Fetal ECG during labour: a suggested standard

Lindecrantz, Kaj; Lilja, Håkan; Widmark, Catharina; Rosén, Karl G.

doi:10.1016/0141-5425(88)90067-2

Cited by 26 publications

(13 citation statements)

References 3 publications

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“…A unipolar scalp lead with the maternal thigh as reference (second electrode) makes it possible to identify the T wave and, at the same time to decrease signal noise. The vector ECG aspects of T wave recording have been clarified by Lindecrantz et al . (1988).…”

Section: Methodsmentioning

confidence: 99%

Clinical assessment of fetal electrocardiogram monitoring in labour

Murphy

Russell

Johnson

et al. 1992

BJOG

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Objective To assess the potential clinical value of fetal electrocardiographic (ECG) monitoring in labour. Design Descriptive study of the use of ECG waveform analysis during labour and its correlation with other indices of fetal and neonatal well‐being. Setting Teaching hospital in Oxford. Subjects 86 high risk pregnancies. Main outcome measures Suitability of ST Segment Analyser (Cinventa, Sweden) for clinical use; relation between the T/QRS ratio during labour (an index of ST segment and T wave elevation) and intrapartum cardiotocography, umbilical artery pH at birth and Apgar scores; T/QRS ratio trends in labour. Results The system was robust and user‐friendly. No statistically significant relation was found between T/QRS ratios in labour and FHR abnormalities in the cardiotocograph. There was a weak relation between T/QRS ratios and umbilical artery acidosis: at a cervical dilatation of 4 cm, the Spearman rank correlation of the mean T/QRS ratio with umbilical artery actual base deficit was r =−0.31, 0.05

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Section: Methodsmentioning

confidence: 99%

Clinical assessment of fetal electrocardiogram monitoring in labour

Murphy

Russell

Johnson

et al. 1992

BJOG

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“…The raw FECG was recorded via a scalp electrode (Corometrics single spiral), isolated and amplified by a patient isolation box, and fed into the main analyser. In the STAN system, averaging of the waveform is controlled by software QRS detector (Lindecrantz et al 1988) with a template‐comparing algorithm and an averaged complex formed from 30 raw waveform complexes. The height of the T‐wave, as well as the total amplitude of the QRS complex (peak to nadir), is calculated from the average ECG complex, which is based on 10 to 30 accepted ECG complexes.…”

Section: Methodsmentioning

confidence: 99%

A comparative study of the fetal electrocardiogram recorded by the STAN and Nottingham systems

Skillern¹,

Cockburn²,

Benjamin³

et al. 1994

BJOG

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Objective To compare the T:QRS ratio recorded by the STAN and Nottingham fetal electrocardiogram (FECG) monitors. Design Prospective observational study. Setting London teaching hospital delivery suite and research unit. Methods and subjects The T:QRS ratios generated by the STAN and Nottingham FECG monitors were simultaneously recorded and compared using signals generated from a computer‐produced ECG signal and signals from 11 term fetuses recorded during labour. Results There was an acceptable level of agreement between the two systems with the computer‐generated signals, but it was not clinically acceptable with the signals from the fetuses recorded during labour. Disagreements in the T:QRS values were probably due to differences in the reference points for the measurement of the S‐T segment and T‐wave height. Conclusion The different points of reference for measurement of S‐T segment and T‐wave height can explain poor agreement between the two methods of FECG waveform analysis. The suggested adopted points of reference are those corresponding to adult electrocardiographic methodology.

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“…60 This can be achieved by using a skin electrode on the maternal thigh as the reference electrode. The other advantages of this lead con®guration are that it ensures the T wave vector is unaffected by fetal rotation 61 and reduces the amount of baseline noise recorded with the ECG signal. 62 A number of off-line systems to analyse the fetal ECG recorded during labour were developed in the 1980s and early 90s and were used in small observational studies.…”

Section: Ecg Monitoring Technologymentioning

confidence: 99%

The role of fetal ECG monitoring in labour

Westgate

Gunn

2002

Fet. Mat. Med. Rev.

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Objectives: To determine if the degree of caput impacts the accuracy of assessing fetal position in labour when completed by third and fourth year obstetrics residents. Methods: Assessment of fetal position during labour was performed by third and fourth year residents when patients were 8 cm dilated or more, had ruptured membranes, and the gestation was 35 weeks or greater. The residents performed digital examinations for location and axis of fetal sutures and fontanelles in order to determine the orientation of the fetal brow and occiput. Ultrasound assessment was performed immediately following resident examination. Residents were blinded to ultrasound findings. Assessments were considered correct if within 15 degrees of ultrasound findings. Transabdominal and transperineal scanning with a 3.5mHz abdominal probe were utilised. Caput was measured at the time of transperineal ultrasound and grouped into no/mild (0-0.99 cm), moderate (1.0-1.99 cm), and marked (2cm+) caput. Chi-squared analysis was performed using SPSS. Results: Twelve residents assessed 143 labouring women. Mean maternal age was 26.4 years (SD 6.2), mean gestational age was 39.3 weeks (SD 1.2), and 42% had a history of a vaginal delivery. Maternal ethnicity was 60.1% black, 35.7% Caucasian, and 4.2% ''other.'' The overall accuracy of the resident exams was 47.9%. The amount of caput widely varied from 0 to 3.10 cm, with the largest number having 1.0-1.99 cm of caput. Caput did not change the accuracy of assessment of fetal position (table 1). Conclusions: Degree of caput did not play an important role in the ability to assess fetal position of sutures and fontanelles by palpation. P13.01: Table 1. Amount of caput Correct % (N) Incorrect % (N) Total N (% of total) No/minimal Objectives: To determine if a history of vaginal delivery and station of the fetus at the time of vaginal exam impact the accuracy of determining fetal position in labour when assessed by third and fourth year obstetrics residents. Methods: Residents performed digital examinations for location and axis of fetal sutures and fontanelles when patients were 8 cm dilated or more, had ruptured membranes, and the gestation was 35 weeks or greater. Transabdominal and transperineal scanning using a 3.5mHz probe were performed immediately following digital exams. Exams were considered correct if within 15 degrees of ultrasound findings. For analysis, assessments were grouped based upon a history of vaginal delivery and then by fetal station of-1 or higher (high), 0 to +1.5 (mid), and +2 or lower (low). Chi-squared analysis was performed using SPSS. Results: Twelve residents assessed 143 labouring women for fetal position. The overall accuracy rate was 47.9%. Women who had a prior vaginal delivery were more likely to have fetal position inaccurately assessed by exam. Correct assessment occurred in 55.4% (N=46) of women without a history of vaginal delivery versus 38.3% (N=23) of women with a vaginal delivery (p=0.044). When the axis of the fetal head was assessed without taking into acc...

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Fetal ECG during labour: a suggested standard

Cited by 26 publications

References 3 publications

Clinical assessment of fetal electrocardiogram monitoring in labour

Clinical assessment of fetal electrocardiogram monitoring in labour

A comparative study of the fetal electrocardiogram recorded by the STAN and Nottingham systems

The role of fetal ECG monitoring in labour

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