Interpretation of British experts’ illustrations of fetal heart rate (FHR) decelerations by Consultant Obstetricians, registrars and midwives: A prospective study—Reasons for major disagreement with experts and implications for clinical practice

Sholapurkar, Shashikant L.

doi:10.4236/ojog.2013.36085

Cited by 19 publications

(21 citation statements)

References 24 publications

(52 reference statements)

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“…There does seem to be dissatisfaction and improvement‐potential with the current categorisation of FHR decelerations because the proposed underlying pathophysiological hypotheses do not fit . However, criticism of every aspect of the current guidelines/3‐tier classification including attempts at structured interpretation/documentation (DRCBRaVADO) seems misconceived and unjustified.…”

Section: Disclosure Of Interestsmentioning

confidence: 99%

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

2015

BJOG

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Sir, I thank Dr Amin for her positive comments on my review of the role of current guidelines on intrapartum fetal heart rate (FHR) monitoring, and the proposed algorithm based on fetal cardiovascular adaptation to intrapartum asphyxia.1 The reliance of the guidelines on the morphological appearances, and the reference values for FHR features rather than on the relationships, temporal sequence, and the natural connection between FHR decelerations, tacchycardia or bradycardia, and loss of variability leaves the bedside clinician without an understanding of how the fetus defends itself from intrapartum hypoxia and the FHR patterns that suggest failure of that defense. This approach weakens the clinical utility of current guidelines and contributes to increased operative delivery of non-acidotic babies. In too many training modules, terms implying the presumed origins of the FHR decelerations are emphasised, overused, and presumed to be innocuous. As a result clinicians expend valuable time and energy trying to characterise and distinguish between the different types of FHR decelerations and the subtypes of 'complicated' variable decelerations from each other 2 even though most of them have been shown to have no association with fetal acidosis.3 The important point is how the fetus is handling the decelerations.Obstetric units like yours that have grasped the physiological principles of FHR monitoring and are prepared to invest in staff training and education will continue to enjoy lower rates of unwarranted operative delivery for presumed fetal compromise, escalating costs to their service and the resultant short-and long-term maternal morbidity. Disclosure of interestsNone. n References 1 Ugwumadu A. Are we (mis)guided by current guidelines on intrapartum fetal heart rate monitoring? Case for a more physiological approach to interpretation.

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Section: Disclosure Of Interestsmentioning

confidence: 99%

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

2015

BJOG

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“…This is attributable to the perceived lack of clinical usefulness and agreement. In fact, the experts seemed more inconsistent in their interpretation of fetal heart rate decelerations (centre‐stage in CTG interpretation) than front‐line clinicians . Following the enforced adoption of the flawed American concept of ‘variable decelerations being vast majority’ in 2007, there have been a succession of mistakes followed by forced corrections.…”

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confidence: 99%

“…Following the enforced adoption of the flawed American concept of ‘variable decelerations being vast majority’ in 2007, there have been a succession of mistakes followed by forced corrections. NICE recently made a major U‐turn (quite rightly) abandoning typical/atypical categorisation with a single cryptic nontransparent sentence. It was replaced with an arbitrary cut‐off of ‘>1‐minute duration’ for abnormal variable decelerations which seems unsound.…”

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confidence: 99%

“…The FIGO criterion of ‘>3‐minute duration’ can be shown to be unsafe. After (wrongly) classifying almost all decelerations as ‘variable’, the discrimination of pathological variables is left to trial‐and‐error arbitrary criteria, indicating a wrong premise. The main pathophysiology of fetal hypoxia is contraction‐induced reduction in uteroplacental blood flow .…”

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confidence: 99%

“…Notwithstanding, the pathophysiological model underpinning current categorisation of decelerations (dominated by misconceived cord‐compression) seems fundamentally flawed, comprising probably the biggest framing and confirmation fallacies in modern medicine . Without its reform the current problems of CTG interpretation may not be solved . Regular training and semi‐formal testing are already in place.…”

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confidence: 99%

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Re: Time to optimise and enforce training in interpretation of intrapartum cardiotocograph

Sholapurkar

2016

BJOG

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Artificial Intelligence and Machine Learning in Electronic Fetal Monitoring

Barnova,

Martinek,

Vilimkova Kahankova

et al. 2024

Arch Computat Methods Eng

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Electronic fetal monitoring is used to evaluate fetal well-being by assessing fetal heart activity. The signals produced by the fetal heart carry valuable information about fetal health, but due to non-stationarity and present interference, their processing, analysis and interpretation is considered to be very challenging. Therefore, medical technologies equipped with Artificial Intelligence algorithms are rapidly evolving into clinical practice and provide solutions in the key application areas: noise suppression, feature detection and fetal state classification. The use of artificial intelligence and machine learning in the field of electronic fetal monitoring has demonstrated the efficiency and superiority of such techniques compared to conventional algorithms, especially due to their ability to predict, learn and efficiently handle dynamic Big data. Combining multiple algorithms and optimizing them for given purpose enables timely and accurate diagnosis of fetal health state. This review summarizes the currently used algorithms based on artificial intelligence and machine learning in the field of electronic fetal monitoring, outlines its advantages and limitations, as well as future challenges which remain to be solved.

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Interpretation of British experts’ illustrations of fetal heart rate (FHR) decelerations by Consultant Obstetricians, registrars and midwives: A prospective study—Reasons for major disagreement with experts and implications for clinical practice

Cited by 19 publications

References 24 publications

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

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

Re: Time to optimise and enforce training in interpretation of intrapartum cardiotocograph

Artificial Intelligence and Machine Learning in Electronic Fetal Monitoring

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