European Community Multi-Center Trial "Fetal ECG Analysis During Labor": ST plus CTG analysis

This report form part of the European Community Multi-Center Trial "Fetal ECG Analysis during Labor". Aim of this prospective trial was to identify changes in the fetal ECG waveform with cases of verified fetal hypoxia. In this paper we also report on the use of a newly developed automatic system for identification of ST waveform changes (ST Log). All ECG were recorded with the STAN recorder (Neoventa Medical AB, Gothenburg, Sweden). The ECG information was not displayed during labor in order not to influence the clinical management. This report includes data from 320 cases and include six cases of fetal intrapartum hypoxia. Twenty seven cases showed changes in ST waveform. All five cases with the most marked ST change (a rise in T/QRS of >0.10 units and lasting more then 10 minutes) had signs of ongoing intrapartum hypoxia. Six out of six cases with evidence of intrapartum asphyxia, showed ST changes. On the basis of our multi-center trial it appears that the combined analysis of CTG and ST waveform changes provides an accurate way to identify adverse events during labor. The work is continuing with a new STAN recorder developed by Neoventa Medical in Goteborg and currently being tested in a Swedish randomized, controlled multi-center trial

The impact of electrostatic air cleaning in free-ranging egg production

The development of a patented polymer based electron emitting technology (EAC) has provided a means to study the impact of reduced bioload in stable air on productivity. Apart from capturing particles in a negatively charged electrostatic field operating over the entire stable with hundreds of meters of emitting structure, the electrons combine with oxygen and vapor to produce H2O2 to block mould metabolism. Before and after data from three egg producing farms with 20-50 000 free-roaming layers were collected as part of their standard productivity control. The number of mould colonies decreased from >7 (range 7 – 30) to single colonies. Lay percentage over the production period covering 22 to 75 weeks of age increased by 3% and the feed conversion improved by 9%. During the last 10 production weeks, the overall improvement in productivity was 27% enabling the farmers to maintain a high productivity despite an ageing population of layers

ST analysis of the fetal electrocardiogram - Comments on recent experimental data.

In their paper, Andriessen at al present a validation of fetal ECG analysis and the clinical STAN device in midgestation fetal lambs exposed to 25 minutes of umbilical cord occlusion. The study presents results that contrast remarkably from previously published experimental data which raises a number of questions and comments. The most striking finding of Andriessen et al is the recording of an extremely high number of alarms from the STAN equipment during control conditions when no alarms at all are expected. These patterns have never been seen, neither in the clinical situation nor in our own fetal sheep studies. The reason for this becomes apparent when their way of recording the FECG is scrutinized. In their assessment of STAN, Andriessen at al use an assumed negative aVF lead with the assumption that it will reflect the FECG in the same way as the unipolar scalp lead used clinically. The signal used for disqualification of STAN is itself not qualified to properly represent the fetal scalp lead signal that STAN is designed for. To question a proven technology is fully accepted but those attempting would be asked to argue along fully validated data and related analysis including questioning of their own data

Nyttoeffekter med mobila trygghetslarm för personer med demenssjukdom och deras anhöriga

För kommunerna utgör kostnaderna för personer med demenssjukdom mer än 40 procent av deras totala kostnader för vård och omsorg och vi vet att samhällets insats förväntas öka framgent. Risken är att resurserna inte kommer att räcka till för att bevara en optimal livskvalité. Ett sätt att möta detta är att utnyttja olika tekniska lösningar. Mobila trygghetslarm är en möjliggörande teknologi med stor potential. Huvudsyftet med studien var att se på vilken grund mobila trygghetslarm kan vara ett verktyg som utvecklar vården och omsorgen för personer med demenssjukdom och underlättar för deras familjer i den dagliga tillvaron. Studien fokuserade på personer med demenssjukdom i eget boende.Sponsorship:Alzheimerfonden, Hjälpmedelsinstitutet</p

Identifying newborns with umbilical cord blood metabolic acidosis by intrapartum cardiotography combined with fetal ECG ST analysis (STAN) : comparison of the new and old FIGO systems to classify cardiotocograms

Introduction: The intrapartum cardiotocography (CTG) classification system by FIGO in 2015 (FIGO2015) was introduced to simplify CTG interpretation, but it is not harmonized with the fetal ECG ST analysis (STAN) algorithm from 2007 (STAN2007), which is based on the FIGO CTG system from 1987. The study aimed to determine time courses and sensitivity between the systems in classifying CTG + ST events to indicate metabolic acidosis at birth. Material and methods: Forty-four cases with umbilical cord artery metabolic acidosis were retrieved from a European multicenter database. CTG patterns and timing of the first occurring significant ST events were evaluated post hoc in consensus by an expert panel and sensitivity statistics were performed. Wilcoxon’s matched-pairs signed-ranks test and McNemar’s test were used with a two-tailed p <.05 regarded significant. Results: STAN2007 had a higher sensitivity (73 versus 43%, p =.0002) and alarmed for metabolic acidosis in mean 34 min earlier than the FIGO2015 system did (p =.002). In every fourth case, the time difference was ≥20 min. Conclusions: In this simulation study, surveillance with STAN2007 combined with fetal ECG ST analysis had a significantly higher sensitivity and would have alarmed for metabolic acidosis significantly earlier than the new FIGO system would have

FHR patterns that become significant in connection with ST waveform changes and metabolic acidosis at birth

<p><b>Introduction:</b> Recent developments have produced new CTG classification systems and the question is to what extent these may affect the model of FHR + ST interpretation? The two new systems (FIGO2015 and SSOG2017) classify FHR + ST events differently from the current CTG classification system used in the STAN interpretation algorithm (STAN2007).</p> <p><b>Aim:</b> Identify the predominant FHR patterns in connection with ST events in cases of cord artery metabolic acidosis missed by the different CTG classification systems. Indicate to what extent STAN clinical guidelines could be modified enhancing the sensitivity. Provide a pathophysiological rationale.</p> <p><b>Material and methods:</b> Forty-four cases with umbilical cord artery metabolic acidosis were retrieved from a European multicenter database. Significant FHR + ST events were evaluated <i>post hoc</i> in consensus by an expert panel.</p> <p><b>Results:</b> Eighteen cases were not identified as in need of intervention and regarded as negative in the sensitivity analysis. In 12 cases, ST changes occurred but the CTG was regarded as reassuring. Visual analysis of the FHR + ST tracings revealed specific FHR patterns:</p> <p><b>Conclusion:</b> These findings indicate FHR + ST analysis may be undertaken regardless of CTG classification system provided there is a more physiologically oriented approach to FHR assessment in connection with an ST event.</p