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At least 145 records · Page 8Linked to original sources
PubMed2000

[Validity of cardiotocography in acute fetal hypoxia--neonatal status after cesarean section].

OBJECTIVE: Judging the validity of CTG monitoring as a method of acute foetal hypoxia diagnosis (AFH), quantifying the number of cesarean section (SC), performed from the indication of acute fetal hypoxia and point out a number of surgeries based on false positive CTG results. DESIGN: Retrospective study. SETTING: 1st Department of Obsterics and Gynaecology Faculty of Medicine MU, Brno. METHODS: 100 women, patients of the 1st Department of Obstetrics and Gynaecology in Obilní trh, Brno, who had cesarean section due to foetal hypoxia indicated on the base of pathological or suspect CTG, were involved in the collection. In the next stage newborns were divided into 2 clinical groups: "Acidosis" and "Normal" depending on the pH value from a. umbilicalis and statistically analysed. RESULTS: From 100% suspect or pathological CTG, only 36.19% were valid (newborns showed depression after birth). Remaining 63.18% of newborns, although showed CTG signs of hypoxia were born normal and probably were not necessary to be born by cesarean section. CONCLUSION: Although CTG investigation is in most places the only "objective" method for diagnosis of AFH, this investigation cannot precisely determinate whether hypoxia is present or it is not. For true objectivity of foetal intrauterine condition and correct indication of SC is suitable to use further diagnostic methods of AFH in future, for example intrapartal foetal pulse oximetry or blood analysis from foetal scalp.

Acute Disease↗
PubMed2000

[Pre-partum cardiotocography: comparison between the traditional and the computed systems].

The objective of our study was to determine the usefulness of a computerized antepartum fetal heart rate (FHR) analysis instead of the common visual evaluation of cardiotocographic parameters. From a total of 4,000 antepartum FHR tracings performed in our institute in the years 1994-1996, and analyzed on-line by the software HP 2CTG, 100 were visually assessed by five physicians in three different moments. To each reader a qualitative and quantitative interpretation was required. With use of k coefficient, we have analyzed the differences in observer's qualitative interpretation, then, with use of the intraclass correlation coefficient (RINTRA) and the contingency table X2 we have compared the quantitative analysis with that of the computer. Our results show that variability is the most difficult parameter to interpret, so that the interobserver agreement isn't in anyway sufficient (k 0.43). The agreement between observers on the clinical judgment of the FHR traces proves to be low (k 0.54). The agreement between each of the observers and the computer readings is good for the estimation of the FHR (RINTRA between 0.96 e 0.98) and low for the mean term variability (RINTRA between 0.81 and 0.58). There is a valuable agreement with the computer for tracings with 0 or 1 large acceleration (94.7% and 97.5% respectively), but it is significantly poorer (p < 0.001) for tracings with 0 or 1 small acceleration (57.4% and 50.8% respectively). Decelerations are the most difficult pattern of interpretation. Usually observers do not identify 36% of the FHR traces having at least one deceleration according to computer analysis. Our study confirms the wide variability in fetal monitoring interpretation, a difficulty which can be overcome thanks to a computerized analysis.

Cardiotocography↗
PubMed2001

[Epidural obstetrical analgesia and cardiotocography].

OBJECTIVE: The increase of cardiotocographic abnormalities, such as late decelerations, bradycardia and reduced variability have been reported with epidural analgesia (EDA) in some studies. The aim of our study was to assess the influence of epidural analgesia on the incidence of the pathological cardiotocographic patterns. DESIGN: A clinical study. SETTING: Department of Obstetrics and Gynaecology, Jessenius Medical Faculty of Comenius University, Martin, Slovak Republic. METHODS: Clinical group consists of 200 parturients, who borne in our department from 1997 to 2000. The epidural group of parturients (n = 100) borne under epidural analgesia, the control group of (n = 100) borne under other resp. no analgesic method. We compared BFHR, variability and the incidence of accelerations and decelerations in CTG between both groups. All cardiotocographic patterns were evaluated by Fischer score. For statistic evaluation was used Student t-test. RESULTS: We did not find any statistically significant differences in Fischer score between epidural and control group. CONCLUSION: The epidural labour analgesia is safe method of ease pain during labour. In our study we confirmed, that EDA is not responsible for the increase of pathological cardiotocographic patterns.

Analgesia, Epidural↗
PubMed2002

[Use of oxi-cardiotocography in twin delivery].

