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Evolving Frameworks for the Foundation and Practice of Electronic fetal monitoring

Maternal-fetal Medicine 2022年第2期4卷 141-151页

作者： Mark I.Evans David W.Britt Shara M.Evans Lawrence D.Devoe fetal Medicine Foundation of America New YorkNY 10065USA Comprehensive Genetics PLLCNew YorkNY 10065USA Department of Obstetrics&Gynecology Icahn School of Medicine at Mt.SinaiNew YorkNY10029USA Department of Maternal Child Health Gillings School of Public Health University of North Carolina at Chapel HillChapel HillNY 27599USA Department of Obstetrics and Gynecology Medical College of GeorgiaAugusta UniversityAugustaGA 30907USA.

Since the 1970s,electronic fetal monitoring(EFM)also known as cardiotocography(CTG)has been used extensively in labor around the world,despite its known failure to help prevent many babies from developing neonatal encephalopathy and cerebral *** of EFM’s poor performance with respect to these outcomes arises from a fundamental misunderstanding of the differences between screening and diagnostic tests,subjective classifications of fetal heart rate(FHR)patterns that lead to large inter-observer variability in its interpretation,failure to appreciate early stages of fetal compromise,and poor statistical modeling for its use as a screening *** have developed a new approach to the practice and interpretation of EFM called the fetal reserve index(FRI)which does the following:(1)breaking FHR components down into 4 components,(heart rate,variability,accelerations,and decelerations);(2)contextualizing the metrics by adding increased uterine activity;(3)adding specific maternal,fetal,and obstetric risk *** result is an eight-point scoring metric that,when directly compared with current American College of Obstetricians and Gynecologists EFM categories,even in version 1.0 with equal weighting of variables,shows that the FRI has performed much better for identifying cases at risk before damage had occurred,reducing the need for emergency deliveries,and lowering overall Cesarean delivery *** increased data,we expect further refinements in the specifics of scoring that will allow even earlier detection of compromise in labor.

关键词： fetal monitoring Cardiotocography fetal reserve index

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维普期刊数据库

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The Efficacy of In-Phase and Quadrature Demodulation in Electronic fetal Heart Rate monitoring During Labor

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Maternal-fetal Medicine 2022年第2期4卷 113-120页

作者： Yiheng Liang Ping Liu Shaomei Yan Yun Li Duijin Chen Shangrong Fan Department of Obstetrics and Gynecology Peking University Shenzhen HospitalShenzhenGuangdong 518036China Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases ShenzhenGuangdong 518036China Department of Obstetrics and Gynecology The Third Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdong 510150China.

Objective:To investigate the efficacy of in-phase and quadrature(IQ)demodulation in electronic fetal heart rate monitoring(EFM)to reduce false reports of fetal heart rate(FHR)doubling or ***:This is a prospective cohort study.A total of 263 full-term pregnant women who delivered at Peking University Shenzhen Hospital between August 2019 and July 2020 were prospectively enrolled in the *** monitoring began when the cervix was dilated to 2-3 cm and continued until *** fetal Doppler audio signals and internal and external cardiotocography curves from internal electrode monitoring,EFM with conventional demodulation(external),and EFM with IQ demodulation(external)were acquired to compare FHR doubling and halving *** cohort 1,FHR was compared between IQ demodulation and conventional *** cohort 2,FHR was compared between IQ demodulation,conventional demodulation,and internal FHR *** data were statistically analyzed using the Chi-squared test,and measurement data were statistically analyzed usingt-test for correlation coefficients,and Bland-Altman analysis for concordance ***:To compare IQ demodulation and conventional demodulation,225 pregnant women were monitored for a total of 835,870 *** beat-to-beat interval of FHRs in raw fetal Doppler audio signals was used as the *** results showed a doubling time of 3401 seconds(0.407%,3401/835,870)and a halving time of 2918 seconds(0.349%,2918/835,870)with conventional demodulation,compared to 241 seconds(0.029%,241/835,870)and 589 seconds(0.070%,589/835,870),respectively,with IQ *** demodulation reduced FHR doubling by approximately 93%(3160/3401)and FHR halving by approximately 80%(2329/2918)compared to conventional demodulation(Pmonitoring.

关键词： fetal monitoring Heart rate,fetal Doubling Halving IQ demodulation

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维普期刊数据库

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Safety of Internal Electronic fetal Heart Rate monitoring During Labor

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Maternal-fetal Medicine 2022年第2期4卷 121-126页

作者： Yihang Liang Yun Li Ghunhua Huang Xiaohong Li Oiaoqing Gai Jiying Peng Shangrong Fan Department of Obstetrics and Gynecology Peking University Shenzhen HospitalShenzhen 518036China Department of Pathology Peking University Shenzhen HospitalShenzhen 518036China $Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases Shenzhen 518036China.

