Heart Rate Tracings Research Articles

A Robust and Accurate FMCW MIMO Radar Vital Sign Monitoring Framework With 4-D Cardiac Beamformer and Heart-Rate Trace Carving Technique

A Robust and Accurate FMCW MIMO Radar Vital Sign Monitoring Framework With 4-D Cardiac Beamformer and Heart-Rate Trace Carving Technique

Shorter sleep among adolescents is associated with lower fruit and vegetable consumption the following day

BackgroundInsufficient sleep has been associated with weight gain and metabolic dysregulation, with one suggested mechanism being through reduction in diet quality. Experimental evidence supports a causal effect of sleep timings on diet but this may not be applicable to a free-living adolescent population. In this analysis we use daily measures of sleep timings and diet quality, to examine the effect of sleep duration and timing on diet quality the following day among free-living adolescents.MethodsThe ROOTS study is a prospective cohort recruited from secondary schools in Cambridgeshire and Suffolk (UK). Participants (n = 815) at mean age 15.0y (SD 0.3y) completed a diet diary and wore a combined heart rate and accelerometer device over 4 consecutive days. Sleep duration and timing (midpoint) were derived from acceleration and heart rate traces, while daily energy density and fruit and vegetable intake were calculated from dietary data. Analyses were performed at day-level (1815 person-days). Multilevel random effects models were used to test associations between sleep each night and subsequent day diet, with daily sleep and diet measures nested within individuals and schools, and adjusted for day-level and individual-level confounding variables.ResultsAdolescents slept a mean of 7.88 hrs (SD 1.10) per night, reporting a mean energy density of 2.12 kcal/g (SD 0.48) and median energy-adjusted daily fruit and vegetable intake of 137.3 g (IQR 130.4). One hour shorter sleep duration was associated with lower intake of fruit and vegetables (-6.42 g, 95%CI -1.84, -10.99) the following day. An association with higher dietary energy density (0.016 kcal/g, 95%CI 0.034, -0.002) the following day was observed but did not reach statistical significance. Sleep timing was not associated with either fruit and vegetable intake (-2.52 g/d, 95%CI -7.66, 2.62) or dietary energy density (-0.001 kcal/g, 95%CI -0.022, 0.020).ConclusionsOur observational findings from a free-living adolescent population support the experimental evidence for a causal role of sleep on diet, with shorter sleep duration at night leading to a small decrease in diet quality the following day. These findings support experimental evidence to suggest inclusion of sleep duration as one component of interventions designed to improve diet quality and weight status in adolescents.

Heart rate variability and subsequent psychological distress among family members of intensive care unit patients.

ObjectiveTo determine whether heart rate variability (HRV; a physiological measure of acute stress) is associated with persistent psychological distress among family members of adult intensive care unit (ICU) patients.MethodsThis prospective study investigated family members of patients admitted to a study ICU. Participants’ variability in heart rate tracings were measured by low frequency (LF)/high frequency (HF) ratio and detrended fluctuation analysis (DFA). Questionnaires were completed 3 months after enrollment to ascertain outcome rates of anxiety, depression, and post-traumatic stress disorder (PTSD).ResultsNinety-nine participants were enrolled (median LF/HF ratio, 0.92 [interquartile range, 0.64–1.38]). Of 92 participants who completed the 3-month follow-up, 29 (32%) had persistent anxiety. Logistic regression showed that LF/HF ratio (odds ratio [OR] 0.85, 95% confidence interval [CI] 0.43, 1.53) was not associated with 3-month outcomes. In an exploratory analysis, DFA α (OR 0.93, 95% CI 0.87, 0.99), α1 (OR 0.97, 95% CI 0.94, 0.99), and α2 (OR 0.94, 95% CI 0.88, 0.99) scaling components were associated with PTSD development.ConclusionAlmost one-third of family members experienced anxiety at three months after enrollment. HRV, measured by LF/HF ratio, was not a predictor of psychologic distress, however, exploratory analyses indicated that DFA may be associated with PTSD outcomes.

