Fetal Heart Rate

The ability of human fetuses to recognize their own mother's voice was examined. Sixty term fetuses were assigned to one of two conditions during which they were exposed to a tape recording of their mother or a female stranger reading a passage. Voice stimuli were delivered through a loudspeaker held approximately 10 cm above the maternal abdomen and played at an average of 95 dB SPL. Each condition consisted of three 2-min periods: no stimulus, voice (mother or stranger), and no stimulus. Fetal heart rate increased in response to the mother's voice and decreased in response to the stranger's; both responses were sustained for 4 min. The finding of differential behavior in response to a familiar versus a novel voice provides evidence that experience influences fetal voice processing. It supports an epigenetic model of speech perception, presuming an interaction between genetic expression of neural development and species-specific experience.

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 3rd 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.

The consequences of perinatal stress and/or exposure to neuropeptides on the developing organism can include permanent influences on the brain and behavior. In human subjects, infant and early childhood separation stress is associated with a significant increase in adult psychopathology and permanent elevation in plasma P-endorphin (PE) and cortisol.' A study of over 3,000 patients2 reported that the type of anteor intrapartum stress significantly predicted the category of selfdestructive behavior exhibited among adults. For instance, perinatal hypoxia was associated with significant tendencies to attempt suicide by asphyxic means such as suffocation. Intrapartum "mechanical" trauma (e.g., use of forceps) was associated with significant tendencies to self-destruct with instruments such as guns. Some less severe forms of self-injurious behavior related to developmental compromise observed among mentally retarded and autistic individuals can be attenuated by centrally acting drug^.^-^ In these individuals the best predictor of a positive response to drugs is a history of perinatal These studies in clinical populations suggest that perinatal stress is strongly associated with developmental patterns and with influences on the central nervous system.

Background: The aim of the study was to assess prospectively the evolution of multiple clinical parameters throughout the first trimester of pregnancy. Method: A transvaginal ultrasound examination and a blood test was weekly performed until the 13th gestational week in a group of healthy volunteers. A total of 25 spontaneously conceived singleton pregnant women with good pregnancy outcome finally completed the study. The evolution of 10 transvaginal ultrasound parameters, 5 Doppler measurements and 6 serum parameters was studied.

Objective. To find out the efficacy of continuous fetal heart monitoring by analyzing the cases of cesarean section for nonreassuring fetal heart in labor, detected by cardiotocography (CTG) and correlating these cases with perinatal outcome. To evaluate whether a 30 minute decision to delivery (D-D) interval for emergency cesarean section influences perinatal outcome.

Methadone Fetal development Substance abuse Pregnancy Fetal heart rate Fetal movement Objective: The purpose of this study was to investigate the effect of methadone on fetal neurobehavioral functions and maternal physiologic indicators. Study design: Forty women attending a substance abuse treatment facility with otherwise uncomplicated pregnancies were evaluated at peak and trough methadone levels. Fetal measures included heart rate, variability, periodic accelerations/decelerations, motor activity, and fetal movement-heart rate coupling. Maternal measures included maternal heart period, variability, electrodermal skin conductance, respiration, and respiratory sinus arrhythmia (RSA). Repeated measure analysis of variance was used to evaluate within-subject changes. Results: At peak methadone, fetal heart rate was slower, less variable, and displayed fewer accelerations. Fetuses displayed less motor activity, and the integration between heart rate and motor activity was attenuated. Maternal heart rate and skin conductance were unchanged, but methadone administration was associated with lower respiratory rate and RSA, an indicator of parasympathetic tone. Conclusion: Maternal methadone administration has significant effects on fetal behavioral functions that are independent of maternal effects.

a b s t r a c t a r t i c l e i n f o Keywords: Hypoxic ischemic encephalopathy Neonatal encephalopathy Intrapartum asphyxia Cerebral palsy Fetal heart monitoring Hypoxic ischemic encephalopathy (HIE) describes neonatal encephalopathy that is caused by intrapartum asphyxia and it can result in the long term sequelae of cerebral palsy which is a major cause of disability. The incidence of cerebral palsy has not changed over the last few decades and the challenge to obstetricians remains how best to recognise those babies at risk of this intrapartum insult both before and during labour. Many associations and risk factors are unavoidable or unrecognisable, and others are fairly common and associated with poor predictive value. Intrapartum fetal heart monitoring remains the main focus of attention but how this is best achieved is still the subject of research. Computerised decision support systems built into fetal heart rate monitoring and non-invasive fetal ECG signal pick-up are currently being explored.

