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Inês Nunes

Faculdade de Medicina da Universidade do Porto, Departamento de Obstetrícia e Ginecologia, Post-Doc

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Andrea Muñoz Martínez

Universidad de Chile

DR.ABHITOSH DEBATA

Rajiv Gandhi University of Health Sciences

Anamaria Bechir

Titu Maiorescu

Rony Christian Hidalgo

Universidad Peruana Cayetano Heredia

CLEMENT C AZODO

University of Benin

Fatma Yasmin Mahdani

Universitas Airlangga

University of Michigan

Arcelino Farias Neto

Universidade Potiguar Unp

Dr. Syed Wali Peeran

Sebha University

University of Hail

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Papers by Inês Nunes

6. Systems for computer analysis of intrapartum fetal heart rate signals

De Gruyter eBooks, May 18, 2015

European Guidelines on Perinatal Care - Oxytocin for induction and augmentation of labor

Journal of Maternal-fetal & Neonatal Medicine, Sep 1, 2021

10 min is reached, a non-reassuring CTG pattern ensues, or maximum rates are reached (Low quality... more 10 min is reached, a non-reassuring CTG pattern ensues, or maximum rates are reached (Low quality evidence 11-; Strong recommendation). If the frequency of contractions exceeds 5 in 10 min, the infusion rate should be reduced, even if a normal CTG pattern is present. With a non-reassuring CTG pattern, urgent clinical assessment by an obstetrician is indicated, and strong consideration should be given to reducing or stopping the oxytocin infusion. The minimal effective dose of oxytocin should always be used. (Low 11-to Moderate 111-quality evidence; Strong recommendation). 6. Use of oxytocin for induction and augmentation of labor should be regularly audited (Low quality evidence 11-; Strong recommendation).

Prolonged saltatory fetal heart rate pattern leading to newborn metabolic acidosis

Clinical and Experimental Obstetrics & Gynecology, 2014

The saltatory pattern, characterized by wide and rapid oscillations of the fetal heart rate (FHR)... more The saltatory pattern, characterized by wide and rapid oscillations of the fetal heart rate (FHR), remains a controversial entity. The authors sought to evaluate whether it could be associated with an adverse fetal outcome. Material and Methods: The authors report a case series of four saltatory patterns occurring in the last 30 minutes before birth in association with cord artery metabolic acidosis, obtained from three large databases of internally acquired FHR tracings. The distinctive characteristics of this pattern were evaluated with the aid of a computer system. Results: All cases were recorded in uneventful pregnancies, with normal birthweight singletons, born vaginally at term. The saltatory pattern lasted between 23 and 44 minutes, exhibited a mean oscillatory amplitude of 45.9 to 80.0 beats per minute (bpm) and a frequency between four and eight cycles per minute. Conclusions: A saltatory pattern exceeding 20 minutes can be associated with the occurrence of fetal metabolic acidosis.

European Guidelines on Perinatal Care - Oxytocin for induction and augmentation of labor

The Journal of Maternal-Fetal & Neonatal Medicine, 2021

10 min is reached, a non-reassuring CTG pattern ensues, or maximum rates are reached (Low quality... more 10 min is reached, a non-reassuring CTG pattern ensues, or maximum rates are reached (Low quality evidence 11-; Strong recommendation). If the frequency of contractions exceeds 5 in 10 min, the infusion rate should be reduced, even if a normal CTG pattern is present. With a non-reassuring CTG pattern, urgent clinical assessment by an obstetrician is indicated, and strong consideration should be given to reducing or stopping the oxytocin infusion. The minimal effective dose of oxytocin should always be used. (Low 11-to Moderate 111-quality evidence; Strong recommendation). 6. Use of oxytocin for induction and augmentation of labor should be regularly audited (Low quality evidence 11-; Strong recommendation).

