Normal Fetal Heart Rate Patterns Research Articles

Associations among fetal heart rate patterns and mothers’ spiritual health and forgiveness

Objective: Studies have shown that spiritual commitment and positive personality traits such as forgiveness are considered a factor in effective adaptation to stressful problems and events and stress reduction. This study was to associations among fetal heart rate (FHR) patterns and mothers’ spiritual health and forgiveness in women referring to Maternity Hospital Affiliated to Shiraz University of Medical Sciences. Materials and Methods: This study is a correlational study, which was performed on pregnant women referring to selected hospitals with a sample size of 200 pregnant mothers in 2016. After receiving written consent from qualified individuals, a general information questionnaire, medical history, spiritual health, and forgiveness were recorded. Then, data were analyzed using descriptive statistics (frequency and percentage) and Chi-square test in SPSS software, version 22. Results: The mean age of the participants was 28.92 years, with a gestational age of 37–31 weeks. The mean spiritual health was 102.64 (14.61) and 133.2 (16.99). 31.5% of mothers' spiritual health was average, 68.5% their spiritual health was estimated to be high. Twenty-five percent had a moderate level of forgiveness and 75% had a high level of forgiveness. According to the Chi-square test, there is a significant relationship between spiritual health and forgiveness with normal FHR patterns (P = 0.001). Conclusion: The majority of pregnant women had a high score of spiritual health and forgiveness, and there was a statistically significant relationship with the normal FHR. It is suggested that implementing a spirituality-based care program that promotes spirituality and positive personality traits can be a good way to reduce maternal anxiety and regular FHR.

Does a Nonreassuring Fetal Heart Rate Pattern Impair Renal Function in Neonates Prenatally Diagnosed with Congenital Anomalies of the Kidneys and Urinary Tract?

This study aimed to determine the effect of nonreassuring fetal heart rate (NRFHR) patterns in labor on the postnatal renal function of neonates with a prenatal diagnosis of congenital anomalies of the kidney and urinary tract (CAKUT). A retrospective cohort study was conducted in a single tertiary referral center between 2012 and 2020. All cases with a prenatal diagnosis of CAKUT were extracted, and their fetal, maternal, obstetrical, and neonatal characteristics were analyzed. Cases of multiple gestations, preterm delivery, small for gestational age, major associated malformations or genetic aberrations, and prelabor acute obstetrical events were excluded from the analysis. The study group was comprised of patients who experienced NRFHR during labor. The control groups included (1) patients who had a trial of labor with a normal fetal heart rate pattern and (2) patients who delivered by elective cesarean section (CS). The primary outcome was abnormal serum creatinine levels in the perinatal period. For statistical purposes, the CAKUT cases were classified into a low and high estimated risk for an abnormal postnatal renal outcome. A subgroup analysis of the results was performed accordingly. Two hundred and fifty-six fetuses diagnosed prenatally with CAKUT comprised the study group. Among these, 214 women (83%) opted for a labor trial, while 42 (17%) chose elective CS. Within the labor trial group, 21/214 patients (9.8%) experienced NRFHR during labor. Analysis of maternal and fetal characteristics revealed no statistically significant disparities between the groups. NRFHR patterns were not associated with a deterioration in neonatal serum creatinine compared with those with normal fetal monitoring or those born by an elective CS. NRFHR patterns during labor and delivery did not impair neonatal renal function status in fetuses diagnosed prenatally with low- and high-risk CAKUT. Delivery can be managed according to standard obstetrical guidelines. · Kidneys affected by CAKUT commonly display renal dysplasia and a reduction in nephron mass.. · Low Apgar scores and asphyxia are recognized as risk factors for perinatal acute kidney injury.. · Lack of research on NRFHR impact on perinatal renal function in prenatally diagnosed CAKUT.. · NRFHR patterns during labor did not impair neonatal renal function status in prediagnosed fetuses..

