European Community Multicentre Trial “Fetal ECG Analysis During Labour”: the P-R Interval

Luzietti, R.; Erkkola, Risto; Hasbargen, Uwe; Mattson, L.; Thoulon, Jean M.; Rosén, Karl G.

doi:10.1515/jpme.1997.25.1.27

Cited by 24 publications

(13 citation statements)

References 8 publications

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“…The current methods to assess fetal arrhythmias are scalp electrodes attached to ECG recorders [6][7][8][9], magnetocardiography [10][11][12], fetal electrocardiographic recordings from the maternal abdomen [13,14] and fetal echocardiography with pulsed Doppler techniques [4,5,15,16].…”

Section: Discussionmentioning

confidence: 99%

The Fetal Doppler Mechanical PR Interval: A Validation Study

et al. 2003

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Objective: To evaluate the accuracy of pulsed Doppler-derived fetal PR interval measurements obtained by physicians participating in a multicenter prospective fetal echocardiographic study. Methods: Echocardiograms on healthy fetuses were performed and evaluated by 15 pediatric cardiologists/perinatologists across the United States who are participating in a larger clinical trial involving fetuses at risk for autoantibody-associated congenital heart block. Prior to enrolling women in the main trial, each physician was provided with a teaching tape to demonstrate how the pulsed Doppler-derived PR interval is measured. The procedure involves placing a gated pulsed Doppler sample volume in the left ventricle at the junction of the anterior leaflet of the mitral valve and the left ventricular outflow tract in an apical 5-chamber view, and simultaneously obtaining left ventricular filling and emptying. Time intervals are measured from the onset of the mitral A wave (atrial systole) to the onset of the aortic pulsed Doppler tracing (ventricular systole). This represents the mechanical PR interval. Each physician measured the pulsed Doppler-derived fetal PR interval on 5 different subjects recruited from the physician’s specific site. To validate each physician’s technique, the tapes were sent to a central facility and the same intervals were remeasured by an experienced central reader (D.M.F.). A physician was determined to have adequate ability to measure the fetal PR interval if all 5 measurements were within ± 30 ms of the central reader’s measurements, where 30 ms corresponds to 25% of the mean observed in normative PR interval data. This difference was deemed to be the minimum clinically important difference in Doppler PR interval. Results: Fourteen of the 15 physicians were considered to have adequate ability to measure the fetal PR interval according to our established criterion. The overall mean difference between the physicians and the central reader’s measurements was –0.26 ± 11.04 ms (p = 0.84). In addition, 95% of the observed differences were included in the interval (–22.23 to 21.81), which is well within our clinically acceptable range of ± 30 ms. Conclusions: The pulsed Doppler assessment of the mechanical PR interval in the fetus can be accurately performed after minimal training. This technique may be a valuable tool for identification of early and potentially reversible conduction abnormalities in fetuses at risk for more advanced and permanent forms of heart block associated with maternal antibodies to SSA/Ro-SSB/La.

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Section: Discussionmentioning

confidence: 99%

The Fetal Doppler Mechanical PR Interval: A Validation Study

et al. 2003

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“…Van Wijngaarden et al ont montré chez l'humain dans un travail randomisé que l'adjonction de ce paramètre de l'ECG foetal permettait de mieux surveiller le travail dans la mesure où, dans ce groupe, les gaz du sang mesurés sur le scalp foetal étaient plus perturbés que ceux réalisés dans le groupe où l'on ne disposait que de l'enregistrement du RCF [20]. Une étude observationnelle d'un autre groupe ne trouvait pas de bénéfice à l'utilisation de l'espace PR [21].…”

Section: éTudes Sur L'intervalle Pr De L'ecg Foetalunclassified

Oxymétrie, ECG fœtal et enregistrement informatisé (comparaison avec pH)

Langer

Vayssière

Fritz

et al. 2008

Journal de Gynécologie Obstétrique et Biologie de la Reproducti

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“…Hypoxia may cause an alteration in the P-R time with a PR shortening in spite of an RR lengthening, but this is more related to the foetal heart attempting to preserve an optimal filling of the atrium in situations of a decrease in blood returning to the heart [21][22][23].…”

Section: Pathophysiology Of Foetal Electrocardiogram Changes and Expementioning

confidence: 99%

Foetal ECG and STAN technology—a review

Amer‐Wåhlin

Yli

Arulkumaran

2005

Eur Clinics Obstet Gynaecol

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Waveform analysis of the foetal electrocardiogram (FECG) has been studied from physiological, signal processing and clinical aspects. Two randomised controlled trials (RCT) have been performed during the last 20 years, monitoring high-risk labours with cardiotocography (CTG) only or combining CTG with the ST waveform analysis of the FECG. A significant decrease in neonates born with metabolic acidosis in cord artery blood was observed, along with a decrease of operative deliveries for foetal distress. Blinded assessment of neonatal outcome in the latest RCT revealed an improvement of the Apgar score and the need for intensive care and neonatal encephalopathy when monitoring with CTG in combination with FECG. Also, the interobserver agreement for ST analysis was higher than for CTG alone. The system ability of the STAN technology, including an educational model, was studied in several European University clinics as an EU-supported project. During the last 6 months, the project confirmed the incidence of metabolic acidosis (0.64%) and moderate/severe encephalopathy in the earlier RCT on using ST information in addition to CTG. The available evidence suggests that the expected outcome could be achieved in most clinics, with a special focus on systematic teaching and training. Compared to ST analysis, foetal blood sampling (FBS) for pH analysis is technically complicated and, because it only presents momentary information, needs to be repeated to give adequate information. The STAN method provides continuous on-line information. ST waveform analysis in addition to CTG has the potential to give significant benefits in reducing operative deliveries for foetal distress and reducing the incidence of metabolic acidosis. However, this will depend on the appropriate education and use of STAN according to the guidelines provided.

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European Community Multicentre Trial “Fetal ECG Analysis During Labour”: the P-R Interval

Cited by 24 publications

References 8 publications

The Fetal Doppler Mechanical PR Interval: A Validation Study

The Fetal Doppler Mechanical PR Interval: A Validation Study

Oxymétrie, ECG fœtal et enregistrement informatisé (comparaison avec pH)

Foetal ECG and STAN technology—a review

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