Fetal Monitoring Research Articles

The utility of fetal heart rate deceleration's descending slope in searching for a non-National Institute of Child Health and Human Development parameter for the detection of fetal acidosis.

To identify new parameters predicting fetal acidemia. A retrospective case-control study in a cohort of deliveries from a tertiary referral hospital-based cohort deliveries in Zaragoza, Spain between 2018 and 2021 was performed. To predict fetal acidemia, the NICHD categorizations and non-NICHD parameters were analyzed in the electronic fetal monitoring (EFM). Those included total reperfusion time, total deceleration area and the slope of the descending limb of the fetal heart rate of the last deceleration curve. The accuracy of the parameters was evaluated using the specificity for (80%, 85%, 90%, 95%) sensitivity and the area under the receiver operating characteristic curve (AUC). A total of 10 362 deliveries were reviewed, with 224 cases and 278 controls included in the study. The NICHD categorizations showed reasonable discriminatory ability (AUC = 0.727). The non-NICHD parameters measured during the 30-min fetal monitoring, total deceleration area (AUC = 0.807, 95% CI: 0.770, 0.845) and total reperfusion time (AUC = 0.750, 95% CI: 0.707, 0.792), exhibited higher discriminatory ability. The slope of the descending limb of the fetal heart rate of the last deceleration curve had the best AUC value (0.853, 95% CI: 0.816, 0.889). The combination of total deceleration area or total reperfusion time with the slope demonstrated high discriminatory ability (AUC = 0.908, 95% CI: 0.882, 0.933; specificities of 71.6% and 72.7% for a sensitivity of 90%). The slope of the descending limb of the fetal heart rate of the last deceleration curve is the strongest predictor of fetal acidosis, but its combination with the total reperfusion time shows better clinical utility.

Exploring the association between PLGF and pregnancy outcomes

Introduction and Aim: Pregnancy demands vigilant fetal monitoring, yet traditional methods have limitations, leading to research on biomarkers like placental growth factor (PLGF) to enhance predictive accuracy for adverse outcomes. This investigation focuses on assessing the relationship between PLGF levels and pregnancy outcomes in women with suspected preeclampsia. Materials and Methods: A simple longitudinal design was employed, following pregnant women with suspected preeclampsia from enrollment until delivery. The study included 160 subjects, and their characteristics were recorded at admission. PLGF levels were measured, and pregnancy outcomes were assessed. Results: Among the study population, the distribution of pregnancies showed that 45.62% were in the first pregnancy, 40% in the second pregnancy, 11.85% in the third pregnancy, and 2.5% in the fifth pregnancy. The highest PLGF levels were observed in the fifth pregnancy group.Analysis revealed that subjects with NICU admission had a lower mean PLGF value compared to those without NICU admission. Among subjects with low PLGF levels, the mean baby weight was lower by approximately 5.3% when match up to those with normal PLGF levels.Regarding blood pressure, subjects with decreased PLGF levels had a higher mean systolic blood pressure in contrast to those with normal PLGF levels. Conclusion: Lower PLGF levels were associated with NICU admission, lower baby weight, and higher systolic blood pressure in women with suspected preeclampsia. These findings suggest that PLGF levels may have implications for pregnancy outcomes. Additional investigation with expanded sample sizes is necessary to authenticate these discoveries and look into the clinical relevance of PLGF in understanding and addressing preeclampsia.

Is it time to end the use of base deficit for fetal well-being assessment?

Authors have expressed reservations regarding the use of base deficit measured in umbilical artery blood samples to assess fetal well-being during the course of labor and to predict neonatal neurologic morbidity. Despite its integration into clinical practice for more than 50 years, obstetricians and maternal-fetal medicine specialists may not realize that this marker has significant limitations in accurately identifying neonatal metabolic acidosis as a proxy for fetal well-being. In brief, there are 2 large families of base deficit, namely whole blood and extracellular fluid. Both rely on equations that use normal adult acid-base characteristics (pH 7.40 and partial CO2 pressure of 40 mm Hg) that overlook the specificity of the normal in utero acid-base status of pH 7.27 and partial CO2 pressure of 54 mm Hg. In addition, it ignores the unique characteristic of the in utero fetal response to acute hypoxia. The dependence on placental circulation for CO2 elimination may lead to extremely high values (up to 130 to 150 mm Hg) during hypoxic events, a phenomenon that is absent in adults with acute metabolic acidosis who can hyperventilate. The dispute over if to include a correction for high partial CO2 pressure in the bicarbonate estimation, as presented in the Great Trans-Atlantic Debates, remains unresolved. The key constants computed for adult acid-base physiology in the current base deficit algorithms, without accounting for the impact of high partial CO2 pressure or other fetal characteristics of buffering capacity (eg, differences in body water content composition, plasma protein, and hemoglobin attributes), may lead to an overestimation of metabolic acidosis, especially in newborns who are experiencing hypercarbia during the early stages of the hypoxic response. These unrecognized limitations impact the base deficit results and may mislead clinicians on fetal well-being assessments when discussing the management of fetal heart rate monitoring and neonatal outcomes. Based on our arguments, we believe that it is prudent to consider an alternative to base deficit for drawing conclusions regarding fetal well-being during the course of birth management. We propose a marker specifically related to the newborn acid-base physiology--the neonatal eucapnic pH correction. This marker can be added to arterial cord blood gas analysis, and we have described how to interpret it as a marker of neonatal metabolic acidosis.

