Baseline Fetal Heart Rate Research Articles

Vaginal delivery among women who underwent labor induction with vaginal dinoprostone (PGE2) insert: a retrospective study of 1656 women in China

Objective: This study aimed to qualify relevant factors for vaginal delivery among women who underwent labor induction with vaginal dinoprostone (PGE2) insert in a Chinese tertiary maternity hospital.Material and methods: A retrospective study was conducted in Hubei Maternal and Child Health Hospital. A total of 1656 pregnancies that underwent labor induction with vaginal dinoprostone insert between January and August 2016 were finally included in this study. Data were analyzed using univariate and multivariable regression modeling.Results: Of 1656 women with PGE2-induced labor at term, 396 (23.91%) gave birth by cesarean section, 1260 (76.09%) had a vaginal delivery among which 921 (55.61%) delivered vaginally within 24 h. Multivariable regression analysis showed that maternal age (p < .001, OR = 0.89, 95%CI 0.85–0.93), parity (multiparous versus nulliparous, p < .001, OR = 8.74, 95%CI 4.36–17.50), baseline fetal heart rate (p = .009, OR = 0.98, 95%CI 0.96–0.99), and birth weight (p < .001, OR = 0.37, 95%CI 0.28–0.51) were significantly correlated with vaginal delivery. Moreover, body mass index (p < .001, OR = 1.11, 95%CI 1.05–1.19), parity (multiparous versus nulliparous, p < .001, OR = 6.57, 95%CI 2.37–18.23), baseline fetal heart rate (p = .004, OR = 0.96, 95%CI 0.94–0.99), and birth weight (p < .001, OR = 0.34, 95%CI 0.21–0.54) were independent predictors of vaginal delivery within 24-h.Conclusions: Our findings suggested a vaginal delivery rate of 76.09% when dinoprostone vaginal insert was used for labor induction, which was markedly higher than the overall annual vaginal delivery rate of 65.1% in China during 2014. Maternal age, parity, baseline fetal heart rate, and birth weight were significant factors for vaginal delivery. This study enables us to better understand the efficiency of dinoprostone and the potential predictors of vaginal delivery in dinoprostone-induced labor, which may be helpful to guide the clinical use of dinoprostone and therefore provide better service clinically.

Entropy and Compression Capture Different Complexity Features: The Case of Fetal Heart Rate

Entropy and compression have been used to distinguish fetuses at risk of hypoxia from their healthy counterparts through the analysis of Fetal Heart Rate (FHR). Low correlation that was observed between these two approaches suggests that they capture different complexity features. This study aims at characterizing the complexity of FHR features captured by entropy and compression, using as reference international guidelines. Single and multi-scale approaches were considered in the computation of entropy and compression. The following physiologic-based features were considered: FHR baseline; percentage of abnormal long (%abLTV) and short (%abSTV) term variability; average short term variability; and, number of acceleration and decelerations. All of the features were computed on a set of 68 intrapartum FHR tracings, divided as normal, mildly, and moderately-severely acidemic born fetuses. The correlation between entropy/compression features and the physiologic-based features was assessed. There were correlations between compressions and accelerations and decelerations, but neither accelerations nor decelerations were significantly correlated with entropies. The %abSTV was significantly correlated with entropies (ranging between −0.54 and −0.62), and to a higher extent with compression (ranging between −0.80 and −0.94). Distinction between groups was clearer in the lower scales using entropy and in the higher scales using compression. Entropy and compression are complementary complexity measures.

Variations from morning to afternoon of middle cerebral and umbilical artery blood flow, and fetal heart rate variability, and fetal characteristics in the normally developing fetus.

To determine if there are changes in maternal uterine blood flow, fetal brain blood flow, fetal heart rate variability, and umbilical blood flow between morning (AM) and afternoon (PM) in healthy, uncomplicated pregnancies. In this prospective study, 68 uncomplicated singleton pregnancies (mean 35 + 0.7 weeks gestation) underwent a standard observational protocol at both 08:00 (AM) and 13:30 (PM) of the same day. This protocol included Doppler measurements of uterine, umbilical, and fetal middle cerebral artery (MCA) volume flow parameters (flow, HR, peak systolic velocity [PSV], PI, and RI) followed by computerized cardiotocography. Standard descriptive statistics, χ2 and t tests were used where appropriate. P < .05 was considered significant. A significant increase in MCA flow and MCA PSV was observed in the PM compared to the AM. This was accompanied by a fall in MCA resistance. Higher umbilical artery resistance indices were also observed in the PM compared to AM. In contrast, fetal heart rate characteristics, maternal uterine artery Doppler flow and resistance indices did not vary significantly between the AM and PM. In normal pregnancies, variations in fetal cerebral and umbilical blood flow parameters were observed between AM and PM independent of other fetal movements or baseline fetal heart rate. In contrast, uterine flow parameters remained stable across the day. These findings may have implications for the use of serial Doppler parameters used to guide clinical management in high-risk pregnancies.