O504 Prolonged Saltatory Fetal Heart Rate Pattern Leading to an Adverse Neonatal Outcome

International Journal of Gynecology & Obstetrics, 2012

Results: A total of 1105 women were referred under the 2WW rule for suspected gynaecological mali... more Results: A total of 1105 women were referred under the 2WW rule for suspected gynaecological malignancy. Seven-hundred sixty five women (69.23%) were referred with suspected endometrial cancer, 179 women (16.20%) with suspected ovarian cancer, 117 women (10.59%) with suspected cervical cancer and 44 women (3.98%) with suspected vulvo-vaginal cancer. The positive predictive value of referrals for diagnosing endometrial, ovarian, cervical and vulvo-vaginal malignancy was 8.1%, 9.5%, 5.98% and 13.64%. The overall predictive value for diagnosing gynaecological malignancy was 8.33% and was lower in premenopausal than postmenopausal women (1.86% and 9.89% respectively, p < 0.0005). The number of cancers diagnosed through non-urgent referrals was higher than the number diagnosed through 2WW referrals (95 vs. 92). Endometrial cancer was associated with older age (p < 0.0005), recurrent bleeding (p < 0.0005), prolonged bleeding (p < 0.0005), diabetes mellitus (p < 0.0005), hypertension (p = 0.01) and increased endometrial thickness (p < 0.0005). The use of HRT, tamoxifen and severity of bleeding was not related to the risk of malignancy. Conclusions: In conclusion, the overall predictive value of the 2-week wait referral system for suspected gynaecological malignancies is low particularly in premenopausal women. The current referral criteria need to be reviewed to gain the maximum benefits from this care pathway with a view to incorporating clinical risk factors to prioritise urgent clinic slots and refine subsequent management strategies.

Systematic Review of Intrapartum Fetal Heart Rate Spectral Analysis and an Application in the Detection of Fetal Acidemia

Frontiers in Pediatrics, 2021

It is fundamental to diagnose fetal acidemia as early as possible, allowing adequate obstetrical ... more It is fundamental to diagnose fetal acidemia as early as possible, allowing adequate obstetrical interventions to prevent brain damage or perinatal death. The visual analysis of cardiotocography traces has been complemented by computerized methods in order to overcome some of its limitations in the screening of fetal hypoxia/acidemia. Spectral analysis has been proposed by several studies exploring fetal heart rate recordings while referring to a great variety of frequency bands for integrating the power spectrum. In this paper, the main goal was to systematically review the spectral bands reported in intrapartum fetal heart rate studies and to evaluate their performance in detecting fetal acidemia/hypoxia. A total of 176 articles were reviewed, from MEDLINE, and 26 were included for the extraction of frequency bands and other relevant methodological information. An open-access fetal heart rate database was used, with recordings of the last half an hour of labor of 246 fetuses. Four...

Compressive Neuropathy: A Consequence of Mal-Positioning during Labour?

Acta Médica Portuguesa

Infecções Sexualmente Transmissíveis: desafio passado, presente ou futuro?

Fetal Heart Rate Fragmentation

Frontiers in Pediatrics

Intrapartum fetal monitoring's primary goal is to avoid adverse perinatal outcomes related to... more Intrapartum fetal monitoring's primary goal is to avoid adverse perinatal outcomes related to hypoxia/acidosis without increasing unnecessary interventions. Recently, a set of indices were proposed as new biomarkers to analyze heart rate (HR), termed HR fragmentation (HRF). In this work, the HRF indices were applied to intrapartum fetal heart rate (FHR) traces to evaluate fetal acidemia. The fragmentation method produces four indices: PIP-Percentage of inflection points; IALS-Inverse of the average length of acceleration/deceleration segments; PSS-Percentage of short segments; PAS-Percentage of alternating segments. On the other hand, the symbolic approach studied the existence of different patterns of length four. We applied the measures to 246 selected FHR recordings sampled at 4 and 2 Hz, where 39 presented umbilical artery's pH ≤ 7.15. When applied to the 4 Hz FHR, the PIP, IASL, and PSS showed significantly higher values in the traces from acidemic fetuses. In compariso...

