Improvements in fetal heart rate analysis by the removal of maternal-fetal heart rate ambiguities

BMC Pregnancy and Childbirth

João Bernardes³  Diogo Ayres-De-Campos²  Hernâni Gonçalves¹  Cristina Costa-Santos¹  Paula Pinto⁴ 

[1] Center for Health Technology and Services Research (CINTESIS), Porto, Portugal;INEB – Institute of Biomedical Engineering; I3S – Institute for Research and Innovation in Health, University of Porto, Porto, Portugal;Unidade Local de Saúde de Matosinhos, Hospital Pedro Hispano, Matosinhos, Portugal;Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal

关键词: FIGO guidelines;    Computer analysis;    Misinterpretation;    Cardiotocography;    Maternal heart rate;    Fetal;    Heart rate;   

Others  :  1233981
DOI  :  10.1186/s12884-015-0739-1

 received in 2014-11-20, accepted in 2015-11-10,  发布年份 2015

【 摘 要 】

Background

Misinterpretation of the maternal heart rate (MHR) as fetal may lead to significant errors in fetal heart rate (FHR) interpretation. In this study we hypothesized that the removal of these MHR-FHR ambiguities would improve FHR analysis during the final hour of labor.

Methods

Sixty-one MHR and FHR recordings were simultaneously acquired in the final hour of labor. Removal of MHR-FHR ambiguities was performed by subtracting MHR signals from their FHR counterparts when the absolute difference between the two was less or equal to 5 beats per minute. Major MHR-FHR ambiguities were defined when they exceeded 1 % of the tracing. Maternal, fetal and neonatal characteristics were evaluated in cases where major MHR-FHR ambiguities occurred and computer analysis of FHR recordings was compared, before and after removal of the ambiguities.

Results

Seventy-two percent of tracings (44/61) exhibited episodes of major MHR-FHR ambiguities, which were not significantly associated with any maternal, fetal or neonatal characteristics, but were associated with MHR accelerations, FHR signal loss and decelerations. Removal of MHR-FHR ambiguities resulted in a significant decrease in FHR decelerations, and improvement in FHR tracing classification.

Conclusions

FHR interpretation during the final hour of labor can be significantly improved by the removal of MHR-FHR ambiguities.