Fetal Surveillance From 39 Weeks’ Gestation to Reduce Stillbirth in South Asian–Born Women

ABSTRACT Women of South Asian background are known to have higher rates of stillbirth than women in other high-income countries, such as Australia or the United Kingdom. To reduce the rate of stillbirth, leading societies recommend antenatal fetal monitoring or induction of labor (IOL) at 41 weeks of gestation regardless of race/ethnicity. However, at 41 weeks' gestation, the risk of stillbirth for South Asian–born women is already up to 5 times higher than for Australian-born women. Initially, the UK National Institution for Health and Care Excellence recommended that all South Asian women undergo IOL earlier, at 39 weeks of gestation. However, this recommendation was criticized as being racist, and perpetuating the myth that race plays a factor in poor outcomes, so it was amended to state that South Asian–born women might benefit from additional monitoring and support. Still, there is no evidence to support this guidance. In July 2017, the State of Victoria in Australia implemented a new clinical guideline to provide South Asian women with biweekly cardiotocography and amniotic fluid measurement at 39 weeks of gestation. The aim of this study was to assess the impact of the new clinical guideline on the rates of stillbirth and select pregnancy outcomes for South Asian women. This was a cohort study that included women with singleton pregnancies who gave birth at term or beyond at a university- affiliated teaching health service located in 3 metropolitan areas in Australia from January 1, 2016, to December 31, 2020. Women were classified as South Asian born if they self-identified as being from Afghanistan, Bangladesh, Bhutan, India, Iran, the Maldives, Nepal, Pakistan, or Sri Lanka. The timeframe between January 1, 2016, and June 30, 2017, represented the period before the change in practice for fetal monitoring for South Asian women; the timeframe between July 1, 2017, and December 31, 2020, represented the period after. Although the new practice was applied to South Asian–born women in the second timeframe, fetal monitoring at 41 weeks was applied to all other women. The primary outcome was stillbirth at the onset of or during labor at 37 weeks and 39 weeks of gestation. The secondary outcomes included neonatal death at <7 days, admission to the special care nursery or neonatal intensive care, Apgar score <7 at 5 minutes, infant birthweight, gestation of birth, IOL, and mode of birth. A total of 3506 South Asian women gave birth before the change in practice, whereas 8532 gave birth postimplementation. The rate of stillbirth at 37 weeks' gestation for South Asian–born women was 2.3 per 1000 births—a 2.6-fold higher rate than for other women (0.9 per 1000 births; P = 0.06). After the change in practice, the rate of stillbirth fell by 64% for South Asian–born women (95% confidence interval, 87%–2%; P = 0.047). The association was stronger when the results were restricted to births after 39 weeks of gestation. Also, after the change in practice, reduced rates for early neonatal death (3.1 per 1000 vs 1.3 per 1000; P = 0.03) and admission to the special care nursery (16.5% vs 11.1%; P < 0.001) were observed. The median gestation of birth for South Asian–born women was 39+3 weeks preimplementation compared with 39+2 weeks postimplementation, a difference of 1 day. The rate of IOL for South Asian–born women was 4.9% higher than other women (95% confidence interval, 1.3%–8.5%; P = 0.008). However, no significant difference was observed between the 2 groups in the rate of IOL per month after the change in practice, nor across the other secondary outcomes. In conclusion, fetal monitoring starting at 39 weeks' gestation among South Asian–born women reduced the rate of stillbirth, neonatal death, and admission to the special care nursery compared with previous guidelines to begin monitoring at 41 weeks.