Background: Despite increased attention to the role of antenatal maternal psychological stress in postnatal development, remarkably little information is available on the nature of the intrauterine fetal response to maternal psychological state. Aims: To determine whether: (1) the fetus responds to maternal stress; (2) the fetal response changes over gestation; and (3) individual maternal and fetal response patterns are stable over time. Study design: Induced maternal stress at 24 and 36 weeks gestational age using the Stroop color -word task. Subjects: 137 low-risk pregnant women with normally developing fetuses. Outcome measures: Maternal (heart rate and skin conductance) and fetal (heart rate, heart rate variability, and motor activity) responses. Results: The manipulation evoked maternal sympathetic activation, which declined in magnitude from 24 to 36 weeks gestation. Fetuses responded to the manipulation with increased variability in heart rate ( F(2,256) = 7.80, p < 0.001) and suppression of motor activity ( F(2,216) = 15.47, p < 0.001). The magnitude of the fetal response increased over gestation. The degree of maternal reactivity to and recovery from the stressor were correlated over time (r's = 0.53 and 0.60 for heart rate; r's = 0.31 and 0.36 for skin conductance; p's < 0.001). There was moderate stability in the magnitude of the fetal motor response (r = 0.25, p < 0.01). Conclusions: Demonstration of fetal responses to maternal sympathetic activation evoked by a benign cognitive stressor suggests that fetal neurobehavioral regulation is routinely disrupted by maternal environmental intrusions. There is no evidence of a protective effect of diminished maternal sensitivity to stress on the fetus. Individual stability in the magnitude of the evoked maternal physiologic and psychological responses from 24 to 36 weeks and stability in the fetal motor response implies that characteristic response patterns emerge in utero. We propose that autonomic development is partially entrained through these processes. D

Fetal electrocardiogram (FECG) signal contains potentially precise information that could assist clinicians in making more appropriate and timely decisions during labor. The ultimate reason for the interest in FECG signal analysis is in clinical diagnosis and biomedical applications. The extraction and detection of the FECG signal from composite abdominal signals with powerful and advance methodologies are becoming very important requirements in fetal monitoring. The purpose of this review paper is to illustrate the various methodologies and developed algorithms on FECG signal detection and analysis to provide efficient and effective ways of understanding the FECG signal and its nature for fetal monitoring. A comparative study has been carried out to show the performance and accuracy of various methods of FECG signal analysis for fetal monitoring. Finally, this paper further focused some of the hardware implementations using electrical signals for monitoring the fetal heart rate. This paper opens up a passage for researchers, physicians, and end users to advocate an excellent understanding of FECG signal and its analysis procedures for fetal heart rate monitoring system.

Fetal heart rate monitoring is fundamental to infer information about fetal health state during pregnancy. The cardiotocography (CTG) is the most common antepartum monitoring technique. Abdominal ECG recording represents the most valuable alternative to cardiotocography, as it allows passive, non invasive and long term fetal monitoring. Unluckily fetal ECG has low SNR and needs to be extracted from abdominal recordings using ad hoc algorithms. This work describes a prototype of a wearable fetal ECG electrocardiograph. The system has flat band frequency response between 1-60 Hz and guarantees good signal quality. It was tested on pregnant women between the 30(th) and 34(th) gestational week. Several electrodes configurations were tested, in order to identify the best solution. Implementation of a simple algorithm for FECG extraction permitted the reliable detection of maternal and fetal QRS complexes. The system will allow continuative and deep screening of fetal heart rate, introduc...

This paper considers the multiscale entropy (MSE) approach for estimating the regularity of time series at different scales. Sample entropy (SampEn) and approximate entropy (ApEn) are evaluated in MSE analysis on simulated data to enhance the main features of both estimators.

We determined interobserver variability in the classification of fetal heart rate (FHR) tracing with periodic deceleration as being reassuring or nonreassuring and in the ability to predict emergency cesarean delivery (ECD) or umbilical arterial pH Ͻ 7.00. STUDY DESIGN: Five clinicians reviewed 100 FHR tracings 1 hour before abnormalities and, if applicable, the hour before delivery. We calculated weighted Kappa coefficients (WKC) to assess interobserver variability and likelihood ratio of FHR tracing to identify ECD and low pH.

This letter describes a fast and very simple algorithm for estimating the fetal electrocardiogram (FECG). It is based on independent component analysis, but we substitute its computationally demanding calculations for a much simpler procedure. The resulting method consists of two steps: 1) a dimensionality reduction step and 2) a computationally light postprocessing stage used to enhance the FECG signal.

