Dawes-Redman Criteria Research Articles

Computerized cardiotocography and Dawes-Redman criteria: how should we interpret criteria not met?

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The significance of meeting Dawes-Redman criteria in computerised antenatal fetal heart rate assessment.

To investigate the significance of not meeting Dawes-Redman criteria on computerised cardiotocography in high-risk pregnancies. Retrospective observational study. UK university hospital. High-risk pregnancies undergoing antenatal assessment. We interrogated the database for records of computerised fetal heart rate assessment and pregnancy outcomes. Neonatal outcome and stillbirths. Excluding duplicate assessment in the same pregnancy, 14 025 records with complete information on the criteria of normality having been met and the outcome of the pregnancy were available. Criteria were not met for 907 records (6.46%). The gestational age of assessment was lower in the group not meeting criteria of normality. Overall, 32 stillbirths occurred in normally formed fetuses (2.28/1000). Stillbirths were more frequent in the group not meeting criteria (odds ratio [OR] 8.78, 95% CI 4.28-18.02). This finding persisted even after records with abnormally low short-term variation (STV) were excluded. The confidence intervals around the rate of stillbirth in the two groups overlapped beyond an STV of 8 ms. Approximately 1:16 pregnancies do not meet the criteria of normality. The criteria are not met more often at preterm gestation than at term. The risk of stillbirth was higher in the group not meeting criteria of normality, even if cases with low STV are excluded. Cases not meeting criteria should be followed up closely, unless the STV is ≥8 ms. Stillbirths still occurred in the group meeting criteria, but the rate was lower than in the general population.

Considering evidence in the management of fetal growth restriction.

Considering evidence in the management of fetal growth restriction.

VP54.02: Prelabour short‐term variability in fetal heart rate by computerised cardiotocogram and maternal fetal Doppler indices for the prediction of labour outcomes

A prospective study in 218 women with term singleton pregnancy in latent phase of labour or due to undergo induction of labour. Data on maternal characteristics, maternal-fetal Dopplers indices and computerised 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, labour onset, indication of labour 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. 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, labour onset, indication of labour induction, pre-labour assessment of EFW, maternal-fetal Doppler indices, FHR STV and Dawes-Redman criteria by computerised CTG. In unselected women in latent phase of labour or undergoing induction of labour at term, admission maternal-fetal Doppler indices, FHR STV and Dawes-Redman criteria are not predictive of composite neonatal morbidity.

Recognising Fetal Compromise in the Cardiograph during the Antenatal Period: Pearls and Pitfalls

There are several national and international guidelines to aid the interpretation of the cardiotocograph (CTG) trace during labour. These guidelines are based on assessing changes in the fetal heart rate (i.e. cardiograph) in response to mechanical and hypoxic stresses during labour secondary to ongoing frequency, duration and strength of uterine contractions (i.e. tocograph). However, during the antenatal period, uterine contractions are absent, and therefore, these intrapartum CTG guidelines cannot be used to reliably identify fetuses at risk of compromise. Computerised analysis of CTG using the Dawes-Redman Criteria could be used to detect fetal compromise. However, clinicians should be aware of the multiple pathways of fetal damage (i.e. inflammation, infection, intrauterine fetal stroke, chronic fetal anaemia, acute feto-maternal haemorrhage and fetal cardiac or neurological disorders) which can cause changes on the CTG trace which may not be recognised by using CTG guidelines.

Prelabor short-term variability in fetal heart rate by computerized cardiotocogram and maternal fetal doppler indices for the prediction of labor outcomes

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.

