Topics

Intra-uterine Fetal Brain Activity Monitoring.

2019-05-02 16:17:36 | BioPortfolio

Summary

Fetal cardiac monitoring is used during labor. Fetal decelerations may imply fetal hypoxia and distress. Brain activity monitoring is not used to evaluate fetal distress during labor. In this study the investigators intend to use an EEG based algorithm to evaluate and monitor fetal brain activity during the 2nd stage of labor.

Description

Fetal heart rate (FHR) monitoring is commonly used in order to reduce fetal intrapartum asphyxia or any associated long-term disabilities. The electronic fetal monitoring (EFM) was first described by Hon and others during the 1960s (1) (2) and introduced into clinical practice before any clear evidence of benefits had been demonstrated.

The EFM records the fetal heart rate, and characteristics such as baseline, accelerations, decelerations and variability are constantly evaluated in order to assess the hypoxic condition of the fetus and to identify fetal distress.

Nevertheless, most of the studies (3-5) demonstrated that abnormal patterns of the fetal heart rate are of low predictive value for intrapartum fetal hypoxia or metabolic acidosis. Among high-risk pregnant woman, the probability of fetal metabolic acidosis in the presence of repeated, variable decelerations is 25%, and 48% in the presence of late decelerations (6). According to the Cochrane review (7) EFM didn't decrease the rates of cerebral palsy (CP), asphyxias complications or perinatal morbidity. The positive predictive value of non-reassuring FHR patterns for the prediction of CP among singleton newborns with birth weight of 2500 grams or more is only 0.14% (8).

Hypoperfusion to a certain brain areas involves the rapid loss of brain function due to disturbances in brain blood supply. EEG shows typical changes in brain ischemia. These changes include: attenuation of faster waves, particularly in the beta and alpha frequency bands; enhancement of slower waves, mainly in the delta frequency band; regional attenuation without delta enhancement (RAWOD) and reduction of variability in the EEG signal (9). However, reaching effective sensitivity and specificity in immediate brain ischemia detection on the basis of EEG changes is still considered a challenge, as it depends on the presence of a skilled expert in neurophysiology to analyses raw EEG data in real-time.

The investigators developed a unique platform algorithm, which analyses EEG data, and recognizes patients suffering from brain ischemia (stroke), based on the phenomena of interhemispheric decreased synchronization. Interhemispheric synchronization is the measure of correlation in EEG activity between ipsilateral and contralateral hemispheres, where values range between 1 (complete synchronization) and 0 (no synchronization). Increased synchronization means greater correlation between related ipsilateral and contralateral activities and vice versa for decreased synchronization. Normal brains should have a high correlation/ synchronization. Once brain ischemia occurs and the hemisphere is damaged, the interhemispheric synchronization decreases. In a recent study, we have shown the decrease in synchronization when a certain part of the brain is anaesthetized, causing a lesion similar to brain ischemia, and the recovery of synchronization, when the anesthesia recovered2. In another study, the investigators have tested the reliability of the algorithm in patients undergoing mechanical thrombectomy for acute stroke. In the study patients with acute stroke admitted to neuro angio intervention undergone short EEG test for 5 minutes. At the end of the procedure patients underwent a second short EEG test. In the test the interhemispheric synchronization were analyzed. It was shown that patients admitted to the neuro-angio intervention, who had brain tissue that might be salvable, had an average synchronization of 0.8. If the procedure succeeded and there was a clinical improvement - the synchronization remained high. If the procedure did not succeed, or succeed without clinical improvement, the synchronization decreased to an average of 0.65. Importantly, patients who were not candidates for neuro intervention, because they didn't have salvable brain, their index of synchronization was low to begin with (figure 1a and 1b). This preliminary assay proves the ability of the synchronization index to detect brain hypoperfusion that occurs, for example, in stroke.

The objective of this proof of concept study is to test whether there is a correlation between the EEG index of interhemispheric synchronization, to the umbilical PH of the newborn and to the gold standard fetal heart rate monitor.

