Fetal Heart Rate

CTG is a tool used to monitor fetal activity and heart rate, as well as uterine contractions while the baby is in the womb. Through this examination, the doctor can evaluate whether the fetus is healthy before delivery. Objective: To determine the effect of lullaby music therapy on CTG rhythm in third-trimester pregnant women. Method: The design used in this research is preexperimental. This research was conducted at Bina Husada Hospital with a research period of December 2021-January 2022. The population in this study was 15 third-trimester pregnant women who underwent CTG. The sample in the research consisted of 15 respondents. The instrument used is an observation sheet. Statistical testing with Paired Sample Test. The results of statistical tests show that the p-value is 0.036, meaning P<0.05. There is an influence of lullaby music therapy on CTG rhythm in third-trimester pregnant women.

Maternal peptides from the hypothalamic-pituitary-adrenal (HPA) axis rise during human pregnancy. The effects of circulating maternal adrenocorticotropin (ACTH) and ß-endorphin (BE) on human fetal behavior was determined in 135 women during their 32nd week of gestation. Fetal behavior was measured by assessing heart rate habituation to a series of repeated vibroacoustic stimuli. Individual differences in habituation were determined by computing the number of consecutive responses above the standard deviation during a control period. There was no significant relation between levels of ACTH, BE and the rate of fetal heart rate habituation. However, an index of HPA disregulation (uncoupling of ACTH and BE) was related significantly to fetal behavior. Fetal exposure to high levels of maternal BE relative to ACTH was associated with significantly lower rates of habituation. Results indicate that maternal stress and stress-related peptides influence fetal response patterns. It is possible that this influence persists over the life span.

Background-Continuous fetal heart rate (FHR) monitoring remains central to intrapartum care. However, advances in signal analysis are needed to increase its accuracy in diagnosis of fetal hypoxia. Aims-Todetermine whether FHR complexity, an index of multiscale variability, islower among fetuses born with low (≤7.05) versus higher pH values, and whether this measure can potentially be used to help discriminate the two groups. Study design-Evaluation of a pre-existing database of sequentially acquired intrapartum FHR signals. Subjects-FHR tracings, obtained from a continuous scalp electrocardiogram during labor, were analyzed using the multiscale entropy (MSE) method in 148 singletons divided in two groups according to umbilical artery pH at birth: 141 fetuses with pH> 7.05 and 7 with pH≤7.05. A complexity index derived from MSE analysis was calculated for each recording. Results-The complexity of FHR signals for the last two hours before delivery was significantly (p< 0.004) higher for non-acidemic than for acidemic fetuses. The difference between the two ☆ Funding:

Pregnant rats were flown on the NASA Space Shuttle during the early developmental period of their fetuses' vestibular apparatus and onset of vestibular function. The authors report that prenatal spaceflight exposure shapes vestibular-mediated behavior and central morphology. Postflight testing revealed (a) delayed onset of body righting responses, (b) cardiac deceleration (bradycardia) to 70°h ead-up roll, (c) decreased branching of gravistatic afferent axons, but (d) no change in branching of angular acceleration receptor projections with comparable synaptogenesis of the medial vestibular nucleus in flight relative to control fetuses. Kinematic analyses of the dams' on-orbit behavior suggest that, although the fetal otolith organs are unloaded in microgravity, the fetus' semicircular canals receive high levels of stimulation during longitudinal rotations of the mother's weightless body. Behaviorally derived stimulation from maternal movements may be a significant factor in studies of vestibular sensory development. Taken together, these studies provide evidence that gravity and angular acceleration shape prenatal organization and function within the mammalian vestibular system.

Background: Fetal heart rate abnormalities (FHR) during and after external cephalic version (ECV) are relatively frequent. They may raise concern about fetal wellbeing. Only occasionally they may lead to an emergency cesarean section. Methods: Prospective cohort study in 980 women (> 34 weeks gestation) with a singleton fetus in breech presentation. During and after external cephalic version (ECV) FHR abnormalities were recorded. Obstetric variables and delivery outcome were evaluated. Primary outcome was to identify which fetuses are at risk for FHR abnormalities. Secondary outcome was to identify a possible relationship between FHR abnormalities during and after ECV and mode of delivery and fetal distress during subsequent labor. The overall success rate of ECV was 60% and in 9% of the attempts there was an abnormal FHR pattern. In two cases FHR abnormalities after ECV led to an emergency CS. Estimated fetal weight per 100 g (OR 0.90, CI: 0.87-0.94) and longer duration of the ECV-procedure (OR 1.13, CI: 1.05-1.21) were factors significantly associated with the occurrence of FHR abnormalities. FHR abnormalities were not associated with the mode of delivery or the occurrence of fetal distress during subsequent labor. Conclusions: FHR abnormalities during and after ECV are more frequent with lower estimated fetal weight and longer duration of the procedure. FHR abnormalities during and after ECV have no consequences for subsequent mode of delivery. They do not predict whether fetal distress will occur during labor. Trial registration: The Eindhoven Breech Intervention Study, NCT00516555. Date of registration: August 13, 2007.

