Fetal monitoring in labour: summary and update of NICE guidance

O’heney, Josie; McAllister, Sophie; Maresh, Michael; Blott, Maggie

doi:10.1136/bmj.o2854

Cited by 14 publications

(22 citation statements)

References 6 publications

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“…There was marked variation in Suspicious variability criteria, with most guidelines indicating that variability below 5 BPM for between 30 to 90 min indicates moderate risk of fetal hypoxia. Five guidelines (ACOG, DGGG, NICE, NICHD, WALES) indicated increased variability above 25 BPM as a Suspicious feature 15,16,18,19,25 . All guidelines agreed on absent variability as an Abnormal feature.…”

Section: Resultsmentioning

confidence: 98%

“…All guidelines considered a fetal heart rate below 100 BPM to be abnormal and a feature of the highest possible risk category. Four guidelines (DGGG, NICE, SLCOG, WALES) considered fetal tachycardia above 180 BPM to also meet criteria for the highest risk category 16,18,23,25 . Most guidelines noted a baseline between 100–110 BPM and 160–180 BPM to be a Suspicious feature.…”

Section: Resultsmentioning

confidence: 99%

“…Most guidelines noted a baseline between 100–110 BPM and 160–180 BPM to be a Suspicious feature. Only two guidelines (NICE, SOGC) included a rise in baseline (without breaching the above limits) as a Suspicious feature 18,24 …”

Section: Resultsmentioning

confidence: 99%

“…Two guidelines (FIGO, IRELAND) permitted no repetitive decelerations (<50% of contractions) 4,17 . Five (ACOG, NICE, NICHD, SWE‐17, WALES) confirmed typical early decelerations also in the Normal category, 7,15,18,19,25 while one (DGGG) placed early decelerations in the Suspicious category 16 . However, other (NICE, SWE‐17, WALES), guidelines also permitted limited typical variable decelerations as Normal 7,18,25 …”

Section: Resultsmentioning

confidence: 99%

“…Decelerations qualifying as Suspicious were discrepant between the guidelines. Some guidelines (NICE, SWE‐17, WALES) considered recurrent typical variable decelerations Normal if present for less than 90 min and up to 60 sec in duration, 7,18,25 while others (ACOG, SWE‐17) made explicit that all other features (such as variability and baseline) must be in the range expected of the Normal category 7,15 . There was more consistency in the Abnormal criteria for decelerations, with unanimous classification of late decelerations and bradycardia (>5 min) as convincing evidence of fetal compromise.…”

Section: Resultsmentioning

confidence: 99%

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Clinical practice guidelines for intrapartum cardiotocography interpretation: A systematic review

Brown

Kanagaretnam

Zen

2023

Aust NZ J Obst Gynaeco

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Background Clinical practice guidelines on intrapartum cardiotocography (CTG) interpretation provide structured tools to detect fetal hypoxia. Despite frequent use of different guidelines, little is known about their comparable consistency. We sought to appraise guidelines relevant to intrapartum CTG interpretation and summarise consensus and non‐consensus recommendations. Aims To compare existing intrapartum CTG interpretation guidelines. Materials and methods We searched PubMed, CINAHL, Cochrane, Embase, guideline databases and websites of guideline development institutions using terms ‘cardiotocography’, ‘electronic fetal/foetal monitoring’, and ‘guideline’ or equivalent term. The search was restricted to English‐language articles published between January 1980 and January 2023 and excluded animal studies. The initial search yielded 2128 articles with 1253 unique citations. Guidelines were included if they: used English as the reporting language; included CTG interpretation criteria or guidelines as a primary objective; were published or updated since 1980; and were the most recently updated publications when multiple versions were identified. Results Nineteen studies were considered for full review, and 13 met inclusion criteria. Two reviewers independently assessed guideline quality using the AGREE II instrument, and synthesised consensus and non‐consensus recommendations using the content analysis approach. Most guidelines employed a three‐tier interpretation framework. There were significant differences between the guidelines for relative importance of key CTG features such as accelerations, decelerations and variability, with respect to the outcome of fetal hypoxia. Conclusions There are significant differences between key intrapartum CTG interpretation guidelines currently being used. Greater consistency is needed across CTG interpretation guidelines to improve the quality of data, clinical governance, monitoring of outcomes, and to support future developments.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Clinical practice guidelines for intrapartum cardiotocography interpretation: A systematic review

Brown

Kanagaretnam

Zen

2023

Aust NZ J Obst Gynaeco

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Effects and mechanisms of acupuncture on women related health

Qin,

Feng,

2023

Front. Med.

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Fetal QRS extraction from single-channel abdominal ECG using adaptive improved permutation entropy

Mansourian,

Sarafan,

Torkamani-Azar

et al. 2024

Phys Eng Sci Med

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The fetal electrocardiogram (fECG), extracted from the abdominal ECG (aECG) signal of an expectant mother, provides vital information about the fetal condition. There is an increased interest in continuous fECG monitoring during pregnancy to ensure the well-being and development of the fetus. The implementation of continuous fECG monitoring devices necessitates robust and efficient signal processing techniques for extracting the fECG from the aECG. However, existing fECG extraction algorithms are not suitable for wearables due to the requirement of multi-channel signals and/or their high computational cost. In this paper, we propose a novel algorithm for fetal QRS extraction from a singlechannel aECG signal, which is robust and computationally less complex. The algorithm is based on a novel Permutation Entropy (PE) method we developed and referred to as the Adaptive Improved Permutation Entropy (AIPE) method. To evaluate the performance of the proposed algorithm, we utilized our own clinical data obtained from a pilot study with 10 subjects, each recording lasting 20 i minutes, as well as data from the PhysioNet 2013 Challenge bank with labeled QRS complex annotations. The proposed methodology demonstrates an average positive predictive value (PPV) of 91.0227%, sensitivity (SE) of 90.4726%, and F1-score of 90.6525% from the PhysioNet 2013 Challenge bank, outperforming other methods. These results indicate that our proposed algorithm is reliable and effective, making it suitable for deployment in wearable devices for continuous home-based monitoring of unborn babies.

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Fetal monitoring in labour: summary and update of NICE guidance

Abstract: DJ. Comparing second-line tests to assess fetal wellbeing in Labor: a feasibility study and pilot randomized controlled trial.

Cited by 14 publications

References 6 publications

Clinical practice guidelines for intrapartum cardiotocography interpretation: A systematic review

Clinical practice guidelines for intrapartum cardiotocography interpretation: A systematic review

Effects and mechanisms of acupuncture on women related health

Fetal QRS extraction from single-channel abdominal ECG using adaptive improved permutation entropy

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