Heart Rate, Fetal
Longitudinal changes in the ductus venosus, cerebral transverse sinus and cardiotocogram in fetal growth restriction. (1/58)OBJECTIVE: To evaluate the changes in flow velocity waveforms in the transverse cerebral sinus in growth-restricted fetuses and to correlate these changes with (1) flow velocity waveforms in the ductus venosus and (2) changes in computerized analysis of the fetal cardiotocogram. DESIGN: Fetuses between 22 and 37 weeks' gestation with an estimated fetal weight below the fifth centile were included in this prospective longitudinal study. Doppler measurements of the umbilical artery, descending aorta, middle cerebral artery, transverse cerebral sinus and ductus venosus were recorded. Fetal heart rate was analyzed by a computer system according to the Dawes-Redman criteria. RESULTS: We measured a significant correlation between pulsatility index in the cerebral transverse sinus and in the ductus venosus over the study period and at delivery. There was a negative correlation between these indices and short- and long-term variability of the fetal heart rate. There was a parallel increase in pulsatility in the ductus venosus and the transverse cerebral sinus. These changes were inversely correlated with fetal heart rate variability and preceded fetal distress. CONCLUSION: Cerebral venous blood flow in IUGR fetuses may be a useful additional investigation to discriminate between fetal adaptation and fetal decompensation in chronic hypoxemia. (+info)
Reducing risk by improving standards of intrapartum fetal care. (2/58)Confidential Enquiries into Stillbirths and Deaths in Infancy (CESDI) have pointed to a high frequency of suboptimal intrapartum fetal care of a kind that, in the event of an adverse outcome, is hard to defend in court. In an effort to minimize liability, various strategies were applied in a district hospital labour ward--guidelines, cyclical audit, monthly feedback meetings and training sessions in cardiotocography (CTG). The effects of these interventions on quality of care was assessed by use of the CESDI system in all babies born with an Apgar score of 4 or less at 1 min and/or 7 or less at 5 min. 540 babies (4.3%) had low Apgar scores, and neither the percentage nor gestational age differed significantly between audit periods. In the baseline audit, care was judged suboptimal (grade II/III) in 14 (74%) of 19 cases, and in the next four periods it was 23%, 27%, 27% and 32%. In the latest audit period, after further educational interventions, it was 9%. Many of the failures to recognize or act on abnormal events were related to CTG interpretation. After the interventions there was a significant increase in cord blood pH measurement. There were no differences between audit periods in the proportion of babies with cord pH < 7.2. These results indicate that substantial improvements in quality of intrapartum care can be achieved by a programme of clinical risk management. (+info)
Randomised controlled trial of cardiotocography versus Doppler auscultation of fetal heart at admission in labour in low risk obstetric population. (3/58)OBJECTIVE: To compare the effect of admission cardiotocography and Doppler auscultation of the fetal heart on neonatal outcome and levels of obstetric intervention in a low risk obstetric population. DESIGN: Randomised controlled trial. SETTING: Obstetric unit of teaching hospital PARTICIPANTS: Pregnant women who had no obstetric complications that warranted continuous monitoring of fetal heart rate in labour. INTERVENTION: Women were randomised to receive either cardiotocography or Doppler auscultation of the fetal heart when they were admitted in spontaneous uncomplicated labour. MAIN OUTCOME MEASURES: The primary outcome measure was umbilical arterial metabolic acidosis. Secondary outcome measures included other measures of condition at birth and obstetric intervention. RESULTS: There were no significant differences in the incidence of metabolic acidosis or any other measure of neonatal outcome among women who remained at low risk when they were admitted in labour. However, compared with women who received Doppler auscultation, women who had admission cardiotocography were significantly more likely to have continuous fetal heart rate monitoring in labour (odds ratio 1.49, 95% confidence interval 1.26 to 1.76), augmentation of labour (1.26, 1.02 to 1.56), epidural analgesia (1.33, 1.10 to 1.61), and operative delivery (1.36, 1.12 to 1.65). CONCLUSIONS: Compared with Doppler auscultation of the fetal heart, admission cardiotocography does not benefit neonatal outcome in low risk women. Its use results in increased obstetric intervention, including operative delivery. (+info)
