Physiological CTG interpretation: the significance of baseline fetal heart rate changes after the onset of decelerations and associated perinatal outcomes

Jia, Yan-Ju; Xu, Chunli; Cui, Hongyan; Whelehan, Virginia; Archer, Abigail; Chandraharan, Edwin

doi:10.1080/14767058.2019.1666819

Cited by 28 publications

(29 citation statements)

References 13 publications

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“…Intrapartum or early neonatal death may be the severe consequences of this trauma. The lower intensity of hypoxia may contribute to transient or potentially permanent morbidity 8 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Fetal Myocardial Performance Index in Abnormal Cardiotocography Cases in 3rd Trimester of Pregnancy and Fetal Outcome

Sakna,

Nasr El din,

Mehanna

et al. 2021

Indian Journal of Forensic Medicine & Toxicology

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Background: Cardiotocography is broadly used, particularly in pregnancies with an elevated probability of risks, to assess fetal well-being. The study's objective was to evaluate the accuracy of the myocardial performance index (MPI) in predicting fetal distress in pregnant women with unsatisfactory cardiotocography. Methods: This prospectivestudy included 145 women in late pregnancy divided into two groups: Cases (n=72) including women with abnormal cardiotocography and Controls (n=73) including women with normal cardiotocography. Results: The MPI significantly increased in cases compared to control groups (0.46 vs. 0.38, p<0.001). In heatmap correlation, the MPI remained a significant negative correlation with Apgar score At 1 and 5 min., acceleration, and variability, whilethe positive correlation with ET, FHR, deceleration, and mode of delivery. A cut-off MPI of ≥0.51 conferred a specificity of 71.23 %, sensitivity of 65.28 %. Conclusion: MPI measurement during the third trimester is a promising surrogate marker for abnormal cardiotocography (CTG) and fetal distress. Women with abnormal cardiotocography (CTG) had significantly higher MPI and worse fetal outcomes.

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“…Intrapartum or early neonatal death may be the severe consequences of this trauma. The lower intensity of hypoxia may contribute to transient or potentially permanent morbidity 8 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Fetal Myocardial Performance Index in Abnormal Cardiotocography Cases in 3rd Trimester of Pregnancy and Fetal Outcome

Sakna,

Nasr El din,

Mehanna

et al. 2021

Indian Journal of Forensic Medicine & Toxicology

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“…Similar to adults who will rapidly become decompensated if the undertake any hypoxic exercise when they are unwell (i.e., due to infection, preexisting cardiac, respiratory or other systemic disorders, severe anemia or hypovolemia and hypotension), fetuses who have sustained an antenatal insult, leading to specific features on the CTG trace indicative of such an ongoing insult, will not be able to sustain further hypoxic stress as a result of ongoing, progressively worsening and increasing frequency, duration and strength of uterine contractions [12]. A fetus with features on the CTG trace which suggest that "THIS fetus is fit to undertake the journey of labor" [12], like adults, would demonstrate predictable features on the CTG trace, when exposed to intrapartum hypoxic stress [13,14]. Therefore, the second, "Intrapartum Fetal Assessment Tool" (Figure 2) is aimed at recognizing the onset of hypoxic and mechanical stresses or fetal inflammation (i.e., chorioamnionitis) by comparing the parameters observed earlier.…”

Section: What Is Physiological Interpretation Of Ctg?mentioning

confidence: 99%

“…Therefore, our MDT wanted to embrace the difficult process of change, and like other maternity units [29], we have demonstrated improved perinatal outcomes after stopping NICE guidelines and embracing a deeper understanding of physiological responses of a human fetus to ongoing intrapartum hypoxic, inflammatory and mechanical stresses (Figure 7). Understanding of fetal pathophysiological responses and different types of hypoxic would enable midwives and obstetricians to ensure timely interventions to improve outcomes [8,13,29]. The historical, illogical practices of fluids to the wrong person (i.e., the mother) to treat "suspicious" CTG traces, and then assessing the pH of a nonessential fetal scalp tissue for the presence of acidosis (FBS) with the mistaken, nonsensical belief that it would provide information regarding the well-being of fetal central organs, need to change urgently if perinatal outcomes are to be improved in the UK.…”

mentioning

confidence: 99%

Introduction of the Physiological CTG Interpretation & Hypoxia in Labour (HIL) Tool, and its Incorporation into a Software Programme: Impact on Perinatal Outcomes

