Intrapartum fetal heart rate patterns in the prediction of neonatal acidemia

Williams, Keith Philip; Galerneau, France

doi:10.1067/mob.2003.183

Cited by 119 publications

(66 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Multifractal analysis has the strength to reach results consistent with previous studies about variability using other mathematical methods, such as the classical spectral analysis, and to provide additional information that could help in discriminating fetuses with acidosis from nonacidotic fetuses. 2,7,16,18 Consistent with previous studies and physiopathologic mechanisms, the results of this study showed that variability is lower in the acidotic fetuses when compared with the nonacidotic fetuses as demonstrated by higher values of C 1 , h min , h Max , and zeta(2) in group C. 2,7,16,18 Moreover, multifractal analysis focuses on characterizing the evolution of signal variability in a collection of windows of growing size, identified by the method itself according to the intrinsic data characteristics and not chosen a priori. Our results showed that windows of interest for multifractal analysis ranged from 4 to 64 seconds.…”

Section: Discussionmentioning

confidence: 99%

Multifractal Analysis of Fetal Heart Rate Variability in Fetuses with and without Severe Acidosis during Labor

et al. 2010

View full text Add to dashboard Cite

We performed multifractal analysis of fetal heart rate (FHR) variability in fetuses with and without acidosis during labor. Multifractal analysis was performed on fetal electrocardiograms in 10-minute sliding windows within the last 2 hours before delivery in 45 term fetuses divided in three groups according to umbilical arterial pH and FHR pattern: group A had pH !7.30 and normal FHR, group B had pH !7.30 and intermediate or abnormal FHR, and group C had acidosis (pH 7.05) and intermediate or abnormal FHR. Six multifractal parameters were compared using Wilcoxon rank sum test. Multifractal parameters were significantly different between the three groups in the last 10 minutes before delivery (p <0.05). Two parameters (h min , zeta(2)) exhibited a significant difference 70 minutes before delivery, and one parameter (C 2 ) was different 10 minutes before birth (p <0.05). Multifractal parameters were significantly different in acidotic and nonacidotic fetuses, independently from FHR pattern.

show abstract

Section: Discussionmentioning

confidence: 99%

Multifractal Analysis of Fetal Heart Rate Variability in Fetuses with and without Severe Acidosis during Labor

et al. 2010

View full text Add to dashboard Cite

show abstract

“…In the case of fetal stress or in a pathological situation, the fetus has several mechanisms for adaptation: increased oxygen-tissue extraction, the redistribution of blood flow to protect vital organs, and the activation of an anaerobic metabolism, resulting in metabolic acidosis [31] . All these mechanisms for fetal homeostasis are regulated by the ANS.…”

Section: Discussionmentioning

confidence: 99%

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

Garabédian

Butruille²,

Servan-Schreiber³

et al. 2016

Gynecol Obstet Invest

View full text Add to dashboard Cite

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.

show abstract

“…[30][31][32] In contrast, absent or reduced FHR variability was associated with significant newborn acidaemia in term and preterm infants. [32][33][34] In a recent systematic review minimal or undetectable FHR variability was the most consistent predictor of newborn acidaemia. 30 In contrast, increased FHR variation was observed in association with severe acidosis and hypotension in a hypoxia ischaemia model using term-equivalent fetal sheep.…”

Section: Baseline Fhr Variabilitymentioning

confidence: 99%

Are we (mis)guided by current guidelines on intrapartum fetal heart rate monitoring? Case for a more physiological approach to interpretation

Ugwumadu

2014

BJOG

View full text Add to dashboard Cite

Original interpretations of fetal heart rate (FHR) patterns equated FHR decelerations with 'fetal distress', requiring expeditious delivery. This simplistic interpretation is still implied in our clinical guidelines despite 40 years of increasing understanding of the behaviour and regulation of the fetal cardiovascular system during labour. The physiological basis of FHR responses and adaptations to oxygen deprivation is de-emphasised, whilst generations of obstetricians and midwives are trained to focus on, and classify, the morphological appearances of decelerations into descriptive categories, with no attempt to understand how the fetus defends itself and compensates for intrapartum hypoxic ischaemic insults, or the patterns that suggest progressive loss of compensation. Consequently, there is a lack of confidence, marked variation in FHR interpretation, defensive practices, unnecessary operative interventions, and a failure to recognise abnormal FHR patterns, resulting in adverse outcomes and expensive litigation. Keywords CTG practice algorithm, deceleration, fetal cardiovascular physiology, intrapartum fetal heart rate monitoring.Please cite this paper as: Ugwumadu A. Are we (mis)guided by current guidelines on intrapartum fetal heart rate monitoring? Case for a more physiological approach to interpretation.

show abstract

Intrapartum fetal heart rate patterns in the prediction of neonatal acidemia

Cited by 119 publications

References 12 publications

Multifractal Analysis of Fetal Heart Rate Variability in Fetuses with and without Severe Acidosis during Labor

Multifractal Analysis of Fetal Heart Rate Variability in Fetuses with and without Severe Acidosis during Labor

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

Are we (mis)guided by current guidelines on intrapartum fetal heart rate monitoring? Case for a more physiological approach to interpretation

Contact Info

Product

Resources

About