Baseline Fetal Heart Rate Research Articles

A Pragmatic Approach to Fetal Monitoring via Cardiotocography Using Feature Elimination and Hyperparameter Optimization.

Cardiotocography (CTG) is used to assess the health of the fetus during birth or antenatally in the third trimester. It concurrently detects the maternal uterine contractions (UC) and fetal heart rate (FHR). Fetal distress, which may require therapeutic intervention, can be diagnosed using baseline FHR and its reaction to uterine contractions. Using CTG, a pragmatic machine learning strategy based on feature reduction and hyperparameter optimization was suggested in this study to classify the various fetal states (Normal, Suspect, Pathological). An application of this strategy can be a decision support tool to manage pregnancies. On a public dataset of 2126 CTG recordings, the model was assessed using various standard CTG dataset specific and relevant classifiers. The classifiers' accuracy was improved by the proposed method. The model accuracy was increased to 97.20% while using Random Forest (best classifier). Practically speaking, the model was able to correctly predict 100% of all pathological cases and 98.8% of all normal cases in the dataset. The proposed model was also implemented on another public CTG dataset having 552 CTG signals, resulting in a 97.34% accuracy. If integrated with telemedicine, this proposed model could also be used for long-distance "stay at home" fetal monitoring in high-risk pregnancies.

How well can the fetal heart rate baseline be assessed by intrapartum intermittent auscultation? An interrater reliability and agreement study.

We aimed to examine the inter-reliability and agreement among midwives when assessing the fetal heart rate (FHR) using the handheld Doppler. The primary aim was to measure the reliability and agreement of FHR baseline (baseline) as beats per minute (bpm). The secondary aims were to measure fluctuations from the baseline, defined as increases and decreases, and classifications (normal or abnormal) of FHR soundtracks. This is the first interrater reliability and agreement study on intermittent auscultation (IA) to our knowledge. The participant population consisted of 154 women in labor, from a mixed-risk population and admitted to hospital for intrapartum care. The rater population were 16 midwives from various maternity care settings in Norway. A total of 154 soundtracks were recorded with a handheld Doppler device, and the 16 raters assessed 1-min soundtracks once, through an online survey (Nettskjema). They assessed the baseline, FHR increase or decrease, and the FHR classification. The primary outcome, baseline, was measured with intraclass correlation coefficient (ICC). The secondary outcomes were measured with kappa and proportion of agreement. The interrater reliability for the baseline (bpm) was ICC(A,1) 0.74 (95% CI 0.69-0.78). On average, an absolute difference of 7.9 bpm (95% CI 7.3-8.5 bpm) was observed between pairs of raters. Our results demonstrate an acceptable level of reliability and agreement in assessing the baseline using a handheld Doppler.

Computerized cardiotocography and fetal heart response to maternal coffee intake: a prospective study.

The aim of this study was to determine the effect of caffeine on fetal heart rate (FHR) as determined by computerized cardiotocography (cCTG) parameters. Term pregnancies that performed a fetal antepartum cCTG were included. Two physicians recorded coffee habits before the cCTG, and pregnant women were divided into two groups: the coffee group and the control group. Furthermore, cCTG' parameters were compared between the two groups. One hundred thirty-four pregnant women were enrolled. Based on maternal coffee habits, 82 pregnant women were allocated to the coffee group, while 52 were in the control group. The two groups shared similar demographic and obstetric characteristics. The mean daily coffee intake was 1.4±0.6 cups. Coffee group fetuses evidenced a lower FHR baseline, 135±9.9 bpm, versus the control group, 138±8.0 bpm, (P value = 0.03). Other cCTG parameters did not show statistical differences. Multivariate analysis demonstrated no confounding factors. A subanalysis that evaluated the daily amount of coffee consumed or the half-life of caffeine found no difference in cCTG measures. Maternal caffeine consumption did not influence fetal cardiac reactivity after absorption.

