Can the reproducibility of fetal heart rate baseline estimation be improved?

Ayres-de-Campos, Diogo; Bernardes, João; Maršál, Karel; Nickelsen, Carsten; Mäkäräinen, Leo; Banfield, Philip; Xavier, Pedro; Campos, I

doi:10.1016/s0301-2115(03)00191-x

Cited by 27 publications

(25 citation statements)

References 17 publications

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“…There is an urgent need to develop noninvasive methods that provide complementary information on fetal well-being and that can be used ante-and intrapartum. Indeed, there are substantial variations in the interpretation FHR patterns [4][5][6][7] . In our study, we observed a discordance of 41.6% in interpretation using the NCHID classification method, and similar results can be found in the literature [8][9][10] .…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, FHR monitoring has some limitations. One of its main disadvantages is the substantial variations that can occur in the interpretation of FHR patterns [4][5][6][7] , even when using standardized classification methods (3-or 5-tier approaches, used according to the risk of fetal acidosis) [8][9][10] . The second concern is the low level of efficacy in the use of FHR-pattern analysis to predict neonatal outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Fetal Heart-Rate Variability: Validation of a New Continuous, Noninvasive Computerized Analysis

Garabédian

Butruille²,

Servan-Schreiber³

et al. 2016

Gynecol Obstet Invest

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Objective: We developed a computerized heart-rate variability index related to the fetal parasympathetic activity: the Fetal Stress Index (FSI). The objective was to determine whether the FSI is related to the visual analysis of the fetal heart rate (FHR). Methods: Thirty tracings recorded at a labor ward were classified according to the NICHD categories: (I) normal FHR tracing, (II) intermediate risk of acidosis, and (III) high risk. FSI was calculated as minimum, maximum, and mean, and was evaluated before the onset of the FHR pattern, during the 10 min following, and between 10 and 20 min after that. Results: The FSI for categories II and III was similar to that of category I before the onset of the FHR pattern. FSI min was lower just after the onset of the abnormal FHR in category III, compared with that of category I (33 vs. 43, p < 0.001). Between 10 and 20 min after the onset of the abnormal FHR, we observed a significant reduction in FSI min in categories II and III (44 vs. 39 vs. 29.7, p < 0.0001). Conclusion: Although further studies are necessary for the sake of clinical validation, FSI could constitute an interesting method for the evaluation of fetal well-being.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fetal Heart-Rate Variability: Validation of a New Continuous, Noninvasive Computerized Analysis

Garabédian

Butruille²,

Servan-Schreiber³

et al. 2016

Gynecol Obstet Invest

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“…Visual analysis of FHR tracings has been demonstrated to suffer from significant intra and interobserver disagreement, both in identification of basic FHR features (accelerations, decelerations and variability) [6] and in overall classification of tracings [7]. Appropriate training and use of consensus guidelines do not appear to solve this problem, although some improvements can be achieved in baseline estimation [24]. Computerized analysis remains the best alternative to obtain a completely reproducible and quantitative analysis of FHR tracings.…”

Section: Foetal Heart Rate Analysismentioning

confidence: 99%

The persistent challenge of foetal heart rate monitoring

Bernardes

Ayres-de-Campos

2010

Current Opinion in Obstetrics &Amp; Gynecology

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FHR monitoring needs to be used with realistic expectations. Acquisition, storage and analysis of tracings according to available guidelines need to be guaranteed. Integration of data with foetal blood sampling and foetal ECG analysis during labour, and with umbilical artery blood flow analysis or the biophysical profile in the antepartum period, may further improve clinical decisions. Central monitoring stations and computer analysis are becoming more widespread and are currently undergoing wide clinical evaluation. Research, development and training need to take into account recent guidelines outlining the main issues in these fields.

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“…FHR baseline, as the mean FHR in the absence of fetal activity and uterine contractions, conveys information especially about the intrinsic activity of the heart [12,30,31]. Short and longterm variability reflect the interaction between sympathetic and parasympathetic systems, expressing the influence of external and internal stimuli that can affect the fetus, namely from its central nervous system [24,28,29].…”

Section: Significance and Computation Of Entropy And Frequency Domainmentioning

confidence: 99%

Frequency Domain and Entropy Analysis of Fetal Heart Rate: Appealing Tools for Fetal Surveillance and Pharmacodynamic Assessment of Drugs

Gonçalves

Rocha²,

Ayres-de-Campos³

et al. 2008

CHDDT

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Recently, frequency domain and entropy analysis of fetal heart rate (FHR) have been assessed in several studies, providing new insights into physiologic regulatory mechanisms, constituting appealing tools for pharmacodynamic assessment, namely during fetal life. There is evidence that entropy and frequency domain analysis convey information on cortical and autonomic nervous system activities, respectively. Use of internal versus external FHR acquisition sensors and the signal sampling frequency may dramatically affect results. Most FHR frequency domain indices are significantly increased with rising fetal activity, namely during active wakefulness and active sleep, whereas the opposite occurs with nonlinear indices. This is in favour of increased activity of the autonomous nervous system and decreased activity of the central nervous system complexity control systems, during periods of fetal activity. Progression of labor is associated with a significant increase in FHR frequency domain indices, whereas entropy indices are significantly decreased. This denotes activation of the autonomic nervous system in the final minutes of labour, associated with decreased central nervous system activity. The emerging knowledge on FHR frequency domain and entropy analysis substantiates a continued interest of these methods in evaluation of the fetal pathophysiologic regulatory mechanisms, and opens new perspectives for clinical and pharmacodynamic assessment.

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Can the reproducibility of fetal heart rate baseline estimation be improved?

Cited by 27 publications

References 17 publications

Fetal Heart-Rate Variability: Validation of a New Continuous, Noninvasive Computerized Analysis

Fetal Heart-Rate Variability: Validation of a New Continuous, Noninvasive Computerized Analysis

The persistent challenge of foetal heart rate monitoring

Frequency Domain and Entropy Analysis of Fetal Heart Rate: Appealing Tools for Fetal Surveillance and Pharmacodynamic Assessment of Drugs

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