Graded classification of fetal heart rate tracings: association with neonatal metabolic acidosis and neurologic morbidity

Elliott, C.; Warrick, Philip; Graham, Ernest M.; Hamilton, Emily

doi:10.1016/j.ajog.2009.06.026

Cited by 81 publications

(53 citation statements)

References 18 publications

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“…The most common causes of false positives are when certain disturbances and influencing variables are disregarded (e.g., fetal behavioral states, age of gestation), failure to use additional complementary evaluation methods, uncertainty of interpretation, and inconsistent threshold values and assessment modalities [15,23,26,37,61,68].…”

Section: Aim and Problems Of Ctg Recordingsmentioning

confidence: 99%

“…But if CTG monitoring is waived, the necessary auscultation would be time-consuming and would require higher levels of staffing while providing only sketchy documentation from a medical and legal point point of view [75] with no early identification of fetal deterioration. More recent studies found electronic CTG monitoring to be beneficial [12,15,23,26,61,68,76]. Vintzileos and colleagues found that the use of computerized CTG monitoring resulted in a reduction of hypoxia-related perinatal mortality rates compared to monitoring done by auscultation alone ( [92,103,104]; EL I b) and also noted a significant improvement in identifying different types of fetal acidemia ( [93,103,104]; EL Ib).…”

Section: Intrapartummentioning

confidence: 99%

“…[61,76]. This was incorporated in the practical recommendations of the ACOG on the nomenclature and interpretation of CTG patterns [4], and the ACOG recommendations on intrapartum management [5], including a subclassification based on the association with neonatal metabolic acidosis [23]. Fetal monitoring using modern monitoring systems can give rise to ambiguous heart rate readings which are caused by the erroneous attribution of maternal heart rate signals to fetal CTG signals [68].…”

Section: Intrapartummentioning

confidence: 99%

See 2 more Smart Citations

S1-Guideline on the Use of CTG During Pregnancy and Labor

Schneider¹

2014

Geburtshilfe Frauenheilkd

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The aim of this consensus paper is to standardize the use of cardiotocograms (CTG) in fetal monitoring using an evidence-based approach. Recommended standards take the impact of disturbances and other influencing variables on the CTG into account, use standard definitions and objective assessment methods, and look at upstream diagnostic procedures and adjunct monitoring methods. The target audience for this consensus paper are all professionals who use CTG readings to monitor pregnancies and childbirth, most notably gynecologists and midwives. Method: This guideline was compiled with particular reference to and in consideration of previous recommendations [85], the FIGO guidelines [59, 82], and the guidelines of the Royal College of Obstetricians and Gynaecologists [84], the NICHD [72], the Society of Obstetrics and Gynecologists Canada [110] and the American College of Obstetricians and Gynecologists [4, 5] as well as evidence-based data, where available. The basis for this guideline is the best available "evidence" which was carefully collected and classified by the members of the consensus group. It was not possible in every case to compile recommendations directly from the evidence level provided in the available literature. The recommendations show what is generally considered good clinical practice, so far as this was not queried by the persons involved in the consensus process. With regard to the requirements speci

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Section: Aim and Problems Of Ctg Recordingsmentioning

confidence: 99%

Section: Intrapartummentioning

confidence: 99%

Section: Intrapartummentioning

confidence: 99%

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S1-Guideline on the Use of CTG During Pregnancy and Labor

Schneider¹

2014

Geburtshilfe Frauenheilkd

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“…Elliot et al [20] studied the last three hours of recordings in 2472 near-term singletons. Of the 60 cases with neonatal hypoxic-ischaemic encephalopathy, the system displayed a red alert in 8.3 % , it reached an orange alert in 51.7 % and it reached a yellow alert in 88.3 % .…”

Section: Pericalm Tm (Lms Medical Systems Montreal Canada and Perigmentioning

confidence: 99%

An overview of central fetal monitoring systems in labour

Nunes¹,

Ayres-de-Campos²,

Figueiredo

et al. 2012

Journal of Perinatal Medicine

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A variety of systems for centralised viewing of fetal signals during labour are currently available, allowing simultaneous monitoring of multiple tracings in one or more locations. Display of maternal vital signs, ST signals and an electronic partogram are available in the majority of these systems. A few of them have incorporated computer analysis of cardiotocographic signals or combined cardiotocographic and ST data analysis. Computer analysis may elicit real-time alerts for healthcare professionals when changes associated with fetal hypoxia are detected. Central fetal monitoring systems have been installed in a large number of maternity hospitals in industrialised countries, but there is still limited evidence of their impact on perinatal indicators, on the behaviour of healthcare professionals and on related health costs.

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“…We have measured the sensitivity and specifi city of one of the most methodical and detailed classifi cation methods that defi ned fi ve color-coded levels based on baseline variability, baseline level and the severity of recurrent decelerations [25,51] . Red was the most abnormal, with orange, yellow, and blue defi ning progressively less concerning patterns.…”

Section: Three Basic Steps In Clinical Monitoringmentioning

confidence: 99%

New perspectives in electronic fetal surveillance

Hamilton¹,

Warrick²

2012

Journal of Perinatal Medicine

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Despite its recognized limitations, fetal heart rate monitoring is a mainstay of intrapartum care. Although the basic technology in standard electronic fetal monitors has changed little in recent decades, clinical behavior in response to heart rate monitoring has changed considerably. In addition to clearly defi ned nomenclature and clinical guidelines, there is an increased awareness that environmental and human factors can impair clinical judgment, resulting in delayed intervention and, consequently, birth-related injury. This review examines three essential steps that affect clinical outcome: (1) signal acquisition, (2) associations with physiological outcome, and (3) clinical intervention. Only the third step is directly responsible for changing clinical outcome. However, timely initiation of interventions is dependent upon the second step, which is dependent upon the fi rst step. Thus, defi ciencies at each step tend to accumulate and contribute to the worsening of overall clinical outcome. This review article summarizes advances occurring at each step. The synergy and convergence of innovations in engineering, mathematics, and behavioral science shows considerable promise in intrapartum fetal surveillance.

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Graded classification of fetal heart rate tracings: association with neonatal metabolic acidosis and neurologic morbidity

Cited by 81 publications

References 18 publications

S1-Guideline on the Use of CTG During Pregnancy and Labor

S1-Guideline on the Use of CTG During Pregnancy and Labor

An overview of central fetal monitoring systems in labour

New perspectives in electronic fetal surveillance

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