Computer Vision for Identification of Increased Fetal Heart Variability in Cardiotocogram

Introduction: Increased fetal heart rate variability (IFHRV), defined as fetal heart rate (FHR) baseline amplitude changes of >25 beats per minute with a duration of ≥1 min, is an early sign of intrapartum fetal hypoxia. This study evaluated the level of agreement of machine learning (ML) algorithms-based recognition of IFHRV patterns with expert analysis. Methods: Cardiotocographic recordings and cardiotocograms from 4,988 singleton term childbirths were evaluated independently by two expert obstetricians blinded to the outcomes. Continuous FHR monitoring with computer vision analysis was compared with visual analysis by the expert obstetricians. FHR signals were graphically processed and measured by the computer vision model labeled SALKA. Results: In visual analysis, IFHRV pattern occurred in 582 cardiotocograms (11.7%). Compared with visual analysis, SALKA recognized IFHRV patterns with an average Cohen’s kappa coefficient of 0.981 (95% CI: 0.972–0.993). The sensitivity of SALKA was 0.981, the positive predictive rate was 0.822 (95% CI: 0.774–0.903), and the false-negative rate was 0.01 (95% CI: 0.00–0.02). The agreement between visual analysis and SALKA in identification of IFHRV was almost perfect (0.993) in cases (N = 146) with neonatal acidemia (i.e., umbilical artery pH <7.10). Conclusions: Computer vision analysis by SALKA is a novel ML technique that, with high sensitivity and specificity, identifies IFHRV features in intrapartum cardiotocograms. SALKA recognizes potential early signs of fetal distress close to those of expert obstetricians, particularly in cases of neonatal acidemia.

Machine Learning Prediction of Fetal Health Status from Cardiotocography Examination in Developing Healthcare Contexts

Reducing neonatal mortality is a critical global health objective, especially in resource-constrained developing countries. This study employs machine learning (ML) techniques to predict fetal health status based on cardiotocography (CTG) examination findings, utilizing a dataset from the Kaggle repository due to the limited comprehensive healthcare data available in developing nations. Features such as baseline fetal heart rate, uterine contractions, and waveform characteristics were extracted using the RFE wrapper feature engineering technique and scaled with a standard scaler. Six ML models—Logistic Regression (LR), Decision Tree (DT), Random Forest (RF), Gradient Boosting (GB), Categorical Boosting (CB), and Extended Gradient Boosting (XGB)—are trained via cross-validation and evaluated using performance metrics. The developed models were trained via cross-validation and evaluated using ML performance metrics. Eight out of the 21 features selected by GB returned their maximum Matthews Correlation Coefficient (MCC) score of 0.6255, while CB, with 20 of the 21 features, returned the maximum and highest MCC score of 0.6321. The study demonstrated the ability of ML models to predict fetal health conditions from CTG exam results, facilitating early identification of high-risk pregnancies and enabling prompt treatment to prevent severe neonatal outcomes.

Fetal cardiovascular changes during open and fetoscopic in-utero spina bifida closure.

Fetoscopic closure of spina bifida using heated and humidified carbon dioxide gas (hhCO2) has been associated with lower maternal morbidity compared with open closure. Fetal cardiovascular changes during these surgical interventions are poorly defined. Our objective was to compare fetal bradycardia (defined as fetal heart rate (FHR) < 110 bpm for 10 min) and changes in umbilical artery (UA) Doppler parameters during open vs fetoscopic closure. This was a prospective cohort study of 22 open and 46 fetoscopic consecutive in-utero closures conducted between 2019 and 2023. Both cohorts had similar preoperative counseling and clinical management. FHR and UA Doppler velocimetry were obtained systematically during preoperative assessment, every 5 min during the intraoperative period, and during the postoperative assessment. FHR, UA pulsatility index (PI) and UA end-diastolic flow (EDF) were segmented into hourly periods during surgery, and the lowest values were averaged for analysis. Umbilical vein maximum velocity was measured in the fetoscopic cohort. At each timepoint at which FHR was recorded, maternal heart rate and systolic and diastolic blood pressure were measured. Fetal bradycardia occurred in 4/22 (18.2%) cases of open closure and 21/46 (45.7%) cases of fetoscopic closure (P = 0.03). FHR decreased gradually in both cohorts after administration of general anesthesia and decreased further during surgery. FHR was significantly lower during hour 2 of surgery in the fetoscopic-repair cohort compared with the open-repair cohort. The change in FHR from baseline in the final stage of fetal surgery was significantly more pronounced in the fetoscopic-repair cohort compared with the open-repair cohort (mean, -32.4 (95% CI, -35.7 to -29.1) bpm vs -23.5 (95% CI, -28.1 to -18.8) bpm; P = 0.002). Abnormal UA-EDF (defined as absent or reversed EDF) occurred in 3/22 (13.6%) cases in the open-repair cohort and 23/46 (50.0%) cases in the fetoscopic-repair cohort (P = 0.004). There were no differences in UA-EDF or UA-PI between closure techniques at the individual stages of assessment. We observed a decrease in FHR and abnormalities in UA Doppler parameters during both open and fetoscopic spina bifida closure. Fetal bradycardia was more prominent during fetoscopic closure following hhCO2 insufflation, but FHR recovered after cessation of hhCO2. Changes in FHR and UA Doppler parameters during in-utero spina bifida closure were transient, no cases required emergency delivery and no fetoscopic closure was converted to open closure. These observations should inform algorithms for the perioperative management of fetal bradycardia associated with in-utero spina bifida closure. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