Duration of biophysical profile in periviable and very preterm low-risk pregnancies

BackgroundIn recent years, perinatal viability has shifted from 24 to 22 weeks of gestation at many institutions after improvements in survival in neonates delivered at the limit of viability. Monitoring these fetuses is essential since antenatal interventions with resuscitation efforts are available for patients at risk of delivery at the limit of viability. However, fetal monitoring as biophysical profile has not been extensively studied in very preterm pregnancies, particularly in the periviable period (20 weeks 0 days – 23 weeks 6 days). Objectives (i)To investigate whether the completion of biophysical profiles within 30 min is feasible in very preterm pregnancies. (ii) To determine the average observation time required to achieve a score of 8/8 in very preterm pregnancies from 20 weeks 0 days to 31 weeks 6 days. Study DesignThis study prospectively evaluated biophysical scores in singleton pregnancies undergoing routine ultrasonography at or near viability from 20 weeks 0 days to 23 weeks 6 days (periviable or group I), 24 weeks 0 days to 27 weeks 6 days (group II), and 28 weeks 0 days to 31 weeks 6 days (group III). The results and duration of biophysical profiles were compared to those of a control group (32 weeks 0 days to 35 weeks 6 days) undergoing indicated fetal surveillance. Biophysical profiles were performed on all studied pregnancies until a score of 8/8 was obtained. When more than one biophysical profile was obtained during pregnancy, each was analyzed individually. Pregnancies with fetal anomalies or obstetric/medical indications for fetal well-being surveillance were excluded. Analysis of variance and post-hoc Tukey’s test were used for comparisons. ResultsData was completed for 123 participants, yielding 79, 75, and 72 studies for groups I, II, and III, respectively. The control group included 42 patients, yielding 140 studies. At 30 min, 80% (63/79) of the studies in the periviable group had a score of 8/8, compared to 100% (140/140) in the control group (P<0.001). The mean + standard deviation time in minutes to achieve a biophysical score of 8/8 was 23.3 + 10.1 in the periviable group compared to 9.4 + 6.5 in controls (P<0.001). Extending the study to +2 standard deviations (43.6 min) in the periviable group resulted in 97% (77/79) of the scans scoring 8/8 in the absence of adverse outcomes. In the other groups, a biophysical score of 8/8 within 30 min was obtained in 97% (73/75) and 100% (72/72) in groups II and III, respectively; the mean + standard deviation times were 17.1 + 8.4 min (group II) and 13.1 + 7.3 min (group III). No adverse outcomes developed during the study participation in groups I–III. ConclusionsBiophysical scores of 8/8 can be successfully obtained in low-risk periviable pregnancies (20 weeks 0 days – 23 weeks 6 days) within an observation time longer than the standard 30 min. The time required to reach a score of 8/8 decreases as gestation progresses. We suggest adjusting the observation time for biophysical profile completion according to the gestational age.

The effect of acetylsalicylic acid intake on fetal adaptation in placental dysfunction

Placental dysfunction (PD) is one of the actual topics of research in the modern scientific world. Fetal growth retardation (FGR) is the leading clinical manifestation of chronic PD. Assessment of fetal growth is one of the key tasks in prenatal care. FGR is associated with an increased risk of perinatal morbidity and mortality, with long-term adverse outcomes for the child.Prenatal diagnosis of FGR is an important task for stillbirth prevention, up to 30% of cases of which are associated with this pathology or with a small-for-gestational-age fetus at the end of the III trimester.The objective: to study the influence of acetylsalicylic acid on the development of compensatory abilities of the fetus by PD.Materials and methods. 118 pregnancies with FGR and/or PD were analyzed. The women were divided into two groups: I group (67 persons) – patients with FGR and/or PD who used acetylsalicylic acid during pregnancy; II group (51 women) – pregnant women with FGR and/or PD who did not use acetylsalicylic acid during pregnancy. In all cases, the method of delivery was cesarean section due to fetal distress.Fetal distress was diagnosed using ultrasound examinations based on the following criteria: abnormal blood flow according to Doppler data (Volusun S10 ultrasound device), fetal biophysical profile indicators (Volusun S10 ultrasound device, Sonicaid Team fetal monitor) and cardiotocographic assessment of short-term variability (STV) fetal heart rate; STV &gt; 4.5 according to the Sonicaid Team fetal monitor. Exclusion criteria: multiple pregnancy, antenatally confirmed fetal malformations.Results. The use of acetylsalicylic acid through placental regulation allows to achieve a longer gestation period before the development of fetal distress. The average gestational age before the appearance of this pathology in 50.75% of patients of the I group (34 persons) was larger – 33–36 weeks. On the other hand, 54.9% of women (28 individuals) in the II group had fetal distress earlier – at 28–32 weeks of gestation (p&lt;0.05).Pathological blood flow in the umbilical artery or fetal biophysical profile &lt;4 points was determined in 83.6% of cases in the I group (56 pregnant women) and in 23.5% in the II group (12 women). In women who used acetylsalicylic acid (I group) acute fetal distress diagnosed by STV was detected in 11 (16.4%) cases. In women who did not use acetylsalicylic acid (II group), distress manifested itself sharply – due to acidosis – in 39 (76.5%) cases (p&lt;0.05).Conclusions. 1. In women who did not use acetylsalicylic acid, fetal distress manifested itself sharply – due to acidosis (STV&lt;4.5 was recorded in 39 (76.5%) patients of the II group, while in women who used acetylsalicylic acid – in 11 pregnant women of the I group (16.4%; p&lt;0.05). 2. Prophylactic use of acetylsalicylic acid allows to slow down the growth of placental dysfunction, which lets to the development of compensatory mechanisms and adaptation. 3. By use of acetylsalicylic acid the gestational period delivery closer to full term pregnancy. In women who used acetylsalicylic acid, most cases of fetal distress occurred at 33–36 weeks – 50.75%, while in the group that did not use acetylsalicylic acid most cases of fetal distress occurred at 28–32 weeks – in 54.9% (p&lt;0.05).

