 LID - 10.1111/jog.13176 [doi] AB - AIM: The creatine phosphokinase (CPK) level is believed to increase in neonatal peripheral blood after tissue damage, including damage from perinatal hypoxia. However, it is not clear whether it is truly a reliable marker for fetal hypoxia. We investigated the chronological changes in neonatal CPK and the reliability of CPK as a marker for fetal hypoxia. METHODS: Sixty term neonates admitted to the neonatal intensive care unit at Tokyo Women's Medical University Medical Center East from April 2009 to April 2010 were enrolled in this study. We evaluated whether asphyxia and fetal heart rate (FHR) abnormality could predict the neonatal CPK level by using receiver-operator curve analysis. We also compared umbilical cord blood pH levels with neonatal CPK levels. In addition, we investigated factors that influence neonatal CPK in non-asphyxia cases. RESULTS: The median value of CPK peaked on day 1. There were no significant differences in CPK levels regardless of the presence of asphyxia or FHR abnormality. Non-asphyxiated neonates with older gestational ages and amniotic fluid abnormalities had significantly higher levels of CPK. CONCLUSION: Our results indicate that the neonatal CPK level is not an appropriate marker for retrospectively predicting either asphyxia or FHR abnormality. There are influencing factors other than asphyxia that increase neonatal CPK. Therefore, one should be careful when making a diagnosis of perinatal hypoxia based solely on increased levels of neonatal CPK after birth. CI - © 2016 Japan Society of Obstetrics and Gynecology. FAU - Muraoka, Mitsue AU - Muraoka M AD - Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan. FAU - Takagi, Koichiro AU - Takagi K AD - Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan. FAU - Morita, Yoshihiro AU - Morita Y AD - Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan. FAU - Nagano, Hiroaki AU - Nagano H AD - Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan. FAU - Henmi, Nobuhide AU - Henmi N AD - Department of Neonatology, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan. FAU - Hasegawa, Hisaya AU - Hasegawa H AD - Department of Neonatology, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan. LA - eng PT - Journal Article DEP - 20161112 PL - Australia TA - J Obstet Gynaecol Res JT - The journal of obstetrics and gynaecology research JID - 9612761 RN - 0 (Biomarkers) RN - EC 2.7.3.2 (Creatine Kinase) SB - IM MH - Adult MH - Asphyxia Neonatorum/blood/diagnosis MH - Biomarkers/blood MH - Creatine Kinase/*blood MH - Female MH - Fetal Hypoxia/*blood/*diagnosis MH - Gestational Age MH - Heart Rate, Fetal MH - Humans MH - Infant, Newborn MH - ROC Curve OTO - NOTNLM OT - *fetal acid base status OT - *intrapartum fetal assessment OT - *perinatal brain damage EDAT- 2016/11/20 06:00 MHDA- 2017/04/26 06:00 CRDT- 2016/11/19 06:00 PHST- 2016/01/08 00:00 [received] PHST- 2016/08/21 00:00 [accepted] PHST- 2016/11/20 06:00 [pubmed] PHST- 2017/04/26 06:00 [medline] PHST- 2016/11/19 06:00 [entrez] AID - 10.1111/jog.13176 [doi] PST - ppublish SO - J Obstet Gynaecol Res. 2017 Jan;43(1):114-121. doi: 10.1111/jog.13176. Epub 2016 Nov 12. PMID- 27831546 OWN - NLM STAT- MEDLINE DCOM- 20180222 LR - 20181008 IS - 1476-5543 (Electronic) IS - 0743-8346 (Linking) VI - 37 IP - 3 DP - 2017 Mar TI - Diurnal variations of short-term variation and the impact of multiple recordings on measurement accuracy. PG - 231-235 LID - 10.1038/jp.2016.202 [doi] AB - OBJECTIVE: Short-term variation (STV) from computerized cardiotocogram heart rate analysis is a parameter that complements decision making, regarding the delivery of fetuses in several high-risk situations. Although studies on the effects of gestational age and fetal pathology are convincing, there is a lack of data exploring diurnal variation and the adequacy of a single measurement. STUDY DESIGN: In this prospective observational study, fetal STV was monitored with the AN24 fetal ECG monitor (Monica Healthcare) each hour for at least 10 h in total, beginning at different times. This resulted in data covering all 24 h of the day. Seventy fetuses, low risk with respect to conditions accessible to heart rate monitoring (median 37th week of gestation) were monitored for an average of 12 h. Results of STV per hour were categorized as 'compromised' (STV<4 ms) or 'healthy', (STV⩾4 ms) to calculate the model of predictability. RESULTS: The model proposed (STV of 'healthy' fetuses: 9.6±2.6 ms, 'compromised' fetuses 3.0±0.5 ms, prevalence 1%) leads to a positive predictive value of 39%, which increased to 68 or 80% given two or three pathological (STV<4 ms) measurements, respectively. Diurnal variation was not observed. CONCLUSIONS: Single pathological STV values should be corroborated by further measurements in a 24-h interval in otherwise low-risk fetuses before inducing delivery. This may help to avoid unnecessary early births and give the fetus valuable days for intrauterine maturity. FAU - Seliger, G AU - Seliger G AD - Martin Luther University, Maternity Clinic/Perinatal Treatment Center, Halle (Saale), Germany. FAU - Petroff, D AU - Petroff D AD - Clinical Trial Centre, University of Leipzig, Leipzig, Germany. FAU - Seeger, S AU - Seeger S AD - St Elisabeth Hospital's Clinic for Women's Health and Perinatal Care, Halle (Saale), Germany. FAU - Hoyer, D AU - Hoyer D AD - Hans Berger Department of Neurology, Biomagnetic Center, Jena University Hospital, Jena, Germany. FAU - Tchirikov, M AU - Tchirikov M AD - Martin Luther University, Maternity Clinic/Perinatal Treatment Center, Halle (Saale), Germany. FAU - Schneider, U AU - Schneider U AD - Department of Obstetrics, Jena University Hospital, Jena, Germany. LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study DEP - 20161110 PL - United States TA - J Perinatol JT - Journal of perinatology : official journal of the California Perinatal Association JID - 8501884 SB - IM MH - Adolescent MH - Adult MH - Cardiotocography/*methods MH - Circadian Rhythm MH - Female MH - Fetal Monitoring/*methods MH - Germany MH - Gestational Age MH - *Heart Rate, Fetal MH - Humans MH - Linear Models MH - Pregnancy MH - Prospective Studies MH - Young Adult EDAT- 2016/11/11 06:00 MHDA- 2018/02/23 06:00 CRDT- 2016/11/11 06:00 PHST- 2016/04/28 00:00 [received] PHST- 2016/09/26 00:00 [revised] PHST- 2016/09/30 00:00 [accepted] PHST- 2016/11/11 06:00 [pubmed] PHST- 2018/02/23 06:00 [medline] PHST- 2016/11/11 06:00 [entrez] AID - jp2016202 [pii] AID - 10.1038/jp.2016.202 [doi] PST - ppublish SO - J Perinatol. 2017 Mar;37(3):231-235. doi: 10.1038/jp.2016.202. Epub 2016 Nov 10. PMID- 27734746 OWN - NLM STAT- MEDLINE DCOM- 20180425 LR - 20180425 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) VI - 30 IP - 19 DP - 2017 Oct TI - Why STAN might not be dead. PG - 2306-2308 LID - 10.1080/14767058.2016.1247263 [doi] AB - Recently, a meta-analysis, including 26 526 laboring vertex singletons at term, summarized all available level-1 data from six high-quality randomized clinical trials (RCTs) on the use of ST analysis (STAN) during labor as an adjunct to conventional intrapartum fetal heart rate monitoring. The meta-analysis showed that STAN did not improve perinatal outcomes or decrease cesarean deliveries. Nonetheless, there are still reasons to believe STAN may have a role in the future research on intrapartum fetal monitoring. Out of six trials included in the meta-analysis, two included all cephalic singletons in labor, and four enrolled only high-risk pregnant women. This combination of both low- and high-risk populations may have distorted the potential impact of STAN. The test for heterogeneity between both subgroups was found to be statistically significant, indicating that the effect of STAN was different in high-risk women compared to a combination of both low- and high-risk women. Furthermore, the classifications of the fetal heart rate patterns used in the included randomized trials were different. Last but not least, despite >26 000 women with singleton gestations were included in the meta-analysis, the evidence still suffers from a lack of power, especially for subgroup analyses. In summary, while the level-1 data so far indicate overall no perinatal benefit of adding STAN to conventional intrapartum fetal heart rate monitoring for the outcomes most of interest, several issues point to the fact that more research is needed before the STAN technology can be deemed of no value for fetal monitoring in labor. FAU - Xodo, Serena AU - Xodo S AD - a Department of Gynecology and Obstetrics , School of Medicine, University of Udine , Udine , Italy. FAU - Saccone, Gabriele AU - Saccone G AUID- ORCID: 0000-0003-0078-2113 AD - b Department of Neuroscience , Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II , Naples , Italy. FAU - Schuit, Ewoud AU - Schuit E AD - c Department of Medicine , Stanford Prevention Research Center, Stanford University , Stanford , CA , USA. FAU - Amer-Wåhlin, Isis AU - Amer-Wåhlin I AD - d Department of Learning Informatics Management and Ethics and Department of Women and Child Health , Medical Management Center, Karolinska Institute , Stockholm , Sweden , and. FAU - Berghella, Vincenzo AU - Berghella V AUID- ORCID: 0000-0003-2854-0239 AD - e Division of Maternal-Fetal Medicine , Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia , PA , USA. LA - eng PT - Journal Article DEP - 20161102 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 SB - IM MH - *Cardiotocography MH - Female MH - Humans MH - Pregnancy OTO - NOTNLM OT - Cardiotocography OT - STAN OT - delivery OT - labor OT - nonstress test EDAT- 2016/11/04 06:00 MHDA- 2018/04/26 06:00 CRDT- 2016/10/14 06:00 PHST- 2016/11/04 06:00 [pubmed] PHST- 2018/04/26 06:00 [medline] PHST- 2016/10/14 06:00 [entrez] AID - 10.1080/14767058.2016.1247263 [doi] PST - ppublish SO - J Matern Fetal Neonatal Med. 2017 Oct;30(19):2306-2308. doi: 10.1080/14767058.2016.1247263. Epub 2016 Nov 2. PMID- 27794572 OWN - NLM STAT- MEDLINE DCOM- 20180612 LR - 20180612 IS - 1423-002X (Electronic) IS - 0378-7346 (Linking) VI - 82 IP - 5 DP - 2017 TI - The Value of the Cerebroplacental Ratio for the Prediction of Intrapartum Fetal Monitoring in Low-Risk Term Pregnancies. PG - 475-480 LID - 10.1159/000452664 [doi] AB - AIM: The study aimed to investigate the use of fetal cerebroplacental ratio (CPR) to identify fetuses at high risk before labor due to the brain sparing phenomenon. MATERIALS AND METHODS: Four hundred and seventy-six singleton pregnancies were enrolled in this study. The CPR was recorded within 1 week of delivery and labor was managed according to local protocols and guidelines. Intrapartum and neonatal outcome details were recorded. RESULTS: The CPR values of fetuses subsequently presenting category III intrapartum electronic fetal monitoring (EFM) or category II EFM without improvement (category IIB EFM) or with progression to category III (category IIC EFM) were significantly lower. On multivariate logistic regression, CPR was independently associated with the risk of categories III EFM, IIB EFM and IIC EFM. CPR was also a predictor of categories III EFM, IIB EFM and IIC EFM. CONCLUSIONS: Fetal CPR could be used to identify fetuses at high risk before labor and to help guide intrapartum management decisions. CI - © 2016 S. Karger AG, Basel. FAU - Liu, Jing AU - Liu J AD - Department of Obstetrics, The First Affiliated Hospital of China Medical University, Shenyang, China. FAU - Song, Guang AU - Song G FAU - Zhao, Ge AU - Zhao G FAU - Meng, Tao AU - Meng T LA - eng PT - Journal Article DEP - 20161029 PL - Switzerland TA - Gynecol Obstet Invest JT - Gynecologic and obstetric investigation JID - 7900587 SB - IM MH - Adult MH - Cerebral Palsy/prevention & control MH - Delivery, Obstetric/methods MH - Female MH - Fetal Hypoxia/*diagnosis MH - Fetal Monitoring/*methods MH - Heart Rate, Fetal MH - Humans MH - Labor, Obstetric MH - Middle Cerebral Artery/diagnostic imaging/*embryology MH - Pregnancy MH - Pregnancy Outcome MH - Risk Factors MH - Ultrasonography, Prenatal MH - Umbilical Arteries/diagnostic imaging/*embryology OTO - NOTNLM OT - Cerebroplacental ratio OT - Classification of 3-tiered intrapartum OT - Doppler OT - Fetal compromise OT - Intrapartum electronic fetal monitoring EDAT- 2016/10/31 06:00 MHDA- 2018/06/13 06:00 CRDT- 2016/10/31 06:00 PHST- 2016/04/19 00:00 [received] PHST- 2016/10/14 00:00 [accepted] PHST- 2016/10/31 06:00 [pubmed] PHST- 2018/06/13 06:00 [medline] PHST- 2016/10/31 06:00 [entrez] AID - 000452664 [pii] AID - 10.1159/000452664 [doi] PST - ppublish SO - Gynecol Obstet Invest. 2017;82(5):475-480. doi: 10.1159/000452664. Epub 2016 Oct 29. PMID- 27780275 OWN - NLM STAT- MEDLINE DCOM- 20180109 LR - 20180507 IS - 1098-8785 (Electronic) IS - 0735-1631 (Linking) VI - 34 IP - 5 DP - 2017 Apr TI - Diagnostic Accuracy of the FIGO and the 5-Tier Fetal Heart Rate Classification Systems in the Detection of Neonatal Acidemia. PG - 508-514 LID - 10.1055/s-0036-1593810 [doi] AB - Objective The objective of this study was to determine ability to detect neonatal acidemia and interobserver agreement with the FIGO 3-tier and 5-tier fetal heart rate (FHR) classification systems. Design This was a case-control study. Setting This study was set at the University Medical Center. Population A total of 202 FHR tracings of 102 women who delivered an acidemic fetus (umbilical arterial cord gas pH ≤ 7.10 and BE < - 8) and 100 who delivered a nonacidemic fetus (umbilical arterial cord gas pH > 7.10) were assessed. A subanalysis was performed for those fetuses who suffered severe metabolic acidemia (pH ≤ 7.0 and BE < - 12). Methods Two reviewers blind to clinical and outcome data classified tracings according to the new 3-tier system proposed by the FIGO and the 5-tier system proposed by Parer and Ikeda. Main Outcome Measures Sensitivity and specificity for detecting neonatal acidemia and interobserver agreement in classifying FHR tracings into categories of both systems were studied. Results The 3-tier system showed a greater sensitivity and lower specificity to detect neonatal acidemia (43.6% sensitivity, 82.5% specificity) and severe metabolic acidemia (71.4% sensitivity, 74.0% specificity) compared with the 5-tier system (36.3% sensitivity, 88% specificity and 61.9% sensitivity, 80.1% specificity, respectively). Both systems were compared by area under the receiver-operating characteristic curve, with comparable predictive ability for detecting neonatal acidemia (FIGO-area under the curve [AUC]: 0.63 [95% confidence interval [CI]: 0.57-0.68] and Parer-AUC: 0.62 [95% CI: 0.56-0.67]). Interobserver agreement was moderate for both systems, but performance at each specific category showed a better agreement for the 5-tier system identifying a pathological tracing (orange or red, κ: 0.625 vs. pathological category, κ: 0.538). Conclusion Both systems presented a comparable ability to predict neonatal acidemia, although the 5-tier system showed a better interobserver agreement identifying pathological tracings. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Martí Gamboa, Sabina AU - Martí Gamboa S AD - Department of Obstetrics, Miguel Servet University Hospital, Zaragoza, Spain. FAU - Giménez, Olga Redrado AU - Giménez OR AD - Department of Obstetrics, Miguel Servet University Hospital, Zaragoza, Spain. FAU - Mancho, Jara Pascual AU - Mancho JP AD - Department of Obstetrics, Miguel Servet University Hospital, Zaragoza, Spain. FAU - Moros, María Lapresta AU - Moros ML AD - Department of Obstetrics, Miguel Servet University Hospital, Zaragoza, Spain. FAU - Sada, Julia Ruiz AU - Sada JR AD - Department of Obstetrics, Miguel Servet University Hospital, Zaragoza, Spain. FAU - Mateo, Sergio Castan AU - Mateo SC AD - Department of Obstetrics, Miguel Servet University Hospital, Zaragoza, Spain. LA - eng PT - Comparative Study PT - Journal Article DEP - 20161025 PL - United States TA - Am J Perinatol JT - American journal of perinatology JID - 8405212 SB - IM MH - Acid-Base Imbalance/physiopathology MH - Acidosis/*diagnosis/*physiopathology MH - Adult MH - Area Under Curve MH - Cardiotocography/*classification MH - Case-Control Studies MH - Female MH - Fetal Blood/chemistry MH - *Heart Rate, Fetal MH - Humans MH - Hydrogen-Ion Concentration MH - Infant, Newborn MH - Observer Variation MH - ROC Curve MH - Retrospective Studies MH - Severity of Illness Index MH - Young Adult EDAT- 2016/10/26 06:00 MHDA- 2018/01/10 06:00 CRDT- 2016/10/26 06:00 PHST- 2016/10/26 06:00 [pubmed] PHST- 2018/01/10 06:00 [medline] PHST- 2016/10/26 06:00 [entrez] AID - 10.1055/s-0036-1593810 [doi] PST - ppublish SO - Am J Perinatol. 2017 Apr;34(5):508-514. doi: 10.1055/s-0036-1593810. Epub 2016 Oct 25. PMID- 27769196 OWN - NLM STAT- MEDLINE DCOM- 20171116 LR - 20191210 IS - 1471-2393 (Electronic) IS - 1471-2393 (Linking) VI - 16 IP - 1 DP - 2016 Oct 21 TI - Cardiotocography in breech versus vertex delivery: an examiner-blinded, cross-sectional nested case-control study. PG - 319 LID - 319 AB - BACKGROUND: The safety of vaginal breech delivery has been debated for decades. Although it has been shown to predispose infants to immediate depression, several observational studies have also shown that attempting vaginal breech delivery does not increase perinatal morbidity or low Apgar score at the age of five minutes. Cardiotocography monitoring is recommended during vaginal breech delivery, but comparative data describing differences between cardiotocography tracings in breech and vertex deliveries is scarce. This study aims to evaluate differences in intrapartum cardiotocography tracings between breech and vertex deliveries in the final 60 min of delivery. A secondary goal is to identify risk factors for suboptimal neonatal outcome in the study population. METHODS: One hundred eight breech and 108 vertex singleton, intended vaginal deliveries at term from a tertiary hospital with 5000 annual deliveries were included. Two experienced obstetricians, blinded to fetal presentation, neonatal outcome and actual mode of delivery, evaluated traces recorded 60 min before delivery. They provided a three-tier classification and evaluated different trace features according to FIGO (1987) guidelines. Factors associated with acidemia and low Apgar scores were identified by univariate and multivariable analyses performed with binary logistic regression. Student's T-test and chi-square test were used, as appropriate. RESULTS: Late decelerations were seen in 13.9 % of breech and 2.8 % of vertex deliveries (p = 0.003) and decreased variability in 26.9 % of breech and 8.3 % of vertex deliveries (p < 0.001). In multivariable analysis complicated variable decelerations and breech presentation were identified as risk factors for neonatal acidemia and low Apgar score at the age of five minutes. Pathological trace and breech presentation were independent risk factors for low Apgar score at the age of one minute. CONCLUSIONS: Decreased variability and late decelerations were more prevalent in breech compared to vertex deliveries. Pathological trace predicts immediate neonatal depression and especially complicated variable decelerations may signal more severe distress. Further research is needed to create guidelines for safe management of vaginal breech delivery. FAU - Toivonen, Elli AU - Toivonen E AUID- ORCID: 0000-0001-5637-3445 AD - School of Medicine, University of Tampere, 33014, Tampere, Finland. toivonen.elli.m@student.uta.fi. FAU - Palomäki, Outi AU - Palomäki O AD - Department of Obstetrics and Gynecology, Tampere University Hospital, PL 2000, 33521, Tampere, Finland. FAU - Huhtala, Heini AU - Huhtala H AD - School of Health Sciences, University of Tampere, 33014, Tampere, Finland. FAU - Uotila, Jukka AU - Uotila J AD - School of Medicine, University of Tampere, 33014, Tampere, Finland. AD - Department of Obstetrics and Gynecology, Tampere University Hospital, PL 2000, 33521, Tampere, Finland. LA - eng PT - Evaluation Study PT - Journal Article DEP - 20161021 TA - BMC Pregnancy Childbirth JT - BMC pregnancy and childbirth JID - 100967799 SB - IM MH - Acidosis/diagnostic imaging/etiology MH - Adult MH - Apgar Score MH - Breech Presentation/*diagnostic imaging MH - Cardiotocography/methods/*statistics & numerical data MH - Case-Control Studies MH - Chi-Square Distribution MH - Cross-Sectional Studies MH - Delivery, Obstetric/methods/*statistics & numerical data MH - Female MH - Humans MH - Infant, Newborn MH - Logistic Models MH - Multivariate Analysis MH - Pregnancy MH - Prenatal Diagnosis/methods MH - Risk Factors MH - Single-Blind Method MH - Term Birth/physiology PMC - PMC5073907 OTO - NOTNLM OT - *Breech presentation OT - *Cardiotocography OT - *Fetal monitoring OT - *Vaginal breech delivery EDAT- 2016/10/23 06:00 MHDA- 2017/11/29 06:00 CRDT- 2016/10/23 06:00 PHST- 2015/09/04 00:00 [received] PHST- 2016/10/14 00:00 [accepted] PHST- 2016/10/23 06:00 [pubmed] PHST- 2017/11/29 06:00 [medline] PHST- 2016/10/23 06:00 [entrez] AID - 10.1186/s12884-016-1115-5 [pii] AID - 1115 [pii] AID - 10.1186/s12884-016-1115-5 [doi] PST - epublish SO - BMC Pregnancy Childbirth. 