Background: Fetal heart rate abnormalities (FHR) during and after external cephalic version (ECV) are relatively frequent. They may raise concern about fetal wellbeing. Only occasionally they may lead to an emergency cesarean section. Methods: Prospective cohort study in 980 women (> 34 weeks gestation) with a singleton fetus in breech presentation. During and after external cephalic version (ECV) FHR abnormalities were recorded. Obstetric variables and delivery outcome were evaluated. Primary outcome was to identify which fetuses are at risk for FHR abnormalities. Secondary outcome was to identify a possible relationship between FHR abnormalities during and after ECV and mode of delivery and fetal distress during subsequent labor. The overall success rate of ECV was 60% and in 9% of the attempts there was an abnormal FHR pattern. In two cases FHR abnormalities after ECV led to an emergency CS. Estimated fetal weight per 100 g (OR 0.90, CI: 0.87-0.94) and longer duration of the ECV-procedure (OR 1.13, CI: 1.05-1.21) were factors significantly associated with the occurrence of FHR abnormalities. FHR abnormalities were not associated with the mode of delivery or the occurrence of fetal distress during subsequent labor. Conclusions: FHR abnormalities during and after ECV are more frequent with lower estimated fetal weight and longer duration of the procedure. FHR abnormalities during and after ECV have no consequences for subsequent mode of delivery. They do not predict whether fetal distress will occur during labor. Trial registration: The Eindhoven Breech Intervention Study, NCT00516555. Date of registration: August 13, 2007.

Background: Fetal lung immaturity is a major problem in the management of elective birth with respect to predicting the development of infant respiratory distress syndrome (IRDS) in the neonate after birth. Aim and Objectives: The aim of this study was to evaluate the validity of measuring fetal thalamic echogenicity by ultrasound as a marker of fetal lung maturity. Subjects and Methods: This was a prospective observational study that was being carried out on 80 pregnant patients. They were recruited from Obstetrics and Gynaecology clinics at Tanta University Hospitals during the period of research from March 2021 till the end of the study. Results: There was statistically significant difference between RDS group and those without RDS regarding thalamic echogenicity, 1 and 5-min APGAR score, NICU admission and neonatal mortality. Conclusion: Evaluation of echogenic thalamus by ultrasound at the level of the BPD is of value, and can be considered as a new marker of fetal lung maturity; however, further studies are required to strengthen such idea.

For parturients desiring labor analgesia who have contraindications to neuraxial techniques, intravenous opioid-based patientcontrolled analgesia (IVPCA) offers a reasonable alternative, although incomplete analgesia and maternal and neonatal respiratory depression can occur. Dexmedetomidine, a highly selective a 2 agonist with negligible placental transfer, may be a valuable adjunct to IVPCA by providing additional analgesia without the respiratory depression associated with increasing opioid usage. The successful use of a dexmedetomidine infusion as an adjunct to unsatisfactory fentanyl IVPCA is reported in a 31-year-old parturient with spina bifida occulta and a tethered spinal cord reaching L5-S1. Dexmedetomidine significantly improved the analgesic quality; increased sedation was observed, but the patient was easily rousable to verbal stimuli. No episodes of maternal hypotension or bradycardia, or fetal heart rate irregularities occurred. Cesarean delivery was required for prolonged first stage of labor and presumed chorioamnionitis; it was conducted under general anesthesia during which the dexmedetomidine infusion was continued. A healthy baby boy was delivered with normal Apgar scores and no discernible neurobehavioral or other deficits.

INTRODUCTION: Intrapartum fetal heart rate (FHR) monitoring although sensitive, lacks specificity for predicting fetal acidosis. Category II tracings, within the last hour of labor, occur in &gt;/=96% of uncomplicated, term, laboring patients. Most result in delivery of well oxygenated neonates. Neonatal acidosis occurs in &lt;3% of term neonates and may result in neonatal encephalopathy. Currently, there is no standard approach to management of Category II tracings. METHODS: We retrospectively reviewed Category II tracings in singleton, uncomplicated, term patients, during the last hour prior to delivery, in women who delivered neonates with cord blood pH /=8 (Group 1) and pH ≥ 7.20, base excess. RESULTS: In Group 1 (n=414), 91% of tracings exhibited good/moderate variability, 17.5% demonstrated minimal/absent variability, 13% had accelerations (≥15 bpm, lasting ≥15 secs). In Group 2 (n = 913), 97% showed moderate/good variability, 9% minimal/absent variability, 92% demonstrated ac...

Objective: To examine the possible maternal and fetal variables associated with meconium aspiration syndrome in labors with thick meconium. Study design: The fetal heart rate tracings, cord pH, Apgar scores and maternal risk factors were evaluated in singleton pregnancies with vertex presentation and thick meconium in labor. The study included 33 consecutive fetuses which developed a moderate or severe meconium aspiration syndrome and 104 consecutive fetuses which had a favorable outcome. Results: Significant differences between fetuses with meconium aspiration syndrome and healthy fetuses were found in the following parameters: baseline FHR (154617 vs. 136610, P , 0.0001), small accelerations / 30 min (1.4761.52 vs. 3.0461.2, P , 0.0001), large accelerations / 30 min (1.4661.96 vs. 3.562.31, P , 0.0003), decelerations / 30 min (4.963.9 vs. 2.462.1, P , 0.0034), number of fetuses with reduced beat-to-beat variability (9 / 33 vs. 0 / 104, P , 0.0001), cord pH (7.2160.09 vs. 7.3360.08, P , 0.0013) and Apgar scores at 1 min (562 vs. 861, P , 0.0001) and Apgar scores at 5 min (862 vs. 9.760.6, P , 0.0001). Maternal risk factors were found in two of 33 sick infants and in 13 of 104 healthy infants. Conclusion: Thick meconium by itself is not associated with adverse fetal outcome. However, the incidence of meconium aspiration syndrome increases in cases of a non-reassuring FHR.

