Search

BACKGROUND: The iPREFACE score may aid in predicting fetal acidemia and neonatal asphyxia in emergency cesarean sections and vaginal deliveries, which may improve labor management precision in the future. OBJECTIVE: This study aimed to assess the use of the iPREFACE score as an objective indicator of the need for rapid delivery in cases of repeated abnormal waveforms without concurrent indications for immediate medical intervention during labor. STUDY DESIGN: This retrospective cohort study was conducted among term (37+ 0 days to 41+6 days) singleton pregnant women who underwent emergency cesarean section owing to a nonreassuring fetal status. The iPREFACE-DCS score, calculated from a 30-minute cardiotocography waveform before the decision to perform emergency cesarean section, and the iPREFACE-RCT score, calculated from a 30-minute cardiotocography waveform before cardiotocography transducer removal, were employed. The primary outcome was the assessment of the predictive ability of these scores for fetal acidemia, whereas the secondary outcomes were differences in umbilical artery blood gas findings and postnatal outcomes between the 2 groups, divided by the cutoff values of the iPREFACE-RCT score. RESULTS: The iPREFACE-DCS and iPREFACE-RCT scores demonstrated the capability to predict an umbilical artery blood pH of

Cerebral cavernous malformation is a rare but important cause of cerebral hemorrhage in pregnancy and puerperium. In pregnancy, cavernomas can more easily bleed as a result of increased female hormones and growth factors such as vascular endothelial growth factor. We present the case of a pregnant woman who had been diagnosed with a cerebral cavernoma about ten years previously, after repeated headache episodes; at the 28th week of pregnancy the woman was hospitalized for epileptic seizures and active bleeding from the anterior cerebral artery. We describe the management of the case, the decision for a preterm delivery and for a resolutive neurosurgical procedure. [ABSTRACT FROM AUTHOR]

The article focuses on the classification of fetal heart rate patterns and questions the need for a change in the current terminology and definitions associated with electronic fetal monitoring (EFM), which is widely used in obstetrical procedures in the U.S. Topics include the ubiquity of EFM in assessing fetal tolerance during labor, its limitations, including variability and increased operative deliveries.

Background: Given the demanding nature of labour, alterations in the cardiotocography (CTG) trace may be an indication of how the foetus is responding to continuous hypoxic or mechanical stressors, such as compression of the umbilical cord or a decrease in placental blood flow. Any foetus deemed to be at a "high risk" of experiencing intrapartum hypoxic damage requires constant foetal monitoring. Objective: The aim of our study was to evaluate CTG in high-risk pregnancy and its correlation with maternal and fetal outcomes. Methodology: Two hundred antenatal patients with ≥ 37 weeks period of gestation with high-risk pregnancies were included in the study. As per the RCOG guidelines, the CTG analysis of recruited patients was performed. Maternal and fetal outcomes were then correlated with the CTG. Results: The mean age of the patients was 27.84 ± 4.58 years. Patients with non-reactive CTG found to have significantly high risk of premature rupture of membranes. Prolonged labour was also encountered significantly high in patients with non-reactive CTG. No significant difference in the mode of delivery was observed between patients with reactive or non-reactive CTG. APGAR score was significantly low in patients with non-reactive CTG. NICU admissions was also significantly high in patients non-reactive CTG. Conclusion: A non-reactive CTG indicate a lack of fetal well-being, which may be due to various causes such as fetal distress, umbilical cord compression, or low fetal oxygenation. In present study, we found that patients with non-reactive CTG tends to have poor maternal and foetal outcomes compared to the patients with reactive CTG which indicate potential role of CTG in predicting outcomes in high-risk pregnancy. [ABSTRACT FROM AUTHOR]

Background: In the Netherlands, antenatal cardiotocography (aCTG), used to assess fetal well‐being, is performed in obstetrician‐led care. To improve continuity of care, an innovation project was designed wherein primary care midwives perform aCTGs for specific indications. The aim of this study was to examine the satisfaction and experiences of pregnant women who received an aCTG in primary midwife‐led care and explore which factors were associated with high satisfaction. Methods: Data were collected through a self‐administered questionnaire based on the Consumer Quality Index. The primary outcome was general satisfaction on a 10‐point scale, with a score above nine indicating participants were "highly satisfied". Results: In total, 1227 women were included in the analysis. The study showed a mean general satisfaction score of 9.2. Most women were highly satisfied with receiving an aCTG in primary midwife‐led care (77.4%). On the Consumer Quality Index, the mean satisfaction level varied from 3.98 (SD ± 0.11) for the subscale "client satisfaction" to 3.87 (SD ± 0.32) for the subscale "information provision" on a 4‐point scale. Women at between 33 and 36 weeks' gestation were more likely to be highly satisfied (adjusted OR [aOR] = 3.35). Compared with a completely comfortable position during the aCTG, a mostly comfortable or somewhat comfortable level had decreased odds of being associated with a ranking of highly satisfied (aOR 0.24 and 0.19, respectively). Conclusions: This study shows that pregnant women are satisfied with having an aCTG in midwife‐led care. Providing aCTG in midwife‐led care can increase access to continuity of care. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Nursology is the property of Ataturk University Coordinatorship of Scientific Journals and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Intelligent cardiotocography (CTG) classification can assist obstetricians in evaluating fetal health. However, high classification performance is often achieved by complex machine learning (ML)-based models, which causes interpretability concerns. The trade-off between accuracy and interpretability makes it challenging for most existing ML-based CTG classification models to popularize in prenatal clinical applications. Methods: Aiming to improve CTG classification performance and prediction interpretability, a hybrid model was proposed using a stacked ensemble strategy with mixed features and Kernel SHapley Additive exPlanations (SHAP) framework. Firstly, the stacked ensemble classifier was established by employing support vector machines (SVM), extreme gradient boosting (XGB), and random forests (RF) as base learners, and backpropagation (BP) as a meta learner whose input was mixed with the CTG features and the probability value of each category output by base learners. Then, the public and private CTG datasets were used to verify the discriminative performance. Furthermore, Kernel SHAP was applied to estimate the contribution values of features and their relationships to the fetal states. Results: For intelligent CTG classification using 10-fold cross-validation, the accuracy and average F1 score were 0.9539 and 0.9249 in the public dataset, respectively; and those were 0.9201 and 0.8926 in the private dataset, respectively. For interpretability, the explanation results indicated that accelerations (AC) and the percentage of time with abnormal short-term variability (ASTV) were the key determinants. Specifically, the probability of abnormality increased and that of the normal state decreased as the value of ASTV grew. In addition, the likelihood of the normal status rose with the increase of AC. Conclusions: The proposed model has high classification performance and reasonable interpretability for intelligent fetal monitoring. [ABSTRACT FROM AUTHOR]