Using Interprofessional OSCE-Based Simulation Collaboration to Teach Obstetrics to Second-Year Medical Students

BACKGROUND: We have shown that it is possible to introduce an obstetric simulation program to preclinical 2nd-year medical students. In the second year of our obstetrics simulation curriculum for 2nd-year medical students, we introduced OSCE assessment in collaboration with the nursing school educator with the program occurring in the nursing school simulation center in November 2015. METHODS: Students rotated through three stations: 1) simulated vaginal delivery demonstrated by nurse educator and OBGYN resident; 2) MFM faculty gave interactive presentation on fetal heart rate (FHR), a student nurse then role played with students and they were assessed by OSCE format; and 3) OBGYN resident and faculty taught and assessed students on cervical dilation using cervical models. Students completed surveys on attitude, knowledge before, after and 7 months postcurriculum. RESULTS: Of 95 students, mean scores for the FHR OSCE were: identifies FHR baseline=0.97, identifies FHR variability=0.92, provides accurate identification of periodic pattern=0.73, identifies FHR category=0.67 and orders appropriate medical interventions=0.93. For the cervical station OSCE, the mean score on cervical examination skills after training was 75%. For the knowledge questions on obstetrics and fetal heart rate monitoring, students obtained a mean prescore of 2.57±0.09, postsimulation the mean score increased to 3.24±0.11 (P=.12). Presimulation; students scored their comfort level with obstetric procedures as 12.2±0.63, after simulation the mean score increased to 28±0.63 (P&lt;.001). DISCUSSION: We have demonstrated the feasibility of an OSCE-based inter-professional educational curriculum utilizing nursing, physician and resident faculty instructing medical students and nursing students jointly. For FHR teaching, the concept of FHR category was the most challenging for the students to grasp. The course improved students' short-term knowledge but had dropped back to baseline by 7 months. Students' comfort level increased immediately posttraining and decreased but was still higher than baseline at 7 months. Further curriculum development is undergoing on increasing long term knowledge gain.

Chorioamnionitis following preterm premature rupture of membranes and fetal heart rate variability.

IntroductionThe objective of this study was to identify prenatal markers of histological chorioamnionitis (HC) during pPROM using fetal computerized cardiotocography (cCTG).Materials and methodsRetrospective review of medical records from pregnant women referred for pPROM between 26 and 34 weeks, in whom placental histology was available, in a tertiary level obstetric service over a 5-year period. Fetal heart rate variability was assessed using cCTG. Patients were included if they were monitored at least six times in the 72 hours preceding delivery. Clinical and biological cCTG parameters during the pPROM latency period were compared between cases with or without HC.ResultsIn total, 222 pPROM cases were observed, but cCTG data was available in only 23 of these cases (10 with and 13 without HC) after exclusion of co-morbidities which may potentially perturb fetal heart rate variability measures. Groups were comparable for maternal age, parity, gestational age at pPROM, pPROM duration and neonatal characteristics (p>0.1). Baseline fetal heart rate was higher in the HC group [median 147.3 bpm IQR (144.2–149.2) vs. 141.3 bpm (137.1–145.4) in no HC group; p = 0.02]. The number of low variation episodes [6.4, (3.5–15.3) vs. 2.3 (1–5.2); p = 0.04] was also higher in the HC group, whereas short term variations were lower in the HC group [7.1 ms (6–7.4) vs. 8.1 ms (7.4–9); p = 0.01] within 72 hours before delivery. Differences were especially discriminant within 24 hours before delivery, with less short-term variation [5 ms (3.7–5.9) vs. 7.8 ms (5.4–8.7); p = 0.007] and high variation episodes [3.9 (4.9–3.2) vs. 0.8 (1.5–0.2); p < 0.001] in the HC group.ConclusionThese results show differences in fetal heart rate variability, suggesting that cCTG could be used clinically to diagnoses chorioamnionitis during the pPROM latency period.