Objective:To investigate the safety and efficacy of internal electronic fetal heart rate(FHR)monitoring during ***:This was a retrospective case-control study,which was an analysis of monitoring FHR with a fetal scalp electrode or a Doppler probe(94 pregnant women per group).In the internal monitoring group,when the opening of the uterine orifice was≥3 cm,the fetal scalp electrode was placed after natural or artificial rupture of the *** was simultaneously monitored using a Doppler *** the external monitoring group,continuous FHR monitoring was performed using an ultrasound Doppler transducer fixed on the maternal *** toco transducer was used to record uterine *** examination of the placenta was performed prospectively in 49 and 48 cases in the internal electronic FHR monitoring group and control group,***-infant outcomes(***,puerperal infection,puerperal morbidity,delivery mode,Apgar score,and scalp injury)were *** artery blood was extracted for blood gas *** between the two groups were compared using the pairedt-test,χ^(2) test,Yates correctedχ^(2) test or Fisher exact ***:Non-statistically significant differences between the internal and external monitoring groups were observed in the incidence of neonatal acidosis(1/94(1.06%)vs.3/94(3.19%),respectively;χ^(2)=0.255,P=0.613),cesarean section/operative vaginal delivery(8/94(8.51%)vs.15/94(15.96%),respectively;χ^(2)=2.427,P=0.181),fever during labor(18/94(19.15%)vs.15/94(15.96%),respectively;χ^(2)=0.331,P=0.565),puerperal morbidity(2/94(2.13%)vs.3/94(3.19%),respectively;χ^(2)=0.000,P=1.000),chorioamnionitis(9/49(18.37%)vs.7/48(14.58%),respectively;χ^(2)=0.252,P=0.616),and neonatal asphyxia(0/94(0.00%)vs.1/94(1.06%),respectively;χ^(2)=0.000,P=1.000).There were no puerperal infections,neonatal scalp injuries,or scalp abscesses found in either *** the internal monitoring value as reference,the

关键词： fetal monitoring Neonatal academia Cesarean section Chorioamnionitis Puerperal morbidity Puerperal infection

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Applicability of initial optimal maternal and fetal electrocardiogram combination vectors to subsequent recordings

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Chinese Physics B 2014年第11期23卷 639-645页

作者：闫华文黄晓林肇莹司峻峰刘铁兵刘红星 School of Electronic Science and Engineering Nanjing University Xianlin Campus Nanjing General Hospital of Nanjing Military Command

A series of experiments are conducted to confirm whether the vectors calculated for an early section of a continuous non-invasive fetal electrocardiogram （fECG） recording can be directly applied to subsequent sections in order to reduce the computation required for real-time monitoring. Our results suggest that it is generally feasible to apply the initial optimal maternal and fetal ECG combination vectors to extract the fECG and maternal ECG in subsequent recorded sections.

关键词： fetal monitoring real-time multi-channel recording independent component analysis (ICA) peri-odic component analysis

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Interobserver Agreement and Reliability of Intrapartum Nonreassuring Cardiotocography and Prediction of Neonatal Acidemia

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Maternal-fetal Medicine 2022年第2期4卷 95-102页

作者： Zhuyu Li Yan Wang Jian Cai Peizhen Zhao Hanqing Chen Haiyan Liu Lixia Shen Lian Chen Shufang Li Yangyu Zhao Zilian Wang Department of Obstetrics and Gynaecology The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510080 China Department of Obstetrics and Gynaecology Peking University Third HospitalBeijing 100191China Dermatology Hospital Southern Medical UniversityGuangzhou 510091China

Objective:To evaluate the agreement and reliability of intrapartum nonreasurring cardiotocography(CTG)interpretation and prediction of neonatal acidemia by obstetricians working in different ***:A retrospective cohort study involving two tertiary hospitals(The First Affiliated Hospital of Sun Yat-sen University and Perking University Third Hospital)was conducted between 30th September 2018 and 1st April *** obstetricians from two hospitals with three levels of experience(junior,medium,and senior)reviewed 100 nonreassuring fetal heart rate(FHR)tracings from 1 hour before the onset of abnormalities until *** reviewer determined the FHR pattern,the baseline,variability,and presence of acceleration,deceleration,sinusoidal pattern,and predicted whether neonatal acidemia and abnormal umbilical arterial pH0.5),with the exception of early deceleration(Pa=0.39,95%confidence interval(CI):0.36,0.43).Reliability was also good among most variables(AC1>0.40),except for acceleration,early deceleration,and prediction of neonatal acidemia(AC1=0.17,0.10,and 0.25,respectively).There were no statistically significant differences among the three groups,except in the identification of accelerations(Pa=0.89,95%CI:0.83,0.95;Pa=0.50,95%CI:0.41,0.60,and Pa=0.35,95%CI:0.25,0.43 in junior,medium and senior groups,respectively)and the prediction of neonatal acidemia(Pa=0.52,0.52,and 0.62 in junior,medium and senior groups,respectively),where agreement was highest and lowest in the junior-level group,*** accuracy and sensitivity of the prediction for umbilical artery pH<7.1 were similar among the three groups,but the s

关键词： Cardiotocography fetal monitoring fetal distress

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Computerized Analysis of Antepartum Cardiotocography: A Review

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Maternal-fetal Medicine 2022年第2期4卷 130-140页

作者： Gabriel Davis Jones William R.Cooke Manu Vatish Christopher W.G.Redman Nuffield Department of Women's and Reproductive Health University of OxfordOxford OX39DUUnited Kingdom

Cardiotocography measures the human fetal heart rate and uterine activity using *** it has been a mainstay in antepartum care since the 1960s,cardiotocograms consist of complex signals that have proven difficult for clinicians to interpret accurately and as such clinical inference is often difficult and *** attempts at codifying approaches to analyzing the features within these signals have failed to demonstrate reliability or gain sufficient *** the early 1990s,the Dawes-Redman system of automated computer analysis of cardiotocography signals has enabled robust analysis of cardiotocographic signal features,employing empirically-derived criteria for assessing fetal wellbeing in the *** the past 30 years,the Dawes-Redman system has been iteratively updated,now incorporating analyses from over 100,000 *** this review,we examine the history of cardiotocography,signal processing methodologies and feature identification,the development of the Dawes-Redman system,and its clinical applications.

关键词： Antepartum Cardiotocography Computerized Electronic fetal monitoring fetal monitoring

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