Monitoring Of High-risk Pregnancies Research Articles

Fast Mask Recurrent Convolutional Neural Network for IoT-Based Maternal and Fetal Monitoring in High-Risk Pregnancies

Fast Mask Recurrent Convolutional Neural Network for IoT-Based Maternal and Fetal Monitoring in High-Risk Pregnancies

Epidemiological and clinical aspects of congenital heart disease in Fallujah Maternity and Children Hospital, Iraq

Objective: This study aimed to analyze the descriptive characteristics of children diagnosed with Congenital Heart Disease (CHD) at Fallujah Maternity and Children Hospital (FMCH).
 Methods: The prospective study included 1,025 pediatric patients born between 1st December 2018 and 30th September 2022, admitted to the newborns and children's wards, and diagnosed with CHD. Data were collected through interviews with patients' guardians using a registration and questionnaire form, capturing variables related to the child (e.g., name, sex, birth weight, type of CHD) and the mother (e.g., age, occupation, consanguinity, previous CHD births, chronic diseases during pregnancy). Residence (rural or urban) was also recorded.
 Results: Among the CHD cases, Atrial Septal Defect (ASD) was the most common (72%), followed by Ventricular Septal Defect (VSD) (25%) and Patent Ductus Arteriosus (PDA) (21%). Most diagnoses occurred in children aged 1-28 days. The male-to-female ratio was 1.2:1, and 0.2% had an ambiguous gender. About 58% of children weighed ≥ 2.5kg at birth, and 20% had a family history of CHDs.
 Conclusion: The increasing prevalence of congenital heart diseases in Fallujah requires preventive strategies targeting modifiable risk factors, better monitoring of high-risk pregnancies, and increased awareness of genetic counseling for families with congenital anomalies. The cardiology department should receive more attention and resources to improve diagnostic and therapeutic capabilities. Further research is needed to understand the reasons behind the recent rise in CHD cases in newborns.

Compensation of Measurement Uncertainty in a Remote Fetal Monitor

The perinatal mortality rate is very high throughout the world. A fetal monitor may be used remotely, and this would tackle the problem of continuous monitoring of high-risk pregnancies. There is evidence that current technology is of low reliability, and, therefore, of low precision to identify fetal health. In medical technological implementation, a safe, efficient, and reliable operation must be guaranteed, and the main problem is that remote fetal monitor gathers just a few samples, so the hypothesis of classical theory is not met. We are proposing an approach that improves the data’s lack of reliability that accompanies the use of a remote fetal monitor. The method refers to how, by using the existing technologies and the initial experimental data, it is possible to apply probabilistic models that are truly representative of each application. This leads to the characterization of properties of the statistics used to generate a representative probabilistic model without the need to consider the hard suppositions. Results show that, for every case study, it was possible to improve estimations of measurement uncertainty. The proposed method is a useful tool to increase the reliability of medical technology, especially for pieces of equipment where a health care professional is not available.

A prospective study on correlation of non-stress test in high risk pregnancy at a tertiary care centre

Introduction: Perinatal outcome can be improved by timely prediction of antenatal risk factors contributing to complications, by providing appropriate antenatal surveillance. Non-stress test has the capacity to identify danger to the in utero fetus, which ensures well-timed intervention in order to attain best possible outcome. Aims and Objectives: To evaluate the role of NST in high risk pregnancy with relation to perinatal outcome. Materials and methods: The study was carried out in the Department of OBG, Sree Mookambika Institute of Medical Sciences, Kulasekharam over a period of 16 months. OPD Patients from Obstetrics and Gynecology department were included in the study. After thorough clinical examination, patients were subjected to NST. Clinical and NST data from the study was recorded as per the proforma. Result: In high risk pregnant women, it was noticed that there was more fetal distress compare to normal pregnant women. The high risk group had a higher value of nonstress test compare to low risk group. There is high association between NST and low APGAR score at 5 min. Most common, indication for LSCS was fetal distress followed by GDM in High risk group, but previous LSCS in low risk group. Elderly primi was the commonest risk factor. Conclusion: NST is simple, cheap, non-harmful, non-invasive, easily repeated, and cost effective with low maintenance profile and needs less training. It plays a crucial role in the monitoring of high risk pregnancies and henceforth, help to evaluate the optimal time for delivery and management.

Canine ovulation timing: A survey on methodology and an assessment on reliability of vaginal cytology.