Objectives: To compare oral misoprostol with dinoprostone for induction of labor and their effects on the fetal heart rate patterns. Methods: In a randomized controlled trial, 200 patients received either misoprostol 50 Ag orally for every 4 h, or dinoprostone 0.5 mg intracervically for every 6 h. Cardiotocographic recordings, in 10-min windows 30, 60, and 80 min after prostaglandin administration during induction and continuously during labor, were compared between the two groups. Primary outcome for effectiveness and safety was assessed in terms of the number of vaginal deliveries within 24 h and fetal heart rate abnormalities during induction and labor respectively. Results: Data from 96 patients in the misoprostol group and 95 in the dinoprostone group were analyzed. There were no significant differences in respect of the number of vaginal deliveries within 24 h (RR 1.12; 95% CI 0.88-1.42). The frequency of suspicious and pathological fetal heart rate patterns did not differ significantly but significantly more cardiotocographs in the dinoprostone group had non-reassuring baseline variability 60 min after dose administration (RR 0.33; 95% CI 0.14-0.77). Maternal and neonatal outcomes did not differ significantly. Conclusion: Oral misoprostol is as effective as intracervical dinoprostone for induction of labor with no difference in the frequency of fetal heart rate abnormalities.

The aim of this study was to compare the visual analyses of fetal heart rate tracings by observers according to recent National Institute of Child Health and Human Development interpretative guidelines both with each other and with those of a computerized fetal heart rate analysis and alerting system. STUDY DESIGN: One-hour sections of intrapartum fetal heart rate records were analyzed by a computerized monitoring system (Hewlett-Packard TraceVue; HP GmbH, Böblingen, Germany) and by 4 observers (a registered obstetric nurse, a certified nurse-midwife, an obstetrics resident physician, and a physician maternalfetal medicine faculty member) instructed to use the new National Institute of Child Health and Human Development guidelines. We compared specific alerts, baseline rates, frequencies of accelerations and decelerations, and signal quality assessments generated by the TraceVue system and the observers. Power analysis indicated that 50 tracings were required to detect interobserver and observer-computer agreement levels of 80% ± 10%. Statistical comparisons used κ coefficient, χ 2 test, and analysis of variance with repeated measures as appropriate. RESULTS: Levels of agreement between observer pairs and the computer did not vary significantly across successive 10-minute intervals. Overall levels of interobserver agreement for baseline rate, tracing quality assessment, frequencies of accelerations and decelerations, and alerts ranged from 45% to 99% and were highest for baseline rate and signal loss and lowest for acceleration and deceleration counts. Interobserver agreement for alerts was relatively high (range, 72%-84%), with virtually no difference between any of the observers and the computer (range, 76.9%-79.2%; κ = 0.25). CONCLUSION: Use of the National Institute of Child Health and Human Development guidelines for visual fetal heart rate interpretation did not increase agreements on most fetal heart rate features beyond those expected by chance or noted in previous reports. These guidelines did appear to blunt some interpretive differences, possibly as a result of observer background. Although levels of agreement on fetal heart rate features differed, agreements on clinical alerts were similar among all observers and a computerized fetal heart rate monitoring system. Computer analysis of fetal heart rate tracings could eliminate interobserver variation that results from visual analysis and could produce more consistent clinical responses to normal and abnormal fetal heart rate patterns. (Am J Obstet Gynecol 2000;183:361-6.)

For parturients desiring labor analgesia who have contraindications to neuraxial techniques, intravenous opioid-based patient-controlled analgesia (IVPCA) offers a reasonable alternative, although incomplete analgesia and maternal and neonatal respiratory depression can occur. Dexmedetomidine, a highly selective alpha(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 fo...

A 32-year-old woman, gravida 2 para 1, was hospitalized in the 31st week of gestation with a diagnosis of preterm labor. Ritodrine tocolysis failed to control uterine contractions, and an emergency cesarean section was performed for a decelerative fetal heart rate tracing. After the infant was delivered, ligation of the bilateral uterine arteries and their anastomoses with the ovarian arteries was performed. A 4×6-cm ellipsoid area of the anterior uterine corpus with placenta percreta was excised. Unilateral tubal occlusion was noted on hysterosalpingography 3 months after surgery, but the patient refused further interventions. The second case we present is that of a 28-year-old woman, gravida 3 para 2, who had her third cesarean delivery at the 38th week of gestation because of bleeding from placenta previa. We performed a repeat laparotomy for decreasing hemoglobin levels and drained 1,600 ml of blood from the abdomen. The bilateral uterine arteries and their anastomoses with ovarian arteries were ligated. Retained placental fragments were removed, and the bleeding areas were sutured. Despite resuturing of the vertical incision, uterine bleeding and hypotonia were observed, and transuterine sutures were inserted. Unilateral left tubal occlusion was observed on hysterosalpingography 3 months after surgery, and hysteroscopic balloon tuboplasty and laparoscopic tubal adhesiolysis were performed.

