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PubMed2003

Intrapartum surveillance of IUGR fetuses with cardiotocography and fetal pulse oximetry.

OBJECTIVE: To investigate the efficacy and safety of intrapartum fetal pulse oximetry, as a predictor of metabolic acidosis at birth of fetuses with intrauterine growth retardation (IUGR). STUDY DESIGN: We studied 18 IUGR fetuses (group I) and a control group of 30 appropriate for gestational age (AGA) fetuses (group II) during labor. Both groups had abnormal fetal heart rate tracings and were monitored simultaneously throughout labor with cardiotocography and fetal pulse oximetry. Apgar scores, pH and base excess of fetal blood obtained from the umbilical artery after delivery were compared in both groups. SETTING: The Fetal Surveillance Unit of the 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, Athens University. RESULTS: In IUGR fetuses, when their oxygen saturation value (FSPO2) was less than 34%, cord artery pH was 7.10 +/- 0.04, base excess -13 +/- -1 mmol/l and Apgar scores < or =5 at the 5th min, and when FSPO2 was over 35%, artery pH was 7.29 +/- 0.08, base excess -8 +/- -2 mmol/l and Apgar scores > or =7 at the 5th minute. In cases of drops of FSPO2)below 30% for more than 2 min, labor was completed operatively and cord pH was 7.00 +/- 0.04, base excess -15 +/- -2 mmol/l and Apgar scores < or =5 at the 5th minute. In AGA fetuses, when FSPO2 was over 30%, artery pH was over 7.20, base excess <-11 mmol/l and Apgar scores > or =9 at the 5th minute; in contrast, when FSPO2 was <30% for 2 min, a cesarean section was performed and cord pH was < or =7.02, base excess > or =-13 mmol/l and Apgar scores < or =4 at the 5th minute. CONCLUSIONS: In IUGR fetuses, FSPO2 values less than 34% represent an acidotic status, while values of > or =35% are well tolerated. Fetal pulse oximetry proved reliable, according to umbilical cord blood measurements and Apgar scores, reducing cesarean deliveries in cases of nonreassuring cardiotocographic patterns in IUGR fetuses.

Acidosis↗

PubMedDate not supplied

Effect of betamethasone on the fetal heart rate pattern assessed by computerized cardiotocography in normal twin pregnancies.

The effects of corticosteroids, given for enhancement of fetal lung maturation, on fetal heart rate (FHR) are controversial and may decrease its variability. FHR patterns were analyzed by computerized cardiotocography in 46 fetuses from 23 normal dichorionic twin pregnancies on days 0, 1 and 4-7 while the mothers received four intramuscular injections of 3 mg betamethasone sodium and 3 mg betamethasone acetate within 48 h to enhance fetal lung maturation. Compared with pretreatment values, FHR showed a decrease in long- and short-term variations; other parameters, e.g. the number of fetal movements, remained unchanged. However, decreased FHR variation was followed by an increase in the acceleration rate after maternal administration of betamethasone. These modifications were transient and should not lead to unnecessary anxiety or intervention in otherwise normal fetuses.

Betamethasone↗

PubMed1991

Intrapartal cardiotocography in prediction of well-being of small for gestational age newborns.

An attempt to predict neonatal well-being in vaginal delivery was made in groups of 103 term small for gestational age (SGA) and 103 term adequate for gestational age (AGA) newborns, by assessing cardiotocography scores immediately before birth. For assessment, modified Fischer scores (from 0 to 10, normal greater than or equal to 8) and subjective visual scores (from 0 to 6, normal greater than or equal to 5) were used. Modified Fischer scores had a sensitivity of 25% in detecting acidosis (umbilical artery pH less than 7.20) in SGA cases; and of 50%, in AGA cases. Visual scores had a sensitivity of 75 and of 50%, respectively. Specificities in these groups were 64 and 65%, and 56 and 60%, respectively. The positive predictive values in all groups were below 10%. It is concluded that intrapartal cardiotocographic scoring is neither very sensitive nor specific in the prediction of neonatal condition in term vaginal SGA and AGA deliveries.

Acidosis↗

PubMed2004

Ventricular bigeminy misdiagnosed as fetal bradycardia by cardiotocography--the value of non-invasive fetal electrocardiography.

We document the value of non-invasive fetal electrocardiography (fECG) in a case of fetal arrhythmia in which an unnecessary cesarean section was almost performed. The fetal heart rate (fHR) was 60-70 beats per minute (bpm) on the cardiotocography (CTG), with occasional, sudden fluctuations to 130 bpm. This was probably a result of the technical limitations of the CTG.