The intrapartum management of multiple gestation continues to challenge the obstetrics profession. Electronic fetal heart rate monitoring and fetal pulse oximetry are used in clinical research to assess fetal well-being during labor. The objective of this study was to establish values of fetal arterial oxygen saturation (FSpO2) and some other parameters by dint of computerised analysis of cardiotocogram during twin delivery. 5 cases of vaginal twin deliveries as the Clinic of Perinatology of the Institute of Gynecology and Obstetrics Lodz Mecical University over the years 1988-1999 were reviewed. In four cases vertex-vertex twins were delivered vaginally, while in one case an assisted breech extraction was conducted on vertex-non vertex twins. The foetus was monitored continually with a Oxford S 8000 systems and pulse oximeter Nellcor N-400. the medium parameters of computerised analysis of CTG and FSpO2 during progressive stages of labour were shown. Twin delivery needs modern fetal monitoring tools to provide the obstetrician information on well-being of the foetus. It is possible to monitor fetal oxygen saturation and CTG parameters in both of the twins during labour The ability to measure fetal oxygen saturation especially during the second stage of twin labor adds critical information about fetal status and refines the interpretation of abnormal FHR patterns. Only after examining a large number of twin fetuses we can assess whether pulse oximetry in useful in management of labor.

Cardiotocography↗
PubMed2002

[Antepartal cardiotocography and doppler flowmetry in the diagnosis of fetal hypoxia ].

OBJECTIVE: To evaluate by analysis of the most serious obstetric cases during a five-year period the contribution of ante-partum CTG and Doppler flowmetry in the diagnosis of foetal risk and to assess the part of risk factors of hypoxia during pregnancy. DESIGN: Retrospective epidemiological analysis. SETTING: Gynaecological and Obstetric Clinic Medical Faculty Palacký University and Faculty Hospital Olomouc. METHOD: In a retrospective analysis based on 6494 deliveries during a five-year period (1996-2000) the authors evaluate a selected sample of 1087 most serious conditions with the diagnosis of imminent foetal hypoxia. In the evaluated group 90.3% of the women had a cardiotocographic examination, 50.8% Doppler flowmetry with assessment of umbilical RI and PI indexes. The diagnosis of neonatal hypoxia was based on evaluation according to Apgar score < 7 and pH of arterial blood < 7.20. The authors compare both diagnostic methods with a common gold standard as regards their ability to predict hypoxia. In the logistic regression model they evaluate risk factors of pregnancy in relation to foetal hypoxia. RESULTS: Clinical manifestations of hypoxia were recorded in 114 neonates (10.5%). Perinatal deaths occurred in 46 infants, 16 were stillborn. Pathological ante-partum CCTG findings are associated with more active approaches (earlier termination of pregnancy, SC, preinduction by prostaglandins). Pathological ante-partum CTG and flowmetry was paradoxically more frequently associated with a better condition of the neonate. Pathological findings of ante-partum CTG were significantly less frequent in neonates with hypoxia than those without it (27%) vs. (40.9%), (relative risk 0.56 [95% CL 0.36-0.88], P = 0.01) while pathological findings of umbilical flowmetry were insignificantly more frequent (34.9%) vs. (33%), (relative risk 1.08 [95% Cl 0.59-1.97], P = 0.9). Both examinations were made in 547 (50.3%) women of the whole group, in 43 (7.9%) hypoxia of the foetus developed. Sensitivity: CTG 32.6%, Doppler 34.9%, Specificity: CTG 51.4%, Doppler 67.3%. Falsely positive CTG 48.6%, Doppler 32.7%. Analysis of risk factors of pregnancy in relation to foetal hypoxia defines by retrospective elimination as significant risks haemorrhage during pregnancy (n = 76, OR 2.35 [95% Cl 1.31-4.23], P = 0.01) and premature delivery (n = 258, OR 2.02 [95% Cl 1.34-3.05], P = 0.0004). CONCLUSION: The value of ante-partum CTG and Doppler flowmetry in the prognosis of neonatal hypoxia is low. The lower rate of pathological findings in affected neonates is probably associated with the fact that part of the hypoxias develop during delivery and cannot be predicted before delivery. The high number of falsely positive findings may by due by the adaptational abilities and reserves of the infant, by a more active approach when there are signs of danger and incorrect interpretation of findings. Premature delivery and haemorrhage are significant risks of neonatal hypoxia.

Adult↗
PubMedDate not supplied

[The study of effects of geomagnetic disturbances at high latitudes on the intrauterine condition of fetus by cardiotocography].

The effect of geomagnetic disturbances on the intrauterine condition of the fetus in high latitudes was studied by comparing the index of fetus condition (IFC) with the heliogeophysical indices (planetary Kp index and Dst variation index). The functional state of fetus at late terms of pregnancy was assessed by the method of cardiomonitoring. The data of fetal cardiomonitoring were processed by the method of Prof. Demidov by calculating the integral IFC using a computer program. It was found that the variations in maximum IFC values (approximately 15% of the total number of cases) coincide with seasonal variations in geomagnetic disturbances. The maximum values of IFC were observed at the equinox (March-April-May, October-November), and the minimum values were registered in the period of the solstice. A comparison of IFC values with the indices of geomagnetic disturbances indicated that the IFC value was maximum in the periods of either the greatest weakening of geomagnetic activity or maximum disturbances.

Arctic Regions↗