Fetal heart rate changes observed on the CTG trace during instrumental vaginal delivery

Introduction: Instrumental vaginal delivery (IVD) helps expedite delivery during second stage of labour so as to avoid a second stage caesarean section. However, due to mechanical effects on the fetal head, vacuum and forceps may cause cardiotocograph (CTG) abnormalities due to vigal stimulation as well as increased intracranial pressure. Objective: To determine the features observed on the CTG during IVD in term pregnancy and correlate them to perinatal outcomes. Methods: A retrospective analysis of 445 cases who had vacuum deliveries (227) and forceps deliveries (218) at St. George’s University Hospitals NHS Foundation Trust during a 12-month period was performed. CTG features were analysed at 10 minutes prior to and immediately after applications of the chosen instrument till delivery. Specific abnormalities were correlated to Apgar score and umbilical blood pH. Results: Specific CTG abnormalities after applications of vacuum and forceps were: tachycardia (99 (43.61%) versus 88 (40.37%)), increased baseline fetal heart rate (FHR) [14 (6.17%) versus 4 (1.83%) p = .0204], baro-receptor-mediated “variable” deceleration (101 (44.49%) versus 85 (38.99%)), chemoreceptor-mediated “late” deceleration (62 (27.31%) versus 76 (34.86%)), prolonged deceleration (32 (14.10%) versus 24 (11.01%)), saltatory pattern [35 (15.42%) versus 76 (34.86%) p < .0001], and reduced baseline variability (10 (4.41%) versus 7 (3.21%)). There were no significant differences in the mean Apgar Scores at 1 and 5 minutes between ventouse and forceps delivery (8 and 9, respectively) or the umbilical blood pH (both >7.20). Conclusions: After application of instruments, 90% of CTG traces showed abnormal features. Tachycardia, baro- and chemoreceptor-mediated decelerations, and saltatory patterns were the most common abnormalities. Increased baseline FHR during vacuum as compared to forceps delivery was possibly secondary to pain/pressure and resultant sympathetic overactivity. The saltatory pattern was more common in forceps deliveries, possibly secondary to increased intracranial pressure and resultant autonomic instability. Despite these CTG abnormalities, the perinatal outcomes were good.

Are Baseline Elevations in Reactive Non-Stress Testing of Diabetic Mothers an Indicator of Fetal Compromise? [4B

INTRODUCTION: To determine if baseline fetal tachycardia in reactive non-stress test (NST) is an indicator of fetal compromise in diabetic pregnancies. METHODS: Retrospective analysis of 145 diabetic mothers including gestational and pregestational diabetics from 2013-2016. Demographics included age, BMI, race, and gestational age. We reviewed the NST of patients &gt;34 weeks of gestation and within 7 days of delivery. Baseline fetal heart rate (FHR) and the presence of 15x15mm accelerations were noted. Outcome measures included mode and indications for delivery. RESULTS: Of 145 diabetic patients, 55 patients had a baseline &gt;150bpm. 47 of them had reactive tracings. Of those 47 patients, 35 underwent cesarean deliveries (C/S) (74.4%). Two patients with baseline tachycardia were diagnosed with IUFD on subsequent testing. 17 of 47 C/S performed were for non-reassuring tracing (36.17%). In comparison, 92 of 145 diabetic patients had baseline FHR &lt; 150 bpm. 68 of 92 patients had reactive tracings. Of these 68 patients, 40 underwent C/S (58.82%), 8 were for non-reassuring fetal heart tracing (11.76%). The C/S rate for non-reassuring fetal heart tracing was significantly higher in the diabetics with elevated baseline FHR and reactive tracings in comparison to those with baseline FHR &lt; 150bpm and reactive tracings, P &lt; 0.05. CONCLUSION: The C/S rate secondary to non-reassuring fetal heart tracings was significantly higher in diabetics with elevated baseline FHR than those with baseline FHR &lt; 150bpm even in the setting of a reactive tracing. This may be clinically relevant in antenatal testing of diabetic mothers as it implies that elevation in baseline heart rate may indicate fetal jeopardy.