Adolescent↗

PubMed1994

Indications for operative termination of labor on cardiotocography and fetal blood analysis: the reliability of these methods.

In a retrospective study it was possible to show that of 110 cases with operative delivery, performed due to suspicious or pathological fetal blood acidity findings, 93.6% were justified. A pre-pathological or pathological umbilical cord artery pH of < 7.25 was taken as the basis for correct clinical management ("true" positive cases). There was a clear relationship between the pH of the umbilical artery blood and the clinical state of depression in the newborn. This study shows that, with the help of combined fetal supervision using cardiotocography (CTG) as a screening method and fetal blood analysis (FBA) as a method of differentiation, early stages of threatened fetal acidosis can be reliably detected without having too high a rate of operative deliveries, which must inevitably result when continuous CTG supervision is used on its own. Obstetricians should therefore try to prevent severe acidosis combined with a corresponding clinical state of depression of the newborn. This requires the use of modern monitoring (CTG and FBA) and prompt clinical measures (tocolysis or termination of labor) when the pH levels are reduced or are apparently falling.

Acidosis↗

PubMed1989

Diagnostic potential of cardiotocography (CTG) for silent uterine rupture.

We report on 3 patients with silent rupture of previous uterine scars. Despite continuous monitoring by cardiotocography, diagnosis was not made until the time of surgery. The cesarean section was indicated by the obstetrical-clinical examination, while CTG offered no evidence of uterine rupture.

Adult↗

PubMed2006

Role of pathological cardiotocography in evaluating fetal well-being.

OBJECTIVE: To determine the frequency of pathological pattern of cardiotocography (C.T.G) in antepartum and intrapartum period and to evaluate the significance of those patterns in determining fetal well-being. DESIGN: Analytical study. PLACE AND DURATION OF STUDY: The study was conducted at Lady Dufferin Hospital, Karachi from February 2000 to January 2001. PATIENTS AND METHODS: All women with singleton pregnancies of >35 weeks gestation and cephalic presentations were electronically monitored in antepartum and intrapartum period and those with pathological trace were identified according to International Federation of Obstetricians and Gynaecologists (FIGO) classification. After delivery, Apgar score, fetal cord, blood gas values and neonatal intensive care unit admission duration were examined as the main outcome measures. RESULTS: Among the 3701 patients who qualified for the study, 60 (1.62%) had tracing, classified as pathological, of which 44 (73%) were in the intrapartum and 16 (27%) in the antepartum period. Out of these 60 patients, 53 (88.33%) were delivered alive while neonatal death (NNDs) occurred in 9 (16.9%) of the live born babies. There were 07 (11.6%) still births. In 53 of live born babies, Apgar score was <7 at 1 minute in 34 (64.15 %), while it was >7 at 1 minute in 19 (35.84%). Low Apgar score persisted at 5 minutes in 10 (18.86%) cases of pathological CTG. Out of these 10, there were 3(30%) NNDs, while 6 (13.95%) NNDs occurred in those whose apgar had improved to >7 at 5 minute (P=0.9). Cord pH results were available in 31 (58.49 %) cases and were acidotic (<7.20) in 16 (51.61%), pre-acidotic (7.20-7.25) in 9 (29.03%) and normal (7.25-7.35) in 6 (19.35 %). All alive born babies with a pathological CTG tracing were admitted in NICU as per hospital policy. The duration of admission was less than 24 hours in 15 (28.30 %), 2-4 days in 26 (49%) and more than 4 days in 12 (22.64%). CONCLUSION: In this series, an increased frequency of detectable hypoxia on CTG was observed during the intrapartum period as compared to the antepartum period, however, no significant association was found between a pathological CTG recording, fetal APGAR score and acidemia, if a pathological trace is used alone to assess fetal well-being. An increased cesarean section rate in babies with a pathological CTG stresses on the need for additional tests to differentiate hypoxic from non-hypoxic fetuses thus avoiding unnecessary intervention.

Apgar Score↗

PubMed2005

Comparison between visual and computerized cardiotocography in low risk pregnancy.

OBJECTIVE: To compare between visual and computerized cardiotocography (cCTG) in low-risk pregnant women in predicting pregnancy outcome. METHODS: One hundred and fifty-three consecutive computerized fetal heart tracings were recorded from non-laboring pregnant women at > or = 30 weeks gestation. All traces were reviewed by 2 experienced obstetricians. The study was carried out at Al-Ain Medical District, United Arab Emirates, between August 2004 and December 2004. RESULTS: Of the 153 pregnant women, 11 (7.2%) were delivered by cesarean section. The interobserver agreement was 0.60. The observers cCTG agreement were 0.48 and 0.45. The difference in cesarean section rate was not statistically significant. Observers' interpretation and cCTG did not correlate well with Apgar score at 5 minutes and admission to special care baby unit. CONCLUSIONS: Computerized CTG has little advantage over conventional CTG in the prediction of Apgar score and need for neonatal intensive care unit admission in a low-risk population.