Perinatal losses in anamnesis as a factor of fetus adaptation damage

In literature there are many works about prediction of chronic hypoxia of fetus, based on the assessment of the mother-placenta-fetus system, such as ultrasound, doppler velocimetry, cardiotocography, placental hormones and proteins tests; separate immunological, biochemical, hemostasiological and functional markers were introduced. However, the prognostic value most of these methods is insufficient by the standards of evidence-based medicine; they do not have a complex pathogenetically based approach. In this regard, the search for new methods for timely prediction and preclinical detection of fetal hypoxia continues to be a priority for obstetrics and perinatology. Cardiointervalography can be a promising method to study the relationship of the mother-placenta-fetus system; it allows simultaneous registration and assessment of the functional systems of mother and fetus. The high probability of such interrelations is evidenced by previous studies.Study aim was to assess the adaptation disorders of the fetus and newborn, to determine perinatal outcomes with a burdened obstetric history.A total of 200 pregnant women with perinatal losses in history (main group) and 100 pregnant women without perinatal losses in history (control group) were examined. Accordingto the results of fetal cardiointervalography in women with perinatal losses in history, the state of regulation of the fetal autonomic nervous system is characterized by a tendency to hypersympathicotonia, stress adaptation systems in the fetus in 66.0% of women. In 10.0% of women, hypertension of the regulatory systems of the fetus enters the stage of exhaustion and breakdown of adaptation, which is confirmed by the diagnosis of fetal distress. Assessing the condition of the fetus with an automatic analysis of the cardiotogram by the Dawes-Redman criteria showed an STV value of <4 in 89.6% of women with fetal distress. The total assessment of the biophysical profile of the fetus was 4.43 ± 0.31 points. The results of the Gausknecht test were less than 15 s, and in severe cases they dropped to 5–7 s. 76.1% of children after intrauterine distress are born in a state of asphyxia, which causes a high frequency of disadaptation syndromes: most often central nervous system disorders (73.9%) and cardiovascular disadaptation (41.3%) was occured.

Antenatal cardiotocography: problems and facilitiies

The role of antenatal cardiotocography (CTG) in algorithm of fetal functional conditions disorders diagnosis is discussed in this article. Furthermore, visual and computer analysis of antenatal monitoring results have been compared. There were discussed Dawes-Redman criteria and based on them CTG systems of computer numeral analysis (Sonicaid System 8000, Sonicaid System 8002, Sonicaid FetalCare). There were shown that based principles of antenatal CTG registrations should be kept in any case, its analysis is possible only in time of active phase of the fetus rest-activity cycle. Any kind of questionable tracing should be analyzed by medical expert in special centers with appropriate experience.

Commentary on 'Antenatal cardiotocogram quality and interpretation using computers'.

Commentary on 'Antenatal cardiotocogram quality and interpretation using computers'.

Computerized cardiotocography in the management of intrauterine growth restriction associated with Doppler velocimetry alterations

Objective: To verify the reliability of computerized cardiotocography (cCTG) in the prediction of the oxygen metabolism status of fetuses with growth restriction and Doppler velocimetry alterations. Methods: From 24 third-trimester cesarean section performed because of intrauterine growth restriction (IUGR) and Doppler velocimetry alterations, there were 11 cases of fetal heart rate alterations (Dawes–Redman criteria were not satisfied) and 13 cases of reactive cCTG. Fetal lung maturity was detected by amniocentesis and blood samples for umbilical blood gas analysis (UBGA) were collected before the first neonatal breath from the umbilical artery in a double-clamped segment of the cord. Results: Umbilical cord gas analysis showed arterial cord blood pH to be 7.20 or less in 11 newborns (45.8%), 7.10 or less in 6 (25%), and 7.00 or less in 3 (12.5%). Linear regression analysis showed short-term variation (STV) in the fetal heart rate to be significantly correlated with umbilical artery pH ( r=0.49; P=0.01) and pCO 2 ( r=−0.50; P=0.01). There were no significant correlations between cCTG and the other UBGA parameters considered. Receiver operator curves permitted to calculate the STV values at which pathological neonatal UBGA values can be expected (pH<7.00 and pCO 2>80 mmHg). A short-term variation less than 4.5 ms was found to predict acidemia with a sensitivity of 100% and a specificity of 70% (positive predictive value, 33%; negative predictive value, 100%), and hypercarbia with a sensitivity of 100% and a specificity of 77.8% (positive predictive value, 55.6%; negative predictive value, 100%). Conclusion: In view of the results of this study, 4.5 ms for STV may be a threshold below which timing of delivery should be decided in cases of fetal growth restriction.