Association of Fetal Heart Rate Baseline Change and Neonatal Outcomes.

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.

Strip of the Month: January 2017

* Abbreviations: ACOG, : American College of Obstetricians and Gynecologists AWHONN, : Association of Women's Health, Obstetric and Neonatal Nurses EFM, : electronic fetal monitoring FHR, : fetal heart rate IUPC, : intrauterine pressure catheter NICHD, : National Institute of Child Health and Human Development OR, : operating room TOLAC, : trial-of-labor-after-cesarean VABC, : vaginal birth after cesarean Electronic fetal monitoring (EFM) is a popular technology used to establish fetal well-being. Despite its widespread use, the terminology used to describe patterns seen on the monitor has not been consistent until recently. In 1997, the National Institute of Child Health and Human Development (NICHD) Research Planning Workshop published guidelines for interpretation of fetal tracings. This publication was the culmination of 2 years of work by a panel of experts in the field of fetal monitoring, and was endorsed in 2005 by both the American College of Obstetricians and Gynecologists (ACOG) and the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). In 2008, ACOG, NICHD, and the Society for Maternal-Fetal Medicine reviewed and updated the definitions for fetal heart rate patterns, interpretation, and research recommendations. Following is a summary of the terminology definitions and assumptions found in the 2008 NICHD workshop report. Normal values for arterial umbilical cord gas values and indications of acidosis are defined in Table 1. View this table: Table 1. Arterial Umbilical Cord Gas Values ### Assumptions from the NICHD Workshop ### Baseline Fetal Heart Rate

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.

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.

Ethnic analogies and differences in fetal heart rate variability signal: A retrospective study.

We aimed to analyze computerized cardiotocographic (cCTG) parameters (including fetal heart rate baseline, short-term variability, Delta, long-term irregularity [LTI], interval index [II], low frequency [LF], movement frequency [MF], high frequency [HF], and approximate entropy [ApEn]) in physiological term pregnancies in order to correlate them with ethnic differences. The clinical meaning of numerical parameters may explain physiological or paraphysiological phenomena that occur in fetuses of different ethnic origins. A total of 696 pregnant women, including 384 from Europe, 246 from sub-Saharan Africa, 45 from South-East Asia, and 21 from South America, were monitored from the 37th to the 41st week of gestation. Statistical analysis was performed with the analysis of variance test, Pearson correlation test and receiver-operator curves (P<0.05). Our results showed statistically significant differences (P<0.05) between white and black women for Delta, LTI, LF, MF, HF, and ApEn; between white and Asian women for Delta, LTI, MF, and the LF/(HF + MF) ratio; and between white and Latina women for Delta, LTI, and ApEn. In particular, Delta and LTI performed better in the white group than in the black, Asian, and Latina groups. Instead, LF, MF, HF, and ApEn performed better in the black than in the white group. Our results confirmed the integrity and normal functionality of both central and autonomic nervous system components for all fetuses investigated. Therefore, CTG monitoring should include both linear and nonlinear components of fetal heart rate variability in order to avoid misinterpretations of the CTG trace among ethnic groups.

Characteristics of long-range monitoring of fetal heart rate in third trimester with atypical non-stress test

Objective To analyze the characteristics of long-range monitoring of fetal heart rate in the third trimester fetuses with atypical non-stress test (NST). Methods Long-range monitoring of fetal heart rate was performed in low-risk pregnant women who received antenatal care between April 2014 and October 2015 in Peking University Third Hospital. All subjects underwent NST from the 36th gestational week, and divided into normal NST (30 cases) and atypical NST (36 cases) groups according to the results of NST. The clinical data, including maternal age, gestational age at delivery, termination of pregnancy, neonatal asphyxia, hospitalization rate and umbilical cord blood peak-systolic/diastolic ratio value were collected. The data of long-range monitoring were analyzed by specially designed computer software. T test and Chi-square test were applied for statistical analysis. Results There were no differences in maternal age, gestational age at delivery, mode of delivery and incidence of neonatal asphyxia between the two groups (all P>0.05). In atypical NST group, fetal heart rate baseline was higher [(138.05±5.65) vs (135.10±5.39) bpm] (t=-2.170, P<0.05), and fetal heart rate baseline variability was lower than in normal NST group [(5.19±1.07) vs (6.28±1.15) bpm] (t=3.960, P<0.001). Compared with normal NSTs, the percentage of mild baseline variability was significantly increased in atypical NST group [(40.79±9.97) vs (51.17±10.84)%], while that of moderate variability was significantly decreased [(56.57±8.86) vs (46.72±10.24)%] (t=-4.018 and 4.133, both P<0.001). In atypical NSTs, the average ratio of time of acceleration/the whole time of monitoring [(37.41±4.60)%] and acceleration area per unit time[(1.42±0.48) cm2/20 min] were decreased compared with normal NSTs [(40.78±4.23)% and (2.03±0.67) cm2/20 min] (t=3.079 and 4.359, both P<0.05). Conclusions Long-range monitoring of fetal heart rate in the third trimester fetuses with atypical NST is characterized by the declined fetal heart rate baseline variability, increased proportion of mild variability and unit time acceleration area; but these are not associated with pregnancy outcomes and short-term prognosis. Key words: Fetal monitoring; Heart rate, fetal; Pregnancy trimester, third; Electrocardiography

