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Intrapartum fetal monitoring

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https://www.readbyqxmd.com/read/28403965/understanding-fetal-physiology-and-second-line-monitoring-during-labor
#1
REVIEW
C Garabedian, J De Jonckheere, L Butruille, P Deruelle, L Storme, V Houfflin-Debarge
Cardiotocography (CTG) is a technique used to monitor intrapartum fetal condition and is one of the most common obstetric procedures. Second line methods of fetal monitoring have been developed in an attempt to reduce unnecessary interventions due to continuous cardiotocography and to better identify fetuses at risk of intrapartum asphyxia. The acid-base balance of the fetus is evaluated by fetal blood scalp samples, the modification of the myocardial oxygenation by the fetal ECG ST-segment analysis (STAN) and the autonomic nervous system by the power spectral analysis of the fetal heart variability...
February 2017: J Gynecol Obstet Hum Reprod
https://www.readbyqxmd.com/read/28392944/monitoring-fetal-heart-rate-during-labor-a-comparison-of-three-methods
#2
Tammy Y Euliano, Shalom Darmanjian, Minh Tam Nguyen, John D Busowski, Neil Euliano, Anthony R Gregg
The purpose of the study was to compare the accuracy of a noninvasive fetal heart rate monitor with that of ultrasound, using a fetal scalp electrode as the gold standard, in laboring women of varying body habitus, throughout labor and delivery. Laboring women requiring fetal scalp electrode were monitored simultaneously with the investigational device (noninvasive fetal ECG), ultrasound, and fetal scalp electrode. An algorithm extracted the fetal heart rate from the noninvasive fetal ECG signal. Each noninvasive device recording was compared with fetal scalp electrode with regard to reliability by positive percent agreement and accuracy by root mean squared error...
2017: Journal of Pregnancy
https://www.readbyqxmd.com/read/28369712/computerized-data-driven-interpretation-of-the-intrapartum-cardiotocogram-a-cohort-study
#3
Antoniya Georgieva, Christopher W G Redman, Aris T Papageorghiou
Continuous intrapartum fetal monitoring remains a significant clinical challenge. We propose utilising cohorts of routinely collected data. We aim to combine non-classical (data-driven) and classical cardiotocography (CTG) features with clinical features into a system (OxSys), which generates automated alarms for the fetus at risk of intrapartum hypoxia. We hypothesise that OxSys can outperform clinical diagnosis of 'fetal distress', when optimised and tested over large retrospective datasets MATERIAL AND METHODS: We studied a cohort of 22,790 labouring women (≥36 weeks gestation)...
March 28, 2017: Acta Obstetricia et Gynecologica Scandinavica
https://www.readbyqxmd.com/read/28350703/rf-safety-analysis-of-a-novel-ultra-wideband-fetal-monitoring-system
#4
Jerrold T Bushberg, J Paul Tupin
The LifeWave Ultra-Wideband RF sensor (LWUWBS) is a monitoring solution for a variety of physiologic assessment applications, including maternal fetal monitoring in both the antepartum and intrapartum periods. The system uses extremely low power radio frequency (RF) ultra-wide band (UWB) signals to provide continuous fetal heart rate and contractions monitoring during labor and delivery. Even with the incorporation of three very conservative assumptions, (1) concentration of the RF energy in 1 cm, (2) minimal (2...
May 2017: Health Physics
https://www.readbyqxmd.com/read/28341515/computerised-interpretation-of-fetal-heart-rate-during-labour-infant-a-randomised-controlled-trial
#5
(no author information available yet)
BACKGROUND: Continuous electronic fetal heart-rate monitoring is widely used during labour, and computerised interpretation could increase its usefulness. We aimed to establish whether the addition of decision-support software to assist in the interpretation of cardiotocographs affected the number of poor neonatal outcomes. METHODS: In this unmasked randomised controlled trial, we recruited women in labour aged 16 years or older having continuous electronic fetal monitoring, with a singleton or twin pregnancy, and at 35 weeks' gestation or more at 24 maternity units in the UK and Ireland...
March 21, 2017: Lancet
https://www.readbyqxmd.com/read/28301889/geburtshilfe-an%C3%A3-sthesie-bei-exit-prozedur
#6
Alexander Torossian
The ex utero intrapartum treatment (EXIT) procedure is performed as a part of an extended caesarean section for example to treat fetal airway disorders. For treatment, optimal uterine relaxation is necessary, however utero-placental supply of the fetus has to be guaranteed as well. "Balanced" anesthesia, tocolysis and tight maternal arterial blood pressure control are recommended. Standard fetal monitoring comprises pulse oxymetry and echocardiography. The article describes the physiology and anesthestic goals of the EXIT procedure, discusses alternative anesthesia techniques and gives an outlook on emerging progress...