Adult↗

PubMed2001

[Relationship between computerized cardiotocography and perinatal outcomes].

OBJECTIVE: To analyze the relationship between the parameters of computerized cardiotocography (CTG) and perinatal outcomes. METHODS: Three hundred and eight CTG examination in 190 third trimester pregnancy were performed, 46 cases in antepartum, 262 cases in intrapartum. CTG parameters including: baseline fetal heart rate (BHR), the square root of the mean squared differences (RMSSD), the proportion derived by dividing the number of differences greater than 3 beats/min by the total number (NN50), acceleration (AC), deceleration (DC), amplitude of deceleration (AMP), duration of deceleration from BHR to bottom (T1) and duration from bottom to BHR (T2), the ratio of T2 to T1 (T2/T1), square of deceleration (DS), the ratio of AMP to duration of deceleration (H/T), the ratio of DS to the product of AMP multiplied deceleration duration (S/HT), amplitude of uterine contraction (UTAMP), number of uterine contraction (UTNO), duration of uterine contraction (UTDUR), square of uterine contraction (UTS), the ratio of AMP to UTAMP (HR/HU), the ratio of DS to UTS (SR/SU), the ratio of DS to UTAMP (SR/HU). After childbirth record neonatal Apgar scores, amniotic fluid colour (COL) and volume (VOL), umbilical cord arteria blood gas analysis. RESULTS: (1) The fetal heart rate (FHR) baseline and variability . In antepartum, there were significantly relationship between BHR and Apgar (r = 0.460, P < 0.01), RMSSD and COL (r = - 0.389, P < 0.05), NN50 and COL (r = - 0.368, P < 0.05), RMSSD and actual base excess (ABE) (r = 0.904, P < 0.05), NN50 and ABE (r = 0.919, P < 0.05), AC and ABE (r = 0.943, P < 0.05), BHR and SO2 ( r = - 0.895, P < 0.05). But during intrapartum, there were no significantly relationship between the baseline and variability of CTG with the Apgar scores, the quality and color of amniotic fluid, and the indexes of blood gas analysis of umbilical artery blood. (2) The deceleration of FHR. During antepartum there were significantly relationship between Apgar and AMP (r = - 0.472, P < 0.05), Apgar and H/T (r = - 0.526, P < 0.05), COL and AMP (r = 0.447, P < 0.05), COL and H/T (r = 0.543, P < 0.05) . During intrapartum the relationship of COL and T1 was significant (r = - 0.205, P < 0.05), there were significantly relationship between PH and H/T (r = 0.386, P < 0.05), ABE and H/T (r = 0.367, P < 0.05), Apgar and UTDUR (r = 0.149, P < 0.05), Apgar and UTS (r = 0.148, P < 0.05), PO2 and UTS (r = 0.234, P < 0.05), PO2 and UTNO (r = -0.246, P < 0.05), HCO3 and UTAMP (r = - 0.265, P < 0.05), TCO2 and UTAMP (r = - 0.268, P < 0.05), HCO3 and HR/HU (r = 0.385, P < 0.01), TCO2 and HT/HU (r = 0.385, P < 0.01), ABE and HR/HU (r = 0.323, P < 0.05). CONCLUSIONS: In antepartum, the baseline and variability of FHR play a more important role in predicting prenatal outcome than any other parameters; during intrapartum deceleration become more important, but with the affect by uterin contraction, the ratio of HR/HU may be useful during intrapartum.

Amniotic Fluid↗

PubMed2006

[Comparison between computerized cardiotocography analysis in triplet and singleton pregnancies].

OBJECTIVES: Triplet pregnancies have higher perinatal morbidity and mortality rates than singleton pregnancies. In modern perinatology computer cardiotocography is one of the best methods of fetus state assessment. DESIGN: The research was based on computer analysis of cardiotocograph printouts. MATERIALS AND METHODS: The studies were made on 39 pregnant women in 27-36 week of gestation. The women were hospitalized in the Clinic of Perinatology I Department of Gynecology and Obstetrics, Medical University of Lodz and divided into two groups. First consisted of 30 singleton, second of 9 triplet pregnancies. RESULTS: Computer analysis of cardiotocograph printouts was performed and compared between the triplet and singleton pregnancy groups and presented in forms of tables. CONCLUSIONS: In the studded group of triplet pregnancy statistically significant higher number of high episodes, accelerations, fetal movements and signal loss were observed. The Apgar score and arterial cord pH was not different between the both groups.

