E. Grossi

I. Cetin

P. Antonazzo

V.M. Savasi

AIR Universita degli studi di Milano

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was associated with 42% of all cases of subacute hypoxia. 12.1% of
fetuses with a subacute hypoxic pattern had an umbilical cord arterial
pH57.0 compared to 7.7% without the subacute hypoxic pattern.
Conclusion: 30% of fetuses demonstrated features of subacute
hypoxia on the CTG trace during active maternal pushing. The use
of oxytocin or prostaglandins appear to increase the likelihood of
subacute hypoxic pattern. Subacute hypoxia which occurs secondary
to a combination of repetitive and prolonged compressions of the
umbilical cord and reduction in utero-placental oxygenation, which
results in a progressively less time spent at the normal baseline fetal
heart rate appears to increase the likelihood of lower umbilical cord
arterial pH at birth. This may be secondary to reduced time available
to expel carbon dioxide and metabolic acid as well as to obtain fresh
oxygenated blood from the placental venous sinuses.
Keywords: Cardiotocograph, subacute hypoxic pattern, rate of fall
in pH
733
Electronic fetal monitoring
during labor: comparison of
abdominal fetal
electrocardiography and doppler
cardiotocography
E. Grossi, P. Antonazzo, V. M. Savasi, and I. Cetin
Unit of Obstetrics and Gynaecology, Hospital Luigi Sacco, via Gb
Grassi 74, Milan, Centre for fetal research Giorgio Pardi,
Introduction: Electronic fetal monitoring is a method of fetal well
being monitoring during labur. It is the most utilized worldwide.
Nerveless it presents a poor sensitivity and limits regarding variability
inter- and intra-observer, frequently due to record of undetermined
tracks. Recently a non-invasive electronic feta monitoring has been
introduced. It is called Monica AN24 (abfECG) and is able to monitor
both maternal and fetal heart rate by abdominal ECG and uterine
activity by electrohysterography (EHG). This new tool presents
superiority in distinguishing fetal and maternal heart rate and it
appears more efficacy in obese pregnant. The aim of our study is to
compare lecture and clinicians interpretation of fetal heart tracing
obtained by these different tools.
Materials and methods: A total of twenty eight simultaneous CTG and
abfECG have been evaluated. One expert senior observer calculated
the percentage of success of each recording; total amount of small
and large accelerations, small and large decelerations and uterine
contractions have been counted. Ninety-two traces lasting 30minutes
each have assigned to four clinicians (2 senior and 2 junior) to be
classified according to ACOG classification.
Clinical cases & summary results: Overall perceived signal quality was
significantly superior for abfECG than CTG Doppler (94.19% vs.
88.23%, p<0.01). The number of small accelerations, small decelera-
tions and uterine contractions detected were greater in the trace
obtained using abfECG, while big decelerations were counted fewer
times. During second stage of labour, signal quality decreased using
both recording methods (85.00% vs. 84.60%, p = 0.638). Given 46 CTG
tracks of 30minutes each and the corresponding abfECG tracks (total:
92 tracks), percentage of agreement (Pa) among 4 observers in
interpreting the FHR patterns according to ACOG criteria was
calculated. Overall Pa was superior for abfECG than Doppler CTG
(47.8% vs. 39.1%), although this difference was not significant. All
observers choose the same ACOG category (namely ACOG 1, 2 or 3) in
47.8% of abfECG tracks, and only in 39.1% of Doppler CTG tracks. A
bad signal quality hindering the interpretation of the track was
reported on average in 8.7% abfECG recording and in 35.9% Doppler
recording (p<0.05). On average, in 0.5% of abfECG tracks no ACOG
category was attributed due to a bad signal quality, while this
happened in 3.8% of Doppler CTG recordings (p<0.05).
Conclusion: Monica AN24, through a better acquisition of the fetal
heart rates signal, could provide clearer information about fetal well
being and uterine contractions improving the skills of interpretation
of the CTG pattern and decreasing variability between clinicians.
Keywords: Electronic fetal monitoring, abdominal CTG, fetal well
being, sensitivity.
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 39


Electronic fetal monitoring during labor: comparison of abdominal fetal electrocardiography and doppler cardiotocography

https://air.unimi.it/retrieve/handle/2434/473713/778488/Grossi%20XXV%20ECPM.pdf

Electronic fetal monitoring during labor: comparison of abdominal fetal electrocardiography and doppler cardiotocography

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