A prospective study of myeloperoxidase levels in water immersion

IntroductionWe aimed to compare myeloperoxidase levels in cord blood samples of mothers undergoing water immersion or conventional labor. MethodWe enrolled 52 pregnant women to this case control study meeting the following criteria: uneventful gestational follow-ups, no history of known chronic or pregnancy-associated diseases, cesarean section or uterine operation, BMI <29.9 kg/m2, single vertex presentation, normal fetal heart rate pattern, 37–41 weeks of gestation, estimated fetal weight of 2500–4000 g. The subjects were either undergoing immersion in water (n = 26) or conventional labor (n = 26) and their myeloperoxidase levels were measured from cord blood samples. ResultsThe mean age of the study population was 24.55 ± 4.9 years. The mean BMI and weight gain during pregnancy were 26.8 ± 2.7 kg/m2 and 11.6 ± 5.3 kg, respectively. The mean age of gestation at birth was 39.6 ± 1.1 weeks, with a mean birth weight of 3205.5 ± 433.2 g. The subjects in water immersion and conventional labor groups showed no difference in terms of age, gestational age, BMI, and birth weight. The mean myeloperoxidase level was significantly lower in the water immersion group (759.8 ± 391.5 U/L) compared to that in the conventional labor group (1832.2 ± 1011.9 U/L, p = 0.004). DiscussionImmersion in water during the first stage of labor seems to be associated with low myeloperoxidase levels, suggesting reduced oxidative stress in this delivery method.

Intrapartum zigzag pattern of fetal heart rate is an early sign of fetal hypoxia: A large obstetric retrospective cohort study

IntroductionThe aim of the present study was to identify possible associations of fetal heart rate (FHR) patterns during the last 2 hours of labor with fetal asphyxia expressed by umbilical artery acidemia at birth and with neonatal complications in a large obstetric cohort.Material and methodsCardiotocographic recordings from 4988 singleton term childbirths over 1 year were evaluated retrospectively and blinded to the pregnancy and neonatal outcomes in a university teaching hospital in Helsinki, Finland. Umbilical artery pH, base excess and pO2, low Apgar scores at 5 minutes, need for intubation and resuscitation, early neonatal hypoglycemia, and neonatal encephalopathy were used as outcome variables. According to the severity of the neonatal complications at birth, the cohort was divided into three groups: no complications (Group 1), moderate complications (Group 2) and severe complications (Group 3).ResultsOf the 4988 deliveries, the ZigZag pattern (FHR baseline amplitude changes of >25 bpm with a duration of 2‐30 minutes) occurred in 11.7%, late decelerations in 41.0%, bradycardia episodes in 52.9%, reduced variability in 36.7%, tachycardia episodes in 13.9% and uterine tachysystole in 4.6%. No case of saltatory pattern (baseline amplitude changes of >25 bpm with a duration of >30 minutes) was observed. The presence of the ZigZag pattern or late decelerations, or both, was associated with cord blood acidemia (odds ratio [OR] 3.3, 95% confidence interval [CI] 2.3‐4.7) and severe neonatal complications (Group 3) (OR 3.3, 95% CI 2.4‐4.9). In contrast, no significant associations existed between the other FHR patterns and severe neonatal complications. ZigZag pattern preceded late decelerations in 88.7% of the cases. A normal FHR preceded the ZigZag pattern in 90.4% of the cases, whereas after ZigZag episodes, a normal FHR pattern was observed in only 0.9%.ConclusionsZigZag pattern and late decelerations during the last 2 hours of labor are significantly associated with cord blood acidemia at birth and neonatal complications. The ZigZag pattern precedes late decelerations, and the fact that normal FHR pattern precedes the ZigZag pattern in the majority of the cases suggests that the ZigZag pattern is an early sign of fetal hypoxia, which emphasizes its clinical importance.

The effect of maternal low flow oxygen administration during the second stage of labour on umbilical cord artery pH: a randomised controlled trial.