Fetal heart rate (FHR) monitoring is a proven means of assessing fetal health during the antenatal period. Currently, the only widely available instrumentation for producing these data is based on Doppler ultrasound, a technology that is unsuitable for long-term use. For nearly a century, it has been known that the fetal Photoplethysmography (FPPG) can be detected using electrodes placed on the maternal abdomen. The paper describes the design, construction and use of a compact, long-term recorder of three channels of 24 h antenatal transabdominal data. Preliminary use of the recorder in around 400 short recording sessions demonstrates that FHR records of equivalent quality to those from Doppler ultrasoundbased instruments can be extracted from such data. The success of FHR derivation is, on average, around 65% of the recording period from around 20 weeks gestation (although this figure is reduced from around 28-32 weeks, and the success rates exhibit a wide range when individual subjects are considered). These results demonstrate that the technique offers, not only a means of acquiring long-term FHR data that are problematic to obtain by other means, but also a more patient-friendly alternative to the Doppler ultrasound technique.

Fetal heart rate (FHR) monitoring is a proven means of assessing fetal health during the antenatal period. Currently, the only widely available instrumentation for producing these data is based on Doppler ultrasound, a technology that is unsuitable for long-term use. For nearly a century, it has been known that the fetal Photoplethysmography (FPPG) can be detected using electrodes placed on the maternal abdomen. The paper describes the design, construction and use of a compact, long-term recorder of three channels of 24 h antenatal transabdominal data. Preliminary use of the recorder in around 400 short recording sessions demonstrates that FHR records of equivalent quality to those from Doppler ultrasound- based instruments can be extracted from such data. The success of FHR derivation is, on average, around 65% of the recording period from around 20 weeks gestation (although this figure is reduced from around 28-32 weeks, and the success rates exhibit a wide range when individual s...

This study was performed to investigate whether spinal cord stimulation (SCS) at intensities below motor threshold prolongs cutaneous vasodilation and whether sustained vasodilation by SCS is mediated through sympathetic inhibition and/or antidromic activation of sensory fibers. SCS was applied to the dorsal surface of the L 2 -L 3 spinal cord of anesthesized rats with stimulus parameters used clinically (i.e., 50 Hz, 0.2 ms duration, and stimulus intensity at 30%, 60%, or 90% of motor threshold). Peripheral vasodilation induced by 5-min SCS was not attenuated by hexamethonium, an autonomic ganglion-blocking agent, but was abolished by dorsal rhizotomy. SCS at V60% of motor threshold increased cutaneous blood flow to the level similar to that obtained at 90% of motor threshold, but the vasodilation did not last for 5 min. SCS-induced vasodilation at 90% of motor threshold persisted for the entire stimulation period up to 30 min, and the vasodilation was not attenuated by hexamethonium. It is concluded that sustained vasodilation, which is induced by SCS at only 90% of motor threshold, in this study was mediated via antidromic activation of sensory fibers.

Fetal heart rate (FHR) variability is an indirect index of fetal autonomic nervous system (ANS) integrity. FHR variability analysis in labor fails to detect early hypoxia and acidemia. Phase-rectified signal averaging (PRSA) is a new method of complex biological signals analysis that is more resistant to non-stationarities, signal loss and artifacts. It quantifies the average cardiac acceleration and deceleration (AC/DC) capacity. The aims of the study were: (1) to investigate AC/DC in ovine fetuses exposed to acute hypoxic-acidemic insult; (2) to explore the relation between AC/DC and acid-base balance; and (3) to evaluate the influence of FHR decelerations and specific PRSA parameters on AC/DC computation. Repetitive umbilical cord occlusions (UCOs) were applied in 9 pregnant near-term sheep to obtain three phases of MILD, MODERATE, and SEVERE hypoxic-acidemic insult. Acid-base balance was sampled and fetal ECGs continuously recorded. AC/DC were calculated: (1) for a spectrum of T...