2016 Oct 21;16(1):319. doi: 10.1186/s12884-016-1115-5. PMID- 27751795 OWN - NLM STAT- MEDLINE DCOM- 20170531 LR - 20180112 IS - 1097-6868 (Electronic) IS - 0002-9378 (Linking) VI - 216 IP - 2 DP - 2017 Feb TI - The limits of electronic fetal heart rate monitoring in the prevention of neonatal metabolic acidemia. PG - 163.e1-163.e6 LID - S0002-9378(16)30872-9 [pii] LID - 10.1016/j.ajog.2016.10.009 [doi] AB - BACKGROUND: Despite intensive efforts directed at initial training in fetal heart rate interpretation, continuing medical education, board certification/recertification, team training, and the development of specific protocols for the management of abnormal fetal heart rate patterns, the goals of consistently preventing hypoxia-induced fetal metabolic acidemia and neurologic injury remain elusive. OBJECTIVE: The purpose of this study was to validate a recently published algorithm for the management of category II fetal heart rate tracings, to examine reasons for the birth of infants with significant metabolic acidemia despite the use of electronic fetal heart rate monitoring, and to examine critically the limits of electronic fetal heart rate monitoring in the prevention of neonatal metabolic acidemia. STUDY DESIGN: The potential performance of electronic fetal heart rate monitoring under ideal circumstances was evaluated in an outcomes-blinded examination fetal heart rate tracing of infants with metabolic acidemia at birth (base deficit, >12) and matched control infants (base deficit, <8) under the following conditions: (1) expert primary interpretation, (2) use of a published algorithm that was developed and endorsed by a large group of national experts, (3) assumption of a 30-minute period of evaluation for noncritical category II fetal heart rate tracings, followed by delivery within 30 minutes, (4) evaluation without the need to provide patient care simultaneously, and (5) comparison of results under these circumstances with those achieved in actual clinical practice. RESULTS: During the study period, 120 infants were identified with an arterial cord blood base deficit of >12 mM/L. Matched control infants were not demographically different from subjects. In actual practice, operative intervention on the basis of an abnormal fetal heart rate tracings occurred in 36 of 120 fetuses (30.0%) with metabolic acidemia. Based on expert, algorithm-assisted reviews, 55 of 120 patients with acidemia (45.8%) were judged to need operative intervention for abnormal fetal heart rate tracings. This difference was significant (P=.016). In infants who were born with a base deficit of >12 mM/L in which blinded, algorithm-assisted expert review indicated the need for operative delivery, the decision for delivery would have been made an average of 131 minutes before the actual delivery. The rate of expert intervention for fetal heart rate concerns in the nonacidemic control group (22/120; 18.3%) was similar to the actual intervention rate (23/120; 19.2%; P=1.0) Expert review did not mandate earlier delivery in 65 of 120 patients with metabolic acidemia. The primary features of these 65 cases included the occurrence of sentinel events with prolonged deceleration just before delivery, the rapid deterioration of nonemergent category II fetal heart rate tracings before realistic time frames for recognition and intervention, and the failure of recognized fetal heart rate patterns such as variability to identify metabolic acidemia. CONCLUSIONS: Expert, algorithm-assisted fetal heart rate interpretation has the potential to improve standard clinical performance by facilitating significantly earlier recognition of some tracings that are associated with metabolic acidemia without increasing the rate of operative intervention. However, this improvement is modest. Of infants who are born with metabolic acidemia, only approximately one-half potentially could be identified and have delivery expedited even under ideal circumstances, which are probably not realistic in current US practice. This represents the limits of electronic fetal heart rate monitoring performance. Additional technologies will be necessary if the goal of the prevention of neonatal metabolic acidemia is to be realized. CI - Copyright © 2016 Elsevier Inc. All rights reserved. FAU - Clark, Steven L AU - Clark SL AD - Baylor College of Medicine and Texas Children's Hospital, Houston, TX. Electronic address: slclark@bcm.edu. FAU - Hamilton, Emily F AU - Hamilton EF AD - Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada; PeriGen, Cranbury, NJ, and Westmount, QC, Canada. FAU - Garite, Thomas J AU - Garite TJ AD - University of California Irvine, Orange, CA; Pediatrix Medical Group, Sunrise, FL. FAU - Timmins, Audra AU - Timmins A AD - Baylor College of Medicine and Texas Children's Hospital, Houston, TX. FAU - Warrick, Philip A AU - Warrick PA AD - PeriGen, Cranbury, NJ, and Westmount, QC, Canada. FAU - Smith, Samuel AU - Smith S AD - Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC; Department of Obstetrics and Gynecology, MedStar Franklin Square Medical Center, Rossville, MD; Department of Obstetrics and Gynecology, MedStar Harbor Hospital, Baltimore, MD. LA - eng PT - Journal Article DEP - 20161014 PL - United States TA - Am J Obstet Gynecol JT - American journal of obstetrics and gynecology JID - 0370476 SB - AIM SB - IM CIN - Am J Obstet Gynecol. 2017 May;216(5):536-537. PMID: 28034654 CIN - Am J Obstet Gynecol. 2017 May;216(5):535-536. PMID: 28034656 CIN - Am J Obstet Gynecol. 2017 May;216(5):532. PMID: 28143699 CIN - Am J Obstet Gynecol. 2017 Jul;217(1):92-93. PMID: 28274709 CIN - Am J Obstet Gynecol. 2017 Jul;217(1):93. PMID: 28283441 CIN - Am J Obstet Gynecol. 2018 Sep;219(3):314. PMID: 29705189 CIN - Am J Obstet Gynecol. 2018 Sep;219(3):314. PMID: 29705190 MH - Acidosis/etiology/*prevention & control MH - Adult MH - *Algorithms MH - Cardiotocography/*methods MH - Case-Control Studies MH - Cesarean Section MH - Clinical Decision-Making MH - Delivery, Obstetric/*methods MH - Extraction, Obstetrical MH - Female MH - Heart Rate, Fetal MH - Humans MH - Hypoxia/complications/*diagnosis MH - Infant, Newborn MH - Infant, Newborn, Diseases/etiology/*prevention & control MH - Pregnancy MH - Young Adult OTO - NOTNLM OT - category II OT - fetal heart rate monitoring OT - metabolic acidemia EDAT- 2016/10/30 06:00 MHDA- 2017/06/01 06:00 CRDT- 2016/10/30 06:00 PHST- 2016/08/16 00:00 [received] PHST- 2016/09/29 00:00 [revised] PHST- 2016/10/06 00:00 [accepted] PHST- 2016/10/30 06:00 [pubmed] PHST- 2017/06/01 06:00 [medline] PHST- 2016/10/30 06:00 [entrez] AID - S0002-9378(16)30872-9 [pii] AID - 10.1016/j.ajog.2016.10.009 [doi] PST - ppublish SO - Am J Obstet Gynecol. 2017 Feb;216(2):163.e1-163.e6. doi: 10.1016/j.ajog.2016.10.009. Epub 2016 Oct 14. PMID- 28405117 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200306 IS - 0971-9202 (Print) IS - 0975-6434 (Electronic) IS - 0975-6434 (Linking) VI - 67 IP - 2 DP - 2017 Apr TI - Oligoamnios and Perinatal Outcome. PG - 104-108 LID - 10.1007/s13224-016-0938-3 [doi] AB - OBJECTIVES: We aimed at evaluating the predictive value of amniotic fluid index ≤5 on perinatal outcome in terms of effect on cardiotocography, mode of delivery, meconium in liquor, birth weight, fetal distress, APGAR score at birth and neonatal admission to ICU. METHODS: This is a prospective study of 308 antenatal women admitted to labor ward of MIMS during February 2014-December 2015 with gestational ages between 34 and 41 weeks. All women enrolled were subjected to history taking, examination, AFI estimation and compared between those with AFI ≤5 from rest. RESULTS: The non-reactive CTG, cesarean section rate due to fetal distress, low birth weight, APGAR score <7 and NICU admission were significantly high among those with oligoamnios than the control group. CONCLUSION: Oligoamnios has a significant correlation with adverse perinatal outcome. FAU - Panda, Sandhyasri AU - Panda S AUID- ORCID: 0000-0002-2717-839X AD - Department of OBGYN, MIMS, Vizianagaram, A.P 535217 India. FAU - Jayalakshmi, M AU - Jayalakshmi M AD - Department of OBGYN, MIMS, Vizianagaram, A.P 535217 India. FAU - Shashi Kumari, G AU - Shashi Kumari G AD - Department of OBGYN, MIMS, Vizianagaram, A.P 535217 India. FAU - Mahalakshmi, G AU - Mahalakshmi G AD - Department of OBGYN, MIMS, Vizianagaram, A.P 535217 India. FAU - Srujan, Y AU - Srujan Y AD - Department of OBGYN, MIMS, Vizianagaram, A.P 535217 India. FAU - Anusha, V AU - Anusha V AD - Department of OBGYN, MIMS, Vizianagaram, A.P 535217 India. LA - eng PT - Journal Article DEP - 20160906 TA - J Obstet Gynaecol India JT - Journal of obstetrics and gynaecology of India JID - 0374763 PMC - PMC5371525 OTO - NOTNLM OT - *AFI OT - *Oligoamnios OT - *Perinatal outcome COIS- CONFLICT OF INTEREST: All the authors declare that they have no conflict of interest. INFORMED CONSENT: Informed consent was obtained from all individual participants included in the study. EDAT- 2017/04/14 06:00 MHDA- 2017/04/14 06:01 CRDT- 2017/04/14 06:00 PHST- 2016/05/25 00:00 [received] PHST- 2016/08/16 00:00 [accepted] PHST- 2017/04/14 06:00 [entrez] PHST- 2017/04/14 06:00 [pubmed] PHST- 2017/04/14 06:01 [medline] AID - 938 [pii] AID - 10.1007/s13224-016-0938-3 [doi] PST - ppublish SO - J Obstet Gynaecol India. 2017 Apr;67(2):104-108. doi: 10.1007/s13224-016-0938-3. Epub 2016 Sep 6. PMID- 27374723 OWN - NLM STAT- MEDLINE DCOM- 20170222 LR - 20210109 IS - 1600-0412 (Electronic) IS - 0001-6349 (Print) IS - 0001-6349 (Linking) VI - 95 IP - 9 DP - 2016 Sep TI - Fetal movements as a predictor of health. PG - 968-75 LID - 10.1111/aogs.12944 [doi] AB - The key determinant to a fetus maintaining its health is through adequate perfusion and oxygen transfer mediated by the functioning placenta. When this equilibrium is distorted, a number of physiological changes, including reduced fetal growth, occur to favor survival. Technologies have been developed to monitor these changes with a view to prolong intrauterine maturity while reducing the risks of stillbirth. Many of these strategies involve complex interpretation, for example Doppler ultrasound for fetal blood flow and computerized analysis of fetal heart rate changes. However, even with these modalities of fetal assessment to determine the optimal timing of delivery, fetal movements remain integral to clinical decision-making. In high-risk cohorts with fetal growth restriction, the manifestation of a reduction in perceived movements may warrant an expedited delivery. Despite this, there has been little evolution in the development of technologies to objectively evaluate fetal movement behavior for clinical application. This review explores the available literature on the value of fetal movement analysis as a method of assessing fetal wellbeing, and demonstrates how interdisciplinary developments in this area may aid in the improvement of clinical outcomes. CI - © 2016 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). FAU - Lai, Jonathan AU - Lai J AD - Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Imperial College London, London, UK. FAU - Nowlan, Niamh C AU - Nowlan NC AUID- ORCID: 0000-0002-9083-6279 AD - Department of Bioengineering, Imperial College London, London, UK. FAU - Vaidyanathan, Ravi AU - Vaidyanathan R AUID- ORCID: 0000-0002-9625-4544 AD - Department of Mechanical Engineering, Imperial College London, London, UK. FAU - Shaw, Caroline J AU - Shaw CJ AUID- ORCID: 0000-0002-8002-2976 AD - Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Imperial College London, London, UK. AD - Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK. FAU - Lees, Christoph C AU - Lees CC AUID- ORCID: 0000-0002-1346-511X AD - Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Imperial College London, London, UK. AD - Department of Development and Regeneration, KU Leuven, Leuven, Belgium. LA - eng PT - Journal Article PT - Review TA - Acta Obstet Gynecol Scand JT - Acta obstetricia et gynecologica Scandinavica JID - 0370343 SB - IM MH - Adaptation, Physiological MH - Cardiotocography MH - Female MH - Fetal Growth Retardation/physiopathology MH - Fetal Hypoxia/diagnosis MH - Fetal Monitoring/*methods MH - *Fetal Movement MH - Heart Rate, Fetal MH - Humans MH - Pregnancy MH - Pregnancy Outcome MH - Stillbirth MH - Ultrasonography, Doppler MH - Ultrasonography, Prenatal PMC - PMC6680271 OTO - NOTNLM OT - Fetal movements OT - biophysical profile OT - fetal growth restriction OT - fetal monitoring OT - stillbirth EDAT- 2016/07/05 06:00 MHDA- 2017/02/23 06:00 CRDT- 2016/07/05 06:00 PHST- 2016/01/28 00:00 [received] PHST- 2016/06/27 00:00 [accepted] PHST- 2016/07/05 06:00 [entrez] PHST- 2016/07/05 06:00 [pubmed] PHST- 2017/02/23 06:00 [medline] AID - AOGS12944 [pii] AID - 10.1111/aogs.12944 [doi] PST - ppublish SO - Acta Obstet Gynecol Scand. 2016 Sep;95(9):968-75. doi: 10.1111/aogs.12944. PMID- 27568410 OWN - NLM STAT- MEDLINE DCOM- 20171106 LR - 20171106 IS - 1769-6682 (Electronic) IS - 1297-9589 (Linking) VI - 44 IP - 9 DP - 2016 Sep TI - [Per partum acidosis: Interest and feasibility of cerebral Doppler during labor]. PG - 475-9 LID - S1297-9589(16)30177-1 [pii] LID - 10.1016/j.gyobfe.2016.07.001 [doi] AB - OBJECTIVES: To evaluate feasibility and interest of fetal cerebral Doppler during labor and the link with fetal pH to predict perinatal fetal asphyxia. METHODS: Our prospective study in a university perinatal center, included patients during labor. There were no risk factors during pregnancy and patients were included after 37 weeks of pregnancy. For each patient an ultrasound with cerebral Doppler was done concomitant to a fetal scalp blood sample. We collected maternal and fetal characteristics as well as cervix dilatation, fetal heart rate analysis and fetal presentation. RESULTS: Among 49 patients included over a period of 4 months, cerebral Doppler failed in 7 cases (11%). Majority of failure occurred at 10cm of dilatation (P=0.007, OR=14.1 [1.483; 709.1275]). Others factors like: maternal age, body mass index, parity, history of C-Section were not associated with higher rate of failure. We did not found either significant correlation between cerebral fetal Doppler and pH on fetal scalp blood sample (r=0.15) nor pH at cord blood sample (r=0.13). No threshold of cerebral Doppler is significant for fetal asphyxia prediction. CONCLUSION: Fetal cerebral Doppler is feasible during labor with a low rate of failure but not a good exam to predict fetal acidosis and asphyxia. CI - Copyright © 2016 Elsevier Masson SAS. All rights reserved. FAU - Barrois, M AU - Barrois M AD - Maternité Port-Royal, groupe hospitalier Broca-Cochin-Hôtel Dieu, 53, avenue de l'Observatoire, 75014 Paris, France. Electronic address: barrois.mathilde@gmail.com. FAU - Chartier, M AU - Chartier M AD - Maternité Port-Royal, groupe hospitalier Broca-Cochin-Hôtel Dieu, 53, avenue de l'Observatoire, 75014 Paris, France. FAU - Lecarpentier, E AU - Lecarpentier E AD - Maternité Port-Royal, groupe hospitalier Broca-Cochin-Hôtel Dieu, 53, avenue de l'Observatoire, 75014 Paris, France; PRES Sorbonne Paris Cité, Université Paris Descartes, 75013 Paris, France; DHU risques et grossesse, 75014 Paris, France; PremUP foundation, 75014 Paris, France; Inserm, UMR-S 1139, physiopathologie et pharmacotoxicologie placentaire humaine, 75006 Paris, France. FAU - Goffinet, F AU - Goffinet F AD - Maternité Port-Royal, groupe hospitalier Broca-Cochin-Hôtel Dieu, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, 75014 Paris, France; Inserm, U-1153, 75004 Paris, France. FAU - Tsatsaris, V AU - Tsatsaris V AD - Maternité Port-Royal, groupe hospitalier Broca-Cochin-Hôtel Dieu, 53, avenue de l'Observatoire, 75014 Paris, France; PRES Sorbonne Paris Cité, Université Paris Descartes, 75013 Paris, France; DHU risques et grossesse, 75014 Paris, France; PremUP foundation, 75014 Paris, France; Inserm, UMR-S 1139, physiopathologie et pharmacotoxicologie placentaire humaine, 75006 Paris, France. LA - fre PT - Journal Article TT - Intérêt et faisabilité du Doppler cérébral en cours de travail pour prédire une acidose néonatale. DEP - 20160824 PL - France TA - Gynecol Obstet Fertil JT - Gynecologie, obstetrique & fertilite JID - 100936305 SB - IM MH - Acidosis/*diagnosis MH - Asphyxia Neonatorum/*diagnosis MH - Brain/*diagnostic imaging/embryology MH - Feasibility Studies MH - Female MH - Fetal Blood/*chemistry MH - Fetal Hypoxia MH - Heart Rate, Fetal MH - Humans MH - Hydrogen-Ion Concentration MH - Infant, Newborn MH - Labor Presentation MH - *Labor, Obstetric MH - Pregnancy MH - Prospective Studies MH - Scalp/blood supply/embryology MH - *Ultrasonography, Prenatal OTO - NOTNLM OT - Acidose néonatale OT - Cerebral Doppler OT - Doppler cérébral OT - Fetal acidosis OT - Labor OT - PH au scalp OT - Scalp pH OT - Travail EDAT- 2016/08/29 06:00 MHDA- 2017/11/07 06:00 CRDT- 2016/08/29 06:00 PHST- 2016/03/15 00:00 [received] PHST- 2016/07/04 00:00 [accepted] PHST- 2016/08/29 06:00 [entrez] PHST- 2016/08/29 06:00 [pubmed] PHST- 2017/11/07 06:00 [medline] AID - S1297-9589(16)30177-1 [pii] AID - 10.1016/j.gyobfe.2016.07.001 [doi] PST - ppublish SO - Gynecol Obstet Fertil. 