Chandraharan

2021

GJORM

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Each Baby Counts Reports in the UK from 2016-2021 have consistently highlighted that 33% of intrapartum related perinatal deaths and severe hypoxic ischaemic injuries in the UK were due to CTG misinterpretation. Moreover, in approximately 72% of cases, a different care may have given rise to different outcomes. International consensus guidelines on Physiological Interpretation of the CTG produced by 34 CTG experts from 14 countries was aimed at individualisation of care by considering the compensatory response of the individual human fetus to ongoing hypoxic and mechanical stresses during labour and determining the type of ongoing fetal hypoxia. This tool was introduced in a large maternity unit, and it also was incorporated into the Maternity software programme after midwives and obstetricians providing intrapartum care were trained on fetal physiology by conducting Physiological CTG Masterclasses. There was a total elimination of fetal scalp blood sampling (FBS), and a dramatic reduction in the number of babies with severe hypoxic ischaemic encephalopathy.

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“…The classification and the management should not be based solely on the observed patterns on the CTG trace, but on the deeper understanding of the different types of intrapartum hypoxia [14,15]. It is vital to understand the compensatory fetal responses to ongoing repetitive hypoxic and mechanical stresses during labor, as well as the onset of fetal decompensation [16], so that timely and appropriate action can be taken to avoid hypoxicischemic encephalopathy and perinatal deaths, whilst at the same time avoiding unnecessary operative interventions to the mother by differentiating the "fetal stress response" from "fetal decompensation". Recently, 34 CTG experts on fetal physiology from 14 countries produced the first International Consensus Guidelines on physiological interpretation of CTG in 2018 [17].…”

Section: What Is "Physiological Interpretation Of Ctg"?mentioning

confidence: 99%

The Impact of Physiological Interpretation of Cardiotocogram (CTG) in Conjunction with Fetal ECG (STAN) on Intrapartum Emergency Caesarean Sections

Chandraharan

2021

GJORM

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Background:The false-positive rate of the "pathological" CTG has been reported as >60%, which resulted in an exponential increase in emergency intrapartum caesarean sections for "fetal distress". Fetal ECG (ST-Analyser or STAN) was introduced into clinical practice to reduce the false positive rate of the CTG.Objective: To determine the impact of Physiological interpretation of Cardiotocogram (CTG) in Conjunction with Fetal ECG (STAN) on intrapartum emergency caesarean sections. Materials & Methods:A retrospective study at the Royal Gwent Hospital in South Wales following the introduction of STAN monitoring after training in Physiological Interpretation of CTG in 2014. Total Caesarean section rate, emergency caesarean section rate for fetal compromise (i.e., "fetal distress"), operative vaginal delivery rate and spontaneous vaginal delivery (SVD) rate were analyzed for the first 19 months after the intervention (October 2014-2016) and were compared with 2012 -September 2014).Result: There were 7977 deliveries during the 19-month period from 01 October 2014 to 30 April 2016. The average total Caesarean section rate was 23.5% and the emergency Caesarean section rate for suspected fetal compromise ("fetal distress") was 13.6%, an observed increase in the rate of spontaneous vaginal births from 63% to 71%. There was a statistically significant reduction in the intrapartum emergency caesarean sections performed for "fetal distress" immediately after the introduction of STAN following training on Physiological Interpretation of CTG from 5.57% to 2.1%. The rate of hypoxic ischaemic encephalopathy (HIE) due to CTG misinterpretation was reduced by 50% following the training on Physiological Interpretation of CTG. Conclusion:Training on physiological interpretation of the CTG before the introduction of STAN, and its use in conjunction with STAN resulted in a statistically significant reduction of intrapartum emergency caesarean section for "fetal distress", and a 50%reduction in the HIE rate due to CTG misinterpretation.

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Physiological CTG interpretation: the significance of baseline fetal heart rate changes after the onset of decelerations and associated perinatal outcomes

Cited by 28 publications

References 13 publications

Evaluation of the Fetal Myocardial Performance Index in Abnormal Cardiotocography Cases in 3rd Trimester of Pregnancy and Fetal Outcome

Evaluation of the Fetal Myocardial Performance Index in Abnormal Cardiotocography Cases in 3rd Trimester of Pregnancy and Fetal Outcome

Introduction of the Physiological CTG Interpretation & Hypoxia in Labour (HIL) Tool, and its Incorporation into a Software Programme: Impact on Perinatal Outcomes

The Impact of Physiological Interpretation of Cardiotocogram (CTG) in Conjunction with Fetal ECG (STAN) on Intrapartum Emergency Caesarean Sections

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