Functional Outcome of Lower Limb Long Bone Trauma Management in Pregnant Mothers: A Prospective Study of 30 Cases From a Tertiary Care Centre in North India.

The occurrence of orthopedic injuriesduring pregnancy carries considerable morbidity and mortality for both the mother and fetus. Successful care of lower limb fractures during pregnancy requires a multidisciplinary approach. Both operative and non-operative treatments must be taken into account by the treating orthopedic physician. There is limited literature available on the management of these lower limb fractures in pregnancy, and peri-operative management of this obstetric and orthopedic trauma is largely unclear. Trauma during pregnancy is a common cause of non-obstetrical maternal death, having a significant public health burden to both the mother and child. The aims and objectives of this study were to review the common causes of lower limb long bone trauma during pregnancy and their functional outcome in terms of morbidity and mortality. This study evaluates various operative and conservative methods of treatment to provide a comprehensive management approach to pregnant patients with lower limb trauma. A prospective study on functional outcomes of 30 pregnant females who were admitted with lower limb long bone fractures from 2017 to 2021 was done. The patients were randomly selected intra-operatively for various procedures based on the surgeon's preference. All patients were followed for two years or till union occurred, and the radiographic union score for tibial (RUST) and modified radiographic union score for tibial (mRUST) fracture criteria were used to assess bony union clinico-radiologically. Results: During this study, the mean age of patients was 27 years (range 19-38), having right-side (53.33%) predominance with road traffic accidents (n=22) and falls (n=6) as the most common causes of injury. Two cases of domestic violence were also reported. In our study, the maximum number of cases was 17-25 weeks of their gestation; 12 (40%) patients had tibial fractures, and 18 (60%) had femoral fractures. Six tibial fractures were handled conservatively, while all femoral fractures required surgical intervention. Out of 18 femoral fractures, which were treated surgically, dynamic compression plating was done in 15 (83.33%) patients, while interlock nailing was done in three patients. Six tibial fractures have been operated upon, two (66.66%) with dynamic compression plating and four (33.33%) with an interlocking nail. A multidisciplinary approach in terms of both operative and non-operative methods must be taken into account for treating pregnant mothers by the orthopedic physician while carefully weighing the benefits and risks of both procedures. Based on the pattern and displacement of the fracture, many prenatal fractures can be treated conservatively. Another alternative that is frequently safe is to postpone the surgical procedure until childbirth. The physiologic changes associated with pregnancy and any potential dangers to the fetus must be taken into account by the orthopedic surgeon when fractures necessitate surgical intervention. The surgeon is responsible for the patient's correct placement, the C-arm's use, the radiation dose, and the intra-operative fetal monitoring, as well as the danger brought on by anesthetics, antibiotics, analgesics, and anticoagulants.

Anesthetic recommendations for maternal and fetal safety in nonobstetric surgery: a balancing act.

Nonobstetric surgery during pregnancy is associated with maternal and fetal risks. Several physiologic changes create unique challenges for anesthesiologists. This review highlights physiologic changes of pregnancy and presents clinical recommendations based on recent literature to guide anesthetic management for the pregnant patient undergoing nonobstetric surgery. Nearly every anesthetic technique has been safely used in pregnant patients. Although it is difficult to eliminate confounding factors, exposure to anesthetics could endanger fetal brain development. Perioperative fetal monitoring decisions require an obstetric consult based on anticipated maternal and fetal concerns. Given the limitations of fasting guidelines, bedside gastric ultrasound is useful in assessing aspiration risk in pregnant patients. Although there is concern about appropriateness of sugammadex for neuromuscular blockade reversal due its binding to progesterone, preliminary literature supports its safety. These recommendations will equip anesthesiologists to provide safe care for the pregnant patient and fetus undergoing nonobstetric surgery.