Ovulation timing in bitches is a routine procedure in small animal practice around the world. It is most frequently used for supporting breeding management, high-risk pregnancy monitoring and determination of the time of parturition. To learn more about how and for what reasons veterinarians interested in small animal reproduction perform canine ovulation timing, an online survey was conducted in 2017. The link to the survey was distributed via the mailing list cafereprod-l@list.cornell.edu and the website, the Twitter account and the Facebook page of EVSSAR. All respondents recommended using quantitative progesterone measurement for ovulation timing alone or in combination with other diagnostic tests. Vaginal cytology was also a commonly used technique. The 63 respondents followed different protocols for sampling and staining vaginal epithelial cells. Interestingly, 50 respondents used vaginal cytology routinely, but only two consider it as a very reliable and another nine as a somewhat reliable test if used alone. In a second project, delegates attending the EVSSAR congress held in Vienna, Austria, in June 2017 had the opportunity to examine seven stained vaginal smear slides under optical microscopy in a blinded approach. The results showed a marked heterogeneity in the identification of vaginal cells and assessment of the time in relation to ovulation. This heterogeneity supports the opinion of survey participants that vaginal cytology alone is not a valid tool for determining the day of ovulation. Results of both projects suggest that there is no standard procedure for the examination of vaginal smears in dogs. It is not recommended to determine the optimal time for mating based on the examination of a single vaginal smear only. According to some comments of survey participants, it is more useful to assess vaginal samples repeatedly and to use the findings to determine when to start progesterone measurement.

Faktor-Faktor yang Berhubungan dengan Peran Bidan dalam Pemantauan dan Deteksi Dini Resiko Tinggi Kehamilan di Wilayah Kerja Puskesmas Basuki Rahmat Kota Bengkulu

The purpose of this research is to find out the relation between factors related to the role and early monitoring in ​​Basuki Rahmat Health Center.The research method was quantitative research with cross sectional study approach. The population in this study was all active midwives in ​​Puskesmas Basuki Rahmat Bengkulu City that teaches 25 people with total sampling technique. The results of the study, more than half of respondents (60%) have poor midwives, 52% adults, 16% have low education, 48% have enough knowledge, 55% have favorabel, 60% have high motivation, 44% have no experience in treatment, 60% never received a reward, 40% never received supervision. There is no significant relationship between education with the role and early monitoring of high risk pregnancy (P: 0.759). It is expected that the Health Office/Puskesmas can improve human resources by contributing to the study, providing training, awards and supervision continuously and simultaneously to the midwives at Puskesmas Basuki Rahmat, Bengkulu City.
 Keywords: Monitoring, Early Detection, Midwife Role.

Updated Protocol for Management of Placenta Previa

Background: Antepartum hemorrhage complicates 2-5% of pregnancies, whichapproximately one-third are due to placenta previa. Placenta previa is acondition derived to an abnormal implantation of the embryos in thelower uterine segment. In placenta previa hemorrhage is more likely to occur during third trimester,as a consequence of the development of the lower uterine segment and of the dilation of the cervix due to the uterine contractions; alsovaginal examination may lead to an antepartum hemorrhage. Risk factors for the development of placenta previa include prior cesarean delivery, pregnancy termination, intrauterine surgery, smoking, multifetal gestation, increasing parity, maternal age and the rising rates of Cesarean section. Placenta previa is associated with adverse consequences for both mother and children, such as Intra-Uterine Growth Restriction (IUGR), preterm birth, antenatal and intra-partum hemorrhage, maternal blood transfusion and emergency hysterectomy. Placenta previa has been diagnosed increasingly in recent decades, due to mostly to the widespread use of ultrasound (US). Apart from ultrasound a valid imaging modality to study and investigate placenta in antepartum period seems to be magnetic resonance (MR).Careful monitoring of high risk pregnancies is of utmost importance. Avoidance of unnecessary caesarean sections and early week’s pregnancy terminations can minimize the placenta previa. In diagnosed cases, preoperative planning, preoperative decisions and good postoperative management can safe a mother and child.J Shaheed Suhrawardy Med Coll, June 2017, Vol.9(1); 26-30

Assessment of the Fetal Cerebral Artery: Importance of Doppler Preset Settings.

