Fetal Pulse Oximetry Research Articles

The Effect of Intrapartum Fetal Pulse Oximetry, in the Presence of a Nonreassuring Fetal Heart Rate Pattern, on Operative Delivery Rates: A Multicenter, Randomized, Controlled Trial (The FOREMOST Trial)

The Effect of Intrapartum Fetal Pulse Oximetry, in the Presence of a Nonreassuring Fetal Heart Rate Pattern, on Operative Delivery Rates: A Multicenter, Randomized, Controlled Trial (The FOREMOST Trial)

The reliability of fetal pulse oximetry: The effect of fetal oxygen saturation below 30% on perinatal outcome

Objectives The objective of this prospective study was to determine the reliability of fetal pulse oximetry (FPO) in cases of abnormal fetal heart rate (FHR) pattern and fetal oxygen saturation (FSpO 2) below 30%. Study design Three hundred and one deliveries complicated by abnormal FHR pattern were monitored with both CTG and FPO. Cases of FSpO 2 values below 30% ( n = 52) formed the study group and those above 30% ( n = 249) were the control group. pH and base excess (BE) in the umbilical cord artery, 5-min Apgar score, and pH and BE in the newborn were measured and compared. Statistical analysis included the Epi info 2002 program, Chi-squared test, and linear regression. Results FSpO 2 values were consequently below 30% in 52 and above 30% in 249 cases. When FSpO 2 values were below 30%, umbilical pH was significantly lower than in controls ( P < 0.01), while other parameters were not significantly different. If the time interval between the measurement of the first low (<30%) FSpO 2 value and delivery did not exceed 32.4 ± 2.5 min, umbilical pH and Apgar scores did not show fetal acidosis. Conclusion Our findings suggest that FPO is a reliable method of estimating fetal condition and may help reduce the number of cesarean sections performed due to abnormal FHR tracings.

Fetal Pulse Oximetry and Cesarean Delivery

ABSTRACT More than 5 years ago the Food and Drug Administration approved, conditionally, the OxiFirst Fetal Oxygen Saturation Monitoring System as an adjunct to electronic fetal monitoring. The goal of monitoring was to gain more knowledge of the condition of the fetus by continuously monitoring oxygen saturation when there is a nonreassuring fetal heart rate pattern. The sensor is inserted through the dilated cervix following membrane rupture, and positioned against the fetal face. This randomized trial, conducted at 14 university-based clinical centers, was designed as a means of learning whether adjunctive fetal oximetry lessens the need for cesarean delivery. Participants were nulliparous women with a singleton fetus in cephalic presentation at 36 or more weeks' gestation. The 5341 women in the study were randomized to either “open” fetal pulse oximetry with oxygen saturation values displayed to the clinician, or “masked” oximetry in which the results were hidden. Overall rates of cesarean delivery were 26.3% for the open group and 27.5% for masked monitoring, not a significant difference. The respective operative delivery rates were 7.1% and 7.9% for a nonreassuring fetal heart rate pattern; and 18.6% and 19.2% for dystocia, Findings were similar for the 2168 women in whom a nonreassuring fetal heart rate pattern was identified before randomization. There were no significant differences between the open and masked groups in the rates of forceps or vacuum-assisted delivery, even after excluding women who had labor induced. The relative risk of cesarean delivery associated with knowing the fetal oxygen saturation was 0.96 (95% confidence interval, 0.87–1.04). Neither maternal nor infant complications differed significantly in incidence between the study groups. The sensitivity, specificity, positive predictive value, and negative predictive value of a nonreassuring fetal heart rate pattern for low oxygen saturation (defined as less than 30% for 2 consecutive minutes) were, respectively, 87%, 19.5%, 35%, and 75%. One-fourth of fetuses with a normal heart rate pattern exhibited low oxygen saturation. This large-scale study failed to demonstrate that knowledge of intrapartum fetal oxygen saturation significantly lowers the rate of cesarean delivery or improves infant outcomes. The findings emphasize the need to rigorously evaluate new technologies.