UK student midwives' theoretical knowledge, confidence, and experience of intermittent auscultation of the fetal heart rate during labour: An online cross-sectional survey

AimThis study aimed to explore student midwives' theoretical knowledge of intrapartum intermittent auscultation, their confidence in, and their experience of this mode of fetal monitoring. Design and SettingAn online cross-section survey with closed and open questions. Descriptive statistics were used to analyse participants' intermittent auscultation knowledge, confidence, and experience. Reflexive thematic analysis was used to identify patterns within the free text about participants' experiences. ParticipantsUndergraduate midwifery students (n = 303) from Nursing and Midwifery Council-approved educational institutions within the United Kingdom. FindingsMost participants demonstrated good theoretical knowledge. They had witnessed the technique being used in clinical practice, and when performed, the practice was reported to be in line with national guidance. In closed questions, participants reported feeling confident in their intermittent auscultation skills; however, these data contrasted with free-text responses. ConclusionThis cross-sectional survey found that student midwives possess adequate knowledge of intermittent auscultation. However, reflecting individual clinical experiences, their confidence in their ability to perform intermittent auscultation varied. A lack of opportunity to practice intermittent auscultation, organisational culture, and midwives' preferences have caused student midwives to question their capabilities with this essential clinical skill, leaving some with doubt about their competency close to registration.

Monitoring of Women with Anti-Ro/SSA and Anti-La/SSB Antibodies in Germany-Status Quo and Intensified Monitoring Concepts.

Background: The fetuses of pregnant women affected by anti-Ro/anti-La antibodies are at risk of developing complete atrioventricular heart block (CAVB) and other potentially life-threatening cardiac affections. CAVB can develop in less than 24 h. Treatment with anti-inflammatory drugs and immunoglobulins (IVIG) can restore the normal rhythm if applied in the transition period. Routine weekly echocardiography, as often recommended, will rarely detect emergent AVB. The surveillance of these pregnancies is controversial. Home-monitoring using a hand-held Doppler is a promising new approach. Methods: To obtain an overview of the current practice in Germany, we developed a web-based survey sent by the DEGUM (German Society of Ultrasound in Medicine) to ultrasound specialists. With the intention to evaluate practicability of home-monitoring, we instructed at-risk pregnant women to use a hand-held Doppler in the vulnerable period between 18 and 26 weeks at our university center. Results: There are trends but no clear consensus on surveillance, prophylaxis, and treatment of anti-Ro/La positive pregnant between specialists in Germany. Currently most experts do not offer home-monitoring but have a positive attitude towards its prospective use. Intensified fetal monitoring using a hand-held Doppler is feasible for pregnant women at risk and does not lead to frequent and unnecessary contact with the center. Conclusion: Evidence-based guidelines are needed to optimize the care of anti-Ro/La-positive pregnant women. Individual risk stratification could help pregnancy care of women at risk and is welcmed by most experts. Hand-held doppler monitoring is accepted by patients and prenatal medicine specialists as an option for intensified monitoring and can be included in an algorithm for surveillance.

UTILIZATION OF THE ANDROID APPLICATION SI-RAJA BUMIL (ESTIMATED FETAL WEIGHT OF PREGNANT WOMEN) IN MONITORING FETAL GROWTH IN MIDWIFE AT INDEPENDENT PREMISES IN TANJUNGPINANG CITY

Estimated fetal weight is useful for tracking fetal growth in the womb, allowing for the early detection of aberrant fetal growth. With the advancement of technology, Android users can be used as a channel for health education information. The objective of this study was to look at how utilizing the Android application Si-RAJA Bumil (Estimated Fetal Weight of Pregnant Women) affects pregnant women’s understanding of fetal growth monitoring. This study applied a quasi-experimental design with two groups pre-testing and post-testing. Samples of 60 pregnant women were collected using the Simple Random Sampling approach and divided into two groups: the intervention group and the control group. The Midwife Independent Practice in Tanjungpinang City collected data in September 2023. Wilcoxon and Mann-Whitney tests were used to analyze data. The knowledge value of pregnant women differs significantly between groups who do not utilize the Si-RAJA Bumil android application and groups that do, with a p-value of 0.003. Pregnant mothers are expected to be able to monitor their foetus’ growth and development using technological media such as the Si-RAJA Bumil application.

