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[The cardiotocography instrument test].

This paper reports on a comparative test of eight cardiotocographic units which compute fetal heart rate on the basis of an ultrasonic signal. In order to ensure comparable test conditions for each unit, consisting of the monitor and the signal recorder, a simple measuring system was built. From outside the system, via a controlled electromagnet, a diaphragm in a water tank was put into defined motion. With individual recorders and by exploiting the Doppler effect it was possible to register and process each movement of the diaphragm. The frequencies and amplitudes of the artificially generated signals had been matched to the in vivo signals. The individual test graphs are compared, as a standard comparison, to the graphs obtained when the generation signal is fed to the direct ECG input of a cardiotocograph. In view of their high clinical information value, attention was focused in particular on the number of oscillations per minute and the oscillation amplitude. In this connection the electronic distortion of these two factors is as disregardable as portions of them which are incompletely or not at all recorded. Applying stringent criteria, the test shows that none of the units tested satisfies the desires of the obstetrician wanting to determine the fetal heart rate on a beat-to-beat basis.

Echocardiography↗

[Possibilities and value of discontinuous labor monitoring by cardiotocography. A retrospective study based on a continuous cardiotocogram].

The effectiveness of fictitious discontinuous intrapartum CTG monitoring was investigated and compared with available continuous CTG's by means of a retrospective analysis of 200 CTG tracings. CTG is a method of high sensitivity and offers, together with foetal intrapartum blood sampling, a possibility to detect foetal distress with high specificity and predictive value. From these CTG tracings the fictitious periods of time were assessed according to a certain schema to give women a possibility of being unrestricted in their activities without intrapartum monitoring while at the same time they were under satisfactory surveillance to notice sufficiently early any foetal distress that might lead to severe acidosis. The study was subdivided into 4 groups: Group 1: Patients at no risk during pregnancy and/or risk on admittance or during labour, no alarming signs from the foetus during the intrapartum period. Group 2: No risk, but with alarming signs from the foetus. Group 3: Patients at risk, no alarming signs from the foetus. Group 4: Patients at risk and with alarming signs from the foetus. The results suggest the possibility of discontinuous intrapartum monitoring according to a certain schema up to the second stage of labour, at minimum intrapartum risk for the baby, especially if there were no risks during pregnancy and at the beginning of delivery. According to these results 83% of all patients in labour would not have needed continuous CTG for more than half of the time spent in the labour ward. Only one in 6 deliveries (17%) would have required continuous monitoring.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗

Antepartum diagnosis of the "terminal" fetal state by cardiotocography.

Since 1969 it has been the policy of this department to perform regular cardiotocograms on all patients admitted during the antenatal period for severe hypertension, with or without proteinuria, and on those in whom poor intrauterine fetal growth was suspected. In five such patients where the fetus died in utero, beat-to-beat variation was reduced and late decelerations were observed. In a further twelve patients similar changes made delivery by elective Caesarean section appear advisable. Half of the infants so delivered had severe metabolic acidosis at birth.

Acidosis↗

The value of cardiotocography in abruptio placentae. Case report.

The main indication for Caesarean section in cases of placental abruption is fetal distress. We report a patient in whom clinical examination, including auscultation of the fetal heart, suggested a mild haemorrhage, which would normally have been managed conservatively, but continuous fetal heart rate monitoring showed severe asphyxia, necessitating emergency Caesarean section at which a large concealed haemorrhage was found.

Abruptio Placentae↗

Significance of antepartum cardiotocography in normal pregnancy.

Antepartum cardiotocographs (CTGs) were obtained at weekly intervals from 34 weeks onwards and twice weekly from 40 weeks onwards in 91 strictly normal pregnancies. The Fischer score was used to assess the 594 CTGs obtained. Ominous patterns were not encountered but 7.2 per cent of CTGs showed a suspicious pattern. Absence of accelerations and an oscillatory amplitude of less than 10 beats/minute contributed to respectively 95 and 88 per cent of these patterns. The combination of reduced variability and absence of accelerations accounted for 84 per cent of suspicious CTGs. This pattern is compatible with normal pregnancy even when fetal movements are present. One-third (37 per cent) of perfectly normal pregnancies had a suspicious CTG on at least one occasion and in 9 per cent of cases it was found twice or more. This should be borne in mind when using antepartum CTG in the surveillance of high-risk pregnancy.