2016 Sep;44(9):475-9. doi: 10.1016/j.gyobfe.2016.07.001. Epub 2016 Aug 24. PMID- 27450900 OWN - NLM STAT- MEDLINE DCOM- 20180307 LR - 20180307 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) VI - 30 IP - 12 DP - 2017 Jun TI - Elevated C-reactive protein levels in histological chorioamnionitis at term: impact of funisitis on term neonates. PG - 1428-1433 LID - 10.1080/14767058.2016.1216539 [doi] AB - OBJECTIVE: To compare clinical features and inflammatory effects for mothers and newborns between cases with or without funisitis among histlogical chorioamnionitis (HCA) at term. METHODS: We recruited 42 patients who were diagnosed with HCA at term. The women were classified into group HCA1/2 (HCA without funisitis, n = 22) and group HCA3 (HCA with funisitis, n = 20). Medical records and cardiotocograms were retrospectively reviewed to analyze predelivery maternal signs, abnormal FHR patterns, and neonatal outcomes. Differences between the two groups were evaluated using the Mann-Whitney U-test. RESULTS: The maternal CRP and WBC level of group HCA3 was observed to be significantly greater than that of group HCA1/2. Moreover, neonatal CRP levels at days 0, 1 and 2 of group HCA3 were significantly greater than of group HCA1/2. The ratios of abnormal FHR patterns of the two groups for recurrent late deceleration and prolonged deceleration were 26% and 43%, respectively, which was not statistically significant between the two groups. CONCLUSION: We showed that HCA at term, particularly for funisitis, elevates the levels of maternal and neonatal CRP. Neonatal inflammatory signs, including elevated CRP levels, should be considered when managing cases of abnormal elevated CRP levels during labor at term. FAU - Samejima, Taiki AU - Samejima T AD - a Department of Obstetrics and Gynecology , Showa General Hospital , Kodaira , Tokyo , Japan. FAU - Takechi, Kimihiro AU - Takechi K AD - a Department of Obstetrics and Gynecology , Showa General Hospital , Kodaira , Tokyo , Japan. LA - eng PT - Journal Article DEP - 20160818 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 RN - 0 (Biomarkers) RN - 9007-41-4 (C-Reactive Protein) SB - IM MH - Adult MH - Biomarkers/blood MH - C-Reactive Protein/*analysis MH - Case-Control Studies MH - Chorioamnionitis/*blood/diagnosis/pathology MH - Connective Tissue Diseases/blood/diagnosis/pathology MH - Female MH - Heart Rate, Fetal/physiology MH - Humans MH - Infant, Newborn MH - Predictive Value of Tests MH - Pregnancy MH - Pregnancy Outcome MH - Retrospective Studies MH - Statistics, Nonparametric OTO - NOTNLM OT - Inflammation OT - abnormal fetal heart rate pattern OT - infection OT - noninfectious neonates EDAT- 2016/07/28 06:00 MHDA- 2018/03/08 06:00 CRDT- 2016/07/25 06:00 PHST- 2016/07/28 06:00 [pubmed] PHST- 2018/03/08 06:00 [medline] PHST- 2016/07/25 06:00 [entrez] AID - 10.1080/14767058.2016.1216539 [doi] PST - ppublish SO - J Matern Fetal Neonatal Med. 2017 Jun;30(12):1428-1433. doi: 10.1080/14767058.2016.1216539. Epub 2016 Aug 18. PMID- 27567534 OWN - NLM STAT- MEDLINE DCOM- 20170428 LR - 20170428 IS - 1872-7654 (Electronic) IS - 0301-2115 (Linking) VI - 205 DP - 2016 Oct TI - Quantitative cardiotocography to improve fetal assessment during labor: a preliminary randomized controlled trial. PG - 91-7 LID - S0301-2115(16)30871-5 [pii] LID - 10.1016/j.ejogrb.2016.08.023 [doi] AB - OBJECTIVE: To evaluate the effectiveness of a computerized decision support system, referred to as "quantitative cardiotocography" (qCTG), to reduce adverse birth outcomes compared to conventional CTG with fetal blood sampling. STUDY DESIGN: A preliminary parallel randomized control trial in a tertiary maternity hospital (Sofia, Bulgaria) was conducted with a sample size of 360 women per trial arm (N=720). Women in labor were recruited between March 2008 and March 2011. Unadjusted relative risks were derived to assess the effect of qCTG on outcomes of interest. A ROC curve was derived to determine the sensitivity and specificity of qCTG to detect acidemia (Clinical trial registration: Current Controlled Trials, http://www.controlled-trials.com/, ISRCTN46449237). MAIN OUTCOME MEASURES: Primary outcomes were hypoxia (cord-artery blood pH<7.20), acidemia (umbilical-artery blood pH<7.05), cesarean delivery, and forceps extraction. Secondary outcomes were Apgar score <7 at five minutes, neonatal seizures, and admission to the neonatal intensive care unit (NICU). RESULTS: Reduced risks were observed for all outcomes of interest in women monitored using qCTG. There was a significant reduction in hypoxia (RR: 0.53; 0.33, 0.84), acidemia (RR: 0.31; 95% CI: 0.12, 0.84), cesarean delivery (95% CI: 0.45, 0.85), and admission to the NICU (RR: 0.33; 95% CI: 0.14, 0.77) in women monitored using qCTG versus conventional CTG. CONCLUSION: qCTG may reduce risk of adverse birth outcomes; however, the small sample size and long recruitment period in this trial may overstate the benefits of this intervention. Further large-scale randomized control trials with sufficient sample size to detect rare adverse events are required prior to the adoption of qCTG in daily clinical practice. CI - Copyright © 2016 Elsevier Ireland Ltd. All rights reserved. FAU - Ignatov, Petar N AU - Ignatov PN AD - Second Municipal Hospital for Obstetrics and Gynecology Sheynovo, Sofia, Bulgaria; Orthogyn Medical Center, Sofia, Bulgaria. Electronic address: ignatov@orthogyn.com. FAU - Lutomski, Jennifer E AU - Lutomski JE AD - National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands. LA - eng PT - Journal Article PT - Randomized Controlled Trial DEP - 20160810 PL - Ireland TA - Eur J Obstet Gynecol Reprod Biol JT - European journal of obstetrics, gynecology, and reproductive biology JID - 0375672 SB - IM MH - Acidosis/*diagnosis MH - Adult MH - Cardiotocography/*methods MH - Decision Support Systems, Clinical MH - Female MH - Fetal Distress/*diagnosis MH - Fetal Monitoring/*methods MH - Heart Rate, Fetal MH - Humans MH - Infant, Newborn MH - *Labor, Obstetric MH - Pregnancy MH - Sensitivity and Specificity MH - Young Adult OTO - NOTNLM OT - *Acidemia OT - *Cardiotocography OT - *Cesarean section OT - *Clinical decision support systems OT - *Fetal hypoxia EDAT- 2016/08/29 06:00 MHDA- 2017/04/30 06:00 CRDT- 2016/08/29 06:00 PHST- 2016/01/06 00:00 [received] PHST- 2016/07/29 00:00 [revised] PHST- 2016/08/01 00:00 [accepted] PHST- 2016/08/29 06:00 [entrez] PHST- 2016/08/29 06:00 [pubmed] PHST- 2017/04/30 06:00 [medline] AID - S0301-2115(16)30871-5 [pii] AID - 10.1016/j.ejogrb.2016.08.023 [doi] PST - ppublish SO - Eur J Obstet Gynecol Reprod Biol. 2016 Oct;205:91-7. doi: 10.1016/j.ejogrb.2016.08.023. Epub 2016 Aug 10. PMID- 27566218 OWN - NLM STAT- MEDLINE DCOM- 20170428 LR - 20170428 IS - 1872-7654 (Electronic) IS - 0301-2115 (Linking) VI - 205 DP - 2016 Oct TI - Interobserver agreement in CTG interpretation using the 2015 FIGO guidelines for intrapartum fetal monitoring. PG - 27-31 LID - S0301-2115(16)30865-X [pii] LID - 10.1016/j.ejogrb.2016.08.017 [doi] AB - BACKGROUND: Visual analysis of cardiotocographic (CTG) tracings has been shown to be prone to poor intra- and interobserver agreement when several interpretation guidelines are used, and this may have an important impact on the technology's performance. OBJECTIVES: The aim of this study was to evaluate agreement in CTG interpretation using the new 2015 FIGO guidelines on intrapartum fetal monitoring. STUDY DESIGN: A pre-existing database of intrapartum CTG tracings was used to sequentially select 151 cases acquired with a fetal electrode, with duration exceeding 60minutes, and signal loss less than 15%. These tracings were presented to six clinicians, three with more than 5 years' experience in the labor ward, and three with 5 or less years' experience. Observers were asked to evaluate tracings independently, to assess basic CTG features: baseline, variability, accelerations, decelerations, sinusoidal pattern, tachysystole, and to classify each tracing as normal, suspicious or pathologic, according to the 2015 FIGO guidelines on intrapartum fetal monitoring. Agreement between observers was evaluated using the proportions of agreement (Pa), with 95% confidence intervals (95%CI). RESULTS: A good interobserver agreement was found in the evaluation of most CTG features, but not bradycardia, reduced variability, saltatory pattern, absence of accelerations and absence of decelerations. For baseline classification Pa was 0.85 [0.82-0.90], for variability 0.82 [0.78-0.85], for accelerations 0.72 [0.68-0.75], for tachysystole 0.77 [0.74-0.81], for decelerations 0.92 [0.90-0.95], for variable decelerations 0.62 [0.58-0.65], for late decelerations 0.63 [0.59-0.66], for repetitive decelerations 0.73 [0.69-0.78], and for prolonged decelerations 0.81 [0.77-0.85]. For overall CTG classification, Pa were 0.60 [0.56-0.64], for classification as normal 0.67 [0.61-0.72], for suspicious 0.54 [0.48-0.60] and for pathologic 0.59 [0.51-0.66]. No differences in agreement according to the level of expertise were observed, except in the identification of accelerations, where it was better in the more experienced group. CONCLUSIONS: A good interobserver agreement was found in evaluation of most CTG features and in overall tracing classification. Results were better than those reported in previous studies evaluating agreement in overall tracing classification. Observer experience did not appear to play a role in agreement. CI - Copyright © 2016 Elsevier Ireland Ltd. All rights reserved. FAU - Rei, Mariana AU - Rei M AD - Department of Obstetrics and Gynecology, Medical School, University of Porto, Portugal; S. Joao Hospital, Porto, Portugal; Institute of Biomedical Engineering (INEB), Porto, Portugal; Instituto de Investigação e Inovação em Saúde (i3s), Porto, Portugal. Electronic address: marianacruzrei@gmail.com. FAU - Tavares, Sara AU - Tavares S AD - Department of Obstetrics and Gynecology, Medical School, University of Porto, Portugal; S. Joao Hospital, Porto, Portugal. FAU - Pinto, Pedro AU - Pinto P AD - S. Joao Hospital, Porto, Portugal. FAU - Machado, Ana P AU - Machado AP AD - S. Joao Hospital, Porto, Portugal. FAU - Monteiro, Sofia AU - Monteiro S AD - S. Joao Hospital, Porto, Portugal. FAU - Costa, Antónia AU - Costa A AD - Department of Obstetrics and Gynecology, Medical School, University of Porto, Portugal; S. Joao Hospital, Porto, Portugal; Institute of Biomedical Engineering (INEB), Porto, Portugal; Instituto de Investigação e Inovação em Saúde (i3s), Porto, Portugal. FAU - Costa-Santos, Cristina AU - Costa-Santos C AD - Department of Health Informatics and Decision Sciences, Medical School, University of Porto, Portugal; Centre for Research in Health Information Systems and Technologies (CINTESIS), Portugal. FAU - Bernardes, João AU - Bernardes J AD - Department of Obstetrics and Gynecology, Medical School, University of Porto, Portugal; S. Joao Hospital, Porto, Portugal; Institute of Biomedical Engineering (INEB), Porto, Portugal; Instituto de Investigação e Inovação em Saúde (i3s), Porto, Portugal; Centre for Research in Health Information Systems and Technologies (CINTESIS), Portugal; Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Portugal. FAU - Ayres-De-Campos, Diogo AU - Ayres-De-Campos D AD - Department of Obstetrics and Gynecology, Medical School, University of Porto, Portugal; S. Joao Hospital, Porto, Portugal; Institute of Biomedical Engineering (INEB), Porto, Portugal; Instituto de Investigação e Inovação em Saúde (i3s), Porto, Portugal; Centre for Research in Health Information Systems and Technologies (CINTESIS), Portugal. LA - eng PT - Journal Article DEP - 20160809 PL - Ireland TA - Eur J Obstet Gynecol Reprod Biol JT - European journal of obstetrics, gynecology, and reproductive biology JID - 0375672 SB - IM MH - Cardiotocography/*methods MH - Female MH - Fetal Monitoring/*methods MH - Heart Rate, Fetal/*physiology MH - Humans MH - Observer Variation MH - Practice Guidelines as Topic MH - Pregnancy OTO - NOTNLM OT - Cardiotocography OT - Fetal heart rate OT - Interobserver agreement OT - Intrapartum fetal monitoring OT - Reliability OT - Reproducibility EDAT- 2016/08/28 06:00 MHDA- 2017/04/30 06:00 CRDT- 2016/08/28 06:00 PHST- 2016/05/14 00:00 [received] PHST- 2016/07/06 00:00 [revised] PHST- 2016/08/01 00:00 [accepted] PHST- 2016/08/28 06:00 [entrez] PHST- 2016/08/28 06:00 [pubmed] PHST- 2017/04/30 06:00 [medline] AID - S0301-2115(16)30865-X [pii] AID - 10.1016/j.ejogrb.2016.08.017 [doi] PST - ppublish SO - Eur J Obstet Gynecol Reprod Biol. 2016 Oct;205:27-31. doi: 10.1016/j.ejogrb.2016.08.017. Epub 2016 Aug 9. PMID- 28268931 OWN - NLM STAT- MEDLINE DCOM- 20170630 LR - 20200928 IS - 2694-0604 (Electronic) IS - 2375-7477 (Linking) VI - 2016 DP - 2016 Aug TI - Selective heart rate variability analysis to account for uterine activity during labor and improve classification of fetal distress. PG - 2950-2953 LID - 10.1109/EMBC.2016.7591348 [doi] AB - Cardiotocography (CTG) is currently the most often used technique for detection of fetal distress. Unfortunately, CTG has a poor specificity. Recent studies suggest that, in addition to CTG, information on fetal distress can be obtained from analysis of fetal heart rate variability (HRV). However, uterine contractions can strongly influence fetal HRV. The aim of this study is therefore to investigate whether HRV analysis for detection of fetal distress can be improved by distinguishing contractions from rest periods. Our results from feature selection indicate that HRV features calculated separately during contractions or during rest periods are more informative on fetal distress than HRV features that are calculated over the entire fetal heart rate. Furthermore, classification performance improved from a geometric mean of 69.0% to 79.6% when including the contraction-dependent HRV features, in addition to HRV features calculated over the entire fetal heart rate. FAU - Warmerdam, G J J AU - Warmerdam GJ FAU - Vullings, R AU - Vullings R FAU - Van Laar, J O E H AU - Van Laar JO FAU - Van der Hout-Van der Jagt, M B AU - Van der Hout-Van der Jagt MB FAU - Bergmans, J W M AU - Bergmans JW FAU - Schmitt, L AU - Schmitt L FAU - Oei, S G AU - Oei SG LA - eng PT - Journal Article PL - United States TA - Annu Int Conf IEEE Eng Med Biol Soc JT - Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference JID - 101763872 SB - IM MH - Algorithms MH - Female MH - Fetal Distress/*diagnosis/*physiopathology MH - Heart Rate, Fetal/*physiology MH - Humans MH - Labor, Obstetric/*physiology MH - Pregnancy MH - Signal Processing, Computer-Assisted MH - Uterine Contraction/*physiology EDAT- 2017/03/09 06:00 MHDA- 2017/07/01 06:00 CRDT- 2017/03/09 06:00 PHST- 2017/03/09 06:00 [entrez] PHST- 2017/03/09 06:00 [pubmed] PHST- 2017/07/01 06:00 [medline] AID - 10.1109/EMBC.2016.7591348 [doi] PST - ppublish SO - Annu Int Conf IEEE Eng Med Biol Soc. 2016 Aug;2016:2950-2953. doi: 10.1109/EMBC.2016.7591348. PMID- 28268471 OWN - NLM STAT- MEDLINE DCOM- 20170731 LR - 20200928 IS - 2694-0604 (Electronic) IS - 2375-7477 (Linking) VI - 2016 DP - 2016 Aug TI - Examining the effect of MgSO4 on sharp wave transient activity in the hypoxic-ischemic fetal sheep model. PG - 908-911 LID - 10.1109/EMBC.2016.7590848 [doi] AB - Hypoxic-ischemic encephalopathy (HIE) due to lack of oxygen is a debilitating disorder experienced by a significant number of preterm infants during birth. Studies show that the brain undergoes different phases of injury following hypoxic insult, but the first 6-8 hours (known as a latent phase) are the key to treatment efficacy. Cerebral hypothermia is one known treatment, and for it to be effective it must be started during the latent phase and continued for several days. In order to determine the effectiveness of treatment it is important to pinpoint the time of insult. Monitoring of sharp wave transient activity in the hypoxic-ischemic (HI) electroencephalogram (EEG) could be a predictor for time of hypoxic insult. Due to practicality, it is optimal if this monitoring is performed automatically. Further, MgSO4 is a drug given to an increasing number of women in labor, due to its neuroprotective properties. This drug may influence transient activity in the HI fetal sheep EEG, leading to further complications in predicting hypoxic insult. This paper explores the effect of MgSO4 on sharp wave transient activity in the EEG of a HI fetal sheep. Demonstrated in this paper is the usage of a Wavelet-Type-II Fuzzy classifier to detect sharp wave transients during the latent phase of a control group fetal sheep and an MgSO4-treated fetal sheep. This detection was performed with an average overall performance of 93.21%±5.49 over 660 minutes of latent phase, post occlusion. There were no significant differences in number of sharp wave transients in the early- and mid-latent phases of injury for both fetal sheep. However, in the late-latent phase the MgSO4-treated fetal sheep had significantly fewer sharp wave transients than the control fetal sheep. FAU - Lakadia, Meherzad J AU - Lakadia MJ FAU - Abbasi, Hamid AU - Abbasi H FAU - Gunn, Alistair J AU - Gunn AJ FAU - Unsworth, Charles P AU - Unsworth CP FAU - Bennet, Laura AU - Bennet L LA - eng PT - Journal Article PL - United States TA - Annu Int Conf IEEE Eng Med Biol Soc JT - Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference JID - 101763872 RN - 7487-88-9 (Magnesium Sulfate) SB - IM MH - Animals MH - Brain/*drug effects/embryology/physiology MH - Electroencephalography/*methods MH - Female MH - Fuzzy Logic MH - Hypoxia-Ischemia, Brain/*drug therapy/physiopathology MH - Magnesium Sulfate/*pharmacology MH - Pregnancy MH - Sheep, Domestic MH - Signal Processing, Computer-Assisted MH - Wavelet Analysis EDAT- 2017/03/09 06:00 MHDA- 2017/08/02 06:00 CRDT- 2017/03/09 06:00 PHST- 2017/03/09 06:00 [entrez] PHST- 2017/03/09 06:00 [pubmed] PHST- 2017/08/02 06:00 [medline] AID - 10.1109/EMBC.2016.7590848 [doi] PST - ppublish SO - Annu Int Conf IEEE Eng Med Biol Soc. 2016 Aug;2016:908-911. doi: 10.1109/EMBC.2016.7590848. PMID- 27462527 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20160727 LR - 20200930 IS - 2193-1801 (Print) IS - 2193-1801 (Electronic) IS - 2193-1801 (Linking) VI - 5 IP - 1 DP - 2016 TI - Electrocardiography versus photoplethysmography in assessment of maternal heart rate variability during labor. PG - 1079 LID - 10.1186/s40064-016-2787-z [doi] LID - 1079 AB - PURPOSE: Evaluation of maternal heart rate (MHR) variability provides useful information on the maternal-fetal clinical state. Electrocardiography (ECG) is the most accurate method to monitor MHR but it may not always be available, and pulse oximetry using photoplethysmography (PPG) can be an alternative. In this study we compared ECG and PPG signals, obtained with conventional fetal monitors, to evaluate signal loss, MHR variability indices, and the ability of the latter to predict fetal acidemia and operative delivery. METHODS: Both signals were simultaneously acquired in 51 term pregnancies during the last 2 h of labor (H1 and H2). Linear time- and frequency-domain, and nonlinear MHR variability indices were estimated, and the dataset was divided into normal and acidemic cases, as well as into normal and operative deliveries. Differences between ECG and PPG signals were assessed using non-parametric confidence intervals, hypothesis testing, correlation coefficient and a measure of disagreement. Prediction of fetal acidemia and operative delivery was assessed using areas under the receiver operating characteristic curve (auROC). RESULTS: Signal loss was higher with ECG during the first segments of H1, and higher with PPG in the last segment of H2, and it increased in both signals with labour progression. MHR variability indices were significantly different when acquired with ECG and PPG signals, with low correlation coefficients and high disagreement for entropy and fast oscillation-based indices, and low disagreement for the mean MHR and slow oscillation-based indices. However, both acquisition modes evidenced significant differences between H1 and H2 and comparable auROC values were obtained in the detection of fetal acidemia and operative vaginal delivery. CONCLUSION: Although PPG captures the faster oscillations of the MHR signal less well than ECG and is prone to have higher signal loss in the last 10-min preceding delivery, it can be considered an alternative for MHR monitoring during labor, with adaptation of cut-off values for MHR variability indices. FAU - Gonçalves, Hernâni AU - Gonçalves H AD - Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Rua Dr Plácido da Costa, s/n, 4200-450 Porto, Portugal. FAU - Pinto, Paula AU - Pinto P AD - Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Rua Dr Plácido da Costa, s/n, 4200-450 Porto, Portugal ; Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal ; Hospital Dr Nélio Mendonça, EPE, Funchal, Portugal. FAU - Silva, Manuela AU - Silva M AD - Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal. FAU - Ayres-de-Campos, Diogo AU - Ayres-de-Campos D AD - Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal ; Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal ; INEB - Institute of Biomedical Engineering, Porto; I3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal. FAU - Bernardes, João AU - Bernardes J AD - Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Rua Dr Plácido da Costa, s/n, 4200-450 Porto, Portugal ; Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal ; Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal ; Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Senhora da Hora, Portugal. LA - eng PT - Journal Article DEP - 20160715 TA - Springerplus JT - SpringerPlus JID - 101597967 PMC - PMC4945517 OTO - NOTNLM OT - Cardiotocography OT - Electrocardiography OT - Fetal monitoring OT - Maternal heart rate OT - Pulse oximetry OT - Signal processing EDAT- 2016/07/28 06:00 MHDA- 2016/07/28 06:01 CRDT- 2016/07/28 06:00 PHST- 2016/02/03 00:00 [received] PHST- 2016/07/06 00:00 [accepted] PHST- 2016/07/28 06:00 [entrez] PHST- 2016/07/28 06:00 [pubmed] PHST- 2016/07/28 06:01 [medline] AID - 2787 [pii] AID - 10.1186/s40064-016-2787-z [doi] PST - epublish SO - Springerplus. 