Cesarean section, fetal monitoring, and perinatal mortality in California.

Williams, Ronald L.; Hawes, Warren E.

doi:10.2105/ajph.69.9.864

Cited by 54 publications

(8 citation statements)

References 17 publications

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“…The percentage of deliveries with no reported complication fell from 70% in 1970 to 39% in 1984 (Shiono et aL, 1987). and Williams and Hawes (1979) document a suong correlation between the percent of deliveries by cesarean-section and the proportion of labor electronically monitored across California hospitals in 1977. However, cesarean section rates grew within diagnosis as well.…”

Section: Part I: Background On Cesarean Deliverymentioning

confidence: 97%

Physician Financial Incentives and Cesarean Section Delivery

Gruber¹,

Owings²

1996

The RAND Journal of Economics

300

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The "induced-demand" model states that in the face of negative income shocks, physicians may exploit their agency relationship with patients by providing excessive care. We test this model using an exogenous change in the financial environment facing obstetrician/gynecologists: declining fertility in the United States. We argue that the 13.5% fall in fertility over the 1970-1982 period led ob/gyns to substitute from normal childbirth toward a more highly reimbursed alternative, cesarean delivery. Using a nationally representative microdata set for this period, we show that there is a strong correlation between within-state declines in fertility and within-state increases in cesarean utilization.

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Section: Part I: Background On Cesarean Deliverymentioning

confidence: 97%

Physician Financial Incentives and Cesarean Section Delivery

Gruber¹,

Owings²

1996

The RAND Journal of Economics

300

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“…In the following step, the balance vector − → w (n) is updated using the estimation error value and the gain vectors, see equation (13). In the last step, the inverse matrix is calculated, see equation (14), and the pattern selection from the training set is terminated. In Figure 6, the RLS algorithm application block can be seen, where the λ parameter shows the forgetting coefficient and N RLS indicates the filter order [71], [113], [114].…”

Section: B Recursive Least Squares Filtermentioning

confidence: 99%

Novel Hybrid Extraction Systems for Fetal Heart Rate Variability Monitoring Based on Non-Invasive Fetal Electrocardiogram

et al. 2019

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This study focuses on the design, implementation and subsequent verification of a new type of hybrid extraction system for noninvasive fetal electrocardiogram (NI-fECG) processing. The system designed combines the advantages of individual adaptive and non-adaptive algorithms. The pilot study reviews two innovative hybrid systems called ICA-ANFIS-WT and ICA-RLS-WT. This is a combination of independent component analysis (ICA), adaptive neuro-fuzzy inference system (ANFIS) algorithm or recursive least squares (RLS) algorithm and wavelet transform (WT) algorithm. The study was conducted on clinical practice data (extended ADFECGDB database and Physionet Challenge 2013 database) from the perspective of non-invasive fetal heart rate variability monitoring based on the determination of the overall probability of correct detection (ACC), sensitivity (SE), positive predictive value (PPV) and harmonic mean between SE and PPV (F1). System functionality was verified against a relevant reference obtained by an invasive way using a scalp electrode (ADFECGDB database), or relevant reference obtained by annotations (Physionet Challenge 2013 database). The study showed that ICA-RLS-WT hybrid system achieve better results than ICA-ANFIS-WT. During experiment on ADFECGDB database, the ICA-RLS-WT hybrid system reached ACC > 80 % on 9 recordings out of 12 and the ICA-ANFIS-WT hybrid system reached ACC > 80 % only on 6 recordings out of 12. During experiment on Physionet Challenge 2013 database the ICA-RLS-WT hybrid system reached ACC > 80 % on 13 recordings out of 25 and the ICA-ANFIS-WT hybrid system reached ACC > 80 % only on 7 recordings out of 25. Both hybrid systems achieve provably better results than the individual algorithms tested in previous studies. INDEX TERMS Noninvasive fetal electrocardiography, independent component analysis (ICA), adaptive neuro fuzzy inference system (ANFIS), recursive least squares (RLS), wavelet transform (WT), ICA-ANFIS-WT, ICA-RLS-WT, hybrid methods, fetal heart rate variability monitoring, extraction systems.

