Reliability of cardiotocography in predicting baby's condition at birth.

Curzen, Peter; Bekir, Jinan; McLintock, D G; Patel, Mehul D.

doi:10.1136/bmj.289.6455.1345

Cited by 28 publications

(13 citation statements)

References 9 publications

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“…The prerent results, however, apply to clearly defined and marked abnormalities, all of which arose at least 3 h before death and did not resolve or remit. The application of continuous monitoring as a routine in all labours remains at best controversial and is often unwanted by women in labour (MacDonald et al 1985;Kelso et al 1978;Curzen et al 1984;Niswander et al 1984). When, however, there is pnor evidence of substantial risk of fetal distress in labour, these Several factors were not found to be associated with perinatal death in this group, although they may have been suspected on the basis of previous evidence (Morris & Heady 19SSa, 19SSb;Heady et al 19S5a, 19556;Daly el al.…”

Section: Present and Previous Findingsmentioning

confidence: 99%

‘Normal but dead’: perinatal mortality in nonmalformed babies of birthweight 2.5 kg and over in the Northern Region in 1983

Kirkup

Welch

1990

BJOG

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Summary. The case notes relating to 75 of the 91 perinatal deaths of nonmalformed babies of birthweight ≥2.5 kg born in the Northern Region in 1983 were examined. The major groups involved antepartum deaths of unknown cause (40%), and deaths due to intrapartum anoxia or trauma (35%). A case‐control study compared each of the 75 cases with two controls matched for place of birth, obtained by taking the next two babies born in the same maternity unit (excluding perinatal deaths, birthweight <2.5 kg, and malformations). Four factors were found to be significantly associated with risk of perinatal death in this group: primigravidity, parity ≥3, not booked for antenatal care by 20 weeks, and corrected birthweight <3.2 kg (adjusted for gestation). Two further factors were related only to the risk of perinatal death consequent upon intrapartum events: labour post‐term and malpresentation in labour. All four factors relevant to the whole group remained independently associated with risk of perinatal death after multivariate analysis by two techniques. Adjusted odds ratios (95% CI) were estimated as: primigravidity 2.1 (1.1 to 4.1); parity three or more 5.7 (1.9 to 17); not booked for antenatal care by 20 weeks 15.7 (3.0 to 81); and corrected birthweight <3.25 kg 2.5 (1.3 to 4.6). An avoidable factor, as defined, was detected in 50% of deaths. In 30% of deaths there was an avoidable factor (grade 2) such that absence may have been expected to lead to a different outcome had all other factors remained equal. Of the avoidable factors detected, 61% related to intrapartum management, as did 76% of the grade 2 factors. Most of these involved failure to respond to evidence of fetal distress in labour. The defined group constituted 21% of all perinatal deaths, suggesting that this is an important category, particularly as their potential for normal survival should otherwise have been high.

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Section: Present and Previous Findingsmentioning

confidence: 99%

‘Normal but dead’: perinatal mortality in nonmalformed babies of birthweight 2.5 kg and over in the Northern Region in 1983

Kirkup

Welch

1990

BJOG

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“…They found that the diagnosis of fetal distress has a low positive predictive value. Subsequent studies [2,10] and a retrospective study within the European Community Concerted Action project 'Perinatal Monitoring' addressing a series of consecutive data from seven European university clinics showed a low sensitivity and a high false-positive (FP) rate in all centers [4]. None of the studies published reached 95% sensitivity, which has been proposed as a general minimum sensitivity for diagnostic tests [11].…”

Section: Introductionmentioning

confidence: 98%

Critical analysis of the validity of electronic fetal monitoring

Jongsma¹,

Nijhuis²

1991

Jpme

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The validity of the diagnosis fetal distress based on electronic fetal monitoring (EFM) is low. It can be argued that the prediction of fetal distress may be influenced by the obstetric intervention, and a number of false-positive (FP) decisions are in fact cases of successful prevention of acidosis. The false-negative decisions (FN) may include cases in which an operative delivery was not performed, although the impaired fetal condition was correctly recognized. To estimated the magnitude of these effects, deliveries after 28 weeks of gestation, in which EFM was applied, were studied. The medical staff involved in these deliveries was asked to estimate the umbilical artery pH immediately before birth. After birth the pH was measured. Cases were classified as operative delivery for fetal distress or other. Fetal distress was supposes to be confirmed if the umbilical artery pH was less than or equal to 7.14. Pre-birth estimates of the pH were obtained in 393 cases. Of the 20 FP cases, 70% were real FP after considering the prebirth estimate; of the 35 FN cases, 89% were real FN. After correction for mistaken false results the sensitivity increased from 20.5% to 29.5% and the predictive value from 31.0% to 51.7%. Although validity and predictive values improve after correcting for the mistaken false results, their values are still unsatisfactorily low.

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“…Current techniques for fetal surveillance during labor and delivery consist of mainly cardiotocography (CTG), ST‐analysis of the fetal ECG (STAN) and fetal scalp blood sampling. These techniques involve a risk of both over‐ and underestimation of fetal hypoxia, with unnecessary operative intervention and/or hypoxic injury to the fetus as possible consequences17.…”

Section: Introductionmentioning

confidence: 99%

Rapid Perturbation of Free‐Energy Landscapes: From In Vitro to In Vivo

Gelman

Platkov

Gruebele

2012

Chemistry A European J

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Biological systems are often studied under the most "physiological" conditions possible. However, purposeful perturbation of biological systems can provide much information about their dynamics, robustness, and function. Such perturbations are particularly easy to apply at the interface of molecular biophysics and cellular biology, at which complex and highly regulated networks emerge from the behavior of individual biomolecules. Due to the size of diffusion coefficients and the length scale of biomolecules, the fastest timescales at this interface extend to below a microsecond. Thus perturbations must be induced and detected rapidly. We focus on examples of proteins and RNAs interacting with themselves (folding) or one another (binding, signaling). Beginning with general principles that have been learned from simple models and perturbation experiments in vitro, we progress to more complex environments that mimic aspects of the living cell, and finally rapid perturbation experiments in living cells. On the experimental side we highlight in particular two classes of rapid perturbation methods (nanoseconds to seconds) that have been traditionally employed in biophysical chemistry, but that will become increasingly important in cell biology and in vivo: fast relaxation techniques and phase-sensitive modulation techniques. These techniques are now increasingly married with imaging to produce a spatiotemporal map of biomolecular stability, dynamics and, in the near future, interaction networks inside cells. Many important chemical processes occur on biologically fast timescales, and yet have important ramifications for slower biological networks.

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Reliability of cardiotocography in predicting baby's condition at birth.

Cited by 28 publications

References 9 publications

‘Normal but dead’: perinatal mortality in nonmalformed babies of birthweight 2.5 kg and over in the Northern Region in 1983

‘Normal but dead’: perinatal mortality in nonmalformed babies of birthweight 2.5 kg and over in the Northern Region in 1983

Critical analysis of the validity of electronic fetal monitoring

Rapid Perturbation of Free‐Energy Landscapes: From In Vitro to In Vivo

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