Physical exercise in pregnancy: benefits, risks and prescription

Journal of Perinatal Medicine

Objectives Regular physical exercise during pregnancy is associated with numerous benefits. In ge... more Objectives Regular physical exercise during pregnancy is associated with numerous benefits. In general women are not adequately advised on this matter and along with their concerns regarding the potential risks, it contributes to the abandonment or refusal to start exercising during pregnancy. Content The aim of this article is to provide a comprehensive literature review, gathering the strongest evidence about the risks and benefits and the prescription of physical exercise. A systematic search was conducted in MEDLINE including articles considered to have the highest level of scientific evidence. Fifty-seven articles, including 32 meta-analysis, 9 systematic reviews and 16 randomized controlled trials were included in the final review. Summary Exercise can help preventing relevant pregnancy related disorders, such as gestational diabetes, excessive gestational weight gain, hypertensive disorders, urinary incontinence, fetal macrosomia, lumbopelvic pain, anxiety and prenatal depres...

Complexity of Cardiotocographic Signals as A Predictor of Labor

by Inês Nunes and Célia Amorim-Costa

Entropy

Prediction of labor is of extreme importance in obstetric care to allow for preventive measures, ... more Prediction of labor is of extreme importance in obstetric care to allow for preventive measures, assuring that both baby and mother have the best possible care. In this work, the authors studied how important nonlinear parameters (entropy and compression) can be as labor predictors. Linear features retrieved from the SisPorto system for cardiotocogram analysis and nonlinear measures were used to predict labor in a dataset of 1072 antepartum tracings, at between 30 and 35 weeks of gestation. Two groups were defined: Group A—fetuses whose traces date was less than one or two weeks before labor, and Group B—fetuses whose traces date was at least one or two weeks before labor. Results suggest that, compared with linear features such as decelerations and variability indices, compression improves labor prediction both within one (C-Statistics of 0.728) and two weeks (C-Statistics of 0.704). Moreover, the correlation between compression and long-term variability was significantly different...

Computer‐based intrapartum fetal monitoring and beyond: a review of the 2 nd Workshop on Signal Processing and Monitoring in Labor (Oct 2017, Oxford UK )

Acta Obstetricia et Gynecologica Scandinavica

Central Fetal Monitoring With and Without Computer Analysis: A Randomized Controlled Trial

Obstetrics and gynecology, 2017

To evaluate whether intrapartum fetal monitoring with computer analysis and real-time alerts decr... more To evaluate whether intrapartum fetal monitoring with computer analysis and real-time alerts decreases the rate of newborn metabolic acidosis or obstetric intervention when compared with visual analysis. A randomized clinical trial carried out in five hospitals in the United Kingdom evaluated women with singleton, vertex fetuses of 36 weeks of gestation or greater during labor. Continuous central fetal monitoring by computer analysis and online alerts (experimental arm) was compared with visual analysis (control arm). Fetal blood sampling and electrocardiographic ST waveform analysis were available in both arms. The primary outcome was incidence of newborn metabolic acidosis (pH less than 7.05 and base deficit greater than 12 mmol/L). Prespecified secondary outcomes included operative delivery, use of fetal blood sampling, low 5-minute Apgar score, neonatal intensive care unit admission, hypoxic-ischemic encephalopathy, and perinatal death. A sample size of 3,660 per group (N=7,320)...

SisPorto 4.0 - computer analysis following the 2015 FIGO Guidelines for intrapartum fetal monitoring

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 3, 2016

SisPorto 4.0 is the most recent version of a program for computer analysis of cardiotocographic s... more SisPorto 4.0 is the most recent version of a program for computer analysis of cardiotocographic signals and ST events, which has been adapted to the 2015 International Federation of Gynecology and Obstetrics (FIGO) guidelines for intrapartum fetal monitoring. This paper provides a detailed description of the analysis performed by the system, including the signal processing algorithms involved in identification of basic CTG features and the resulting real-time alerts.