Previous literature has highlighted the importance of maternal behavior during the prenatal period for the upbringing of healthy adults. During pregnancy, fetal health assessments are mainly carried out non-invasively by monitoring fetal growth and heart rate (HR) or RR interval (RRI). Despite this, research entailing prediction of fHRs from mHRs is scarce mainly due to the difficulty in non-invasive measurements of fetal electrocardiogram (fECG). Also, so far, it is unknown how mHRs are associated with fHR over the short term. In this study, we used two machine learning models, support vector regression (SVR) and random forest (RF), for predicting average fetal RRI (fRRI). The predicted fRRI values were compared with actual fRRI values calculated from non-invasive fECG. fRRI was predicted from 13 maternal features that consisted of age, weight, and non-invasive ECG-derived parameters that included HR variability (HRV) and R wave amplitude variability. 156 records were used for training the models and the results showed that the SVR model outperformed the RF model with a root mean square error (RMSE) of 29 ms and an average error percentage (< 5%). Correlation analysis between predicted and actual fRRI values showed that the Spearman coefficient for the SVR and RF models were 0.31 (P < 0.001) and 0.19 (P < 0.05), respectively. The SVR model was further used to predict fRRI of 14 subjects who were not included in the training. The latter prediction results showed that individual error percentages were (≤ 5%) except in 3 subjects. The results of this study show that maternal factors can be potentially used for the assessment of fetal well-being based on fetal HR or RRI. [ABSTRACT FROM AUTHOR]

Objective: To describe our individualized management protocol for women with an antenatal diagnosis of vasa previa (VP) and to report maternal and neonatal outcomes in patients managed according to our protocol. Methods: A retrospective study of prospectively collected data of antenatally diagnosed VP managed at our hospital between 2014 and 2021. Obstetric and neonatal outcomes were reviewed and analyzed. Results: Fourteen cases of antenatally diagnosed VP in 5150 total deliveries were analyzed (0.3%) Five cases (36%) of VP were diagnosed during the routine fetal morphological ultrasound screening, and nine cases (64%) were referred to our hospital due to perinatal complications. There were nine cases that required hospitalization (due to fetal growth restriction [FGR] [1], preterm labor [3], patients' request [5]). The other five were asymptomatic. Eight patients were delivered by scheduled cesarean section at around 36 weeks and only three neonates were admitted to NICU with transient tachypnea of newborn. However, six patients required CS before the scheduled dates because of other complications (preterm labor [3], abnormal cardiotocogram patterns [1], FGR [1] and twin pregnancy [1]). Four neonates born by CS before their scheduled dates were admitted to NICU. No cases required prolonged hospitalization and there were no serious neonatal complications. Conclusion: Individualized management may lead to favorable outcomes with VP. Outpatient management may be considered in patients without risk factors. However, maternal hospitalization and earlier scheduled CS should be considered in symptomatic patients or those at risk for preterm delivery. [ABSTRACT FROM AUTHOR]

BACKGROUND: Fetal scalp electrodes are used routinely for intrapartum fetal heart rate monitoring. The electrode is typically removed from the newborn's scalp immediately after vaginal delivery. However, there is no guidance on the timing of fetal scalp electrode removal in the event of an unplanned cesarean delivery. CASE: A 43-year-old woman with a prior cesarean delivery presented for gynecologic care with the chief symptom of chronic abdominal pain for 2 years. Imaging revealed a retained fetal scalp electrode in the abdominal cavity. The patient underwent an uncomplicated surgical extraction of the retained item, and her symptoms resolved. CONCLUSION: A standardized protocol to manage and account for fetal scalp electrodes during an unplanned cesarean delivery is an important patient-safety measure to prevent surgical retention of fetal scalp electrodes. [ABSTRACT FROM AUTHOR]

The plaintiff's labor examination revealed no fetal abnormalities; after her water broke, she was admitted to hospital to await delivery and the defendant induced labor. The defendant administered oral prostaglandin five times per hour between 6:00 p.m. and 10:00 p.m., and oxytocin at 10:22 p.m., and then adjusted the rate of administration. The defendant did not use a fetal monitor and only monitored the fetal heart rate intermittently. At 10:45 p.m., the fetal heart rate dropped, and defendant treated the fetus with suction, resulting in plaintiff's spontaneous delivery at 11:08 p.m. After birth, the fetus was taken to the hospital for respiratory distress and was subsequently diagnosed with anoxic encephalopathy and died four years later. The plaintiff claimed damages from the defendant. The court found that the defendant had violated the rules for the use of oxytocin and prostaglandin and had failed to use monitoring methods in accordance with the list of drugs to be used and the report of the medical association; however, although the defendant was negligent, given that the fetus was not abnormal at the time of birth, the plaintiff's uterus was not excessively contracted, and the defendant attracted prompt treatment, the defendant's negligent conduct was not causally related to the damages and there was at most a substantial degree of probability. [ABSTRACT FROM AUTHOR]

Introduction: Supine sleep position is associated with stillbirth, likely secondary to inferior vena cava compression, and a reduction in cardiac output (CO) and uteroplacental perfusion. Evidence for the effects of prone position in pregnancy is less clear. This study aimed to determine the effect maternal prone position on maternal haemodynamics and fetal heart rate, compared with left lateral position. Methods: Twenty-one women >28 weeks' gestation underwent non-invasive CO monitoring (Cheetah) every 5 minutes and continuous fetal heart rate monitoring (MONICA) in left lateral (20 minutes), prone (30 minutes), followed by left lateral (20 minutes). Anxiety and comfort were assessed by questionnaires. Regression analyses (adjusted for time) compared variables between positions. The information derived from the primary study was used in an existing mathematical model of maternal circulation in pregnancy, to determine whether occlusion of the inferior vena cava could account for the observed effects. In addition, a scoping review was performed to identify reported clinical, haemodynamic and fetal effects of maternal prone position; studies were included if they reported clinical outcomes or effects or maternal prone position in pregnancy. Study records were grouped by publication type for ease of data synthesis and critical analysis. Meta-analysis was performed where there were sufficient studies. Results: Maternal blood pressure (BP) and total vascular resistance (TVR) were increased in prone (sBP 109 vs 104 mmHg, p = 0.03; dBP 74 vs 67 mmHg, p = 0.003; TVR 1302 vs 1075 dyne.s-1cm-5, p = 0.03). CO was reduced in prone (5.7 vs 7.1 mL/minute, p = 0.003). Fetal heart rate, variability and decelerations were unaltered. However, fetal accelerations were less common in prone position (86% vs 95%, p = 0.03). Anxiety was reduced after the procedure, compared to beforehand (p = 0.002), despite a marginal decline in comfort (p = 0.04).The model predicted that if occlusion of the inferior vena cava occurred, the sBP, dBP and CO would generally decrease. However, the TVR remained relatively consistent, which implies that the MAP and CO decrease at a similar rate when occlusion occurs. The scoping review found that maternal and fetal outcomes from 47 included case reports of prone positioning during pregnancy were generally favourable. Meta-analysis of three prospective studies investigating maternal haemodynamic effects of prone position found an increase in sBP and maternal heart rate, but no effect on respiratory rate, oxygen saturation or baseline fetal heart rate (though there was significant heterogeneity between studies). Conclusion: Prone position was associated with a reduction in CO but an uncertain effect on fetal wellbeing. The decline in CO may be due to caval compression, as supported by the computational model. Further work is needed to optimise the safety of prone positioning in pregnancy. Trial registration: This trial was registered at clinicaltrials.gov (NCT04586283). [ABSTRACT FROM AUTHOR]