To assess the effect of maternal low flow oxygen administration during the second stage of labour on umbilical cord artery pH. A randomised controlled trial. A tertiary teaching hospital in China. Women in the second stage of labour with no complications. About 443 women were randomly allocated to receive either supplemental oxygen at a flow rate of 2l/min or a sham supplementation by nasal cannula. Healthcare providers, women and outcome assessors were blinded to allocation. Umbilical cord artery pH and fetal heart rate (FHR) pattern. Baseline characteristics were similar between the two groups. There were no significant differences between the two groups in the umbilical cord artery pH [median 7.261, interquartile range (IQR) 7.228-7.295 versus 7.266 (IQR 7.232-7.297), P=0.64], the proportion with pH less than 7.2 [30/219 versus 34/224, P=0.66, RR (relative risk) 0.9, 95% CI 0.57-1.42], and the proportion with normal FHR pattern (147/219 versus 153/224, P=0.79, RR 0.98, 95% CI 0.86-1.12). Maternal partial pressure of dissolved oxygen was significantly higher in the oxygen group than in the sham group [median 150.0mmHg (IQR 142.6-156.7) versus 112.0 (IQR 104.8-118.3), P<0.001], whereas carbon dioxide was significantly lower in the oxygen group than in the sham group (mean difference -1.1, 95% CI -2.1 to -0.1, P=0.03). The use of 2l/min maternal oxygen during the second stage of labour did not adversely affect either the umbilical artery pH or the FHR pattern distribution. No difference in abnormal fetal acid base or normal heart rate if maternal O2 given, randomised trial finds.

Colloidion Baby: A Rare Clinical Entity.

Colloidion baby is a rare clinical entity. Herein the neonate is born with a shiny, yellowish parchment like transparent membrane stretched over the skin. It was Hallopeau and Watelet in 1892, who first used this term and since then literature has a record of nearly 270 colloidian babies [1]. Eventually, these children will develop signs of one of the several types of ichthyosis, giving the skin ‘fish scales’ appearance [2]. We herein report one such case owing to its rarity. A primi gravida presented at 32 weeks of gestation according to her last menstrual period with complaint of leaking per vaginum for two days prior to presentation. There was no personal or family history of diabetes, any exposure to teratogenic drug, no history of any chronic medical disorders. Mother was diagnosed as pregnancy induced hypertension but was not on any treatment. Her present pregnancy was followed in a local hospital with regular follow-up with ultrasonography examination done one week prior to delivery showing oligohydramnios (decreased amniotic fluid index=4). There was no comment on any congenital malformations. On admission patient was haemodynamically stable. On abdominal examination, fundal height corresponded to 32 weeks of gestation with breech presentation with normal fetal heart rate pattern. On per vaginal examination cervix was closed and not effaced with high breech with clear dribbling liquid. She was started on intravenous antibiotics and betamethasone was given. Caessarean section was planned after 48 hours and a 1900 grams female baby was born with following morphological features [Table/Fig-1]. [Table/Fig-1]: Appearance of baby on day 1 of life. Thick shield like taut skin all over body with cracked pinkish areas in between, scanty hair, malformed ears, everted eyelids with exposed swollen conjunctiva, slit like nostril, open mouth, flexed limbs with malformed palms, oedematous feet were present. Baby did not need active resuscitation and was shifted to neonatal intensive care unit. Dermatological opinion was taken and a diagnosis of Harlequin ichthyosis was made. Baby was managed with intravenous fluids, intravenous antibiotics and topical emollients. Baby remained haemodynamically stable with cracks in the skin increasing [Table/Fig-2]. Baby was taken to home against medical advice on fifth day of life and lost to follow-up. [Table/Fig-2]: Appearance of baby on day 4 of life. Approximately 75% of collodion baby develops a type of autosomal recessive congenital ichthyosis, either lamellar ichthyosis or congenital ichthyosiform erythrodema) [3]. The third type of autosomal recessive congenital ichthyosis, Harlequin ichthyosis, is the most rare and severe form. Other rare causes of colloidion baby include-Epidermolytic hyperkeratosis (bullous congenital ichthyosiform erythroderma), Gaucher’s disease and Sjogren-Larsson syndrome. Although, the colloidian membrane develops due to an epidermal cornification disorder, keratinocyte protein and lipid metabolism defects resulting from autosomal recessive genetic mutations have also been notified as important cofactors [4]. Transglutaminase 1 gene mutation localized on the 14q11 have been implicated in congenital autosomal recessive ichthyosis [5]. Owing to impairment of the skin barrier function, collodion babies prone for a number of complications like hypernatremic dehydration, hypothermia, skin infections, fissures, conjunctivitis, sepsis, dehydration and constrictive bands of the extremities resulting in vascular compromise and oedema [1,2]. They require proper fluid and electrolyte balance, emollients and lubricants for hydrating the membrane. Suitable eye care and pain control should be carried out for the collodion babies with ectropion. Prophylactic antibiotics should be used to prevent sepsis. In the present scenario, owing to intensive care, the survival of neonates has increased. Humidified incubators and water dressings followed by emollient agents are important aspects in its management.