The effect of prone positioning on maternal haemodynamics and fetal wellbeing in the third trimester-A primary cohort study with a scoping review.

Supine sleep position is associated with stillbirth, likely secondary to inferior vena cava compression, and a reduction in cardiac output (CO) and uteroplacental perfusion. Evidence for the effects of prone position in pregnancy is less clear. This study aimed to determine the effect maternal prone position on maternal haemodynamics and fetal heart rate, compared with left lateral position. Twenty-one women >28 weeks' gestation underwent non-invasive CO monitoring (Cheetah) every 5 minutes and continuous fetal heart rate monitoring (MONICA) in left lateral (20 minutes), prone (30 minutes), followed by left lateral (20 minutes). Anxiety and comfort were assessed by questionnaires. Regression analyses (adjusted for time) compared variables between positions. The information derived from the primary study was used in an existing mathematical model of maternal circulation in pregnancy, to determine whether occlusion of the inferior vena cava could account for the observed effects. In addition, a scoping review was performed to identify reported clinical, haemodynamic and fetal effects of maternal prone position; studies were included if they reported clinical outcomes or effects or maternal prone position in pregnancy. Study records were grouped by publication type for ease of data synthesis and critical analysis. Meta-analysis was performed where there were sufficient studies. Maternal blood pressure (BP) and total vascular resistance (TVR) were increased in prone (sBP 109 vs 104 mmHg, p = 0.03; dBP 74 vs 67 mmHg, p = 0.003; TVR 1302 vs 1075 dyne.s-1cm-5, p = 0.03). CO was reduced in prone (5.7 vs 7.1 mL/minute, p = 0.003). Fetal heart rate, variability and decelerations were unaltered. However, fetal accelerations were less common in prone position (86% vs 95%, p = 0.03). Anxiety was reduced after the procedure, compared to beforehand (p = 0.002), despite a marginal decline in comfort (p = 0.04).The model predicted that if occlusion of the inferior vena cava occurred, the sBP, dBP and CO would generally decrease. However, the TVR remained relatively consistent, which implies that the MAP and CO decrease at a similar rate when occlusion occurs. The scoping review found that maternal and fetal outcomes from 47 included case reports of prone positioning during pregnancy were generally favourable. Meta-analysis of three prospective studies investigating maternal haemodynamic effects of prone position found an increase in sBP and maternal heart rate, but no effect on respiratory rate, oxygen saturation or baseline fetal heart rate (though there was significant heterogeneity between studies). Prone position was associated with a reduction in CO but an uncertain effect on fetal wellbeing. The decline in CO may be due to caval compression, as supported by the computational model. Further work is needed to optimise the safety of prone positioning in pregnancy. This trial was registered at clinicaltrials.gov (NCT04586283).

Double-sided asymmetric method for automated fetal heart rate baseline calculation.

