Unselected low-risk pregnancies and the effect of continuous intrapartum fetal heart rate monitoring on umbilical blood gases and cerebral palsy

Sameshima, Hiroshi; Ikenoue, Tsuyomu; Ikeda, Tomoaki; Kamitomo, Masato; Ibara, Satoshi

doi:10.1016/j.ajog.2003.07.014

Cited by 63 publications

(51 citation statements)

References 10 publications

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“…Samejima, et al evaluated the relation among the heart rate pattern under CTG and umbilical blood gases and cerebral palsy. 26) They reported that the decreased variability of heart rate pattern correlated with decreased umbilical pH. They suggested that CP caused by intrapartum asphyxia was restricted under CTG.…”

Section: )mentioning

confidence: 98%

Development and Significance of a Fetal Electrocardiogram Recorded by Signal-Averaged High-Amplification Electrocardiography

et al. 2009

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SummaryAlthough ultrasonic diagnostic imaging and fetal heart monitors have undergone great technological improvements, the development and use of fetal electrocardiograms to evaluate fetal arrhythmias and autonomic nervous activity have not been fully established. We verified the clinical significance of the novel signal-averaged vector-projected high amplification ECG (SAVP-ECG) method in fetuses from 48 gravidas at 32-41 weeks of gestation and in 34 neonates. SAVP-ECGs from fetuses and newborns were recorded using a modified XYZ-leads system. Once noise and maternal QRS waves were removed, the P, QRS, and T wave intervals were measured from the signal-averaged fetal ECGs. We also compared fetal and neonatal heart rates (HRs), coefficients of variation of heart rate variability (CV) as a parasympathetic nervous activity, and the ratio of low to high frequency (LF/HF ratio) as a sympathetic nervous activity. The rate of detection of a fetal ECG by SAVP-ECG was 72.9%, and the fetal and neonatal QRS and QTc intervals were not significantly different. The neonatal CVs and LF/HF ratios were significantly increased compared with those in the fetus. In conclusion, we have developed a fetal ECG recording method using the SAVP-ECG system, which we used to evaluate autonomic nervous system development. (Int Heart J 2009; 50: 161-171)

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Section: )mentioning

confidence: 98%

Development and Significance of a Fetal Electrocardiogram Recorded by Signal-Averaged High-Amplification Electrocardiography

et al. 2009

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“…Hypoxic ischemic encephalopathy events are not limited to high-risk pregnancies. They may occur in about 50 % of the low-risk population [23], and thus is recommended in all high-risk deliveries. High-risk pregnancies are screened antenatally by fetal Doppler, biophysical profile, and CTG to identify at-risk fetuses which is confirmed by ABG analysis of cord blood immediately after birth.…”

Section: Resultsmentioning

confidence: 99%

Predictability of Fetal Doppler, Biophysical Profile, and Cardiotocography for Fetal Acidosis at Birth

Gupta

Mehta

Fazal

et al. 2014

Journal of Fetal Medicine

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Fetal Doppler has allowed evaluation of the fetus in both physiological and pathological conditions which has helped in establishing the relationship between Doppler and fetal oxygenation. It is difficult to define pathological acidosis, but the threshold pH of\7 is the best independent predictor for unexplained seizures. Most infants tolerate acidemia well and recover without any remarkable long term sequelae. Worsening umbilical artery acidosis is directly and adversely related to worsening of neurological outcome, hypoxic ischemic encephalopathy, and multiorgan involvement with permanent neurologic injury. Hypoxic ischemic encephalopathy events are not limited to high-risk pregnancies but may occur in about 50 % of the low-risk population. Combination of low pH at birth with other abnormal clinical parameters, e.g., requirement for intubation, 5 min Apgar score B5 has 80 % positive predictability of seizures. Predictability of fetal Doppler examination for asphyxiated fetuses is in the tune of 86 %. High-risk pregnancies are screened antenatally by fetal Doppler, biophysical profile, and CTG to identify at-risk fetuses which are confirmed by the ABG analysis of cord blood immediately after birth. All these noninvasive modalities complement each other to identify, at the earliest, any clinical deterioration. Isolated abnormal, e.g., absent end diastolic flow in umbilical artery, abnormal biophysical profile, or nonreactive CTG are not adequately sensitive in identifying these fetuses which was observed in the present cohort. Thus, fetal Doppler in combination with biophysical profile supplemented with cardiotocograph helps in identifying at-risk fetuses for fetal acidosis and encephalopathy and helps in considering early intervention.

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“…However, its systematic use has not turned into a reduction of cerebral palsy cases, but into an increase in C-section rates; there is also, no greater benefit with continuous monitoring of the fetal heart rate versus intermittent auscultation [21]. It seems that the issue is more with monitoring protocols and adequate assessment of the findings with one method or the other.…”

Section: Discussionmentioning

confidence: 99%

A Check List to Reduce Misuse of Primary Cesarean Sections in Women with a Single Fetus in Cephalic Position

Pradilla¹,

Pereira²,

Díaz‐Martínez³

2017

Health

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Background: Avoiding primary C-section is the safest and most effective way of decreasing C-section rates. We analyzed circumstances and decisions made among pregnant women without history of C-section and cephalic single fetus (group B), who ended up having a Cesarean birth, to identify opportunities that may optimize the decisions about delivery. Methodology: We evaluated the clinical histories of pregnant women from group B who completed their pregnancies in the Hospital Universitario de Santander (Bucaramanga, Colombia) during 2013. We evaluated the decision moments from admission until birth, including the registry of the reasons for having a C-section, compliance of all the criteria to support the decision and its appropriateness, and how adequate were the procedures done during the induction or augmentation of labor. Results: We evaluated 1320 histories; 666 (55.7%) ended by C-Section. In 59.8% of the histories, we identified at least one decision that could have been addressed differently to optimize the delivery type and, potentially, avoid ending in a Cesarean birth. The most frequent opportunities arise due to a lack of clarity in the record of the reason for performing the C-section (70.1%), and inadequate use of labor induction in the patients that had to end their gestation (38.5%). Conclusion: In the Hospital Universitario de Santander during 2013, despite observing a meaningful subregistry of the indication to perform a C-section, we found that in one out of every two patients there are opportunities of improvement in the registry and attention to reduce the high incidence of C-sections in the institution. This analysis allowed us to create a checklist to fill out before making the final decision of performing a Cesarean birth.

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Unselected low-risk pregnancies and the effect of continuous intrapartum fetal heart rate monitoring on umbilical blood gases and cerebral palsy

Cited by 63 publications

References 10 publications

Development and Significance of a Fetal Electrocardiogram Recorded by Signal-Averaged High-Amplification Electrocardiography

Development and Significance of a Fetal Electrocardiogram Recorded by Signal-Averaged High-Amplification Electrocardiography

Predictability of Fetal Doppler, Biophysical Profile, and Cardiotocography for Fetal Acidosis at Birth

A Check List to Reduce Misuse of Primary Cesarean Sections in Women with a Single Fetus in Cephalic Position

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