“…This simulator can either function in a stand‐alone configuration on a personal computer, or can be integrated with a full‐scale simulator representing the mother 11 . We have recently presented an original low order, yet realistic model for the educational simulation of oxygen delivery to the foetus 12 . Validation of model response was based on human data for the baseline arterial oxygen levels, and on animal data for the response to reductions in uterine perfusion pressure and maternal arterial oxygen levels.…”
We expect that, after initial clinical and educational validation, the presented models and simulators will play a role in simulator-based educational programmes contributing to increased perinatal safety.
“…This simulator can either function in a stand‐alone configuration on a personal computer, or can be integrated with a full‐scale simulator representing the mother 11 . We have recently presented an original low order, yet realistic model for the educational simulation of oxygen delivery to the foetus 12 . Validation of model response was based on human data for the baseline arterial oxygen levels, and on animal data for the response to reductions in uterine perfusion pressure and maternal arterial oxygen levels.…”
We expect that, after initial clinical and educational validation, the presented models and simulators will play a role in simulator-based educational programmes contributing to increased perinatal safety.
“…It is also known that maternal and fetal pathophysiological conditions are intimately related, namely concerning blood gas and H + exchange [5,21,28]. The occurrence of strenuous uterine contractions leading to maternal acidemia of myometrial origin and the secretion of neuro-endocrine mediators associated with uterine activity could lead to changes in MHR variability in addition to the well-known changes in FHR.…”
Fetal heart rate (FHR) monitoring is used routinely in labor, but conventional methods have a limited capacity to detect fetal hypoxia/acidosis. An exploratory study was performed on the simultaneous assessment of maternal heart rate (MHR) and FHR variability, to evaluate their evolution during labor and their capacity to detect newborn acidemia. MHR and FHR were simultaneously recorded in 51 singleton term pregnancies during the last two hours of labor and compared with newborn umbilical artery blood (UAB) pH. Linear/nonlinear indices were computed separately for MHR and FHR. Interaction between MHR and FHR was quantified through the same indices on FHR-MHR and through their correlation and cross-entropy. Univariate and bivariate statistical analysis included nonparametric confidence intervals and statistical tests, receiver operating characteristic curves and linear discriminant analysis. Progression of labor was associated with a significant increase in most MHR and FHR linear indices, whereas entropy indices decreased. FHR alone and in combination with MHR as FHR-MHR evidenced the highest auROC values for prediction of fetal acidemia, with 0.76 and 0.88 for the UAB pH thresholds 7.20 and 7.15, respectively. The inclusion of MHR on bivariate analysis achieved sensitivity and specificity values of nearly 100 and 89.1%, respectively. These results suggest that simultaneous analysis of MHR and FHR may improve the identification of fetal acidemia compared with FHR alone, namely during the last hour of labor.
“…To validate the model response to simulated critical situations we used fetal lamb data, as no data on humans were available. Model block diagram. Results Figure 2 shows the model output: O 2 partial pressure in the fetal arterial blood, following simulated maternal hypotension [1] and partial occlusion of the umbilical cord [2]. The reduction in partial pressure for these two situations compares favourably with data from the literature [3,4].…”
mentioning
confidence: 98%
“…Results Figure 2 shows the model output: O 2 partial pressure in the fetal arterial blood, following simulated maternal hypotension [1] and partial occlusion of the umbilical cord [2]. The reduction in partial pressure for these two situations compares favourably with data from the literature [3,4].…”
mentioning
confidence: 98%
“…The target audience of such simulations consists of residents in obstetrics and anaesthesia, midwives and nurse anaesthetists in training. We described a component of a simulator for fetal distress, namely a mathematical model for the educational simulation of the oxygen delivery to the fetus [1]. This abstract outlines this model and the main simulation results. Methods The underlying physiology is represented using a multiple modeling approach ( Fig.…”
Introduction Maternal hypotension or cardiac arrest, maternal hypoxia associated to ventilatory complications, and fetal asphyxia caused by compression of the umbilical cord are examples of critical situations in obstetrics and in anaesthesia of the pregnant woman. These incidents are rare and associated with a high risk to the woman and fetus. Therefore, simulation is a valuable tool in teaching the diagnostic and therapeutic skills in this context. The target audience of such simulations consists of residents in obstetrics and anaesthesia, midwives and nurse anaesthetists in training. We described a component of a simulator for fetal distress, namely a mathematical model for the educational simulation of the oxygen delivery to the fetus [1]. This abstract outlines this model and the main simulation results.
Methods The underlying physiology is represented using a multiple modeling approach (
Fig. 1). The haemodynamic model simulates the uterine, placental and umbilical blood flow rates as a function of maternal and fetal blood pressures. The model parameter: resistance to umbilical cord blood flow rate permits simulation of occlusion. The flow rates of the haemodynamic model are inputs to the oxygen uptake and distribution model. This model simulates the O2 supply to the placenta, the exchange of O2 across the placental barrier, the O2 transport in the umbilical cord, and the fetal O2 consumption. The differences in O2 dissociation between maternal and fetal blood are taken into account. Model parameters for the human placenta and fetus were found in the literature [2]. To validate the model response to simulated critical situations we used fetal lamb data, as no data on humans were available.
1
Model block diagram.
Results Figure 2 shows the model output: O2 partial pressure in the fetal arterial blood, following simulated maternal hypotension [1] and partial occlusion of the umbilical cord [2]. The reduction in partial pressure for these two situations compares favourably with data from the literature [3,4].
2
Simulation results.
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