Background: Compared to traditional fetal heart rate monitoring (FHR) for the outpatients in clinic, remote FHR monitoring shows real-time assessment of fetal wellbeing at home. The clinical function of remote FHR monitoring in pregnant wome in outpatient is still unclear. Objective: To explore the feasibility of remote FHR self-monitoring in singleton pregnant women from southern China. Study design: This prospective cohort study was conducted at one tertiary center in southern China. Pregnant women used a mobile cardiotocogram device to measure the FHR at least once a week until delivery in the remote group. For the control group, pregnant women underwent traditional FHR monitoring once a week in the outpatient clinic. The rate of cesarean section, risk of postpartum hemorrhage and adverse neonatal outcomes were compared between the two groups. All the pregnant women completed a questionnaire survey to evaluate their acquisition of remote FHR self-monitoring. Results: Approximately 500 women were recruited in the remote FHR self-monitoring group (remote group), and 567 women were recruited in the traditional FHR monitoring group (control group). The women in the remote FHR monitoring group were more likely to be nulliparous (P < 0.001), more likely to have a higher education level (P < 0.001) and more likely to be at high risk (P = 0.003). There was no significant difference in the risk of cesarean section (P = 0.068) or postpartum hemorrhage (P = 0.836) between the two groups. No difference in fetal complications was observed across groups, with the exception of the incidence of NICU stays, which was higher in the remote group (12.0% vs. 8.3%, P = 0.044). The questionnaire survey showed that the interval time (P = 0.001) and cost (P = 0.010) of fetal heart rate monitoring were lower in the remote group. Regarding age, prepregnancy BMI, risk factors, education level, maternal risk and household income, senior high school (OR 2.86, 95% CI 1.67–4.90, P < 0.001), undergraduate (OR 2.96, 95% CI 1.73–5.06, P < 0.001), advanced maternal age (OR 1.42, 95% CI 1.07–1.89, P = 0.015) and high-risk pregnancy (OR 1.61, 95% CI 1.11–2.35, P = 0.013) were independent factors for pregnant women to choose remote fetal monitoring. Multiparty (OR 0.33, 95% CI 0.21–0.51, P < 0.001), full-time motherhood (OR 0.47, 95% CI 0.33–0.678, P < 0.001) and high household income (OR 0.67, 95% CI 0.50–0.88, P = 0.004) were negatively correlated with the choice of remote FHR self-monitoring. Conclusion: Remote FHR self-monitoring technology has a lower cost and shows potential clinical efficacy for the outpatient setting in southern China. This approach does not increase the risk of cesarean section or adverse neonatal outcomes. It is acceptable among nulliparous pregnant women with a high education level, high household income or high risk. Further research is needed to assess the impact of this technology on obstetric outcomes in different health settings. [ABSTRACT FROM AUTHOR]

This article explores different methods of monitoring fetal growth and well-being during pregnancy. It discusses the use of cardiotocography, which analyzes the fetal heart rate to prevent brain injury, and Doppler ultrasound, which assesses blood flow and identifies the risk of fetal growth restriction. The article also mentions other methods such as fetal pulse oximetry, fetal scalp blood sampling, and fetal electrocardiogram. Each method has its own advantages and disadvantages, and their invasiveness and accuracy should be taken into account. The article emphasizes the need for further research to understand the benefits of these monitoring methods in improving fetal neurodevelopmental outcomes. [Extracted from the article]

Objective: To assess the association between undetected small‐for‐gestational age (SGA) fetuses and abnormal admission cardiotocography (admCTG) in a low‐risk population. Design: An observational study. Setting: Four hospitals in Stockholm‐Gotland, Sweden. Sample: A cohort of 127 461 deliveries between 1 February 2012 and 15 June 2020. Methods: This cohort was linked to the Swedish Neonatal Quality Register. Pregnancies were designated as high or low risk at the time of admission to the labour ward according to pre‐defined risk measures. SGA was defined as a birthweight at or below the tenth centile and at or below the third centile for gestational age. Main outcome measures: The main outcome was the proportion of undetected SGA by admCTG (normal or abnormal). The secondary outcome was a composite severe adverse neonatal outcome for fetuses born less than 6 hours after admission (Apgar score <4 at 5 minutes, hypoxic–ischaemic encephalopathy grade of 2–3, neonatal seizures and neonatal death). Results: The rate of abnormal admCTG was 4.9%. The proportion of SGA at or below the tenth centile was higher in the abnormal admCTG group than in the normal admCTG group, 18.6% versus 9.7% (odds ratio 2.1, 95% CI 1.9–2.3). Abnormal admCTG and SGA (≤10th) was associated with a more than 20‐fold increased risk of an adverse outcome compared with normal admCTG and non‐SGA (adjusted odds ratio 23.7, 95% CI 9.8–57.3). The latter had a risk of 1/2000 of an adverse outcome. Conclusions: In this low‐risk population, undetected SGA fetuses were more prone to having abnormal admCTG and had a substantially higher risk of severe adverse neonatal outcomes. [ABSTRACT FROM AUTHOR]