The fetal heart rate (FHR) signal is used to assess the well-being of a fetus during labor. Manual interpretation of the FHR is subject to high inter- and intra-observer variability, leading to inconsistent clinical decision-making. The baseline of the FHR signal is crucial for its interpretation. An automated method for baseline determination may reduce interpretation variability. Based on this claim, we present the Auto-Regressed Double-Sided Improved Asymmetric Least Squares (ARDSIAsLS) method as a baseline calculation algorithm designed to imitate expert obstetrician baseline determination. As the FHR signal is prone to a high rate of missing data, a step of gap interpolation in a physiological manner was implemented in the algorithm. The baseline of the interpolated signal was determined using a weighted algorithm of two improved asymmetric least squares smoothing models and an improved symmetric least squares smoothing model. The algorithm was validated against a ground truth determined from annotations of six expert obstetricians. FHR baseline calculation performance of the ARDSIAsLS method yielded a mean absolute error of 2.54bpm, a max absolute error of 5.22bpm, and a root mean square error of 2.89bpm. In a comparison between the algorithm and 11 previously published methods, the algorithm outperformed them all. Notably, the algorithm was non-inferior to expert annotations. Automating the baseline FHR determination process may help reduce practitioner discordance and aid decision-making in the delivery room.

Comparison of fetal heart rate baseline estimation by the cardiotocograph network and clinicians: a multidatabase retrospective assessment study.

This study aims to compare the fetal heart rate (FHR) baseline predicted by the cardiotocograph network (CTGNet) with that estimated by clinicians. A total of 1,267 FHR recordings acquired with different electrical fetal monitors (EFM) were collected from five datasets: 84 FHR recordings acquired with F15 EFM (Edan, Shenzhen, China) from the Guangzhou Women and Children's Medical Center, 331 FHR recordings acquired with SRF618B5 EFM (Sanrui, Guangzhou, China), 234 FHR recordings acquired with F3 EFM (Lian-Med, Guangzhou, China) from the NanFang Hospital of Southen Medical University, 552 cardiotocographys (CTG) recorded using STAN S21 and S31 (Neoventa Medical, Mölndal, Sweden) and Avalon FM40 and FM50 (Philips Healthcare, Amsterdam, The Netherlands) from the University Hospital in Brno, Czech Republic, and 66 FHR recordings acquired using Avalon FM50 fetal monitor (Philips Healthcare, Amsterdam, The Netherlands) at St Vincent de Paul Hospital (Lille, France). Each FHR baseline was estimated by clinicians and CTGNet, respectively. And agreement between CTGNet and clinicians was evaluated using the kappa statistics, intra-class correlation coefficient, and the limits of agreement. The number of differences <3 beats per minute (bpm), 3-5 bpm, 5-10 bpm and ≥10 bpm, is 64.88%, 15.94%, 14.44% and 4.74%, respectively. Kappa statistics and intra-class correlation coefficient are 0.873 and 0.969, respectively. Limits of agreement are -6.81 and 7.48 (mean difference: 0.36 and standard deviation: 3.64). An excellent agreement was found between CTGNet and clinicians in the baseline estimation from FHR recordings with different signal loss rates.

DeepCTG® 1.0: an interpretable model to detect fetal hypoxia from cardiotocography data during labor and delivery.

Cardiotocography, which consists in monitoring the fetal heart rate as well as uterine activity, is widely used in clinical practice to assess fetal wellbeing during labor and delivery in order to detect fetal hypoxia and intervene before permanent damage to the fetus. We present DeepCTG® 1.0, a model able to predict fetal acidosis from the cardiotocography signals. DeepCTG® 1.0 is based on a logistic regression model fed with four features extracted from the last available 30 min segment of cardiotocography signals: the minimum and maximum values of the fetal heart rate baseline, and the area covered by accelerations and decelerations. Those four features have been selected among a larger set of 25 features. The model has been trained and evaluated on three datasets: the open CTU-UHB dataset, the SPaM dataset and a dataset built in hospital Beaujon (Clichy, France). Its performance has been compared with other published models and with nine obstetricians who have annotated the CTU-UHB cases. We have also evaluated the impact of two key factors on the performance of the model: the inclusion of cesareans in the datasets and the length of the cardiotocography segment used to compute the features fed to the model. The AUC of the model is 0.74 on the CTU-UHB and Beaujon datasets, and between 0.77 and 0.87 on the SPaM dataset. It achieves a much lower false positive rate (12% vs. 25%) than the most frequent annotation among the nine obstetricians for the same sensitivity (45%). The performance of the model is slightly lower on the cesarean cases only (AUC = 0.74 vs. 0.76) and feeding the model with shorter CTG segments leads to a significant decrease in its performance (AUC = 0.68 with 10 min segments). Although being relatively simple, DeepCTG® 1.0 reaches a good performance: it compares very favorably to clinical practice and performs slightly better than other published models based on similar approaches. It has the important characteristic of being interpretable, as the four features it is based on are known and understood by practitioners. The model could be improved further by integrating maternofetal clinical factors, using more advanced machine learning or deep learning approaches and having a more robust evaluation of the model based on a larger dataset with more pathological cases and covering more maternity centers.

