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Anti-Ro/SSA antibodies are associated with a risk of 1-2 % to develop complete atrioventricular block (AVB) in fetuses of positive mothers. Complete AVB is irreversible, but studies suggest that anti-inflammatory treatment during the transition period from a normal fetal heart rate (FHR) to an AVB might stop this progression and restore sinus rhythm. The most efficient method for diagnostic evaluation of this arrhythmia is the pulsed-Doppler fetal echocardiography. However, weekly or bi-weekly recommended fetal echocardiographic surveillance can rarely identify an AVB in time for treatment success, also because the transition from a normal rhythm to a third degree AVB is very fast. Daily FHR monitoring in a medical facility could increase the chances of identifying the AVB onset but is difficult to realize. For this reason, an alternative method of FHR monitoring, performed directly by mothers in their home context, has been recently proposed. We present a case report utilizing this approach and review the current evidence about this condition.

Objective: To compare the frequency of cesarean section in elective induction of labour at 40 weeks and 41weeks of gestation. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Gynecology & Obstetrics, Sialkot, from July to Dec 2017. Methodology: The pregnant females at full-term were divided in 2 groups. All patients aged 20-35 years andparity less than 5 with singleton alive pregnancy and vertex presentation at 40+0 weeks gestation were placedin group A and all singleton alive pregnancies with vertex presentation at 41+0 weeks in group B. Group A wasinduced at 40+0 weeks and group B was induced at 41+0 weeks of gestation. Induction of labour was performed and fetal heart rate monitoring was conducted every 15 minutes. Augmentation was completed and frequency of cesarean section recorded in both groups. Results: In this study a total of 100 patients were included. The mean age of the patients was 27.33 ± 4.87 years(range 20-35 years) with mean age of 26.54 ± 4.66 and 28.12 ± 4.99 years in group A and group B respectively.The cesarean section was performed in 20 (20%) patients, with 14 (28%) in group A and 6 (12%) in group B.Statistically significant difference of cesarean section was noted in both groups (p-value=0.046). Conclusion: There was a significantly lower rate of cesarean section in elective induction of labour at 41weeks as compared to 40 weeks of gestation.

BackgroundThe risk of mortality for the mother and the newborn is aggravated during birth in low- and middle-income countries due to preventable causes, which can be addressed with increased quality of care practices. One such practice is intrapartum fetal heart rate (FHR) monitoring, which is crucial for the early detection of fetal ischemia, but is inadequately monitored in low- and middle-income countries. In India, there is currently a lack of sufficient data on FHR monitoring.MethodsAn assessment using facility records, interviews and observation was conducted in seven facilities providing tertiary, secondary or primary level care in aspirational districts of three states. The study sought to investigate the frequency of monitoring, devices used for monitoring and challenges in usage.ResultsFHR was not monitored as per standard protocol. Case sheets revealed 70% of labor was monitored at least once. Only 33% of observed cases were monitored every half hour during active labor, and none were monitored every 5 min during the second stage of labor. More time was observed for monitoring with a Doppler compared with a stethoscope, as providers reported fluctuation in readings. Reportedly, low audibility and a perceived need of expertise were associated with using a stethoscope. High case load and the time required for monitoring were reported as challenges in adhering to standard monitoring protocols.ConclusionThe introduction of a standardized device and a short refresher training on the World Health Organization and skilled birth attendant protocols for FHR monitoring will improve usage and compliance.

Aim Cardiotocography is used worldwide to evaluate fetal well‐being during pregnancy and labor. In past guidelines, the management plan was determined based on the assessment of the most severe waveform. There are no guidelines for evaluating the integrated recurrent decelerations; however, we believe their assessment to be essential for predicting the status of the fetus. The objective of this study was to propose an indicator for performing medical interventions during labor by creating a scoring system that reflects integrated recurrent decelerations. Methods In this retrospective cohort study, we included data for only full‐term single fetus births from vaginal deliveries. The score named the iPREFACE score (integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring) was calculated using cardiotocography findings from continuing 30 min before delivery. We examined the iPREFACE score and fetal acidemia association and calculated the cut‐off iPREFACE scores for acidemia using receiver operating characteristic curves. Results The study included 469 delivery cases. Their iPREFACE scores exhibited a significant negative correlation with the umbilical artery blood pH (correlation coefficient; −0.43). The cut‐off iPREFACE scores for the umbilical artery blood with pH

