Fetal acidemia and electronic fetal heart rate patterns: Is there evidence of an association?

Parer, Julian T.; King, Tekoa L.; Flanders, Scott A.; Fox, Michael R.; Kilpatrick, Sarah J.

doi:10.1080/14767050500526172

Cited by 148 publications

(107 citation statements)

References 29 publications

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“…Depressed temporal HR variability correlates to acidosis, (13) and frequency domain-based normalized LF and HF HRV markers were likewise correlated to acidosis (14). Temporal HRV was calculated as the SD of HRs of 5 min, and this is reflected in sharp transitions at the start and end of UCO (Supplementary Figure S3 online), when HR abruptly changes.…”

Section: Discussionmentioning

confidence: 99%

Comparison of ECG-based physiological markers for hypoxia in a preterm ovine model

et al. 2016

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Background: Current methods for assessing perinatal hypoxic conditions did not improve infant outcomes. Various waveform-based and interval-based ECG markers have been suggested, but not directly compared. We compare performance of ECG markers in a standardized ovine model for fetal hypoxia. Methods: Sixty-nine fetal sheep of 0.7 gestation had ECG recorded 4 h before, during, and 4 h after a 25-min period of umbilical cord occlusion (UCO), leading to severe hypoxia. Various ECG markers were calculated, among which were heart rate (HR), HR-corrected ventricular depolarization/ repolarization interval (QT c ), and ST-segment analysis (STAN) episodic and baseline rise markers, analogue to clinical STAN device alarms. Performance of interval-and waveform-based ECG markers was assessed by correlating predicted and actual hypoxic/normoxic state. results: Of the markers studied, HR and QT c demonstrated high sensitivity (≥86%), specificity (≥96%), and positive predictive value (PPV) (≥86%) and detected hypoxia in ≥90% of fetuses at 4 min after UCO. In contrast, STAN episodic and baseline rise markers displayed low sensitivity (≤20%) and could not detect severe fetal hypoxia in 65 and 28% of the animals, respectively. conclusion: Interval-based HR and QT c markers could assess the presence of severe hypoxia. Waveform-based STAN episodic and baseline rise markers were ineffective as markers for hypoxia. c ontinuous monitoring of the fetal heart rate (HR) is assumed to provide clinical information about the wellbeing of the fetus (1). Cardiotocography (CTG) allows noninvasive real-time assessment of fetal HR and its response to uterine contractions and is nowadays used in clinics worldwide. However, HR patterns in CTG are often not predictive for hypoxia (2). Introduction of CTG in clinics did not significantly reduce occurrences of neonatal death or cerebral palsy but did lead to an increase in caesarean sections (1). Consequently, analysis of the ECG ST waveform (STAN) was proposed as an additional analysis method. STAN assesses hypoxia-induced changes in the ST waveform of the ECG (3) and operates in conjunction with CTG. Implementation of STAN in clinical practice was initially associated with a beneficial reduction in hypoxia-induced outcomes (metabolic acidosis and moderate/ severe neonatal encephalopathy) compared to CTG alone (4). However, recent meta-analyses of clinical trials demonstrated no clear advantage of STAN with CTG over CTG alone with respect to primary outcomes (5,6).STAN markers are based on the shape of the ECG waveform. Other ECG markers for hypoxia detection have been suggested, namely, atrioventricular (AV) conduction delay (PR) (7,8), the relationship of AV delay and HR (PR/RR and PR-HR) (9,10) and ventricular activation and repolarization (QT) (11) and HR-corrected QT (QT c,Bazett and Qt c,Hodges ), as well as heart rate variability (HRV) in the temporal and frequency domain. These markers are all interval-based, i.e., they use time intervals between characteristic points in the ECG. A major di...

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Section: Discussionmentioning

confidence: 99%

Comparison of ECG-based physiological markers for hypoxia in a preterm ovine model

et al. 2016

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“…Metabolic acidemia can develop over 60 min following a fetus being deprived of adequate oxygenation (Parer, King, Flanders, Fox, & Kilpatrick, 2006). Hypoxia during labor can be caused by compression of the umbilical cord, or in more serious cases, by decreased placental perfusion during a uterine contraction seen in late decelerations (Miller & Miller, 2012).…”

Section: Factors Influencing Fetal Heart Rate Changesmentioning

confidence: 99%

“…Metabolic acidemia is associated with increased rates of neonatal morbidity, specifically cerebral palsy (Miller & Miller, 2012;Parer et al, 2006); however, fetal hypoxia during labor is a very rare cause of cerebral palsy (Blair & Stanley, 1988). Approximately 2 out of 1,000 children have cerebral palsy with the main risk factors for cerebral palsy being low birth weight, intrauterine infections, and multiple gestations (Odding, Roebroeck, & Stam, 2006).…”

Section: Factors Influencing Fetal Heart Rate Changesmentioning

confidence: 99%

Fetal Monitoring: Creating a Culture of Safety With Informed Choice

Heelan¹

2013

J Perinat Educ

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The dominant culture in labor and birth is the medical model, not the midwifery model of woman-centered care. Consensus among professional and governmental groups is that, based on the evidence, intermittent auscultation is safer to use in healthy women with uncomplicated pregnancies than electronic fetal monitoring (EFM). Barriers impact the laboring woman's ability to give informed choice regarding fetal monitoring. Lack of informed choice denies a woman her right to be in control of her birth experience, and is in opposition to a woman's right to autonomy and self-determination.

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“…Therefore, the risk factors are associated with decreased blood flow and oxygenation to the tissues [52,53]. So birth asphyxia can be caused by events that have their roots in 50% of cases primarily antepartum in origin, 40% cases intra-partum and remaining 10% of cases are postpartum periods or combinations thereof [3,33,41,54].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Birth Asphyxia and Associated Factors among Neonates Delivered in Dilchora Referral Hospital, in Dire Dawa, Eastern Ethiopia

Ibrahim¹,

Seid²,

Abdulie³

2017

Clinics Mother Child Health

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Introduction: The greatest gap in new-born care is often during the critical first week of life when most neonatal and maternal deaths often occur at home and without any contact with the formal health sector. Some unacceptable practices such as unskilled attendants during delivery, unhygienic delivery practices, taboos and superstitions associated with caring for the new-born greatly affect new-born survival in Ethiopia.

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Fetal acidemia and electronic fetal heart rate patterns: Is there evidence of an association?

Cited by 148 publications

References 29 publications

Comparison of ECG-based physiological markers for hypoxia in a preterm ovine model

Comparison of ECG-based physiological markers for hypoxia in a preterm ovine model

Fetal Monitoring: Creating a Culture of Safety With Informed Choice

Prevalence of Birth Asphyxia and Associated Factors among Neonates Delivered in Dilchora Referral Hospital, in Dire Dawa, Eastern Ethiopia

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