Advertisement

Topics

Fetal electrocardiography ST analysis for intrapartum monitoring: a critical appraisal of conflicting evidence and a way forward.

08:00 EDT 10th April 2019 | BioPortfolio

Summary of "Fetal electrocardiography ST analysis for intrapartum monitoring: a critical appraisal of conflicting evidence and a way forward."

In the past century, some areas of obstetric including intrapartum care have been slow to benefit from the dramatic advances in technology and medical care. Although fetal heart rate monitoring (cardiotocography, CTG) became available a half century ago, its interpretation often differs between institutions and countries, its diagnostic accuracy needs improvement, and a technology to help reduce the unnecessary obstetric interventions that have accompanied the CTG is urgently needed. During the second half of the 20 century, key findings in animal experiments captured the close relationship between myocardial glycogenolysis, myocardial workload, and ST changes, thus demonstrating that ST waveform analysis of the fetal ECG can provide information on oxygenation of the fetal myocardium and establishing the physiological basis for the use of ECG in intrapartum fetal surveillance. Six randomized controlled trials (RCTs), 10 meta-analyses, and more than 20 observational studies have evaluated the technology developed based on this principle. Nonetheless, despite this intensive assessment, differences in study protocols, inclusion criteria, enrollment rates, clinical guidelines, use of fetal blood sampling, and definitions of key outcome parameters, as well as inconsistencies in RCT data handling and statistical methodology, have made this voluminous evidence difficult to interpret. Enormous resources spent on RCTs have failed to guarantee the generalizability of their results to other settings or their ability to reflect everyday clinical practice. The latest meta-analysis used revised data from primary RCTs and data from the largest RCT from the USA to demonstrate a significant reduction of metabolic acidosis rates by 36% (odds ratio, 0.64; 95% confidence interval 0.46-0.88) and of operative vaginal delivery rates by 8% (relative risk, 0.92; 95% confidence interval, 0.86-0.99), compared with CTG alone.

Affiliation

Journal Details

This article was published in the following journal.

Name: American journal of obstetrics and gynecology
ISSN: 1097-6868
Pages:

Links

DeepDyve research library

PubMed Articles [22745 Associated PubMed Articles listed on BioPortfolio]

Implementation of a novel continuous fetal Doppler (Moyo) improves quality of intrapartum fetal heart rate monitoring in a resource-limited tertiary hospital in Tanzania: An observational study.

Intrapartum Fetal Heart Rate (FHR) monitoring is crucial for the early detection of abnormal FHR, facilitating timely obstetric interventions and thus the potential reduction of adverse perinatal outc...

Routines for intrapartum fetal monitoring are important, but why and how they are used even more so.

Recently Kaasen et al describe clinical routines for intrapartum fetal monitoring in all Norwegian birth units (1). All units had Pinard stethoscope, hand-held Doppler and CTG. Half of the units used...

Cardiotocography alone vs. cardiotocography with ST segment analysis for intrapartum fetal monitoring in women with late-term pregnancy. A randomized controlled trial.

Randomized studies have obtained conflicting results regarding the usefulness of fetal electrocardiographic (ECG) ST-segment analysis, possibly because these studies included non-homogeneous populatio...

National survey of routines for intrapartum fetal monitoring in Norway.

This study describes clinical routines for intrapartum fetal monitoring in Norway and compliance with national clinical recommendations.

Non-invasive fetal electrocardiography for the detection of fetal arrhythmias.

To assess whether non-invasive fetal electrocardiography (NI-FECG) enables the diagnosis of fetal arrhythmias.

Clinical Trials [6887 Associated Clinical Trials listed on BioPortfolio]

Antepartum Cardiotocography With and Without Computer Analysis in High Risk Pregnancies

Electronic fetal hear rate monitoring (EFM), or cardiotocography (CTG), records changes in fetal heart rate and their temporal relationship to uterine contraction. It has been developed wi...

Moyo; strap-on Fetal Heart Rate Monitoring in a Rural Setting

Annually, an estimated 2.6 million still births occur half of which die during labor and delivery (fresh stillbirths). In addition, around 750,000 newborns die shortly after birth due to i...

Moyo; strap-on Fetal Heart Rate Monitoring in an Urban Setting

Annually, an estimated 2.6 million still births occur half of which die during labor and delivery (fresh stillbirths). In addition, around 750,000 newborns die shortly after birth due to i...

Determinants of Fetal Inflammatory Exposure at Term

The hypothesis of this study is that maternal and fetal biologic variation in the balance between pro-inflammatory and anti-inflammatory mediators can be measured by currently available te...

Use of Intrapartum Biophysical Profile When Fetal Heart Rate Monitoring is Non-reassuring in Labor

In this research project the investigators want to figure out whether ultrasound (a non-invasive method) can be used to assess how the fetus is doing during labor.

Medical and Biotech [MESH] Definitions

Physiologic or biochemical monitoring of the fetus. It is usually done during LABOR, OBSTETRIC and may be performed in conjunction with the monitoring of uterine activity. It may also be performed prenatally as when the mother is undergoing surgery.

Measurement or recording of contraction activity of the uterine muscle. It is used to determine progress of LABOR, OBSTETRIC and assess status of pregnancy. It is also used in conjunction with FETAL MONITORING to determine fetal response to stress of maternal uterine contractions.

Comprehensive, methodical analysis of complex biological systems by monitoring responses to perturbations of biological processes. Large scale, computerized collection and analysis of the data are used to develop and test models of biological systems.

A system of safety management (abbreviated HACCP) applied mainly to the food industry. It involves the analysis and control of biological, chemical, and physical hazards, from raw material production, procurement and handling, to manufacturing, distribution and consumption of finished products.

Critical care treatment using intensive monitoring and aggressive management of perioperative hemodynamics in high risk patients,

Advertisement
Quick Search
Advertisement
Advertisement

 


DeepDyve research library

Relevant Topics

Obstetrics and gynaecology
Fertility Menopause Obstetrics & Gynaecology Osteoporosis Women's Health Obstetrics and gynaecology comprises the care of the pregnant woman, her unborn child and the management of diseases specific to women. Most consultant...

Cardiovascular disease (CVD)
Acute Coronary Syndromes (ACS) Blood Cardiovascular Dialysis Hypertension Stent Stroke Vascular Cardiovascular disease (CVD) includes all the diseases of the heart and circulation including coronary heart disease (angina...


Searches Linking to this Article