Intrapartum PRSA: a new method to predict fetal acidosis?—a case-control study

Weyrich, Joy; Ortiz, JU; Müller, Alexander; Schmidt, Georg; Brambs, Christine; Graupner, O; Kuschel, Bettina; Lobmaier, Silvia M.

doi:10.1007/s00404-019-05419-y

Cited by 18 publications

(28 citation statements)

References 22 publications

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“…It has been used as a measure of heart rate variability [15][16][17] but can be adapted to average the magnitude of all falls in FHR between successive heartbeats and so provide an integrated measure of the magnitude and frequency of FHR decelerations. 12,15 DC has been shown to predict acidaemia or fetal compromise in a cohort study of >22 000 human labours 10 and to be associated with acidaemia in fetal sheep. 18 DC does not rely on correctly identifying baseline FHR and decelerations, as is required to measure DA, and it is very tolerant of noise and loss of contact during FHR recording.…”

Section: Introductionmentioning

confidence: 97%

Deceleration area and capacity during labour‐like umbilical cord occlusions identify evolving hypotension: a controlled study in fetal sheep

Georgieva

Lear

Westgate

et al. 2021

BJOG

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Objective Cardiotocography is widely used to assess fetal wellbeing during labour. The positive predictive value of current clinical algorithms to identify hypoxia-ischaemia is poor. In experimental studies, fetal hypotension is the strongest predictor of hypoxic-ischaemic injury. Cohort studies suggest that deceleration area and deceleration capacity of the fetal heart rate trace correlate with fetal acidaemia, but it is not known whether they are indices of fetal arterial hypotension.Design Prospective, controlled study.Setting Laboratory.Sample Near-term fetal sheep.Methods One minute of complete umbilical cord occlusions (UCOs) every 5 minutes (1:5 min, n = 6) or every 2.5 minutes (1:2.5 min, n = 12) for 4 hours or until fetal mean arterial blood pressure fell <20 mmHg.Main outcome measures Deceleration area and capacity during the UCO series were related to evolving hypotension.Results The 1:5 min group developed only mild metabolic acidaemia, without hypotension. By contrast, 10/12 fetuses in the 1:2.5-min group progressively developed severe metabolic acidaemia and hypotension, reaching 16.8 AE 0.9 mmHg after 71.2 AE 6.7 UCOs. Deceleration area and capacity remained unchanged throughout the UCO series in the 1:5-min group, but progressively increased in the 1:2.5-min group. The severity of hypotension was closely correlated with both deceleration area (P < 0.001, R 2 = 0.66, n = 18) and capacity (P < 0.001, R 2 = 0.67, n = 18). Deceleration area and capacity predicted development of hypotension at a median of 103 and 123 minutes before the final occlusion, respectively.Conclusions Both deceleration area and capacity were strongly associated with developing fetal hypotension, supporting their potential to improve identification of fetuses at risk of hypotension leading to hypoxic-ischaemic injury during labour.

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Section: Introductionmentioning

confidence: 97%

Deceleration area and capacity during labour‐like umbilical cord occlusions identify evolving hypotension: a controlled study in fetal sheep

Georgieva

Lear

Westgate

et al. 2021

BJOG

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“…We analysed end of labour FHR data which are fundamentally different from pre-labour (antepartum) FHR data [5]. Antepartum FHR data are more likely to be stable and usually do not have decelerations, whereas end-of-labour traces are more likely to be unstable, with frequent signal loss and FHR decelerations [5,32] as observed in our study.…”

Section: Plos Onementioning

confidence: 77%

Is short-term-variation of fetal-heart-rate a better predictor of fetal acidaemia in labour? A feasibility study

et al. 2020

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Background Continuous intrapartum fetal monitoring is challenging and its clinical benefits are debated. The project evaluated whether short-term-variation (STV) and other computerised fetal heart rate (FHR) parameters (baseline FHR, long-term-variation, accelerations and decelerations) predicted acidaemia at birth. The aims of the study were to assess the changes in FHR pattern during labour and determine the feasibility of undertaking a definitive trial by reporting the practicalities of using the monitoring device, participant recruitment, data collection and staff training. Methods 200 high-risk women carrying a term singleton, non-anomalous fetus, requiring continuous FHR monitoring in labour were consented to participate from the Jessop Wing maternity unit, Sheffield, UK. The trans-abdominal fetal ECG monitor was placed as per clinical protocol. During the monitoring session, clinicians were blinded to the computerised FHR parameters. We analysed the last hour of the FHR and its ability to predict umbilical arterial blood pH <7.20 using receiver operator characteristics (ROC) curves. Results Of 200 women, 137 cases were excluded as either the monitor did not work from the onset of labour (n = 30), clinical staff did not return or used the monitor on another patient (n = 37), umbilical cord blood not obtained (n = 25), FHR data not recorded within an hour of birth (n = 34) and other reasons (n = 11). In 63 cases included in the final analysis, the computerderived FHR parameters did not show significant correlation with umbilical artery cord pH <7.20. Labour was associated with a significant increase in short and long term variation of

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“…Our previous proof-of-concept work, to which Sholapurkar refers, reported the accuracy of DC and a prototype Oxford System (OXSYS1.5) on over 22 790 births. 4 Receiver operating characteristics curves were not directly applicable and so are not shown, but the data-driven approach had comparable sensitivity and specificity to experienced clinicians. This analysis did not use a 'black box' approach, but well-documented algorithms, in a similar way to our study in fetal sheep.…”

Section: Sirmentioning

confidence: 98%

“…1 Another cohort study on 11 980 women showed the area under curve (AUC) for DC to be 0.66. 4 This AUC reveals that if we want to detect 90%, 80% or 50% of acidaemic babies, the same deceleration capacity (DC) was shared by 80%, 60%, 25% of normal babies, respectively, making DC disappointing for clinical application. 4 Similarly, AUCs for deceleration area (DA) in human studies are very comparable and demonstrate DA to be unhelpful in practice.…”

Section: Sirmentioning

confidence: 99%

Deceleration area and deceleration capacity: deficient predictors of fetal acidaemia in human labour. Visual versus computerised cardiotocography

Sholapurkar

2021

BJOG

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Intrapartum PRSA: a new method to predict fetal acidosis?—a case-control study

Cited by 18 publications

References 22 publications

Deceleration area and capacity during labour‐like umbilical cord occlusions identify evolving hypotension: a controlled study in fetal sheep

Deceleration area and capacity during labour‐like umbilical cord occlusions identify evolving hypotension: a controlled study in fetal sheep

Is short-term-variation of fetal-heart-rate a better predictor of fetal acidaemia in labour? A feasibility study

Deceleration area and deceleration capacity: deficient predictors of fetal acidaemia in human labour. Visual versus computerised cardiotocography

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