Nader Rabie,1 Ronak Shah,2 Shona Ray-Griffith,3 Jessica L Coker,3 Everett F Magann,4 Zachary N Stowe5 1Tripler Army Medical Center, Department of Obstetrics and Gynecology, Honolulu, HI, USA; 2Our Lady of Angels, Department of Obstetrics and Gynecology, Bogalusa, LA, USA; 3University of Arkansas for Medical Sciences, Department of Psychiatry, Little Rock, AR, USA; 4University of Arkansas for Medical Sciences, Department of Obstetrics and Gynecology, Little Rock, AR, USA; 5University of Wisconsin School of Medicine and Public Health, Psychiatric Institute and Clinic, Madison, WI, USACorrespondence: Everett F MagannUniversity of Arkansas for Medical Sciences, Department of Obstetrics and Gynecology, Little Rock, AR, USAEmail efmagann@uams.eduObjective: The use of electroconvulsive therapy in pregnancy has been limited by concerns about its effects on fetal well-being, despite limited evidence that suggests it is safe and effective. No studies have utilized continuous fetal heart rate monitoring during electroconvulsive therapy sessions. We aimed to describe the fetal heart rate patterns of patients undergoing electroconvulsive therapy.Design: This study is a prospective case series of pregnant patients undergoing electroconvulsive therapy with continuous fetal heart rate monitoring.Setting: University-based hospital.Population: Pregnant patients with a psychiatric indication for electroconvulsive therapy.Methods: Patients underwent fetal heart rate monitoring immediately prior, during and immediately after ECT therapy.Main Outcome Measures: Characterization of the fetal heart rate tracing.Results: Five subjects underwent 44 electroconvulsive therapy sessions. Continuous fetal monitoring was performed on 34 of the sessions. Transient fetal heart rate decelerations occurred in 4 sessions, all self-resolved and none required intervention.Conclusion: This case series is the first to report the results of continuous FHR monitoring during electroconvulsive therapy. The most common finding was a transient, self-resolving bradycardia that was not associated with adverse perinatal outcomes. This supports the opinion that electroconvulsive therapy is a safe treatment option in pregnancy in women with severe mental disease.Keywords: pregnancy, electroconvulsive therapy, fetal monitoring, mental illness and pregnancy

Objective Monitoring the heartbeat of the fetus during pregnancy is a vital part in determining their health. Current fetal heart monitoring techniques lack the accuracy in fetal heart rate monitoring and features acquisition, resulting in diagnostic medical issues. The demand for a reliable method of non-invasive fetal heart monitoring is of high importance. Method Electrocardiogram (ECG) is a method of monitoring the electrical activity produced by the heart. The extraction of the fetal ECG (FECG) from the abdominal ECG (AECG) is challenging since both ECGs of the mother and the baby share similar frequency components, adding to the fact that the signals are corrupted by white noise. This paper presents a method of FECG extraction by eliminating all other signals using AECG. The algorithm is based on attenuating the maternal ECG (MECG) by filtering and wavelet analysis to find the locations of the FECG, and thus isolating them based on their locations. Two signals of AECG collected at different locations on the abdomens are used. The ECG data used contains MECG of a power of five to ten times that of the FECG. Results The FECG signals were successfully isolated from the AECG using the proposed method through which the QRS complex of the heartbeat was conserved, and heart rate was calculated. The fetal heart rate was 135 bpm and the instantaneous heart rate was 131.58 bpm. The heart rate of the mother was at 90 bpm with an instantaneous heart rate of 81.9 bpm. Conclusion The proposed method is promising for FECG extraction since it relies on filtering and wavelet analysis of two abdominal signals for the algorithm. The method implemented is easily adjusted based on the power levels of signals, giving it great ease of adaptation to changing signals in different biosignals applications.

AIM To assess the accuracy of neonatal distress prediction using the five-level classification of fetal heart rate (FHR) and management protocol of the Japan Society of Obstetrics and Gynecology (JSOG). METHODS A case-control study was conducted. Vertex singleton pregnant women who delivered after 37 weeks' gestation from 2013 to 2015 were enrolled. The participants were categorized into two groups; controls were levels 1-3 (n = 1184), whereas cases were levels 4-5 (n = 117) group. Neonatal distress was defined as Apgar score

Use of intrapartum fetal heart rate (FHR) monitoring has had limited success in preventing hypoxic injury to neonates. One of the most common limitations of FHR interpretation is the failure to consider chronic and acute clinical factors that may increase the risk of evolving acidemia. This manuscript reviews common clinical factors that may affect the FHR and should be considered when determining the need for early intervention based on changes in the FHR.

Despite its ubiquitous use, fetal heart rate (FHR) monitoring has not resulted in a significant reduction in hypoxic-ischemic encephalopathy following delivery. This manuscript reviews the reasons for this failure including limitations of FHR to accurately predict hypoxia, low prevalence of hypoxic-ischemic encephalopathy, and lack of standardization of interpretation and intervention. We propose an alternative goal for FHR monitoring during labor to provide optimal care by early identification of truly concerning features, initiation of appropriate interventions, clear documentation of concerns and plans, and clear communication between team members on labor and delivery, including initiation of the chain of command as needed.