Fetal Heart Rate (FHR) monitoring gives important information about the fetus health state during pregnancy. This paper presents a new prototype for remote fetal monitoring. The device will allow to monitor FHR in a domiciliary context and to send fetal ECG traces to a hospital facility, where clinicians can interpret them. In this way the mother could receive prompt feedback about fetal wellbeing. The system is characterized by two units: (i) a wearable unit endowed with textile electrodes for abdominal ECG recordings and with a Field Programmable Gate Array (FPGA) board for fetal heart rate (FHR) extraction; (ii) a dock station for the transmission of the data through the telephone line. The system will allow to reduce costs in fetal monitoring, improving the assessment of fetal conditions. The device is actually in development state. In this paper, the most crucial aspects behind its fulfillment are discussed.

We determined interobserver variability in the classification of fetal heart rate (FHR) tracing with periodic deceleration as being reassuring or nonreassuring and in the ability to predict emergency cesarean delivery (ECD) or umbilical arterial pH Ͻ 7.00. STUDY DESIGN: Five clinicians reviewed 100 FHR tracings 1 hour before abnormalities and, if applicable, the hour before delivery. We calculated weighted Kappa coefficients (WKC) to assess interobserver variability and likelihood ratio of FHR tracing to identify ECD and low pH.

Background: Stress during pregnancy can have adverse effects on the course of pregnancy and on fetal development. There are few studies investigating the outcome of stress reduction interventions on maternal well-being and obstetric outcome. Aims: This study aims (1) to obtain fetal behavioral states (quiet/active sleep, quiet/active wakefulness), (2) to investigate the effects of maternal relaxation on fetal behavior as well as on uterine activity, and (3) to investigate maternal physiological and endocrine parameters as potential underlying mechanisms for maternal-fetal relaxation-transferral. Study design: The behavior of 33 fetuses was analyzed during laboratory relaxation/quiet rest (control group, CG) and controlled for baseline fetal behavior. Potential associations between relaxation/quiet rest and fetal behavior (fetal heart rate (FHR), FHR variation, FHR acceleration, and body movements) and uterine activity were studied, using a computerized cardiotocogram (CTG) system. Maternal heart rate, blood pressure, cortisol, and norepinephrine were measured. Results: Intervention (progressive muscle relaxation, PMR, and guided imagery, GI) showed changes in fetal behavior. The intervention groups had higher long-term variation during and after relaxation compared to the CG (p = .039). CG fetuses had more FHR acceleration, especially during and after quiet rest (p = .027). Women in the PMR group had significantly more uterine activity than women in the GI group (p = .011) and than CG women. Maternal heart rate, blood pressure, and stress hormones were not associated with fetal behavior. Conclusions: This study indicates that the fetus might participate in maternal relaxation and suggests that GI is superior to PMR. This could especially be true for women who tend to direct their attention to body sensations such as abdominal activity.

Fetal heart rate (FHR) and uterine contractions (UC) are simultaneously recorded by Cardiotocography
(CTG). The CTG, which is one of the most common diagnostic techniques used to evaluate maternal and
fetal well-being during pregnancy and before delivery. By observing the Cardiotocography trace patterns
doctors can understand the state of the fetus. There are several signal processing and computer
programming based techniques for interpreting a typical Cardiotocography data. Even few decades after
the introduction of cardiotocography into clinical practice, the predictive capacity of these methods
remains controversial and still inaccurate. In this paper, we evaluate machine learning based Naine Bayes
probabilistic model based classifier for their suitability towards classifying CTG data. We used Precision,
Recall and F-Score as the metric to evaluate the performance. In previous works such as [1], the overall
Precision, Recall and F-Score were only considered. But in this evaluation, we are going to measure class
wise Precision, Recall and F-Score to make the analysis very specific. They arrived results prove that,
even though the traditional clustering methods can identify the Normal CTG patterns, they were incapable
of Suspicious and Pathologic patterns. This fact was not highlighted in [1].

Fetal heart rate (FHR) and uterine contractions (UC) are simultaneously recorded by Cardiotocography
(CTG). The CTG, which is one of the most common diagnostic techniques used to evaluate maternal and
fetal well-being during pregnancy and before delivery. By observing the Cardiotocography trace patterns
doctors can understand the state of the fetus. There are several signal processing and computer
programming based techniques for interpreting a typical Cardiotocography data. Even few decades after
the introduction of cardiotocography into clinical practice, the predictive capacity of these methods
remains controversial and still inaccurate. In this paper, we evaluate commonly used unsupervised
clustering method k-mean clustering for their suitability towards clustering CTG data. We used Precision,
Recall, F-Score and Rand Index as the metric to evaluate the performance. In previous works such as [1],
the overall Precision, Recall and F-Score were only considered. But in this evaluation, we are going to
measure class wise Precision, Recall and F-Score to make the analysis very specific. They arrived results
prove that, even though the traditional clustering methods can identify the Normal CTG patterns, they were
incapable of Suspicious and Pathologic patterns. This fact was not highlighted in [1]

meconium aspiration syndrome (mas) is a rare condition affecting infants who inhale or aspirate meconium-stained liquor during or after labour. it is a serious disease with complications of neonatal respiratory distress, and can lead to the death of infants if it is not detected early or is left untreated.