The relation between pre-eclampsia at term and neonatal encephalopathy. (4/58)OBJECTIVES: To determine whether pre-eclampsia, hypothesised to be an inflammatory condition, is associated with fever in term labour, and confirm and examine the reported association of pre-eclampsia at term with neonatal encephalopathy. DESIGN: Prospective cohort study. SETTING: A Dublin teaching hospital. PARTICIPANTS: 6163 women in labour with singleton pregnancies at term at low risk for intrapartum hypoxia, recruited to a randomised trial examining the effect of admission cardiotocography on neonatal outcome. RESULTS: Pre-eclampsia was associated with maternal fever > 37.5 degrees in labour (odds ratio (OR) 3.39, 95% confidence interval (CI) 2.1 to 5.4); this was independent of obstetric intervention (adjusted OR 2.07, 95% CI 1.24 to 3.47). Pre-eclampsia was associated with neonatal encephalopathy (OR 25.5, 95% CI 8.4 to 74.7); this too was independent of obstetric intervention (adjusted OR 18.5, 95% CI 5.9 to 58.1). Cord arterial pH values were significantly lower in pre-eclamptics (7.20 v 7.24), although severe cord acidaemia was not significantly more common (OR 2.91, 95% CI 0.7 to 9.9). The association of pre-eclampsia with encephalopathy was independent of maternal fever (adjusted OR 16.5, 95% CI 5.1 to 54) and cord acidaemia (adjusted OR 13.5, 95% CI 3.2 to 56.7). CONCLUSIONS: The association of pre-eclampsia with maternal fever at term supports the hypothesis that pre-eclampsia is an inflammatory condition. The association of pre-eclampsia with neonatal encephalopathy is independent of obstetric intervention and cannot be explained by either acidaemia or maternal fever. A systemic inflammatory response in the fetus, perhaps secondary to oxidative stress, could explain the link between maternal pre-eclampsia and neonatal encephalopathy, and this may occur through cerebral vasoconstriction. (+info)
Flecainide in the intrauterine treatment of fetal supraventricular tachycardia. (5/58)OBJECTIVES: To assess the efficacy of flecainide in the intrauterine treatment of fetal supraventricular tachycardia (SVT) with 1 : 1 atrioventricular conduction. DESIGN: Twenty fetuses (21-35 weeks of gestation) with SVT ranging between 215 and 280 bpm were analyzed retrospectively. Fetuses received flecainide and digoxin as either first, second or third line therapy. Intracardiac blood flow, venous Doppler waveforms and cardiotocograms were evaluated before and after drug induced conversion to sinus rhythm. RESULTS: After initiation of combined flecainide and digoxin therapy, the median time interval until final conversion to sinus rhythm was 5 days (range, 0-14 days). The majority of fetuses (n = 15; 75%) converted to sinus rhythm within 7 days of treatment, whereas the remaining five (25%) showed initial reduction of the heart rate to 160-215 bpm over several days, with restoration of a triphasic venous blood flow pattern before late conversion within 7-14 days after initiation of flecainide treatment. One of these fetuses showed a decrease in fetal heart rate to 160-190 bpm without conversion to sinus rhythm but with resolution of hydrops. All fetuses survived. CONCLUSIONS: Flecainide is safe and highly effective in the intrauterine treatment of hydropic fetuses with supraventricular tachycardia. Conversion into sinus rhythm can be expected 72 h after initiation of therapy but may take up to 14 days. Therefore therapy should be continued beyond 72 h, especially when an initial decrease of fetal heart rate is observed which may represent an early therapeutic response. (+info)
Unnecessary emergency caesarean section due to silent CTG during anaesthesia? (6/58)We present a case of a probably unnecessary Caesarean section due to misinterpretation of the cardiotocography (CTG) trace during general anaesthesia. A 27-yr-old patient in her 30th week of an uneventful, normal first pregnancy presented with a deep venous thrombosis in the pelvic region. She was to undergo an emergency thrombectomy under general anaesthesia. During the operation, the CTG showed a lack of beat-to-beat heart rate variation (silent pattern CTG) with normal fetal heart rate. This silent CTG pattern was probably a result of the effect of general anaesthesia on the fetus. The CTG pattern was interpreted as indicating fetal distress, and an emergency Caesarean section was performed after the thrombectomy. The infant was apnoeic and had to be resuscitated and admitted to the neonatal intensive care unit. The pH at delivery was 7.23 and the baby was extubated 2 days later. Mother and child recovered without short-term sequelae. In the absence of alternative explanations, reduced fetal beat-to-beat variability with a normal baseline heart rate during general anaesthesia is probably normal. (+info)