2016 Jul 15;5(1):1079. doi: 10.1186/s40064-016-2787-z. eCollection 2016. PMID- 27238561 OWN - NLM STAT- MEDLINE DCOM- 20170227 LR - 20170817 IS - 1600-0412 (Electronic) IS - 0001-6349 (Linking) VI - 95 IP - 10 DP - 2016 Oct TI - Longitudinal evaluation of computerized cardiotocographic parameters throughout pregnancy in normal fetuses: a prospective cohort study. PG - 1143-52 LID - 10.1111/aogs.12932 [doi] AB - INTRODUCTION: The longitudinal cardiotocographic (CTG) changes throughout pregnancy in normal fetuses have never been fully described. We aimed at characterizing the evolution of CTG parameters in healthy fetuses, from 24 to 41 weeks of gestation. MATERIAL AND METHODS: A prospective cohort study was conducted in singleton fetuses without structural abnormalities on second-trimester ultrasound. At least one CTG was performed in each of the following intervals: 24-26 weeks(+6d) , 27-29 weeks(+6d) , 30-32 weeks(+6d) , 33-35 weeks(+6d) , 36-38 weeks(+6d) and ≥39 weeks; tracings were analyzed by the OMNIVIEW-SISPORTO 3.6 system. Cases of preterm delivery, fetal death, birthweight under the 10th percentile, low five-minute Apgar, umbilical artery acidemia or neonatal intensive care unit admission were subsequently excluded. RESULTS: A total of 1049 eligible tracings were obtained from 145 fetuses. There was a significant increase over time in average long-term variability (LTV), average short-term variability (STV), number of accelerations and uterine contractions. Conversely, fetal heart rate (FHR) baseline and number of decelerations decreased. A high inter-fetal variability was observed, but there was considerable intra-fetal consistency. Fetuses showing a marked decrease in FHR baseline and those with a marked increase in average LTV had a significantly lower birthweight. Cesarean section rate was significantly higher in cases with a decrease in average STV throughout gestation. CONCLUSIONS: This prospective longitudinal study shows an evolution in computerized CTG parameters during pregnancy, indicating the need to adapt interpretation criteria based on gestational age. The high inter-fetal variability and considerable intra-fetal consistency suggests the possible value of using each fetus as its own reference in serial assessments. CI - © 2016 Nordic Federation of Societies of Obstetrics and Gynecology. FAU - Amorim-Costa, Célia AU - Amorim-Costa C AD - Department of Obstetrics and Gynecology, Porto Medical School, University of Porto, Porto, Portugal. celia.m.costa@hotmail.com. AD - Institute for Research and Innovation in Health (I3S) and Institute of Biomedical Engineering (INEB), University of Porto, Porto, Portugal. celia.m.costa@hotmail.com. AD - Center for Research in Health Technologies and Information Systems (CINTESIS), Porto Medical School, University of Porto, Porto, Portugal. celia.m.costa@hotmail.com. FAU - Costa-Santos, Cristina AU - Costa-Santos C AD - Center for Research in Health Technologies and Information Systems (CINTESIS), Porto Medical School, University of Porto, Porto, Portugal. AD - Department of Health Information and Decision Sciences, Porto Medical School, University of Porto, Porto, Portugal. FAU - Ayres-de-Campos, Diogo AU - Ayres-de-Campos D AD - Department of Obstetrics and Gynecology, Porto Medical School, University of Porto, Porto, Portugal. AD - Institute for Research and Innovation in Health (I3S) and Institute of Biomedical Engineering (INEB), University of Porto, Porto, Portugal. AD - Center for Research in Health Technologies and Information Systems (CINTESIS), Porto Medical School, University of Porto, Porto, Portugal. AD - Department of Obstetrics and Gynecology, S. João Hospital, Porto, Portugal. FAU - Bernardes, João AU - Bernardes J AD - Department of Obstetrics and Gynecology, Porto Medical School, University of Porto, Porto, Portugal. AD - Institute for Research and Innovation in Health (I3S) and Institute of Biomedical Engineering (INEB), University of Porto, Porto, Portugal. AD - Center for Research in Health Technologies and Information Systems (CINTESIS), Porto Medical School, University of Porto, Porto, Portugal. AD - Department of Obstetrics and Gynecology, S. João Hospital, Porto, Portugal. AD - Department of Obstetrics and Gynecology, Hospital Pedro Hispano, Matosinhos, Portugal. LA - eng PT - Journal Article DEP - 20160712 PL - United States TA - Acta Obstet Gynecol Scand JT - Acta obstetricia et gynecologica Scandinavica JID - 0370343 SB - IM MH - Adult MH - Cardiotocography/*methods MH - Diagnosis, Computer-Assisted/*methods MH - Female MH - Heart Rate, Fetal/*physiology MH - Humans MH - Longitudinal Studies MH - Pregnancy MH - Pregnancy Complications/diagnosis MH - Prospective Studies MH - Young Adult OTO - NOTNLM OT - Cardiotocography OT - antepartum OT - computer analysis OT - fetal heart rate OT - longitudinal EDAT- 2016/05/31 06:00 MHDA- 2017/02/28 06:00 CRDT- 2016/05/31 06:00 PHST- 2016/02/01 00:00 [received] PHST- 2016/05/26 00:00 [accepted] PHST- 2016/05/31 06:00 [entrez] PHST- 2016/05/31 06:00 [pubmed] PHST- 2017/02/28 06:00 [medline] AID - 10.1111/aogs.12932 [doi] PST - ppublish SO - Acta Obstet Gynecol Scand. 2016 Oct;95(10):1143-52. doi: 10.1111/aogs.12932. Epub 2016 Jul 12. PMID- 27423030 OWN - NLM STAT- MEDLINE DCOM- 20170418 LR - 20170418 IS - 1872-7654 (Electronic) IS - 0301-2115 (Linking) VI - 203 DP - 2016 Aug TI - Cardiotocographic findings in the second stage of labor among fetuses delivered with acidemia: a comparison of two classification systems. PG - 297-302 LID - S0301-2115(16)30310-4 [pii] LID - 10.1016/j.ejogrb.2016.06.028 [doi] AB - BACKGROUND: The RCOG classification system of CTG trace is widely used for the analysis of the fetal heart rate during the first and second stage of labor. Other authors proposed specific classification systems for the second stage traces. OBJECTIVE: To evaluate the accuracy of RCOG and Piquard cardiotocographic patterns classification systems in predicting fetal acidemia in the second stage of labor. STUDY DESIGN: This was a nested retrospective case-control study including fetuses delivered with metabolic acidemia in the second stage of labor and a matched group of non-acidemic fetuses as controls. Cases and controls were selected from the electronic medical records of the University Hospital of Bologna between 2008 and 2013. The last 60min of the cardiotocograms recorded during the second stage of labor were independently classified by a senior consultant and a trainee according to RCOG and Piquard classifications. The inter-observer agreement and the accuracy of the two classifications in predicting fetal acidemia were evaluated. RESULTS: In all, 82 acidemic fetuses and 164 controls were recruited in the study period. Regarding the CTG traces assessment, the inter-observer agreement was moderate for both the categorizations (RCOG κ=0.584). Unclassifiable CTG patterns were more frequent among acidemic fetuses vs controls either at RCOG and at Piquard evaluation (26.8% vs 7.9%, p<0.001). Both systems yielded a moderate and comparable ability to predict fetal acidemia (RCOG ROC AUC=0.731; 95% CI 0.660-0.795; Piquard ROC AUC=0.773; 95% CI 0.704-0.833. DeLong z-test=1.186, p=0.236). CONCLUSIONS: RCOG and Piquard systems have a moderate accuracy in identifying acidemic fetuses during the second stage of labor. The occurrence of unclassifiable findings seems significantly more common among the acidemic fetuses. CI - Copyright © 2016 Elsevier Ireland Ltd. All rights reserved. FAU - Ghi, Tullio AU - Ghi T AD - Department of Obstetrics and Gynecology, University of Parma, Via Gramsci 14, 43126 Parma, Italy. Electronic address: tullioghi@yahoo.com. FAU - Morganelli, Giovanni AU - Morganelli G AD - Department of Medicine and Surgery (DIMEC), Division of Obstetrics and Gynecology, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy. FAU - Bellussi, Federica AU - Bellussi F AD - Department of Medicine and Surgery (DIMEC), Division of Obstetrics and Gynecology, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy. FAU - Rucci, Paola AU - Rucci P AD - Department of Biomedical and Neuromotor Sciences, Unit of Hygiene and Biostatistics, Via San Giacomo 12, 40126 Bologna, Italy. FAU - Giorgetta, Francesca AU - Giorgetta F AD - Department of Medicine and Surgery (DIMEC), Division of Obstetrics and Gynecology, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy. FAU - Rizzo, Nicola AU - Rizzo N AD - Department of Medicine and Surgery (DIMEC), Division of Obstetrics and Gynecology, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy. FAU - Frusca, Tiziana AU - Frusca T AD - Department of Obstetrics and Gynecology, University of Parma, Via Gramsci 14, 43126 Parma, Italy. FAU - Pilu, Gianluigi AU - Pilu G AD - Department of Medicine and Surgery (DIMEC), Division of Obstetrics and Gynecology, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy. LA - eng PT - Comparative Study PT - Journal Article DEP - 20160705 PL - Ireland TA - Eur J Obstet Gynecol Reprod Biol JT - European journal of obstetrics, gynecology, and reproductive biology JID - 0375672 SB - IM MH - Acidosis/*physiopathology MH - Adult MH - Cardiotocography/*classification MH - Case-Control Studies MH - Female MH - Heart Rate, Fetal/*physiology MH - Humans MH - Labor Stage, Second/*physiology MH - Pregnancy MH - Retrospective Studies OTO - NOTNLM OT - *Asphyxia OT - *Cardiotocography OT - *Fetal acidemia OT - *Labor OT - *Piquard OT - *Second stage EDAT- 2016/07/17 06:00 MHDA- 2017/04/19 06:00 CRDT- 2016/07/17 06:00 PHST- 2016/01/24 00:00 [received] PHST- 2016/06/24 00:00 [revised] PHST- 2016/06/28 00:00 [accepted] PHST- 2016/07/17 06:00 [entrez] PHST- 2016/07/17 06:00 [pubmed] PHST- 2017/04/19 06:00 [medline] AID - S0301-2115(16)30310-4 [pii] AID - 10.1016/j.ejogrb.2016.06.028 [doi] PST - ppublish SO - Eur J Obstet Gynecol Reprod Biol. 2016 Aug;203:297-302. doi: 10.1016/j.ejogrb.2016.06.028. Epub 2016 Jul 5. PMID- 27306144 OWN - NLM STAT- MEDLINE DCOM- 20181211 LR - 20181211 IS - 1471-0528 (Electronic) IS - 1470-0328 (Linking) VI - 124 IP - 5 DP - 2017 Apr TI - Complications of external cephalic version: a retrospective analysis of 1121 patients at a tertiary hospital in Sydney. PG - 767-772 LID - 10.1111/1471-0528.14169 [doi] AB - OBJECTIVE: To report the complication rate associated with external cephalic version (ECV) at term. DESIGN: Single-centre retrospective study. SETTING: A major tertiary hospital in Sydney, Australia. POPULATION OR SAMPLE: All women who underwent an ECV at Royal Prince Alfred Hospital from 1995-2013 were included. METHODS: ECV was attempted on all consenting women with a breech presentation at term in the absence of contraindications. Complications were classified as minor (transient cardiotocography abnormalities, ruptured membranes, small antepartum haemorrhage) or serious (fetal death, placental abruption, fetal distress requiring emergency caesarean section, fetal bone injury, cord prolapse). ECV success rates and rate of reversion to breech were recorded. MAIN OUTCOME MEASURES: The primary outcome was the incidence of serious complications. Secondary outcome measures were the rate of minor complications and reversion to breech. RESULTS: Of 1121 patients that underwent ECV, five (0.45%) experienced a serious complication. There was one placental abruption, one emergency caesarean section for fetal distress and two cord prolapses. There was one fetal death attributable to a successful ECV. Forty-eight women (4.28%) experienced a minor complication. Reversion to the breech occurred in sixteen patients (3.32%). CONCLUSION: ECV at term is associated with a low rate of serious complications. TWEETABLE ABSTRACT: Study of 1121 consecutive ECV attempts shows low rate of complications although one fetal death reported. CI - © 2016 Royal College of Obstetricians and Gynaecologists. FAU - Rodgers, R AU - Rodgers R AD - Department of Gynaecology, Royal Hospital for Women, Sydney, NSW, Australia. AD - Department of Women and Babies, Royal Prince Alfred Hospital, Sydney, NSW, Australia. FAU - Beik, N AU - Beik N AD - Department of Women and Babies, Royal Prince Alfred Hospital, Sydney, NSW, Australia. FAU - Nassar, N AU - Nassar N AD - Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, NSW, Australia. FAU - Brito, I AU - Brito I AD - Department of Gynaecology, Royal Hospital for Women, Sydney, NSW, Australia. FAU - de Vries, B AU - de Vries B AD - Department of Women and Babies, Royal Prince Alfred Hospital, Sydney, NSW, Australia. LA - eng PT - Journal Article DEP - 20160616 PL - England TA - BJOG JT - BJOG : an international journal of obstetrics and gynaecology JID - 100935741 SB - AIM SB - IM MH - Australia/epidemiology MH - Breech Presentation/*therapy MH - Female MH - Humans MH - Incidence MH - Obstetric Labor Complications/epidemiology/*etiology MH - Pregnancy MH - Retrospective Studies MH - Term Birth MH - Tertiary Care Centers MH - Version, Fetal/*adverse effects OTO - NOTNLM OT - Breech presentation OT - complications OT - external cephalic version EDAT- 2016/06/17 06:00 MHDA- 2018/12/12 06:00 CRDT- 2016/06/17 06:00 PHST- 2016/05/12 00:00 [accepted] PHST- 2016/06/17 06:00 [pubmed] PHST- 2018/12/12 06:00 [medline] PHST- 2016/06/17 06:00 [entrez] AID - 10.1111/1471-0528.14169 [doi] PST - ppublish SO - BJOG. 2017 Apr;124(5):767-772. doi: 10.1111/1471-0528.14169. Epub 2016 Jun 16. PMID- 27297955 OWN - NLM STAT- MEDLINE DCOM- 20170302 LR - 20170817 IS - 1479-828X (Electronic) IS - 0004-8666 (Linking) VI - 56 IP - 4 DP - 2016 Aug TI - Involving the consultant before fetal blood sampling. PG - 387-90 LID - 10.1111/ajo.12480 [doi] AB - BACKGROUND: Fetal scalp lactate (FSL) is used when the cardiotocography (CTG) is not normal in an attempt to reduce the false-positive rate and the likelihood of unnecessary intervention. Whilst the test has almost a 100% negative predictive value, the positive predictive value of this test is very low. AIMS: To measure the effect of introducing consultant obstetrician review of every abnormal CTG prior to the decision to perform FSL. MATERIALS AND METHODS: A retrospective cohort study was performed using routinely collected de-identified data. Mode of birth outcomes for women who had a continuous CTG in labour were compared in two equal time periods, 12 months before and after a change in hospital policy. Change in hospital policy dictated that FSL was only performed on a pathological CTG after consultant obstetrician review of the CTG. RESULTS: Consultant obstetrician review of CTG prior to FSL was associated with fewer FSL performed (1.7% vs 3.5%; P ≤ 0.01), fewer babies acidaemic at birth pH < 7.1 (0.8% vs 2.2%; P < 0.01), fewer caesarean sections for presumed fetal distress (CS for FD) (6.6% vs 8.1%; P = 0.05) and fewer instrumental births (17.6% vs 20%; P = 0.04). When adjusted for confounders, the change in policy was independently associated with a reduced likelihood of CS for FD (adjusted odds ratios = 0.78 (0.63-0.97); P = 0.03). CONCLUSIONS: A hospital policy whereby a consultant obstetrician reviews abnormal CTGs prior to performing FSL may help to increase the pretest probability and reduce the rate of CS for FD, as well as instrumental birth and unnecessary FSL. CI - © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. FAU - Lowe, Belinda AU - Lowe B AD - Department of Obstetrics and Gynaecology, Mater Health Services, South Brisbane, Queensland, Australia. FAU - Beckmann, Michael AU - Beckmann M AD - Department of Obstetrics and Gynaecology, Mater Health Services, South Brisbane, Queensland, Australia. AD - Mater Research, The University of Queensland, South Brisbane, Queensland, Australia. AD - School of Medicine, The University of Queensland, Brisbane, Queensland, Australia. LA - eng PT - Journal Article DEP - 20160614 PL - Australia TA - Aust N Z J Obstet Gynaecol JT - The Australian & New Zealand journal of obstetrics & gynaecology JID - 0001027 RN - 33X04XA5AT (Lactic Acid) SB - IM MH - Acidosis/diagnosis MH - Adult MH - *Blood Specimen Collection MH - *Cardiotocography MH - Cesarean Section/*statistics & numerical data MH - Clinical Decision-Making MH - Extraction, Obstetrical/statistics & numerical data MH - Female MH - Fetal Blood/chemistry MH - Fetal Distress/*diagnosis MH - Fetal Monitoring MH - Humans MH - Hydrogen-Ion Concentration MH - Lactic Acid/blood MH - Obstetrics/*methods MH - Organizational Policy MH - Pregnancy MH - Referral and Consultation MH - Retrospective Studies MH - Scalp/blood supply MH - Young Adult OTO - NOTNLM OT - blood gas analysis OT - fetal monitoring OT - labour obstetric OT - sensitivity and specificity EDAT- 2016/06/15 06:00 MHDA- 2017/03/03 06:00 CRDT- 2016/06/15 06:00 PHST- 2016/01/08 00:00 [received] PHST- 2016/04/23 00:00 [accepted] PHST- 2016/06/15 06:00 [entrez] PHST- 2016/06/15 06:00 [pubmed] PHST- 2017/03/03 06:00 [medline] AID - 10.1111/ajo.12480 [doi] PST - ppublish SO - Aust N Z J Obstet Gynaecol. 