Cardiotocography↗

PubMed1991

[Diagnosis of disorders of the fetal status using computer-assisted cardiotocography].

The diagnostic system of cardiotocogram analysis in real time scale is described, and the diagnostic data of computer cardiotocography in various periods of os dilatation presented. Analysis of correlations and regressions of the parameters reflecting disorders of the fetal status has shown that the most significant parameter in the diagnosis of fetal status abnormalities is variability from beat to beat.

Adolescent↗

PubMed1993

[Cardiotocography admission monitoring and intermittent intrapartum monitoring for fetal distress in labour].

Cardiotocography (CTG) monitoring on admission was performed in 71 patients for 30 to 60 minutes in a semilateral position. Intermittent intrapartum CTG monitoring were performed in 40 of these patients. Admission monitoring might provide information of fetal basic status and predict asphyxia that could develop during labour. There was less intrapartum asphyxia, lower Apgar score, umbilical artery pH < or = 7.10 and meconium stained amniotic fluid in high-score group than that in medium-score group and low-score group (P < 0.05). Admission monitoring had high predictive value of umbilical cord complication in labour and enable to detect them in the early first stage of labour. Fischer's composite score of FHR of admission monitoring was closely related to that of intermittent FHR monitoring in the late first stage of labour. In this study, it is suggested that admission monitoring is a useful, simple, convenient and noninvasive method for screening fetal basic condition. When continuous FHR monitoring is not available, the intermittent intrapartum FHR monitoring in the late first stage of labour is of importance.

Cardiotocography↗

PubMed1996

Computerised cardiotocography in a high-risk unit in a developing country--its influence on inter-observer variation and duration of recording.

OBJECTIVE: To determine the role of computer-assisted cardiotocography in an obstetric special care unit and its influence on inter-observer variation in interpretation, proposed management and monitoring time. DESIGN: A prospective comparative study. SETTING: The obstetric special care unit, Tygerberg Hospital, W. Cape. STUDY POPULATION: A group of 10 registrars in obstetrics who have had experience in the interpretation of both standard and computer-assisted cardiotocographs. MAIN OUTCOME MEASURES: The influence of method of cardiotocograph recording on inter-observer variation in respect of suggested management of the patient, as well as the observer's opinion of the duration of the recording. RESULTS: Variation in suggested management decreased significantly after assessment of the computer reports, compared with the standard cardiotocographs. While delivery was regarded to be indicated in 3.5% of patients and an immediate repeat of the cardiotocograph in a further 10%, no such action was proposed after evaluation of the computer reports of the same recordings. Thirty-four per cent of tracings were considered to have been too long and 12.5% too short. However, suggested management in 40% of the latter cases seemed inappropriate for tracings regarded as of too short a duration. CONCLUSION: While computer-assisted cardiotocographs significantly decrease inter-observer variation in the proposed management of patients, its cost-effectiveness in an obstetric special care unit in a developing country should be validated, as it might increase monitoring time.

Cardiotocography↗

PubMedDate not supplied

[The duration of the outpatient nonstress test (NST) and the diagnosis of fetal reactivity with noncomputerized cardiotocography, A critical review of 1160 tracings].

STUDY DESIGN: Our purpose was to verify the times of appearance and the relative percentage of fetal reactivity during a nonstress test. The minimum time for each control has been fixed at 30 minutes. To identify fetal reactivity we have observed the conventional patterns of fetal heart rate. MATERIALS AND METHODS: We have examined 1160 cardiotocograms of 483 patients with obstetric low risk controlled by ambulatory NST in the morning and by appointment. We have divided the tracings according to three different periods of pregnancy (< 37, between 37 and 40 and over 40 weeks) and each tracing in three periods of 10 minutes. In each period we have checked the mean values and standard deviations of accelerations, decelerations, uterine contractions and fetal movements. For each patient the total numbers of NST and the type of birth (spontaneous or caesarean section for fetal distress) has been considered. At statistic analysis we have employed "t"-Student test. RESULTS: We have observed a significative difference (p < 0.001) between the presence of fetal reactivity after 20 and 30 minutes and the number of doubtful cases after 30 minutes for the different periods of pregnancy. With minimum time of 30 minutes of NST, an incidence of doubtful cases of 4.48% and an incidence of caesarean section for fetal distress for the same group of 19.27% has been observed, while for all the cases with reactive NST this incidence intrapartum has been of 9.73%. CONCLUSION: Our experience confirms that the optimal duration of NST has been of 30 minutes. We think that this time must be suggested also from prudence, since the noncomputerized cardiotocography is often characterized by false positiveness and low predictability.