What Do Women Want? Consent for the Use of Electronic Fetal Monitoring

BACKGROUNDGuidelines published by professional associations of midwives, obstetricians, and nurses in the United States recommend against using continuous cardiotocography (CTG) in low-risk patients. In the United States, CTG or electronic fetal/uterine monitoring (EFM) rather than auscultation with a fetoscope or Pinard horn is the norm. Interpretation of the fetal heart rate (FHR) and uterine activity (UA) tracings provided by continuous EFM may be associated with the decision for a cesarean birth. Typically, consent is not sought in the decision about type of monitoring. No studies were identified where women's attitudes about the need to consent to the type of fetal monitoring used during labor have been explored. Therefore, the purpose of this research was to examine women's attitudes about the use of EFM in a healthcare setting.METHODSWe asked a sample of women aged 18–50 years to respond to one of three monitoringscenarios. The scenarios were used to distinguish between attitudes about monitoring in general, monitoring the health of a mother in labor, and monitoring the health of the fetus during labor. Wemeasured their level of interest in being monitored and their opinions about whether healthcare providers should be required to obtain consent for the monitoring described in the scenario.RESULTSInterest in receiving monitoring (across all three scenarios) was moderate, with the highest level of interest in monitoring the fetus during labor and the least interest in monitoring a general health context. Across all scenarios, 82% of respondents believed that practitioners should obtain consent for monitoring, 14% were unsure, and 4% said there should not be a requirement for consent. While low (6%), the percentage responding that consent was not needed was highest in monitoring a fetus in labor.CONCLUSIONSWomen in our study expressed a strong preference for the opportunity to consent to the use of monitoring regardless of the healthcare scenario. There is findings suggest the need for further research exploring what women do and do not know about CTG and what their informed performance are a pressing need to rethink the role of a pressing need to rethink the role of shared decision-making and informed consent about the type of monitoring use during labor.

Acute fetal response to high-intensity interval training in the second and third trimesters of pregnancy.

The majority of women do not meet the recommended levels of exercise during their pregnancies, frequently due to a lack of time. High-intensity interval training offers a potential solution, providing an effective, time-efficient exercise modality. This exercise modality has not been studied in pregnancy therefore, the objective of this study was to evaluate fetal response to a high-intensity interval training resistance circuit in the late second and early third trimesters of pregnancy. Fourteen active, healthy women with uncomplicated, singleton pregnancies participated in a high-intensity interval training resistance circuit between 28 + 0/7 and 32 + 0/7 weeks. A Borg rating of perceived exertion of 15-17/20 and an estimated heart rate of 80%-90% of maternal heart-rate maximum was targeted. Fetal well-being was evaluated continuously with fetal heart-rate tracings and umbilical artery Doppler velocimetry conducted pre-and post-exercise. Fetal heart rate tracings were normal throughout the exercise circuit. Post-exercise, umbilical artery end-diastolic flow was normal and significant decreases were observed in the mean systolic/diastolic ratios, pulsatility indexes and resistance indexes. Therefore, in a small cohort of active pregnant women, a high-intensity interval training resistance circuit in the late second and early third trimesters of pregnancy appears to be a safe exercise modality with no acute, adverse fetal effects but further study is required. Novelty: High-intensity interval training, at an intensity in excess of current recommendations, does not appear to be associated with any adverse fetal effects in previously active pregnant women. High-intensity interval training is an enjoyable and effective exercise modality in previously active pregnant women.

826 Obesity’s impact on incision to delivery interval and neonatal outcomes at time of urgent cesarean

To determine if increased body mass index (BMI) impacts incision to delivery interval, in the setting of category II and III fetal heart-rate tracing, necessitating emergent cesarean delivery. A retrospective cohort study of all emergent cesarean deliveries occurring at one institution from 2012-2018. Three comparison groups were divided by BMI /=35 kg/cm2 (n=51). The primary outcome was time from operating room and skin incision to infant delivery. Secondary outcomes were a measure of neonatal morbidity: 5-minute Apgar score less than 7, umbilical cord arterial pH, and NICU admission. There was a statistically significant difference in the length of time from arrival in the operating room to delivery and from incision to delivery for patients with higher BMI (p=0.037 and 0.025). There were also higher rates of fetal acidosis in fetuses born to moms with a higher BMI (p=0.047). these findings were consistent when controlling for number of prior laparotomies and when excluding patients who received general anesthesia. These findings support prior literature that describe a longer incision to delivery interval in patients undergoing cesarean delivery, as well as worse neonatal outcomes in patients with a larger BMI. Our study is unique in the sense that it describes this challenge in the context of urgent cesarean deliveries. We advise the Obstetrician to consider these findings when patients with large BMI have fetal heart rate tracings that do not respond to initial resuscitative efforts.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Maternal Exercise Uncovers Placental Insufficiency in Diabetic Mothers