Computer analysis of foetal monitoring signals

Best Practice & Research Clinical Obstetrics & Gynaecology, 2015

Five systems for computer analysis of foetal monitoring signals are currently available, incorpor... more Five systems for computer analysis of foetal monitoring signals are currently available, incorporating the evaluation of cardiotocographic (CTG) or combined CTG with electrocardiographic ST data. All systems have been integrated with central monitoring stations, allowing the simultaneous monitoring of several tracings on the same computer screen in multiple hospital locations. Computer analysis elicits real-time visual and sound alerts for health care professionals when abnormal patterns are detected, with the aim of prompting a re-evaluation and subsequent clinical action, if considered necessary. Comparison between the CTG analyses provided by the computer and clinical experts has been carried out in all systems, and in three of them, the accuracy of computer alerts in predicting newborn outcomes was evaluated. Comparisons between these studies are hampered by the differences in selection criteria and outcomes. Two of these systems have just completed multicentre randomised clinical trials comparing them with conventional CTG monitoring, and their results are awaited shortly. For the time being, there is limited evidence regarding the impact of computer analysis of foetal monitoring signals on perinatal indicators and on health care professionals&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; behaviour.

Differences between external and internal fetal heart rate monitoring during the second stage of labor: a prospective observational study

Journal of Perinatal Medicine, 2000

To compare fetal heart rate (FHR) signals acquired simultaneously by an external ultrasound probe... more To compare fetal heart rate (FHR) signals acquired simultaneously by an external ultrasound probe and a scalp electrode during the second stage of labor.This was a prospective observational study in a labor ward of a tertiary care university hospital. The population was women in labor with uneventful singleton pregnancies at term. Simultaneous external and internal FHR monitoring was performed in 67 consecutively recruited women during the second stage of labor. Cases were subsequently excluded if the trace length was under 40 min, cesarean birth occurred, or the interval between trace-end and birth exceeded 5 min, leaving a total of 33 traces for analysis. The last 40–60 min of these traces were analyzed by a computer system (Omniview-SisPortoA higher signal loss was observed with external monitoring [10% vs. 4%; P<0.001, LoA=(–6, 18)]. No differences were found in mean FHR baseline [129 bpm vs. 130 bpm, P=0.245, LoA=(–15, 12)], but more accelerations [12 vs. 8, P<0.001, LoA=...

An overview of central fetal monitoring systems in labour

Journal of Perinatal Medicine, 2000

ABSTRACT Abstract A variety of systems for centralised viewing of fetal signals during labour are... more ABSTRACT Abstract A variety of systems for centralised viewing of fetal signals during labour are currently available, allowing simultaneous monitoring of multiple tracings in one or more locations. Display of maternal vital signs, ST signals and an electronic partogram are available in the majority of these systems. A few of them have incorporated computer analysis of cardiotocographic signals or combined cardiotocographic and ST data analysis. Computer analysis may elicit real-time alerts for healthcare professionals when changes associated with fetal hypoxia are detected. Central fetal monitoring systems have been installed in a large number of maternity hospitals in industrialised countries, but there is still limited evidence of their impact on perinatal indicators, on the behaviour of healthcare professionals and on related health costs.

O504 Prolonged Saltatory Fetal Heart Rate Pattern Leading to an Adverse Neonatal Outcome

by Inês Nunes and D. Ayres-De-Campos

International Journal of Gynecology & Obstetrics, 2012

6. Systems for computer analysis of intrapartum fetal heart rate signals

De Gruyter eBooks, May 18, 2015

European Guidelines on Perinatal Care - Oxytocin for induction and augmentation of labor

Journal of Maternal-fetal & Neonatal Medicine, Sep 1, 2021

10 min is reached, a non-reassuring CTG pattern ensues, or maximum rates are reached (Low quality... more 10 min is reached, a non-reassuring CTG pattern ensues, or maximum rates are reached (Low quality evidence 11-; Strong recommendation). If the frequency of contractions exceeds 5 in 10 min, the infusion rate should be reduced, even if a normal CTG pattern is present. With a non-reassuring CTG pattern, urgent clinical assessment by an obstetrician is indicated, and strong consideration should be given to reducing or stopping the oxytocin infusion. The minimal effective dose of oxytocin should always be used. (Low 11-to Moderate 111-quality evidence; Strong recommendation). 6. Use of oxytocin for induction and augmentation of labor should be regularly audited (Low quality evidence 11-; Strong recommendation).