A higher incidence of fetal losses, especially after the use of artificial reproduction techniques, asks for more intensive monitoring of bovine pregnancies. In this study, a model for fetal death (FD) was created by administering the antiprogesterone aglepristone twice, ...

To determine the clinical significance of the existence of poor prognostic features in fetal heart rate (FHR) traces with variable decelerations. This study was prospectively performed on 167 randomly selected women with a singleton pregnancy at term. Ninety-one patients had an FHR trace without pathological features. The remaining 76 women had variable decelerations and their FHR traces were analyzed carefully for the existence of poor prognostic features. Fetal and neonatal outcomes were compared in the normal and variable deceleration groups. There were statistically significant differences between the groups in 1 and 5 minute Apgar scores, fetal heart rate (FHR), umbilical artery blood pH, pCO2; whereas no significant differences were found in the levels of umbilical artery HCO3, pO2. Prolonged deceleration had the highest specificity for 1 minute Apgar score &amp;lt; 7.5 minute Apgar score &amp;lt; 7 and umbilical artery blood pH &amp;lt; 7.20 (95.0%, 96.3%, 97.5%, respectively). Loss of variability during deceleration showed the highest specificity for the same fetal features (66.7%, 72.3%, 63.9%, respectively). All other poor prognostic features had high specificities but low sensitivities.

Emerging data suggest that prenatal factors influence children's temperament. In 50 dyads, we examined fetal heart rate (FHR) activity and women's antenatal psychiatric illness as predictors of infant temperament at 4 months (response to novelty and the Infant Behavior Checklist). FHR change during maternal challenge was positively associated with observed infant motor reactivity to novelty (p ¼ .02). The odds of being classified as high versus low motor among fetuses who had an increase in FHR during maternal stress was 11 times those who had a decrease in FHR (p ¼ .0006). Antenatal psychiatric diagnosis was associated with an almost fourfold greater odds of having a high cry reactivity classification (p ¼ .03). There also were modest associations between baseline FHR and maternal reports of infant temperament and between observed temperament and that based on mothers' reports. All of the infant results were found independent of the influence of women's postnatal anxiety. These data indicate that physiological markers of individual differences in infant temperament are identifiable in the fetal period, and possibly shaped by the prenatal environment. ß 2007 Wiley Periodicals, Inc. Dev Psychobiol 49: 474-484, 2007.

Background. Contradictory findings on the effect of betamethasone versus dexamethasone on antenatal tests of fetal well-being have been reported. The purpose of this study was to compare the effects of these steroid compounds on fetal heart rate patterns and biophysical activities in a prospective, randomized trial. Study design. Forty-six pregnant women (gestational age range 27-34 weeks) at risk for preterm delivery were randomized to receive betamethasone or dexamethasone for enhancement of fetal lung maturity. Fetal heart rate was recorded for 60 minutes and analyzed with the Sonicaid System 8000 before (0 hours), and 48 hours and 96 hours after steroid administration. Subsequently, fetal limb, body and breathing movements were sonographically observed and quantified for 30 minutes. To account for fetal circadian rhythms, all examinations were performed between 1 p.m. and 5 p.m., at least one hour after maternal meals. Results. Fetal heart rate accelerations (p∞0.001; p∞0.01), short-term variation (p∞0.0001; p∞0.05), long-term variation (p∞0.01; pΩNS), duration of high episodes (p∞0.001; p∞0.05), total movement count (p∞0.001; p∞0.05), and duration of breathing time (p∞0.0001; p∞0.0001) were substantially reduced 48 h after betamethasone and dexamethasone administration, respectively, with percent reduction being larger for the betamethasone group, except for breathing movements (p∞0.05; p∞0.001; p∞0.001; p∞0.005; p∞0.05; pΩNS; respectively). In 68.2% and 45.5% of fetuses, less than 30 seconds of continuous breathing movements were found in the betamethasone and dexamethasone groups, respectively. In 71.8% and 12.5% of fetuses, respectively, less than 2 body/limb movements were observed. Therefore five and two fetuses in the betamethasone and dexamethasone study group, respectively, had both nonreactive fetal heart rate monitors for 60 minutes and biophysical profiles of AE4/10. All parameters returned to baseline values at 96 h. Baseline fetal heart rate and numbers of decelerations remained unchanged (pΩNS). Conclusions. Both betamethasone and dexamethasone induce a profound, albeit transient, suppression of fetal heart rate characteristics and biophysical activities in the preterm fetus. However, the effect of betamethasone is more pronounced. Awareness of these phenomena might prevent unwarranted iatrogenic delivery of preterm fetuses.