The Doppler assessment of the middle cerebral artery (MCA) has a central role in the monitoring of high-risk pregnancies. The objective of this study was to investigate the importance of Doppler preset settings for measurement of the peak systolic velocity (PSV) and pulsatility index (PI) of the MCA. The PI and PSV of the MCA were determined prospectively in 350 healthy fetuses between 19 and 42 weeks of pregnancy. The first measurement of the MCA (MCA.S) was performed with the conventional settings and the second (MCA.O) with an optimized setting of the maximum achievable frame rate. For the MCA.O measurement, the width of the B-mode image and the color Doppler window were adjusted as narrowly as possible. In addition, the MCA was shown in optimized high-definition zoom. Resulting values were compared with commonly used reference values. The PSV and PI values and frame rates of the MCA.O setting were noticeably greater than those of the MCA.S setting (P < .001 for all). For both settings, the PSV and PI values were increased compared to common reference values. The assessment of the MCA with the optimized Doppler default setting yielded increased PSV and PI values compared to the commonly used measurement technique. Moreover, the resulting median curves differed from the established median reference curves. Therefore, an updated standardization for measuring the MCA should be set out, and current reference values should be adjusted.

Monitoring of High Risk Pregnancy by Non-Stress Test

Monitoring of High Risk Pregnancy by Non-Stress Test

Current insights in brain protection for the sick newborn infant

This paper presents an overview of the modern antenatal and postnatal strategies in brain protection for both preterm and term born infants. It is known, that the two most common causes of neonatal brain injury are prematurity and hypoxic-ischemic encephalopathy (HIE) in the term born infant. Approximately one in nine babies is born before term. Nowadays these preterm born infants more often survive the neonatal period due to developments in treatment options in the last decades. They are however at a high risk for developing brain damage and neurodevelopmental impairment later in life. Approximately 40 % of survivors develop long-term intellectual or physical impairment, including cerebral palsy (CP). Term born infants born after perinatal asphyxia may also survive with a variety of neurocognitive disorders due to brain damage as a result from the hypoxic ischemic encephalopathy (HIE). Untreated, the sequelae of moderate to severe HIE includes a 60 to 65 % risk of mental retardation, CP, hydrocephalus, seizures, or death. The main goal in neonatal care for these surviving but vulnerable infants is to preserve brain function and prevent further brain damage, in order to improve neurocognitive outcome and the subsequent quality of life. In preterm brain protection antenatal strategies besides educating and supporting pregnant women regarding life style and healthy food intake, centralization of care for extreme preterm born infants, fetal monitoring in high risk pregnancies, administration of antenatal steroids for lung maturity, the use of intravenous magnesium sulfate administration to mothers just before preterm delivery are of great importance. In the postnatal strategies setting optimal oxygen saturation, the avoidance of prolonged artificial mechanical ventilation, hypoglycemia, hypocapnia electrolytic imbalances, hyperbilirubinemia, blood pressure shifts, stress and pain, inflammation, necrotizing enterocolitis as well as adequate feeding strongly predict neurocognitive outcome. In the term asphyxiated infants the brain experiences a cascade of problems occurring after energy failure which in fact are the basis of neuroprotective strategies. These strategies consist of anti-oxidative, anti-inflammatory, anti-excitatoxic and anti-apoptotic agents, and in the future possibly neurogenetic approaches, including stem cell therapy. In antenatal strategies prevention of asphyxia starts at promoting a healthy pregnancy and of an early recognition of fetal, placental or perinatal risk factors for hypoxia. Recent experimental trials have shown a possible beneficial effect of antenatal administration of the anti-oxidative agent allopurinol in a HIE. In postnatal strategies two methods to achieve therapeutic hypothermia were evaluated in newborn infants with HIE: whole body cooling and selective head cooling with mild systemic hypothermia with the conclusion: hypothermia should be instituted in term infants with moderate-to-severe hypoxic ischemic encephalopathy if identified before six hours of age. Monitoring of brain activity by means of amplitude integrated electroencephalography to identify infants with HIE is promising. Potential agents with either anti-oxidative, anti-inflammatory, anti-excitatoxic or anti-apoptotic capacities are currently being investigated in various phases of research.