Fetal welfare IPE improves learning and clinical outcomes

Interprofessional education (IPE) or ‘learning and teaching together as a team’ is a relatively new concept for postgraduate maternity professional education. In 2007 work commenced on an IPE program ‘Fetal welfare, Obstetric emergency, Neonatal resuscitation Training (FONT)’. One of the aims of the program was to improve clinicians understanding of fetal heart rate (FHR) pattern interpretation and neonatal outcomes associated with FHR interpretation. In total, 240 clinicians, including obstetricians, general practitioners and midwives were trained as FONT trainers to provide local FONT education sessions in maternity units across the state. A pre-test/post-test study was designed to evaluate the clinicians interpretation of one pathological and one normal FHR pattern. The preand post-test interpretation measured the use of consistent language and assessed the overall ability to interpret the FHR pattern. Neonatal clinical outcomes were assessed using de-identifiedneonatal outcomedata fromtheNSWNeonatal Intensive Care Unit System (NICUS) from Jan 2006 (one year prior to the implementationof FONT) toDec2011. Thedata described thenumber of babies born with an Apgar score of <6 at 5min of age, rates ofhypoxic ischaemic encephalopathy (HIE) and rates of antenatal and intrapartum stillbirths. Serious adverse events associatedwith FHR pattern interpretation were also determined for the same sixyear period to assess alteration in clinical outcomes. Preliminary analysis shows a 77% improvement in clinicians use of a common language for reporting FHR decelerations in a pathological pattern and a 35% improvement in identification of a normal FHR pattern. Further evaluation of the preand post-test will be ready for the conference. The serious adverse events associated with FHR monitoring and the neonatal outcomes for the years 2006–2011 will also be provided.

Use of Continuous Electronic Fetal Monitoring in a Preterm Fetus: Clinical Dilemmas and Recommendations for Practice

The aim of intrapartum continuous electronic fetal monitoring using a cardiotocograph (CTG) is to identify a fetus exposed to intrapartum hypoxic insults so that timely and appropriate action could be instituted to improve perinatal outcome. Features observed on a CTG trace reflect the functioning of somatic and autonomic nervous systems and the fetal response to hypoxic or mechanical insults during labour. Although, National Guidelines on electronic fetal monitoring exist for term fetuses, there is paucity of recommendations based on scientific evidence for monitoring preterm fetuses during labour. Lack of evidence-based recommendations may pose a clinical dilemma as preterm births account for nearly 8% (1 in 13) live births in England and Wales. 93% of these preterm births occur after 28 weeks, 6% between 22–27 weeks, and 1% before 22 weeks. Physiological control of fetal heart rate and the resultant features observed on the CTG trace differs in the preterm fetus as compared to a fetus at term making interpretation difficult. This review describes the features of normal fetal heart rate patterns at different gestations and the physiological responses of a preterm fetus compared to a fetus at term. We have proposed an algorithm “ACUTE” to aid management.

Computerized analysis of normal fetal heart rate pattern throughout gestation

To analyze the evolution of computerized cardiotocography (cCTG) parameters throughout gestation in a large archive of traces from healthy fetuses. This was a cross-sectional study of the first cCTG record from 4412 singleton fetuses with good pregnancy outcome. Normal ranges of cCTG parameters for 25 to 42 weeks were derived from analysis of only one cCTG record per fetus, and the relationship between the parameters and gestational age was investigated. Fetal heart rate (FHR) accelerations, short- and long-term variation overall, duration of episodes of high and low variation and variation in high episodes increased with advancing gestation. In contrast, maternal perception of fetal movements, basal FHR, variation in low episodes and the time until criteria for normality were met decreased with advancing gestation. Gestational age-related changes in FHR variation were less evident at the lowest percentiles. Episodes of high FHR variation were detected in most fetuses, even at 25 weeks. Opposite trends of basal FHR and variation were observed at 42 weeks. Large decelerations and the frequency and duration of low episodes were also higher at 42 weeks. The characteristics of the normal FHR pattern are quite defined from early on in gestation, follow a continuous trend with advancing gestation and change abruptly at 42 weeks. Gestational age-related changes are less obvious at the lowest percentiles.