Aim: To compare and study the perinatal maternal outcome and complications in neonates in patients with meconium-stained amniotic fluid. Materials and methods: This was a randomized comparative analysis and prospective study conducted from 1st October 2021to 30th May 2022. 120 patients with meconium-stained amniotic fluid were studied for fetomaternal outcomes and compared to 120 patients with clear amniotic fluid. The patients were monitored for fetal heart rate, mode of delivery, Apgar score at 1 and 5 minutes, NICU admissions and neonatal complications. Result: An increased rate of caesarean section and operative vaginal deliveries was associated with meconium-stained amniotic fluid as compared to clear amniotic fluid. The commonest fetal abnormality seen was bradycardia in 35% of meconium-stained amniotic fluid cases. The APGAR score was less than 7 at 5 min in 5% of the meconium-stained amniotic fluid group and the major complication was birth asphyxia (18.18%) which was more in the thick MSL group (14.87%). Meconium aspiration syndrome was seen in 4 in the the MSL group and 2 in thin MSL group. NICU admission was required in 18% of cases in MSL group while 7% in the control group. The morbidity was more in the MSL group (52%) than thin MSL group (20%). Conclusion: The study proved that meconium staining of amniotic fluid affects the fetal outcome adversely. [ABSTRACT FROM AUTHOR]

Objectives: ST waveform analysis (STAN) was introduced to improve the interpretation of cardiotocography (CTG) resulting in reduction of unnecessary interventions and metabolic acidosis. A systematic review was conducted with the aim to evaluate the effect of STAN method compared with isolated CTG on perinatal and neonatal outcomes. Materials and methods: A search of electronic databases (PubMed, Cochrane, Scopus) was conducted to identify randomized controlled trials (RCTs) in English language. Outcomes considered operative deliveries, fetal blood sampling (FBS), metabolic acidosis, perinatal and neonatal death, neonatal seizures, neonatal encephalopathy, transfer to the neonatal intensive care unit (NICU) and Apgar score. Results: Seven RCTs were included in the present review. The first two RCTs showed that the combination of STAN and CTG was a better option than using CTG alone, because there was a documented reduction in the rate of operative deliveries due to fetal distress and metabolic acidosis. The following studies showed no statistically significant changes with the combination of methods, except from a reduction in FBS. Conclusions: The findings from the RCTs were inconclusive. Most studies did not demonstrate a superiority of the combination regarding operative deliveries and neonatal outcomes but there were many methodological differences between the trials. [ABSTRACT FROM AUTHOR]

Fetal monitoring in the intrapartum and peripartum periods is important for the well-being of both baby and mother. Electronic fetal monitoring was first designed over 50 years ago in an attempt to improve perinatal outcomes. Its purpose is to assess fetal oxygenation and acid-base status during the antepartum course when indicated and during labor. Maternal assessment begins early in gestation with blood pressure monitoring and urine protein excretion to diagnose potential complications, such as severe hypertension and preeclampsia/eclampsia. [ABSTRACT FROM AUTHOR]

Cardiotocography (CTG) represents the fetus's health inside the womb during labor. However, assessment of its readings can be a highly subjective process depending on the expertise of the obstetrician. Digital signals from fetal monitors acquire parameters (i.e., fetal heart rate, contractions, acceleration). Objective: This paper aims to classify the CTG readings containing imbalanced healthy, suspected, and pathological fetus readings. Method: We perform two sets of experiments. Firstly, we employ five classifiers: Random Forest (RF), Adaptive Boosting (AdaBoost), Categorical Boosting (CatBoost), Extreme Gradient Boosting (XGBoost), and Light Gradient Boosting Machine (LGBM) without over-sampling to classify CTG readings into three categories: healthy, suspected, and pathological. Secondly, we employ an ensemble of the above-described classifiers with the oversamplingmethod. We use a random over-sampling technique to balance CTG records to train the ensemble models. We use 3602 CTG readings to train the ensemble classifiers and 1201 records to evaluate them. The outcomes of these classifiers are then fed into the soft voting classifier to obtain the most accurate results. Results: Each classifier evaluates accuracy, Precision, Recall, F1-scores, and Area Under the Receiver Operating Curve (AUROC) values. Results reveal that the XGBoost, LGBM, and CatBoost classifiers yielded 99% accuracy. Conclusion: Using ensemble classifiers over a balanced CTG dataset improves the detection accuracy compared to the previous studies and our first experiment. A soft voting classifier then eliminates the weakness of one individual classifier to yield superior performance of the overall model. [ABSTRACT FROM AUTHOR]

Objectives: Fully effective intrapartum cardiotocographic (CTG) fetal heart monitoring is still missing. Visual analysis is far from credibility. Additional, computerized analysis techniques were proposed however they did not substantially decrease possible risks of fetal asphyxia. In twin pregnancies the problem is even more complicated. Our goal is to find the most valuable parameters in intrapartum CTG surveillance in twins, based on actual FIGO criteria. Material and methods: Study included 58 women in labor who had been admitted to Delivery Department of tertiary care hospital with twin pregnancy in a period of one year. The features of the CTG (e.g., baseline, oscillation, decelerations, brady- or tachycardia) were grouped to create three variables that were closest to the FIGO CTG scale. All three groups were compared according to neonatal status (Apgar score at 5 min ≥ 7 or < 7; pH value in umbilical artery ≥ 7.20, < 7.20 or < 7.10 and BE (base excess) > or ≤ –12). Fetal status and its acid — base equilibrium was compared either with long term variability (LTV), short term variability (STV), or percentage of the signal loss. Results: Out of 58 twin pregnancies, a total of 116 babies were born. One baby was born dead. From this group, 11 deliveries were natural births and 47 deliveries were C-sections. None of the analyzed features (pH, BE, Apgar, CTG features except tracing length, CTG FIGO categories) were statistically different between groups of singleton and twin pregnancies, except percentage of C-sections. No differences were found either for STV or LTV and fetal status.org CTG categories. Conclusions: Prior to cardiotocographic tracing of twins during labor, ultrasound examination should be mandatory. Considerable loss of signal in CTG tracing in twins should provoke ultrasonographic confirmation of the fetal status. [ABSTRACT FROM AUTHOR]

Monitoring the fetal heartbeat underpins assessment of fetal wellbeing in labour. Although commonly employed in clinical practice, shortcomings remain. A recent review of clinical practice guidelines highlights the variation in definitions of the fetal heart rate that will lead to differences in interpretation. Will intrapartum care be improved by greater consensus around clinical practice guidelines through rationalisation or refinement of guidelines, or will the future see this technique replaced by more accurate forms of fetal monitoring? [ABSTRACT FROM AUTHOR]

The article discusses the importance of understanding the timing, mechanism, and preventability of fetal neurological injury and its subsequent handicaps. It mentions that intrauterine perinatal asphyxia is implicated in stillbirth and perinatal mortality and that major neurological impairments such as hypoxic-ischemic encephalopathy (HIE) and cerebral palsy (CP) can result from it.

