The limits of electronic fetal heart rate monitoring in the prevention of neonatal metabolic acidemia

Clark, Steven L.; Hamilton, Emily; Garite, Thomas J.; Timmins, Audra; Warrick, Philip; Smith, Samuel

doi:10.1016/j.ajog.2016.10.009

Cited by 120 publications

(96 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The assessment of shortterm variations (STV) and long-term variations (LTV) was found to be of use in diagnosing fetal compromise. These variables used in CTG monitors are known as the most evident markers of fetal distress [4,9]. But the duration of the recording should be not less than 1 hour or, at least, 30 minutes.…”

Section: Discussionmentioning

confidence: 99%

“…But the duration of the recording should be not less than 1 hour or, at least, 30 minutes. This time interval is known to be associated with better sleep/awake fetal status ratio [2,4]. Therefore, the application of the proposed fetal HRV variables will help to use fetal noninvasive ECG tracing of the only 10 minutes long.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiotocography (CTG) methods have been standard, despite the lack of evidence that it reduces the adverse sequelae of neurodevelopment, including neonatal hypoxic-ischemic encephalopathy and cerebral palsy. This method has a high rate of false positives, and poor inter-and intraobserver reliability [2][3][4], such that fetal status and the perinatal outcome cannot be predicted reliably.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Fuzzy Detection of Fetal Distress for Antenatal Monitoring in Pregnancy with Fetal Growth Restriction and Normal

Лахно¹,

Guzmán-Velázquez²,

Diaz-Mendez³

2018

Non-Invasive Diagnostic Methods - Image Processing

View full text Add to dashboard Cite

Monitoring of fetal cardiac activity is a well-known approach to the assessment of fetal health. The fetal heart rate can be measured using conventional cardiotocography (CTG). However, this method does not provide the beat-to-beat variability of the fetal heart rate because of the averaging nature of the autocorrelation function that is used to estimate the heart rate from a set of heart beats enclosed in the autocorrelation function window. Therefore, CTG presents important limitations for fetal arrhythmia diagnosis. CTG has a high rate of false positives and poor inter-and intra-observer reliability, such that fetal status and the perinatal outcome cannot be predicted reliably. Non-invasive fetal electrocardiography (NI-FECG) is a promising low-cost and non-invasive continuous fetal monitoring alternative. However, there is little that has been published to date on the clinical usability of NI-FECG. The chapter will include data on the accurate diagnosing of fetal distress based on heart rate variability (HRV). A fuzzy logic inference system was designed based on a set of fetal descriptors selected from the HRV responses, as evident descriptors of fetal well-being, to increase the sensitivity and specificity of detection. This approach is found to be rather prospective for the subsequent clinical implementation.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Fuzzy Detection of Fetal Distress for Antenatal Monitoring in Pregnancy with Fetal Growth Restriction and Normal

Лахно¹,

Guzmán-Velázquez²,

Diaz-Mendez³

2018

Non-Invasive Diagnostic Methods - Image Processing

View full text Add to dashboard Cite

show abstract

“…These numbers are not that different from those from a similarly designed study that found that 46% of neonates with metabolic acidemia would have been delivered via operative delivery if a fetal heart rate monitoring algorithm was applied. 7 One response to a study like this is to point out the limitations of fetal heart rate monitoring -it is an imperfect tool. However, if fetal heart rate monitoring is used judiciously, there appears to be opportunity to improve outcomes.…”

Section: + Related Articlementioning

confidence: 99%

Electronic Fetal Monitoring—Imperfect but Opportunities for Improvement

Caughey

2020

JAMA Netw Open

View full text Add to dashboard Cite

Being born is one of the riskiest endeavors that most of us have undertaken. For example, the risk of dying or developing cerebral palsy ranges from 1 in 500 to 1 in 1000 associated with events around the time of birth. Electronic fetal monitoring was specifically developed to reduce the risk of cerebral palsy. While an initial study of electronic fetal monitoring reported a reduction in neonatal seizures, 1 a follow-up study did not find similar reductions in cerebral palsy. 2 Furthermore, because it appears that only approximately 25% to 35% of cases of cerebral palsy are associated with intrapartum events, 3 a modified goal would be to reduce the risk of neonatal encephalopathy or metabolic acidemia, 2 relatively common precursors of cerebral palsy associated with birth asphyxia.Over the past 2 decades there have been efforts to refine how electronic fetal monitoring may reduce perinatal asphyxia. The Fetal Pulse-Oximetry Trial randomized approximately 1000 laboring women to a fetal oxygen saturation assessment vs standard fetal monitoring and found no differences in neonatal acidemia. 4 The STAN fetal heart monitor (Neoventa Medical) trial randomized more than 11 000 women to a new tool that analyzed the fetal electrocardiogram ST wave form vs standard fetal monitoring and again found no differences. 5 Another recent study 6 randomized more than 45 000 laboring women to receive care that was augmented by a computer algorithm and support tool designed to both identify abnormal fetal heart rate tracings and provide standardized care plans to the clinicians. This study found no difference in worse neonatal outcomes (0.7% in each group) between the computer-supported care group or the usual care group. Of note, while there was no difference in outcomes between the groups, clinicians were not blinded regarding the study, and the overall rates of both perinatal mortality and neonatal encephalopathy were lower than had been estimated by prestudy institutional data. Because the clinicians in the study were trained in the use of the algorithm, these data suggest that outcomes were associated with improved training and algorithmic approaches, even if not demonstrated by the comparative portion of the study.Additionally, in both groups of the study, 38% of the time when the computer identified abnormal fetal heart rate readings that would have resulted in changes from a care algorithm, the clinicians did not engage in the change in care.Thus, there are multiple opportunities to use electronic fetal monitoring in the context of neonatal encephalopathy: (1) there must be identifiable events that can be detected by continuous electronic fetal monitoring; (2) the events must be interpretable by clinicians; (3) there need to be practice changes that clinicians can engage in that prevent the progression to fetal acidemia; and (4) the consequences must be substantial enough to prevent the fetal or neonatal injury. There appear to be limitations for each of these steps.Farquhar and colleagues 8 designed a case-control study to ...

show abstract

“…To date, this goal has been elusive. 9,10 The purpose of this study was to determine if the use of a standardized approach for labors complicated by Category II fetal heart rates with "significant decelerations" would improve neonatal outcome and determine the impact on the rate of primary cesarean and operative vaginal delivery birth rates.…”

mentioning

confidence: 99%

A Standardized Approach for Category II Fetal Heart Rate with Significant Decelerations: Maternal and Neonatal Outcomes

et al. 2018

View full text Add to dashboard Cite

show abstract

The limits of electronic fetal heart rate monitoring in the prevention of neonatal metabolic acidemia

Cited by 120 publications

References 23 publications

Fuzzy Detection of Fetal Distress for Antenatal Monitoring in Pregnancy with Fetal Growth Restriction and Normal

Fuzzy Detection of Fetal Distress for Antenatal Monitoring in Pregnancy with Fetal Growth Restriction and Normal

Electronic Fetal Monitoring—Imperfect but Opportunities for Improvement

A Standardized Approach for Category II Fetal Heart Rate with Significant Decelerations: Maternal and Neonatal Outcomes

Contact Info

Product

Resources

About