Couplings between uterine contractions (UC) and fetal heart rate (fHR) provide important information on fetal condition during labor. At present, couplings between UC and fHR are assessed by visual analysis and interpretation of cardiotocography. The application of computerized approaches is restricted due to the non-stationarity of the signal, missing data and noise, typical for fHR. Herein, we propose a novel approach to assess couplings between UC and fHR, based on a signal-processing algorithm termed bivariate phase-rectified signal averaging (BPRSA). Methods: Electrohysterogram (EHG) and fetal electrocardiogram (fECG) were recorded non-invasively by a trans-abdominal device in 73 women at term with uneventful singleton pregnancy during the first stage of labor. Coupling between UC and fHR was analyzed by BPRSA and by conventional cross power spectral density analysis (CPSD). For both methods, degree of coupling was assessed by the maximum coefficient of coherence (C PRSA and C RAW , respectively) in the UC frequency domain. Coherence values greater than 0.50 were consider significant. C PRSA and C RAW were compared by Wilcoxon test. Results: At visual inspection BPRSA analysis identified coupled periodicities in 86.3% (63/73) of the cases. 11/73 (15%) cases were excluded from further analysis because no 30 minutes of fECG recording without signal loss was available for spectral analysis. Significant coupling was found in 90.3% (56/62) of the cases analyzed by BPRSA, and in 24.2% (15/62) of the cases analyzed by CPSD, respectively. The difference between median value of C PRSA and C RAW was highly significant (0.79 [IQR 0.69-0.90] and 0.29 [IQR 0.17-0.47], respectively; p,0.0001). BPRSA is a novel computer-based approach that can be reliably applied to trans-abdominally acquired EHG-fECG. It allows the assessment of correlations between UC and fHR patterns in the majority of labors, overcoming the limitations of non-stationarity and artifacts. Compared to standard techniques of cross-correlations, such as CPSD, BPRSA is significantly superior.

This pitching research letter (PRL) describes the application of the pitching research template introduced by Faff (2015, 2021) to a reverse-engineering process in the practice of electronic fetal monitoring (EFM) as a form of defensive medicine with regard to the field of medical technology. The pitch structure underlines a succinct and streamlined approach to recapitulate key components of scientific studies that form the basis upon which a researcher's scientific or seminal research work is assembled.

Objective: To evaluate the inter-and intra-observer agreement of visual analysis of fetal heart rate tracing and to evaluate the bias introduced by knowledge of perinatal outcome in this interpretation. Methods: One hundred tracings were independently analyzed by four observers. In a second study period, two observers re-analysed the 100 tracings in order to evaluate intra-observer agreement. The other two observers re-analyzed the tracings, which were labelled with fictitious perinatal outcome to evaluate the impact of this information on reliability. Agreement was analyzed by means of the proportion of agreement for qualitative parameters and the inter-and intra-class correlation coefficient for quantitative data. Results: Poor agreement was found for quantitative variability, low variability category and number of decelerations. Moderate agreement was observed for baseline, normal variability category and number of accelerations. Fetal heart rate variability and number of accelerations and decelerations were found to be significantly influenced by clinical information of perinatal outcome. Biased observers showed lower reliability than unbiased ones. Conclusion: Visual assessment of fetal heart rate tracings is unreliable due to low rates of agreement between and within observers. Only qualitative classification such as normal baseline and normal variability showed good agreement. Knowledge of clinical information introduces subjectivity to the visual analysis, leading to a negative impact on reliability.

Background and Objectives: Intrathecal opioids used to relieve labor pain have been associated with uterine hyperactivity and nonreassuring fetal heart rate abnormalities. We retrospectively evaluated all charts of singleton, term, vertex-presenting parturients in active labor requesting neuraxial pain relief during a 1-year period for the occurrence of nonreassuring fetal heart rate tracings. Methods: Three different strategies to relieve labor pain were routinely used in our department: conventional epidural using 10 mL bupivacaine 0.125% and sufentanil 0.75 g/mL; combined spinal and epidural (CSE) using intrathecal sufentanil (7.5 g); and CSE using intrathecal bupivacaine (2.5 mg) and sufentanil (1.5 g). Charts (n ϭ 1,293) were evaluated for nonreassuring fetal heart tracings and uterine hyperactivity as well as for neonatal and labor outcome. Results: Intrathecal sufentanil (7.5 g) produced significantly more nonreassuring tracings and uterine hyperactivity. However, this did not result in more cesarean deliveries or detrimental neonatal outcome. Conclusion: Based on this retrospective analysis, we conclude that intrathecal sufentanil in a dose of 7.5 g has the potential to result in more nonreassuring fetal heart rate tracings compared with both intrathecal analgesia using a bupivacaine (2.5 mg)/sufentanil (1.5 g) mixture and epidural analgesia using bupivacaine, sufentanil, and epinephrine.