The combination of computerized cardiotocography and amniotic fluid index for the prediction of neonatal acidemia at birth: a modified biophysical profile.

To study the combination of computerized cardiotocography (cCTG) and the amniotic fluid index (AFI) in the prediction of neonatal acidemia at birth. A total of 89 singleton third-trimester high-risk pregnancies delivered by Cesarean section, with an AFI evaluated within 24 h from birth, and an antepartum cCTG performed within 6 h from delivery, were studied. The score was the sum of values for AFI (oligo/anhydramnios = 1, normal = 0) and cCTG (Dawes-Redman criteria, not met = 1, met = 0). The endpoint was to predict an abnormal neonatal outcome as defined by an umbilical artery pH of < or = 7.2. Fifteen neonates had an umbilical artery pH of < 7.2. The combination of cCTG + AFI score was able to predict pH values (< or = 7.20) with an OR = 2.83 (p < 0.02). The diagnostic accuracy of the combination of cCTG + AFI was as follows: sensitivity 80%, specificity 58%, positive predictive value 28%, negative predictive value 83%. We suggest that the cCTG + AFI score may be of value in the prediction of neonatal acidemia and help in the management of third-trimester high-risk pregnancies.

The combination of computerized cardiotocography and amniotic fluid index for the prediction of neonatal acidemia at birth: a modified biophysical profile

Objective: To study the combination of computerized cardiotocography (cCTG) and the amniotic fluid index (AFI) in the prediction of neonatal acidemia at birth. Methods: A total of 89 singleton third-trimester high-risk pregnancies delivered by Cesarean section, with an AFI evaluated within 24 h from birth, and an antepartum cCTG performed within 6 h from delivery, were studied. The score was the sum of values for AFI (oligo/anhydramnios = 1, normal = 0) and cCTG (Dawes-Redman criteria, not met = 1, met = 0). The endpoint was to predict an abnormal neonatal outcome as defined by an umbilical artery pH of &#104 7.2. Results: Fifteen neonates had an umbilical artery pH of < 7.2. The combination of cCTG + AFI score was able to predict pH values ( &#104 7.20) with an OR = 2.83 ( p < 0.02). The diagnostic accuracy of the combination of cCTG + AFI was as follows: sensitivity 80%, specificity 58%, positive predictive value 28%, negative predictive value 83%. Comment: We suggest that the cCTG + AFI score may be of value in the prediction of neonatal acidemia and help in the management of third-trimester high-risk pregnancies.

A comparison of visual and automated methods of analyzing fetal heart rate tests

Our objective in this study was to compare evaluation and clinical implications of visual versus computerized analysis of nonstress tests. Nonstress tests of 575 high-risk patients were analyzed visually and by a computer using the Oxford Sonicaid System 8000. Standard reactivity criteria were used for visual assessment; the System 8000 used an algorithm with the Dawes-Redman criteria. Ninety-six percent of nonstress tests that met Dawes-Redman criteria were reactive by visual analysis; 93% of reactive nonstress tests met Dawes-Redman criteria. Only 30% of tests that failed Dawes-Redman criteria were nonreactive, whereas 44% of nonreactive tests failed to meet Dawes-Redman criteria. Sensitivities, specificities, and positive and negative predictive values were similar for both approaches. Additional tests or interventions would have occurred in 9% of the cases analyzed by System 8000 and in 49% of the cases analyzed visually. Although these approaches rate nonstress tests differently, their diagnostic performances are similar. Automated fetal heart rate testing may become an acceptable alternative to conventional visual analysis.