Maternal and perinatal outcomes of oligohydramnios in late term and post term pregnancies at public hospitals in Ethiopia: a cross-sectional study

BackgroundThe prevalence of oligohydramnios ranges from 12 to 14% after 41 weeks to as high as 30% in post term pregnancies. Oligohydramnios poses a dilemma in the choice of mode of labor and delivery in a setup where there is lack of continuous electronic fetal monitoring during labor. The condition also puts the mother at risks of operative interventions and cesarean delivery. We aimed to asses the maternal and perinatal outcomes in pregnancies with oligohydramnios in late term and post term pregnancy in this study.MethodsA cross-sectional study was conducted among mothers with diagnosis of oligohydramnios after 40+ 6 weeks of gestation at four hospitals at four public hospitals in Addis Ababa, Ethiopia from May 1, 2021 to September 30, 2021. Data were collected using structured questionnaire. Logistic regression were performed to assess factors associated with the adverse maternal and perinatal outcomes.ResultsFrom a total of 142 mothers with oligohydramnios in late term and post tem pregnancies, 40.8% delivered through cesarean section. Spontaneous labor and elective cesarean section were more likely to occurr in parous women (AOR 2.5, 95% CI 1.06–6.04, p = 0.04), but with less likely in those with secondary level education (AOR 0.13, 95% CI 0.02–0.74, p = 0.02). There was no statistically significant difference in adverse outcomes between those who had induction of labor and those who had either spontaneous labor or had elective cesarean section.ConclusionsThe adverse maternal and perinatal outcomes in late term and post term pregnancies with oligohydramnios may not be different among different modes of delivery. Induction of labor can be safe in these particular group of women with intermittent auscultation with fetoscope in a setup where continuous electronic fetal monitoring is not readily available.

The role of the cerebroplacental ratio in predicting pregnancy outcomes at 40-42 gestational weeks: a prospective observational trial.

The cerebroplacental ratio is a sonographic tool used to predict poor pregnancy outcomes. Data are insufficient regarding its use in postdate pregnancy. We evaluated the cerebroplacental ratio's prediction of unfavorable pregnancy outcomes in women at 40-42 weeks gestation with normal amniotic fluid index. This prospective observational study included 101 women with low-risk singleton pregnancy and gestational age > 40 weeks who delivered in a university affiliated hospital during 2020-2021. The middle cerebral artery pulsatility index, the umbilical artery pulsatility index, and the cerebroplacental ratio, which is their quotient, were compared between women with favorable and unfavorable pregnancy outcomes. The latter included: meconium-stained amniotic fluid, cesarean or vacuum-assisted delivery due to pathological cardiotocography (category 2 or 3), 5-min Apgar score < 7, umbilical cord pH < 7.1, neonatal intensive care unit admission, and neonatal death. Fetal Doppler, performed at a median gestational age of 40.3 (40.0-41.6), did not differ between 75 (74.3%) women with favorable obstetrical outcomes and 26 (25.7%) with unfavorable outcomes. In multivariate analysis, advanced maternal age and a history of a cesarean section were correlated with unfavorable outcomes, while Doppler indices were not found to be predictive. Among women at 41-42 weeks' gestation, for those with intrapartum fetal monitor category 2-3 vs. category 1, the mean umbilical artery pulsatility index was higher: 0.92±0.34 vs. 0.71±0.11 (p = 0.044). According to the study results, fetal Doppler indices, including the cerebroplacental ratio, are not predictive of unfavorable outcome in women with pregnancies exceeding 40 weeks. Larger prospective studies are needed.

The role of confined placental mosaicism in fetal growth restriction: A retrospective cohort study.

To evaluate which cytogenetic characteristics of confined placental mosaicism (CPM) detected in the first trimester chorionic villi and/or placentas in terms of chromosome aberration, cell lineage involved and trisomy origin will lead to fetal growth restriction and low birthweight. Cohort study using routinely collected perinatal data and cytogenetic data of non-invasive prenatal testing, the first trimester chorionic villi sampling and postnatal placentas. 215 CPM cases were found. Fetal growth restriction (FGR) and low birthweight below the 10th percentile (BW<p10) were seen in 34.0% and 23.1%, respectively. Excluding cases of trisomy 16, 29.1% showed FGR and 17.9% had a BW<p10. The highest rate of FGR and BW<p10 was found in CPM type 3, but differences with type 1 and 2 were not significant. FGR and BW<p10 were significantly more often observed in cases with meiotic trisomies. There is an association between CPM and FGR and BW<p10. This association is not restricted to trisomy 16, neither to CPM type 3, nor to CPM involving a meiotic trisomy. Pregnancies with all CPM types and origins should be considered to be at increased risk of FGR and low BW<p10. A close prenatal fetal monitoring is indicated in all cases of CPM.

