Uncertain Value of Electronic Fetal Monitoring in Predicting Cerebral Palsy

Nelson, Karin B.; Dambrosia, James M.; Ting, Tricia Y.; Grether, Judith K.

doi:10.1056/nejm199603073341001

Cited by 487 publications

(219 citation statements)

References 31 publications

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“…This problem indicates the need for a novel method for prenatal diagnosis. 15,16 In the present study, we developed a FMCG by modifying our recently developed 64-channel MCG. 17,18 The special features of MCG make it possible for the device to perform a 3-dimensional analysis of the magnetic fi eld generated by the One-way ANOVA: P = 0.003 phenomenal electric activities of the heart in both fetuses and adults.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Fetal Autonomic Nervous System Activity by Fetal Magnetocardiography

Fukushima

Nakai

Itoh³

et al. 2008

Clinical medicine. Cardiology

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Aim: To clarify the signifi cance of heart rate variability for the evaluation of an autonomic nervous system (ANS) in the normal fetus using fetal magnetocardiography (FMCG).Methods: Subjects consisted of normal pregnancy (n = 35) at 28-39 weeks gestation. FMCG was recorded using 64-channel magnetocardiography (MCG) in a magnetically shielded room. The QRS interval was derived from signal-averaged MCG. The R-R interval variability induced by an R-wave trigger was eventually adopted to calculate for time-domain and frequency domain analysis. The power spectrum in the frequency domain was derived from frequency-fi eld components using the maximum entropy method of fetal heart rate variability. Based on frequency analysis, the ranges of the LF and HF domains were defi ned as 0.01-0.15 and 0.15-0.4 Hz, respectively. We defi ned a coeffi cient of variance (CV RR ) as an index of parasympathetic activity, and defi ned a low frequency/high frequency (LF/HF) ratio as a sympathetic activity. Results:The value of CV RR in the normal pregnancy group displayed a slight increasing trend with gestational age (y = 1.77 + 0.10x; r = 0.32). In contrast, the LF/HF ratio in the normal pregnancy group clearly increased over the gestational period (one-way ANOVA: P = 0.003). Conclusions:Analyses based on the time and frequency domains of heart rate variability using FMCG enable an evaluation of fetal ANS activity. Sympathetic nervous activity increased with gestational age in the normal pregnancy group.

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Section: Discussionmentioning

confidence: 99%

Assessment of Fetal Autonomic Nervous System Activity by Fetal Magnetocardiography

Fukushima

Nakai

Itoh³

et al. 2008

Clinical medicine. Cardiology

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“…Conversely, its low specificity justifies efforts to develop additional tests to help identifying false-positive tests of FHR visual analysis. 1,2 Complementary methods, such as fetal scalp pH and lactates, fetal electrocardiogram (ECG) ST segment analysis, and T/QRS ratio (STAN 1 ; Neoventa Medical, Moelndal, Sweden), have been shown, at the best, to modestly reduce fetal metabolic acidosis and rate of operative deliveries. [3][4][5][6] As FHR with reduced or absent variability is one of the most significant parameters to predict the development of fetal acidosis, 2,7 some researches focused on FHR variability analysis.…”

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confidence: 99%

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

et al. 2010

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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.

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“…Thus, our findings are consistent with the earlier studies suggesting high false-positive rate of CTG, making it a poor tool in predicting the outcome of asphyxiated children. 7,11,29 Several serum, urine or cerebrospinal fluid biomarkers have been examined as markers of outcome in HIE, but none has been studied extensively enough to warrant routine clinical use. 31 In this study, there was likewise no correlation between the blood biomarkers according to the outcome in the asphyxiated.…”

Section: Discussionmentioning

confidence: 99%

“…CTG has a high sensitivity but low specificity for fetal hypoxia or asphyxia. 11 Increased cerebral blood flow velocity (CBFV) and resistive index reduced below 0.55 by pulsed Doppler ultrasonography, have been associated with poor outcome in birth asphyxia assessed at the age from 24 to 72 h. [12][13][14] We have previously shown a strong association of increased systolic CBFV in the anterior cerebral (ACA) or in the basilar (BA) arteries at around 24 h of age with adverse neurological outcome at the age of 1 year, whereas reduced resistive index failed to show association with poor outcome (submitted/unpublished data). In this study, we sought to analyse the obstetric parameters, biochemical asphyxia markers, HIE symptoms or their combinations, in predicting the neurological outcome at 1 year in full-term asphyxiated infants.…”

Section: Introductionmentioning

confidence: 99%

Obstetric parameters and Doppler findings in cerebral circulation as predictors of 1 year neurodevelopmental outcome in asphyxiated infants

et al. 2011

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Objective: To establish the association of cardiotocography (CTG) and other obstetric parameters with pulsed Doppler findings in cerebral arteries during the first day of life, and to compare the cerebral artery Doppler with other determinants of asphyxia in predicting 1-year neurological outcome in asphyxiated full-term infants.Study Design: Cerebral blood flow velocity (CBFV) were measured from the anterior cerebral (ACA) and basilar (BA) arteries in 30 asphyxiated and 30 healthy-term infants using pulsed Doppler ultrasonography at approximately 24 h of age. CTG, cord artery pH, Apgar scores, biochemical asphyxia markers and symptoms of hypoxic-ischemic encephalopathy (HIE) were compared with the Doppler findings in respect of the ability to predict the outcome, defined by death or impaired neurological performance at 1 year of age.Result: In all, 20% of the asphyxiated infants but none in the control group had increased peak systolic CBFVs (mean þ 3 s.d.) in the ACA or BA. The sensitivity of increased systolic CBFV to predict abnormal outcome in the asphyxia group was 83%, specificity 95% and the sensitivity of the combination of HIE grade from 2 to 3 and increased systolic CBFV in the ACA or BA was 100% and specificity was 95%, respectively. Pathological CTG and low cord artery pH or low Apgar scores showed low predictive power. Conclusion:Grade from 2 to 3 HIE and the systolic CBFV (mean þ 3 s.d.) in the ACA or BA by Doppler ultrasound seemed to predict the outcome in asphyxiated infants at 1 year of age better than CTG, acid basement status, Apgar scores or asphyxia markers. If an increase of more than þ 3 s.d. in the systolic CBFV does not occur within the first 24 h of life, a good 1-year neurological outcome may be anticipated.

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Uncertain Value of Electronic Fetal Monitoring in Predicting Cerebral Palsy

Cited by 487 publications

References 31 publications

Assessment of Fetal Autonomic Nervous System Activity by Fetal Magnetocardiography

Assessment of Fetal Autonomic Nervous System Activity by Fetal Magnetocardiography

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

Obstetric parameters and Doppler findings in cerebral circulation as predictors of 1 year neurodevelopmental outcome in asphyxiated infants

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