Continuous Intrapartum Maternal and Fetal Temperature Monitoring

The maternal temperature is normally increasing during delivery. Maternal fever in labor is a common problem.Such fever could represent a chorioamnionitis (CAM), leading to an increased risk of neonatal encephalopathy andsubsequent cerebral palsy, as well as other complications. There are also noninfectious reasons for elevatedtemperature during delivery. There is no fetal heart rate that is specific for incipient or manifest CAM. Maternalfever in labor increases the risk of cesarean section and assisted vaginal delivery.The fetal intrapartum temperature has been studied sparsely before. Fetal head heat flux has been found to berelated to the metabolic condition of the fetus. Fetal skin temperature has been found to correlate with changingtemperature and baseline fetal heart rate.The aim of the present thesis was to investigate the fetal scalp temperature (FST) and maternal axillarytemperature (MAT) during vaginal delivery relative to progression of labor, uterine contractions, epidural analgesia(EDA), and to construct normal temperature reference ranges related to stage of labor. The purpose was also tostudy FST and MAT and the relation to inflammatory response in the placenta. Furthermore, the present thesisattempted to establish whether paracetamol (acetaminophen) has effect on fetal and maternal temperatures inlabor.An equipment to continuously record fetal scalp temperature during labor was developed by placing a temperaturesensor in the fetal scalp electrode aimed for fetal heart rate (FHR) monitoring. In the first study the equipment wasvalidated in a fetal lamb model, where the intracranial and subcutaneous temperatures were measured. Thesubcutaneous temperature mirrored the intracranial temperature closely, even in a situation of increasing fetalhypoxia, with the intracranial temperature being higher.In the following three studies the equipment was used in a total of 307 deliveries at Helsingborg hospital. Thematernal temperature was measured axillary. The development of FST and MAT was examined during normallabor. The temperatures increased significantly by progression of labor, and significantly more in the presence ofEDA. Reference intervals for maternal temperature were created. Changes of the FST were not seen duringuterine contractions.The relation between temperature and histological inflammatory changes was studied. There was a significantrelation between inflammatory changes in the placenta, umbilical cord and amniotic membranes, and maximumFST and MAT. Women with EDA had significantly more often inflammatory changes.Paracetamol is the only safe pharmacological choice to try to lower body temperature during delivery. The aim ofthe last study was to investigate the effect of paracetamol on maternal and fetal temperatures when given to febrileparturients. Neither maternal nor fetal temperatures decreased after paracetamol. However, paracetamol halted anincreasing trend and stabilized the fetal temperature, i.e. it has an anti-pyretic effect

Effects on fetal and maternal temperatures of paracetamol administration during labour: a case-control study.

OBJECTIVE: To study the effect of paracetamol (acetaminophen) on maternal and fetal temperatures in labour. STUDY DESIGN: From a cohort of 185 women with continuous maternal axillary and fetal scalp temperature recordings in labour, 18 women treated with 1000mg paracetamol orally for pyrexia and 36 untreated controls matched for parity, cervical dilatation, and epidural analgesia were selected. Electronically stored temperature data were analysed offline post hoc. The dual temperatures recorded every 30min from 60min before (T-60) paracetamol administration (T0) until delivery, were noted. Longitudinal data were compared with Wilcoxon matched-pairs signed-ranks test and cross-sectional data with Mann-Whitney U test. Shapes of the temperature curves were compared with mixed-effect models statistics for repeated measurements. The main outcome measures were temperature changes after paracetamol. A two-tailed P<0.05 was considered significant. RESULTS: Prior to T0 maternal and fetal temperatures increased in the paracetamol group, but after T0 no significant changes (P≥0.1) were seen when compared with Wilcoxon signed-ranks test. In the control group, both temperatures increased from T-60 and onwards. Delta-temperatures (fetal minus maternal temperature) remained unchanged in both groups. Analyses of the mixed-effect models showed a significant difference (P=0.01) in the shape of fetal temperature curves between the paracetamol and control groups, but no significant difference (P=0.4) in maternal temperature curve shapes. CONCLUSION: In febrile parturients, neither maternal nor fetal temperatures dropped after paracetamol, but paracetamol halted an increasing trend and stabilised the fetal temperature. The effect of paracetamol on maternal temperature was inconclusive

Status Quo and Problems of Requirements Engineering for Machine Learning: Results from an International Survey

