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

Abstract

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

Maternal hemodynamics and computerized cardiotocography during labor with epidural analgesia

“…In the time of a contraction, most fetuses resist a period of short hypoxia, while fetuses with lower hypoxic tolerance limits show signs of compensation detected by the CTG in the form of decelerations and reduced variability. Short term variation (STV) is affirmed as a good predictor for fetal acid–base status during pregnancy and despite there are demonstrations of a significant increase in short and long term variation in peripartum period [ 27 ] in our series, in women with high-TVR, STV after an epidural bolus was significantly lower than in women with low-TVR, on the other hand women with low TVR and higher levels of CO have an improuved fetal response to maternal hypotension induced by epidural analgesic drugs as demonstrated by the reduced number of decelerations and higher short term variation.…”

Multi-Classification of Fetal Health Status Using Extreme Learning Machine

“…Cardiotocographyis a medical device used to diagnose fetal heart rate status. This device is used by specialists for simultaneous recording and monitoring of FHR and UC patterns during pregnancy Kapaya et al (2020). It was obtained from the open source UCI repository for the experimental analysis of the method proposed in the study UCI Machine Learning Repository (2021).…”

Prediction of labour outcomes using prelabour computerised cardiotocogram and maternal and fetal Doppler indices: A prospective cohort study

“…decelerations). [3][4][5] These CTG patterns, however, are difficult for human visual interpretation to reliably and consistently identify. 1,6,7 It is well-established that subjective assessment of the CTG patterns suffers from poor inter-observer and intra-observer reproducibility 1,[8][9][10][11][12][13] and is associated with increased operative vaginal delivery and caesarean section rates without improving perinatal outcomes.…”

“…Fetal hypoxia and acidosis can be detected primarily through the recognition of specific patterns on the CTG signal (e.g. decelerations) 3–5 . These CTG patterns, however, are difficult for human visual interpretation to reliably and consistently identify 1,6,7 .…”