Background The annual global neonatal mortality stands at 2.5 million deaths, 1 million of them dying within the first day of life. An additional 2.6 million are stillborn globally, the majority of them due to intrapartum events. Optimal fetal heart rate (FHR) monitoring has the potential to timely detect fetuses at risk and, if coupled with timely obstetric responses may save more newborns. Moyo is a new Doppler with nine crystals capable of monitoring FHR both intermittently and continuously. Aim To assess women's and midwives' opinions on the use of Moyo for intrapartum FHR monitoring. Methods We conducted a cross-sectional study using a structured questionnaire to assess women's and midwives' perception. Women who gave birth at the hospital who used Moyo were interviewed using a questionnaire immediately before discharge from the hospital. Twenty-eight midwives who have been using Moyo for more than 6 months were also interviewed using a structured questionnaire. Data were analyzed using excel and result presented in figures. Results In total 113 postpartum women who were monitored using Moyo were interviewed before discharge. Out of these, 46 (40.7%) were first-time mothers and the rest were multipara. In total, 95 women (84.1%) used Moyo and other devices for FHR monitoring, 81 (72%) said Moyo was better than Fetoscopes and handheld Doppler, two-third 75 (66.4%) felt that Moyo was comfortable and 93 (82.3%) would like Moyo to be used on them in the future. Out of 28 midwives, 11 (39.3%) used Moyo continuous only, 3 (10.7%) used Moyo intermittently only and 14 (50.0%) used both intermittent and continuous. Thirteen (46.4%) midwives prefer to use Moyo both intermittent and continuous. Sixteen (55.6%) said Moyo was effective, 21 (75%) felt comfortable to use Moyo, and 13 (46.4%) said Moyo was easy to use. Conclusion The majority of midwives and women who used Moyo felt that Moyo was comfortable for intrapartum FHR monitoring. Moyo can be used both intermittently and continuously depending on the user's preferences.

Introduction Noninvasive fetal heart rate monitoring using transabdominal fetal electrocardiographic detection is now commercially available and has been demonstrated to be an effective alternative to traditional Doppler ultrasonographic techniques. Our objective in this study was to compare the results of computerized identification of fetal heart rate patterns generated by ultrasound-based and transabdominal fetal electrocardiogram-based techniques with simultaneously obtained fetal scalp electrode-derived heart rate information. Material and methods We applied an objective computer-based analysis for recognition of fetal heart rate patterns (Monica Decision Support) to data obtained simultaneously from a direct fetal scalp electrode, Doppler ultrasound, and the abdominal-fetal electrocardiogram techniques. This allowed us to compare over 145 hours of fetal heart rate patterns generated by the external devices with those derived from the scalp electrode in 30 term singleton uncomplicated pregnancies during labor. The direct fetal scalp electrode is considered to be the most accurate and reliable technique used in current clinical practice, and was, therefore, used as the standard for comparison. The program quantified the baseline heart rate, long- and short-term variability. It indicated when an acceleration or deceleration was present and whether it was large or small. Results Ultrasound was associated with significantly greater deviations from the fetal scalp electrode results than the abdominal fetal electrocardiogram technique in recognizing the correct baseline heart rate, its variability, and the presence of small and large accelerations and small decelerations. For large decelerations the two external methods were each not significantly different from the scalp electrode results. Conclusions Noninvasive fetal heart rate monitoring using maternal abdominal wall electrodes to detect fetal cardiac activity more reliably reproduced the computerized analysis of heart rate patterns derived from a direct fetal scalp electrode than did traditional ultrasound-based monitoring. Abdominal-fetal electrocardiogram should, therefore, be considered a primary option for externally monitored patients.

Background:CTG remains the only non-invasive tool available to the maternity team for continuous monitoring of fetal well-being during labour. Despite widespread use and investment in staff training, difficulty with CTG interpretation continues to be identified as a problem in cases of fetal hypoxia, which often results in permanent brain injury. Given the recent advances in AI, it is hoped that its application to CTG will offer a better, less subjective and more reliable method of CTG interpretation.Objectives:This mini-review examines the literature and discusses the impediments to the success of AI application to CTG thus far. Prior randomised control trials (RCTs) of CTG decision support systems are reviewed from technical and clinical perspectives. A selection of novel engineering approaches, not yet validated in RCTs, are also reviewed. The review presents the key challenges that need to be addressed in order to develop a robust AI tool to identify fetal distress in a timely manner so that appropriate intervention can be made.Results:The decision support systems used in three RCTs were reviewed, summarising the algorithms, the outcomes of the trials and the limitations. Preliminary work suggests that the inclusion of clinical data can improve the performance of AI-assisted CTG. Combined with newer approaches to the classification of traces, this offers promise for rewarding future development.