Systems that use Machine Learning (ML) have become commonplace for companies that want to improve their products and processes. Literature suggests that Requirements Engineering (RE) can help address many problems when engineering ML-enabled systems. However, the state of empirical evidence on how RE is applied in practice in the context of ML-enabled systems is mainly dominated by isolated case studies with limited generalizability. We conducted an international survey to gather practitioner insights into the status quo and problems of RE in ML-enabled systems. We gathered 188 complete responses from 25 countries. We conducted quantitative statistical analyses on contemporary practices using bootstrapping with confidence intervals and qualitative analyses on the reported problems involving open and axial coding procedures. We found significant differences in RE practices within ML projects. For instance, (i) RE-related activities are mostly conducted by project leaders and data scientists, (ii) the prevalent requirements documentation format concerns interactive Notebooks, (iii) the main focus of non-functional requirements includes data quality, model reliability, and model explainability, and (iv) main challenges include managing customer expectations and aligning requirements with data. The qualitative analyses revealed that practitioners face problems related to lack of business domain understanding, unclear goals and requirements, low customer engagement, and communication issues. These results help to provide a better understanding of the adopted practices and of which problems exist in practical environments. We put forward the need to adapt further and disseminate RE-related practices for engineering ML-enabled systems.Comment: Accepted for Publication at PROFES 202

Fetal and maternal temperatures during labor and delivery : a prospective descriptive study

Objective: The objective of this study is to study the fetal scalp temperature (FST) and maternal axillary temperature (MAT) during vaginal delivery relative to progression of labor, uterine contractions (UC) and epidural analgesia (EDA), and to construct normal temperature reference ranges related to stage of labor. Material and methods: Temperatures were recorded continuously in labor of 132 women with a bi-metal temperature sensor attached to the axilla (MAT) and a similar sensor mounted in a scalp electrode (FST). The temperature data were stored electronically and analyzed offline at cervical dilatations of 2–3, 5, 7–8, and 10 cm, and at full retraction. The FST was read before, at increasing, at peak, at decreasing, and after UC. The MAT and FST curves were compared with mixed-effect models statistics for repeated measurements. A two-tailed p <.05 was considered significant. Results: The FST did not vary during UC (p = .24). Both FST and MAT increased linearly by progression of labor (both p < .001). The increases in temperatures were greater with EDA than without (p < .001). Conclusions: During UC, the FST showed no alteration. Both FST and MAT increased significantly by progression of labor, and significantly more in the presence of EDA. The presented normal temperature reference ranges can be used for future research

Continuous monitoring of fetal scalp temperature in labor: a new technology validated in a fetal lamb model.

OBJECTIVE: To evaluate a new technical equipment for continuous recording of human fetal scalp temperature in labor. DESIGN: Experimental animal study. METHODS: Two temperature sensors were placed subcutaneously and intracranially on the forehead of 10 fetal lambs and connected to a temperature monitoring system. The system records temperatures simultaneously on-line and stores data to be analyzed off-line. Throughout the experiment, the fetus was oxygenated via the umbilical cord circulation. Asphyxia was induced by intermittent cord compression, as assessed by pH in jugular vein blood. The intracranial (ICT) and subcutaneous (SCT) temperatures were compared with simple and polynomial regression analyses. MAIN OUTCOME MEASURES: Absolute and delta ICT and SCT changes. RESULTS: ICT and SCT were both successfully recorded in all 10 cases. With increasing acidosis, the temperatures decreased. The correlation coefficient between ICT and SCT had a range of 0.76-0.97 (median 0.88) by simple linear regression and 0.80-0.99 (median 0.89) by second grade polynomial regression. After an initial system stabilization period of 10 minutes, the delta temperature values (ICT minus SCT) were less than 1.5 degrees C throughout the experiment in all but one case. CONCLUSIONS: The fetal forehead SCT mirrored the ICT closely, with the ICT being higher

Status Quo and Problems of Requirements Engineering for Machine Learning: Results from an International Survey

Systems that use Machine Learning (ML) have become commonplace for companies that want to improve their products and processes. Literature suggests that Requirements Engineering (RE) can help address many problems when engineering ML-enabled systems. However, the state of empirical evidence on how RE is applied in practice in the context of ML-enabled systems is mainly dominated by isolated case studies with limited generalizability. We conducted an international survey to gather practitioner insights into the status quo and problems of RE in ML-enabled systems. We gathered 188 complete responses from 25 countries. We conducted quantitative statistical analyses on contemporary practices using bootstrapping with confidence intervals and qualitative analyses on the reported problems involving open and axial coding procedures. We found significant differences in RE practices within ML projects. For instance, (i) RE-related activities are mostly conducted by project leaders and data scientists, (ii) the prevalent requirements documentation format concerns interactive Notebooks, (iii) the main focus of non-functional requirements includes data quality, model reliability, and model explainability, and (iv) main challenges include managing customer expectations and aligning requirements with data. The qualitative analyses revealed that practitioners face problems related to lack of business domain understanding, unclear goals and requirements, low customer engagement, and communication issues. These results help to provide a better understanding of the adopted practices and of which problems exist in practical environments. We put forward the need to adapt further and disseminate RE-related practices for engineering ML-enabled systems

A perineal protection device designed to protect the perineum during labor: a multicenter randomized controlled trial.

The objective of this study was to evaluate the protective effects of a new device for reducing perineal tears during vaginal childbirth