Congenital intestinal malrotation masquerading as hyperemesis gravidarum

A 33-year-old woman (gravida 2, para 1) was admitted at 38 weeks of gestation with progressive complaints of persistent nausea, vomiting, and colicky abdominal pain of 3 weeks duration unresponsive to conventional medical therapy. The patient's medical history revealed frequent episodes of postprandial abdominal pain accompanied by nausea and vomiting—although less severe—in childhood as well as during her first pregnancy. Previous evaluations were inconclusive. The patient had a fundal height consistent with gestational age and a normal fetal heart rate pattern. She had no signs of peritonitis and laboratory tests were normal. Transabdominal ultrasound showed no abnormalities. When pharmacologic therapy failed to improve her clinically, labor was induced; this resulted in spontaneous vaginal delivery under epidural anesthesia of a healthy female neonate. However, the patient's symptoms did not subside post partum. Gastroscopy was normal, but transabdominal ultrasound showed ascites, which was found to be transudative. Computed tomography (CT) indicated intestinal malrotation and subsequent volvulus (Fig. 1a and b), which were confirmed at laparotomy. After 2 complete counterclockwise rotations of the small bowel, the duodenum appeared to be lying parallel to the ascending colon. Tight peritoneal folds (Ladd's bands) [1,2] passing from the ascending colon to the right lateral gutter were incised and revealed thrombosed mesenteric veins of the ascending colon. Because of questionable viability, a right colectomy with ileocolic anastomisis was performed. The postoperative course was uneventful and at 2 years follow-up the patient was free of postprandial pain. Figure 1 a) Axial 16-multidetector CT scan after oral and IV contrast material. The small intestine (A) lies in the right upper abdomen. In the left upper abdomenmoderate ascites (B) can be seen. b) Axial 16-multidetector CTscan after oral and IV contrast material. The duodenum (A) fails to pass between the aorta (B) and the superior mesenteric artery (C) horizontally, and instead lies in a whirl-like pattern around the superior mesenteric artery.

Fetal heart rate pattern reflecting the severity of placental abruption

To identify fetal heart rate (FHR) patterns reflecting the severity of placental abruption, and to determine the incidence of normal FHR pattern in cases of placental abruption. We analyzed FHR tracings from 40 pregnant Japanese women with placental abruption. We analyzed which FHR patterns appeared more frequently in cases of low 5-min Apgar score, low cord arterial pH, and large separation. Eight out of 40 cases showed a normal FHR pattern, while 32 cases did not show a normal FHR pattern. Undetectable variability and bradycardia appeared more frequently in cases with 5-min Apgar < 7, with cord blood pH < 7.1, and with larger placental separation than in cases without these features. The normal FHR pattern was associated with 5-min Apgar > or = 7, cord blood pH > or = 7.1, and separation of <25%. Fetal heart rate pattern reflected the severity of placental abruption. Undetectable variability and bradycardia occurred significantly more frequently in cases of severe placental abruption, and thus may reflect the severity of placental abruption.

Analysis of malpractice claims with a focus on oxytocin use in labour

The objective of this study was to analyse the motives behind disciplinary action in obstetric malpractice cases concerning delivery, and to evaluate the frequency of inappropriate oxytocin use in these cases. An analysis of all malpractice claims resulting in disciplinary action against physicians and midwives during the period 1996-2003. Investigations and decisions made by the Board of Medical Responsibility were reviewed with special focus on the use of oxytocin. Of 77 cases, 60 regarded patients in labour. In the majority, there had been a normal pregnancy and spontaneous start of labour (78%). At the beginning of labour, 87% showed a normal fetal heart rate (FHR) pattern, indicating fetal well-being. In 70%, there was adverse fetal outcome with brain damage or death. The most common reason for disciplinary action was improper interpretation of fetal monitor tracings and corresponding failure to recognise fetal distress (76%). Injudicious use of oxytocin was common (68.5%), and was the primary reason for disciplinary action in 33% of the cases. In a Swedish setting, a few common clinical problems pervade; interpretation of FHR patterns and the use of oxytocin account for the majority of rulings of negligence in malpractice cases regarding delivery. Analysis of the cases suggests that the adverse fetal outcomes could possibly have been prevented.