2016 Aug;56(4):387-90. doi: 10.1111/ajo.12480. Epub 2016 Jun 14. PMID- 27417058 OWN - NLM STAT- MEDLINE DCOM- 20170526 LR - 20191210 IS - 1872-8952 (Electronic) IS - 1388-2457 (Linking) VI - 127 IP - 8 DP - 2016 Aug TI - Real-time multi-channel monitoring of burst-suppression using neural network technology during pediatric status epilepticus treatment. PG - 2820-2831 LID - S1388-2457(16)30421-7 [pii] LID - 10.1016/j.clinph.2016.05.358 [doi] AB - OBJECTIVE: To develop a real-time monitoring system that has the potential to guide the titration of anesthetic agents in the treatment of pediatric status epilepticus (SE). METHODS: We analyzed stored multichannel electroencephalographic (EEG) data collected from 12 pediatric patients with generalized SE. EEG recordings were initially segmented in 500ms time-windows. Features characterizing the power, frequency, and entropy of the signal were extracted from each segment. The segments were annotated as bursts (B), suppressions (S), or artifacts (A) by two electroencephalographers. The EEG features together with the annotations were inputted in a three-layer feed forward neural network (NN). The sensitivity and specificity of NNs with different architectures and training algorithms to classify segments into B, S, or A were estimated. RESULTS: The maximum sensitivity (95.96% for B, 89.25% for S, and 75% for A) and specificity (89.36 for B, 96.26% for S, and 99.8% for A) was observed for the NN with 10 nodes in the hidden layer. By using this NN, we designed a real-time system that estimates the burst-suppression index (BSI). CONCLUSIONS: Our system provides a reliable real-time estimate of multichannel BSI requiring minimal memory and computation time. SIGNIFICANCE: The system has the potential to assist intensive care unit attendants in the continuous EEG monitoring. CI - Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved. FAU - Papadelis, Christos AU - Papadelis C AD - Center for Fetal-Neonatal Neuroimaging and Developmental Science, Boston Children's Hospital, Harvard Medical School, 1 Autumn St, Boston, MA 02215, USA; Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA. Electronic address: christos.papadelis@childrens.harvard.edu. FAU - Ashkezari, Seyedeh Fatemeh Salimi AU - Ashkezari SFS AD - Center for Fetal-Neonatal Neuroimaging and Developmental Science, Boston Children's Hospital, Harvard Medical School, 1 Autumn St, Boston, MA 02215, USA; Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA. FAU - Doshi, Chiran AU - Doshi C AD - Center for Fetal-Neonatal Neuroimaging and Developmental Science, Boston Children's Hospital, Harvard Medical School, 1 Autumn St, Boston, MA 02215, USA; Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA. FAU - Thome-Souza, Sigride AU - Thome-Souza S AD - Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA. FAU - Pearl, Phillip L AU - Pearl PL AD - Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA. FAU - Grant, P Ellen AU - Grant PE AD - Center for Fetal-Neonatal Neuroimaging and Developmental Science, Boston Children's Hospital, Harvard Medical School, 1 Autumn St, Boston, MA 02215, USA; Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA; Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA. FAU - Tasker, Robert C AU - Tasker RC AD - Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA; Department of Anesthesia, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA. FAU - Loddenkemper, Tobias AU - Loddenkemper T AD - Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA. LA - eng GR - U54 HD090255/HD/NICHD NIH HHS/United States PT - Journal Article DEP - 20160611 PL - Netherlands TA - Clin Neurophysiol JT - Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology JID - 100883319 SB - IM MH - Adolescent MH - Brain/*physiopathology MH - Child MH - Child, Preschool MH - Electroencephalography MH - Female MH - Humans MH - Intensive Care Units MH - Male MH - Monitoring, Physiologic/*methods MH - *Neural Networks, Computer MH - Sensitivity and Specificity MH - Status Epilepticus/*physiopathology OTO - NOTNLM OT - *Burst-suppression OT - *Electroencephalography OT - *Intensive care unit OT - *Monitoring OT - *Neural network OT - *Status epilepticus EDAT- 2016/07/16 06:00 MHDA- 2017/05/27 06:00 CRDT- 2016/07/16 06:00 PHST- 2015/11/26 00:00 [received] PHST- 2016/05/12 00:00 [revised] PHST- 2016/05/27 00:00 [accepted] PHST- 2016/07/16 06:00 [entrez] PHST- 2016/07/16 06:00 [pubmed] PHST- 2017/05/27 06:00 [medline] AID - S1388-2457(16)30421-7 [pii] AID - 10.1016/j.clinph.2016.05.358 [doi] PST - ppublish SO - Clin Neurophysiol. 2016 Aug;127(8):2820-2831. doi: 10.1016/j.clinph.2016.05.358. Epub 2016 Jun 11. PMID- 27082710 OWN - NLM STAT- MEDLINE DCOM- 20170831 LR - 20181202 IS - 1097-0223 (Electronic) IS - 0197-3851 (Linking) VI - 36 IP - 7 DP - 2016 Jul TI - Placental and fetal hemodynamics in prolonged pregnancies. PG - 622-7 LID - 10.1002/pd.4828 [doi] AB - OBJECTIVE: We hypothesized that Doppler measurements of the placental and fetal central and peripheral hemodynamics would predict adverse outcomes in prolonged uncomplicated singleton pregnancies. METHOD: A total of 160 participants were recruited to this study. Doppler measurements of placental and fetal hemodynamics as well as cardiotocography (CTG) were assessed prior to induction of labor at >41+ weeks. CTG during delivery, umbilical artery (UA) pH and base excess at birth and neonatal data were evaluated. RESULTS: In 16% of cases the outcome was unfavorable, defined as UA pH <7.10, 5-min Apgar score <7, cesarean delivery for fetal distress and/or need for admission to neonatal intensive care. There were no differences in the pulsatility indices of the uterine and umbilical arteries, middle cerebral artery, descending aorta, ductus venosus and inferior vena cava between the groups with favorable and unfavorable outcome. In addition, the ventricular inflow patterns, outflow velocities of the great arteries, cardiac outputs and myocardial performance indices were similar between the groups. CONCLUSION: Doppler parameters of the placental and fetal central and peripheral hemodynamics do not differ prior to the induction of labor in prolonged pregnancies with favorable and unfavorable outcomes. This suggests that their value is limited and that other clinical tools are needed for intermittent fetal surveillance in prolonged pregnancies. © 2016 John Wiley & Sons, Ltd. CI - © 2016 John Wiley & Sons, Ltd. FAU - Kauppinen, Tuomas AU - Kauppinen T AD - Department of Obstetrics and Gynecology and PEDEGO Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland. FAU - Kantomaa, Tiina AU - Kantomaa T AD - Department of Obstetrics and Gynecology and PEDEGO Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland. FAU - Tekay, Aydin AU - Tekay A AD - Department of Obstetrics and Gynecology and PEDEGO Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland. AD - Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. FAU - Mäkikallio, Kaarin AU - Mäkikallio K AD - Department of Obstetrics and Gynecology and PEDEGO Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland. AD - Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland. LA - eng PT - Journal Article DEP - 20160603 PL - England TA - Prenat Diagn JT - Prenatal diagnosis JID - 8106540 SB - IM MH - Adult MH - Aorta, Thoracic/*diagnostic imaging MH - Apgar Score MH - Cardiotocography MH - Cesarean Section/statistics & numerical data MH - Female MH - Fetal Distress/*epidemiology MH - Fetus/*blood supply MH - Gestational Age MH - Hemodynamics MH - Humans MH - Hydrogen-Ion Concentration MH - Infant, Newborn MH - Intensive Care Units, Neonatal/statistics & numerical data MH - Labor, Induced MH - Male MH - Middle Cerebral Artery/*diagnostic imaging MH - Placenta/*blood supply MH - Pregnancy MH - Prospective Studies MH - Pulsatile Flow MH - Ultrasonography, Doppler MH - Ultrasonography, Prenatal MH - Umbilical Arteries/*diagnostic imaging MH - Uterine Artery/*diagnostic imaging MH - Vacuum Extraction, Obstetrical/statistics & numerical data MH - Vena Cava, Inferior/*diagnostic imaging MH - Young Adult EDAT- 2016/04/16 06:00 MHDA- 2017/09/01 06:00 CRDT- 2016/04/16 06:00 PHST- 2015/08/20 00:00 [received] PHST- 2016/02/13 00:00 [revised] PHST- 2016/04/11 00:00 [accepted] PHST- 2016/04/16 06:00 [entrez] PHST- 2016/04/16 06:00 [pubmed] PHST- 2017/09/01 06:00 [medline] AID - 10.1002/pd.4828 [doi] PST - ppublish SO - Prenat Diagn. 2016 Jul;36(7):622-7. doi: 10.1002/pd.4828. Epub 2016 Jun 3. PMID- 27165310 OWN - NLM STAT- MEDLINE DCOM- 20170929 LR - 20191210 IS - 1742-2094 (Electronic) IS - 1742-2094 (Linking) VI - 13 IP - 1 DP - 2016 May 10 TI - Decreased neuroinflammation correlates to higher vagus nerve activity fluctuations in near-term ovine fetuses: a case for the afferent cholinergic anti-inflammatory pathway? PG - 103 LID - 10.1186/s12974-016-0567-x [doi] LID - 103 AB - BACKGROUND: Neuroinflammation in utero may contribute to brain injury resulting in life-long neurological disabilities. The pivotal role of the efferent cholinergic anti-inflammatory pathway (CAP) in controlling inflammation, e.g., by inhibiting the HMGB1 release, via the macrophages' α7 nicotinic acetylcholine receptor (α7nAChR) has been described in adults, but its importance in the fetus is unknown. Moreover, it is unknown whether CAP may also exert anti-inflammatory effects on the brain via the anatomically predominant afferent component of the vagus nerve. METHODS: We measured microglial activation in the ovine fetal brain near term 24 h after the umbilical cord occlusions mimicking human labor versus controls (no occlusions) by quantifying HMGB1 nucleus-to-cytosol translocation in the Iba1+ and α7nAChR+ microglia. Based on multiple clinical studies in adults and our own work in fetal autonomic nervous system, we gauged the degree of CAP activity in vivo using heart rate variability measure RMSSD that reflects fluctuations in vagus nerve activity. RESULTS: RMSSD correlated to corresponding plasma IL-1β levels at R = 0.57 (p = 0.02, n = 17) and to white matter microglia cell counts at R = -0.89 (p = 0.03). The insult increased the HMGB1 translocation in α7nAChR+ microglia in a brain region-dependent manner (p < 0.001). In parallel, RMSSD at 1 h post insult correlated with cytosolic HMGB1 of thalamic microglia (R = -0.94, p = 0.005), and RMSSD at pH nadir correlated with microglial α7nAChR in the white matter (R = 0.83, p = 0.04). Overall, higher RMSSD values correlated with lower HMGB1 translocation and higher α7nAChR intensity per area in a brain region-specific manner. CONCLUSIONS: Afferent fetal CAP may translate increased vagal cholinergic signaling into suppression of cerebral inflammation in response to near-term hypoxic acidemia as might occur during labor. Our findings suggest a new control mechanism of fetal neuroinflammation via the vagus nerve, providing novel possibilities for its non-invasive monitoring in utero and for targeted treatment. FAU - Frasch, M G AU - Frasch MG AD - Department of Obstetrics and Gynaecology, CHU Ste-Justine Research Centre, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada. mfrasch@uw.edu. AD - Department of Neurosciences, CHU Ste-Justine Research Centre, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada. mfrasch@uw.edu. AD - Animal Reproduction Research Centre (CRRA), Faculty of Veterinary Medicine, Université de Montréal, Montréal, QC, Canada. mfrasch@uw.edu. AD - Department of Obstetrics and Gynaecology, Lawson Health Research Institute, University of Western Ontario, London, ON, Canada. mfrasch@uw.edu. AD - Department of Obstetrics and Gynecology, University of Washington, 1959 NE Pacific St, Box 356460, Seattle, WA, 98195, USA. mfrasch@uw.edu. FAU - Szynkaruk, M AU - Szynkaruk M AD - Department of Obstetrics and Gynaecology, Lawson Health Research Institute, University of Western Ontario, London, ON, Canada. FAU - Prout, A P AU - Prout AP AD - Department of Obstetrics and Gynaecology, Lawson Health Research Institute, University of Western Ontario, London, ON, Canada. FAU - Nygard, K AU - Nygard K AD - Microscopy Imaging@Biotron, University of Western Ontario, London, ON, Canada. FAU - Cao, M AU - Cao M AD - Department of Obstetrics and Gynaecology, CHU Ste-Justine Research Centre, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada. AD - Department of Neurosciences, CHU Ste-Justine Research Centre, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada. FAU - Veldhuizen, R AU - Veldhuizen R AD - Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada. FAU - Hammond, R AU - Hammond R AD - Department of Pathology, University of Western Ontario, London, ON, Canada. FAU - Richardson, B S AU - Richardson BS AD - Department of Obstetrics and Gynaecology, Lawson Health Research Institute, University of Western Ontario, London, ON, Canada. AD - Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada. LA - eng GR - CIHR/Canada PT - Journal Article DEP - 20160510 TA - J Neuroinflammation JT - Journal of neuroinflammation JID - 101222974 RN - 0 (AIF1 protein, human) RN - 0 (Calcium-Binding Proteins) RN - 0 (DNA-Binding Proteins) RN - 0 (HMGB1 Protein) RN - 0 (Interleukin-1beta) RN - 0 (Interleukin-6) RN - 0 (Microfilament Proteins) RN - 0 (Proto-Oncogene Proteins c-fos) RN - 0 (alpha7 Nicotinic Acetylcholine Receptor) SB - IM MH - Animals MH - Brain/pathology MH - Brain Stem/metabolism/pathology MH - Calcium-Binding Proteins MH - DNA-Binding Proteins/metabolism MH - Diagnosis, Computer-Assisted MH - Disease Models, Animal MH - Encephalitis/blood/*etiology/*therapy MH - Female MH - Fetal Hypoxia/blood/*complications/therapy MH - Fetus MH - Gene Expression Regulation/physiology MH - HMGB1 Protein/metabolism MH - Heart Rate/physiology MH - Interleukin-1beta/blood MH - Interleukin-6/blood MH - Male MH - Microfilament Proteins MH - Microglia/metabolism/pathology MH - Proto-Oncogene Proteins c-fos/metabolism MH - Sheep MH - Vagus Nerve/embryology/*physiology MH - Vagus Nerve Stimulation MH - alpha7 Nicotinic Acetylcholine Receptor/*metabolism PMC - PMC4894374 OTO - NOTNLM OT - *CHRNA7 OT - *Fetus OT - *HMGB1 OT - *HRV OT - *Labor OT - *Microglia OT - *RMSSD OT - *Vagus EDAT- 2016/05/12 06:00 MHDA- 2017/09/30 06:00 CRDT- 2016/05/12 06:00 PHST- 2016/04/12 00:00 [received] PHST- 2016/05/02 00:00 [accepted] PHST- 2016/05/12 06:00 [entrez] PHST- 2016/05/12 06:00 [pubmed] PHST- 2017/09/30 06:00 [medline] AID - 10.1186/s12974-016-0567-x [pii] AID - 567 [pii] AID - 10.1186/s12974-016-0567-x [doi] PST - epublish SO - J Neuroinflammation. 2016 May 10;13(1):103. doi: 10.1186/s12974-016-0567-x. PMID- 27476249 OWN - NLM STAT- MEDLINE DCOM- 20160915 LR - 20160801 IS - 0300-9041 (Print) IS - 0300-9041 (Linking) VI - 84 IP - 5 DP - 2016 May TI - [Second stage of labor: Does accelerations matter?]. PG - 287-93 AB - BACKGROUND: Accelerations role during the second stage of labor has not been studied and current classification system NICHD downplays its presence. The objective of this study is to determine validity for acidemia detection of the loss of accelerations during the second stage of labor. MATERIAL AND METHOD: This is a one year retrospective case-control study of 102 neonates with acidemia defined as an umbilical cord gas pH≤7.10 compared to 100 non acidemic controls. The last thirty minutes of CTG were evaluated by two obstetricians blind to clinical and outcome data that classified tracings into categories according to NICHD definitions, determining the presence or absence of accelerations. Validity of NICHD categories and absence of accelerations were calculated. RESULTS: 85% of fetuses presented a category II tracing in the last 30 minutes of labor. Absence of accelerations was associated with neonatal acidemia (ORa 4.43). Category II tracings were not associated with acidemia after adjusting for confounding factors.Validity of the absence of accelerations during the second stage of labor was higher in terms of sensitivity (80.3%), specificity (54%) and global value (67%) to that of the presence of a category II tracing (96%, 24% and 60% respectively) in this period. CONCLUSIONS: The absence of accelerations during the second stage of labor shows a bigger validity for neonatal acidemia than the presence of a category II tracing. FAU - Martí-Gamboa, S AU - Martí-Gamboa S FAU - Rodríguez-Lázaro, L AU - Rodríguez-Lázaro L FAU - Redrado-Giménez, O AU - Redrado-Giménez O FAU - Ruiz-Sada, J AU - Ruiz-Sada J FAU - Castón-Mateo, S AU - Castón-Mateo S LA - spa PT - English Abstract PT - Journal Article PT - Observational Study TT - Segundo estadio del parto: importan las aceleraciones? PL - Mexico TA - Ginecol Obstet Mex JT - Ginecologia y obstetricia de Mexico JID - 0376552 SB - IM MH - Adult MH - Cardiotocography MH - Case-Control Studies MH - Female MH - *Heart Rate, Fetal MH - Humans MH - *Labor Stage, Second MH - Pregnancy MH - Retrospective Studies EDAT- 2016/08/02 06:00 MHDA- 2016/09/16 06:00 CRDT- 2016/08/02 06:00 PHST- 2016/08/02 06:00 [entrez] PHST- 2016/08/02 06:00 [pubmed] PHST- 2016/09/16 06:00 [medline] PST - ppublish SO - Ginecol Obstet Mex. 2016 May;84(5):287-93. PMID- 27101261 OWN - NLM STAT- MEDLINE DCOM- 20160905 LR - 20160422 IS - 1471-0528 (Electronic) IS - 1470-0328 (Linking) VI - 123 IP - 6 DP - 2016 May TI - Fetal heart monitoring in labour: from pinard to artificial intelligence. PG - 870 LID - 10.1111/1471-0528.13844 [doi] FAU - Jauniaux, E AU - Jauniaux E AD - Academic Department of Obstetrics and Gynaecology, Institute for Women's Health, University College London, London, UK. FAU - Prefumo, F AU - Prefumo F AD - Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy. LA - eng PT - Historical Article PT - Journal Article PL - England TA - BJOG JT - BJOG : an international journal of obstetrics and gynaecology JID - 100935741 SB - AIM SB - IM MH - Artificial Intelligence MH - Cardiotocography/*history MH - Female MH - Fetal Hypoxia/diagnosis MH - Fetoscopes/history MH - *Heart Rate, Fetal MH - History, 18th Century MH - History, 19th Century MH - History, 20th Century MH - History, 21st Century MH - Humans MH - Labor, Obstetric/*history MH - Observer Variation MH - Obstetrics/*history/instrumentation MH - Pregnancy EDAT- 2016/04/23 06:00 MHDA- 2016/09/07 06:00 CRDT- 2016/04/22 06:00 PHST- 2016/04/22 06:00 [entrez] PHST- 2016/04/23 06:00 [pubmed] PHST- 2016/09/07 06:00 [medline] AID - 10.1111/1471-0528.13844 [doi] PST - ppublish SO - BJOG. 2016 May;123(6):870. doi: 10.1111/1471-0528.13844. PMID- 27177514 OWN - NLM STAT- MEDLINE DCOM- 20170421 LR - 20170421 IS - 1879-3479 (Electronic) IS - 0020-7292 (Linking) VI - 134 IP - 2 DP - 2016 Aug TI - A study of fresh stillbirths weighing 2500g or more at three academic hospitals in South Africa. PG - 186-9 LID - S0020-7292(16)30104-7 [pii] LID - 10.1016/j.ijgo.2016.01.011 [doi] AB - OBJECTIVE: To determine the frequency of fresh stillbirths weighing 2500g or more, to assess the risk factors and direct obstetric causes, and to describe avoidable factors in terms of substandard intrapartum management. METHODS: A prospective, cross-sectional, descriptive study was conducted at three obstetric teaching units in Johannesburg, South Africa. Data were consecutively collected for 6months at each of the hospitals, leading to an 18-month data collection period from May 1, 2011, to October 31, 2012. The study population was hospital-born, singleton fresh stillbirths weighing 2500g or more. RESULTS: Overall, 52 fresh stillbirths were eligible. Intrapartum catastrophic events were recorded in 30 (58%) cases (16 placental abruption, 7 cord prolapse, 4 ruptured uterus, and 3 entrapment of aftercoming head during breech delivery). Intrauterine fetal death was recorded on arrival at hospital in 15 (29%) cases. Twenty-two (42%) women underwent cardiotocography monitoring; 15 (29%) had no fetal monitoring. Among 25 cases in which the emergency was recognized, the median time from recognition of emergency to delivery was 182minutes (range 13-360). CONCLUSION: There appears to be a failure to detect or respond to evidence of fetal distress even in facilities with skilled staff and available resources. CI - Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. FAU - Bothma, Marlene AU - Bothma M AD - Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: marlene.bothma@ogdr.co.za. FAU - Buchmann, Eckhart J AU - Buchmann EJ AD - Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20160429 PL - United States TA - Int J Gynaecol Obstet JT - International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics JID - 0210174 SB - IM MH - Adult MH - Birth Weight MH - Cross-Sectional Studies MH - Delivery, Obstetric/*adverse effects MH - Female MH - Fetal Monitoring/*methods MH - Humans MH - Infant, Newborn MH - *Perinatal Mortality MH - Poverty MH - Pregnancy MH - Prospective Studies MH - Risk Factors MH - South Africa/epidemiology MH - Stillbirth/*epidemiology MH - Young Adult OTO - NOTNLM OT - *Birth asphyxia OT - *Fetal monitoring OT - *Intrapartum-related deaths OT - *Low-income countries OT - *Perinatal mortality OT - *Stillbirth EDAT- 2016/05/15 06:00 MHDA- 2017/04/22 06:00 CRDT- 2016/05/15 06:00 PHST- 2015/10/10 00:00 [received] PHST- 2016/01/11 00:00 [revised] PHST- 2016/04/19 00:00 [accepted] PHST- 2016/05/15 06:00 [entrez] PHST- 2016/05/15 06:00 [pubmed] PHST- 2017/04/22 06:00 [medline] AID - S0020-7292(16)30104-7 [pii] AID - 10.1016/j.ijgo.2016.01.011 [doi] PST - ppublish SO - Int J Gynaecol Obstet. 