Prenatal diagnosis of a bundle branch block based on the fetal ECG

A non-invasive fetal ECG was performed on a 36-year-old pregnant woman at 24+6 weeks of gestation as part of ongoing clinical research. A paediatric cardiologist suspected an incomplete bundle branch block based on the averaged ECGs from the recording. The characteristic terminal R' wave was present in multiple leads of the fetal ECGs. A fetal anomaly scan had been performed at 20 weeks of gestation and showed no abnormalities. An incomplete right bundle branch block was confirmed on an ECG recorded at the age of 2 years. This case shows the possibility of novel non-invasive fetal ECG technology as an adjunct to the diagnosis of fetal cardiac anomalies in the future

The fetal electrocardiogram to detect the effects of betamethasone on fetal heart rate variability.

\u3cp\u3eBackground: Betamethasone is widely used to enhance fetal lung maturation in case of threatened preterm birth. Antenatal corticosteroids are known to reduce fetal heart rate variability (fHRV) in the days following administration. Since decreased fHRV is a marker for fetal distress, this transient decrease of fHRV can cause unnecessary medical intervention. Aim: To describe the effect of betamethasone on fHRV, by applying spectral analysis on non-invasive fetal electrocardiogram (fECG) recordings. Study design: Secondary analysis of a prospective cohort study. Subjects: Women with a singleton pregnancy, at risk for preterm delivery and receiving betamethasone, admitted to the obstetric high care unit in the period from March 2013 until July 2016. Outcome measures: The primary outcome measure was fHRV in both time- and frequency-domain. Secondary outcome measures included basal fetal heart rate (fHR) and fHR variance. FHRV parameters were then calculated separately for the quiet and active state. Results: Following 68 inclusions, 22 patients remained with complete series of measurements and sufficient data quality. FHRV parameters and fHR showed a decrease on day 2 compared to day 1, significant for short-term variability and high-frequency power. Similar results were found when analyzing for separate behavioral states. The number of segments in quiet state increased during days 1 and 2. Normalized values showed no difference for all behavioral states. Conclusion: FHRV decreases on day 2 after betamethasone administration, while periods of fetal quiescence increase. No changes were found in the normalized values, indicating that the influence of autonomic modulation is minor. Clinical trial registration number NL43294.015.13\u3c/p\u3

Feasibility of non-invasive Foetal electrocardiography in a twin pregnancy

BACKGROUND: Twin pregnancy is associated with increased perinatal mortality. Close foetal monitoring is therefore warranted. Doppler Ultrasound cardiotocography is currently the only available method to monitor both individual foetuses. Unfortunately, the performance measures of this method are poor and erroneous monitoring of the same twin with both transducers may occur, leaving the second twin unmonitored. In this study we aimed to determine the feasibility of monitoring both foetuses simultaneously in twin gestation by means of non-invasive foetal electrocardiography (NI-fECG), using an electrode patch on the maternal abdomen. METHODS: A NI-fECG recording was performed at 25 + 3 weeks of gestation on a multiparous woman pregnant with dichorionic diamniotic twins. An electrode patch consisting of eight adhesive electrodes was applied on the maternal abdomen, yielding six channels of bipolar electrophysiological measurements. The output was digitized and stored for offline processing. The recorded signals were preprocessed by suppression of high-frequency noise, baseline wander, and powerline interference. Secondly, the maternal ECG was subtracted and segmentation into individual ECG complexes was performed. Finally, ensemble averaging of these individual ECG complexes was performed to suppress interferences. RESULTS: Six different recordings were obtained from each of the six recording channels. Depending on the orientation and distance of the fetal heart with respect to each electrode, a distinction could be made between each fetus based on the morphology of the signals. Yielding of the fetal ECGs was performed manually based on the QRS complexes of each fetus. CONCLUSION: NI-fECG with multiple electrodes allows for monitoring of the fetal heart rate and ECG of both individual fetuses in twin pregnancies

The Noninvasive Fetal Electrocardiogram During Labor: A Review of the Literature

Importance: The introduction of the cardiotocogram (CTG) during labor has not been found to improve neonatal outcome. The search for a more reliable, less invasive, and patient-friendly technique is ongoing. The noninvasive fetal electrocardiogram (NI-fECG) has been proposed as one such alternative. Objectives: The aim of this study was to review the literature on the performance of NI-fECG for fetal monitoring during labor. Following the PRISMA guidelines, a systematic search in MEDLINE, EMBASE, and Cochrane Library was performed. Studies involving original research investigating the performance of NI-fECG during labor were included. Animal studies and articles in languages other than English, Dutch, or German were excluded. The QUADAS-2 checklist was used for quality assessment. A descriptive analysis of the results is provided. Results: Eight articles were included. Pooled analysis of the results of the separate studies was not possible due to heterogeneity. All studies demonstrate that it is possible to apply NI-fECG during labor. Compared with Doppler ultrasound, NI-fECG performs equal or better in most studies. Conclusions and Relevance: NI-fECG for fetal monitoring is a promising noninvasive and patient-friendly technique that provides accurate information. Future studies should focus on signal quality throughout labor, with the aim to further optimize technical development of NI-fECG

Stuitbevalling in ‘all fours’-positie

Since the publication of the results of the Term Breech Trial (TBT) in 2000 the number of planned Caesarean sections for breech presentation has increased dramatically, at the expense of vaginal breech deliveries. The favourable effect of a planned Caesarean section for breech presentation on perinatal outcomes described in the TBT could not, however, be reproduced in later trials. A planned Caesarean section does carry an increased risk of maternal complications; furthermore, a previous Caesarean section leads to higher risks for both mother and child in any subsequent pregnancy. A recent prospective study advocates vaginal breech delivery 'on all fours', a position in which the mother leans on her hands and knees during delivery. A vaginal breech delivery in this position seems to be just as safe for the child as a planned Caesarean section, while a vaginal delivery is safer for the mother than a Caesarean section. This article describes two uncomplicated vaginal breech deliveries in the all fours position

Breech delivery 'on all fours'

Since the publication of the results of the Term Breech Trial (TBT) in 2000 the number of planned Caesarean sections for breech presentation has increased dramatically, at the expense of vaginal breech deliveries. The favourable effect of a planned Caesarean section for breech presentation on perinatal outcomes described in the TBT could not, however, be reproduced in later trials. A planned Caesarean section does carry an increased risk of maternal complications; furthermore, a previous Caesarean section leads to higher risks for both mother and child in any subsequent pregnancy. A recent prospective study advocates vaginal breech delivery 'on all fours', a position in which the mother leans on her hands and knees during delivery. A vaginal breech delivery in this position seems to be just as safe for the child as a planned Caesarean section, while a vaginal delivery is safer for the mother than a Caesarean section. This article describes two uncomplicated vaginal breech deliveries in the all fours position.</p