Prolonged saltatory fetal heart rate pattern leading to newborn metabolic acidosis

Clinical and Experimental Obstetrics & Gynecology, 2014

The saltatory pattern, characterized by wide and rapid oscillations of the fetal heart rate (FHR)... more The saltatory pattern, characterized by wide and rapid oscillations of the fetal heart rate (FHR), remains a controversial entity. The authors sought to evaluate whether it could be associated with an adverse fetal outcome. Material and Methods: The authors report a case series of four saltatory patterns occurring in the last 30 minutes before birth in association with cord artery metabolic acidosis, obtained from three large databases of internally acquired FHR tracings. The distinctive characteristics of this pattern were evaluated with the aid of a computer system. Results: All cases were recorded in uneventful pregnancies, with normal birthweight singletons, born vaginally at term. The saltatory pattern lasted between 23 and 44 minutes, exhibited a mean oscillatory amplitude of 45.9 to 80.0 beats per minute (bpm) and a frequency between four and eight cycles per minute. Conclusions: A saltatory pattern exceeding 20 minutes can be associated with the occurrence of fetal metabolic acidosis.

European Guidelines on Perinatal Care - Oxytocin for induction and augmentation of labor

The Journal of Maternal-Fetal & Neonatal Medicine, 2021

10 min is reached, a non-reassuring CTG pattern ensues, or maximum rates are reached (Low quality... more 10 min is reached, a non-reassuring CTG pattern ensues, or maximum rates are reached (Low quality evidence 11-; Strong recommendation). If the frequency of contractions exceeds 5 in 10 min, the infusion rate should be reduced, even if a normal CTG pattern is present. With a non-reassuring CTG pattern, urgent clinical assessment by an obstetrician is indicated, and strong consideration should be given to reducing or stopping the oxytocin infusion. The minimal effective dose of oxytocin should always be used. (Low 11-to Moderate 111-quality evidence; Strong recommendation). 6. Use of oxytocin for induction and augmentation of labor should be regularly audited (Low quality evidence 11-; Strong recommendation).

O504 Prolonged Saltatory Fetal Heart Rate Pattern Leading to an Adverse Neonatal Outcome

International Journal of Gynecology & Obstetrics, 2012

Results: A total of 1105 women were referred under the 2WW rule for suspected gynaecological mali... more Results: A total of 1105 women were referred under the 2WW rule for suspected gynaecological malignancy. Seven-hundred sixty five women (69.23%) were referred with suspected endometrial cancer, 179 women (16.20%) with suspected ovarian cancer, 117 women (10.59%) with suspected cervical cancer and 44 women (3.98%) with suspected vulvo-vaginal cancer. The positive predictive value of referrals for diagnosing endometrial, ovarian, cervical and vulvo-vaginal malignancy was 8.1%, 9.5%, 5.98% and 13.64%. The overall predictive value for diagnosing gynaecological malignancy was 8.33% and was lower in premenopausal than postmenopausal women (1.86% and 9.89% respectively, p < 0.0005). The number of cancers diagnosed through non-urgent referrals was higher than the number diagnosed through 2WW referrals (95 vs. 92). Endometrial cancer was associated with older age (p < 0.0005), recurrent bleeding (p < 0.0005), prolonged bleeding (p < 0.0005), diabetes mellitus (p < 0.0005), hypertension (p = 0.01) and increased endometrial thickness (p < 0.0005). The use of HRT, tamoxifen and severity of bleeding was not related to the risk of malignancy. Conclusions: In conclusion, the overall predictive value of the 2-week wait referral system for suspected gynaecological malignancies is low particularly in premenopausal women. The current referral criteria need to be reviewed to gain the maximum benefits from this care pathway with a view to incorporating clinical risk factors to prioritise urgent clinic slots and refine subsequent management strategies.