OBJECTIVE: Recent developments permit the use of pulse oximetry to evaluate fetal oxygenation in labor. We tested the hypothesis that the addition of fetal pulse oximetry in the evaluation of abnormal fetal heart rate patterns in labor improves the accuracy of fetal assessment and allows safe reduction of cesarean deliveries performed because of nonreassuring fetal status. STUDY DESIGN: A randomized, controlled trial was conducted concurrently in 9 centers. The patients had term pregnancies and were in active labor when abnormal fetal heart rate patterns developed. The patients were randomized to electronic fetal heart rate monitoring alone (control group) or to the combination of electronic fetal monitoring and continuous fetal pulse oximetry (study group). The primary outcome was a reduction in cesarean deliveries for nonreassuring fetal status as a measure of improved accuracy of assessment of fetal oxygenation. RESULTS: A total of 1010 patients were randomized, 502 to the control group and 508 to the study group. There was a reduction of >50% in the number of cesarean deliveries performed because of nonreassuring fetal status in the study group (study, 4.5%; vs control, 10.2%; P = .007). However, there was no net difference in overall cesarean delivery rates (study, n = 147 [29%]; vs control, 130 [26%]; P = .49) because of an increase in cesarean deliveries performed because of dystocia in the study group. In a blinded partogram analysis 89% of the study patients and 91% of the control patients who had a cesarean delivery because

The authors investigated the association between maternal psychological and fetal neurobehavioral functioning. Data were provided by 52 maternal-fetal pairs at 24, 30, and 36 weeks gestation. The relations between maternal measures and fetal heart rate, variability, and motor activity were statistically modeled. Fetuses of women who were more affectively intense, appraised their lives as more stressful, and reported more frequent pregnancy-specific hassles were more active across gestation. Fetuses of women who perceived their pregnancy to be more intensely and frequently uplifting and had positive emotional valence toward pregnancy were less active. Associations with fetal heart-rate measures were detected at 36 weeks gestation. These data provide evidence for proximal effects of maternal psychological functioning on fetal neurobehavior.

The origin of sleep and circadian rhythms development is found during the fetal period. Both quiet (NREM) and active (REM) sleep are distinguishable during the last 10 weeks of gestation. Comparable to fetuses, low risk preterm infants recorded at 30±40 weeks postconceptional age, had a similar development of sleep i.e. an increase in quiet sleep and a decrease in indeterminate sleep. A further development in sleep organization characterized by increased slow wave and spindle activity during quiet sleep and coupling with circadian rhythm takes place during the ®rst 6 months of life in both term and preterm infants.

Objective To identify fetal heart rate (FHR) patterns reXecting the severity of placental abruption, and to determine the incidence of normal FHR pattern in cases of placental abruption. Materials and methods We analyzed FHR tracings from 40 pregnant Japanese women with placental abruption. We analyzed which FHR patterns appeared more frequently in cases of low 5-min Apgar score, low cord arterial pH, and large separation. Results Eight out of 40 cases showed a normal FHR pattern, while 32 cases did not show a normal FHR pattern. Undetectable variability and bradycardia appeared more frequently in cases with 5-min Apgar < 7, with cord blood pH < 7.1, and with larger placental separation than in cases without these features. The normal FHR pattern was associated with 5-min Apgar¸7, cord blood pH¸7.1, and separation of <25%. Conclusion Fetal heart rate pattern reXected the severity of placental abruption. Undetectable variability and bradycardia occurred signiWcantly more frequently in cases of severe placental abruption, and thus may reXect the severity of placental abruption.

Background-Intrathecal neostigmine produces analgesia, but also severe nausea. In contrast, epidural neostigmine enhances opioid and local anesthetic analgesia without causing nausea. Previous studies examined only single epidural neostigmine bolus administration and did not assess the efficacy of continuous epidural infusion or several aspects of maternal and fetal safety. We therefore tested the hypothesis that epidural neostigmine in combination with bupivacaine by continuous infusion during labor would reduce the amount of bupivacaine required.