The primary objective of antepartum fetal surveillance is the prevention of stillbirth. Antepartum fetal surveillance, for the most part, became possible only in the second half of the 20th century, mainly due to the advent of ultrasound and external continuous electronic fetal heart rate (FHR) monitoring (EFM). Until late in the 20th century, the main methods of antepartum fetal monitoring were the measurement of fundal height and maternal kick counts. The oxytocin challenge test (OCT) was considered positive if greater than 50% of contractions were followed by late decelerations, and negative if there were no late or significant variable decelerations. A rapidly occurring acceleration following the stimulation is considered a positive response. The converse, however, is not necessarily true; the absence of a single fetal biophysical activity is not always due to hypoxia and acidosis. The biophysical activities appear progressively in normal fetuses as gestation advances.

Multi-channel measurements from the maternal abdomen acquired by means of dry electrodes can be employed to promote long-term monitoring of fetal heart rate (fHR). The signals acquired with this type of electrode have a lower signal-to-noise ratio and different artifacts compared to signals acquired with conventional wet electrodes. Therefore, starting from the benchmark algorithm with the best performance for fHR estimation proposed by Varanini et al., we propose a new method specifically designed to remove artifacts typical of dry-electrode recordings. To test the algorithm, experimental textile electrodes were employed that produce artifacts typical of dry and capacitive electrodes. The proposed solution is based on a hybrid (hardware and software) pre-processing step designed specifically to remove the disturbing component typical of signals acquired with these electrodes (triboelectricity artifacts and amplitude modulations). The following main processing steps consist of the removal of the maternal ECG by blind source separation, the enhancement of the fetal ECG and identification of the fetal QRS complexes. Main processing is designed to be robust to the high-amplitude motion artifacts that corrupt the acquisition. The obtained denoising system was compared with the benchmark algorithm both on semi-simulated and on real data. The performance, quantified by means of sensitivity, F1-score and root-mean-square error metrics, outperforms the performance obtained with the original method available in the literature. This result proves that the design of a dedicated processing system based on the signal characteristics is necessary for reliable and accurate estimation of the fHR using dry, textile electrodes.

Analysis of the fetal heart rate during pregnancy is essential for monitoring the proper development of the fetus. Current fetal heart monitoring techniques lack the accuracy in fetal heart rate monitoring and features acquisition, resulting in diagnostic medical issues. The challenge lies in the extraction of the fetal ECG from the mother ECG during pregnancy. This approach has the advantage of being a reliable and non-invasive technique. In the present paper, a wavelet/multiwavelet method is proposed to perfectly extract the fetal ECG parameters from the abdominal mother ECG. In a first step, due to the wavelet/mutiwavelet processing, a denoising procedure is applied to separate the noised parts from the denoised ones. The denoised signal is assumed to be a mixture of both the MECG and the FECG. One of the well-known measures of accuracy in information processing is the concept of entropy. In the present work, a wavelet/multiwavelet Shannon-type entropy is constructed and applied to evaluate the order/disorder of the extracted FECG signal. The experimental results apply to a recent class of Clifford wavelets constructed in Arfaoui, et al. J. Math. Imaging Vis. 2020, 62, 73–97, and Arfaoui, et al. Acta Appl. Math. 2020, 170, 1–35. Additionally, classical Haar–Faber–Schauder wavelets are applied for the purpose of comparison. Two main well-known databases have been applied, the DAISY database and the CinC Challenge 2013 database. The achieved accuracy over the test databases resulted in Se = 100%, PPV = 100% for FECG extraction and peak detection.

Fetal monitoring, ubiquitous in obstetrics is used to predict and prevent intrapartum fetal injury. Despite decades of education and nomenclature revision, clinicians show low agreement on key elements, including the types of deceleration and hence their presumed etiology. Cumulative deceleration area is not dependent on deceleration type and could potentially mitigate this problem. Although deceleration area has shown promise as a marker of acidemia, no reports have shown how deceleration area evolves in late labor. Advances in computerization allow for direct measurement of deceleration area and standard fetal heart rate (FHR) patterns. The objective of this study was to compare the evolution and discrimination performance of deceleration area and other FHR patterns in late labor in term neonates with metabolic acidemia (MA) and in those with normal cord gases.This retrospective cohort study included women with a term singleton (≥37 weeks) in cephalic presentation with cord gas data and FHR tracings available for analysis. MA included neonates with an umbilical artery base deficit12 mmol/L (Deceleration area had the highest AUC (0.702, 95% CI 0.655-0.749) and was a superior marker of MA compared to baseline (AUC 0.588, 95% CI 0.530-0.645), baseline variability (AUC 0.611, 95% CI 0.558-0.663), and number of late decelerations (AUC 0.582, 95% CI 0.527-0.637).Cumulative deceleration area reduces the necessity to determine deceleration type. In a single number, it objectively quantifies three important aspects of decelerations; frequency, depth and duration and was a superior marker of MA compared to baseline level, baseline variability and number of late decelerations. The acidemia group had higher deceleration area over the last two hours prior to delivery. This result indicates that the cumulative area and persistence of repetitive decelerations is important clinically.

