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431 results on '"Chandraharan, Edwin"'

151. Foetal electrocardiograph (ST-analyser or STAN) for intrapartum foetal heart rate monitoring: a friend or a foe?

Author

Chandraharan, Edwin

Subjects
*FETAL heart rate monitoring, *INTRAPARTUM care, *ELECTROCARDIOGRAPHY, *CESAREAN section, *VASOCONSTRICTION, *ACIDOSIS, *COMPARATIVE studies, *DELIVERY (Obstetrics), *RESEARCH methodology, *MEDICAL cooperation, *META-analysis, *RESEARCH, *UNNECESSARY surgery, *EVALUATION research, *PREVENTION
Abstract

Cardiotocograph (CTG) is associated with a high false positive rate of up to 60% which may increase the risk of unnecessary intrapartum interventions (emergency caesarean sections or operative vaginal deliveries) without any significant benefits. A recent study on variation of caesarean section rates in England has concluded that there was a very wide variation even in the adjusted rates of caesarean section from 14.9% to 32.1%. Cochrane Systematic Reviews have concluded that the use of FBS does not reduce caesarean section rate or any pre-specified neonatal outcomes. Fetal ECG (ST-Analyser or STAN) has been used in the clinical practice for more than 20 years. Although, initial randomised controlled trials (RCTs) showed great promise regarding the role of STAN in reducing operative delivery rates (instrumental vaginal births and emergency caesarean sections) and neonatal metabolic acidosis, subsequent studies have questioned the role of STAN in clinical practice. A recent meta-analysis which included six randomised controlled trials (a total of 26,446 women) has concluded that there was a 36% reduction in the rate of neonatal metabolic acidosis. Practising clinicians currently face a dilemma as to whether STAN has a place in contemporary obstetric practice or whether it?s use should be discouraged and discontinued. [ABSTRACT FROM PUBLISHER]

Published
2018
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152. Intrapartum care: An urgent need to question historical practices and ‘non-evidence’-based, illogical foetal monitoring guidelines to avoid patient harm

Author

Chandraharan, Edwin

Abstract

Childbirth should be a very happy, positive and rewarding experience for the woman, her partner and her family as well as for health-care providers. Women and their families have every right to expect that bringing a new life into this world would be a safe process. However, the latest ‘Each Baby Counts’ Report published by the Royal College of Obstetricians and Gynaecologists in November 2018 has highlighted that out of nearly 700,000 babies born in the UK, 1123 babies died or sustained a severe brain damage during the intrapartum period (i.e., during labour). Despite excellent antenatal surveillance in the UK with regular antenatal clinic visits, ultrasound scans and blood tests as well as the free availability of the cardiotocograph machines to monitor the foetal heart rate during labour, very sadly 124 babies had died during labour. Moreover, 145 babies were born alive but died within the first days after birth, and 854 babies met the criteria for severe brain damage. According to this latest ‘Each Baby Counts’ Report, 71% of babies might have a different outcome with different care, and cardiotocograph misinterpretation accounted for 34% of all cases of poor perinatal outcomes. It is no longer acceptable to continue ‘counting’ our poor perinatal outcomes and produce glossy reports such as the ‘Each Baby Counts’ without scrutinising the underlying causes which are forcing excellent and caring midwives and obstetricians to make bad mistakes in the labour wards.

Published
2019
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153. Use of Continuous Electronic Fetal Monitoring in a Preterm Fetus: Clinical Dilemmas and Recommendations for Practice

Author

Afors, Karolina and Chandraharan, Edwin

Subjects
Article Subject, embryonic structures, reproductive and urinary physiology
Abstract

The aim of intrapartum continuous electronic fetal monitoring using a cardiotocograph (CTG) is to identify a fetus exposed to intrapartum hypoxic insults so that timely and appropriate action could be instituted to improve perinatal outcome. Features observed on a CTG trace reflect the functioning of somatic and autonomic nervous systems and the fetal response to hypoxic or mechanical insults during labour. Although, National Guidelines on electronic fetal monitoring exist for term fetuses, there is paucity of recommendations based on scientific evidence for monitoring preterm fetuses during labour. Lack of evidence-based recommendations may pose a clinical dilemma as preterm births account for nearly 8% (1 in 13) live births in England and Wales. 93% of these preterm births occur after 28 weeks, 6% between 22–27 weeks, and 1% before 22 weeks. Physiological control of fetal heart rate and the resultant features observed on the CTG trace differs in the preterm fetus as compared to a fetus at term making interpretation difficult. This review describes the features of normal fetal heart rate patterns at different gestations and the physiological responses of a preterm fetus compared to a fetus at term. We have proposed an algorithm “ACUTE” to aid management.

Published
2011
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157. Does ST analysis have a place in electronic fetal monitoring?

Author

Turnbull, Tamara L., Mol, Ben Willem J., Matthews, Geoff, Wilkinson, Chris, Chandraharan, Edwin, and Kuah, Sabrina

Subjects
FETAL monitoring, FETAL heart rate monitoring, INTRAPARTUM care, OBSTETRICS, PERINATAL care, FETAL anoxia
Abstract

Intrapartum cardiotocography (CTG) has a high false-positive rate. This has contributed to the rapid increase in obstetric interventions without a strong improvement in perinatal outcomes. We explore the role of ST analysis (STAN®) as an adjunct to CTG in identifying fetal asphyxia during labor. We conclude that STAN® reduces the rate of fetal blood sampling and instrumental vaginal deliveries, and has the potential to reduce the number of Australian operative interventions without compromising neonatal outcome. [ABSTRACT FROM PUBLISHER]

Published
2017
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