Development and evaluation of an algorithm for computer analysis of maternal heart rate during labor

Pinto, Paula; Bernardes, João; Costa-Santos, Cristina; Amorim-Costa, Célia; Silva, Maria João; Ayres-de-Campos, Diogo

doi:10.1016/j.compbiomed.2014.03.007

Cited by 20 publications

(27 citation statements)

References 31 publications

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“…Those associated with fetal acidemia may denote a moderate response to stress on the maternal side, while the fetus has a more marked reaction associated with lower pO 2 values and higher hemodynamic instability. To our knowledge, similar evaluations of MHR features have not been previously conducted, and the only reported change has been an increase in MHR baseline and number of accelerations during labor [26,30].…”

Section: Discussionmentioning

confidence: 80%

“…A heart period is calculated from the RR interval and converted to the nearest quarter of a beat, in beats per minute [4]. The MHR signal was subsequently exported from the STAN monitor at a sampling rate of 4 Hz, via an RS232 port, into the Omniview-SisPorto ® [1,26]. Due to the occurrence of episodes of signal loss and artifacts, MHR signals were then preprocessed using an algorithm for FHR preprocessing described by Gonçalves et al [10], adapted to the MHR scale.…”

Section: Data Acquisitionmentioning

confidence: 99%

“…The occurrence of strenuous uterine contractions leading to maternal acidemia of myometrial origin and the secretion of neuro-endocrine mediators associated with uterine activity could lead to changes in MHR variability in addition to the well-known changes in FHR. There is also evidence that during the final minutes of labor there are significant MHR changes in relation to the uterine contraction rate [26,30], which has a wellestablished relation with fetal acidemia [2,17]. In spite of this, joint MHR and FHR analysis has never been explored or translated into clinical practice.…”

Section: Introductionmentioning

confidence: 95%

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Toward the improvement in fetal monitoring during labor with the inclusion of maternal heart rate analysis

Gonçalves

Pinto

Silva

et al. 2015

Med Biol Eng Comput

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Fetal heart rate (FHR) monitoring is used routinely in labor, but conventional methods have a limited capacity to detect fetal hypoxia/acidosis. An exploratory study was performed on the simultaneous assessment of maternal heart rate (MHR) and FHR variability, to evaluate their evolution during labor and their capacity to detect newborn acidemia. MHR and FHR were simultaneously recorded in 51 singleton term pregnancies during the last two hours of labor and compared with newborn umbilical artery blood (UAB) pH. Linear/nonlinear indices were computed separately for MHR and FHR. Interaction between MHR and FHR was quantified through the same indices on FHR-MHR and through their correlation and cross-entropy. Univariate and bivariate statistical analysis included nonparametric confidence intervals and statistical tests, receiver operating characteristic curves and linear discriminant analysis. Progression of labor was associated with a significant increase in most MHR and FHR linear indices, whereas entropy indices decreased. FHR alone and in combination with MHR as FHR-MHR evidenced the highest auROC values for prediction of fetal acidemia, with 0.76 and 0.88 for the UAB pH thresholds 7.20 and 7.15, respectively. The inclusion of MHR on bivariate analysis achieved sensitivity and specificity values of nearly 100 and 89.1%, respectively. These results suggest that simultaneous analysis of MHR and FHR may improve the identification of fetal acidemia compared with FHR alone, namely during the last hour of labor.

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Section: Discussionmentioning

confidence: 80%

Section: Data Acquisitionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

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Toward the improvement in fetal monitoring during labor with the inclusion of maternal heart rate analysis

Gonçalves

Pinto

Silva

et al. 2015

Med Biol Eng Comput

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“…The system closely follows the International Federation of Gynaecology and Obstetrics (FIGO) guidelines for fetal monitoring [13–16] and has been extensively validated both in the ante [16, 17] and intrapartum periods [15, 17–19]. Analysis is carried out without signal reduction or averaging (Fig.…”

Section: Methodsmentioning

confidence: 99%

Improvements in fetal heart rate analysis by the removal of maternal-fetal heart rate ambiguities

Pinto

Costa-Santos

Gonçalves

et al. 2015

BMC Pregnancy Childbirth

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BackgroundMisinterpretation of the maternal heart rate (MHR) as fetal may lead to significant errors in fetal heart rate (FHR) interpretation. In this study we hypothesized that the removal of these MHR-FHR ambiguities would improve FHR analysis during the final hour of labor.MethodsSixty-one MHR and FHR recordings were simultaneously acquired in the final hour of labor. Removal of MHR-FHR ambiguities was performed by subtracting MHR signals from their FHR counterparts when the absolute difference between the two was less or equal to 5 beats per minute. Major MHR-FHR ambiguities were defined when they exceeded 1 % of the tracing. Maternal, fetal and neonatal characteristics were evaluated in cases where major MHR-FHR ambiguities occurred and computer analysis of FHR recordings was compared, before and after removal of the ambiguities.ResultsSeventy-two percent of tracings (44/61) exhibited episodes of major MHR-FHR ambiguities, which were not significantly associated with any maternal, fetal or neonatal characteristics, but were associated with MHR accelerations, FHR signal loss and decelerations. Removal of MHR-FHR ambiguities resulted in a significant decrease in FHR decelerations, and improvement in FHR tracing classification.ConclusionsFHR interpretation during the final hour of labor can be significantly improved by the removal of MHR-FHR ambiguities.

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“…Currently, randomized controlled trials are underway to assess the usefulness of such computerized decision-support tools in improving perinatal outcomes. Recently, an algorithm has been developed for the computerized recognition of maternal heart rate so as to help avoid erroneous monitoring of maternal heart rate as fetal during labour [29].…”

Section: Role Of Computerized Ctgmentioning

confidence: 99%

Continuous cardiotocography during labour: Analysis, classification and management

Pinas

Chandraharan

2016

Best Practice & Research Clinical Obstetrics & Gynaecol

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Development and evaluation of an algorithm for computer analysis of maternal heart rate during labor

Cited by 20 publications

References 31 publications

Toward the improvement in fetal monitoring during labor with the inclusion of maternal heart rate analysis

Toward the improvement in fetal monitoring during labor with the inclusion of maternal heart rate analysis

Improvements in fetal heart rate analysis by the removal of maternal-fetal heart rate ambiguities

Continuous cardiotocography during labour: Analysis, classification and management

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