Uterine rupture: what family physicians need to know. (7/58)Vaginal birth after cesarean section is common in this country. Physicians providing obstetric care should be aware of the potential complications. Uterine rupture occurs in approximately one of every 67 to 500 women (with one prior low-transverse incision) undergoing a trial of labor for vaginal birth after cesarean section. Rupture poses serious risks to mother and infant. There are no reliable predictors or unequivocal clinical manifestations of rupture, so physicians must maintain a high index of suspicion for possible rupture, especially in the presence of fetal bradycardia or other evidence of fetal distress. Management is surgery for prompt delivery of the infant and control of maternal hemorrhage. Newborns often require admission to an intensive care nursery. Prevention of poor outcomes depends on thorough anticipation and preparation. The physicians and the delivery institution should be prepared to provide emergency surgical and neonatal care in the event of uterine rupture. (+info)
Variations of multifractal structure in the fetal heartbeats. (8/58)Several procedures for evaluating fetal well-being are in clinical use. The cardiotocograph is mostly used as a non-invasive procedure to measure fetal well-being in clinical settings. The cardiotocograph displays the fetal heartbeat counts that vibrate. This variation has been classified into 2 categories. We investigated this variation by a novel method, in which we analyzed the change of structure of the attractors in the phase spaces according to the time course. We adopted the global spectrum, which means the distribution of fractal dimensions, for that structure. In this procedure, we discovered a new variation in which the cycle is much longer than the 2 types of known variabilities. Although loud noises such as white noises with a magnitude 1/4 times as large as the standard deviation of the original data were added to the original data, the variations were still detected. The variation is very difficult to detect by Fourier or wavelet transformation, however, because it changes very slowly. Through this new way of analyzing the vibration phenomena, we obtained a new perspective on the biological information available. (+info)
Types of Fetal Distress:
1. Hypoxia (lack of oxygen): This is one of the most common causes of fetal distress, which can occur due to placental insufficiency, umbilical cord compression, or other issues that restrict the flow of oxygen and nutrients to the fetus.
2. Acidosis: When the fetus's blood becomes too acidic, it can lead to fetal distress, as this can cause damage to the baby's organs and tissues.
3. Heart rate variability: Abnormal heart rate patterns in the fetus can indicate distress and may require closer monitoring or medical interventions.
4. Decreased movements: A decrease in fetal movement can be a sign of distress, particularly if it occurs suddenly or accompanied by other signs such as decreased heart rate or changes in fetal position.
5. Meconium staining: The presence of meconium in the amniotic fluid can indicate fetal distress, as it may be a sign of a prolonged or difficult labor.
6. Cephalopelvic disparity: When the fetus's head is too large to pass through the mother's pelvis, it can cause fetal distress and may require assisted delivery methods such as vacuum extraction or cesarean section.
7. Prolonged labor: A prolonged labor can lead to fetal distress due to decreased blood flow and oxygen supply to the fetus.
8. Maternal complications: Maternal complications such as high blood pressure, preeclampsia, or infection can also cause fetal distress.
Signs and Symptoms of Fetal Distress:
1. Changes in fetal heart rate: An abnormal heart rate pattern may indicate fetal distress, including tachycardia (rapid heart rate), bradycardia (slow heart rate), or variability in heart rate.
2. Decreased fetal movement: A decrease in fetal movement or lack of response to movement can be a sign of fetal distress.
3. Changes in fetal position: Abnormal fetal position, such as breech presentation or shoulder dystocia, can cause fetal distress.
4. Decreased muscle tone: Weak or floppy muscles in the fetus can indicate fetal distress.
5. Cyanosis (blue skin): A bluish tint to the skin may indicate that the fetus is not getting enough oxygen.
6. Acidosis (high blood acidity): An increase in blood acidity can lead to fetal distress and may require immediate medical intervention.
7. Respiratory distress: Difficulty breathing or rapid breathing can be a sign of fetal distress.
8. Umbilical cord issues: Problems with the umbilical cord, such as a prolapsed cord or a cord that is wrapped around the fetus's neck, can cause fetal distress.
Treatment and Management of Fetal Distress:
1. Oxygen supplementation: Providing oxygen to the fetus through a mask or nasal tubes may help improve oxygenation.
2. Intravenous (IV) fluids and medications: Administering IV fluids and medications can help stabilize the fetus and manage symptoms such as low blood pressure, low heart rate, or high acidity in the blood.
