Role of Maternal Artifact in Fetal Heart Rate Pattern Interpretation

Klapholz, Henry; Schifrin, Barry S.; Myrick, Richard

doi:10.1097/00006254-197504000-00005

Cited by 11 publications

(11 citation statements)

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“…Schneiderman et al [2] and Klapholz et al [3] previously reported recording of maternal heart rate following fetal demise. In both of these cases the extrapolated maternal heart rate was below 90 bpm.…”

Section: Discussionmentioning

confidence: 99%

Artifactual fetal electrocardiographic detection using internal monitoring following intrapartum fetal demise during VBAC trial

Ramsey¹,

Johnston²,

Welter³

et al. 2000

J Matern Fetal Neonatal Med

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Section: Discussionmentioning

confidence: 99%

Artifactual fetal electrocardiographic detection using internal monitoring following intrapartum fetal demise during VBAC trial

Ramsey¹,

Johnston²,

Welter³

et al. 2000

J Matern Fetal Neonatal Med

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“…The phenomenon of confusing maternal and fetal heart rate is not unknown and there are a number of published reports (7–11). The subject clearly has both clinical and medicolegal relevance (12) given that misinterpretation of MHR for FHR during critical intervals of the first and second stage can result in inappropriately delayed, or in some cases expedited, delivery.…”

Section: Key Messagementioning

confidence: 99%

Maternal heart rate patterns in the first and second stages of labor

Veen

Belfort

Kofford

2012

Acta Obstet Gynecol Scand

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Objective. To analyze typical maternal heart rate (MHR) patterns in the first and second stages of labor. Design. Observational study. Setting. Tertiary care community hospital. Population. Normal term parturients with epidural anesthesia. Methods. Confirmed MHR and uterine activity were simultaneously recorded. The average MHR was analyzed 10 seconds before, as well as at the peak of, each contraction and/or pushing effort. Each woman contributed one datapoint at each time point to the analysis. Main outcome measure. Change in MHR during contractions. Results. First stage: 7.6±2.1 contractions per woman (n=18) were analyzed. Average MHR decreased during contractions: from 83±13 to 74±10bpm; p<0.001). In 56% (10/18) of the women, 'early' type decelerations were seen in at least 50% of contractions. Second stage: 3.5±1.5 contractions per woman. All women (n=15) showed MHR accelerations during every pushing effort (ΔMHR: +35±13bpm; 88±14 to 123±17bpm; p<0.001). MHR was persistently >100bpm in three women (17%) in the first stage, and in four women (27%) in the second stage. Peak MHR >140bpm occurred during pushing in 20%. Conclusion. Decreases in MHR during contractions in the first stage of labor can mimic fetal heart rate (FHR) accelerations as well as early type decelerations. Thus, first stage tracings with a low baseline and early type decelerations may be maternal in origin and FHR should be independently confirmed in such tracings. Because second stage MHR accelerations generally show greater amplitude than FHR accelerations, tracings with repetitive accelerations during contractions (especially when Δ >20bpm) should be considered MHR until proven otherwise.

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“…Spiral electrode application is not helpful in confirming fetal life, because the printed MHR and artifact may still be misinterpreted as an FHR (Schneiderman et al, 1972;Trimor-Tritsch et al, 1974). Large maternal QRS complexes can be transmitted through the cells of a fetus who has recently died to the spiral electrode-cable-fetal monitor system without filtration or interference (Achiron & Zakut, 1984;Barrett & Boehm, 1980;Fehrmann, 1980;Herbert et al, 1987;Herman et al, 1990;Hutson & Petrie, 1986;Klapholz et al, 1974;McWhinney et al, 1984;Schneiderman et al, 1972;Timor-Tritsch et al, 1974). It remains unknown how long a deceased fetus can continue to conduct maternal electrical impulses (Timor-Tritsch et al, 1974).…”

Section: Fetal Life Confirmationmentioning

confidence: 99%

“…Also included in this article are reports on cases in which misidentification of heart rate signals in fetal demise led to litigation. nal in 90% of women (Klapholz, Schifrin, & Myrick, 1974). The placement and the angle of transmission of the sound waves emitted by the hand-held Doppler device or the ultrasound transducer will determine which tissue movement is used to calculate the rate.…”

mentioning

confidence: 99%

Maternal or Fetal Heart Rate? Avoiding Intrapartum Misidentification

Murray

2004

Journal of Obstetric, Gynecologic & Neonatal Nursing

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Role of Maternal Artifact in Fetal Heart Rate Pattern Interpretation

Cited by 11 publications

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Artifactual fetal electrocardiographic detection using internal monitoring following intrapartum fetal demise during VBAC trial

Artifactual fetal electrocardiographic detection using internal monitoring following intrapartum fetal demise during VBAC trial

Maternal heart rate patterns in the first and second stages of labor

Maternal or Fetal Heart Rate? Avoiding Intrapartum Misidentification

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