Aim: In modern obstetrics, need of labor induction is increasing along with increased caesarean deliveries. Major contributions for these operative deliveries are due to induction failure. This demands a potent labor‐inducing agent. Dinoprostone gel is an established method but having some drawbacks. Misoprostol could be an effective alternative to Dinoprostone, but its fetal safety is not yet well established. This study aimed to evaluate the fetal safety of vaginal Misoprostol tablet by measuring fetal heart rate changes during induction of labor. Methods: This was a single‐center randomized controlled trial incorporating 140 term women, equally randomized to get either tablet Misoprostol or Dinoprostone gel. Fetal heart rate patterns were compared in both the groups by continuous cardiotocographic tracing. All the data were analyzed on an intention‐to‐treat basis. Results: There were no statistically significant changes in fetal heart rate pattern in both Misoprostol and Dinoprostone groups. Vaginal deliveries were statistically higher in Misoprostol group. Neonatal parameters like 1 min Appearance, Pulse, Grimace, Activity, and Respiration score and neonatal intensive care unit admission were comparable, and there was no significant difference in terms of major adverse events and side effects. Conclusions: Misoprostol is a safe alternative to Dinoprostone gel for induction of labor and found to be more effective labor‐inducing agent. In the background of higher caesarean rate, vaginal Misoprostol can be a potential labor‐inducing agent especially in a resource poor setting. [ABSTRACT FROM AUTHOR]

The measurement and analysis of fetal heart rate (FHR) and uterine contraction (UC) patterns, known as cardiotocography (CTG), is a key technology for detecting fetal compromise during labour. This technology is commonly used by clinicians to make decisions on the mode of delivery to minimise adverse outcomes. A range of computerised CTG analysis techniques have been proposed to overcome the limitations of manual clinician interpretation. While these automated techniques can potentially improve patient outcomes, their adoption into clinical practice remains limited. This review provides an overview of current FHR and UC monitoring technologies, public and private CTG datasets, pre-processing steps, and classification algorithms used in automated approaches for fetal compromise detection. It aims to highlight challenges inhibiting the translation of automated CTG analysis methods from research to clinical application and provide recommendations to overcome them. [ABSTRACT FROM AUTHOR]

Background: We assessed the change in obstetric management after implementation of a quality improvement intervention, the Nepal Perinatal Quality Improvement Package (NePeriQIP). Methods: The Nepal Perinatal Quality Improvement Package was a stepped‐wedge cluster‐randomized controlled trial conducted in 12 public hospitals in Nepal between April 2017 and October 2018. In this study, three hospitals allocated at different time points to the intervention were selected for a nested before–after analysis. We used bivariate and multivariate analyses to compare obstetric management in the control vs intervention group. Results: There were 25 977 deliveries in the three hospitals during the study period: 10 207 (39%) in the control and 15 770 (61%) in the intervention group. After adjusting for maternal age, ethnicity, education, gestational age, stage of labor at admission, complications during labor, and birthweight, the intervention group had a higher proportion of fetal heart rate monitoring performed as per protocol (adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 1.12–1.27), shorter time intervals between each fetal heart rate monitoring (aOR 2.09, 95% CI 1.96–2.23), a higher likelihood of abnormal fetal heart rate being detected (aOR 1.53, 95% CI 1.25–1.68), progress of labor more often being recorded immediately after per vaginal examination (aOR 2.73, 95% CI 2.55–2.93), and partograph filled as per standards (aOR 3.18, 95% CI 2.98–3.50). The cesarean birth rate was 2.5% in the control group and 8.2% in the intervention group (aOR 3.12, 95% CI 2.64–3.68). Conclusions: The NePeriQIP intervention has potential to improve obstetric care, especially intrapartum fetal surveillance, in similar low‐resource settings. [ABSTRACT FROM AUTHOR]

Copyright of Matronas Hoy is the property of Asociacion Espanola de Matronas (AEM) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: For decades, antenatal care in high-resource settings has involved 12–14 face-to-face visits across pregnancy. The COVID-19 pandemic forced many care providers to rapidly embrace telehealth to reduce face-to-face visits. Here we review recent advances in telehealth used to provide antenatal care. Main body: We conducted a narrative review examining the impact of telehealth on obstetric care. Two broad types of telehealth are used in antenatal care. The first is real-time telehealth, where consultations are done virtually instead of face-to-face. The second is remote monitoring, where in-clinic physical examinations are replaced with at-home alternatives. These can include blood pressure monitoring, fetal heart rate monitoring, and emerging technologies such as tele-ultrasound. Large cohort studies conducted during the pandemic era have shown that telehealth appears not to have increased adverse clinical outcomes for mothers or babies. However, further studies may be required to confidently conclude rare outcomes are unchanged, such as maternal mortality, serious morbidity, or stillbirth. Health economic studies suggest telehealth has the potential to reduce the financial cost of care provision. Telehealth in antenatal care seems to be acceptable to both pregnant women and healthcare providers. Conclusion: Adoption of telehealth technologies may improve the antenatal care experience for women and reduce healthcare expenditure without adversely impacting health outcomes for the mother or baby. More studies are warranted to confirm telehealth does not alter the risk of rare outcomes such as maternal or neonatal mortality. [ABSTRACT FROM AUTHOR]

This study uses convolutional neural networks (CNNs) and cardiotocography data for the real-time classification of fetal status in the mobile application of a pregnant woman and the computer server of a data expert at the same time (The sensor is connected with the smartphone, which is linked with the web server for the woman and the computer server for the expert). Data came from 5249 (or 4833) cardiotocography traces in Anam Hospital for the mobile application (or the computer server). 150 data cases of 5-minute duration were extracted from each trace with 141,001 final cases for the mobile application and for the computer server alike. The dependent variable was fetal status with two categories (Normal, Abnormal) for the mobile application and three categories (Normal, Middle, Abnormal) for the computer server. The fetal heart rate served as a predictor for the mobile application and the computer server, while uterus contraction for the computer server only. The 1-dimension (or 2-dimension) Resnet CNN was trained for the mobile application (or the computer server) during 800 epochs. The sensitivity, specificity and their harmonic mean of the 1-dimension CNN for the mobile application were 94.9%, 91.2% and 93.0%, respectively. The corresponding statistics of the 2-dimension CNN for the computer server were 98.0%, 99.5% and 98.7%. The average inference time per 1000 images was 6.51 micro-seconds. Deep learning provides an efficient model for the real-time classification of fetal status in the mobile application and the computer server at the same time. [ABSTRACT FROM AUTHOR]