A Fetal Well-Being Diagnostic Method Based on Cardiotocographic Morphological Pattern Utilizing Autoencoder and Recursive Feature Elimination.

Cardiotocography (CTG), which measures the fetal heart rate (FHR) and maternal uterine contractions (UC) simultaneously, is used for monitoring fetal well-being during delivery or antenatally at the third trimester. Baseline FHR and its response to uterine contractions can be used to diagnose fetal distress, which may necessitate therapeutic intervention. In this study, a machine learning model based on feature extraction (autoencoder), feature selection (recursive feature elimination), and Bayesian optimization, was proposed to diagnose and classify the different conditions of fetuses (Normal, Suspect, Pathologic) along with the CTG morphological patterns. The model was evaluated on a publicly available CTG dataset. This research also addressed the imbalance nature of the CTG dataset. The proposed model has a potential application as a decision support tool to manage pregnancies. The proposed model resulted in good performance analysis metrics. Using this model with Random Forest resulted in a model accuracy of 96.62% for fetal status classification and 94.96% for CTG morphological pattern classification. In rational terms, the model was able to accurately predict 98% Suspect cases and 98.6% Pathologic cases in the dataset. The combination of predicting and classifying fetal status as well as the CTG morphological patterns shows potential in monitoring high-risk pregnancies.

The effectiveness of Jacobson's progressive muscle relaxation technique on maternal, fetal and neonatal outcomes in women with non-severe preeclampsia: a randomized clinical trial

BackgroundPreeclampsia (PE), as the most common major pregnancy disorder, has serious maternal, fetal and neonatal complications, and outcomes. The present study was designed to determine the effectiveness of Jacobson's progressive muscle relaxation technique on maternal, fetal, and neonatal outcomes in women with non-severe preeclampsia (PE). MethodsThis is a randomized clinical trial conducted from March 21, 2021 to July 22, 2021 in the Kamali referral center in Karaj, Iran. A total of 88 eligible participants were assigned to intervention and control groups (44 in each group) via blocked randomization. The intervention group (6 groups of 6 participants and one group of 8 participants) received Jacobson's progressive muscle relaxation technique in addition to receiving routine care, twice a week for 6 weeks (4 face-to-face sessions and 8 online sessions). The control group only received routine perinatal care. A checklist collected data before and after the intervention. Data were analyzed in SPSS software v.23. To analyze the obtained data, independent t-test, Paired t-test, Mann-Whitney, Chi-square, and Fisher test were used. ResultsThe results showed a statistically significant difference between intervention and control groups in terms of Systolic Blood pressure (SBP) (P < 0.001), Diastolic Blood pressure (DBP) (P < 0.001), 24-hour urine protein level (proteinuria) (P < 0.001). and Fasting Blood Sugar (FBS) (P < 0.001), birth Weight (BW) (P = 0.01), baseline Fetal heart rate (BFHR) (P < 0.001) and Number fetal movements based on non-stress test (NFMsN), during 20 min (P < 0.001) after intervention (P < 0.001).Also In the intervention group, the results showed a statistically significant difference in Amniotic Fluid Index (AFI) (P = 0.01), SBP(P < 0.001), DBP(P < 0.001), proteinuria (P < 0.001), FBS(P < 0.001), BFHR based on non-stress test (NST) (P < 0.001), and NFMsN during 20 min (P < 0.001) in the intervention group before and after the intervention. There was no statistically significant difference in the control group. ConclusionThis study's results showed the effectiveness of progressive muscle relaxation technique on the improvement of SBP, DBP, proteinuria, FBS, FHR and NFMsN during 20 min based on NST and BW in women with non-severe PE. Therefore, it is recommended to perform this technique in health centers.

Cardiotocography and Clinical Risk Factors in Early Term Labor: A Retrospective Cohort Study Using Computerized Analysis With Oxford System.