Background: Fetal behavioral states are important indicators of fetal physiology and pathology associated to typical fetal heart rate (FHR) patterns. Aim: To provide linear and nonlinear analysis of FHR patterns associated with fetal behavioral states regarding a better understanding of these states and patterns. Study design and subjects: Fifty FHR tracings from normal term pregnancies with a median duration of 40.3 min were acquired with the SisPorto® 2.01 system for computerized analysis of cardiotocograms. Each tracing was divided into consecutive 10-minute segments and each segment was classified by two experts as pattern A, B, C or D. Outcome measures: Linear and nonlinear indices were computed in each segment, namely mean FHR, long-term irregularity index (LTI), very low (VLF), low (LF) and high (HF) frequency spectral indices, approximate entropy (ApEn) and sample entropy (SampEn). Kappa statistic (κ) and proportions of agreement (Pa) were used for assessment of inter-observer agreement. Bootstrap percentile confidence intervals and nonparametric statistical tests were calculated for statistical inference. Results: Overall agreement between experts in pattern classification was good to excellent with values for κ and Pa of 0.74 (95% CI: 0.64-0.94) and 0.94 (95% CI: 0.92-0.96), respectively. Most linear domain indices increased significantly with rising fetal activity whereas the opposite occurred with nonlinear indices, except for SampEn(2, 0.1). LF/(MF + HF) ratio also significantly increased with fetal activity, denoting an increased sympatho-vagal balance. ava i l a b l e a t w w w. s c i e n c e d i r e c t . c o m w w w. e l s ev i e r. c o m / l o c a t e / e a r l h u m d ev Early Human Development (2007) 83, 585-591

Cardiotocography (simultaneous recording of fetal heart rate (FHR) and uterine contractions) is one of the most used diagnostic techniques to evaluate fetal well-being and to investigate the functional state of the fetal autonomic nervous system. Recently, great interest has been paid to the variability of the FHR, and its frequency analysis, as a base for a more objective analysis of the cardiotocographic (CTG) tracings. FHR signals are unevenly sampled series. To obtain evenly sampled series, cardiotocographs often use zero-order interpolation. Such process is simple and fast but results unsuitable for frequency analyses because it introduces alterations in the FHR power spectrum. An algorithm for the recovery of the true FHR series out of the zero-order interpolated CTG data was developed and evaluated. ᭧

Amaç: Abortus çeflitli faktörlere ba¤l› olarak geliflen, önlenmesi sorun olan durumlardand›r. Bu çal›flma erken gebelikte transvaginal ultrasonografi ile yap›lacak bir de¤erlendirme ile abortus riski yüksek olabilecek olgular› saptamak amac›yla planland› Yöntem: Adet gecikmesi ve gebelik flüphesi ile baflvuran hastalar de¤erlendirildi. Medikal hastal›¤›, tekrarlayan abortus hikayesi olanlar çal›flmaya al›nmad›. ‹lk baflvuru zaman›na göre 5-6. ve 7-8. gebelik haftalar›ndaki gebeler transvaginal ultrasonografi ile incelendi. Gebelik kesesi çaplar›, yolk kesesi çap› ve morfolojisi, bafl-popo mesafesi, embriyo kalp at›m say›s› kaydedildi. Bulgular ile ileride abortus yapan olgular›n bulgular› karfl›laflt›r›ld›. Bulgular: Çal›flmaya kriterleri karfl›layan 87 olgu dahil edildi. Bu olgular›n 19'u (%21) abortus ile sonuçland›. Ortalama gebelik kesesi çaplar› gruplar aras›nda hem erken hem de 7-8. haftalarda anlaml› farkl›l›k göstermemekteydi. Ortalama yolk kesesi çap› abortus grubunda erken dönemde yüksek iken (3.1 mm ± 0.9'a karfl›l›k 4.1 mm±1.0 mm, p=0.003) , ikinci dönemde fark anlaml› de¤ildi. Yolk kesesi kalsifikasyonu abortus olanlarda daha s›k idi (1'e karfl›l›k 3 olgu, p=0.001). ‹kinci dönemde abortus grubunda ortalama embriyo kalp at›m h›z› düflük bulundu (110.9±22 at›m/dk'ya karfl›l›k 95.2±19 at›m/dk, p=0.03). Gebelik kesesi çap›ndan CRL de¤eri ç›kar›l-d›¤›nda elde edilen sonuç yaflayan olgular›n hepsinde >5 mm iken, abortus grubunda iki olguda bu de¤er > 5 mm'idi.

Objective: To ascertain the diagnostic ability of a computerized fetal heart rate (FHR) analysis system in the identification of patients at risk of fetal distress in labour. Study design: Three hundred and two healthy post-term pregnancies were enrolled in a retrospective, cross-sectional study and subdivided into two groups, with (n = 42) or without (n = 260) fetal distress in labour. The last computerized FHR recording before onset of labour was analyzed. Results: The two groups showed a significant difference only in FHR baseline and in percentage of small accelerations on total. The multivariate analysis showed that only the percentage of small accelerations was significantly related to the labour outcome. A higher diagnostic accuracy was obtained with use of neural network analysis, which allowed a sensitivity of 56%, specificity 91%, positive predictive value 53% and negative predictive value 92% with an overall accuracy of 86%. Conclusions: The increase in FHR baseline and in small FHR accelerations can be major factors in the prediction of subsequent fetal distress in healthy term fetuses. Use of neural networks seems to further improve the ability of computerized FHR analysis in the prediction of intrapartum distress. #