Fetal pulse oximetry doesn't help women in labour or their infants

Fetal pulse oximetry doesn't help women in labour or their infants

Fetal Pulse Oximetry and Cesarean Delivery

Fetal Pulse Oximetry and Cesarean Delivery

The Effect of Maternal Oxygen Administration on Fetal Pulse Oximetry During Labor in Fetuses with Nonreassuring Fetal Heart Rate Patterns

The Effect of Maternal Oxygen Administration on Fetal Pulse Oximetry During Labor in Fetuses with Nonreassuring Fetal Heart Rate Patterns

Fetal Pulse Oximetry and Cesarean Delivery

The following abstracts of articles from leading journals have been selected on the basis of their importance to the practice of obstetrics and gynecology.

Fetal Pulse Oximetry and Cesarean Delivery

Fetal Pulse Oximetry and Cesarean Delivery

The effect of intrapartum fetal pulse oximetry, in the presence of a non-reassuring fetal heart rate pattern, on operative delivery rates: A multicenter, randomized, controlled trial (the FOREMOST trial)

The effect of intrapartum fetal pulse oximetry, in the presence of a non-reassuring fetal heart rate pattern, on operative delivery rates: A multicenter, randomized, controlled trial (the FOREMOST trial)

Fetal Pulse Oximetry and Cesarean Delivery

Knowledge of fetal oxygen saturation, as an adjunct to electronic fetal monitoring, may be associated with a significant change in the rate of cesarean deliveries or the infant's condition at birth. We randomly assigned 5341 nulliparous women who were at term and in early labor to either "open" or "masked" fetal pulse oximetry. In the open group, fetal oxygen saturation values were displayed to the clinician. In the masked group, the fetal oxygen sensor was inserted and the values were recorded by computer, but the data were hidden. Labor complicated by a nonreassuring fetal heart rate before randomization was documented for subsequent analysis. There was no significant difference in the overall rates of cesarean delivery between the open and masked groups (26.3% and 27.5%, respectively; P=0.31). The rates of cesarean delivery associated with the separate indications of a nonreassuring fetal heart rate (7.1% and 7.9%, respectively; P=0.30) and dystocia (18.6% and 19.2%, respectively; P=0.59) were similar between the two groups. Similar findings were observed in the subgroup of 2168 women in whom a nonreassuring fetal heart rate was detected before randomization. The condition of the infants at birth did not differ significantly between the two groups. Knowledge of the fetal oxygen saturation is not associated with a reduction in the rate of cesarean delivery or with improvement in the condition of the newborn. (ClinicalTrials.gov number, NCT00098709 [ClinicalTrials.gov].).

Fetal pulse oximetry adds value during delivery

Fetal pulse oximetry adds value during delivery

Fetal pulse oximetry adds value during delivery

Fetal pulse oximetry adds value during delivery

The effect of maternal oxygen administration on fetal pulse oximetry during labor in fetuses with nonreassuring fetal heart rate patterns

Using fetal pulse oximetry, we sought to quantify the impact of maternal oxygen administration in the management of nonreassuring fetal heart rate patterns. In fetuses with specified abnormal nonreassuring fetal heart rate patterns, oxygen was administered to the mother, and fetal oxygenation was monitored with fetal pulse oximetry. After the fetal oxygen saturation on room air was recorded as a baseline, oxygen was administered to the mother for 30 minutes at 40% fraction of inspired oxygen and then 30 minutes at 100% of inspired oxygen. The average fetal oxygen saturation during the last 15 minutes of each period was calculated. Paired Student t test was used for comparison to baseline values. Compared with baseline values, a significant increase in fetal oxygen saturation was identified in women who received oxygen at 40% fraction of inspired oxygen (mean increase, 4.9%; P = .001) and at 100% of inspired oxygen (mean increase, 6.5%; P = .003). The administration of supplemental oxygen to laboring patients with nonreassuring fetal heart rate patterns increases fetal oxygen saturation substantially and significantly. Fetuses with the lowest initial oxygen saturations appear to increase the most.

