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Course outline

  1. Analysis of the FHR (Locked)
    1. A twofold issue (Locked)
    2. Some clarifications (Locked)
    3. Cardiotocographic data
    4. A few remarks (Locked)
    5. Later on… (Locked)
    6. Examples of digital tracings (Locked)
Free account (Locked)

A twofold issue

We have previously seen that the reactivity of the fetal heart rate reflected the oxygenation of its brain and that hypoxaemic episodes (pO2 ↓) could manifest as decelerations of its heart rate. However, it is well known that analysis of the heart rate lacks specificity for the diagnosis of the problem that concerns us, namely acidosis ([H+] tissue ↑) (Ugwumadu 2014[16]).

In the 1970s, visual analysis of the FHR became common clinical practice because trials, albeit uncontrolled, had shown that the FHR method reduced the intrapartum fetal mortality rate by a factor of more than 3 (Liu 2008[12]).

References

  1. Alfirevic Z., Devane D., Gyte G. M., et Cuthbert A. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev, 2: CD006066, Mar. 2017. ISSN 1469-493X. doi: 10.1002/14651858.CD006066.pub3.
  2. Ayres-de-Campos D., Arteiro D., Costa-Santos C., et Bernardes J. Knowledge of adverse neonatal outcome alters clinicians' interpretation of the intrapartum cardiotocograph: Knowledge of neonatal outcome and CTG interpretation. BJOG: An International Journal of Obstetrics & Gynaecology, 118 (8): 978–984, July 2011. ISSN 14700328. doi: 10.1111/j.1471-0528.2011.03003.x.
  3. Ayres-de-Campos D., Spong C. Y., et Chandraharan E. FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography. International Journal of Gynecology & Obstetrics, 131 (1): 13–24, 2015b. ISSN 0020-7292. doi: 10.1016/j.ijgo.2015.06.020.
  4. Beaulieu MD., Fabia J., Leduc B., Brisson J., Bastide A., Blouin D., Gauthier RJ., et Lalonde A. The reproducibility of intrapartum cardiotocogram assessments. Canadian Medical Association Journal, 127 (3): 214, 1982.
  5. Bernardes J., Costa-Pereira A., Ayres-de-Campos D., van Geijn H. P., et Pereira-Leite L. Evaluation of interobserver agreement of cardiotocograms. Int J Gynaecol Obstet, 57 (1): 33–37, Apr. 1997. ISSN 0020-7292.
  6. Blix E., Sviggum O., Koss K. S., et Øian P. Inter-observer variation in assessment of 845 labour admission tests: Comparison between midwives and obstetricians in the clinical setting and two experts. BJOG: an international journal of obstetrics and gynaecology, 110 (1): 1–5, 2003. ISSN 1470-0328.
  7. Chandraharan E., Pereira S., Ghi T., Gracia Perez-Bonfils A., Fieni S., Jia Y.-J., Griffiths K., Sukumaran S., Ingram C., Reeves K., Bolten M., Loser K., Carreras E., Suy A., Garcia-Ruiz I., Galli L., et Zaima A. International expert consensus statement on physiological interpretation of cardiotocograph (CTG) - First revision (2024). European Journal of Obstetrics & Gynecology and Reproductive Biology, 302: 346–355, Nov. 2024. ISSN 03012115. doi: 10.1016/j.ejogrb.2024.09.034.
  8. CNGOF. Recommandations pour la pratique clinique : Modalités de surveillance fœtale pendant le travail, 2007.
  9. Fournié A., Connan L., Parant O., et Lesourd-Pontonnier F. Souffrance fœtale aiguë. Encycl Méd Chir, Obstétrique (5-077-A-30): 1–11, 1999.
  10. Garabedian C., Butruille L., Drumez E., Servan Schreiber E., Bartolo S., Bleu G., Mesdag V., Deruelle P., De Jonckheere J., et Houfflin-Debarge V. Inter-observer reliability of 4 fetal heart rate classifications. Journal of Gynecology Obstetrics and Human Reproduction, 46 (2): 131–135, Feb. 2017. ISSN 2468-7847. doi: 10.1016/j.jogoh.2016.11.002.
  11. Jauniaux E. et Prefumo F. Fetal heart monitoring in labour: From pinard to artificial intelligence. BJOG-An International Journal Of Obstetrics And Gynaecology, 123 (6): 870, 2016. ISSN 1470-0328.
  12. Liu M., Shen Y., et Scerbo M. A Survey of Computerized Fetal Heart Rate Monitoring and Interpretation Techniques. In 2008 Modeling and Simulation Capstone Conference, pages 1–8, 2008. ↩
  13. Lutomski J. E., Meaney S., Greene R. A., Ryan A. C., et Devane D. Expert systems for fetal assessment in labour. Cochrane Database of Systematic Reviews, 2015 (4), Apr. 2015. ISSN 14651858. doi: 10.1002/14651858.CD010708.pub2.
  14. Nielsen P. V., Stigsby B., Nickelsen C., et Nim J. Intra- and inter-observer variability in the assessment of intrapartum cardiotocograms. Acta Obstet Gynecol Scand, 66 (5): 421–424, 1987. ISSN 0001-6349.
  15. Sabiani L., Le Dû R., Loundou A., d'Ercole C., Bretelle F., Boubli L., et Carcopino X. Intra-and interobserver agreement among obstetric experts in court regarding the review of abnormal fetal heart rate tracings and obstetrical management. American journal of obstetrics and gynecology, 213 (6): 856.e1–856.e8, 2015. ISSN 0002-9378. doi: 10.1016/j.ajog.2015.08.066.
  16. Ugwumadu A. Are we (mis) guided by current guidelines on intrapartum fetal heart rate monitoring? Case for a more physiological approach to interpretation. BJOG: An International Journal of Obstetrics & Gynaecology, 121 (9): 1063–1070, 2014. ISSN 1471-0528. ↩
  17. Vintzileos A. M., Nochimson D. J., Guzman E. R., Knuppel R. A., Lake M., et Schifrin B. S. Intrapartum electronic fetal heart rate monitoring versus intermittent auscultation: A meta-analysis. Obstet Gynecol, 85 (1): 149–155, Jan. 1995. ISSN 0029-7844.
  18. Zain H. A., Wright JW., Parrish GE., et Diehl SJ. Interpreting the fetal heart rate tracing. Effect of knowledge of neonatal outcome. The Journal of reproductive medicine, 43 (4): 367–370, 1998. ISSN 0024-7758.

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