Objective: To study the pregnancy outcome of induction of labor with prostaglandin E2 (PGE 2 ) in women with one previous lower segment cesarean section. Methods: A retrospective cohort design was used. The study sample included 1028 consecutive women with one previous cesarean section, of whom 97 underwent induction of labor (study group) and 931 were admitted with spontaneous onset of labor (control group). Vaginal tablets of PGE 2 were used for cervical ripening in the study group. Mode of delivery, neonatal outcome, indications for cesarean section, and rate of uterine rupture were compared between the groups. Results: There were no significant differences between the study and control groups in mean (AES.D.) maternal age (30:9 AE 4:7 years versus 31:2 AE 4:8 years, P ¼ 0:6), gestational age at delivery (39:2 AE 1:8 weeks versus 39:3 AE 1:6 weeks, P ¼ 0:36), overall rate of cesarean section (36% versus 37.3%, P ¼ 0:8), rates of low 5-min Apgar score 7 (3.1% versus 3.7%, P ¼ 0:67) or cesarean section performed for nonreassuring fetal heart rate (6.1% versus 3.1%, P ¼ 0:1). There were four cases of uterine rupture, all in the control group compared to none in the study group (nonsignificant). Conclusion: The findings suggest that induction of labor in women with one previous cesarean section does not increase the risk of cesarean section rate and does not adversely affect immediate neonatal outcome. We cautiously suggest that when there is no absolute indication for repeated cesarean section, induction of labor may be considered.

To test the null hypothesis that administering misoprostol orally or vaginally will result in no difference in time to vaginal birth, and to determine whether different frequencies of tachysystole and hyperstimulation are associated with route of administration. Two hundred six women after 37 completed weeks&#39; gestation who presented with an indication for induction were randomly assigned to receive misoprostol (50 microg) either orally or vaginally every 4 hours as needed to induce labor. Placebo use and allocation concealment accomplished blinding until data analysis was completed. Sample size was calculated to allow a two-tailed alpha of .05 and power (1-beta) of 80%. All fetal heart rate and uterine activity graphs were classified according to Curtis&#39; criteria before induction groups were unmasked. Analysis involved 104 women in the oral group and 102 in the vaginal group. The mean time (+/-standard deviation) to vaginal birth with oral misoprostol was 1072 (+/-593) minut...

Fetal Heart Rate (FHR) monitoring gives important information about the fetus health state during pregnancy. This paper presents a new prototype for remote fetal monitoring. The device will allow to monitor FHR in a domiciliary context and to send fetal ECG traces to a hospital facility, where clinicians can interpret them. In this way the mother could receive prompt feedback about fetal wellbeing. The system is characterized by two units: (i) a wearable unit endowed with textile electrodes for abdominal ECG recordings and with a Field Programmable Gate Array (FPGA) board for fetal heart rate (FHR) extraction; (ii) a dock station for the transmission of the data through the telephone line. The system will allow to reduce costs in fetal monitoring, improving the assessment of fetal conditions. The device is actually in development state. In this paper, the most crucial aspects behind its fulfillment are discussed.

Objective: To evaluate the capacity of computer analysis of antepartum cardiotocographs performed by SisPorto 1 2.0 in predicting neonatal outcome. Study design: A prospective observational study was conducted in eight tertiary care centres in Europe and Australia, involving pregnant women in the absence of labor, scheduled for elective caesarean section, whose last fetal heart rate (FHR) tracing was performed within 4 h of delivery. After exclusion of fetal malformations, multiple pregnancies, tracings with less than 30 min, tracings with more than 15% signal loss, difficult fetal extractions, and anesthesia complications, a total of 345 cases were analyzed. Computer quantification of cardiotocographic parameters was compared with newborn Apgar score, umbilical artery pH, metabolic acidosis and neonatal hypoxic-ischemic encephalopathy, by means of receiver operating characteristic (ROC) curves. Results: Acceleration number, mean short-term variability, percentage of abnormal short-term variability and percentage of abnormal long-term variability had an excellent discriminative capacity to predict 1-min Apgar scores under or equal to 4 (areas under the ROC curve 0.96-1.00). The same parameters showed a slightly lower capacity to predict 5-min Apgar scores under or equal to 6 (areas under the ROC curve 0.81-0.89). The best cut-off values for these parameters, derived from the previously referred calculations, detected all cases of hypoxic-ischemic encephalopathy (n ¼ 2). Cardiotocographic parameters showed a lower discriminative capacity in prediction of umbilical artery pH <7.20 (maximum area under the ROC curve 0.66) and <7.15 (maximum area under the ROC curve 0.69). Conclusions: Computerized quantification of accelerations and variability in the antepartum allows a good prediction of 1 and 5-min Apgar scores, and to a much lesser degree umbilical artery pH.