A comparison of visual and automated methods of analyzing fetal heart rate tests

Hiett, Adam K.; Devoe, Lawrence D.; Youssef, Adel; Gardner, Paula; Black, Mary Jane

doi:10.1016/s0002-9378(11)90792-3

Cited by 31 publications

(15 citation statements)

References 10 publications

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“…Our study supports the need for such an investigation, since bedside clinicians do detect steroid-induced FHR changes. The correlation between visual and computerized analyses of FHR tracings is generally good [16,17] , however, disagreement between the two methods occurs almost exclusively in one direction, i.e., the computerized analysis detects more cases of suppressed FHR parameters than visual analysis [13] . Our study confi rms that the magnitude of steroid suppression of the FHR parameters is suffi ciently large to be detected by visual analysis.…”

Section: Discussionmentioning

confidence: 99%

Effect of Betamethasone Administration on Fetal Heart Rate Tracing: A Blinded Longitudinal Study

et al. 2005

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Objective: Computerized fetal heart rate (FHR) analysis revealed that antenatal corticosteroids transiently suppress multiple parameters of fetal well-being, potentially leading to the erroneous diagnosis of fetal distress and to unnecessary iatrogenic delivery of premature infants. Our aim was to determine whether clinicians who visually analyze FHR tracings detect these suppressive effects, thereby potentially affecting their clinical management decisions. Methods: Singleton pregnancies admitted for preterm labor between 26 and 34 weeks’ gestation received two doses of betamethasone, 24 h apart, and were monitored daily between 16:00 and 19:00 h for 5 days. FHR tracings were randomly coded and presented in a non-consecutive order to four clinicians, who were unaware of the time of steroid administration. FHR baseline, FHR variability, number of accelerations and amplitude of maximal FHR acceleration were determined. Variability was scored semiquantitatively based on a modified Hon score. Analysis of variance (ANOVA) with repeated measures was used for primary analysis and followed up with the Wald test of significance. Corrections for multiple comparisons were made and only p < 0.005 considered significant. ANOVA was also used to assess the uniformity of trend in the interpretation by the four examiners for each given day. Results: Baseline FHR was elevated, FHR variability was decreased, and the number of accelerations decreased on day 1 (p < 0.0001; p < 0.0001; p < 0.0001) and day 2 (p > 0.0001; p < 0.0001; p < 0.0001) in comparison to day 0. On day 3, the FHR baseline, variability and number of accelerations returned to pre-exposure values (p = NS). The maximal amplitude of FHR accelerations showed a trend towards reduction (p = 0.08). Subgroup analysis by gestational age (group I = 26–30 weeks and group II = 30–34 weeks) showed the same response patterns and significance levels for both groups. Conclusions: Betamethasone causes profound, but transient, suppression of FHR parameters, which can mimic fetal distress. This effect is clinically recognized by visual FHR analysis. Clinicians need to be aware of this phenomenon, in order to avoid unwarranted iatrogenic delivery.

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Section: Discussionmentioning

confidence: 99%

Effect of Betamethasone Administration on Fetal Heart Rate Tracing: A Blinded Longitudinal Study

et al. 2005

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“…L'analyse informatisée de l'ERCF (système Oxford) avec notamment la mesure de la variabilité à court terme des oscillations pourrait répondre aux insuffisances de l'enregistrement visuel [32]. En fait, l'utilisation comparée des deux types d'analyse ne montre pas de différence significative quant à l'issue périnatale (score d'Apgar inférieur à 7 à cinq minutes, acidoses et transferts néonatals) [35,36]. Cependant, par rapport à l'analyse visuelle de l'ERCF, le système informatique diminue la durée des temps d'enregistrement (12 versus 20 minutes), la répétition des tracés et le recours à d'autres examens de surveillance foetale notamment l'échographie [35,36].…”

Section: Quel Type De Surveillance Effectuer ?unclassified

“…En fait, l'utilisation comparée des deux types d'analyse ne montre pas de différence significative quant à l'issue périnatale (score d'Apgar inférieur à 7 à cinq minutes, acidoses et transferts néonatals) [35,36]. Cependant, par rapport à l'analyse visuelle de l'ERCF, le système informatique diminue la durée des temps d'enregistrement (12 versus 20 minutes), la répétition des tracés et le recours à d'autres examens de surveillance foetale notamment l'échographie [35,36]. Dans la mesure où cette dernière apporte également des informations étiologiques indispensables pour comprendre l'hypoxie foetale, l'ERCF automatisé perd une partie de son intérêt.…”

Section: Quel Type De Surveillance Effectuer ?unclassified

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Diminution des mouvements actifs du fœtus au troisième trimestre : que faire ?

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Verspyck

et al. 2005

Gynécologie Obstétrique & Fertilité

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“…In our department, we monitor fetuses who are growth-restricted or whose mothers have preeclampsia by recording FHR 1-3 times a day, depending on the situation, that is, at most every 8 h. Repeating the STV measurement more often to increase the chances of predicting acidosis is likely to reduce its interest compared with visual FHR analysis. Some authors have shown that computerized FHR analysis does not actually improve the sensitivity of acidosis screening compared with visual FHR analysis; rather, its advantage is that it reduces the repetition of tracings in cases of nonreassuring recordings [17,18]. …”

Section: Discussionmentioning

confidence: 99%

Short-Term Variation of the Fetal Heart Rate for Predicting Neonatal Acidosis in Preeclampsia

et al. 2015

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Introduction: The aim of this study was to measure the performance of short-term variation (STV) in predicting the onset of neonatal acidosis in fetuses at risk due to maternal preeclampsia. Material and Methods: This retrospective study examined data from a series of 159 women with singleton pregnancies, hospitalized for preeclampsia in a level 3 reference maternity hospital in northern France, with an STV measurement in the 24 h preceding cesarean delivery and a measurement of the newborn's arterial cord pH at birth. The main outcome was determined by a correlation between STV and neonatal pH. Results: The last computerized fetal heart rate analysis took place a mean of 7.9 ± 6.3 h before birth, and neonatal acidosis was diagnosed in 38 newborns (23.9%). Although STV and umbilical artery pH at birth were significantly correlated (ρ = 0.16, p < 0.05), the performance of STV in predicting neonatal acidosis was poor, with an area under the ROC curve of 0.63. The sensitivity reached only 50.0% and the specificity 71.9% at the best STV threshold for predicting acidosis. Conclusion: The performance of STV for screening for neonatal acidosis is poor in women with preeclampsia. The divergent results between studies are probably due to the variable intervals between STV measurement and birth.

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A comparison of visual and automated methods of analyzing fetal heart rate tests

Cited by 31 publications

References 10 publications

Effect of Betamethasone Administration on Fetal Heart Rate Tracing: A Blinded Longitudinal Study

Effect of Betamethasone Administration on Fetal Heart Rate Tracing: A Blinded Longitudinal Study

Diminution des mouvements actifs du fœtus au troisième trimestre : que faire ?

Short-Term Variation of the Fetal Heart Rate for Predicting Neonatal Acidosis in Preeclampsia

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