Occurrence of ST-changes recorded with the STAN ® S21-monitor during normal and abnormal fetal heart rate patterns during labour

Objective To determine the frequency of ST-changes in the fetal electrocardiogram (ECG) both during normal and abnormal fetal heart (FHR) traces and to study relations with characteristics of pregnancy and delivery. Study design Retrospective analysis of 563 FHR + ECG-recordings. ST-changes were counted for all recordings with respect to their FHR pattern. Relationships between the occurrence of ST-events and characteristics of pregnancy and delivery were determined for the recordings with a completely normal FHR tracing during the first stage. Results ST-events were present during 51.7% of recordings in the first stage of labour and during 24.3% of the recordings in the second stage. Surprisingly, events occurred during the first stage at a similar incidence during normal and abnormal FHR-patterns. During the second stage of labour events also occurred in a similar percentage of normal, intermediary and abnormal recordings, but – if present – events were more numerous during the abnormal FHR traces. In the subgroup of cases with a normal FHR pattern more events per hour occurred in babies born at 36–37 weeks of gestation and in boys. Conclusion ST-events are a frequent finding during normal FHR tracings.

Fetal heart rate patterns and neurodevelopmental outcome in very low birth weight infants

To evaluate the validity of fetal heart rate monitoring during the last hour prior to birth, as a predictor of long term neurodevelopmental outcome of very low birth weight infants. A total of 111 very low birth weight infants were included in the study. Fetal heart rate tracings were obtained during the last hour prior to delivery. A perinatologist, blinded to the neonatal outcome, evaluated the tracings and divided them into three groups: reassuring, nonreassuring, and pathological. Neurodevelopmental status was evaluated at age 2 years. The relationship between fetal heart rate monitoring results and the neurodevelopmental outcome at 2 years of age was assessed with a chi-square test and the Student's t-test. At 2 years of age 97 (87.4%) of the children had normal neurodevelopmental function, while 14 (12.6%) had variable degrees of neurodevelopmental impairment. The fetal heart rate monitoring results were classified as reassuring (normal) in 35 cases (31.5%), nonreassuring in 56 cases (50.5%), and pathological in 20 cases (18.0%). Both normal and pathological fetal heart rate patterns were associated with similar incidence of abnormal neurodevelopmental outcome, 14.3% and 15.0% of cases, respectively (p=0.778). Pathological fetal heart rate patterns as a predictor of neurodevelopmental outcome had a sensitivity of 27%, specificity of 74%, positive predictive value of 15%, and negative predictive value of 86%. Electronic fetal heart rate monitoring prior to delivery is not a reliable tool for the prediction of neurodevelopmental impairment in premature infants of very low birth weight, at 2 years of age.

Fetal heart rate patterns and neurodevelopmental outcome in very low birth weight infants

Background . To evaluate the validity of fetal heart rate monitoring during the last hour prior to birth, as a predictor of long term neurodevelopmental outcome of very low birth weight infants. Methods. A total of 111 very low birth weight infants were included in the study. Fetal heart rate tracings were obtained during the last hour prior to delivery. A perinatologist, blinded to the neonatal outcome, evaluated the tracings and divided them into three groups: reassuring, nonreassuring, and pathological. Neurodevelopmental status was evaluated at age 2 years. The relationship between fetal heart rate monitoring results and the neurodevelopmental outcome at 2 years of age was assessed with a chi-square test and the Student’s t-test. Results. At 2 years of age 97 (87.4%) of the children had normal neurodevelopmental function, while 14 (12.6%) had variable degrees of neurodevelopmental impairment. The fetal heart rate monitoring results were classified as reassuring (normal) in 35 cases (31.5%), nonreassuring in 56 cases (50.5%), and pathological in 20 cases (18.0%). Both normal and pathological fetal heart rate patterns were associated with similar incidence of abnormal neurodevelopmental outcome, 14.3% and 15.0% of cases, respectively (p /0.778). Pathological fetal heart rate patterns as a predictor of neurodevelopmental outcome had a sensitivity of 27%, specificity of 74%, positive predictive value of 15%, and negative predictive value of 86%. Conclusion. Electronic fetal heart rate monitoring prior to delivery is not a reliable tool for the prediction of neurodevelopmental impairment in premature infants of very low birth weight, at 2 years of age.