Regular physical activity during pregnancy improves or maintains physical fitness, helps with weight management, reduces the risk of gestational diabetes, and enhances patient’s psychological well-being. We studied the possibility to use maternal exercise to test placental reserves in diabetic mothers. We used a motorized treadmill in a moderate exercise regimen (15-minute fast walk at a speed of 3 mph with an incline of 15-25 degrees). Fetal monitoring was provided by using standard Phillips equipment (Avalon CTS and FM40). Adverse fetal outcomes were considered if one or more of the following were present: Category III Fetal Heart Rate (FHR) tracing, 5-minute Apgar score of less than 7, admission to the neonatal intensive care nursery, fetal growth restriction, and fetal and early neonatal death. A total of 819 fetal assessments were performed: 160 patients had gestational diabetes, 80 had pregestational diabetes. The most common complication in fetuses with positive prenatal test results was abnormal FHR in labor (36%) followed by low Apgar score (21%) and need for NICU admission (19%). Most of the adverse outcomes had good correlation with positive results of the exercise test. In conclusion, it appears that maternal exercise causes changes in FHR, which may be used to assess placental and fetal reserves.

Simultaneous monitoring of maternal and fetal heart rate variability during labor in relation with fetal gender.

Male gender is considered a risk factor for several adverse perinatal outcomes. Fetal gender effect on fetal heart rate (FHR) has been subject of several studies with contradictory results. The importance of maternal heart rate (MHR) monitoring during labor has also been investigated, but less is known about the effect of fetal gender on MHR. The aim of this study is to simultaneously assess maternal and FHR variability during labor in relation with fetal gender. Simultaneous MHR and FHR recordings were obtained from 44 singleton term pregnancies during the last 2 hr of labor (H1, H2 ). Heart rate tracings were analyzed using linear (time- and frequency-domain) and nonlinear indices. Both linear and nonlinear components were considered in assessing FHR and MHR interaction, including cross-sample entropy (cross-SampEn). Mothers carrying male fetuses (n = 22) had significantly higher values for linear indices related with MHR average and variability and sympatho-vagal balance, while the opposite occurred in the high-frequency component and most nonlinear indices. Significant differences in FHR were only observed in H1 with higher entropy values in female fetuses. Assessing the differences between FHR and MHR, statistically significant differences were obtained in most nonlinear indices between genders. A significantly higher cross-SampEn was observed in mothers carrying female fetuses (n = 22), denoting lower synchrony or similarity between MHR and FHR. The variability of MHR and the synchrony/similarity between MHR and FHR vary with respect to fetal gender during labor. These findings suggest that fetal gender needs to be taken into account when simultaneously monitoring MHR and FHR.

Lethal fetal stroke in utero

ObjectiveFetal intracranial hemorrhage (ICH) in utero is a rare complication of pregnancy associated with subsequent neurological sequelae or fetal death. Case reportA 34-year-old woman with Crohn's disease presented at 36 weeks' gestation due to decreased fetal movement. Fetal heart-rate tracing indicated poor beat-to-beat variability. In addition, a Doppler ultrasonography suggested a prenatal stroke with evidences of ICH, reverse-end diastolic velocity of the middle cerebral artery, and a persistent distended bladder. A nonaggressive treatment option was chosen after counseling about the unfavorable prognosis. However, 22 hours after her admission, intrauterine fetal death occurred. ConclusionFetal ICH in utero might be a rare yet lethal complication of Crohn's disease in pregnancy.

FETAL HEART RATE VARIABILITY ANALYSIS FROM PHONOCARDIOGRAPHIC RECORDINGS

This paper presents an algorithm for classification of fetal health status using fetal heart rate variability (fHRV) analysis through phonocardiography. First, the fetal heart sound signals are acquired from the maternal abdominal surface using a specially developed Bluetooth-based wireless data recording system. Then, fetal heart rate (FHR) traces are derived from these signals. Ten numbers of linear and nonlinear features are extracted from each FHR trace. Finally, the multilayer perceptron (MLP) neural network is used to classify the health status of the fetus. Results show very promising performance toward the prediction of fetal wellbeing on the set of collected fetal heart sound signals. Finally, this work is likely to lead to an automatic screening device with additional potential of predicting fetal wellbeing.