Maternal predictors of intrauterine growth restriction

Intrauterine growth restriction (IUGR) occurs when fetal growth rate falls below the genetic potential and affects a significant number of pregnancies, but still no therapy has been developed for this pregnancy disease. This article reviews the most recent findings concerning maternal characteristics and behaviours predisposing to IUGR as well as maternal early markers of the disease. A comprehensive understanding of factors associated with IUGR will help in providing important tools for preventing and understanding adverse outcomes. Maternal nutritional status, diet and exposure to environmental factors are increasingly acknowledged as potential factors affecting fetal growth both by altering nutrient availability to the fetus and by modulating placental gene expression, thus modifying placental function. Assessing nutritional and environmental factors associated with IUGR, and the molecular mechanisms by which they may have a role in the disease onset, is necessary to provide comprehensive and common guidelines for maternal care and recommended behaviours. Moreover, maternal genetic predispositions and early serum markers may allow a better and more specific monitoring of high risk pregnancies, optimizing the timing of delivery.

A systematic review of successes and failures in home telehealth. Part 2: Final quality rating results

Each of 1 30 studies about home telehealth was independently rated by three reviewers in terms of patient selection, specification of interventions, specification of analysis, patient disposal and outcomes reported. The mean ratings of study quality were used to calculate an overall decision-making score. From the decision-making score, a net evidence score was derived for each of the 26 diseases/conditions identified. The mean decision-making score, combining study design and quality ratings, was used for comparison with a preliminary report prepared in 2006. The inclusion of ratings of study quality strengthened and confirmed the original findings. In summary, there are good to high quality studies supporting the use of home telehealth in the areas of diabetes, the general area of mental health, high-risk pregnancy monitoring, heart failure, other cardiac conditions and smoking cessation. Incorporating the rating of study quality in systematic reviews is an important step which provides additional information about the strength of evidence available.

An Improved Method of Long-Term Fetal Heart Sound Monitoring in High-Risk Pregnancies

Current method for Fetal Heart Rate (FHR) monitoring relies heavily on Ultrasound Techniques. This has two important disadvantages; firstly, there are significant chances that long-term exposure to ultrasound may harm the unborn, and secondly, the ultrasound machines and its trained operators would prove to be an expensive proposition and could not be utilized for longer period of time. Because of these reasons, the existing instruments are not suitable for carrying out frequent and long-term measurement of FHR, which is highly recommended in high-risk pregnancies.In this paper an alternative method for long-term FHR monitoring is proposed. With the help of a designed acoustic cone, sound wave guide and piezoelectric sensor, acoustic energy produced by fetal heart movement is detected from subject’s (mother’s) abdomen. An additional microphone is used to detect ambient noise, which will be used for adaptive digital filtering and noise cancellation from fetal heart sound wave. Both signals are subsequently filtered, amplified and recorded in a two-channel removable memory device. All these components were assembled in a low power portable electronic instrument to allow long term fetal surveillance. Later on, the recorded data is transferred to a personal computer where it is further digitized, filtered, analyzed and displayed. The designed instrument has been examined and tested in Government Hospital on women with gestation age between 28 to 41 weeks. The results showed that the technique is suitable and effective for long-term fetal heart sound monitoring.

A systematic review of successes and failures in home telehealth: preliminary results

We conducted a systematic review of the literature to identify studies in home telehealth that compared a home telehealth intervention with a non-telehealth standard/usual care alternative in terms of administrative changes, patient management decisions, patient outcomes, caregiver outcomes, economic impact or social impact on patients. A search of various databases produced 6643 references. Of these 769 papers were selected for more detailed investigation. These papers, combined with hand searching of relevant telehealth journals and cross-referencing of citations in identified publications, resulted in 1 38 papers referring to 1 30 projects for review. In this preliminary analysis we used a quality appraisal approach that took into account the study design. An additional analysis of patient numbers was then used to calculate a net evidence score. A large proportion of studies (80%) were randomised controlled trials. Only 22 projects (17%) reported economic data deemed to be sufficient for appraisal. Evidence exists for the clinical effectiveness of home telehealth in diabetes, the general area of mental health, high risk pregnancy monitoring, heart failure and cardiac disease.

The cerebroplacental Doppler ratio revisited.