(1) Background: According to the World Health Organization (WHO), 6.3 million intrauterine fetal deaths occur every year. The most common method of diagnosing perinatal death and taking early precautions for maternal and fetal health is a nonstress test (NST). Data on the fetal heart rate and uterus contractions from an NST device are interpreted based on a trace printer's output, allowing for a diagnosis of fetal health to be made by an expert. (2) Methods: in this study, a predictive method based on ensemble learning is proposed for the classification of fetal health (normal, suspicious, pathology) using a cardiotocography dataset of fetal movements and fetal heart rate acceleration from NST tests. (3) Results: the proposed predictor achieved an accuracy level above 99.5% on the test dataset. (4) Conclusions: from the experimental results, it was observed that a fetal health diagnosis can be made during NST using machine learning. [ABSTRACT FROM AUTHOR]

Background and Objectives: CTG test is a non-invasive investigative modality that is simple to perform and interpret, as well as widely accepted by patients. This test involves the use of Doppler- detected fetal heart rate acceleration that corresponds to fetal movements perceived by the mother. Owing to its cost-effectiveness and ease of application, it is used as a part of antenatal surveillance in developing countries. To analyze and monitor CTG changes in high and low-risk pregnancies as a part of antepartum surveillance and to correlate CTG with perinatal outcomes. Methods: A prospective observational study was conducted in the department of obstetrics, government medical college, Guntur. 200 pregnant females were enrolled in this study after they full filled the selection criteria. Patients were subjected to admission CTG and fetal heart rate was monitored. Perinatal outcomes were assessed. Results: 63% of the 200 patients had high-risk pregnancies. 61.5% needed operative delivery while 38.5% of the cases had NVD. APGAR score at 1 minute was <6 In 40%, & >7 in 60% of the cases. APGAR score at 5 minutes was <7 In 20% and 80% of the cases it was >8. Beat-to-beat variability was absent in 44% of the cases. There was a statistically significant association between perinatal outcome and beat-to-beat FHR variability. A significant association was observed between diagnosis and CST. Conclusion: Admission CTG is an effective, inexpensive, non-invasive technique to detect fetal hypoxia at early stages in low-and high-risk pregnancies, especially in developing countries with an increased workload and fewer resources. [ABSTRACT FROM AUTHOR]

Introduction: Fetal heart rate (FHR) monitoring is routine in intrapartum care worldwide and one of the most common obstetrical procedures. Intrapartum FHR monitoring helps assess fetal wellbeing and interpretation of the FHR help form decisions for clinical management and intervention. It relies on the observers' subjective assessments, with variation in interpretations leading to variations in intrapartum care. The purpose of this systematic review was to summarize and evaluate extant inter‐ and intrarater reliability research on the human interpretation of intrapartum FHR monitoring. Material and Methods: We searched for the terms "fetal heart rate monitoring," "interpretation agreement" and related concepts on Embase, Medline, Maternity and Infant Care Database and CINAHL. The last search was made on January 31, 2022. The protocol for the study was prospectively registered in PROSPERO (CRD42021260937). Studies that assess inter‐ and intrarater reliability and agreement of health professionals' intrapartum FHR monitoring were included and studies including other assessment of fetal wellbeing excluded. We extracted data in reviewer pairs using quality appraisal tool for studies of diagnostic reliability (QAREL) forms. The data retrieved from the studies are presented as narrative synthesis and in additional tables. Results: Forty‐nine articles concerning continuous FHR monitoring were included in the study. For interrater reliability and agreement, in total 577 raters assessed 6315 CTG tracings. There was considerable heterogeneity in quality and measures across the included articles. We found higher reliability and agreement for the basic FHR features than for overall classification and higher agreement for intrarater reliability and agreement than for their interrater counterparts. Conclusions: There is great variation in reliability and agreement measures for continuous intrapartum FHR monitoring, implying that intrapartum CTG should be used with caution for clinical decision making given its questionable reliability. We found few high‐quality studies and noted methodological concerns in the studies. We recommend a more standardized approach to future reliability studies on FHR monitoring. [ABSTRACT FROM AUTHOR]

The article discusses the use of modern technology, such as ultrasound and cardiotocography, to gain insights into fetal behavior and movement. Topics include the significance of maternal perception of reduced fetal movement (RFM) as a potential indicator of stillbirth risk, the need for improved management strategies, challenges and recommendations related to monitoring fetal movements and addressing deficiencies in prenatal care delivery.

Objective: Deceleration area (DA) and capacity (DC) of the fetal heart rate can help predict risk of intrapartum fetal compromise. However, their predictive value in higher risk pregnancies is unclear. We investigated whether they can predict the onset of hypotension during brief hypoxaemia repeated at a rate consistent with early labour in fetal sheep with pre‐existing hypoxaemia. Design: Prospective, controlled study. Setting: Laboratory. Sample Chronically instrumented, unanaesthetised near‐term fetal sheep. Methods One‐minute complete umbilical cord occlusions (UCOs) were performed every 5 minutes in fetal sheep with baseline paO2 <17 mmHg (hypoxaemic, n = 8) and >17 mmHg (normoxic, n = 11) for 4 hours or until arterial pressure fell <20 mmHg. Main outcome measures: DA, DC and arterial pressure. Results: Normoxic fetuses showed effective cardiovascular adaptation without hypotension and mild acidaemia (lowest arterial pressure 40.7 ± 2.8 mmHg, pH 7.35 ± 0.03). Hypoxaemic fetuses developed hypotension (lowest arterial pressure 20.8 ± 1.9 mmHg, P < 0.001) and acidaemia (final pH 7.07 ± 0.05). In hypoxaemic fetuses, decelerations showed faster falls in FHR over the first 40 seconds of UCOs but the final deceleration depth was not different to normoxic fetuses. DC was modestly higher in hypoxaemic fetuses during the penultimate (P = 0.04) and final (P = 0.012) 20 minutes of UCOs. DA was not different between groups. Conclusion: Chronically hypoxaemic fetuses had early onset of cardiovascular compromise during labour‐like brief repeated UCOs. DA was unable to identify developing hypotension in this setting, while DC only showed modest differences between groups. These findings highlight that DA and DC thresholds need to be adjusted for antenatal risk factors, potentially limiting their clinical utility. [ABSTRACT FROM AUTHOR]