3. Fetal heart rate monitoring: Close monitoring of the fetus's heart rate may help identify signs of distress early on.
4. Uterine massage: Gentle massage of the uterus may help improve blood flow to the fetus.
5. Delivery: In some cases, delivery may be necessary to immediately address fetal distress.
6. Neonatal care: If the baby is born with signs of distress, immediate neonatal care may be necessary to ensure proper respiratory and cardiac function.
Prevention of Fetal Distress:
1. Proper prenatal care: Regular check-ups with a healthcare provider can help identify potential issues before they become critical.
2. Avoiding smoking, alcohol, and drug use during pregnancy: These substances can increase the risk of fetal distress.
3. Maintaining a healthy diet and weight gain during pregnancy: A balanced diet and appropriate weight gain can help ensure proper fetal growth and development.
4. Managing chronic medical conditions such as high blood pressure and diabetes: Proper management of these conditions can reduce the risk of fetal distress.
5. Avoiding excessive exercise and heat exposure during pregnancy: Overexertion and overheating can increase the risk of fetal distress.
6. Proper use of medications: Some medications can increase the risk of fetal distress, so it is important to discuss any medications with a healthcare provider before taking them during pregnancy.
The signs and symptoms of fetal hypoxia may include:
1. Decreased fetal movement
2. Abnormal fetal heart rate
3. Meconium staining of the amniotic fluid
4. Premature contractions
5. Preterm labor
If left untreated, fetal hypoxia can lead to serious complications such as:
1. Intracranial hemorrhage
2. Cerebral palsy
3. Developmental delays
4. Learning disabilities
5. Memory and cognitive impairments
6. Behavioral problems
9. Hearing and vision loss
Treatment of fetal hypoxia depends on the underlying cause, but may include:
1. Bed rest or hospitalization
2. Corticosteroids to promote fetal growth and maturity
3. Oxygen supplementation
4. Antibiotics for infections
5. Planned delivery, if necessary
In some cases, fetal hypoxia may be detected through ultrasound examination, which can show a decrease in fetal movement or abnormal heart rate. However, not all cases of fetal hypoxia can be detected by ultrasound, and regular prenatal check-ups are essential to monitor the health of the developing fetus.
Prevention of fetal hypoxia includes proper prenatal care, avoiding harmful substances such as tobacco and alcohol, maintaining a healthy diet, and managing any underlying medical conditions. Early detection and treatment of fetal hypoxia can significantly improve outcomes for both the mother and the baby.
Contraction stress test
Acute fatty liver of pregnancy
External cephalic version
Inferior vena cava syndrome
Delivery after previous caesarean section
Outline of obstetrics
Umbilical cord compression
List of MeSH codes (E01)
Percutaneous umbilical cord blood sampling
Antenatal cardiotocography for fetal assessment Edited (no change to conclusions) | Cochrane Abstracts
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- Re: Training in the use of intrapartum electronic fetal monitoring with cardiotocography: systematic review and meta-analysis: Response to letter to the editor: CTG training is a complex intervention and requires complex evaluations (Lightly K, Weeks AD, Scott H). (bvsalud.org)
- Cardiotocography (CTG) is widely used for antenatal monitoring and assessment of fetal well-being. (igi-global.com)
- External fetal monitoring (EFM), specifically continuous cardiotocography, was introduced in the early 1960s and considered the intervention that would reduce cerebral palsy and perinatal death. (nih.gov)
- Continuous cardiotocography (cCTG), which provides a continuous record of the fetal heart rate, was adopted with little evidence of its efficacy, and is currently utilized in over 90% of labors, regardless of the risk status of the pregnancy. (nih.gov)
- Twice-weekly checks of your baby's heartbeat, using an electronic fetal monitor (called a Cardiotocography (CTG) monitor). (nth.nhs.uk)
- Finally, a comparison of computerised cardiotocography parameters in eFGR and normal pregnancies, although highlighting differences between the two, suggests that further work is required in this area to determine how analysis of fetal heart rate can be improved as a tool for predicting prognosis in these high-risk pregnancies. (manchester.ac.uk)
- Carbonne B, Sabri-Kaci I. Assessment of an e-learning training program for cardiotocography analysis: a multicentre randomized study. (britishjournalofmidwifery.com)
- Pinas A, Chandraharan E. Continuous cardiotocography during labour: Analysis, classification and management. (britishjournalofmidwifery.com)
- 16. Intelligent Neutrosophic Diagnostic System for Cardiotocography Data. (nih.gov)
- Current contraction and cardiotocography devices in clinical use are large and expensive, while at home devices used by untrained professionals cannot be used to make clinical decisions. (nih.gov)