Aims To describe the professional life of Edward H. Hon, MD, and the course of his academic career for the development of electronic fetal heart rate (FHR) monitoring. Methods Review of archives at the Loma Linda University related to Dr Hon's early education and medical school training, his postgraduate training at Yale University, his faculty appointments at Yale University, University of Southern California and his research accomplishment related to electronic FHR monitoring. Results Primarily, Dr Hon advanced the clinical application of the electronic FHR monitoring, particularly during labor and delivery. Dr Hon also defined significance of FHR patterns based on years of clinical studies and astute observations. Conclusion Currently, electronic FHR monitoring, during pregnancy and labor/delivery, has a universal application. Dr Hon's research contribution on FHR monitoring, and its impact for the welfare of mother and her unborn child, is well recognized.

Background: Regulation of medical applications (apps) has not been rigorous. Concern for inaccurate medical apps with potential health consequences has increased. Objective: To identify mo...

Diagnosis of fetal heart rate is very crucial during the prenatal phase of pregnancy as any delay in the early detection and prevention of anomalies in heart functioning may lead to devastating and...

Late-onset fetal growth restriction (FGR) accounts for approximately 70-80% of all cases of FGR secondary to uteroplacental insufficiency. It is associated with an increased incidence of adverse antepartum and perinatal events, which in most instances result from hypoxic insults either present at the onset of labor or supervening during labor as a result of uterine contractions. Labor represents a stressful event for the fetoplacental unit being uterine contractions associated with an up-to 60% reduction of the uteroplacental perfusion. Intrapartum fetal heart rate monitoring by means of cardiotocography (CTG) currently represents the mainstay for the identification of fetal hypoxia during labor and is recommended for the fetal surveillance during labor in the case of FGR or other conditions associated with an increased risk of intrapartum hypoxia. In this review we discuss the potential implications of an impaired placental function on the intrapartum adaptation to the hypoxic stress and the role of the CTG and alternative techniques for the intrapartum monitoring of the fetal wellbeing in the context of FGR secondary to uteroplacental insufficiency.

Aim Perinatal telemedicine efforts have commenced worldwide in response to the COVID‐19 pandemic. As there have been no prior studies on the acceptance of telemedicine by pregnant women, we conducted this survey to investigate the same. Methods We conducted an anonymous questionnaire survey of pregnant women who underwent telemedicine check‐ups from March 4 to June 30, 2020, using a mobile fetal heart rate monitor and video call system through the Hokkaido University Hospital. Results Out of the 77 individuals who received prenatal telemedicine check‐ups, 54 individuals (70%) had complications, and 64 individuals (83%) consented for the questionnaire survey. In the video call system, 18 individuals (28%) were found to be unwell and 17 individuals (27%) experienced difficulty using the mobile fetal heart rate monitoring device. Assuming scores for face‐to‐face consultations were five out of 10, the mean score for satisfaction was 4.2, but 19 (30%) women felt equal or greater satisfaction with face‐to‐face consultations. If not for the threat of COVID‐19, only four individuals (6%) proactively expressed a desire for telemedicine, with a significantly less demand observed among primiparous women than multiparous women. The permissible additional financial burden enabling telemedicine was $10 or less for 80% of subjects. Conclusion In this small preliminary study, 30% of the pregnant women felt equal or greater satisfaction with telemedicine than face‐to‐face consultations. A stronger demand for telemedicine was exhibited by multiparous women than primiparous women. Thus, a system that would be advantages by limiting subjects and enabling low‐cost examinations is required for making perinatal telemedicine more popular.

ObjectivesGlobally, half of all stillbirths occur during birth. Detection of fetal distress with fetal heart rate monitoring (FHRM), followed by appropriate and timely management, might reduce fresh stillbirths and neonatal morbidity. This study aimed to investigate the barriers and facilitators for the implementation of Moyo FHRM use in Bihar state, and secondarily, the feasibility of collecting reliable obstetrical and neonatal outcome data to assess the effect of implementation.SettingCARE Bihar and the hospital management at four district hospitals (DHs) in Bihar state, each with 6500 to 15 000 deliveries a year, agreed to testing the implementation of Moyo FHRM through a process of meetings, training sessions and collecting data. At each hospital, a clinical training expert was trained to train others, while a clinical assessment facilitator collected data.MethodologyObservational notes were taken at all training sessions and meetings. Individual interviews (n=4) were conducted with clinical training experts (CTEs) on training experiences and barriers and facilitators for Moyo FHRM implementation. The CTEs recoded field notes in diaries. Descriptive analyses performed on pre-implementation and post-implementation data (n=521) assessed quality and completeness.ResultsMain barriers to implementation of Moyo FHRM were health system and cultural challenges involving (1) existing practices, (2) insufficient human resources, (3) action delays and (4) cultural and local challenges. Another barrier was insufficient involvement of doctors. Facilitators for implementation were easy use of the Moyo FHRM device and adequate training for staff.Electronic collection of obstetrical data worked well but had substantial missing data.ConclusionHealth system and cultural challenges are a major constraint to Moyo FHRM implementation in low-resource settings. Improvements at all levels of infrastructure, practices and skills will be critical in busy DHs in Bihar. Full-scale implementation needs doctor-led leadership and ownership. Obstetrical data collection for the purpose of scientific analysis needs to be improved.