Observation on validity of the five-tier system for fetal heart rate pattern interpretation proposed by Japan Society of Obstetricians and Gynecologists

Objective: To evaluate the five-tier classification of fetal heart rate (FHR) tracings recently proposed by Japan Society of Obstetricians and Gynecologists (JSOG). Methods: The database between January and June 2009 was reviewed for women in active labor at ≥36 + 0 gestational weeks, with singleton fetuses in cephalic presentation and with umbilical artery blood gas analyses. Continuous FHR tracings were assessed according to the five-tier classification proposed by JSOG, where level 1 is normal, level 2 is subnormal and levels 3–5 are abnormal patterns. Results: A total of 341 parturient women were eligible for this study protocol. The median (range) of the levels in the first and the second stage of labor were 1 (1–4) and 2 (1–4), respectively (p < 0.001). Both pH and base excess of umbilical artery decreased with higher levels of FHR tracings interpretation (p < 0.01). Interventions resulting in delivery were more necessary in the first stage of labor than in the second stage of labor in cases of levels 3 and more. Conclusions: Five-tier system for FHR tracing interpretation proposed by JSOG intercorrelates with the fetal acid-base balance well. Categorization of FHR tracings by uniform diagnostic criteria will be useful to standardize therapeutic strategy by sharing common perception among obstetrical staff.

System for objective assessment of fetal activity

Fetal activity is an important indicator of fetal well-being. It is proposed to assess this activity using the pulsed wave Doppler method to collect fetal activity data and dedicated software for on-line processing. The system, addressed to 3rd trimester pregnancies, provides information on presence of pseudobreathing, the heart rate trace, the fetal movement trace, the movement velocity spectrogram, histograms of the velocity and acceleration of both the body movements and pseudobreathing, parameters of these histograms (mean values, standard deviations, shape descriptors), and cumulative counts of the velocity histograms. These parameters form the feature vector of the fetal activity. The system was validated by simultaneous echographic and cardiotocographic recordings and during oxytocin challenge tests. Feature vectors obtained from 1 h recordings in 61 pregnancies were submitted to multivariate analysis of variance. Activity patterns of physiological cases and “borderline pathologies” were discriminated using reduced feature vectors, containing cumulative counts of velocity histograms.

Prevalence of Nocturnal Hypoxia and Its Association with Disease Severity in Adults with Sickle Cell Disease.

Abstract 261 Introduction:In children with sickle cell disease (SCD), obstructive sleep apnoea (OSA) is common and the degree of overnight hypoxia is closely correlated with disease severity, particularly frequency of painful crises, risk of stroke and presence of pulmonary hypertension. No studies have examined the prevalence or effects of OSA in adults with SCD. Methods:All adults with SCD attending routine sickle cell out-patient clinics were offered screening for OSA using the Epworth Sleepiness Score (ESS) questionnaire. All of those in whom the score was >10 or in whom there was a high clinical suspicion of OSA were offered overnight domiciliary oximetry. Oximetry traces were both analysed by computer and manually. Computerised analysis was used to quantify night time hypoxic load (mean nocturnal SpO2 and sleep time with SpO2 below 90%) and frequency of desaturation (number of times per hour the SpO2 dropped by >4%, or Overnight Desaturation Index, ODI). Manual analysis of each trace was performed by four independent sleep physicians who assigned a diagnosis of normal, OSA, non-OSA nocturnal hypoxia or inadequate based on the pattern of the oxygen saturation and heart rate traces. These parameters were then correlated with measures of disease severity and presence of complications taken from the patient's medical record. Statistical analysis was performed using the t-test and linear regression. Results:93 patients completed the ESS, with 34 patients identified for subsequent oximetry (26 ESS>10, 8 clinical suspicion). 22 patients went on to have subsequent oximetry. 17/22 of recordings (77%) were abnormal of which 11 showed OSA (65%) and 6 showed nocturnal hypoxia without OSA (35%). Nocturnal hypoxic load, measured as mean overnight oxygen saturation, was correlated with glomerular filtration rate (r=0.5; p=0.0008) and pulmonary artery systolic pressure estimated by echocardiography (r=0.71; p=0.0001). Furthermore, urine protein level correlated with ODI (r=0.5 p=0.0007) and mean overnight oxygen saturation (r=0.35; p=0.02). In addition, mean overnight oxygen saturation was 87% in male patients that experienced priapism and 94% in those who did not (p=0.004). Mean ODI was 10/hr in patients with priapism and 4 in those without (p=0.008). There were no correlations demonstrated between either hypoxic load or ODI with the frequency of painful crises, frequency of hospital admissions or avascular necrosis. Lung function test parameters, history of chest syndrome, hydroxyurea therapy and Epworth score did not predict either hypoxic load or ODI. However, daytime SpO2 were highly predictive of nocturnal hypoxic load (r=0.69 p=0.0000007) but not ODI. Conclusion:OSA and non-OSA nocturnal hypoxia are common in adults with sickle cell disease. The degree of nocturnal hypoxia is associated with impaired renal function, proteinuria, priapism and pulmonary hypertension. Daytime SpO2 appears to be a better predictor of night time hypoxic load than daytime somnolence. Further work is needed to investigate the effect of interventions such as nocturnal oxygen therapy or continuous positive airway pressure on the associations reported. Disclosures:No relevant conflicts of interest to declare.