ObjectiveThe role of cardiotocography (CTG) in fetal risk assessment around the beginning of term labor is controversial. We used routinely collected clinical data in a large tertiary hospital to investigate whether infants with “severe compromise” at birth exhibited fetal heart rate abnormalities in their first-hour CTGs and/or other clinical risks, recorded as per routine care.Materials and MethodsRetrospective data from 27,927 parturitions (single UK tertiary site, 2001–2010) were analyzed. Cases were included if the pregnancy was singleton, ≥36 weeks' gestation, cephalic presentation, and if they had routine intrapartum CTG as per clinical care. Cases with congenital abnormalities, planned cesarean section (CS), or CS for reasons other than “presumed fetal compromise” were excluded. We analyzed first-hour intrapartum CTG recordings, using intrapartum Oxford System (OxSys) computer-based algorithms. To reflect the effect of routine clinical care, the data was stratified into three exclusive groups: infants delivered by CS for “presumed fetal compromise” within 2 h of starting the CTG (Emergency CS, n = 113); between 2 and 5 h of starting the CTG (Urgent CS, n = 203); and the rest of deliveries (Others, n = 27,611). First-hour CTG and clinical characteristics were compared between the groups, sub-divided to those with and without severe compromise: a composite outcome of stillbirth, neonatal death, neonatal seizures, encephalopathy, resuscitation followed by ≥48 h in neonatal intensive care unit. Two-sample t-test, X2 test, and Fisher's exact test were used for analysis.ResultsCompared to babies without severe compromise, those with compromise had significantly higher proportion of cases with baseline fetal heart rate ≥150 bpm; non-reactive trace; reduced long-term and short-term variability; decelerative capacity; and no accelerations in the first-hour CTG across all groups. Prolonged decelerations(≥3 min) were also more common. Thick meconium and small for gestational age were consistently more common in compromised infants across all groups. There was more often thick meconium, maternal fever ≥38 C, sentinel events, and other clinical risk factors in the Emergency CS and Urgent CS compared to the Others group.ConclusionA proportion of infants born with severe compromise had significantly different first-hour CTG features and clinical risk factors.

Effect of different maternal positions on comfort of antenatal mothers and fetal parameters during nonstress test.

Providing comfort to an antenatal mother is one of the critical components of the nonstress test (NST). An experimental study was conducted on 450 antenatal mothers beyond 34 weeks, who were randomly allocated into three groups - supine, left lateral, and semi-fowler's position, to explore the association of selected maternal positions on NST results and to find the impact of these positions on the comfort level of antenatal mothers. The fetal parameters were assessed by observing and recording biophysiological measurements from the NST and the maternal comfort of different positions by the Verbal Numerical Rating Scale. The data analyzed reveal a significant association between maternal positions and fetal parameters at P < 0.05 level. Antenatal women who were in semi-fowler's position exhibited more comfort and fetal NST reactivity as noted by significant variation in the baseline fetal heart rate, beat-to-beat variability, acceleration, deceleration, and fetal movements.

Experience with home-based, remote non-stress tests, including automatic decision support for interpretation of reactivity

The fetal non-stress test (NST) for antepartum surveillance involves frequent, burdensome in-office visits. INVUTM is a wireless, remote, FDA-cleared monitoring device, designed to perform self-administered NST from home. Here, we present (1) our initial experience with INVUTM home NST monitoring, and (2) a novel machine learning decision support system (DSS) to detect fetal heart rate (FHR) accelerations, with the potential to alert clinicians on NST reactivity. A single-center, prospective, open label study was conducted, in which women with ≥32 week high-risk singleton gestations performed self-administered NST using the INVUTM device at home, replacing in-clinic NSTs. NSTs were reviewed by clinicians via the INVUTM web application who determined clinically interpretability and reactivity. Interpretable sessions were retrospectively analyzed by the DSS for reactivity and compared to clinician assessment (Figure). The time to reactivity as analyzed by the DSS was compared to the session length until reactivity was determined by clinicians. Of the first 30 INVUTM sessions (across 9 subjects), clinicians deemed 27 (90%) interpretable, and 27/27 as reactive (100%). The DSS correctly classified 92.6% (25/27) of the interpretable NSTs compared with clinicians. In the 2 cases where DSS did not match the clinician decision, DSS did not rule the NST reactive, whereas the clinician did. On review, these cases may have been due to clinician averaging the FHR baseline from which accelerations are measured, compared to the conservative nature of the DSS. In the cases deemed reactive by DSS, time to reactivity was reduced by 14.72±13.79 min as compared to clinician determination. Early clinical experience conducting self-administered, remote NSTs at home using the INVUTM device supports the feasibility of bringing this telehealth solution to high risk pregnancy care. In addition, a novel DSS tool accurately identifies reactivity, which could reduce the length of NST sessions and improve clinician workflow.

