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

Ugwumadu, Austin

doi:10.1111/1471-0528.12900

Cited by 87 publications

(68 citation statements)

References 62 publications

(55 reference statements)

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“…However, it is well known that the interpretation of FHR signals is prone to high intra-and inter-observer variability due to subjectivity in visual inspections. Moreover, current guidelines for FHR evaluation have been criticized for simplistic interpretation and held responsible for defensive practices as well as unnecessary operative interventions [3].…”

Section: Introductionmentioning

confidence: 99%

Recovery of missing samples in fetal heart rate recordings with Gaussian processes

Feng¹,

Quirk

Djurić³

2017

2017 25th European Signal Processing Conference (EUSIPCO)

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Abstract-Missing samples are very common in fetal heart rate (FHR) recordings due to various reasons including fetal or maternal movements and misplaced electrodes. They introduce distortions and cause difficulties in their analysis. In this paper, we propose a Gaussian process-based method that can utilize other intrapartum signals (e.g., uterine activity and maternal heart rate) to recover the missing samples in FHR recordings. The proposed approach was tested on a short real FHR recording segment and its performance was compared with that of cubic spline interpolation which is widely used in pre-processing of FHR recordings. Our results show that the proposed approach, with utilization of UA signals, achieves 2.35 dB to 14.85 dB better recovery performance. Furthermore, even when the percentage of missing samples is more than 50%, the mean square error of this approach is still below one beat per minute.

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Section: Introductionmentioning

confidence: 99%

Recovery of missing samples in fetal heart rate recordings with Gaussian processes

Feng¹,

Quirk

Djurić³

2017

2017 25th European Signal Processing Conference (EUSIPCO)

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“…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 [6].…”

Section: The Acog As Light Bearermentioning

confidence: 99%

Re-visiting the role of intra-partum cardio-tocography (I-P CTG) in cerebral palsy jurisprudence: Time to take cognizance

Buttigieg¹,

Stafrace²

2018

J Pregnancy Reprod

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Both clinical obstetrics as well the relevant medico-legal litigation was severely let down by false scientific conclusions emanating from the USA in the 1960's. The false assumptions considered birth asphyxia as the predominant cause of new-born Cerebral Palsy and proclaimed the just introduced fetal cardio-tocography (CTG), as the great saviour from CP through the detection of intra-partum hypoxia. Although today, fifty odd years later, science admits that neither conclusion is correct, CTG has retained its misplaced strength in CP litigation. Not only does it still hold much pre-eminence in both UK and US jurisprudence, but sometimes, it constitutes the sole basis of discussion.The only scientifically valid and practical way of correction is the recognition that CP due to intra-partum hypoxia has the underlying hallmark pathology of Hypoxic Ischaemic Encephalopathy (HIE). This constitutes no more than 20% of CP. Other aspects of obstetric care, including in the antenatal period may have a basis for alleging negligence, but CP due to peri-partum hypoxia must be accompanied by HIE. The 2003/2014 criteria for diagnosing HIE were established by the American College of Obstetricians in liaison with the American Academy of Paediatricians. This provides a reliable guide to the diagnosis by integrating clinical obstetrics/ neonatology/midwifery observations, fetal/ newborn biochemical data, newborn cerebral MRI/ MRI spectroscopy imaging, and evidence of fetal multisystem organ failure. These must be the new parameters on which CP jurisprudence should be justly and scientifically based.

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“…In the United Kingdom, in response to a belief that the current RCOG recommendations lack incorporation of many details of FHR patterns which are important for management, Ugwumadu 22) presented an expanded classification. This is readily identifiable as similar in many respects to the 5-tier system, as can be seen from the modification of his figure (Figure 5).…”

Section: Adoption Of 5-tier Systemsmentioning

confidence: 99%

Standardization of fetal heart rate pattern management: Is international consensus possible?

Parer¹

2014

Hypertens Res Pregnancy

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

Cited by 87 publications

References 62 publications

Recovery of missing samples in fetal heart rate recordings with Gaussian processes

Recovery of missing samples in fetal heart rate recordings with Gaussian processes

Re-visiting the role of intra-partum cardio-tocography (I-P CTG) in cerebral palsy jurisprudence: Time to take cognizance

Standardization of fetal heart rate pattern management: Is international consensus possible?

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