Comprehensive Classification of Fetal Health Using Cardiotocogram Data Based on Machine Learning

In the realm of obstetrics, the evaluation of fetal health remains a paramount yet challenging endeavor. Traditional approaches, such as electronic fetal monitoring (EFM), despite their widespread adoption, continue to grapple with uncertainties regarding their impact on neonatal outcomes and the reduction of emergency cesarean deliveries. This ambiguity is compounded by a prevailing confusion within the obstetric community about interpreting fetal heart rate patterns, often leading to inconsistent and subjective assessments. Addressing these complexities, our study presents an innovative machine learning-based techniques for the comprehensive classification of fetal health using cardiotocogram (CTG) data, offering a more objective and nuanced alternative to conventional methods. The core of our proposed solution is a novel model employing a sophisticated ensemble of machine learning classifiers, including Multi-Support Vector Machine (Multi-SVM), Decision Tree, Random Forest with Hyperparameter Tuning, XGBoost, and Neural Networks. This model is unique in its application, processing datasets in four different forms: raw datasets, datasets processed with MinMaxScaler, datasets subjected to feature selection using SelectKBest, and a combination of MinMaxScaler processing and SelectKBest feature selection. Such meticulous preprocessing, encompassing normalization and feature selection, is pivotal in ensuring equitable contribution from each feature, thereby optimizing the model's learning process and predictive accuracy. The effectiveness of our model is rigorously evaluated using a dataset comprising 2126 individual records from CTG exams, classified by specialist obstetricians into three types: Normal, Suspect, and Pathological. These records are exhaustively analyzed using various metrics, including Accuracy, Precision, Recall, F1-Score, ROC AUC, and Confusion Matrix. Among the classifiers, XGBoost emerged as the most proficient, consistently outperforming others across multiple metrics. This indicates its superior ability to accurately identify and categorize the different states of fetal health. Our findings thus underscore the significant promise of machine learning in revolutionizing fetal health monitoring, offering a more reliable, objective, and comprehensive method for assessing fetal well-being, with profound implications for prenatal care and clinical decision-making.

Perinatal care and its association with perinatal death among women attending care in three district hospitals of western Uganda

BackgroundProvision of effective care to all women and newborns during the perinatal period is a viable strategy for achieving the Sustainable Development Goal 3 targets on reducing maternal and neonatal mortality. This study examined perinatal care (antenatal, intrapartum, postpartum) and its association with perinatal deaths at three district hospitals in Bunyoro region, Uganda.MethodsA cross-sectional study was conducted in which a questionnaire was administered consecutively to 872 postpartum women before discharge who had attended antenatal care and given birth in the study hospitals. Data on care received during antenatal, labour, delivery, and postpartum period, and perinatal outcome were extracted from medical records of the enrolled postnatal women using a pre-tested structured tool. The care received from antenatal to 24 h postpartum period was assessed against the standard protocol of care established by World Health Organization (WHO). Poisson regression was used to assess the association between care received and perinatal death.ResultsThe mean age of the women was 25 years (standard deviation [SD] 5.95). Few women had their blood tested for hemoglobin levels, HIV, and Syphilis (n = 53, 6.1%); had their urine tested for glucose and proteins (n = 27, 3.1%); undertook an ultrasound scan (n = 262, 30%); and had their maternal status assessed (n = 122, 14%) during antenatal care as well as had their uterus assessed for contraction and bleeding during postpartum care (n = 63, 7.2%). There were 19 perinatal deaths, giving a perinatal mortality rate of 22/1,000 births (95% Confidence interval [CI] 8.1–35.5). Of these 9 (47.4%) were stillbirths while the remaining 10 (52.6%) were early neonatal deaths. In the antenatal phase, only fetal examination was significantly associated with perinatal death (adjusted prevalence ratio [aPR] = 0.22, 95% CI 0.1–0.6). No significant association was found between perinatal deaths and care during labour, delivery, and the early postpartum period.ConclusionWomen did not receive all the required perinatal care during the perinatal period. Perinatal mortality rate in Bunyoro region remains high, although it’s lower than the national average. The study shows a reduction in the proportion of perinatal deaths for pregnancies where the mother received fetal monitoring. Strategies focused on strengthened fetal status monitoring such as fetal movement counting methods and fetal heart rate monitoring devices during pregnancy need to be devised to reduce the incidence of perinatal deaths. Findings from the study provide valuable information that would support the strengthening of perinatal care services for improved perinatal outcomes.

Fetal Diagnosis of Supravalvular Aortic Stenosis and Pulmonary Stenosis in a Family with Non-Syndromic Elastin Mutation.