1847, the scottish obstetrician james simpson administered ether to a woman during labor to treat the pain of childbirth. He was impressed with the degree of analgesia associated with the use of the drug. Nevertheless, he expressed concern about the possible adverse effects of anesthesia: "It will be necessary to ascertain anesthesia's precise effect, both upon the action of the uterus and on the assistant abdominal muscles; its influence, if any, upon the child; whether it has a tendency to hemorrhage or other complications." 1 One and a half centuries later, the maternal and fetal effects of analgesia during labor remain central to discussions among patients, anesthesiologists, and obstetrical caregivers. A number of randomized trials have sought to address the effects of different strategies for analgesia on maternal and fetal outcomes. Despite this effort, it has become increasingly clear that potentially unwanted effects of analgesia for women in labor and their children cannot be determined easily. Remaining controversies in obstetrical anesthesia include that over the effects of regional anesthesia on the progress and outcome of labor, as well as that over its effects on the neonate. In this article we will concentrate on advances in the administration of epidural, spinal, or combined spinal-epidural analgesia during labor. However, there are many other methods of pain management that may be chosen by women in labor, such as opioids, 2 hydrotherapy, hypnotherapy, the use of labor-support personnel (doulas), massage, movement and positioning, and sterile-water blocks, among others. 3 These alternative methods can be used successfully either alone or in conjunction with epidural analgesia. In addition, successful relief of labor pain in itself is not necessarily associated with high levels of satisfaction on the part of parturient women. 4,5 Factors such as the woman's involvement in decision making, social and cultural factors, the woman's relationship with her caregivers, and her expectations regarding labor may be equally, if not more, important. technique of regional analgesia Approximately 60 percent of women, or 2.4 million each year, choose epidural or combined spinal-epidural analgesia for pain relief during labor. 6 Labor pain is transmitted through lower thoracic, lumbar, and sacral nerve roots (Fig. 1 and 2) that are amenable to epidural blockade. Epidural analgesia is achieved by placement of a catheter into the lumbar epidural space. Solutions of a local anesthetic, opioid, or both can then be administered as intermittent rapid doses or as a continuous infusion (Fig. 3). The alternative technique of combined spinal-epidural analgesia has recently gained in popularity. With this technique, a single bolus of an opioid, sometimes in combination with local anesthetic, is injected into the subarachnoid space, in addition to the placement of an epidural catheter (Fig. 3). The use of a subarachnoid bolus of opioids results in the rap-i regional analgesia for vaginal delivery

Purpose of the review The present manuscript reviews recent data on fetal intrapartum surveillance with special attention to new technologies. Recent findings Continuous fetal heart-rate monitoring, fetal blood sampling, intrapartum stimulation tests, fetal pulse oximetry and fetal electrocardiography will be reviewed. Summary From the available data it appears that to date the analysis of the sinus tachycardia segment of the fetal electrocardiography used in conjunction with continuous fetal heart-rate monitoring is the method of choice.

Nuchal cord, or cord around the neck of an infant at birth, is a common finding that has implications for labor, management at birth, and subsequent neonatal status. A nuchal cord occurs in 20% to 30% of births. All obstetric providers need to learn management techniques to handle the birth of an infant with a nuchal cord. Management of a nuchal cord can vary from clamping the cord immediately after the birth of the head and before the shoulders to not clamping at all, depending on the provider's learned practices. Evidence for specific management techniques is lacking. Cutting the umbilical cord before birth is an intervention that has been associated with hypovolemia, anemia, shock, hypoxic-ischemic encephalopathy, and cerebral palsy. This article proposes use of the somersault maneuver followed by delayed cord clamping for management of nuchal cord at birth and presents a new rationale based on the available current evidence.

Objective: To co mpare the efficacy of misoprostol 50 μg vaginally and 50 μg sublingually for labor induction at term. Materials and Methods: One hundred and twenty wo men were randomized to receive misoprostol 50 μg vaginally (n = 60) or 50 μg sublingually misoprostol (n = 60). The doses were g iven every 5 h (maximu m 5 doses). Primary outcome measure was vaginal delivery rate. Induction to delivery t ime, delivery within 12 h, the nu mber of misoprostol doses given and neonatal outcomes were secondary outcome measures. Results: Vaginal delivery rates were 75% in the sublingual group and 73% in the vaginal group (RR, 1.09; 95% CI, 0.4-2.4).The nu mber o f wo men delivering within 12 h was 20 (45.5%) in the vaginal group and 12 (27%) in the sublingual group (RR, 0.5; 95% CI, 0.3-1). There were no significant differences in the number of doses needed, incidence of contractility disturbances, or neonatal results. Conclusion: Sublingual misoprostol is as efficacious as vaginal misoprostol for induction of labor and neonatal outcomes are similar.

Objectives: This study was undertaken to evaluate whether prenatal zinc supplementation affects maturation of fetal cardiac patterns. Study design: A randomized double-blind controlled trial among 242 low-income Peruvian women was performed. Beginning at 10 to 16 weeks' gestation, women received supplements containing 60 mg iron, 250 mg folic acid with or without 25 mg zinc. Fetal heart rate (mean FHR, variability [HRV], number of accelerations) and movements (number and amplitude of movement bouts, time spent moving) were electronically monitored monthly from 20 weeks' gestation. Developmental trends were evaluated by supplement type among 195 women who completed the trial and had no serious complications of pregnancy. Results: Zinc supplementation was associated with lower FHR, greater number of accelerations, and greater HRV. Supplementation effects on HRV and accelerations were more pronounced after 28 weeks' gestation. No differences in motor activity were observed. Conclusion: Prenatal supplementation of zinc-deficient mothers may be beneficial to fetal neurobehavioral development.