Spontaneous umbilical cord hematoma is a rare complication with a usually benign course but is potentially fatal without vigilant and timely medical intervention. We present the case of a 23-year-old primigravida mother who presented in labor. She was placed on continuous fetal heart rate monitoring, which showed two episodes of fetal heart rate tracing of the category II variety. The labor was induced with oxytocin, and the ammonitic membrane was incised artificially. The baby was male, term at 38 weeks, with an appropriate weight, length, and head circumference. There was no gross anomaly or dysmorphic features; the APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score of the baby was 9 and 9 at the first and fifth minutes, respectively. A 4.5 cm hematoma was discovered on the umbilical cord immediately following delivery. He was admitted to the regular nursery for routine newborn care and was discharged home in stable condition. Spontaneous umbilical cord hematoma is usually due to the rupture of the umbilical vein. Mostly, the umbilical cord hematoma occurs spontaneously and often follows a benign course, however, in some cases, the perinatal loss secondary to umbilical cord hematoma could very high, especially if associated with abnormal fetal heart rate tracing. Because of the potential for fatality inherent in this condition and to understand the clinical manifestations, risk factors, and eventual course of spontaneous cord hematoma, we present this case to help fellow pediatricians reduce morbidity and mortality associated with it.

Fetus health intense care is an important aspect concerned in gynic period. Fetal heart rate (FHR) supervising is vital and has an established way of evaluating fetal wellbeing of the pregnant women throughout the gynecological period. Auscultation and electronic fetus monitoring are the two technologies available right now in the market. Auscultation uses Doppler transducer whereas electronic recording can be done by using special recording equipment (Beng in IEEE Transactions on Biomedical Engineering 56:2075–2082, 2009 [1]). Use of electrode was known to output the fetus heart recordings through optical means by photoplethysmography non-invasive technology. Doppler technique is not meant for long-term use whereas optical means are in one suggestible in terms of improvement of the results; for longer use and in this article, a 24h recording mechanism is presented with details explanation of equipment used and procedures following with 400 short recording sessions with on an average success rate of 65% for the recording period from around 20 weeks incubation. The demonstration proves that the methodology adopted is more patient-friendly and improved quality in results.

Background: In Uganda, perinatal mortality is 38 per 1000 pregnancies. One-third of these deaths are due to birth asphyxia. Adequate fetal heart rate (FHR) monitoring during labor may detect birth asphyxia but little is known about monitoring practices in low resource settings. Objective: To explore FHR monitoring practices among health workers at a public hospital in Northern Uganda. Methods: A sequential explanatory mixed methods study was conducted by reviewing 251 maternal records and conducting 11 interviews and two focus group discussions with health workers complemented by observations of 42 women in labor until delivery. Quantitative data were summarized using frequencies and percentages. Content analysis was used for qualitative data. Results: FHR was assessed in 235/251 (93.6%) of records at admission. Health workers documented the FHR at least once in 175/228 (76.8%) of cases during the first stage of labor compared to observed 17/25 (68.0%) cases. Median intervals between FHR monitoring were 30 (IQR 30–120) minutes in patients’ records versus 139 (IQR 87–662) minutes according to observations. Observations suggested no monitoring of FHR during the second stage of labor but records indicated monitoring in 3.2% of cases. Reported barriers to adequate FHR monitoring were inadequate number of staff and monitoring devices, institutional challenges such as few beds, documentation problems and perceived non-compliant women not reporting for repeated checks during the first stage of labor. Health workers demonstrated knowledge of national FHR monitoring guidelines and acknowledged that practice was different. Conclusions: When compared to national and international guidelines, FHR monitoring is sub-optimal in the studied setting. Approximately one in four women was not monitored during the first stage of labor. Barriers to appropriate FHR monitoring included shortage of staff and devices, institutional challenges and mother’s negative attitudes. These barriers need to be addressed in order to reduce neonatal mortality.