【 授权许可】

   
2015 Pinto et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Reinhard J, Hayes-Gill BR, Schiermeier S, Hatzmann H, Heinrich TM, Louwen F. Intrapartum heart rate ambiguity: a comparison of cardiotocogram and abdominal fetal electrocardiogram with maternal electrocardiogram. Gynecol Obstet Invest. 2013; 75:101-228 108.
• [2]Odendaal HJ. False interpretation of fetal heart role monitoring in cases of intra uterine death. S Afr Med J. 1976; 50:1963-1965.
• [3]Barrett JM, Boehm FH. Documentation of recent fetal demise with simultaneous maternal and fetal heart rate monitoring. Obstet Gynecol. 1980; 55 Suppl 3:28S-30S.
• [4]Achiron R, Zakut H. Misinterpretation of fetal heart rate monitoring in case of intrauterine death. Clin Exp Obstet Gynecol. 1984; 11:126-129.
• [5]Herman A, Ron-El R, Arieli S, Schreyer P, Caspi E. Maternal ECG recorded by internal monitoring closely mimicking fetal heart rate in a recent fetal death. Int J Gynaecol Obstet. 1990; 33:269-271.
• [6]Ramsey PS, Johnston BW, Welter VE, Ogburn PL. Artifactual fetal electrocardiographic detection using internal monitoring following intrapartum fetal demise during VBAC trial. J Matern Fetal Med. 2000; 9:360-361.
• [7]Neilson DR, Freeman RK, Mangan S. Signal ambiguity resulting in unexpected outcome with external fetal heart rate monitoring. Am J Obstet Gynecol. 2008; 198:717-724.
• [8]Muñoz Brands RM, Bakker PC, Bolte AC, van Geijn HP. Misidentification of maternal for fetal heart rate patterns after delivery of the first twin. J Perinat Med. 2009; 37:177-179.
• [9]Gonçalves H, Rocha AP, Ayres-de-Campos D, Bernardes J. Internal versus external intrapartum foetal heart rate monitoring: the effect on linear and nonlinear parameters. Physiol Meas. 2006; 27:307-319.
• [10]Nunes I, Ayres-de-Campos D, Costa-Santos C, Bernardes J. Differences between external and internal fetal heart rate monitoring during the second stage of labor: a prospective observational study. J Perinat Med. 2014; 42:493-498.
• [11]The use of electronic fetal monitoring. The use of cardiotocography in intrapartum fetal surveillance. Evidence-based clinical guideline number 8. Clinical Effectiveness Support Unit . RCOG Press, London; 2001.
• [12]Nurani R, Chandraharan E, Lowe V, Ugwumadu A, Arulkumaran S. Misidentification of maternal heart rate as fetal on cardiotocography during the second stage of labor: the role of the fetal electrocardiograph. Acta Obstet Gynecol Scand. 2012; 91:1428-1432.
• [13]Pinto P, Bernardes J, Costa-Santos C, Amorim-Costa C, Silva M, Ayres-de-Campos D. Development and evaluation of an algorithm for computer analysis of maternal heart rate during labor. Comput Biol Med. 2014; 49:30-35.
• [14]Ayres-de-Campos D, Sousa P, Costa A, Bernardes J. Omniview-SisPorto 3.5 - a central fetal monitoring station with online alerts based on computerized cardiotocogram + ST event analysis. J Perinat Med. 2008; 36:260-264.
• [15]Ayres-de-Campos D, Bernardes J. Twenty-five years after the FIGO guidelines for the use of fetal monitoring: time for a simplified approach? Int J Gynaecol Obstet. 2010; 110:1-6.
• [16]Ayres-de-Campos D, Bernardes J, Garrido A, Marques-de-Sá J, Pereira-Leite L. SisPorto 2.0 – a program for automated analysis of cardiotocograms. J Matern Fetal Med. 2000; 9:311-318.
• [17]Ayres-de-Campos D, Costa-Santos C, Bernardes J. Prediction of neonatal state by computer analysis of fetal heart rate tracings: the antepartum arm of the SisPorto multicentre validation study. Eur J Obstet Gynecol Reprod Biol. 2005; 118:52-60.
• [18]Costa MA, Ayres-de-Campos D, Machado AP, Santos CC, Bernardes J. Comparison of a computer system evaluation of intrapartum cardiotocographic events and a consensus of clinicians. J Perinat Med. 2010; 38:191-195.
• [19]Costa A, Ayres-de-Campos D, Costa F, Santos C, Bernardes J. Prediction of neonatal acidemia by computer analysis of fetal heart rate and ST event signals. Am J Obstet Gynecol. 2009; 201:464.
• [20]Bernardes J, Ayres-de-Campos D. Maternal heart rate analysis during labour. Has the time come for computerized analysis? Acta Obstet Gynecol Scand. 2012; 91:1474.
• [21]Sherman DJ, Frenkel E, Kurzweil Y, Padua A, Arieli S, Bahar M. Characteristics of maternal heart rate patterns during labor and delivery. Obstet Gynecol. 2002; 99:542-547.
• [22]Dudenhausen JW, Luhr C, Dimer JS. Umbilical artery blood gases in healthy term newborn infants. Int J Gynaecol Obstet. 1997; 57:251-258.
• [23]Kro GA, Yli BM, Rasmussen S, Norèn H, Amer-Wåhlin I, Rosén KG, Stray-Pedersen B, Saugstad OD. Association between umbilical cord artery pCO2 and the Apgar score; elevated levels of pCO2 may be beneficial for neonatal vitality after moderate acidemia. Acta Obstet Gynecol Scand. 2013; 92:662-670.