Cardiotocography↗

PubMed1997

[Sexual activity, cardiotocographic findings and time of delivery in physiologic pregnancy. Survey of a population controlled by ambulatory cardiotocography].

STUDY DESIGN: Out of 720 patients with physiological pregnancy coming weekly to the cardiotocography service, it was decided to verify if, in comparison with controls, sexual activity after the 37th week, might make some differences as regard to duration of pregnancy, incidence of PROM and cesarean section. RESULTS: Only a small minority was sexually active. From statistical tests it was observed that sexual intercourse coincided with a greater parity, a lower maternal age, a greater number of nonstress test with uterine contractions and an average duration of pregnancy, slightly lower than in controls (38.80 vs 39.76 weeks). Most of the pregnancies over the 40th week and the greatest incidence of cesarean sections due to fetal distress were observed in sexually inactive patients. A sexual activity after the 37th week did not indicate a greater incidence of PROM CONCLUSIONS: According to personal opinion and provided there is not an obstetric pathology, there are advantages and not disadvantages from a less prohibitionist habit concerning sex by the end of the period of pregnancy.

Adolescent↗

PubMed1989

Cardiotocography in cows: A method for monitoring calves during delivery.

Fetal ECG-electrodes and an intrauterine catheter were inserted into 15 Holstein-Friesian cows during their first stage of labor to make a cardiotocogram. Simultaneously, fetal heart rate and intrauterine pressure were recorded until completion of fetal expulsion. Immediatly post partum the viability of the calf was assessed by clinical evaluation and measurements of blood pH, base excess (BE) and pCO(2). Fetal heart rate patterns and their changes were evaluated according to standards used in human medicine. Basal fetal heart rate (90 to 120) in 10 calves gradually increased towards the end of parturition, with a marked loss of variability. Decelerations, coinciding with periods of increased intrauterine pressure, occurred in all cows. When decelerations occurred beyond the end of a contraction the calf was born in a poor condition. Accelerations were only recorded in two cows. Many of the fetal heart rate changes observed were similar to those which in human cardiotocography are considered to be signs of fetal distress. Further investigation is needed to establish the predictive value of fetal heart rate patterns in cows, which would be a welcome addition to improved fetal diagnostics during parturition.

Journal Article↗

PubMed1987

Antepartum cardiotocography.

Antepartum cardiotocography remains a valuable adjunct in the management of the high-risk gravida. Twice weekly use of NST coupled with real-time ultrasound assessment of amniotic fluid volume appear reasonable approaches to testing. More controversial is the use of testing in all pregnancies. Clearly, if one could reduce the perinatal mortality to 1-2/1000, such universal application of testing could be justified. However, more pragmatic concerns, such as personnel and cost constraints have all but prohibited the adoption of this policy. Secondly, in an attempt to improve the predictive reliability of antenatal testing additional evaluation of patients demonstrating diminished AFV or variable decelerations should be considered. More frequent testing or consideration for delivery are reasonable management plans. Finally, the use of acoustic stimulation to reduce the frequency of persistently non-reactive NSTs offers considerable promise. Investigations in this and other techniques of surveillance are ongoing. The best single method remains to be discovered, but utilization of current techniques offers the obstetrician a reliable technique by which to assess fetal well-being.

Acoustic Stimulation↗

PubMed2001

Can cardiotocography prior to induction of labour predict obstetric intervention? A pilot study.

We set out to study the value of cardiotocography (CTG) performed before induction of labour for prolonged pregnancy in predicting obstetric intervention. This was a prospective observational study, based in a district general hospital. We studied 100 consecutive patients who underwent induction of labour for prolonged pregnancy. Cardiotocographs (CTGs) were performed before induction of labour on the tenth day after the estimated date of confinement (290 days). The CTGs were then reviewed without knowledge of the outcome of the induction of labour. Obstetric outcomes were then compared. The main outcome measures were the intrapartum presence or absence of meconium stained liquor and the necessity for obstetric intervention. Ninety per cent of CTGs were normal. There was no difference found between the two groups for operative delivery or the presence of meconium liquor. Caesarean section was more likely in the group with an abnormal CTG before induction of labour, but the possibility of this being due to chance is high in this study. There was one case of undiagnosed growth restriction in the abnormal CTG group. These results may be due to a true lack of difference in obstetric intervention between women with normal or abnormal CTGs prior to induction of labour or more probably an inability to detect a difference in our small study. These baseline data allow the calculations necessary for a more substantive trial.

Journal Article↗