A cost‐effectiveness analysis of the intrapartum fetal pulse oximetry multicentre randomised controlled trial (the FOREMOST trial)

To report an economic analysis of the Australian intrapartum fetal pulse oximetry (FPO) multicentre randomised controlled trial (the FOREMOST trial), which examined whether adding FPO to conventional cardiotocographic (CTG) monitoring (intervention group) was cost-effective in reducing operative delivery rates for non-reassuring fetal status compared with the use of CTG alone (control group). Cost-effectiveness analysis of the FOREMOST trial. Four Australian maternity hospitals, each with more than 4000 births/year. Women in labour at > or =36 weeks of gestation, with a non-reassuring CTG. Costs were for treatment-related expenses, incorporating diagnosis-related grouping costs and direct costs (including fetal monitoring). Incremental cost-effectiveness ratio (ICER) and cost-effectiveness plane were calculated, and sensitivity analysis was conducted. The primary outcome was that of the clinical trial: operative delivery for non-reassuring fetal status avoided in the intervention group relative to that in the control group. The ICER. The ICER demonstrated a saving of $A813 for each operative birth for non-reassuring fetal status averted by the addition of FPO to CTG monitoring compared with the use of CTG monitoring alone. The addition of FPO to CTG monitoring represented a less costly and more effective use of resources to reduce operative delivery rates for non-reassuring fetal status than the use of conventional CTG monitoring alone.

Women's Evaluations of Their Experience in a Multicenter Randomized Controlled Trial of Intrapartum Fetal Pulse Oximetry (The FOREMOST Trial)

Fetal pulse oximetry improves the assessment of fetal well-being during labor. The objective of this study was to evaluate women's satisfaction with their experience with this additional technology. We surveyed women participating in the FOREMOST trial, a randomized controlled trial comparing the addition of fetal pulse oximetry (FPO) to conventional cardiotocograph (CTG) monitoring (intervention group), versus CTG-only (control group), in the presence of nonreassuring fetal status during labor. Our survey evaluated 3 aspects of women's experience: labor, fetal monitoring, and participation in the research. The survey was administered within a few days of giving birth and repeated 3 months later. No differences were found between the intervention and control groups for women's evaluations of their labor, fetal monitoring, research, or overall experiences when surveyed on both occasions. Within each study group, a small but statistically significant decline occurred in women's scores for their experience of labor and overall experience from the initial survey close to the time of giving birth, to 3 months later. The magnitude of differences in responses over time was similar for the both groups. Women were more satisfied after a spontaneous or assisted vaginal birth than after cesarean section. Length of time the research midwife was present had a significant positive effect on women's ratings of their experience several days after giving birth (p = 0.006), but no effect at 3 months. The addition of fetal pulse oximetry for the assessment of fetal well-being during labor did not affect childbearing women's perceptions of fetal monitoring or their labor. Women evaluated their experience in the research process positively overall. Small changes occurred in women's perception of their satisfaction over time.

Clinicians’ evaluations of fetal oximetry sensor placement in a multicentre randomised trial (the FOREMOST trial)

Fetal pulse oximetry (FPO) may improve the assessment of the fetal well-being in labour. Reports of health-care provider's evaluations of new technology are important in the overall evaluation of that technology. To determine doctors' and midwives' perceptions of their experience placing FPO sensors. We surveyed clinicians (midwives and doctors) following placement of a FPO sensor during the FOREMOST trial (multicentre randomised trial of fetal pulse oximetry). Clinicians rated ease of sensor placement (poor, fair, good and excellent). Potential influences on ease of sensor placement (staff category, prior experience in Birth Suite, prior experience in placing sensors, epidural analgesia, cervical dilatation and fetal station) were examined by ordinal regression. There were 281 surveys returned for the 294 sensor placement attempts (response rate 96%). Sensors were placed by midwives (29%), research midwives (48%), registrars (22%) and obstetricians (1%). The majority of clinicians had 1 or more years' Birth Suite experience, had placed six or more sensors previously, and rated ease of sensor placement as good. Advancing fetal station (P < 0.001) and the presence of epidural analgesia prior to sensor placement (P = 0.029) predicted improved ease of sensor placement. Having a clinician placing a sensor for the first time predicted a lower rating for ease of sensor placement (P = 0.001), compared to having placed one or more sensors previously. Clinicians with varying levels of Birth Suite experience successfully placed fetal oxygen saturation sensors, with the majority rating ease of sensor placement as good.