To evaluate the distribution of Doppler pulsatility index (PI) measurements of the umbilical and middle cerebral arteries in singleton fetuses of women with normal uterine artery blood flow and to construct reference ranges for the cerebroplacental PI Doppler ratio. The PI was determined in the mid-portion of the umbilical artery and the mid- or distal segment of the middle cerebral artery in 306 normal singleton fetuses. The cerebroplacental Doppler ratio (CPR) was determined from paired measurements. After determination of the best fit, reference ranges were constructed for each parameter against gestational age (GA). The PI for the umbilical artery had a linear relationship with GA (umbilical artery PI = - 0.0246 x GA + 1.7791, r(2) = 0.4025, P < 0.001). The middle cerebral artery PI and the CPR both showed a quadratic relationship with GA (middle cerebral artery PI = - 0.0058 x GA(2) + 0.3335 x GA - 2.7317, r(2) = 0.2365, P < 0.01), (CPR = - 0.0059 x GA(2) + 0.383 x GA - 4.0636, r(2) = 0.2788, P < 0.001). The CPR is not constant throughout gestation. Reference ranges constructed by a standardized Doppler technique may be of benefit in the monitoring of high-risk pregnancies.

Maternal health, antenatal and at 8 weeks after delivery, in home versus in-hospital fetal monitoring in high-risk pregnancies

Objective: To assess maternal health outcome, comparing high-risk pregnant women to either domiciliary monitoring or in-hospital monitoring, and a low risk pregnant group. Design: Paper and pencil questionnaire, distributed antenatal and 8 weeks after the delivery. Setting: A university hospital. Subjects: Three groups: 130 high-risk pregnant women, who entered a randomized clinical trial and were allocated to either home ( n=69) or in-hospital monitoring ( n=61), and a reference cohort of low risk pregnant women ( n=55). Main outcome measures: Antenatal physical and mental health (RAND36) and social experiences; mode of delivery; complications postpartum; physical health, mental health, and social experiences at 8 weeks postpartum. Results: In all groups, antenatal physical health was considerably lower compared to the physical health of US women aged 18–44 years. Antenatal mental health was lower in high-risk women than in low-risk women ( P<0.05). Antenatal maternal health, the mode of delivery, and maternal complications postpartum did not differ significantly between in-hospital and domiciliary monitored women. Eight weeks after delivery, physical health improved considerably in all groups; mental health was significantly lower in high-risks as compared to low-risk women ( P<0.01). The allocated monitoring strategy showed a significant effect on mental health at 8 weeks after delivery; the mental health score being lower in the domiciliary monitored group ( P<0.05). Conclusions: At 8 weeks after the delivery, physical health improves substantially in all groups. Mental health is higher in low-risks than in high-risks. Within the high-risk group domiciliary and in-hospital monitored women have the same physical maternal outcome at 8 weeks after delivery. However, mental maternal health in in-hospital monitored women at 8 weeks was probably biased by a medicalization effect.

P09Flow velocity waveforms in the spiral artery versus AFP and BHCG maternal serum concentration in pregnancy complicated by threatened abortion

ObjectivesThe aim of the study was to determine the values of resistance index (RI) and pulsatility index (PI) in the spiral arteries and to evaluate the maternal serum concentration of AFP and β‐hCG trying to find correlation between these parameters in the patients in early pregnancy complicated by threatened abortion.Study methodsWe have analysed 32 pregnant women between 5th and 12th weeks of pregnancy diagnosed as threatened abortion. In all patients TV ultrasound with pulsed color doppler was performed. The RI and PI were calculated for blood flow obtained from the spiral arteries. The concentration of AFP and β‐hCG in maternal serum was evaluated by immunoassays.Results32 velocity waveforms from spiral arteries were analysed and blood flow indices were calculated. We have found statistically significant negative correlation between the values of both blood flow parameters (RI &amp; PI) and successive weeks of pregnancy. In the tested group in 37.5% of patients the level of β‐hCG was low. There was statistically significant correlation between serum β‐hCG, AFP concentrations and blood flow parameters.ConclusionsOnly the combination of Doppler blood flow analysis in spiral arteries and evaluation of AFP and β‐hCG in the maternal serum performed in first trimester may be useful for the intensive fetal monitoring of high risk pregnancies.

Ambulatory blood pressure monitoring in pregnancy: What is normal?