Acute increase of umbilical artery vascular flow resistance in compromised fetuses provoked by uterine contractions

Background: An impaired placental circulation is involved in the mechanism of late fetal heart rate (FHR) decelerations. Objectives: To explore umbilical artery (UA) Doppler velocimetry changes in response to uterine contractions during the oxytocin challenge test (OCT) and assess the potentially clinical value of ‘OCT Doppler velocimetry’. Methods: 111 women with pregnancy complications were subjected to an OCT with simultaneous recordings of FHR and UA pulsatility index (PI). Positive OCT cases (late FHR decelarations) were compared with negative OCT cases (normal FHR patterns). Only negative OCT cases were allowed a trial of vaginal delivery. Results: The UA PI was higher in OCT positive ( N=21) than in negative cases ( N=90) during uterine contractions and relaxations ( P<0.05), but not during basal measurements. A positive OCT, but not negative, was associated with an increase of PI during contractions and relaxations compared with basal measurements ( P<0.05). Fetal growth restriction ( N=58), operative delivery for fetal distress (ODFD) in labor ( N=10), and birth asphyxia ( N=8) were not associated with PI changes significantly different from cases without these complications. Conclusions: During uterine contractions and relaxations, but not during basal measurements, a significantly higher UA PI evolved in OCT positive cases compared with OCT negative cases. This indicates a pathophysiological mechanism disclosed only during uterine activity. Although these changes would not have been revealed by traditional Doppler velocimetry, the data suggest a limited predictive value of ‘OCT Doppler velocimetry’ on the short-term neonatal outcome.

Clinical significance of fetal heart rate tracings during the second stage of labor

Objective: To examine the significance of abnormal fetal heart rate (FHR) patterns during the second stage of labor in terms of pregnancy outcome. Methods: A prospective observational study comparing women who had abnormal FHR patterns during the second stage of labor with women who demonstrated normal FHR patterns. Results: Abnormal second-stage FHR patterns were found in 420 tracings (75%), whereas 140 tracings (25%) were normal. In a multivariable analysis, nulliparity (odds ratio [OR] 2.5; 95% confidence interval [CI] 1.5, 4.2), cord problems (OR 1.8; 95% CI 1.03, 3.3), and male sex (OR 1.5; 95% CI 1.01, 2.2) were independent factors affecting the occurrence of abnormal second-stage FHR patterns. Patients with abnormal tracings had significantly higher rates of operative delivery compared with patients with normal tracings. The newborns from the case group had significantly higher percentages of Apgar scores lower than 7 at 1 minute, arterial pH lower than 7.2, and base deficit of 12 mmol/L or higher, and six were admitted to the intensive care unit (ICU). A multiple logistic regression model found second-stage late decelerations, bradycardia less than 70 beats per minute, and the presence of abnormal FHR patterns during the first stage of labor to be independently associated with fetal acidosis (determined by pH less than 7.2 and base deficit greater than 12 mmol/L). Conclusion: Late decelerations, bradycardia less than 70 beats per minute, and abnormal FHR patterns during the first stage of labor might jeopardize fetal well-being, and expedited delivery should be considered.

Clinical Significance of Fetal Heart Rate Tracings During the Second Stage of Labor