2016 Aug;134(2):186-9. doi: 10.1016/j.ijgo.2016.01.011. Epub 2016 Apr 29. PMID- 27140936 OWN - NLM STAT- MEDLINE DCOM- 20180101 LR - 20181113 IS - 1558-075X (Electronic) IS - 0146-0005 (Print) IS - 0146-0005 (Linking) VI - 40 IP - 5 DP - 2016 Aug TI - What we have learned about intrapartum fetal monitoring trials in the MFMU Network. PG - 307-17 LID - S0146-0005(16)00016-1 [pii] LID - 10.1053/j.semperi.2016.03.008 [doi] AB - The vast majority of pregnant women are subjected to electronic fetal heart monitoring during labor. There is limited evidence to support its benefit compared with intermittent auscultation. In addition, there is significant variability in interpretation and its false-positive rate is high. The latter may have contributed to the rise in operative deliveries. In order to address the critical need for better approaches to intrapartum monitoring, the MFMU Network has completed two large multisite randomized trials, one to evaluate fetal pulse oximetry and the other to evaluate fetal ECG ST segment analysis (STAN). Both of these technologies had been approved for clinical use in the United States based on prior smaller trials. These technologies were evaluated in laboring women near term and their primary outcomes were overall cesarean delivery for the oximetry trial and a composite adverse neonatal outcome for STAN. Both the trials failed to show a benefit of the technology, neither in the rates of operative deliveries nor in the rates of adverse neonatal outcomes. The experience with these trials, summarized in this report, highlights the need for rigorous evidence before introduction of new technology into clinical practice and provides a blueprint for future trials to address the need for better intrapartum monitoring approaches. CI - Copyright © 2016 Elsevier Inc. All rights reserved. FAU - Bloom, Steven L AU - Bloom SL AD - Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390. Electronic address: Steven.Bloom@UTSouthwestern.edu. FAU - Belfort, Michael AU - Belfort M AD - Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital Pavilion for Women, 6651 Main Street, Houston, TX 77030. FAU - Saade, George AU - Saade G AD - Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX 77555. CN - Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network LA - eng GR - U10 HD040500/HD/NICHD NIH HHS/United States GR - UG1 HD027869/HD/NICHD NIH HHS/United States GR - U10 HD068268/HD/NICHD NIH HHS/United States GR - U10 HD040544/HD/NICHD NIH HHS/United States GR - UG1 HD034116/HD/NICHD NIH HHS/United States GR - UG1 HD040560/HD/NICHD NIH HHS/United States GR - U10 HD034136/HD/NICHD NIH HHS/United States GR - UG1 HD053097/HD/NICHD NIH HHS/United States GR - UG1 HD027915/HD/NICHD NIH HHS/United States GR - U10 HD040485/HD/NICHD NIH HHS/United States GR - UG1 HD040544/HD/NICHD NIH HHS/United States GR - UG1 HD034208/HD/NICHD NIH HHS/United States GR - UG1 HD040512/HD/NICHD NIH HHS/United States GR - U10 HD034116/HD/NICHD NIH HHS/United States GR - U10 HD027869/HD/NICHD NIH HHS/United States GR - U10 HD027917/HD/NICHD NIH HHS/United States GR - U10 HD027915/HD/NICHD NIH HHS/United States GR - U10 HD068282/HD/NICHD NIH HHS/United States GR - UG1 HD040545/HD/NICHD NIH HHS/United States GR - UG1 HD040485/HD/NICHD NIH HHS/United States GR - UG1 HD068268/HD/NICHD NIH HHS/United States GR - U10 HD027860/HD/NICHD NIH HHS/United States GR - U10 HD040560/HD/NICHD NIH HHS/United States GR - U10 HD034208/HD/NICHD NIH HHS/United States GR - U10 HD053097/HD/NICHD NIH HHS/United States GR - UG1 HD040500/HD/NICHD NIH HHS/United States GR - UG1 HD068282/HD/NICHD NIH HHS/United States GR - U10 HD040512/HD/NICHD NIH HHS/United States GR - U10 HD021410/HD/NICHD NIH HHS/United States GR - U10 HD036801/HD/NICHD NIH HHS/United States GR - M01 RR000080/RR/NCRR NIH HHS/United States GR - U10 HD040545/HD/NICHD NIH HHS/United States GR - U01 HD036801/HD/NICHD NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Review DEP - 20160429 TA - Semin Perinatol JT - Seminars in perinatology JID - 7801132 SB - IM MH - Adult MH - *Cardiotocography MH - Cesarean Section MH - Diagnosis, Computer-Assisted MH - Evidence-Based Medicine MH - Female MH - Fetal Distress/*diagnosis/physiopathology MH - Heart Rate, Fetal/*physiology MH - Humans MH - Infant, Newborn MH - Labor, Obstetric MH - *Oximetry MH - Parturition/*physiology MH - Pregnancy PMC - PMC4983203 MID - NIHMS773777 OTO - NOTNLM OT - *fetal ST segment analysis OT - *fetal pulse oximetry OT - *intrapartum fetal monitoring EDAT- 2016/05/04 06:00 MHDA- 2018/01/02 06:00 CRDT- 2016/05/04 06:00 PHST- 2016/05/04 06:00 [entrez] PHST- 2016/05/04 06:00 [pubmed] PHST- 2018/01/02 06:00 [medline] AID - S0146-0005(16)00016-1 [pii] AID - 10.1053/j.semperi.2016.03.008 [doi] PST - ppublish SO - Semin Perinatol. 2016 Aug;40(5):307-17. doi: 10.1053/j.semperi.2016.03.008. Epub 2016 Apr 29. PMID- 27003831 OWN - NLM STAT- MEDLINE DCOM- 20170605 LR - 20170605 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) VI - 30 IP - 2 DP - 2017 Jan TI - Does gender of the fetus have any relation with fetal heart monitoring during the first and second stage of labor? PG - 150-154 AB - OBJECTIVE: To investigate fetal gender and its influences on neonatal outcomes, taking into consideration the available tools for the assessment of fetal well-being. METHODS: We conducted a retrospective study comparing maternal, fetal and neonatal outcomes according to fetal gender, in women carrying a singleton gestation. A multivariate analysis was performed for the prediction of adverse neonatal outcomes according to fetal gender, after adjustment for gestational age, maternal age and fetal weight. RESULTS: A total of 682 pregnancies were included in the study, of them 56% (n = 383) were carrying a male fetus and 44% (n = 299) a females fetus. Male gender was associated with a significant higher rate of abnormal fetal heart tracing patterns during the first (67.7% versus 55.1, p = 0.001) and the second stage (77.6 versus 67.7, p = 0.01) of labor. Male gender was also significantly associated with lower Apgar scores at 1' (19.1% versus 10.7%, p < 0.01), as well as lower pH values (7.18 ± 0.15 versus 7.23 ± 0.18, p < 0.001), and significant differences in cord blood components (PCO(2), PO(2)) compared with female fetuses. In the multivariate analysis, male gender was found to be significantly associated with first (OR 1.76, 95% CI 1.28-2.43, p = 0.001) and second stage (OR 1.73, 95% CI 1.20-2.50, p < 0.01) pathological fetal heart tracing patterns, pH < 7.1, and for Apgar scores at 1'< 7. CONCLUSIONS: The present study confirms the general trend of a lower clinical performance of male neonates compared with females. In addition, the relation between fetal heart rate patterns during all stages of labor and fetal gender showed an independent association between male fetal gender and abnormal fetal heart monitoring during labor. FAU - Yohai, David AU - Yohai D AD - a Department of Obstetrics and Gynecology , Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev , Beer Sheva , Israel. FAU - Baumfeld, Yael AU - Baumfeld Y AD - a Department of Obstetrics and Gynecology , Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev , Beer Sheva , Israel. AD - b Clinical Research Center, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev , Beer Sheva , Israel , and. FAU - Zilberstein, Tali AU - Zilberstein T AD - a Department of Obstetrics and Gynecology , Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev , Beer Sheva , Israel. FAU - Yaniv Salem, Shimrit AU - Yaniv Salem S AD - a Department of Obstetrics and Gynecology , Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev , Beer Sheva , Israel. FAU - Elharar, Debbie AU - Elharar D AD - a Department of Obstetrics and Gynecology , Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev , Beer Sheva , Israel. FAU - Idan, Inbal AU - Idan I AD - a Department of Obstetrics and Gynecology , Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev , Beer Sheva , Israel. FAU - Mastrolia, Salvatore Andrea AU - Mastrolia SA AD - a Department of Obstetrics and Gynecology , Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev , Beer Sheva , Israel. AD - c Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Policlinico Di Bari, School of Medicine, University of Bari "Aldo Moro" , Bari , Italy. FAU - Sheiner, Eyal AU - Sheiner E AD - a Department of Obstetrics and Gynecology , Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev , Beer Sheva , Israel. LA - eng PT - Journal Article DEP - 20160419 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 SB - IM MH - Adult MH - Apgar Score MH - *Cardiotocography MH - Female MH - Fetal Distress MH - Fetus/*physiology MH - Heart Rate, Fetal/*physiology MH - Humans MH - Infant, Newborn MH - *Labor Stage, First MH - *Labor Stage, Second MH - Labor, Obstetric/*physiology MH - Male MH - Multivariate Analysis MH - Pregnancy MH - Regression Analysis MH - Retrospective Studies MH - *Sex Factors MH - Statistics, Nonparametric MH - Young Adult OTO - NOTNLM OT - *Fetal distress OT - *fetal gender OT - *fetal heart rate monitoring OT - *pregnancy complications EDAT- 2016/03/24 06:00 MHDA- 2017/06/06 06:00 CRDT- 2016/03/23 06:00 PHST- 2016/03/24 06:00 [pubmed] PHST- 2017/06/06 06:00 [medline] PHST- 2016/03/23 06:00 [entrez] AID - 10.3109/14767058.2016.1168802 [doi] PST - ppublish SO - J Matern Fetal Neonatal Med. 2017 Jan;30(2):150-154. doi: 10.3109/14767058.2016.1168802. Epub 2016 Apr 19. PMID- 27457394 OWN - NLM STAT- MEDLINE DCOM- 20181023 LR - 20181023 IS - 1210-7832 (Print) IS - 1210-7832 (Linking) VI - 81 IP - 2 DP - 2016 Apr TI - [Current status and recommendations for intrapartum monitoring of fetal heart rate]. PG - 112-24 AB - Monitoring of fetal heart rate is one of the basic components of obstetrical care, in which the cardiotocography remains the gold standard and screening method in early diagnosis of fetal hypoxia, even after introduction of other selective methods of intrauterine monitoring of fetal well-being. The review article is divided into several parts: pathophysiology of fetal oxygenation, fetal heart rate and changes of fetal hemodynamics, and rules for fetal heart rate auscultation. The main principles of cardiotocographic monitoring and evaluation of ante- and intrapartrum recordings according to the FIGO criteria from 1986 and evaluation of intrapartum recordings according to the 2015 FIGO recommendations are mentioned. At the end a comparative table of 1986 FIGO and 2015 FIGO criteria is presented. DESIGN: Review. FAU - Měchurová, A AU - Měchurová A FAU - Velebil, P AU - Velebil P FAU - Hruban, L AU - Hruban L FAU - Janků, P AU - Janků P LA - cze PT - Journal Article PT - Review TT - Současné možnosti a doporučení pro intrapartální monitorování ozev plodu. PL - Czech Republic TA - Ceska Gynekol JT - Ceska gynekologie JID - 9423768 SB - IM MH - *Cardiotocography MH - Early Diagnosis MH - Female MH - Fetal Hypoxia/*diagnosis MH - *Heart Rate, Fetal MH - Humans MH - Infant, Newborn MH - Pregnancy MH - Prognosis OTO - NOTNLM OT - CTG classification - FIGO 1986 OT - FIGO 2015 OT - auscultation of fetal heart OT - cardiotocography (CTG) OT - diagnosis of fetal hypoxia OT - fetal monitoring in utero. EDAT- 2016/07/28 06:00 MHDA- 2018/10/24 06:00 CRDT- 2016/07/27 06:00 PHST- 2016/07/27 06:00 [entrez] PHST- 2016/07/28 06:00 [pubmed] PHST- 2018/10/24 06:00 [medline] AID - 58685 [pii] PST - ppublish SO - Ceska Gynekol. 2016 Apr;81(2):112-24. PMID- 27190897 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20160518 LR - 20200930 IS - 2249-782X (Print) IS - 0973-709X (Electronic) IS - 0973-709X (Linking) VI - 10 IP - 4 DP - 2016 Apr TI - Evaluation of Clinical Diagnosis of Fetal Distress and Perinatal Outcome in a Low Resource Nigerian Setting. PG - QC08-11 LID - 10.7860/JCDR/2016/17274.7687 [doi] AB - INTRODUCTION: Fetal distress has been shown to contribute to the increasing caesarean section rate. There has been controversy on the usefulness of clinical diagnosis of fetal distress using only the intermittent counting of the fetal heart rate and/or passage of meconium-stained liquor. AIM: To evaluate the clinical diagnosis of fetal distress and the perinatal outcome. MATERIALS AND METHODS: This was a retrospective study in which the case records of the patients, who were diagnosed of fetal distress at Federal Teaching Hospital, Abakaliki, Nigeria, from January 1, 2008 to December 31, 2014, were collated. The statistical analysis was done using the Statistical Package for Social Sciences version 17 software (SPSS Inc., Chicago IL, USA). RESULTS: Out of the 15,640 deliveries carried out within the study period, 3,761 (24.05%) deliveries were through caesarean section. A total of 326 (8.9%) of the 3,761 caesarean sections were due to fetal distress within the study period. More so, a total of 227 (70.9%) babies were born with ≥ 7 Apgar score at the 1(st) minute of delivery. The perinatal mortality rate was 31.25 per 1000 deliveries. Though birth asphyxia was recorded more on babies of mothers that had fresh meconium-stained liquor and whose decision-intervention interval was more than 30 minutes when compared with those without any of the two conditions, there was no statistical significant difference between them. CONCLUSION: The clinical diagnosis of fetal distress is accurate in 29.1% of the cases. However, it has led to an unnecessary caesarean section in the remaining 70.9% of the parturients. In order to reduce this high trend of unnecessary caesarean sections due to clinical diagnosis of fetal distress in this environment, antepartum fetal assessment with non-stress test or biophysical profile and intrapartum use of continuous electronic fetal monitoring should be used to confirm or refute the fetal distress before any surgical intervention. Fetal blood sampling and fetal pulse oximetry should be performed in event of non- re-assuring or abnormal cardiotocography. FAU - Ajah, Leonard Ogbonna AU - Ajah LO AD - Faculty, Department of Obstetrics and Gynaecology, Federal Teaching Hospital , Abakaliki, Nigeria . FAU - Ibekwe, Perpetus Chudi AU - Ibekwe PC AD - Faculty, Department of Obstetrics and Gynaecology, Federal Teaching Hospital , Abakaliki, Nigeria . FAU - Onu, Fidelis Agwu AU - Onu FA AD - Faculty, Department of Obstetrics and Gynaecology, Federal Teaching Hospital , Abakaliki, Nigeria . FAU - Onwe, Ogah Emeka AU - Onwe OE AD - Faculty, Department of Paediatrics, Federal Teaching Hospital , Abakaliki, Nigeria . FAU - Ezeonu, Thecla Chinonyelum AU - Ezeonu TC AD - Faculty, Department of Paediatrics, Federal Teaching Hospital , Abakaliki, Nigeria . FAU - Omeje, Innocent AU - Omeje I AD - Faculty, Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital , Enugu, Nigeria . LA - eng PT - Journal Article DEP - 20160401 TA - J Clin Diagn Res JT - Journal of clinical and diagnostic research : JCDR JID - 101488993 PMC - PMC4866195 OTO - NOTNLM OT - Apgar score OT - Intrapartum fetal monitoring OT - Nigeria OT - Poor setting EDAT- 2016/05/18 06:00 MHDA- 2016/05/18 06:01 CRDT- 2016/05/19 06:00 PHST- 2015/10/13 00:00 [received] PHST- 2016/01/17 00:00 [accepted] PHST- 2016/05/19 06:00 [entrez] PHST- 2016/05/18 06:00 [pubmed] PHST- 2016/05/18 06:01 [medline] AID - 10.7860/JCDR/2016/17274.7687 [doi] PST - ppublish SO - J Clin Diagn Res. 2016 Apr;10(4):QC08-11. doi: 10.7860/JCDR/2016/17274.7687. Epub 2016 Apr 1. PMID- 26902464 OWN - NLM STAT- MEDLINE DCOM- 20170629 LR - 20181202 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) VI - 29 IP - 24 DP - 2016 Dec TI - "Does short-term variation in fetal heart rate predict fetal acidaemia?" A systematic review and meta-analysis. PG - 4070-7 LID - 10.3109/14767058.2016.1156670 [doi] AB - OBJECTIVE: To evaluate the association of short-term variation (STV) of the fetal heart rate in predicting fetal acidaemia at birth. METHODS: The search strategy employed searching of electronic databases (MEDLINE, Web of Science, Scopus, and Google Scholar) and reference lists of relevant studies. Data were extracted from studies, adhering strictly to the following criteria: singleton pregnancy at ≥24 weeks' gestation, computerized CTG (index test) and calculation of STV before delivery. The outcome measure was arterial pH assessed in cord blood obtained at birth. RESULTS: Meta-analysis showed moderate accuracy of STV in predicting fetal acidaemia with a sensitivity of 0.57 (95% CI: 0.45-0.68), specificity of 0.81 (95% CI: 0.69-0.89), positive likelihood ratio of 3.14 (95% CI: 2.13-4.63) and negative likelihood ratio of 0.58, (95% CI: 0.46-0.72). However, in intra-uterine growth restricted fetuses, a small improvement in detecting acidaemia was observed; with a sensitivity of 0.63 (95% CI: 0.49-0.75) and negative likelihood ratio of 0.50 (95% CI: 0.31-0.80). CONCLUSION: STV appears to be a moderate predictor for fetal acidaemia. However, its usefulness as a stand-alone test in predicting acidaemia in clinical setting remains to be determined. FAU - Kapaya, Habiba AU - Kapaya H AD - a Department of Human Metabolism , Academic Unit of Reproductive & Developmental Medicine , Sheffield , UK . FAU - Jacques, Richard AU - Jacques R AD - b School of Health and Related Research (ScHARR), University of Sheffield , Sheffield , UK. FAU - Rahaim, Nadia AU - Rahaim N AD - a Department of Human Metabolism , Academic Unit of Reproductive & Developmental Medicine , Sheffield , UK . FAU - Anumba, Dilly AU - Anumba D AD - a Department of Human Metabolism , Academic Unit of Reproductive & Developmental Medicine , Sheffield , UK . LA - eng PT - Journal Article PT - Review PT - Systematic Review DEP - 20160321 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 SB - IM MH - Acidosis/*diagnosis MH - *Cardiotocography MH - Female MH - Gestational Age MH - Heart Rate, Fetal/*physiology MH - Humans MH - Infant, Newborn MH - Pregnancy MH - Prenatal Diagnosis MH - ROC Curve MH - Reference Standards MH - Risk MH - Sensitivity and Specificity OTO - NOTNLM OT - Computer analysis OT - computerized cardiotocography OT - fetal acidaemia OT - fetal acid–base status OT - fetal heart rate OT - neonatal acidaemia OT - short-term variation OT - umbilical blood gas analysis EDAT- 2016/02/24 06:00 MHDA- 2017/07/01 06:00 CRDT- 2016/02/24 06:00 PHST- 2016/02/24 06:00 [entrez] PHST- 2016/02/24 06:00 [pubmed] PHST- 2017/07/01 06:00 [medline] AID - 10.3109/14767058.2016.1156670 [doi] PST - ppublish SO - J Matern Fetal Neonatal Med. 2016 Dec;29(24):4070-7. doi: 10.3109/14767058.2016.1156670. Epub 2016 Mar 21. PMID- 26984160 OWN - NLM STAT- MEDLINE DCOM- 20161216 LR - 20181113 IS - 1471-2393 (Electronic) IS - 1471-2393 (Linking) VI - 16 DP - 2016 Mar 16 TI - Fetal heart rate monitoring of short term variation (STV): a methodological observational study. PG - 55 LID - 10.1186/s12884-016-0845-8 [doi] LID - 55 AB - BACKGROUND: Cardiotocography (CTG) has high sensitivity, but less specificity in detection of fetal hypoxia. There is need for adjunctive methods easy to apply during labor. Low fetal heart rate short term variation (STV) is predictive for hypoxia during the antenatal period. The objectives of our study were to methodologically evaluate monitoring of STV during labor and to compare two different monitors (Sonicaid™ and EDAN™) for antenatal use. METHODS: A prospective observational study at the obstetric department, Karolinska University hospital, Stockholm (between September 2011 and April 2015). In 100 women of ≥ 36 weeks gestation, STV values were calculated during active labor. In a subset of 20 women we compared STV values between internal and external signal acquisition. Additionally we compared antenatal monitoring with two different monitors in another 20 women. RESULTS: Median STV in 100 fetuses monitored with scalp electrode during labor (EDAN™) was 7.1 msec (range 1.3-25.9) with no difference between early (3-6 cm) and late (7-10 cm) labor (7.1 vs 6.8 msec; p = 0.80). STV calculated from scalp electrode signals were positively correlated with delta-STV (STV internal -external) (R = 0.70; p < 0.01). No significant differences were found between Sonicaid™ and EDAN™ in antenatal external monitoring of STV (median difference 0.9 msec, Spearman Rank Correlation Sonicaid vs delta-STV; R = 0.35; p = 0.14). CONCLUSIONS: Median intrapartum STV was 7.1 msec. Significant differences were found between internal and external signal acquisition, a finding that suggests further intrapartum studies to be analysed separately depending upon type of signal acquisition. Antenatal external monitoring with Sonicaid™ and EDAN™ indicates that the devices perform equally well in the identification of acidemic fetuses. Further studies are needed to assess the clinical value of intrapartum STV. FAU - Wretler, Stina AU - Wretler S AUID- ORCID: 0000-0001-9118-5036 AD - Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden. stina.wretler@karolinska.se. FAU - Holzmann, Malin AU - Holzmann M AD - Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden. FAU - Graner, Sophie AU - Graner S AD - Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden. AD - Department of Medicine, Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. FAU - Lindqvist, Pelle AU - Lindqvist P AD - Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. FAU - Falck, Susanne AU - Falck S AD - Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden. FAU - Nordström, Lennart AU - Nordström L AD - Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden. LA - eng PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20160316 TA - BMC Pregnancy Childbirth JT - BMC pregnancy and childbirth JID - 100967799 SB - IM MH - Adult MH - Cardiotocography/*instrumentation/methods MH - Female MH - Fetal Hypoxia/*diagnosis/prevention & control MH - Gestational Age MH - Heart Rate, Fetal/*physiology MH - Humans MH - Labor, Obstetric/physiology MH - Obstetric Labor Complications/*diagnosis/prevention & control MH - Pregnancy MH - Prospective Studies MH - Sensitivity and Specificity MH - Statistics, Nonparametric PMC - PMC4794822 OTO - NOTNLM OT - Cardiotocography OT - Computerized cardiotocography OT - Fetal heart rate OT - Fetal hypoxia OT - Fetal monitoring OT - Short term variation EDAT- 2016/03/18 06:00 MHDA- 2016/12/17 06:00 CRDT- 2016/03/18 06:00 PHST- 2015/11/10 00:00 [received] PHST- 2016/03/11 00:00 [accepted] PHST- 2016/03/18 06:00 [entrez] PHST- 2016/03/18 06:00 [pubmed] PHST- 2016/12/17 06:00 [medline] AID - 10.1186/s12884-016-0845-8 [pii] AID - 845 [pii] AID - 10.1186/s12884-016-0845-8 [doi] PST - epublish SO - BMC Pregnancy Childbirth. 