Introduction: Cardiotocography (CTG) constitutes a major and generally used tool for the assessment of fetal well-being. Subjectivity is the main difficulty in the interpretation of CTG. Inter- and intra-observer variability are substantival features of the interpretation of CTGs. An auspicious answer for reduction of inter- and intra-observer variability is the computerized analysis of fetal heart rate (FHR). Moreover, computerized analysis contributes to the reduction of adverse maternal and fetal outcomes. Objective: The aim of the present review was to compare the visual and computerized analysis of CTG for establishing whether computerized CTG was related to better perinatal outcomes. Materials and methods: Three electronic medical related databases (PubMed, Scopus and Cochrane) were searched from May to June 2023 in order to find randomized controlled trials (RCTs) in English. Studies were evaluated for their methodological quality with the CONSORT checklist. The target population comprised pregnant or intrapartum women into cardiotocographic monitoring. The intervention was represented by the visual analysis of CTG, and the comparison intervention by the computerized analysis of CTG. Primary outcomes included adverse perinatal outcomes. Results: A total of 47 studies relevant with the topic were examined. However, only five articles met all inclusion and methodological criteria; four of those demonstrated that computerized analysis had no significant reduction in the rate of metabolic acidosis or obstetric interventions, and one study found a lower incidence of adverse perinatal outcome with conventional CTG (with fetal blood sampling). However, all reviews propose further development of decision-support software and more large-scale RCTs in the future. Conclusion: The computerized analysis of FHR is a promising solution for the reduction of adverse perinatal outcomes and elimination of inter- and intra-observer variability. [ABSTRACT FROM AUTHOR]

BACKGROUND: Internet-related technologies have rapidly developed and started to impact the traditional medical practices, which combined wireless communication technology as well as "cloud service" technology with electronic fetal heart monitoring have become a mainstream tendency. OBJECTIVE: To investigate the clinical application value of remote fetal heart rate monitoring mode (RFHRM) on late pregnancy during the coronavirus disease (COVID-19) pandemic. METHODS: From March 2021 to February 2022, we recruited 800 cases of pregnant women received prenatal examination at the Anhui Province Maternity and Child Healthcare Hospital. These pregnant women were randomly divided into two groups: the control group (n = 400), which was given traditional management, and the observation group (n = 400), which received remote monitoring technology on this basis. The two groups were compared with neonatal asphyxia, pregnancy outcomes, Edinburgh postnatal depression scale scores (EPDS), prenatal examination expenses and total time consumption. RESULTS: There were no statistically significant differences between the groups in pregnancy outcome and neonatal outcome (P > 0.05). However, total EPDS score of 12.5% pregnant women in the observation group were higher than 12. The TPE group had significantly higher mean EPDS scores compared with the RFHRM group (7.79 ± 3.58 vs 5.10 ± 3.07; P < 0.05). The results showed a significant difference in maternity expenses (2949.83 ± 456.07 vs 2455.37 ± 506.67; P < 0.05) and total time consumption (42.81 ± 7.60 vs 20.43 ± 4.16; P < 0.05) between the groups. CONCLUSION: Remote fetal heart rate monitoring via internet served as an innovative, acceptable, safe and effective reduced-frequency prenatal examination model without affecting the outcome of perinatology of pregnant women with different risk factors. [ABSTRACT FROM AUTHOR]

Meconium is the first stool passed by a newborn within the first 24-48 hours of life. In certain circumstances, meconium can be expelled while the fetus is still in the uterus, resulting in contamination of the amniotic fluid. Newborns may develop meconium aspiration if they possess risk factors such as the presence of thick meconium, abnormal cardiotocographic trace, fetal acidosis, cesarean section (CS), the requirement for intubation at birth, and low Apgar scores. Meconium aspiration syndrome (MAS) can give rise to a range of complications, varying in severity. This article presents a case report involving a newborn diagnosed with MAS who also experienced pneumothorax complications. Fortunately, the newborn survived without encountering more severe complications. [ABSTRACT FROM AUTHOR]

Rising in the rates of C-section deliveries worldwide is a major public health concern. According to WHO, C-section rate continues to rise globally, accounting for more than 1 in 5(21%) childbirths. There is lack of evidence supporting the maternal and neonatal benefits with the increasing C-section rates. Robson's Ten Group Classification system (RTGCS) serves as an initial structure with which caesarean section rates can be analyzed and allow us to bring changes in clinical practice. The objective of the current study was to audit C-section rate using Robson's Ten Group Classification System in our tertiary care hospital, and to identify the main contributors of each subgroup to overall Csection rate. This was a cross-sectional study conducted at out tertiary care center, Karpaga Vinayaga Institute of Medical Sciences and Research Centre (KIMS&RC), Madhuranthagam, Tamil Nadu, India during the period of January 2019 to December 2021. The study was conducted by reviewing the hospital record for analyzing the C-sections performed during the above-mentioned period. The study population include the pregnant women who underwent Csections in our hospital during the specified period. The 401 women who underwent C-section were classified in Robson's Ten group classification system, 45% women in Group 5 and it contributed to the maximum number of the total C-section rates. The second highest contributor was Group 1 and Group 2 contributing to 41% of the overall C-section rates. The Robson's Ten group classification system provides a useful framework for auditing C-section rates. Regular audits and standardization of indication of C-section will help in reducing the C-section rate in future. [ABSTRACT FROM AUTHOR]

This article discusses the methodology and potential pitfalls in interobserver agreement studies, specifically in the context of assessing the suitability for fetal ECG ST analysis (STAN) when commencing cardiotocography (CTG). The authors used proportions of agreement and kappa analysis to assess the data, which are commonly used methods in similar studies. They also compared their new physiology-based FFTree CTG interpretation approach with the FIGO classification and found some differences in the proportions of agreement. The authors provided special graphs to visualize the results and presented the data in a transparent manner. [Extracted from the article]