BACKGROUND: Phase-rectified signal averaging, an innovative signal processing technique, can be used to investigate quasi-periodic oscillations in noisy, nonstationary signals that are obtained from fetal heart rate. Phase-rectified signal averaging is currently the best method to predict survival after myocardial infarction in adult cardiology. Application of this method to fetal medicine has established significantly better identification than with short-term variation by computerized cardiotocography of growth-restricted fetuses. OBJECTIVE: The aim of this study was to determine the longitudinal progression of phase-rectified signal averaging indices in severely growthrestricted human fetuses and the prognostic accuracy of the technique in relation to perinatal and neurologic outcome. STUDY DESIGN: Raw data from cardiotocography monitoring of 279 human fetuses were obtained from 8 centers that took part in the multicenter European "TRUFFLE" trial on optimal timing of delivery in fetal growth restriction. Average acceleration and deceleration capacities were calculated by phase-rectified signal averaging to establish progression from 5 days to 1 day before delivery and were compared with short-term variation progression. The receiver operating characteristic curves of average acceleration and deceleration capacities and short-term variation were calculated and compared between techniques for short-and intermediate-term outcome. RESULTS: Average acceleration and deceleration capacities and short-term variation showed a progressive decrease in their diagnostic indices of fetal health from the first examination 5 days before delivery to 1 day before delivery. However, this decrease was significant 3 days before delivery for average acceleration and deceleration capacities, but 2 days before delivery for short-term variation. Compared with analysis of changes in short-term variation, analysis of (delta) average acceleration and deceleration capacities better predicted values of Apgar scores <7 and antenatal death (area under the curve for prediction of antenatal death: delta average acceleration capacity, 0.62 [confidence interval, 0.19e1.0]; delta short-term variation, 0.54 [confidence interval, 0.13e0.97]; P¼.006; area under the curve for prediction Apgar <7: average deceleration capacity <24 hours before delivery, 0.64 [confidence interval, 0.52e0.76]; short-term variation <24 hours before delivery, 0.53 [confidence interval, 0.40e0.65]; P¼.015). Neither phase-rectified signal averaging indices nor short-term variation showed predictive power for developmental disability at 2 years of age (Bayley developmental quotient, <95 or <85). CONCLUSION: The phase-rectified signal averaging method seems to be at least as good as short-term variation to monitor progressive deterioration of severely growth-restricted fetuses. Our findings suggest that for short-term outcomes such as Apgar score, phase-rectified signal averaging indices could be an even better test than short-term variation. Overall, our findings confirm the possible value of prospective trials based on phase-rectified signal averaging indices of autonomic nervous system of severely growth-restricted fetuses.

Aim: This pilot study was done to evaluate the immediate effect of Sukha Pranayama, a slow and deep breathing technique on maternal and fetal cardiovascular parameters. Subjects and Methods: Single session pre-post comparison was done for 10 min of Sukha Pranayama in 12 pregnant women in their 3 rd trimester. The study participants were guided to breathe in and out in a slow and regular manner for a count of 4 s each. Maternal cardiovascular parameters, namely mean heart rate (MHR), systolic pressure (SP), and diastolic pressure (DP), were measured before and after the session and rate-pressure product (RPP) derived with the formulae. Fetal heart rate (FHR) was derived from the nonstress test tracing. Results: SP, MHR, FHR, and RPP reduced significantly after single session of Sukha Pranayama. The mothers reported that they felt more relaxed and also sensed active fetal movement while performing the pranayama. Discussion: Reduction in maternal cardiovascular parameters may be attributed to reduced sympathetic activity coupled with enhanced vagal parasympathetic tone. Reduction in RPP signifies reduced myocardial oxygen consumption and load on the heart as evidenced by previous studies. These changes in cardiac autonomic status may enhance placental circulation, leading to healthier fetal development. Conclusion: The present study reiterates the importance of yoga for the psychosomatic health of maternal-fetal unit as an add-on relaxation technique. We plan to develop this pilot study into a full-fledged evaluation of maternal and fetal wellbeing through yoga.

Trisomy 9 in complete non-mosaic state is an uncommon chromosomal abnormality. Because of its high intrauterine lethality rate, mainly in the first trimester of pregnancy, only a few cases regarding sonographic findings have been reported. Ultrasound features leading to the diagnosis of this chromosomal abnormality include central nervous system, craniofacial, cardiovascular, genitourinary and musculoskeletal malformations as well as early intrauterine growth restriction and oligo-anhydramnios. We report two cases of complete trisomy 9 detected in the early second trimester. Both of them had a normal nuchal translucency (NT) at 11 week scan. In case 1, amniocentesis was performed because the risk for trisomy 18 at the combined test was greater than 1/50 (free BhCG: 0.09 MoMs; PaPP-A: 0.23 MoMs) and in case 2 because of advanced maternal age. Ultrasound examination before amniocentesis at 16 and 14 weeks of gestation, respectively, revealed similar findings (case 1: absent cerebellar vermis, ventriculomegaly, dysmorphic face and dysplastic kidneys; case 2: oligohydramnios, absent cerebellar vermis, hypotelorism, complete atrioventricular septal defect, echogenic bowel, echogenic kidneys, mild generalized subcutaneous edema and ductus venosus pulsatility index (DVPI) greater than 95th centile). Quantitative fluorescent polymerase chain reaction (QF-PCR) for chromosomes 21, 13, 18, X and Y was indicated with normal results in both of the cases but diagnosis of trisomy 9 was made by conventional cytogenetic analysis of amniotic fluid samples. An intrauterine fetal death was diagnosed in case 1; in case 2 parents opted for termination of pregnancy. Because the sonographic findings of trisomy 9 are similar to those of trisomy 18 and 13, in spite of its very rare incidence, diagnosis of trisomy 9 should be considered when QF-PCR studies are performed in these fetuses.