2016 Mar 16;16:55. doi: 10.1186/s12884-016-0845-8. PMID- 27627565 OWN - NLM STAT- MEDLINE DCOM- 20161228 LR - 20181023 IS - 1899-5276 (Print) IS - 1899-5276 (Linking) VI - 25 IP - 2 DP - 2016 Mar-Apr TI - Fetal Heart Rate Monitoring Using Maternal Abdominal Surface Electrodes in Third Trimester: Can We Obtain Additional Information Other than CTG Trace? PG - 309-16 LID - 10.17219/acem/60842 [doi] AB - BACKGROUND: Cardiotocography (CTG) is the most widely used procedure despite its low specificity for fetal acidosis and poor perinatal outcome. Fetal electrocardiography (fECG) with transabdominal electrodes is a new, non-invasive and promising method with greater potential for detecting impairment of fetal circulation. This study is the first that attempts to assess the usefulness of fECG in comparison to CTG during antepartum period. OBJECTIVES: To determine if a single fECG examination along with CTG tracing and Doppler flow measurement in the fetal vessels has any additional clinical value in normal and intrauterine growth restricted (IUGR) fetuses. MATERIAL AND METHODS: The study included 93 pregnancies with IUGR, 37 pregnancies with IUGR and brain sparing effect, and 324 healthy pregnant women. The T/QRS ratio, cerebro-placental ratio (CRP), and CTG tracings were analyzed. One-way analysis of variance and Spearman's rank correlation coefficient were applied. The relationship between results of the T/QRS ratio and CTG examination among the study groups was analyzed. RESULTS: The highest average mean value of the T/QRS ratio was recorded in the IUGR group with a normal CPR and a pathologic CTG (0.235 ± 0.014). The highest average maximum values were observed in the groups of IUGR pregnancies with a reduced CPR with normal (0.309 ± 0.100), suspicious (0.330 ± 0.102) and pathologic (0.319 ± 0.056) CTGs. Analysis of variance revealed differences between study groups regarding maximum values and the difference between maximum and minimal values of T/QRS. Correlations between groups were insignificant. CONCLUSIONS: Higher values of T/QRS ratio in IUGR pregnancies with normal and reduced CPR than in control group regardless of the result of CTG examination may indicate minimal worsening of intrauterine fetal well-being in growth retarded fetuses. No relationship between fECG examination and CTG tracings suggests that a single fECG does not provide any additional clinically significant information determining the condition of the fetus; however, further studies are required. FAU - Fuchs, Tomasz AU - Fuchs T AD - 2nd Department and Clinic of Gynaecology and Obstetrics, Wroclaw Medical University, Poland. FAU - Grobelak, Krzysztof AU - Grobelak K AD - 2nd Department and Clinic of Gynaecology and Obstetrics, Wroclaw Medical University, Poland. FAU - Pomorski, Michał AU - Pomorski M AD - 2nd Department and Clinic of Gynaecology and Obstetrics, Wroclaw Medical University, Poland. FAU - Zimmer, Mariusz AU - Zimmer M AD - 2nd Department and Clinic of Gynaecology and Obstetrics, Wroclaw Medical University, Poland. LA - eng PT - Comparative Study PT - Journal Article PL - Poland TA - Adv Clin Exp Med JT - Advances in clinical and experimental medicine : official organ Wroclaw Medical University JID - 101138582 SB - IM MH - Abdomen MH - Blood Flow Velocity MH - *Cardiotocography MH - Case-Control Studies MH - Electrocardiography/instrumentation/*methods MH - Electrodes MH - Female MH - Fetal Growth Retardation/*diagnosis/physiopathology MH - Fetal Heart/*physiopathology MH - *Heart Rate, Fetal MH - Humans MH - Placental Circulation MH - Predictive Value of Tests MH - Pregnancy MH - Pregnancy Trimester, Third MH - Prenatal Diagnosis/instrumentation/*methods MH - Prognosis MH - Ultrasonography, Doppler MH - Ultrasonography, Prenatal OTO - NOTNLM OT - antepartum fetal monitoring OT - cardiotocography OT - fetal electrocardiography OT - fetal growth restriction OT - fetal heart rate EDAT- 2016/09/15 06:00 MHDA- 2016/12/29 06:00 CRDT- 2016/09/15 06:00 PHST- 2015/08/03 00:00 [received] PHST- 2015/11/12 00:00 [revised] PHST- 2015/12/02 00:00 [accepted] PHST- 2016/09/15 06:00 [entrez] PHST- 2016/09/15 06:00 [pubmed] PHST- 2016/12/29 06:00 [medline] AID - 10.17219/acem/60842 [doi] PST - ppublish SO - Adv Clin Exp Med. 2016 Mar-Apr;25(2):309-16. doi: 10.17219/acem/60842. PMID- 26888657 OWN - NLM STAT- MEDLINE DCOM- 20170104 LR - 20170215 IS - 1471-0528 (Electronic) IS - 1470-0328 (Linking) VI - 123 IP - 13 DP - 2016 Dec TI - Does knowledge of fetal outcome influence the interpretation of intrapartum cardiotocography and subsequent clinical management? A multicentre European study. PG - 2208-2217 LID - 10.1111/1471-0528.13882 [doi] AB - OBJECTIVE: To investigate whether knowledge of fetal outcome influences retrospective interpretation of cardiotocographic tracings and subsequent management recommendations. DESIGN: Prospective online study. SETTING: Seven university hospitals in five European countries. POPULATION: Forty-two intrapartum tracings from women with singleton pregnancies and uneventful antepartum courses. METHODS: Using an online questionnaire, 123 healthcare professionals interpreted 42 tracings without any knowledge of fetal outcome and provided management recommendations according to the National Institute of Clinical Excellence guidelines (intrapartum care). Two months later, 93 of the 123 participants re-interpreted the same re-ordered tracings, this time with information on the newborn's umbilical artery pH. OUTCOME MEASURES: Comparison of the evaluation of tracing features, overall tracing classification, and management recommendations between the initial analysis and re-interpretation. RESULTS: In newborns with umbilical artery pH ≤ 7.05, knowledge of the pH value led to significant changes in the evaluation of all basic tracing features. In this group, classification of tracings as 'normal' decreased 76% (8.8-2.1%, P < 0.001), whereas classification as 'pathologic' increased 51% (44.7-67.5%, P < 0.001). In newborns with pH 7.06-7.19, classification of tracings as 'normal' decreased 36% (22.4-14.4%, P < 0.001), and in those with pH ≥ 7.20, classification of tracings as 'pathologic' decreased 40% (23.4-14.1%, P < 0.001). In the group of newborns with umbilical artery pH ≤ 7.05, the recommendations 'no attention needed' decreased 75% (10.2-2.6%, P < 0.001), and the number of recommendations 'rapid reversal of hypoxic cause or immediate delivery' increased 70.3% (42.1-71.7%, P < 0.001). CONCLUSIONS: When provided with information on adverse fetal outcome, healthcare professionals provide a more pessimistic evaluation of basic tracing features, overall classification, and clinical management recommendations. TWEETABLE ABSTRACT: Knowledge of adverse fetal outcome leads to more pessimistic CTG evaluation and management recommendations. CI - © 2016 Royal College of Obstetricians and Gynaecologists. FAU - Reif, P AU - Reif P AD - Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria. FAU - Schott, S AU - Schott S AD - Department of Obstetrics and Gynaecology, Heidelberg University Hospital, Heidelberg, Germany. FAU - Boyon, C AU - Boyon C AD - Department of Obstetrics and Gynaecology, Lille University Hospital, Lille, France. FAU - Richter, J AU - Richter J AD - Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium. FAU - Kavšek, G AU - Kavšek G AD - Department of Obstetrics and Gynaecology, University Clinical Centre Ljubljana, Ljubljana, Slovenia. FAU - Timoh, K N AU - Timoh KN AD - Department of Obstetrics and Gynaecology, Paris Sud 11 University, Paris, France. FAU - Haas, J AU - Haas J AD - Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria. FAU - Pateisky, P AU - Pateisky P AD - Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria. FAU - Griesbacher, A AU - Griesbacher A AD - Department for Risk Assessment, Data and Statistics, Austrian Agency for Health and Food Safety, Vienna, Austria. FAU - Lang, U AU - Lang U AD - Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria. FAU - Ayres-de-Campos, D AU - Ayres-de-Campos D AD - Department of Obstetrics and Gynaecology, Medical School - University of Porto, Porto, Portugal. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20160216 PL - England TA - BJOG JT - BJOG : an international journal of obstetrics and gynaecology JID - 100935741 SB - AIM SB - IM CIN - BJOG. 2016 Dec;123(13):2069-2070 CIN - BJOG. 2016 Dec;123(13):2218. PMID: 26888764 MH - *Cardiotocography MH - *Clinical Decision-Making MH - Europe MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Prospective Studies MH - Surveys and Questionnaires OTO - NOTNLM OT - Cardiotocography OT - delivery OT - fetal heart rate OT - fetal monitoring OT - intrapartum care OT - observer variation OT - obstetric EDAT- 2016/02/19 06:00 MHDA- 2017/01/05 06:00 CRDT- 2016/02/19 06:00 PHST- 2015/11/26 00:00 [accepted] PHST- 2016/02/19 06:00 [pubmed] PHST- 2017/01/05 06:00 [medline] PHST- 2016/02/19 06:00 [entrez] AID - 10.1111/1471-0528.13882 [doi] PST - ppublish SO - BJOG. 2016 Dec;123(13):2208-2217. doi: 10.1111/1471-0528.13882. Epub 2016 Feb 16. PMID- 26872018 OWN - NLM STAT- MEDLINE DCOM- 20160720 LR - 20181113 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 11 IP - 2 DP - 2016 TI - Can Intrapartum Cardiotocography Predict Uterine Rupture among Women with Prior Caesarean Delivery?: A Population Based Case-Control Study. PG - e0146347 LID - 10.1371/journal.pone.0146347 [doi] LID - e0146347 AB - OBJECTIVE: 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. STUDY DESIGN: 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). RESULTS: 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. CONCLUSION: 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. FAU - Andersen, Malene M AU - Andersen MM AD - Dept. of Obstetrics and Gynaecology, University of Copenhagen, Holbaek Hospital, Holbaek, Denmark. FAU - Thisted, Dorthe L A AU - Thisted DL AD - Dept. of Obstetrics and Gynaecology, University of Copenhagen, Holbaek Hospital, Holbaek, Denmark. AD - University of Copenhagen, Hvidovre Hospital, Dept. of Obstetric and Gynecology, Hvidovre, Denmark. FAU - Amer-Wåhlin, Isis AU - Amer-Wåhlin I AD - Dept. of Women and Child Health, Karolinska Institute, Stockholm, Sweden. FAU - Krebs, Lone AU - Krebs L AD - Dept. of Obstetrics and Gynaecology, University of Copenhagen, Holbaek Hospital, Holbaek, Denmark. CN - Danish CTG Monitoring during VBAC study group LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20160212 TA - PLoS One JT - PloS one JID - 101285081 SB - IM MH - Adult MH - Cardiotocography/*statistics & numerical data MH - Case-Control Studies MH - Female MH - Fetal Diseases/*diagnosis/physiopathology MH - Fetal Heart/growth & development/physiopathology MH - Fetal Monitoring/instrumentation/methods MH - Fetus MH - Humans MH - Labor, Obstetric MH - Pregnancy MH - Registries MH - Tachycardia/*diagnosis/physiopathology MH - Uterine Rupture/*diagnosis/prevention & control MH - Uterus/*pathology MH - *Vaginal Birth after Cesarean PMC - PMC4752316 COIS- Competing Interests: The authors have declared that no competing interests exist. EDAT- 2016/02/13 06:00 MHDA- 2016/07/21 06:00 CRDT- 2016/02/13 06:00 PHST- 2015/07/23 00:00 [received] PHST- 2015/12/16 00:00 [accepted] PHST- 2016/02/13 06:00 [entrez] PHST- 2016/02/13 06:00 [pubmed] PHST- 2016/07/21 06:00 [medline] AID - PONE-D-15-32354 [pii] AID - 10.1371/journal.pone.0146347 [doi] PST - epublish SO - PLoS One. 2016 Feb 12;11(2):e0146347. doi: 10.1371/journal.pone.0146347. eCollection 2016. PMID- 26862891 OWN - NLM STAT- MEDLINE DCOM- 20161213 LR - 20161230 IS - 1361-6579 (Electronic) IS - 0967-3334 (Linking) VI - 37 IP - 3 DP - 2016 Mar TI - Using uterine activity to improve fetal heart rate variability analysis for detection of asphyxia during labor. PG - 387-400 LID - 10.1088/0967-3334/37/3/387 [doi] AB - 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). FAU - Warmerdam, G J J AU - Warmerdam GJ AD - Faculty of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands. FAU - Vullings, R AU - Vullings R FAU - Van Laar, J O E H AU - Van Laar JO FAU - Van der Hout-Van der Jagt, M B AU - Van der Hout-Van der Jagt MB FAU - Bergmans, J W M AU - Bergmans JW FAU - Schmitt, L AU - Schmitt L FAU - Oei, S G AU - Oei SG LA - eng PT - Journal Article DEP - 20160210 PL - England TA - Physiol Meas JT - Physiological measurement JID - 9306921 SB - IM MH - Asphyxia/*diagnosis/*physiopathology MH - Female MH - Heart Rate, Fetal/*physiology MH - Humans MH - *Labor, Obstetric MH - Pregnancy MH - Signal Processing, Computer-Assisted MH - Uterine Contraction MH - Uterus/*physiopathology EDAT- 2016/02/11 06:00 MHDA- 2016/12/15 06:00 CRDT- 2016/02/11 06:00 PHST- 2016/02/11 06:00 [entrez] PHST- 2016/02/11 06:00 [pubmed] PHST- 2016/12/15 06:00 [medline] AID - 10.1088/0967-3334/37/3/387 [doi] PST - ppublish SO - Physiol Meas. 2016 Mar;37(3):387-400. doi: 10.1088/0967-3334/37/3/387. Epub 2016 Feb 10. PMID- 26799770 OWN - NLM STAT- MEDLINE DCOM- 20161024 LR - 20161230 IS - 1361-6579 (Electronic) IS - 0967-3334 (Linking) VI - 37 IP - 2 DP - 2016 Feb TI - A novel LabVIEW-based multi-channel non-invasive abdominal maternal-fetal electrocardiogram signal generator. PG - 238-56 LID - 10.1088/0967-3334/37/2/238 [doi] AB - 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. FAU - Martinek, Radek AU - Martinek R AD - Department of Cybernetics and Biomedical Engineering, VSB-Technical University of Ostrava, 17. listopadu 15, 708 33 Ostrava, Czech Republic. FAU - Kelnar, Michal AU - Kelnar M FAU - Koudelka, Petr AU - Koudelka P FAU - Vanus, Jan AU - Vanus J FAU - Bilik, Petr AU - Bilik P FAU - Janku, Petr AU - Janku P FAU - Nazeran, Homer AU - Nazeran H FAU - Zidek, Jan AU - Zidek J LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20160122 PL - England TA - Physiol Meas JT - Physiological measurement JID - 9306921 SB - IM MH - Abdomen/*physiology MH - *Algorithms MH - Cardiotocography MH - Electrocardiography/*methods MH - Female MH - Fetal Monitoring/*methods MH - Fetus/*physiology MH - Gestational Age MH - Heart/physiology MH - Heart Rate, Fetal/physiology MH - Humans MH - Nonlinear Dynamics MH - Pregnancy MH - *Signal Processing, Computer-Assisted EDAT- 2016/01/23 06:00 MHDA- 2016/10/25 06:00 CRDT- 2016/01/23 06:00 PHST- 2016/01/23 06:00 [entrez] PHST- 2016/01/23 06:00 [pubmed] PHST- 2016/10/25 06:00 [medline] AID - 10.1088/0967-3334/37/2/238 [doi] PST - ppublish SO - Physiol Meas. 2016 Feb;37(2):238-56. doi: 10.1088/0967-3334/37/2/238. Epub 2016 Jan 22. PMID- 28508731 OWN - NLM STAT- MEDLINE DCOM- 20180416 LR - 20180416 IS - 2042-1834 (Electronic) IS - 0025-8172 (Linking) VI - 85 IP - 2 DP - 2017 Jun TI - Submitting medico-legal intra-partum CTG (I-P CTG) monitoring to the Bolam and Bolitho principles. PG - 93-96 LID - 10.1177/0025817216683639 [doi] AB - The article analyses some of the seeming weaknesses of the Bolam and Bolitho tests as applied to electronic foetal monitoring in labour, in the form of intra-partum CTG monitoring. Homing on to such aspects as confirmation of foetal hypoxia/acidosis, it evaluates the Bolam and Bolitho tests in the context of evidence-based medicine versus traditionally held views, which still hold their own in medical jurisprudence. Case law examples are quoted to illustrate various points. The discussion is of practical relevance both to the individual obstetrician as well as to national budgetary implications, bearing in mind, that, for example, in 2011, 'birth asphyxia' comprised 50% of the UK NHS litigation costs, and in the 2000-2010 decade, the same NHS forked out £3.1 billion for maternity medico-legal claims (the highest of any speciality), mostly involving cerebral palsy and CTG misinterpretation. The article concludes with suggestions to help level the potential extant equivocity between legal principle and medical practice. It also looks at the ruling in Montgomery v Lanarkshire Health Board, UK Supreme Court, and its challenge to Bolam. The implications pose a serious and overdue challenge to a test, born in 1957 and lacking the necessary qualities to serve many 21st century medical quandaries, including the ones raised here. FAU - Buttigieg, George G AU - Buttigieg GG AD - 1 Mater Dei Hospital, Msida, Malta. AD - 2 University of Malta, Department of Obstetrics and Gynaecology, Faculty of Medicine and Surgery, Msida, Malta. LA - eng PT - Journal Article DEP - 20160101 PL - England TA - Med Leg J JT - The Medico-legal journal JID - 0412004 SB - IM MH - Adult MH - Cardiotocography/classification/*standards MH - Evidence-Based Medicine/*methods/standards MH - Female MH - Humans MH - Infant, Newborn MH - *Jurisprudence MH - Malpractice/legislation & jurisprudence MH - Pregnancy MH - Reproducibility of Results MH - State Medicine/economics/trends MH - United Kingdom OTO - NOTNLM OT - Bolam test revisited 60 years on OT - CTG monitoring OT - Evidence-based practice OT - failure to detect a hypoxic foetus OT - foetal blood sampling OT - guidelines OT - inconsistency between EBM and guidelines OT - time constraints for delivery of foetus EDAT- 2017/05/17 06:00 MHDA- 2018/04/17 06:00 CRDT- 2017/05/17 06:00 PHST- 2017/05/17 06:00 [entrez] PHST- 2017/05/17 06:00 [pubmed] PHST- 2018/04/17 06:00 [medline] AID - 10.1177/0025817216683639 [doi] PST - ppublish SO - Med Leg J. 2017 Jun;85(2):93-96. doi: 10.1177/0025817216683639. Epub 2016 Jan 1. PMID- 26696557 OWN - NLM STAT- MEDLINE DCOM- 20161102 LR - 20161230 IS - 1872-7654 (Electronic) IS - 0301-2115 (Linking) VI - 197 DP - 2016 Feb TI - Fetal heart rate abnormalities associated with uterine rupture: a case-control study: A new time-lapse approach using a standardized classification. PG - 16-21 LID - S0301-2115(15)00383-8 [pii] LID - 10.1016/j.ejogrb.2015.10.019 [doi] AB - OBJECTIVE: The aim of this study was to identify fetal heart rate abnormalities (FHRA) in the two hours preceding uterine rupture during trial of labor after a previous C-section compared with successful vaginal birth after cesarean controls. STUDY DESIGN: A multicenter case-control study was conducted from 2006 to 2012. Fetal heart rate tracings of the two-hour period preceding delivery were segmented, anonymized and independently classified by two obstetricians according to a standardized grid based on FIGO guidelines (4 grades: 1 - normal, 2 - intermediate, 3 - abnormal, 4 - preterminal). Each case of uterine rupture was matched to 2 controls. Survival curves were generated for both groups using the Kaplan-Meier method to analyze the occurrence of each FHR category across time. RESULTS: During the study period, 39,773 patients gave birth. 