In Brief Objective To examine the significance of abnormal fetal heart rate (FHR) patterns during the second stage of labor in terms of pregnancy outcome. Methods A prospective observational study comparing women who had abnormal FHR patterns during the second stage of labor with women who demonstrated normal FHR patterns. Results Abnormal second-stage FHR patterns were found in 420 tracings (75%), whereas 140 tracings (25%) were normal. In a multivariable analysis, nulliparity (odds ratio [OR] 2.5; 95% confidence interval [CI] 1.5, 4.2), cord problems (OR 1.8; 95% CI 1.03, 3.3), and male sex (OR 1.5; 95% CI 1.01, 2.2) were independent factors affecting the occurrence of abnormal second-stage FHR patterns. Patients with abnormal tracings had significantly higher rates of operative delivery compared with patients with normal tracings. The newborns from the case group had significantly higher percentages of Apgar scores lower than 7 at 1 minute, arterial pH lower than 7.2, and base deficit of 12 mmol/L or higher, and six were admitted to the intensive care unit (ICU). A multiple logistic regression model found second-stage late decelerations, bradycardia less than 70 beats per minute, and the presence of abnormal FHR patterns during the first stage of labor to be independently associated with fetal acidosis (determined by pH less than 7.2 and base deficit greater than 12 mmol/L). Conclusion Late decelerations, bradycardia less than 70 beats per minute, and abnormal FHR patterns during the first stage of labor might jeopardize fetal well-being, and expedited delivery should be considered. Second-stage late decelerations, bradycardia of less than 70 beats per minute, and abnormal patterns during the first stage of labor are independently associated with fetal acidosis.

Fetale Laserspektroskopie während mütterlicher O2-Atmung - Fetal Laser Spectroscopy During Administration of Oxygen to the Mother -

Objective: Oxygen is frequently administered to women during labor if the fetus is thought to be at risk of hypoxia. We studied the effect of maternal oxygen administration on the fetus with near infrared laser spectroscopy (NIRS). Methods: 24 patients with normal fetal sonography findings and heart rate pattern were enrolled. After the onset of labor the laser optodes for NIRS were applied to record HbO 2 and HbR as parameters of blood oxygen saturation and cytochrome aa 3 as an indicator of tissue oxygenation. Results: Administration of oxygen to the mother was associated with a significant increase of the oxygenation index in the blood and increased tissue oxygenation. Conclusion: These results suggest that administration of oxygen to the mother during labor can improve the oxygen supply to the fetus.

A comparison of visual analyses of intrapartum fetal heart rate tracings according to the new National Institute of Child Health and Human Development guidelines with computer analyses by an automated fetal heart rate monitoring system

Objectives: The aim of this study was to compare the visual analyses of fetal heart rate tracings by observers according to recent National Institute of Child Health and Human Development interpretative guidelines both with each other and with those of a computerized fetal heart rate analysis and alerting system. Study Design: One-hour sections of intrapartum fetal heart rate records were analyzed by a computerized monitoring system (Hewlett-Packard TraceVue; HP GmbH, Böblingen, Germany) and by 4 observers (a registered obstetric nurse, a certified nurse-midwife, an obstetrics resident physician, and a physician maternal-fetal medicine faculty member) instructed to use the new National Institute of Child Health and Human Development guidelines. We compared specific alerts, baseline rates, frequencies of accelerations and decelerations, and signal quality assessments generated by the TraceVue system and the observers. Power analysis indicated that 50 tracings were required to detect interobserver and observer-computer agreement levels of 80% ± 10%. Statistical comparisons used κ coefficient, χ2 test, and analysis of variance with repeated measures as appropriate. Results: Levels of agreement between observer pairs and the computer did not vary significantly across successive 10-minute intervals. Overall levels of interobserver agreement for baseline rate, tracing quality assessment, frequencies of accelerations and decelerations, and alerts ranged from 45% to 99% and were highest for baseline rate and signal loss and lowest for acceleration and deceleration counts. Interobserver agreement for alerts was relatively high (range, 72%-84%), with virtually no difference between any of the observers and the computer (range, 76.9%-79.2%; κ = 0.25). Conclusion: Use of the National Institute of Child Health and Human Development guidelines for visual fetal heart rate interpretation did not increase agreements on most fetal heart rate features beyond those expected by chance or noted in previous reports. These guidelines did appear to blunt some interpretive differences, possibly as a result of observer background. Although levels of agreement on fetal heart rate features differed, agreements on clinical alerts were similar among all observers and a computerized fetal heart rate monitoring system. Computer analysis of fetal heart rate tracings could eliminate interobserver variation that results from visual analysis and could produce more consistent clinical responses to normal and abnormal fetal heart rate patterns. (Am J Obstet Gynecol 2000;183:361-6.)