March 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/28211140/anesthesia-for-fetal-surgery
#7
REVIEW
Monica A Hoagland, Debnath Chatterjee
Fetal therapy is an exciting and growing field of medicine. Advances in prenatal imaging and continued innovations in surgical and anesthetic techniques have resulted in a wide range of fetal interventions including minimally invasive, open mid-gestation, and ex-utero intrapartum treatment procedures. The potential for maternal morbidity is significant and must be carefully weighed against claimed benefits to the fetus. Appropriate patient selection is critical, and a multidisciplinary team-based approach is strongly recommended...
April 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28157275/continuous-cardiotocography-ctg-as-a-form-of-electronic-fetal-monitoring-efm-for-fetal-assessment-during-labour
#8
REVIEW
Zarko Alfirevic, Declan Devane, Gillian Ml Gyte, Anna Cuthbert
BACKGROUND: Cardiotocography (CTG) records changes in the fetal heart rate and their temporal relationship to uterine contractions. The aim is to identify babies who may be short of oxygen (hypoxic) to guide additional assessments of fetal wellbeing, or determine if the baby needs to be delivered by caesarean section or instrumental vaginal birth. This is an update of a review previously published in 2013, 2006 and 2001. OBJECTIVES: To evaluate the effectiveness and safety of continuous cardiotocography when used as a method to monitor fetal wellbeing during labour...
February 3, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28125772/cardiotocography-versus-intermittent-auscultation-of-fetal-heart-on-admission-to-labour-ward-for-assessment-of-fetal-wellbeing
#9
REVIEW
Declan Devane, Joan G Lalor, Sean Daly, William McGuire, Anna Cuthbert, Valerie Smith
BACKGROUND: The admission cardiotocograph (CTG) is a commonly used screening test consisting of a short (usually 20 minutes) recording of the fetal heart rate (FHR) and uterine activity performed on the mother's admission to the labour ward. This is an update of a review published in 2012. OBJECTIVES: To compare the effects of admission cardiotocography with intermittent auscultation of the FHR on maternal and infant outcomes for pregnant women without risk factors on their admission to the labour ward...
January 26, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28121831/committee-opinion-no-687-approaches-to-limit-intervention-during-labor-and-birth
#10
(no author information available yet)
Obstetrician-gynecologists, in collaboration with midwives, nurses, patients, and those who support them in labor, can help women meet their goals for labor and birth by using techniques that are associated with minimal interventions and high rates of patient satisfaction. Many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor. For women who are in latent labor and are not admitted, a process of shared decision making is recommended. Admission during the latent phase of labor may be necessary for a variety of reasons...
February 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28121830/committee-opinion-no-687-summary-approaches-to-limit-intervention-during-labor-and-birth
#11
(no author information available yet)
Obstetrician-gynecologists, in collaboration with midwives, nurses, patients, and those who support them in labor, can help women meet their goals for labor and birth by using techniques that are associated with minimal interventions and high rates of patient satisfaction. Many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor. For women who are in latent labor and are not admitted, a process of shared decision making is recommended. Admission during the latent phase of labor may be necessary for a variety of reasons...
February 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28099786/labor-intervention-and-outcomes-in-women-who-are-nulliparous-and-obese-comparison-of-nurse-midwife-to-obstetrician-intrapartum-care
#12
Nicole S Carlson, Elizabeth J Corwin, Nancy K Lowe
BACKGROUND: Women who are obese have slower labors than women of normal weight, and show reduced response to interventions designed to speed labor progress like oxytocin augmentation and artificial rupture of membranes. The optimal labor management for these women has not been described. METHODS: This retrospective cohort study compared 2 propensity score-matched groups of women (N = 360) who were healthy, nulliparous, spontaneously laboring, and obese (body mass index ≥ 30 kg/m(2) )...
January 2017: Journal of Midwifery & Women's Health
https://www.readbyqxmd.com/read/28027681/foetal-electrocardiograph-st-analyser-or-stan-for-intrapartum-foetal-heart-rate-monitoring-a-friend-or-a-foe
#13
Edwin Chandraharan
Cardiotocograph (CTG) is associated with a high false positive rate of up to 60% which may increase the risk of unnecessary intrapartum interventions (emergency caesarean sections or operative vaginal deliveries) without any significant benefits. A recent study on variation of caesarean section rates in England has concluded that there was a very wide variation even in the adjusted rates of caesarean section from 14.9% to 32.1%. Cochrane Systematic Reviews have concluded that the use of FBS does not reduce caesarean section rate or any pre-specified neonatal outcomes...
January 23, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27926647/central-fetal-monitoring-with-and-without-computer-analysis-a-randomized-controlled-trial
#14
Inês Nunes, Diogo Ayres-de-Campos, Austin Ugwumadu, Pina Amin, Philip Banfield, Antony Nicoll, Simon Cunningham, Paulo Sousa, Cristina Costa-Santos, João Bernardes
OBJECTIVE: To evaluate whether intrapartum fetal monitoring with computer analysis and real-time alerts decreases the rate of newborn metabolic acidosis or obstetric intervention when compared with visual analysis. METHODS: A randomized clinical trial carried out in five hospitals in the United Kingdom evaluated women with singleton, vertex fetuses of 36 weeks of gestation or greater during labor. Continuous central fetal monitoring by computer analysis and online alerts (experimental arm) was compared with visual analysis (control arm)...
