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PubMed1982

A randomized controlled trial of non-stress antepartum cardiotocography.

In a prospective randomized controlled study of non-stress antepartum cardiotocography (CTG), involving 569 tracings in 300 patients, "non-reactive' traces showed a significant association with still-births and neonatal deaths, intrauterine growth retardation, admission to special care baby unit for conditions associated with intrauterine hypoxia, and low Apgar scores at 1 and 5 min. The report of the CTG was made available to the clinician in 144 patients and withheld in 156 patients. With the report available, significantly more patients were allowed to continue their antenatal care as out-patients, and significantly more antenatal in-patients were allowed home. There were no other significant differences in management, or outcome in the two groups.

Clinical Trials as Topic↗
PubMed1982

The value of antenatal cardiotocography in the management of high-risk pregnancy: a randomized controlled trial.

The value of routine regular antenatal cardiotocography (CTG) in the management of high-risk pregnancy was assessed in a prospective randomized controlled study of 353 patients. All patients had a weekly CTG trace during the last 6 weeks of pregnancy and according to the random allocation the tracings were concealed from, or available to, the clinicians. Other methods of assessing fetal welfare were available to both groups. There was no significant difference between the concealed and revealed groups in the timing and mode of delivery, birthweights, Apgar score and neonatal morbidity. No apparent effect from the routine use of antenatal CTG in high-risk pregnancy was shown.

Adolescent↗
PubMed1978

Antepartum stress cardiotocography using buccal oxytocin.

The use of buccal pitocin in the performance of stressed antenatal cardiotocography was studied. Sixty-three tests were performed on 40 patients. All the patients were followed through labour and delivery. The results were evaluated and compared with those where an intravenous oxytocin infusion was used. Buccal pitocin produced comparable uterine contractions to those obtained by intravenous oxytocin, with similar test results. The avoidance of venepuncture and infusion was a positive advantage of this method of applying the stress.

Administration, Oral↗
PubMed1987

The relevance of antenatal cardiotocography.

In a prospective study of 3,083 patients having antenatal cardiotocography it was shown that ominous fetal heart rate traces were most likely to occur when the test was applied in specific 'at risk' situations rather than as a routine screening test, and when the need for monitoring was perceived relatively early in the pregnancy. The majority of ominous traces were not preceded by a normal trace.

Female↗
PubMed1984

Reliability of cardiotocography in predicting baby's condition at birth.

A prospective study of 6825 labours was undertaken to determine the relation between the Apgar scores of the babies at one minute and the cardiotocograph tracing in labour. The sensitivity of an abnormal tracing was 35.2% for babies who needed intermittent positive pressure ventilation and 20.0% for babies who did not but who had Apgar scores of less than 7. The sensitivity of an abnormal tracing for all babies with an Apgar score of less than 7 was 23.2%. The positive predictive value of an abnormal tracing was 8.7% for babies who needed intermittent positive pressure ventilation and 18.7% for babies who did not but who had an Apgar score of less than 7. The positive predictive value of an abnormal tracing was 27.4% for all babies with an Apgar score of less than 7. The specificity of the tracing was 93.4% for babies with an Apgar score of 7 or over. The relatively high incidence of false positive predictions might be explained on the grounds that abnormalities in the cardiotocograph tracing are a more sensitive indicator of hypoxia than the Apgar score. False negative predictions might have been due to adverse factors other than hypoxia--for example, fetal trauma, compression of the head, infection, and analgesia in labour. These findings suggest that the current overdependence on fetal monitoring by cardiotocography alone should be examined and that other reliable indicators for non-hypoxic fetal distress should be sought.

Apgar Score↗
PubMed1986

The importance of antepartum cardiotocography.

The significance of antepartum cardiotocography was examined on patients at the University of Cologne in the years 1982 and 1983. We analyzed 13,310 cardiotocograms of 1,463 women and correlated their pregnancies and deliveries with the status of their newborns. There were only 66 suspect/prepathologic fetal heart rate recordings in 50 patients. All these patients had severe complications during their pregnancies. Impending prematurity, toxemia, first and second trimester bleeding as well as placental insufficiency and polyhydramnios were the leading complications. The analysis of the cardiotocograms using Hammacher's criteria demonstrated that the CTG characteristics "floating line" and "oscillation type" together accounted for the largest proportion (43.9%) to the total score and thus constituted the most important parameters. Fetuses with abnormal CTGs had a birthweight of less than 1500 grams in 30% of the cases. This group also had poorer Apgar scores and umbilical artery pH values than neonates with normal antepartum cardiotocograms. After excluding non-viable malformations the perinatal mortality was 80 per 1000, i.e. it was nine times higher for newborns with abnormal antepartum heart rate patterns. The study demonstrated that abnormal antepartum CTGs in non-selected patients are rare and are always associated with severe complications of pregnancy. Thus, the method is not suitable as a general screening method but should be used for specific indications in high risk pregnancies and for the evaluation of any tocolytic treatment. The recognition of abnormal CTG characteristics requires technically adequate recording and accurate analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Apgar Score↗
PubMed1998

Lack of benefits of left tilt in emergent cesarean sections: a randomized study of cardiotocography, cord acid-base status and other parameters of the mother and the fetus.