Background: Studies about the feasibility of monitoring fetal electroencephalogram (fEEG) during labor began in the early 1940s. By the 1970s, clear diagnostic and prognostic benefits from intrapartum fEEG monitoring were reported, but until today, this monitoring technology has remained a curiosity. Objectives: Our goal was to review the studies reporting the use of fEEG including the insights from interpreting fEEG patterns in response to uterine contractions during labor. We also used the most relevant information gathered from clinical studies to provide recommendations for enrollment in the unique environment of a labor and delivery unit. Data sources: PubMed. Eligibility criteria: The search strategy was: ("fetus"[MeSH Terms] OR "fetus"[All Fields] OR "fetal"[All Fields]) AND ("electroencephalography"[MeSH Terms] OR "electroencephalography"[All Fields] OR "eeg"[All Fields]) AND (Clinical Trial[ptyp] AND "humans"[MeSH Terms]). Because the landscape of fEEG research has been international, we included studies in English, French, German, and Russian. Results: From 256 screened studies, 40 studies were ultimately included in the qualitative analysis. We summarize and report features of fEEG which clearly show its potential to act as a direct biomarker of fetal brain health during delivery, ancillary to fetal heart rate monitoring. However, clinical prospective studies are needed to further establish the utility of fEEG monitoring intrapartum. We identified clinical study designs likely to succeed in bringing this intrapartum monitoring modality to the bedside. Limitations: Despite 80 years of studies in clinical cohorts and animal models, the field of research on intrapartum fEEG is still nascent and shows great promise to augment the currently practiced electronic fetal monitoring., Comment: Prospero number: CRD42020147474. 55 pages, 8 figures

Fetal heart tracings (FHTs) are useful as a window into the oxygenation status of the fetal brain. Patterns in the FHT reflect the oxygen status of the fetal brain. Fetal adaptive response to progressive hypoxemia and acidosis are detectable and produce recognizable patterns in the fetal heart rate. The basic physiology and adaptive responses that regulate the fetal heart rate and physiological fetal adaptations to stress as reflected in the FHTs are described. Mechanisms of oxygen delivery to the fetus including ways in which those mechanisms can be disrupted are reviewed.

The first hour after admission and the last hour before delivery are critical times for identifying and preventing hypoxic-ischemic encephalopathy. These are times of transition that require coordinated steps to identify fetuses at risk, institute effective plans for fetal heart rate monitoring, and to establish situational awareness. Interpretation and intervention based on fetal heart rate monitoring is an important part of the care provided during these crucial times. We present checklists for the first and last hour of labor for use on labor and delivery to help standardize and optimize the approach to care during these times.

The fetal heart rate can be used to assess the current metabolic state of the fetus and predict the risk of the evolution of metabolic acidemia through the course of labor. In this chapter, we will present the pathophysiology of the development of fetal acidemia and provide an organized approach to identifying the risk of worsening acidemia using changes noted in the fetal heart rate pattern to allow for interventions that might alter this course.

The presented collection of data comprises of a set of 12 linear and nonlinear indices computed at different time scales and extracted from Fetal Heart Rate (FHR) traces acquired through Hewlett Packard CTG fetal monitors (series 1351A), connected to a PC. The sampling frequency of the recorded FHR signal is equal 2 Hz. The recorded populations consist of two groups of fetuses: 60 healthy and 60 Intra Uterine Growth Restricted (IUGR) fetuses. IUGR condition is a fetal condition defined as the abnormal rate of fetal growth. In clinical practice, diagnosis is confirmed at birth and may only be suspected during pregnancy. The pathology is a documented cause of fetal and neonatal morbidity and mortality. The described database was employed in a set of machine learning approaches for the early detection of the IUGR condition: “Integrating machine learning techniques and physiology based heart rate features for antepartum fetal monitoring” [1]. The added value of the proposed indices is their interpretability and close connection to physiological and pathological aspect of FHR regulation. Additional information on data acquisition, feature extraction and potential relevance in clinical practice are discussed in [1]. Keywords: Fetal heart rate monitoring, Cardiotocography, Intra uterine growth restricted, Physiology-based features, Multivariate analysis, Predictive analytics