January 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27886948/variation-in-hospital-intrapartum-practices-and-association-with-cesarean-rate
#15
Lisbet S Lundsberg, Jessica L Illuzzi, Aileen M Gariepy, Sangini S Sheth, Christian M Pettker, Henry C Lee, Heather S Lipkind, Xiao Xu
OBJECTIVE: To examine hospital variation in intrapartum care and its relationship with cesarean rates. DESIGN: Cross-sectional survey. SETTING: Connecticut and Massachusetts hospitals providing obstetric services. PARTICIPANTS: Nurse managers or other clinical staff knowledgeable about intrapartum care. METHODS: We assessed labor and delivery unit capacity and staffing, fetal monitoring, labor management, intrapartum interventions, newborn care, quality assurance, and performance review practices...
January 2017: Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN
https://www.readbyqxmd.com/read/27825311/criteria-based-audit-to-improve-quality-of-care-of-foetal-distress-standardising-obstetric-care-at-a-national-referral-hospital-in-a-low-resource-setting-tanzania
#16
Andrew H Mgaya, Helena Litorp, Hussein L Kidanto, Lennarth Nyström, Birgitta Essén
BACKGROUND: In Tanzania, substandard intrapartum management of foetal distress contributes to a third of perinatal deaths, and the majority are term deliveries. We conducted a criteria-based audit with feedback to determine whether standards of diagnosis and management of foetal distress would be improved in a low-resource setting. METHODS: During 2013-2015, a criteria-based audit was performed at the national referral hospital in Dar es Salaam. Case files of deliveries with a diagnosis of foetal distress were identified and audited...
November 8, 2016: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/27794572/the-value-of-the-cerebroplacental-ratio-for-the-prediction-of-intrapartum-fetal-monitoring-in-low-risk-term-pregnancies
#17
Jing Liu, Guang Song, Ge Zhao, Tao Meng
AIM: The study aimed to investigate the use of fetal cerebroplacental ratio (CPR) to identify fetuses at high risk before labor due to the brain sparing phenomenon. MATERIALS AND METHODS: Four hundred and seventy-six singleton pregnancies were enrolled in this study. The CPR was recorded within 1 week of delivery and labor was managed according to local protocols and guidelines. Intrapartum and neonatal outcome details were recorded. RESULTS: The CPR values of fetuses subsequently presenting category III intrapartum electronic fetal monitoring (EFM) or category II EFM without improvement (category IIB EFM) or with progression to category III (category IIC EFM) were significantly lower...
October 29, 2016: Gynecologic and Obstetric Investigation
https://www.readbyqxmd.com/read/27769196/cardiotocography-in-breech-versus-vertex-delivery-an-examiner-blinded-cross-sectional-nested-case-control-study
#18
Elli Toivonen, Outi Palomäki, Heini Huhtala, Jukka Uotila
BACKGROUND: The safety of vaginal breech delivery has been debated for decades. Although it has been shown to predispose infants to immediate depression, several observational studies have also shown that attempting vaginal breech delivery does not increase perinatal morbidity or low Apgar score at the age of five minutes. Cardiotocography monitoring is recommended during vaginal breech delivery, but comparative data describing differences between cardiotocography tracings in breech and vertex deliveries is scarce...
October 21, 2016: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/27734746/why-stan-might-not-be-dead
#19
Serena Xodo, Gabriele Saccone, Ewoud Schuit, Isis Amer-Wåhlin, Vincenzo Berghella
Recently, a meta-analysis, including 26 526 laboring vertex singletons at term, summarized all available level-1 data from six high-quality randomized clinical trials (RCTs) on the use of ST analysis (STAN) during labor as an adjunct to conventional intrapartum fetal heart rate monitoring. The meta-analysis showed that STAN did not improve perinatal outcomes or decrease cesarean deliveries. Nonetheless, there are still reasons to believe STAN may have a role in the future research on intrapartum fetal monitoring...
November 2, 2016: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27684833/use-of-the-glidescope-video-laryngoscope-for-intubation-during-ex-utero-intrapartum-treatment-in-a-fetus-with-a-giant-cyst-of-the-4th-branchial-cleft-a-case-report
#20
Sung Hye Byun, So Young Lee, Seong Yeon Hong, Taeha Ryu, Baek Jin Kim, Jin Yong Jung
INTRODUCTION: In fetuses who are predicted to be at risk of catastrophic airway obstruction at delivery, the ex utero intrapartum treatment (EXIT) procedure is useful for securing the fetal airway while maintaining fetal oxygenation via placental circulation. Factors, including poor posture of the fetus and physician, narrow visual field, and issues of contamination in the aseptic surgical field, make fetal intubation during the EXIT procedure difficult. Herein, we report our experience of the usefulness of the GlideScope video laryngoscope (GVL) for intubation during the EXIT procedure...
September 2016: Medicine (Baltimore)
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