OBJECTIVE: To assess the benefits of performing the cesarean section in lateral tilt during active labor. SETTING: University Hospital. PATIENTS: 204 unselected women undergoing cesarean section (21.1% fetal distress, 45.6% cephalo-pelvic disproportion, 26.0% induction failure, 7.4% abnormal presentation) under general (86.8%) or spinal anesthesia (13.2%). DESIGN: Randomized study. INTERVENTION: During anesthesia induction and cesarean section 103 women were in partial left lateralization (20 degrees), whereas the remaining 101 remained in the supine position. MAIN OUTCOME MEASURES: Internal cardiotocography during cesarean section. Umbilical artery acid-base analysis. Newborn evaluation. Maternal hemodynamic parameters. RESULTS: Fetal heart rate during cesarean section was similar in both groups, except for a baseline heart rate which was slightly higher in the lateral tilt group (137.5 +/- 19.2 vs 131.1 +/- 20). The umbilical artery pH values, as well as pCO2, base deficit, CO3H and oxygen saturation were similar in both groups. The pO2 value was significantly lower in the lateral tilt group (14.03 +/- 6.04 Hg mm vs 16.02 +/- 7.65). Newborn evaluation was similar in both groups. The blood pressure and heart rate of the mother during the cesarean section were also similar in both groups. CONCLUSIONS: No benefits were found in performing cesarean section in left lateral tilt.

Acid-Base Equilibrium↗
PubMed1980

Antenatal cardiotocography and intrauterine death.

The purpose of the present study was to elucidate the reliability of antenatal cardiotocography (CTG) in predicting fetal death. During a 4-year period, 1 455 patients eith risk pregnancies have been routinely monitored with antenatal CTG. The total number of tracings amounted to more than 10 000. Five cases of fetal death occurred, in all of which pathological CTG patterns were found. Our experience in the present study indicates that antenatal CTG is a reliable technique for the predicting of fetal death and its use should reduce fetal mortality rates.

Adult↗
PubMed1984

Influence of the beta 1-adrenoceptor blocker atenolol on antenatal cardiotocography.

Forty term patients with pregnancy-induced hypertension were treated with the beta 1-adrenoceptor blocker atenolol (Tenormin R; ICI) for at least 7 days prior to parturition. The antenatal cardiotocography (CTG) was visually analysed before and during treatment. The mean basal fetal heart rate (FHR) decreased from 143 +/- 7 beats per minute (bpm) to 133 +/- 8 bpm. In 13.1% of the recordings in treated patients there was a decrease in long-term variability for a period of more than 20 minutes; this was observed in only 2.3% prior to treatment. The amplitude of the accelerations was reduced from 23 +/- 6 bpm to 18 +/- 4 bpm. It was demonstrated that atenolol affected antenatal CTG, and this has to be taken into consideration when interpreting antenatal CTG as one parameter for evaluation of fetal well-being.

Apgar Score↗
PubMed1978

The evaluation of extended analysis of serum, amniotic fluid and cardiotocography in the management of pregnancy complicated by immunization in Rh or Kell antigens.

The estimation of protein and bilirubin concentration together with checking the activity of LDH, AspAT, AlAT and Ech in maternal serum and amniotic fluid was performed with intention to improve the accuracy of antenatal prediction in hemolytic disease of newborns. With the same intention, the cardiotocography was introduced. After study on forty-six pregnancies, the usefulness of estimation of optical density, protein and bilirubin concentration in amniotic fluid and calculation of bilirubin/protein ratio was confirmed. The other investigated methods appeared useless.

Amniotic Fluid↗
PubMed1985

[Supplementation of antenatal cardiotocography (nonstress test) by nipple self stimulation].

Self-stimulations of nipples were performed in 155 late pregnant women in connection with antenatal cardiotocography (nonstress test). Cardiotocographs were interpreted using an own score. Uterine contractions could be produced by nipple stimulation in 111 women (71.6 per cent). In 13 cases with score 6 to 8 these contraction contributed to explantation of fetal condition. In additional 11 cases with score 9 to 10 the attention was focussed to the reduced fetal or placental capacity by the suspect cardiotocogram. In this group frequency of caesarean section was increased significantly. In cases with successful nipple stimulation the rate of labour induction with effect was higher. Oxytocin liberation by nipple stimulation may be regarded as endogenous oxytocin stress test. This simple procedure which can be done quickly and without danger is supposed to be a good supplement to nonstress test. Its reliability can be improved and the success of induction of labour estimated.

Breast↗
PubMed1979

Selection criteria for antenatal cardiotocography.

The present report considers two questions: 1) Which patients should be monitored routinely and 2) the interpretation of antenatal cardiotocography. During 26 months 812 patients with risk pregnancies were monitored with antenatal CTG. Most of them were daily registered. One hundred and seventeen (14.5%) showed pathological CTG changes. The CTG patterns were put into four classes according to the degree of seriousness. A comparison between high risk and low risk pregnancies showed that nearly all abnormal CTGs occurred in the high risk group. Within the high risk group, patients with essential hypertension and intrauterine growth retardation had pathological CTG changes in 20--30%. The study shows that high risk pregnancies should be monitored regularly at short intervals to allow early diagnosis of fetal distress. The value of routine CTG in low risk pregnancy can be questioned.