Assessing the health of both the fetus and mother is vital in preventing and identifying possible complications in pregnancy. This paper focuses on a device that can be used effectively by the mother herself with minimal supervision and provide a reasonable estimation of fetal and maternal health while being safe, comfortable, and easy to use. The device proposed uses a belt with a single accelerometer over the mother's uterus to record the required information. The device is expected to monitor both the mother and the fetus constantly over a long period and provide medical professionals with useful information, which they would otherwise overlook due to the low frequency that health monitoring is carried out at the present. The paper shows that simultaneous measurement of respiratory information of the mother and fetal movement is in fact possible even in the presence of mild interferences, which needs to be accounted for if the device is expected to be worn for extended times.

This study investigated the prediction of the risk of hypoxic ischemic encephalopathy using intrapartum cardiotocography records with a long short-term memory recurrent neural network. Across the 12 hours of labour, HIE sensitivity rose from 0.25 to 0.56 as delivery approached while specificity remained approximately constant with a mean of 0.71 and standard deviation of 0.04. The results show that classification improves as delivery approaches but that performance needs improvement. Future work will address the limitations of this preliminary study by investigating input signal transformations and the use of other network architectures to improve the model performance.

The research objective of our group is to improve the intrapartum detection of cardiotocography tracings associated with an increased risk of developing fetal acidosis and subsequent hypoxic-ischemic encephalopathy (HIE). The detection methods that we aim to develop must be sensitive to abnormal tracings without causing excessive unnecessary interventions. Past studies showed that the dynamic response of fetal heart rate (FHR) to uterine pressure (UP) during the intrapartum could be modelled using linear systems. In this study, we examined the assumption of linearity by comparing the performance of linear dynamic and nonlinear dynamic models of the UP-FHR system. The linear systems were defined by second-order state-space models. The nonlinear systems were defined by Hammerstein models: a cascade of a static nonlinearity and a linear second-order state-space model. Our results showed that nonlinear dynamic models were better than linear systems in 81.8% of UP-FHR segments.

Please cite this paper as: Raheem I, Saaid R, Omar S, Tan P. Oral nifedipine versus intravenous labetalol for acute blood pressure control in hypertensive emergencies of pregnancy: a randomised trial. BJOG 2012;119:78–85.Objective  To compare oral nifedipine with intravenous labetalol in their rapidity to control hypertensive emergencies of pregnancy.Design  A double‐blind randomised trial.Setting  A university hospital in Malaysia.Population  Pregnant women with severe gestational hypertension ≥160/110 mmHg who required immediate treatment.Methods  Patients were randomised to receive nifedipine (10 mg tablet, orally, up to five doses) and intravenous placebo saline injection or intravenous labetalol injection (in an escalating dose regimen of 20, 40, 80, 80 and 80 mg) and a placebo tablet every 15 minutes until the target blood pressure of ≤150/100 mmHg was achieved. Crossover treatment was effected if the initial treatment regimen was unsuccessful.Main outcome measure  The time ta...

Per partum fetal asphyxia is a major cause of neonatal morbidity and mortality. Fetal heart rate monitoring plays an important role in early detection of acidosis, an indicator for asphyxia. This problem is addressed in this paper by introducing a novel complexity analysis of fetal heart rate data, based on producing a collection of piecewise linear approximations of varying dimensions from which a measure of complexity is extracted. This procedure specifically accounts for the highly non-stationary context of labor by being adaptive and multiscale. Using a reference dataset, made of real per partum fetal heart rate data, collected in situ and carefully constituted by obstetricians, the behavior of the proposed approach is analyzed and illustrated. Its performance is evaluated in terms of the rate of correct acidosis detection versus the rate of false detection, as well as how early the detection is made. Computational cost is also discussed. The results are shown to be extremely promising and further potential uses of the tool are discussed. MATLAB routines implementing the procedure will be made available at the time of publication.

We performed multifractal analysis of fetal heart rate (FHR) variability in fetuses with and without acidosis during labor. Multifractal analysis was performed on fetal electrocardiograms in 10-minute sliding windows within the last 2 hours before delivery in 45 term fetuses divided in three groups according to umbilical arterial pH and FHR pattern: group A had pH !7.30 and normal FHR, group B had pH !7.30 and intermediate or abnormal FHR, and group C had acidosis (pH 7.05) and intermediate or abnormal FHR. Six multifractal parameters were compared using Wilcoxon rank sum test. Multifractal parameters were significantly different between the three groups in the last 10 minutes before delivery (p <0.05). Two parameters (h min , zeta(2)) exhibited a significant difference 70 minutes before delivery, and one parameter (C 2 ) was different 10 minutes before birth (p <0.05). Multifractal parameters were significantly different in acidotic and nonacidotic fetuses, independently from FHR pattern.

The improvement in medical care, which we have observed in the last few decades, has been influenced by the introduction of new technologies and methods for monitoring the patient. Medical researchers working have been faced with large amount of different types of data (alphanumeric, signals, images), that are sometimes difficult to analyze using traditional methods. In order to extract maximum information from the collected data, introduction of sophisticated mathematical methods to medical sciences has been necessary. The aim of this article is to explain how virtual instrumentation concept may facilitate creation of tools, which may be useful both in medical investigations and diagnosis support. As the example we present the analysis of the fetal heart rate signal in time, frequency and joined time-frequency domain. The possibility of classification of such obtained results with statistical and artificial intelligence methods will be described.