A Model Practice Template for Hydrotherapy in Labor and Birth.

A Model Practice Template for Hydrotherapy in Labor and Birth.

Longitudinal evaluation of computerized cardiotocographic parameters throughout pregnancy in normal fetuses: a prospective cohort study.

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 41weeks of gestation. 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: 24-26weeks(+6d) , 27-29weeks(+6d) , 30-32weeks(+6d) , 33-35weeks(+6d) , 36-38weeks(+6d) and ≥39weeks; 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. 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. 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.

Influence of gestational age and time of day in baseline and heart rate variation of fetuses.

Fetal electrocardiography (FECG) places electrodes on the maternal abdomen to convert the fetal electrocardiosignals into fetal heart rate (FHR), improving the accuracy and comfort of pregnant woman. At the same time, FECG simplifies the procedure of long term monitoring in the perinatal period. Investigating the influence of gestational age and time of day on FHR features to distinguish between non-stress test (NST) normal fetuses and NST suspicious fetuses. A novel method of FHR baseline estimation was presented; then baseline value and fetal heart rate variation (FHRV) were analyzed in the time domain using FHR signals recorded from 52 fetuses. Baseline values in 1:00, 2:00, 4:00, 5:00 and heart rate variation (HRV) distribution showed a significant difference (p< 0.05) between NST normal fetuses and NST suspicious fetuses. The results suggest that NST normal and suspicious fetuses had same outcome and different FHR features. Accurately distinguishing normal fetuses and suspicious fetuses is important for lowering the false positive rate and reducing unnecessary clinical intervention.

Computerized analysis of fetal heart rate variability signal during the stages of labor.

To analyze computerized cardiotocographic (cCTG) parameters (baseline fetal heart rate, baseline FHR; short term variability, STV; approximate entropy, ApEn; low frequency, LF; movement frequency, MF; high frequency, HF) in physiological pregnancy in order to correlate them with the stages of labor. This could provide more information for understanding the mechanisms of nervous system control of FHR during labor progression. A total of 534 pregnant women were monitored on cCTG from the 37th week before the onset of spontaneous labor and during the first and the second stage of labor. Statistical analysis was performed using Kruskal-Wallis test and Wilcoxon rank-sum test with the Bonferroni adjusted α (< 0.05). Statistically significant differences were seen between baseline FHR, MF and HF (P < 0.001), in which the first two were reduced and the third was increased when compared between pre-labor, and the first and second stages of labor. Differences between some of the stages were found for ApEn, LF and for LF/(HF + MF), where the first and the third were reduced and the second was increased. cCTG modifications during labor may reflect the physiologic increased activation of the autonomous nervous system. Using computerized fetal heart rate analysis during labor it may be possible to obtain more information from the fetal cardiac signal, in comparison with the traditional tracing.