OBJECTIVE: Noninvasive 24-hour ambulatory blood pressure monitoring holds great promise as a useful tool in the management of hypertensive pregnancies and pregnancies considered “at risk” for development of preeclampsia. The purpose of this study was to define ambulatory blood pressure monitoring parameters throughout normal pregnancy, including women considered at risk for development of hypertension who continued to have a completely normal pregnancy. STUDY DESIGN: Two hundred seventy-six 24-hour ambulatory blood pressure monitoring studies were made cross-sectionally with use of a Spacelabs 90207 device (validated for use in pregnancy), at one or more of 9 to 17, 18 to 22, 26 to 30, and >30 weeks' gestation. Upper limits of normal were defined as the mean plus 2 SDs for awake and sleep ambulatory blood pressure monitoring results at each stage. RESULTS: Average awake upper limits of normal were 130/77, 132/79, 133/81, and 135/86 mm Hg at the four stages of pregnancy, respectively. Systolic blood pressure fell significantly by 12% to 14% ( p < 0.0001) and diastolic blood pressure by 18% to 19% ( p < 0.0001) during sleep at all stages of pregnancy. Awake ambulatory blood pressure monitoring systolic measurements were 11 to 12 mm Hg higher than “clinic” measurements ( p < 0.001) and diastolic measurements were 5 to 11 mm Hg higher ( p < 0.0001) throughout pregnancy. Maximum blood pressure variability ranged from 8 to 13 mm Hg. CONCLUSIONS: The upper limits of normal ambulatory blood pressure monitoring–derived measurements rise slightly as pregnancy progresses. Awake measurements are higher than “clinic” measurements recorded under relaxed conditions by a clinical researcher. The diurnal blood pressure fall and variabilities are similar during pregnancy to those seen in nonpregnant subjects. These data should provide valuable references for further studies of ambulatory blood pressure monitoring in high risk pregnancies. (Am J Obstet Gynecol 1998;178:836-42.)

Cost-minimization analysis of domiciliary antenatal fetal monitoring in high-risk pregnancies

To compare safety and cost-effectiveness of domiciliary antenatal fetal monitoring (cardiotocography and obstetric surveillance) with in-hospital monitoring in high-risk pregnancies. From September 1992 to June 1994, 150 consecutive women with high-risk pregnancies, who would otherwise be monitored in the hospital, entered a randomized controlled trial of in-hospital (n = 74) or domiciliary (n = 76) monitoring. The main outcome measures were neonatal safety (Prechtl neurologic optimality score, the proportion of non-optimals) and cost-effectiveness. To test a two-point difference in mean Prechtl scores (two-tailed o = .05. 1-beta = .80), 150 women were needed. Safety and cost-effectiveness were analyzed according to intention to treat. Conditional on the safety outcomes, a cost-minimization analysis based on actual resource use was performed. Uncertainty of results was explored by sensitivity analyses. Neonatal outcomes were equal. No cost-shifting between the antenatal and postpartum period occurred. Substituting domiciliary for in-hospital monitoring reduced mean (standard deviation) antenatal costs from $3558 ($2841) to $1521 ($1459) per woman (P < .001). If costs were varied by the addition of 50%, costs were still reduced. The magnitude of the reduction was sensitive to the costs of hospital care and less sensitive to the costs of domiciliary monitoring. Domiciliary monitoring is safe and reduces costs by one-half. The technique seems transferable to other settings but local circumstances may sometimes hamper its dissemination.

Das KCTG - erste klinische Erfahrungen beim Einsatz des Kinetokardiotokogramms

160 woman patients in whom the course of pregnancy was uneventful or pathological (intrauterine growth retardation, percentile less than 5) were investigated at the Department of Obstetrics and Gynaecology of the University of Homburg/Saar between the 28th and 42nd week of pregnancy, using a newly developed cardiotocograph (HP M1350A Hewlett-Packard, Böblingen, FRG). By means of the kinetocardiotocogram (KCTG), fetal mobility (fetal movements of the whole body or of the extremities) was recorded simultaneously with the conventional recording of the fetal heart rate and uterine contractions. One of the aims in developing the KCTG was to record as far as possible all fetal movements synchronous to the recordings of heart rate and uterine contractions. To this end, the recording algorithm of the KCTG was adapted to the examination results obtained by two simultaneously operating ultrasound investigators. After the 28th week of pregnancy it was possible to record by the KCTG fetal "movement clusters" (combined body and limb movements) independent of the weight of the fetus and of amniotic fluid volume or positional anomalies, reliably and with good correlation with the results of the sonographic control investigations (r = 0.88-0.97). In cases of intrauterine growth retardation (percentile less than 5) a significantly reduced motility was observed on average as early as 13 days before delivery (p less than 0.005). It must be emphasized that, at this stage, most of the antenatal CTGs were normal. These findings indicate that KCTG can contribute to improved monitoring in high-risk pregnancies.