Echocardiography↗
PubMed1979

[Cardiotocography -- proposal of system solution (author's transl)].

A system solution with new technical details and new demands on space distribution is proposed for the use of antenatal cardiotocography and cardiotocographic monitoring of labour. Bedside equipment will be reduced and widely shifted to a centralised control room by introduction of the system. All installations are of high flexibility to leave room for future developments in medical engineering and for necessary services. -- Large-scale use of the new technique with capacity utilisation of the hardware involved will be ensured by appropriate upgrading of labour room personnel as well as by techno-organisational improvement of work and minimisation of expenses on diagnosis and monitoring. The measures proposed work according to expectation and lead to good perinatological results.

Female↗
PubMed1983

Antepartum non stress cardiotocography and quantified short term variability of foetal heart rate in high-risk pregnancies.

The clinical significance of non-stress cardiotocography (CTG) and antepartum quantified short-term variability (differential index = DI) of foetal heart rate (FHR) were assessed for prediction of foetal outcome in 461 high-risk pregnancies. The analysis of FHR variability were made by a microprocessor based on-line method which utilizes abdominal foetal electrocardiogram (aFECG) as a triggering signal. In 24 pregnancies no acceptable aFECG was obtained. CTG was classified as pathological in 167 pregnancies (36%), and DI was abnormal in 74 pregnancies (15%) in the last test before delivery. Foetal distress developed in 97 pregnancies. There were no antepartum foetal deaths, but six newborn infants died (perinatal mortality 1.3%). CTG was more sensitive but less predictive, and less specific than DI. Risk of foetal distress after a pathological CTG was 8.9 times that after a normal CTG (relative risk, p less than 0.001), and after a pathological DI 8.0 times that after a normal DI (p less than 0.001). Both tests were pathological in 64, and both normal in 265 cases. The risk of foetal distress after combined pathological tests was 20.3 times that after normal combined tests (p less than 0.001). These results suggest that prediction of foetal outcome may be improved by combining CTG and DI. Since the false abnormal rate of CTG was high, further evaluation is required. DI picked out 74 of 86 cases with false abnormal CTGs. These results suggest that DI could be used for further testing of abnormal CTGs.

Electrocardiography↗
PubMed1978

[Value of the abdominal electrocardiogram for cardiotocography (author's transl)].

The value of abdominal Electrocardiogram (abd. ECG) for cardiotocography has been studied prospectively in 183 ante- and 93 subpartum patients. The indications for using abd. ECG have been worked out and the influence of various factors on the quality of registration were tested. It was found that neither location of the placenta nor obesity nor the state of the membranes influenced the quality of abd. ECG-records. Furthermore abd. ECG was used successfully in cases with advanced labor.

Body Height↗
PubMed1981

Usefulness of cardiotocography in expulsion period.

When an expulsion-period cardiotocographic record is examined, the most important factors, to be carefully controlled, are foetal cardiac frequency, its irregularities, the presence of decelerations and, above all, the appearance of final bradycardia. The Authors have studied 196 cardiotocographic records taken in expulsion period. Apart from the above mentioned factors, they looked for correlations between pathological pictures and parity, length of expulsion period and Apgar score. Satisfactory results lead them to conclude that cardiotocography is indispensable also in expulsion period.

Bradycardia↗
PubMed2004

Quality of intrapartum cardiotocography in twin deliveries.

OBJECTIVE: Intrapartum fetal heart rate (FHR) recordings in twins were compared for fetal signal loss during both stages of labor to assess the quality of these recordings by the method that had been used: external ultrasound or directly via a scalp electrode. STUDY DESIGN: Analysis of recordings collected between January 1, 1994, and January 1, 2002, from consecutive twin deliveries at the Vrije Universiteit Medical Center in Amsterdam. One hundred seventy-two twins that delivered via the vaginal route were included in the study. FHR recordings had a duration of at least 1 hour before the birth of the second twin. Subdivision took place on the basis of the recording technique, ie, ultrasound or scalp electrode. FHR data was obtained with HP-M1350 cardiotocographs. The status (pen on, pen off, maternal signal) and the mode of the signals were acquired. The duration of pen lifts and maternal signals was divided by the total duration of the recording. Statistical analyses were performed with the Mann-Whitney U test and the Wilcoxon signed ranks test. RESULTS: Recordings obtained via ultrasound demonstrated significantly more fetal signal loss than those obtained via the direct mode, particularly in the second stage. Approximately 26% to 33% of first stage and 41% to 63% of second stage ultrasound intrapartum FHR recordings in twins exceeded the International Federation of Gynecology and Obstetrics (FIGO) criteria for fetal signal loss. CONCLUSION: Intrapartum FHR monitoring via ultrasound provides far poorer quality FHR signals than the direct mode. The direct mode deserves a more prominent position in fetal surveillance than it currently has.

Adult↗