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“…The initial acceptance and the application of electronic FHR monitoring came about without rigorous scientific validities of its findings. During widespread use of electronic FHR monitoring in the US, it was found that its routine use during the intrapartum period was associated with significant decrease in perinatal mortality but it was also associated with a significant increase in operative deliveries 1 . Furthermore, it was found that the intrapartum electronic FHR monitoring was not superior to the frequent auscultations by an experienced obstetrical nurse although current shortage of experienced manpower makes frequent auscultation impractical 2,3 …”

Section: Introductionmentioning

confidence: 99%

Sinusoidal heart rate pattern: Reappraisal of its definition and clinical significance

Modanlou

Murata

2004

J of Obstet and Gynaecol

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Objectives: To address the clinical significance of sinusoidal heart rate (SHR) pattern and review its occurrence, define its characteristics, and explain its physiopathology. Background: In 1972, Manseau et al. and Kubli et al. described an undulating wave form alternating with a flat or smooth baseline fetal heart rate (FHR) in severely affected, Rh-sensitized and dying fetuses. This FHR pattern was called 'sinusoidal' because of its sine waveform. Subsequently, Modanlou et al. described SHR pattern associated with fetal to maternal hemorrhage causing severe fetal anemia and hydrops fetalis. Both Manseau et al. and Kubli et al. stated that this particular FHR pattern, whatever its pathogenesis, was an extremely significant finding that implied severe fetal jeopardy and impending fetal death. Undulating FHR pattern: Undulating FHR pattern may be due to the following: (1) true SHR pattern; (2) drugs; (3) pre-mortem FHR pattern; (4) pseudo-SHR pattern; and (5) equivocal FHR patterns. Fetal conditions associated with SHR pattern: SHR pattern has been reported with the following fetal conditions: (1) severe fetal anemia of several etiologies; (2) effects of drugs, particularly narcotics; (3) fetal asphyxia/hypoxia; (4) fetal infection; (5) fetal cardiac anomalies; (6) fetal sleep cycles; and (7) sucking and rhythmic movements of fetal mouth. Definition of true SHR pattern: Modanlou and Freeman proposed the following definition for the interpretation of true SHR pattern: (a) stable baseline FHR of 120-160 bpm; (b) amplitude of 5-15 bpm, rarely greater; (c) frequency of 2-5 cycles per minute; (d) fixed or flat short-term variability; (e) oscillation of the sinusoidal wave from above and below a baseline; and (f) no areas of normal FHR variability or reactivity. Physiopathology: Since its early recognition, the physiopathology of SHR became a matter of debate. Murata et al. noted a rise of arginine vasopressin levels in the blood of posthemorrhagic/anemic fetal lamb. Further works by the same authors revealed that with chemical or surgical vagotomy, arginine vasopressin infusion produced SHR pattern, thus providing the role of autonomic nervous system dysfunction combined with the increase in arginine vasopressin as the etiology. Conclusion: SHR is a rare occurrence. A true SHR is an ominous sign of fetal jeopardy needing immediate intervention. The correct diagnosis of true SHR pattern should also include fetal biophysical profile and the absence of drugs such as narcotics. Key words: fetal anemia, pre-mortem heart rate pattern, pseudo-sinusoidal heart rate pattern, sinusoidal heart rate pattern.

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Cesarean section, fetal monitoring, and perinatal mortality in California.

Cited by 54 publications

References 17 publications

Physician Financial Incentives and Cesarean Section Delivery

Physician Financial Incentives and Cesarean Section Delivery

Novel Hybrid Extraction Systems for Fetal Heart Rate Variability Monitoring Based on Non-Invasive Fetal Electrocardiogram

Sinusoidal heart rate pattern: Reappraisal of its definition and clinical significance

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