The motive of the investigation is analyzing the categorization of fetal state code from the Cardiographic data set based on decision tree method. Cardiotocography is one of the important tools for monitoring heart rate, and this technique is widely used worldwide. Cardiotocography is applied for diagnosing pregnancy and checking fetal heart rate state condition until before delivery. This classification is necessary to predict fetal heart rate situation which is belonging. In this paper, we are using three input attributes of training data set quoted by LB, AC, and FM to categorize as normal, suspect or pathological where NSPF variable is used as a response variable. After drawing necessary analysis into three variables we get the 19 nodes of classification tree and also we have measured every single node according to statistic, criterion, weights, and values. The Cardiotocography Dataset applied in this study is received from UCI Machine Learning Repository. The dataset contains 2...

Background: The extent of the benefits of exercise training during pregnancy on maternal, fetal, and neonatal health outcomes has not been sufficiently addressed. While aerobic exercise training has been determined as safe and efficacious throughout pregnancy, the effects of other training modes on fetal health and development as well as any continued benefits for the neonate, especially with regards to cardiovascular development and function, is largely unknown. In the ENHANCED by Mom study we aim to determine the effects of different modes of exercise training (aerobic, circuit, and resistance) throughout pregnancy on childhood health by controlling individual exercise programs and assessing the effects of each on fetal and neonatal health adaptations. Methods/Design: ENHANCED by mom is a cross sectional comparison study utilizing 3 intervention groups in comparison to a control group. Participants will complete three 5 min warmup + 45 min sessions weekly from 16 weeks to 36 weeks gestation of aerobic, resistance, or circuit training, in comparison to non-exercising controls. Maternal physical measurements will occur every 4 weeks throughout the intervention period. Fetal morphometric and heart measurements will occur at 34 weeks gestation. Neonatal measurements will be acquired at birth and at 1 month, 6 months, and 12 months. Discussion: A better understanding on the effects of exercise training during pregnancy on fetal and neonatal health could have a profound impact on the prevention and development of chronic diseases such as obesity, hypertension, and diabetes.

Background: Cesarean sections (C-sections) are among the most common
surgical procedures worldwide, with an increasing trend in both first-time
and recurrent cesareans. Recurrent C-sections, in particular, pose significant
risks for maternal and neonatal outcomes, yet many are performed due to the
recurrence of initial cesarean indications or maternal request.
Methods: This prospective observational study aimed to compare the causes
and outcomes of recurrent versus first-time C-sections among 120 women
at Bangabandhu Sheikh Mujib Medical University (BSMMU) and Universal
Medical College & Hospital Ltd. in Dhaka, Bangladesh, over a one-year
period. Of the participants, 72 had recurrent C-sections and 48 had first-time
C-sections.

Monitoring (EFM) is an indispensable means for fetal surveillance. However, the early enthusiasm was followed by scepticism, since the introduction of EFM in every day practise resulted in an increase in operative deliveries. Nevertheless the drawbacks of EFM relate not so much to the technique itself but more to the difficulties in reading and interpreting the Fetal Heart Rate (FHR). In an attempt to develop more objective means to analyse the FHR recordings and compensate for the different levels o f expertise among clinicians, computerized systems have been developed during the last 2 decades. In this work we present an approach to automatic classification of FHR tracings belonging to hypoxic and normal newborns. The classification is performed using a set of parameters extracted form the FHR signal and two Hidden Markov Models (one for each class). The results are satisfactory indicating that the FHR convey much more information than what is conventionally used Index Terms-Cardiotocography, Fetal Heart Rate (FHR), Hidden Markov Models (HMM)

Spatio‐temporal image correlation (STIC) is a new approach for clinical assessment of the fetal heart. It offers an easy to use technique to acquire data from the fetal heart and to aid in visualization with both two‐dimensional and three‐dimensional (3D) cine sequences. The acquisition is performed in two steps: first, images are acquired by a single, automatic volume sweep. Second, the system analyzes the image data according to their spatial and temporal domain and processes an online dynamic 3D image sequence that is displayed in a multiplanar reformatted cross‐sectional display and/or a surface rendered display. The examiner can navigate within the heart, re‐slice, and produce all of the standard image planes necessary for a comprehensive diagnosis. The advantages of STIC for use in evaluation of the fetal heart are as follows: the technique delivers a temporal resolution which corresponds to a B‐mode frame rate of approximately 80 frames/s; it provides the examiner with an unl...

Pregnant mares are often removed from work during gestation. However, little is known about the effects of exercise on the pregnant mare and her foetus. In the present study, maternal and foetal heart rates were monitored by electrocardiography before and after exercise in four equine pregnancies (days 250–285). Exercise consisted of lungeing mares in 20 m circles for 5, 10 and 20 min. Following exercise, significant increases in maternal heart rate were detected (P&lt;0.0001) but not in foetal heart rate (P = 0.4331). All mares gave birth to normal foals uneventfully. While these findings suggest that moderate exercise of the pregnant mare does not appear to be harmful to the equine foetus, data are insufficient to draw conclusions. A larger, more controlled study is necessary.