2649 involved women with a previous C-section (6.6%). A total of 33 uterine rupture/scar dehiscence cases occurred (0.08% of all births), of which 22 were included. These were matched to 44 controls. FIGO grade-3 FHRA were significantly associated with uterine rupture in the hour preceding its diagnosis: odds ratios were 4.1 (95% CI 1.2-14.0), 4.3 (95% CI 1.4-13.0) and 3.7 (95% CI 1.2-11.3), in the 60-40 min, 40-20 min and last 20 min before childbirth, respectively. Agreement between the two reviewers (Cohen's kappa) was 84% (CI 95%: 0.79-0.89). CONCLUSION: In the hour preceding uterine rupture, there are often significant FHRA. This leads us to consider the possibility of an earlier C-section when faced with grade-3 FHRA, before the onset of terminal bradycardia jeopardizing maternal and fetal prognosis. CI - Copyright © 2015 Elsevier Ireland Ltd. All rights reserved. FAU - Desseauve, David AU - Desseauve D AD - Université de Poitiers, Faculté de Médecine et Pharmacie, 2 rue de la Milétrie, F-86000 Poitiers, France; Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, F-86000 Poitiers, France. Electronic address: david.desseauve@chu-poitiers.fr. FAU - Bonifazi-Grenouilleau, Marion AU - Bonifazi-Grenouilleau M AD - Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, F-86000 Poitiers, France. FAU - Fritel, Xavier AU - Fritel X AD - Université de Poitiers, Faculté de Médecine et Pharmacie, 2 rue de la Milétrie, F-86000 Poitiers, France; Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, F-86000 Poitiers, France; Inserm CIC0802, 2 rue de la Milétrie, F-86000 Poitiers, France. FAU - Lathélize, Julie AU - Lathélize J AD - Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, F-86000 Poitiers, France. FAU - Sarreau, Mélie AU - Sarreau M AD - Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, F-86000 Poitiers, France. FAU - Pierre, Fabrice AU - Pierre F AD - Université de Poitiers, Faculté de Médecine et Pharmacie, 2 rue de la Milétrie, F-86000 Poitiers, France; Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, F-86000 Poitiers, France. LA - eng PT - Journal Article DEP - 20151202 PL - Ireland TA - Eur J Obstet Gynecol Reprod Biol JT - European journal of obstetrics, gynecology, and reproductive biology JID - 0375672 SB - IM MH - Adult MH - Bradycardia/*epidemiology MH - Case-Control Studies MH - Female MH - Fetal Diseases/*epidemiology MH - *Heart Rate, Fetal MH - Humans MH - Kaplan-Meier Estimate MH - Odds Ratio MH - Pregnancy MH - Risk Assessment MH - Tachycardia/*epidemiology MH - Time Factors MH - *Trial of Labor MH - Uterine Rupture/*epidemiology MH - *Vaginal Birth after Cesarean OTO - NOTNLM OT - Fetal heart rate OT - Risk management OT - Trial of labor after C-section (TOLAC) OT - Uterine rupture EDAT- 2015/12/24 06:00 MHDA- 2016/11/03 06:00 CRDT- 2015/12/24 06:00 PHST- 2015/02/10 00:00 [received] PHST- 2015/08/03 00:00 [revised] PHST- 2015/10/28 00:00 [accepted] PHST- 2015/12/24 06:00 [entrez] PHST- 2015/12/24 06:00 [pubmed] PHST- 2016/11/03 06:00 [medline] AID - S0301-2115(15)00383-8 [pii] AID - 10.1016/j.ejogrb.2015.10.019 [doi] PST - ppublish SO - Eur J Obstet Gynecol Reprod Biol. 2016 Feb;197:16-21. doi: 10.1016/j.ejogrb.2015.10.019. Epub 2015 Dec 2. PMID- 26524932 OWN - NLM STAT- MEDLINE DCOM- 20170612 LR - 20190320 IS - 1476-4954 (Electronic) IS - 1476-4954 (Linking) VI - 29 IP - 19 DP - 2016 Oct TI - Effect of oxytocin during labor on neonatal acidemia. PG - 3098-103 LID - 10.3109/14767058.2015.1114088 [doi] AB - OBJECTIVE: To assess the factors affecting neonatal acidemia, including occurrence of tachysystole/hypertonus in fetuses exposed to oxytocin during labour and with continuously-monitored fetal heart rate (FHR) tracings. METHODS: Prospective observational study of all women with term pregnancies who received oxytocin for induction/augmentation of labour. FHR tracings were prospectively classified using ACOG classification. Independent predictors of neonatal acidemia were identified using multivariate linear regression with p < 0.05 considered significant. RESULTS: We included 430 women, 236 of whom (54.9%) had spontaneous onset of labour. The duration of active phase of the second stage of labour and the presence of abnormal FHR tracing during labour were significantly associated with UA pH (p < 0.001) and BE (p < 0.001), while maximum dose of oxytocin (p < 0.17; p < 0.7) and tachysystole (p < 0.9; p < 0.8) were not. At logistic regression, the duration of active phase of the second stage of labour was independently predictive of neonatal acidemia (p < 0.009) while abnormal FHR tracing approached significance (p < 0.088). CONCLUSIONS: In women receiving oxytocin during labour, the duration of active phase of the second stage of labour correlates with neonatal acidemia, whereas maximum dose of oxytocin, duration of oxytocin administration and occurrence of tachysystole during labour do not. FAU - Mussi, Serena AU - Mussi S AD - a Department of Obstetrics and Gynecology , San Gerardo Hospital-FMBBM, University of Milano-Bicocca , Monza , Italy . FAU - Incerti, Maddalena AU - Incerti M AD - a Department of Obstetrics and Gynecology , San Gerardo Hospital-FMBBM, University of Milano-Bicocca , Monza , Italy . FAU - Plevani, Cristina AU - Plevani C AD - a Department of Obstetrics and Gynecology , San Gerardo Hospital-FMBBM, University of Milano-Bicocca , Monza , Italy . FAU - Ghidini, Alessandro AU - Ghidini A AD - b Perinatal Diagnostic Center, Inova Alexandria Hospital , Alexandria , VA , USA , and. FAU - Pezzullo, John C AU - Pezzullo JC AD - c Georgetown University Medical Center , Washington , DC , USA. FAU - Locatelli, Anna AU - Locatelli A AD - a Department of Obstetrics and Gynecology , San Gerardo Hospital-FMBBM, University of Milano-Bicocca , Monza , Italy . LA - eng PT - Journal Article PT - Observational Study DEP - 20151202 PL - England TA - J Matern Fetal Neonatal Med JT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JID - 101136916 RN - 0 (Oxytocics) RN - 50-56-6 (Oxytocin) SB - IM MH - Acidosis/*prevention & control MH - Cardiotocography MH - Female MH - Fetus MH - Heart Rate, Fetal/*drug effects MH - Humans MH - Infant, Newborn MH - Labor Stage, Second/*drug effects/physiology MH - *Labor, Induced MH - Logistic Models MH - Obstetric Labor Complications MH - Oxytocics/*pharmacology MH - Oxytocin/administration & dosage/*pharmacology MH - Pregnancy MH - Prospective Studies MH - Risk Factors MH - Time Factors OTO - NOTNLM OT - *Fetal heart rate tracings OT - *neonatal academia OT - *oxytocin OT - *tachysystole EDAT- 2015/11/04 06:00 MHDA- 2019/03/21 06:00 CRDT- 2015/11/04 06:00 PHST- 2015/11/04 06:00 [entrez] PHST- 2015/11/04 06:00 [pubmed] PHST- 2019/03/21 06:00 [medline] AID - 10.3109/14767058.2015.1114088 [doi] PST - ppublish SO - J Matern Fetal Neonatal Med. 2016 Oct;29(19):3098-103. doi: 10.3109/14767058.2015.1114088. Epub 2015 Dec 2. PMID- 26638805 OWN - NLM STAT- MEDLINE DCOM- 20161014 LR - 20161230 IS - 1872-7565 (Electronic) IS - 0169-2607 (Linking) VI - 124 DP - 2016 Feb TI - Software for computerised analysis of cardiotocographic traces. PG - 121-37 LID - S0169-2607(15)00268-0 [pii] LID - 10.1016/j.cmpb.2015.10.008 [doi] AB - 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. CI - Copyright © 2015 Elsevier Ireland Ltd. All rights reserved. FAU - Romano, M AU - Romano M AD - DMSC, University "Magna Graecia", Catanzaro, Italy. FAU - Bifulco, P AU - Bifulco P AD - DIETI, University of Naples, "Federico II", Naples, Italy. FAU - Ruffo, M AU - Ruffo M AD - DIETI, University of Naples, "Federico II", Naples, Italy. FAU - Improta, G AU - Improta G AD - DIETI, University of Naples, "Federico II", Naples, Italy. FAU - Clemente, F AU - Clemente F AD - IBB, Italian National Research Council, Rome, Italy. FAU - Cesarelli, M AU - Cesarelli M AD - DIETI, University of Naples, "Federico II", Naples, Italy. Electronic address: cesarell@unina.it. LA - eng PT - Journal Article DEP - 20151105 PL - Ireland TA - Comput Methods Programs Biomed JT - Computer methods and programs in biomedicine JID - 8506513 SB - IM MH - *Algorithms MH - Cardiotocography/*methods MH - Diagnosis, Computer-Assisted/*methods MH - Female MH - Heart Rate, Fetal/*physiology MH - Humans MH - Male MH - Pattern Recognition, Automated/*methods MH - Programming Languages MH - Reproducibility of Results MH - Sensitivity and Specificity MH - *Software OTO - NOTNLM OT - Computerised cardiotocography OT - FHR clinical analysis OT - Foetal heart rate variability OT - Matlab OT - Nonlinear indices OT - Software performance EDAT- 2015/12/08 06:00 MHDA- 2016/10/16 06:00 CRDT- 2015/12/08 06:00 PHST- 2015/02/09 00:00 [received] PHST- 2015/09/11 00:00 [revised] PHST- 2015/10/14 00:00 [accepted] PHST- 2015/12/08 06:00 [entrez] PHST- 2015/12/08 06:00 [pubmed] PHST- 2016/10/16 06:00 [medline] AID - S0169-2607(15)00268-0 [pii] AID - 10.1016/j.cmpb.2015.10.008 [doi] PST - ppublish SO - Comput Methods Programs Biomed. 2016 Feb;124:121-37. doi: 10.1016/j.cmpb.2015.10.008. Epub 2015 Nov 5. PMID- 26321609 OWN - NLM STAT- MEDLINE DCOM- 20170510 LR - 20170510 IS - 1773-0430 (Electronic) IS - 0150-9918 (Linking) VI - 45 IP - 6 DP - 2016 Jun TI - [Intrapartum asphyxia: Risk factors and short-term consequences]. PG - 626-32 LID - S0368-2315(15)00169-6 [pii] LID - 10.1016/j.jgyn.2015.06.022 [doi] AB - Intrapartum asphyxia is a rare yet serious complication during labor with immediate consequences and possible long-term neurological impairment. The international Cerebral Palsy Task Force established criteria that attribute a cerebral palsy to intrapartum asphyxia: metabolic acidemia measured at birth with pH<7 and base deficit≥12mmol/L. OBJECTIVE: To determine the risk factors of an intrapartum asphyxia occurring in term live births, to evaluate the short-term consequences. METHODS: Our retrospective study included all births between 2002 and 2010 in a level 3 maternity of a university hospital center. Inclusion criteria were those of the Cerebral Palsy Task Force associated with a gestational age≥34weeks of gestation. We studied the conventional markers of intrapartum asphyxia: Apgar score at 5minutes, abnormal cardiotogographic recordings whether they occurred after a sentinel hypoxic event or not before and during labor. The duration of expulsive efforts, the amniotic fluid aspects, the delivery mode as well as the preexisting pregnancy pathologies were also evaluated. On the other hand, we studied the short-term consequences at the newborns: death, multiorgan failure and especially the occurring of a neonatal encephalopathy using Sarnat and Sarnat staging. RESULTS: One hundred and twenty-nine newborns (0.43%) out of 29,416 live births had a pH<7 of whom only 82 (0.27%) presented a real intrapartum asphyxia and were included in this study. A preexisting pregnancy pathology was found in 22% of the women. Hypoxic events were noted in only 9/82 of the cases. Abnormal cardiotocographic recordings were present in 97.6% of the cases. The duration of expulsive efforts as well as the amniotic fluid aspects did not interfere with the occurring of a metabolic acidemia. Caesarean rate was at 46.3% and instrumental extraction rate was at 34.1%. Thity-eight newborns (46.3%) were admitted in neonatal intensive care in which we noted 3 deaths (3.65%), 2 multiorgan failures (2.4%) and 17 neonatal encephalopathy (20.7%). The pH value seemed to influence the occurring of an encephalopathy: 50% when pH<6.9 vs. 13.6% when pH≥6.9 (P=0.0013), as well as for the base deficit: 50% when BD<-18 vs. 15.7% when BD≥-18 (P=0.0068). Apgar score at 5minutes also seemed predictive for a neonatal encephalopathy: 100% when<4, 46% between 4 and 6 and 11% when>6 (P<0.001). CONCLUSIONS: Our results showed an intrapartum asphyxia rate half the one widely recorded of 0.5% of total live births. Our study also validates the commonly used markers to evaluate a high risk of an early neonatal encephalopathy. This study should be continued with the evaluation of hypoxia long-term consequences on the psychomotor development of these kids and especially the occurring of cerebral palsy. CI - Copyright © 2016. Published by Elsevier Masson SAS. FAU - Bouiller, J-P AU - Bouiller JP AD - Département d'obstétrique, gynécologie et médecine de la reproduction, CHU de Caen, Caen 14000, France; UFR de médecine, université de Caen Basse-Normandie, esplanade de la Paix, 14032 Caen cedex 5, France. Electronic address: jpbouiller@yahoo.fr. FAU - Dreyfus, M AU - Dreyfus M AD - Département d'obstétrique, gynécologie et médecine de la reproduction, CHU de Caen, Caen 14000, France; UFR de médecine, université de Caen Basse-Normandie, esplanade de la Paix, 14032 Caen cedex 5, France. FAU - Mortamet, G AU - Mortamet G AD - Département de néonatologie, CHU de Caen, Caen 14000, France. FAU - Guillois, B AU - Guillois B AD - UFR de médecine, université de Caen Basse-Normandie, esplanade de la Paix, 14032 Caen cedex 5, France; Département de néonatologie, CHU de Caen, Caen 14000, France. FAU - Benoist, G AU - Benoist G AD - Département d'obstétrique, gynécologie et médecine de la reproduction, CHU de Caen, Caen 14000, France; UFR de médecine, université de Caen Basse-Normandie, esplanade de la Paix, 14032 Caen cedex 5, France. LA - fre PT - Journal Article TT - Asphyxie perpartum à terme : facteurs de risque de survenue et conséquences à court terme. À propos de 82 cas. DEP - 20150828 PL - France TA - J Gynecol Obstet Biol Reprod (Paris) JT - Journal de gynecologie, obstetrique et biologie de la reproduction JID - 0322206 RN - 0 (Biomarkers) SB - IM MH - Adult MH - Apgar Score MH - Asphyxia Neonatorum/*diagnosis/*epidemiology MH - Biomarkers MH - Cesarean Section/*statistics & numerical data MH - Extraction, Obstetrical/*statistics & numerical data MH - Female MH - France/epidemiology MH - Humans MH - Hypoxia-Ischemia, Brain/*diagnosis/*epidemiology MH - Infant, Newborn MH - *Live Birth MH - Pregnancy MH - Pregnancy Complications/*epidemiology MH - Retrospective Studies MH - Risk Factors OTO - NOTNLM OT - *Apgar score OT - *Asphyxie perpartum OT - *Encéphalopathie hypoxo-ischémique OT - *Hypoxic-ischemic encephalopathy OT - *Intrapartum asphyxia OT - *Score d’Apgar EDAT- 2015/09/01 06:00 MHDA- 2017/05/11 06:00 CRDT- 2015/09/01 06:00 PHST- 2015/02/01 00:00 [received] PHST- 2015/05/31 00:00 [revised] PHST- 2015/06/09 00:00 [accepted] PHST- 2015/09/01 06:00 [entrez] PHST- 2015/09/01 06:00 [pubmed] PHST- 2017/05/11 06:00 [medline] AID - S0368-2315(15)00169-6 [pii] AID - 10.1016/j.jgyn.2015.06.022 [doi] PST - ppublish SO - J Gynecol Obstet Biol Reprod (Paris). 2016 Jun;45(6):626-32. doi: 10.1016/j.jgyn.2015.06.022. Epub 2015 Aug 28. PMID- 26219610 OWN - NLM STAT- MEDLINE DCOM- 20170109 LR - 20181113 IS - 1741-0444 (Electronic) IS - 0140-0118 (Linking) VI - 54 IP - 4 DP - 2016 Apr TI - Toward the improvement in fetal monitoring during labor with the inclusion of maternal heart rate analysis. PG - 691-9 LID - 10.1007/s11517-015-1359-7 [doi] AB - Fetal heart rate (FHR) monitoring is used routinely in labor, but conventional methods have a limited capacity to detect fetal hypoxia/acidosis. An exploratory study was performed on the simultaneous assessment of maternal heart rate (MHR) and FHR variability, to evaluate their evolution during labor and their capacity to detect newborn acidemia. MHR and FHR were simultaneously recorded in 51 singleton term pregnancies during the last two hours of labor and compared with newborn umbilical artery blood (UAB) pH. Linear/nonlinear indices were computed separately for MHR and FHR. Interaction between MHR and FHR was quantified through the same indices on FHR-MHR and through their correlation and cross-entropy. Univariate and bivariate statistical analysis included nonparametric confidence intervals and statistical tests, receiver operating characteristic curves and linear discriminant analysis. Progression of labor was associated with a significant increase in most MHR and FHR linear indices, whereas entropy indices decreased. FHR alone and in combination with MHR as FHR-MHR evidenced the highest auROC values for prediction of fetal acidemia, with 0.76 and 0.88 for the UAB pH thresholds 7.20 and 7.15, respectively. The inclusion of MHR on bivariate analysis achieved sensitivity and specificity values of nearly 100 and 89.1%, respectively. These results suggest that simultaneous analysis of MHR and FHR may improve the identification of fetal acidemia compared with FHR alone, namely during the last hour of labor. FAU - Gonçalves, Hernâni AU - Gonçalves H AD - Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Rua Dr Plácido Costa, s/n, 4200-319, Porto, Portugal. hernanigoncalves@med.up.pt. FAU - Pinto, Paula AU - Pinto P AD - Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Rua Dr Plácido Costa, s/n, 4200-319, Porto, Portugal. AD - Hospital Dr Nélio Mendonça, EPE, Funchal, Portugal. AD - Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal. FAU - Silva, Manuela AU - Silva M AD - Hospital Dr Nélio Mendonça, EPE, Funchal, Portugal. FAU - Ayres-de-Campos, Diogo AU - Ayres-de-Campos D AD - Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Rua Dr Plácido Costa, s/n, 4200-319, Porto, Portugal. AD - Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal. AD - Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal. AD - INEB - Institute of Biomedical Engineering; I3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal. FAU - Bernardes, João AU - Bernardes J AD - Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Rua Dr Plácido Costa, s/n, 4200-319, Porto, Portugal. AD - Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal. AD - Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal. AD - Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20150729 PL - United States TA - Med Biol Eng Comput JT - Medical & biological engineering & computing JID - 7704869 SB - IM MH - Acidosis/diagnosis/physiopathology MH - Adult MH - Confidence Intervals MH - Female MH - Fetal Monitoring/*methods MH - Heart Rate/*physiology MH - Heart Rate, Fetal/physiology MH - Humans MH - Hydrogen-Ion Concentration MH - Infant, Newborn MH - *Labor, Obstetric MH - Pregnancy MH - Umbilical Arteries/physiology OTO - NOTNLM OT - Acidosis OT - Cardiotocography OT - Fetal heart rate OT - Fetal monitoring OT - Maternal heart rate EDAT- 2015/07/30 06:00 MHDA- 2017/01/10 06:00 CRDT- 2015/07/30 06:00 PHST- 2014/11/19 00:00 [received] PHST- 2015/07/16 00:00 [accepted] PHST- 2015/07/30 06:00 [entrez] PHST- 2015/07/30 06:00 [pubmed] PHST- 2017/01/10 06:00 [medline] AID - 10.1007/s11517-015-1359-7 [pii] AID - 10.1007/s11517-015-1359-7 [doi] PST - ppublish SO - Med Biol Eng Comput. 2016 Apr;54(4):691-9. doi: 10.1007/s11517-015-1359-7. Epub 2015 Jul 29.