Purpose: To analyze the mechanisms involved in the fetal heart rate (FHR) abnormalities after the epidural analgesia in labor. Methods: A prospective unblinded single-center observational study on 55 term singleton pregnant women with spontaneous labor. All women recruited underwent serial bedside measurements of the main hemodynamic parameters using a non-invasive ultrasound system (USCOM-1A). Total vascular resistances (TVR), heart rate (HR), stroke volume (SV), cardiac output (CO) and arterial blood pressure were measured before epidural administration (T0), after 5 min 5 (T1) from epidural bolus and at the end of the first stage of labor (T2). FHR was continuously recorded through computerized cardiotocography before and after the procedure. Results: The starting CO was significantly higher in a subgroup of women with low TVR than in women with high-TVR group. After the bolus of epidural analgesia in the low-TVR group there was a significant reduction in CO and then increased again at the end of the first stage, in the high-TVR group the CO increased insignificantly after the anesthesia bolus, while it increased significantly in the remaining part of the first stage of labor. On the other hand, CO was inversely correlated with the number of decelerations detected on cCTG in the 1 hour after the epidural bolus while the short-term variation was significantly lower in the group with high-TVR. Conclusion: Maternal hemodynamic status at the onset of labor can make a difference in fetal response to the administration of epidural analgesia. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to investigate if intrapartum monitoring with cardiotocography (CTG) in combination with ST analysis (STAN) results in an improved perinatal outcome. Methods: We performed a two-center randomized trial. 1013 women with term fetuses in cephalic presentation entered the trial. If a CTG showed intermediate or pathological abnormalities, they were offered fetal blood sampling (FBS) and inclusion if the pH value was above 7.25. They were randomized to either CTG + FBS or CTG + STAN. The primary outcome was neonatal metabolic acidosis, defined as umbilical cord arterial blood pH below 7.05, and base excess equal to or below −10. The secondary outcomes included operative vaginal delivery for fetal distress. Results: The rate of metabolic acidosis was 0.8% in the CTG + FBS group and 1.5% in women in the CTG + STAN (P = 0.338). More women in the CTG + STAN group delivered by operative vaginal delivery (25.6% vs 33.5%, P = 0.006). Significantly fewer women in the CTG + STAN group had three to five (28.8% vs 11.0%, P = < 0.001) and six to ten fetal blood samples taken (3.4% vs 0.4%, P = < 0.001). Conclusion: CTG + STAN did not reduce the incidence of neonatal metabolic acidosis compared to CTG + FBS. CTG + STAN was, however, associated with an increased risk of operative vaginal delivery and a reduced use of FBS. If STAN is used for fetal surveillance, we recommend that it is combined with other methods, such as FBS, for confirmation of the need for operative delivery. Clinicaltrials.gov ID: NCT01699646. Date of registration: October 4, 2012 (retrospectively registered). https://clinicaltrials.gov/ct2/show/NCT01699646?id=NCT01699646&draw=2&rank=1 [ABSTRACT FROM AUTHOR]

Background: Clinical practice guidelines on intrapartum cardiotocography (CTG) interpretation provide structured tools to detect fetal hypoxia. Despite frequent use of different guidelines, little is known about their comparable consistency. We sought to appraise guidelines relevant to intrapartum CTG interpretation and summarise consensus and non‐consensus recommendations. Aims: To compare existing intrapartum CTG interpretation guidelines. Materials and methods: We searched PubMed, CINAHL, Cochrane, Embase, guideline databases and websites of guideline development institutions using terms 'cardiotocography', 'electronic fetal/foetal monitoring', and 'guideline' or equivalent term. The search was restricted to English‐language articles published between January 1980 and January 2023 and excluded animal studies. The initial search yielded 2128 articles with 1253 unique citations. Guidelines were included if they: used English as the reporting language; included CTG interpretation criteria or guidelines as a primary objective; were published or updated since 1980; and were the most recently updated publications when multiple versions were identified. Results: Nineteen studies were considered for full review, and 13 met inclusion criteria. Two reviewers independently assessed guideline quality using the AGREE II instrument, and synthesised consensus and non‐consensus recommendations using the content analysis approach. Most guidelines employed a three‐tier interpretation framework. There were significant differences between the guidelines for relative importance of key CTG features such as accelerations, decelerations and variability, with respect to the outcome of fetal hypoxia. Conclusions: There are significant differences between key intrapartum CTG interpretation guidelines currently being used. Greater consistency is needed across CTG interpretation guidelines to improve the quality of data, clinical governance, monitoring of outcomes, and to support future developments. [ABSTRACT FROM AUTHOR]

This study primarily aims to investigate the relationship between decision‐to‐delivery interval (DDI) and fetal and maternal outcomes in patients undergoing an emergency caesarean section. A secondary aim was to investigate if any maternal or labour features adversely affected outcomes. Two‐hundred and forty‐six patients underwent an emergency caesarean section within a 9 month period. Outcomes considered included estimated blood loss, need for special care baby unit admission, need for neonatal resus in the form of continuous positive airway pressure and initial APGARs. A multivariate regression analysis was used. This study found no relation between DDI and outcomes. [ABSTRACT FROM AUTHOR]

The reduction of childhood mortality is an ongoing struggle and a commonly used factor in determining progress in the medical field. The under-5 mortality number is around 5 million around the world, with many of the deaths being preventable. In light of this issue, cardiotocograms (CTGs) have emerged as a leading tool to determine fetal health. By using ultrasound pulses and reading the responses, CTGs help healthcare professionals assess the overall health of the fetus to determine the risk of child mortality. However, interpreting the results of the CTGs is time consuming and inefficient, especially in underdeveloped areas where an expert obstetrician is hard to come by. Using a support vector machine (SVM) and oversampling, this paper proposes a model that classifies fetal health with an accuracy of 99.59%. To further explain the CTG measurements, an algorithm based off of RISE (Randomized Input Sampling for Explanation of Black-box Models) was created, called Feature Alteration for explanation of Black Box Models (FAB). The findings of this novel algorithm were compared to SHapley Additive exPlanations (SHAP) and Local Interpretable Model Agnostic Explanations (LIME). Overall, this technology allows doctors and medical professionals to classify fetal health with high accuracy and determine which features were most influential in the process. [ABSTRACT FROM AUTHOR]

To compare short term variation (STV) and phase rectified signal averaging (PRSA) and their association with fetal outcome in early onset fetal growth restriction (FGR). Data were used from a retrospective cohort study of women who were admitted for FGR and/or pre-eclampsia and who were delivered by pre-labor Cesarean section or had a fetal death before 32 weeks' gestation. Computerized cardiotocography (cCTG) registrations of the 5 days before delivery or fetal death were used for calculation of STV and PRSA. PRSA was expressed as the average acceleration capacity (AAC) and average deceleration capacity (ADC). FHR decelerations were classified visually as absent, 1–2 per hour or recurrent. Abnormality of STV and of PRSA was either analyzed as a single parameter or in combination with recurrent decelerations. Endpoints were defined as composite adverse condition at birth consisting of fetal death, low Apgar score, low umbilical pH, the need for resuscitation after birth and as major neonatal morbidity or neonatal death. Included were 367 pregnancies of which 20 resulted in fetal death. An abnormal cCTG with either recurrent decelerations and/or low STV or recurrent decelerations and/or low PRSA were similarly associated with composite adverse condition at birth (n=99), but neither with major neonatal morbidity. PRSA and STV have similar efficacy for measuring fetal heart rate variation in early onset FGR. An increased risk of a composite adverse condition at birth is indicated by a low value of either parameter and/or the presence of recurrent decelerations. [ABSTRACT FROM AUTHOR]