Diagnosis of Uterine Rupture on CT

A 34-year-old woman with seven previous cesarean deliveries and a history of scant prenatal care presented at 32 weeks' gestation with constant, vague lower abdominal pain that had worsened over the past day. Her vital signs were normal, and the examination was notable for tenderness in both lower quadrants. Laboratory tests revealed a hematocrit value of 39% and a white-cell count of 18,300 per cubic millimeter with 8% bands. The fetal status was reassuring, on the basis of a reactive heart-rate tracing with rare variable decelerations. Infrequent uterine contractions were noted, and the cervix was long and closed with no . . .

Fetal ST segment heart rate analysis in labor: Improvement of intervention criteria using interpolated base deficit

Objective. The addition of ST waveform analysis (STAN, Neoventa, Sweden) to fetal heart rate (FHR) tracings has been demonstrated to improve fetal outcome and reduce operative delivery rates, though the actual level of fetal acidosis at which STAN indicates intervention has not been assessed. We sought to determine if FHR ST segment analysis recommends intervention at appropriate levels of fetal acidosis.Methods. FHR tracings of 10 acidotic and 10 non-acidotic infants with FHR tracings having a minimum of one STAN flag were retrospectively analyzed. Fetal base deficit (BD) was calculated by interpolation throughout the FHR tracing and STAN ‘action’ and ‘ignore’ flags assigned a fetal BD value. A secondary analysis was performed with a revised interpretation of FHR reassuring status.Results. The mean (±SD) BD of the first STAN action was significantly greater than the first ‘ignore’ (4.0 ± 2.1 vs. 3.0 ± 0.8 mmol/L, p < 0.05). Clarified STAN criteria for reassuring vs. non-reassuring FHR resulted in a first action BD of 6.0 ± 2.0 mmol/L with 90% sensitivity and 100% specificity for prediction of fetal acidosis.Conclusion. The STAN monitor discriminates increasing levels of fetal BD. With clarification of the criteria for reassuring FHR, the calculated BDs of action flags are an appropriate threshold for emergent intervention, successfully predict acidotic fetuses, and avoid unnecessary intervention.

Twenty-four-hour CTG monitoring: comparison of normal pregnancies of 25–30 weeks of gestation versus 36–42 weeks of gestation

Routinely antepartal cardiotocogram (CTG) is recorded for 30 min in order to obtain normal resting phases (<30 min) or a decrease of irregulatory due to hypoxia (>30 min) or to differentiate these from each other. In case of early onset of hypoxia first pathological findings might only be seen by chance in incidentally recorded CTG. The goal of this study was, if a continuous 24-h CTG allows an earlier detection of beginning hypoxia in case of normal pregnancies of 36-42 weeks compared to pregnancies of 25-30 weeks of gestation, and if there are any differences between both groups concerning the qualitative and quantitative description or the detection of a circadian rhythm. 21 patients in each group had 24-h CTGs by means of telemetry (Hewlett-Packard type 78101A, 80110A). In both study groups, fetal heart-rate tracing included a full qualitative and quantitative description. Comparison of the results of both groups was done to look for early signs of pathological findings concerning reduced fetal well-being and a potential day and night rhythm. In comparison to 36-42 weeks of pregnancies 25-30 weeks had significantly more physiological undulatory oscillation and less narrowed undulatory oscillation (P < 0.001), as well as less resting phases (P < 0.001). Baseline tachycardia and bradycardia showed significantly increasing quantity (P < 0.001). Twenty-four-hour CTG is a good screening method to detect early onset of hypoxia in case of second and third trimester pregnancies and a big help to detect a fetus at risk earlier. In future computerized CTG-systems should be proved in this connection and should be compared with our study.