Effectiveness of Progressive Muscle Relaxation Technique among the Antenatal Mothers above 32 Weeks of Gestation on the Reactivity and Time Consumption of Non Stress Test: A Randomized Controlled Trial

Background: Non Stress Test is a simple, inexpensive and non-invasive method to assess the wellbeing of the fetus by observing the FHR with its acceleration in response to the movement of the fetus. Objective: To assess the effectiveness of progressive muscle relaxation technique among the antenatal mothers above 32 weeks of gestation on reactivity and time consumption of Non Stress Test Design: Randomized controlled trial Setting: Obstetrics and Gynaecology OPD, PGIMER, Chandigarh Participant: 120 Antenatal mothers ³32 weeks of gestation Methods: 120 pregnant mothers i.e sixty each in Experimental and Control group willing to participate and available at the time of data collection were enrolled through a random sampling technique. Progressive muscle relaxation technique was demonstrated and was performed simultaneously by the antenatal mothers 15 to 20 minutes prior to NST who were enrolled under the Experimental group. Routine care was given to Control group. Data were collected by using an interview schedule in the month of October to December 2020. Non stress test was done as per schedule of antenatal visit and interpretation of NST graph in relation to the reactivity, time consumption and baseline fetal heart rate were compared in both the group. Results: It revealed that all the antenatal mothers in the Exp. group and 90% of mothers in the Control group showed reactivity of Non stress test. In relation to time consumption of Non stress test, all mothers in the Experimental group took normal time i.e 20 minutes. Out of the 90% of antenatal mothers who were reactive in the Control group, 5% took more than 20 minutes. A statistical significant difference was found in relation to reactivity by applying Chi Square (p&lt;0.05). The finding also showed a significant difference in between the Experimental and Control group in relation to the reactivity of Non stress test as shown by Mann Whitney U test, baseline fetal heart rate during NST, all the antenatal mothers had normal BHR between 110 to 160 bpm in both groups. Conclusion: It can be concluded that Progressive muscle relaxation technique performed prior to Non stress test can be used for improving the Non stress test results, time-saving, evokes positive feeling and satisfaction among the antenatal mothers. Keywords: Non Stress Test, Progressive Muscle Relaxation Technique, Reactivity.

The effect of music on fetal well-being and anxiety levels and vital signs of pregnant women during non-stress test: Turkey sample

To assess the effect of music on fetal well-being and anxiety levels and vital signs of pregnant women during the non-stress test. The study was a randomized controlled clinical trial. The sample comprised of 74 (37 music and 37 control group) pregnant women. In the music group, post-procedure pulse values were statistically lower than the pre-procedure values (p < 0.001). There was no difference between the groups in terms of baseline fetal heart rate, variability, fetal movement, presence and number of accelerations-decelerations, non-stress test result parameters. The number of fetal movements was statistically higher in the music group, compared to the control group (p < 0.001). The state anxiety inventory scores lower in the music group after the procedure, compared to the control group (p < 0.001). Researchers determined that music affects vital sign values, fetal movements, reduced the state and trait anxiety levels of pregnant women during the non-stress test procedure.

FETAL TYPE CLASSIFICATION BASED ON FETAL ELECTROCARDIOGRAPH IN NON-STRESS TESTS

Electronic fetal heart rate (FHR) monitoring is a technical means to evaluate the state of the fetus in the uterus by monitoring FHR. The main purpose is to detect intrauterine hypoxia and take corresponding medical measures timely. Because the fetus sleeps quietly for up to 1 hour sometimes, ultrasound Doppler is not easy to continuously detect for a long time. The electronic fetal monitor obtains the fetal heart rate, which not only improves the accuracy and comfort, but also the convenient implementation of long-term monitoring. It is beneficial to reduce perinatal fetal morbidity and mortality. This study used maternal–fetal Holter monitor which is based on the technology of fetal electrocardiograph (FECG) to collect the FHR, and then design algorithm to extract the baseline FHR, acceleration, variation, sleep-wake cycle and nonlinear parameters. There were significant differences in the 22 parameters between the normal and the suspicious group. Using the 22 characteristic parameters, the support vector machine was used to classify the normal and the suspected group of fetuses. 80% of the data was used to train a classification model. The remaining 20% of the data was used as a test set and its accuracy reached 93.75%.