Effect of Music Intervention on Maternal Anxiety and Fetal Heart Rate Pattern During Non-Stress Test

The purpose of this cross-over experimental study was to examine effects of music intervention on maternal anxiety, fetal heart rate pattern and testing time during non-stress tests (NST) for antenatal fetal assessment. Sixty pregnant women within 28 to 40 gestational weeks were randomly assigned to either the experimental group (n=30) or control group (n=30). Music intervention was provided to pregnant women in the experimental group during NST. Degree of maternal anxiety and fetal heart rate pattern were our primary outcomes. State-trait anxiety inventory, blood pressure, pulse rate, and changes in peripheral skin temperature were assessed to determine the degree of maternal anxiety. Baseline fetal heart rate, frequency of acceleration in fetal heart rate, fetal movement test and testing time for reactive NST were assessed to measure the fetal heart rate pattern. The experimental group showed significantly lower scores in state anxiety than the control group. There were no significant differences in systolic blood pressure and pulse rate between the two groups. Baseline fetal heart rate was significantly lower in the experimental group than in the control group. Frequency of acceleration in fetal heart rate was significantly increased in the experimental group compared to the control group. There were no significant differences in fetal movement and testing time for reactive NST between the two groups. Present results suggest that music intervention could be an effective nursing intervention for alel viating anxiety during non-stress test.

Evaluating the fetal heart rate baseline estimation algorithms by their influence on detection of clinically important patterns

A correctly estimated component of fetal heart rate signal (FHR) – so called baseline – is a precondition for proper recognition of acceleration and deceleration patterns. A number of various algorithms for estimating the FHR baseline was proposed so far. However, there is no reference standard enabling their objective evaluation, and thus no methodology of comparing the different algorithms still exists. In this paper we propose a method for evaluation of automatically determined baseline in reference to a set of experts, based on ten separate groups of signals comprising typical variability patterns observed in the fetal heart rate. As it was proposed earlier [1], the given algorithm is evaluated based on the characteristic patterns detected using the obtained baseline, instead of direct analysis of the baseline shape. For the purpose of quantitative assessment of the estimated baseline a new synthetic inconsistency coefficient was applied. The proposed methodology enabled to evaluate eleven well-known algorithms. We believe that the method will be a valuable tool for assessment of the existing algorithms, as well as for developing the new ones.

Sawtooth fetal heart rate pattern due to in utero fetal central nervous system injury

Case reports We present 3 cases of documented central nervous system (CNS) injury with a characteristic fetal heart rate (FHR) sawtooth-like pattern. In the first case, there was category I fetal heart tracing during labor, which was followed by a sudden onset of fetal tachycardia, unstable and indeterminate baseline, and episodes of a sawtooth FHR pattern (Figure 1). The Apgar scores after a vaginal delivery were 9/9 at 1 and 5 minutes. The magnetic resonance imaging of the neonate, which was performed 48 hours postpartum because of facial twitches, showed infarction of the left cerebral hemisphere because of a middle cerebral artery occlusion/thrombosis; the approximate timing of the fetal stroke coincided with the abrupt onset of the aforementioned FHR changes in labor (Figure 2). In the second case, the patient was admitted with indeterminate FHR baseline and sawtooth FHR pattern (Figure 3). Emergent cesarean delivery was performed and the Apgar scores were 0/3/3 at 1, 5, and 10 minutes; the umbilical artery cord pH was 6.87, partial pressure of CO2 was 186, and base excess was e27.7. Immediately after birth the electroencephalogram was abnormal, and the infant received brain cooling but unfortunately died. In the third case, late FHR decelerations, indeterminate baseline, and periods of sawtooth FHR pattern were noted during the second stage of labor because of excessive uterine activity (Figure 4). The Apgar scores were 3/6 at 1 and 5 minutes, the cord pH was 6.90, partial pressure of CO2 was 73 and base excess was e19.5. A cranial ultrasound of the neonate revealed grade II intraventricular hemorrhage.

Intrapartum fetal heart rate patterns of trisomy 21 fetuses: A case–control study

Background/AimTo determine whether there are specific characteristic intrapartum heart rate patterns for fetuses with trisomy 21(T21). Background study design/patientsIntrapartum fetal heart rate (FHR) tracings of T21 fetuses were compared to those of euploid fetuses in a retrospective, observational, matched, case–control study. The study group consisted of 42 fetuses with T21 and 42 matched euploid controls. Matching was designed to accommodate possible confounders. The sign test and McNemar's test were used for categorical variables. The paired t test was used for comparison between quantitative variables. ResultsIntrapartum baseline FHR of fetuses with T21 was found to be slightly decreased compared to controls (122.5 vs 129.05 beats per minute, p=0.028). No differences were detected in the presence of periodic changes, or FHR variability between the groups. ConclusionWhen evaluating intrapartum FHR of fetuses with T21, decreased baseline FHR can be expected.