Supravalvular aortic stenosis (SVAS) has been well described in Williams-Beuren Syndrome and non-syndromic elastin (ELN) mutations. Non-syndromic ELN mutations are inherited in an autosomal dominant pattern with incomplete penetrance and variable expressivity. ELN haploinsufficiency leads to progressive arteriopathy, typically affecting the aortic sinotubular junction. Multi-level pulmonary stenosis has also been reported and biventricular obstruction may portend a worse prognosis. Fetal presentation of ELN mutation with SVAS has not been previously reported in the literature. We present a case of fetal diagnosis of SVAS and multi-level pulmonary stenosis in a family with a known pathogenic ELN mutation (Exon 6, c.278del [p.Pro93Leufs*29]). On the fetus' initial fetal echo, there was only mild flow acceleration through the aortic outflow tract, however, she went on to develop progressive bilateral obstruction. In the early post-natal period, the child was clinically asymptomatic and showed similar mild SVAS and mild valvar and supravalvular pulmonary stenosis. Our case highlights the need for serial monitoring of fetuses with suspected or confirmed ELN arteriopathy.

Fetal monitoring in labour: Best practice for diagnosis, monitoring and treatment (clinical recommendation)

Worldwide, the problem of adequate diagnosis of intrauterine fetus state is extremely relevant. Postponed hypoxia in labour remains the leading cause of stillbirth, neonatal mortality, as well as early and late neonatal and infant morbidity. Ongoing advances in clinical care, especially in diagnosis and management, require efforts to effectively translate these changes to the wide range of obstetric care providers. This article (guideline) covers methods for monitoring the wellbeing of the baby during labour. It includes risk assessment to determine the appropriate level of fetal monitoring, using clinical assessment in addition to fetal monitoring, and interpreting and acting on monitoring findings. This article is directed at multiple stakeholders, including healthcare providers, healthcare delivery organizations and providers and professional organizations.

The Correlation Between the Total Decelerations and Accelerations Areas and Cord Blood pH in Women with Low-Risk Pregnancies.

Fetal acidosis among low-risk pregnancies is not common; however, identifying those at risk for this complication antenatally is of great interest. We aimed to assess the correlation between the total decelerations area during the last 120min of fetal monitoring prior to delivery and neonatal acidemia in low-risk pregnancies and whether the total acceleration area has a protective effect in the presence of decelerations. A retrospective cohort study was conducted among women with term low-risk pregnancies. A researcher blinded to fetal outcomes interpreted electronic fetal monitor patterns during the 120min prior to delivery. The primary outcome was fetal acidemia, defined as umbilical artery pH below 7.10. The correlation between the total decelerations and accelerations areas and cord blood pH was tested using the Spearman correlation coefficient. A total of 109 women were included and of these, six (5.5%) delivered infants with cord blood pH < 7.10. A significant correlation was demonstrated between the total decelerations area and cord blood pH (p = 0.01). No correlation was found between the total accelerations area and cord blood pH. Among low-risk pregnancies, a correlation was found between the total decelerations area but not the total accelerations area during the final 120min of labor and cord blood pH.

Correlation between total deceleration area in CTG records and cord blood pH in pregnancies with IUGR.

Fetal cardiotocography is the most common method to assess fetal well-being during labor. Nevertheless, its predictive ability for acidemia is limited, both in low-risk and high-risk pregnancies (Nelson et al. in N Engl J Med 334: 613-9, 1996; Rinciples P et al. in Health and Human Development Workshop Report on Electronic Fetal Monitoring : Update on Definitions. no. 2007, 510-515, 2008), especially in high-risk pregnancies, such as those complicated by growth restriction. In this study we aim examine the association between deceleration and acceleration areas and other measure of fetal heart rate in intrapartum fetal monitoring and neonatal arterial cord blood pH in pregnancies complicated by growth restriction. A retrospective cohort study of 100 deliveries complicated by growth restriction, delivered during 2018, was conducted. Known major fetal anomalies, non-vertex presentation and elective cesarean deliveries were excluded. Total deceleration and acceleration areas were calculated as the sum of the areas within the deceleration and acceleration, respectively. In deliveries complicated by growth restriction, cord blood pH is significantly associated with total deceleration area (p = 0.05) and correlates with cumulative duration of the decelerations (Spearman's rank -0.363, p < 0.05), and total acceleration area (-0.358, p < 0.05). By comparing the cord blood pH in deliveries with a total deceleration area that was above and below the median total deceleration area, we demonstrated a significant difference between the categories. Cord blood pH significantly correlates with total deceleration area and other fetal monitoring characteristics in neonates with growth restriction. Future studies using real-time, machine-learning based techniques of fetal heart rate monitoring, may provide population specific threshold values that will support bedside clinical decision making and perhaps achieve better outcomes.