Study Design

Conditions

Fetal Hypoxia

Intervention

Electroencephalogram

Status

Not yet recruiting

Source

Rambam Health Care Campus

Results (where available)

View Results

Links

Published on BioPortfolio: 2019-05-02T16:17:36-0400

Clinical Trials [672 Associated Clinical Trials listed on BioPortfolio]

Antenatal Allopurinol During Fetal Hypoxia

A former study (submitted) in 32 severely asphyxiated infants participating in a randomized double blind study, in which early postnatal allopurinol or a placebo (within 4 hours after birt...

Electrophysiology of Fetal Arrhythmia

Fetal research and clinical practice has been hampered by a lack of suitable investigational techniques. Currently, ultrasound is the only widely used method of studying fetal anatomy and ...

Evaluation of Fetal Cardiac Function and Vascular Heamodynamics in Intrauterine Growth Restriction

Intrauterine growth restriction (IUGR) is one of the major contributors to perinatal mortality and morbidity and is characterized by complex hemodynamic changes involving placental and fet...

Studies on the Adaptive Responses to Hypoxia

The general aim of this study is to define the response to hypoxic challenge in patients with diabetes. The investigation will provide response for different questions that are central for...

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...

PubMed Articles [2195 Associated PubMed Articles listed on BioPortfolio]

Normobaric oxygen treatment improves neuronal survival functional recovery and axonal plasticity after newborn hypoxia-ischemia.

Newborn hypoxia ischemia (HI) is one of the most prevalent cases in the emergency and can result from fetal hypoxia during delivery. In HI, restricted blood supply to the fetal brain may cause epileps...

Saltatory Pattern of Fetal Heart Rate during Labor Is a Sign of Fetal Hypoxia.

While late decelerations and major bradycardia episodes in intrapartum cardiotocography (CTG) recordings are known to correlate with fetal distress,little is known of the importance of the saltatory p...

Response to category II tracings: Does anything help?

Electronic fetal monitoring (EFM) is the most commonly used tool to screen for intrapartum fetal hypoxia. Category II EFM is present in over 80% of laboring patients and poses a unique challenge to ma...

Umbilical artery thrombosis: Two case reports.

The umbilical cord is the way to exchange gas, supply nutrients, excrete metabolized. Thrombosis of the umbilical cord leads to fetal hypoxia, which jeopardizes fetal health and can cause fetal death....

EX-UTERO EXTRACORPOREAL SUPPORT AS A MODEL FOR FETAL HYPOXIA AND BRAIN DYSMATURITY.

Congenital heart disease (CHD) is associated with abnormal fetal brain development, a phenomenon that may be related to decreased cerebral oxygen delivery in utero. We utilized an artificial womb mode...

Medical and Biotech [MESH] Definitions

Deficient oxygenation of FETAL BLOOD.

Dioxygenase enzymes that specifically hydroxylate a PROLINE residue on the HYPOXIA-INDUCIBLE FACTOR 1, ALPHA SUBUNIT. They are OXYGEN-dependent enzymes that play an important role in mediating cellular adaptive responses to HYPOXIA.

A nonreassuring fetal status (NRFS) indicating that the FETUS is compromised (American College of Obstetricians and Gynecologists 1988). It can be identified by sub-optimal values in FETAL HEART RATE; oxygenation of FETAL BLOOD; and other parameters.

A complication of pregnancy in which the UMBILICAL CORD wraps around the fetal neck once or multiple times. In some cases, cord entanglement around fetal neck may not affect pregnancy outcome significantly. In others, the nuchal cord may lead to restricted fetal blood flow, oxygen transport, fetal development, fetal movement, and complicated delivery at birth.

Prenatal interventions to correct fetal anomalies or treat FETAL DISEASES in utero. Fetal therapies include several major areas, such as open surgery; FETOSCOPY; pharmacological therapy; INTRAUTERINE TRANSFUSION; STEM CELL TRANSPLANTATION; and GENE THERAPY.

More From BioPortfolio on "Intra-uterine Fetal Brain Activity Monitoring."

Quick Search

Relevant Topics

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...

Cardiology
Cardiology is a specialty of internal medicine.  Cardiac electrophysiology : Study of the electrical properties and conduction diseases of the heart. Echocardiography : The use of ultrasound to study the mechanical function/physics of the h...


Searches Linking to this Trial