Adult↗

Unstressed antepartum cardiotocography in the management of the fetus suspected of growth retardation.

A detailed analysis of the antenatal cardiotocographs (CTGs) in 57 patients with suspected fetal growth retardation is presented. Four traces were normal and 53 were 'non-reactive'. 'Non-reactive' traces can be sub-divided into three categories, which, in order of severity are, 'suspect', 'flat' and 'ominous'. When compared with the 'suspect' group, perinatal mortality was significantly increased and the Apgar scores at one and five minutes significantly decreased in the 'flat' and 'ominous' groups. The presence of fetal distress in labour was significantly higher in the 'flat' group as compared with the 'suspect' group. Intrauterine deaths occurred only in the 'ominous' group. With experience, ten patients later in the series with 'ominous' patterns were delivered within 24 hours of the detection of such and nine infants survived. At follow-up between 6 and 34 months after birth, psychomotor development was normal in 47 of the 49 surviving infants.

Apgar Score↗

Reliability of ultrasound as compared to direct fetal electrocardiography for antepartum cardiotocography.

Eighty-five pairs of simultaneously recorded external and internal cardiotocograms (CTGs) were coded and evaluated with a ten-point scoring system routinely used for the assessment of antepartum CTG. The highest consistency in interpretation between the external ultrasound and the internal fetal scalp CTG was found for basal heart rate followed by decelerations. Oscillatory amplitude and frequency were interpreted differently in 14 per cent of CTGs and accelerations in 16 per cent. When differences in interpretation arose, there was certainly no tendency for the external CTG to present an optimistic image of the fetal heart rate variables. With the exception of oscillatory amplitude all variables, including oscillatory frequency and the total CTG score, were more frequently underestimated than overestimated on external CTGs. When accelerations were present on only one recording, there was an 85 per cent chance for these to be absent on the external CTG. The study abolishes fears that the routine clinical assessment of antepartum CTGs of adequate technical quality provides overrated and more optimistic data than would by achieved by direct fetal scalp monitoring.

Electrocardiography↗

A randomized trial of weekly cardiotocography in high-risk obstetric patients.

A randomized clinical trial of once-weekly antenatal fetal heart rate monitoring in 539 high-risk patients could find no benefit of monitoring in terms of perinatal mortality, morbidity or Apgar score. The previously well-documented association between abnormal antenatal fetal heart rate traces and low Apgar score was confirmed. A detailed case review showed that in this population monitoring was irrelevant to almost all of the 13 perinatal deaths.

Adolescent↗

Antepartum non-stress cardiotocography in 'high risk' pregnancies.

Non-stress antepartum fetal cardiotocographic tracings were obtained on 2268 occasions from 1084 'at risk' pregnancies, and the findings are assessed in 834 of these that were recorded within 7 days of delivery or fetal death. The baseline fetal heart rate, reactivity, baseline variability and the response to spontaneous uterine contractions have been related to the perinatal outcome. Poor or absent reactivity, reduced baseline variability and variable or late decelerations, in response to contractions, were useful indicators of fetal compromise, but baseline heart rate was less helpful. These abnormalities can occur individually, or in combination, and the different patterns so produced have been related to perinatal outcome.

Apgar Score↗

Fetal distress and the condition of the newborn using cardiotocography and fetal blood analysis during labour.

The efficacy of electronic fetal monitoring combined with fetal blood analysis during labour in identifying fetal distress was investigated in a retrospective study. Operative delivery for fetal distress diagnosed during labour was performed in 9% of 2659 deliveries. All had continuous fetal heart rate monitoring and 22% had a fetal scalp blood analysis. Operative delivery had been performed in 53% of the infants who were acidotic at birth (umbilical artery pH less than 7.20) and in 46% of those with a low modified Apgar score (less than 7). These results show that the use of continuous fetal heart rate monitoring and fetal scalp blood sampling detects fetal distress without resulting in a high rate of operative delivery.

Apgar Score↗