Fetal Heart Rate Variability Before and After Antenatal Corticosteroids in Patients at High Risk of Preterm Labor

Background: Premature birth (PTB) occurs in one in ten pregnancies. There are about 13 million PTBs annually worldwide. Antenatal corticosteroids are administered to enhance fetal lung maturation in cases of threatened preterm delivery between 24- and 34-weeks’ gestational age (GA). Objective: This study aimed to study the cardiotocograp (CTG) before and after antenatal corticosteroids administration in patients at high risk of preterm labor to reduce preterm risks. Patients and Methods: A prospective cohort study included 52 women who were at risk of premature birth. Each woman received the recommended course of corticosteroids consists of 4 doses of dexamethasone 6 mg for 48 hours (Dexamethasone 8 ml intramuscularly, 12 h apart). CTG examination: Fetal heart rate was monitored with fetal monitor cardiotocogram machine. Cardiotocography strips were interpreted visually. Results: In our study we recorded decrease in baseline fetal heart rate and increase in fetal heart rate variability (LTV, STV) after dexamethasone course by 24 hours, which were statistically significant. The number of accelerations showed a slight increase, which was significant. Decelerations were not present at all before or after the course. The STV showed a significant change before the course, all participants had moderate STV, but after the course, 8 (15.4%) showed marked variability, which was significant. We found that most of participants (90.4%) had decreased fetal kicks after injection relying on maternal perception. Conclusion: There was a decrease in baseline fetal heart rate and increase in fetal heart rate variability (LTV, STV) after dexamethasone course by 24 hours, which were statistically significant. The number of accelerations showed a slight increase, which was significant.

Absence of fetal heart rate cycling on the intrapartum cardiotocograph (CTG) is associated with intrapartum pyrexia and lower Apgar scores

Background Cycling consists of alternating periods of reduced and normal fetal heart variability, reflecting changes in fetal behavioral states. Occurrence of active and quiet sleep cycles is considered to be a hallmark of fetal autonomic nervous system integrity, demonstrating healthy interaction between the parasympathetic and sympathetic nervous systems. Cycling is an overlooked feature in most international cardiotocography (CTG) guidelines. The authors tested the hypothesis that fetuses showing no cycling in the intrapartum period have poorer outcomes. Aim To investigate whether the absence of cycling at the commencement of intrapartum fetal monitoring is associated with poorer neonatal outcomes (umbilical arterial cord pH, Apgar scores and neonatal unit admission). Methods Analysis of a database of sequentially acquired intrapartum CTG traces from a single center. Only cases of singleton pregnancies over 36 weeks gestation in cephalic presentation with recorded umbilical artery cord pH were considered. Neonatal outcomes were assessed based on umbilical cord artery pH, Apgar ≤7 at 5 min and unexpected admission to the neonatal unit. Intrapartum pyrexia, presence of meconium-stained amniotic fluid and mode of delivery were also recorded. Results A total of 684 cases were analyzed. Absence of cycling from the beginning of the intrapartum CTG recording was noted in 5% of cases. Cases with no cycling were more likely to have maternal pyrexia (≥37.8 °C) (p = .006) and Apgars ≤7 at 5 min (p = .04). There was an association between increasing baseline fetal heart rate and the proportion of cases with no cycling. There was no significant difference between the two groups with regard to the mode of delivery or umbilical cord arterial pH <7.05 (p = .53). Conclusion Absence of cycling is associated with intrapartum maternal pyrexia and fetuses with the absence of cycling are more likely to have poorer perinatal outcomes measured by Apgar ≤ 7 at 5 min, despite no association with fetal acidosis. Results from this research were presented at the XXVI European Congress of Perinatal Medicine in September 2018.