Fetal heart rate variability in growth restricted fetuses

Intrauterine growth restriction (IUGR) remains a major problem in perinatal medicine because of the variety of its underlying causes and the prediction of its outcome. Characteristics of heartbeat interval patterns are associated with neuro-vegetative and humoral regulatory processes. Fetal magnetocardiography allows non-invasive assessment of these processes with high precision throughout the second half of gestation. The aim of our study was the analysis of linear and non-linear parameters of fetal heart rate fluctuations to distinguish between IUGR fetuses and a cohort of normal subjects, both pre-selected from heart-rate traces representing a quiet state of activity in the third trimester of gestation.

Accuracy of fetal heart‐rate variability interpretation by obstetricians using the criteria of the National Institute of Child Health and Human Development compared with computer‐aided interpretation

To evaluate the accuracy of fetal heart rate variability interpretation by obstetricians using the criteria of the National Institute of Child Health and Human Development (NICHD), compared with computer-aided analysis as a gold standard. One hundred and fourteen panels of fetal heart-rate tracings derived from electrocardiogram via scalp electrodes obtained from women with high-risk pregnancies during the intrapartum period. The tracings were interpreted using computer analysis and recorded as a gold standard. The same tracings were distributed to six observers: three residents in the third year of training and three faculty members. All observers blindly interpreted the fetal heart-rate variability without the knowledge of the computer analysis. The main outcome measures were: (i) the accuracy of fetal heart-rate variability interpretation by obstetricians using the NICHD criteria compared with computer-aided analysis was presented as a percentage value; and (ii) the agreement of fetal heart-rate variability interpretation between the obstetricians and the computer analysis using the NICHD criteria was presented as a kappa-value. When using the computer analysis as a gold standard, the accuracy of fetal heart-rate variability interpretation in the residents group was 81.58%, 86.84% and 82.46%, respectively, with a mean of 83.62%, whereas the accuracy of the faculty members was 79.82%, 67.54% and 79.82%, respectively, with a mean of 75.73%. kappa-values, representing the agreement of interpretation, were 0.70, 0.78 and 0.72, with a mean of 0.73 +/- 0.04 among the residents, and 0.67, 0.50 and 0.68, with a mean of 0.62 +/- 0.10 among the faculty members. Agreements in the two groups were not significantly different (Student's t-test, P=0.14). Using the NICHD criteria, the accuracy and agreement of fetal heart-rate variability interpretation in the third-year residents and faculty members are substantial. There was no difference between the groups with regard to the agreement of fetal heart-rate variability interpretation.

Markedly elevated levels of inflammatory cytokines in maternal serum and peritoneal washing during arrested labor.

The role of inflammatory cytokines in the pathophysiology of arrested labor is currently unknown. We measured levels of inflammatory cytokines in maternal serum and peritoneal washings in arrested first stage of labor to assess the possible involvement of these mediators in this obstetric disorder. This was a prospective, case-control study involving 15 women who underwent cesarean section for arrested cervical dilatation (group I), 15 controls who were operated during active labor for nonreassuring fetal heart-rate tracing (group II) and 15 controls who were operated electively (group III). Blood samples were drawn from all women shortly before the operation. The presence of peritoneal fluid was assessed and peritoneal washings were obtained during the operation. All samples were assayed for the inflammatory cytokines interleukin (IL)-1beta, IL-6, IL-8 and soluble IL-2 receptor (sIL-2R) by solid-phase enzyme-linked immunosorbent assay (ELISA). All women from group I and one patient (6.7%) from group II had some degree of peritoneal fluid accumulation, while none from group III had any. Serum samples from group I contained significantly higher IL-1beta, IL-6, IL-8 and IL-2R levels than both control groups. Peritoneal washings from group I contained significantly higher IL-1beta, IL-6 and IL-8 but similar IL-2R levels. Arrested first stage of labor is associated with peritoneal fluid accumulation and increased levels of inflammatory cytokines in both serum and peritoneal fluids. Inflammatory cytokines may therefore be involved in the pathophysiology of arrested labor.

Resident evaluation of intrapartum fetal heart-rate tracings: can they predict acidosis?

Resident evaluation of intrapartum fetal heart-rate tracings: can they predict acidosis?