Fetal pulse oximetry and wavelet analysis of the fetal heart rate in the evaluation of abnormal cardiotocography tracings

Previous studies indicate that the addition of wavelet analysis of the fetal pulse oximetry tracings (FSPO2) and fetal heart rate (FHR) variability to cardiotocography (CTG), for intrapartum fetal monitoring, provides useful information on the fetal response to hypoxia. We applied the new procedure in non-reassuring CTG patterns, in which cesarean section was performed, and tested its accuracy in the diagnosis of the intrapartum fetal compromise. At the 'Aretaieion' University Hospital labor ward, 318 women with term fetuses in the cephalic presentation entered the trial during labor. They all were monitored with external CTG and fetal pulse oximetry. In the cases that cesarean section was applied, because of abnormal CTG tracings, we applied a method based on the multiresolution wavelet analysis and a self-organized map neural network on the first and second stage of labor. The main outcome parameter was the rate of cord metabolic acidosis at birth (pH < 7.05). Secondary outcomes included Apgar scores at 5 min, fetal transmission to neonatal intensive care unit (NICU) and neonatal encephalopathy. Fifty out of 318 cases delivered operatively because of abnormal CTG patterns (rate 15.72%). In 30 cases, cord pH was >7.05, while in 11 Apgar scores at 5 min were <7, while none of those neonates were transferred to NICU. In the rest 20 cases cord pH was <7.05; in all of these cases Apgar scores at 5 min were <7, while four neonates were transferred to NICU. In one of them, neonatal encephalopathy was diagnosed. After the offline application of wavelet analysis and neural networks to the pulse oximetry and FHR variability readings of the 50 cases, statistics calculated that the system showed a sensitivity of 85% and a specificity of 93%, while false negative and false positive rates were 15% and 7%, respectively. Computerized FHR and FSPO2 monitoring shows an excellent efficacy and reliability in interpreting non-reassuring FHR recordings.

The effect of intrapartum fetal pulse oximetry, in the presence of a nonreassuring fetal heart rate pattern, on operative delivery rates: A multicenter, randomized, controlled trial (the FOREMOST trial)

The objective of the study was to compare operative delivery rates for nonreassuring fetal status between 2 groups of laboring women: those having conventional cardiotocograph monitoring and those having cardiotocograph monitoring plus fetal pulse oximetry. The intrapartum fetal oximetry prospective, multicenter, randomized, controlled trial (the FOREMOST trial) was conducted in 4 Australian maternity hospitals. The primary outcome was operative birth rates for nonreassuring fetal status. There was a statistically significant 23% relative risk reduction in operative delivery for nonreassuring fetal status in the fetal pulse oximetry + cardiotocograph group (n = 75 of 305, 25%), compared with those in the cardiotocograph-only group (n = 95/295, 32%) (relative risk 0.77, 95% confidence interval 0.599, 0.999, P = .048). There were no significant between-group differences in overall operative births (fetal pulse oximetry + cardiotocograph group 73%, cardiotocograph-only group 71%, relative risk 1.04, 95% confidence interval 0.94, 1.15, P = .478) or neonatal outcomes. The use of fetal pulse oximetry to augment fetal well-being assessment during labor resulted in a statistically significant reduction in the operative intervention for nonreassuring fetal status, compared with the use of conventional cardiotocograph monitoring alone. This reduction was achieved with no significant difference in neonatal outcomes.

Fetal Pulse Oximetry Fails to Lower C-Section Rate

Fetal Pulse Oximetry Fails to Lower C-Section Rate

Fetal Pulse Oximetry Does Not Alter the Rate of Cesarean Delivery

The introduction of intrapartum fetal heart-rate monitoring in the 1970s was believed to herald an era in which hypoxia during labor would become nonexistent. Three decades later, electronic fetal heart-rate monitoring has contributed to an increase in the rate of cesarean delivery, but there is …