Background The objective of our study was to evaluate the association between perinatal asphyxia and hypoxic-ischemic encephalopathy (HIE) with the presence of ante and intrapartum risk factors and/or abnormal fetal heart rate (FHR) findings, in order to improve maternal and neonatal management. Methods We did a prospective observational cohort study from a network of four hospitals (one Hub center with neonatal intensive care unit and three level I Spoke centers) between 2014 and 2016. Neonates of gestational age ≥ 35 weeks, birthweight ≥1800 g, without lethal malformations were included if diagnosed with perinatal asphyxia, defined as pH ≤7.0 or Base Excess (BE) ≤ − 12 mMol/L in Umbical Artery (UA) or within 1 h, 10 min Apgar 10 min. FHR monitoring was classified in three categories according to the American College of Obstetricians and Gynecologists (ACOG). Pregnancies were divided into four classes: 1) low risk; 2) antepartum risk; 3) intrapartum risk; 4) and both ante and intrapartum risk. In the first six hours of life asphyxiated neonates were evaluated using the Thomson score (TS): if TS ≥ 5 neonates were transferred to Hub for further assessment; if TS ≥ 7 hypothermia was indicated. Results Perinatal asphyxia occurred in 21.5‰ cases (321/14,896) and HIE in 1.1‰ (16/14,896). The total study population was composed of 281 asphyxiated neonates: 68/5152 (1.3%) born at Hub and 213/9744 (2.2%) at Spokes (p Pregnancies resulting in asphyxiated neonates were classified as class 1) 1.1%, 2) 52.3%, 3) 3.2%, and 4) 43.4%. Sentinel events occurred in 23.5% of the cases and FHR was category II or III in 50.5% of the cases. 40.2% cases of asphyxia and 18.8% cases of HIE were not preceded by sentinel events or abnormal FHR. Conclusions We identified at least one risk factor associated with all cases of HIE and with most cases of perinatal asphyxia. In absence of risk factors, the probability of developing perinatal asphyxia resulted extremely low. FHR monitoring alone is not a reliable tool for detecting the probability of eventual asphyxia.

Background and objectives Intrauterine Growth Restriction (IUGR) is a fetal condition defined as the abnormal rate of fetal growth. The pathology is a documented cause of fetal and neonatal morbidity and mortality. In clinical practice, diagnosis is confirmed at birth and may only be suspected during pregnancy. Therefore, designing an accurate model for the early and prompt identification of pathology in the antepartum period is crucial in view of pregnancy management. Methods We tested the performance of 15 machine learning techniques in discriminating healthy versus IUGR fetuses. The various models were trained with a set of 12 physiology based heart rate features extracted from a single antepartum CardioTocographic (CTG) recording. The reason for the utilization of time, frequency, and nonlinear indices is based on their standalone documented ability to describe several physiological and pathological fetal conditions. Results We validated our approach on a database of 60 healthy and 60 IUGR fetuses. The machine learning methodology achieving the best performance was Random Forests. Specifically, we obtained a mean classification accuracy of 0.911 [0.860, 0.961 (0.95 confidence interval)] averaged over 10 test sets (10 Fold Cross Validation). Similar results were provided by Classification Trees, Logistic Regression, and Support Vector Machines. A features ranking procedure highlighted that nonlinear indices showed the highest capability to discriminate between the considered fetal conditions. Nevertheless, is the combination of features investigating CTG signal in different domains, that contributes to an increase in classification accuracy. Conclusions We provided validation of an accurate artificially intelligence framework for the diagnosis of IUGR condition in the antepartum period. The employed physiology based heart rate features constitute an interpretable link between the machine learning results and the quantitative estimators of fetal wellbeing.

This study focuses on fetal electrocardiogram (fECG) processing using hybrid methods that combine two or more individual methods. Combinations of independent component analysis (ICA), wavelet transform (WT), recursive least squares (RLS), and empirical mode decomposition (EMD) were used to create the individual hybrid methods. Following four hybrid methods were compared and evaluated in this study: ICA-EMD, ICA-EMD-WT, EMD-WT, and ICA-RLS-EMD. The methods were tested on two databases, the ADFECGDB database and the PhysioNet Challenge 2013 database. Extraction evaluation is based on fetal heart rate (fHR) determination. Statistical evaluation is based on determination of correct detection (ACC), sensitivity (Se), positive predictive value (PPV), and harmonic mean between Se and PPV (F1). In this study, the best results were achieved by means of the ICA-RLS-EMD hybrid method, which achieved accuracy (ACC) > 80% at 9 out of 12 recordings when tested on the ADFECGDB database, reaching an average value of ACC > 84%, Se > 87%, PPV > 92%, and F1 > 90%. When tested on the Physionet Challenge 2013 database, ACC > 80% was achieved at 12 out of 25 recordings with an average value of ACC > 64%, Se > 69%, PPV > 79%, and F1 > 72%.

AIM Although several studies reported the measurement of fetal oxygen saturation using fetal pulse oximetry (FPO) for evaluation of the fetal intrapartum condition, a systematic review of the seven randomized controlled trials (RCTs) provided no evidence to support FPO for intrapartum fetal monitoring. In the present review, we re-evaluate an overview for the use of FPO and seven RCTs of FPO. METHODS We reviewed numerous previous reports on FPO and seven RCTs of intrapartum FPO. RCTs were conducted with the main outcome measure being a reduction in the cesarean section rate. RESULTS The largest trial with 5341 entries failed to show any reduction. The negative result from this RCT may be explained by the use of a different cutoff value for fetal oxygen saturation compared to the other RCT; in addition, there were differences in the indications for cesarean section due to dystocia and in the definition of non-reassuring fetal status (NRFS). An abnormal FPO value, defined as the fetal oxygen saturation value