Systematic Review of Intrapartum Fetal Heart Rate Spectral Analysis and an Application in the Detection of Fetal Acidemia

Frontiers in Pediatrics, 2021

It is fundamental to diagnose fetal acidemia as early as possible, allowing adequate obstetrical ... more It is fundamental to diagnose fetal acidemia as early as possible, allowing adequate obstetrical interventions to prevent brain damage or perinatal death. The visual analysis of cardiotocography traces has been complemented by computerized methods in order to overcome some of its limitations in the screening of fetal hypoxia/acidemia. Spectral analysis has been proposed by several studies exploring fetal heart rate recordings while referring to a great variety of frequency bands for integrating the power spectrum. In this paper, the main goal was to systematically review the spectral bands reported in intrapartum fetal heart rate studies and to evaluate their performance in detecting fetal acidemia/hypoxia. A total of 176 articles were reviewed, from MEDLINE, and 26 were included for the extraction of frequency bands and other relevant methodological information. An open-access fetal heart rate database was used, with recordings of the last half an hour of labor of 246 fetuses. Four...

Compressive Neuropathy: A Consequence of Mal-Positioning during Labour?

Acta Médica Portuguesa

Infecções Sexualmente Transmissíveis: desafio passado, presente ou futuro?

Fetal Heart Rate Fragmentation

Frontiers in Pediatrics

Intrapartum fetal monitoring's primary goal is to avoid adverse perinatal outcomes related to... more Intrapartum fetal monitoring's primary goal is to avoid adverse perinatal outcomes related to hypoxia/acidosis without increasing unnecessary interventions. Recently, a set of indices were proposed as new biomarkers to analyze heart rate (HR), termed HR fragmentation (HRF). In this work, the HRF indices were applied to intrapartum fetal heart rate (FHR) traces to evaluate fetal acidemia. The fragmentation method produces four indices: PIP-Percentage of inflection points; IALS-Inverse of the average length of acceleration/deceleration segments; PSS-Percentage of short segments; PAS-Percentage of alternating segments. On the other hand, the symbolic approach studied the existence of different patterns of length four. We applied the measures to 246 selected FHR recordings sampled at 4 and 2 Hz, where 39 presented umbilical artery's pH ≤ 7.15. When applied to the 4 Hz FHR, the PIP, IASL, and PSS showed significantly higher values in the traces from acidemic fetuses. In compariso...

Physical exercise in pregnancy: benefits, risks and prescription

Journal of Perinatal Medicine

Objectives Regular physical exercise during pregnancy is associated with numerous benefits. In ge... more Objectives Regular physical exercise during pregnancy is associated with numerous benefits. In general women are not adequately advised on this matter and along with their concerns regarding the potential risks, it contributes to the abandonment or refusal to start exercising during pregnancy. Content The aim of this article is to provide a comprehensive literature review, gathering the strongest evidence about the risks and benefits and the prescription of physical exercise. A systematic search was conducted in MEDLINE including articles considered to have the highest level of scientific evidence. Fifty-seven articles, including 32 meta-analysis, 9 systematic reviews and 16 randomized controlled trials were included in the final review. Summary Exercise can help preventing relevant pregnancy related disorders, such as gestational diabetes, excessive gestational weight gain, hypertensive disorders, urinary incontinence, fetal macrosomia, lumbopelvic pain, anxiety and prenatal depres...

Complexity of Cardiotocographic Signals as A Predictor of Labor

by Inês Nunes and Célia Amorim-Costa

Entropy

Prediction of labor is of extreme importance in obstetric care to allow for preventive measures, ... more Prediction of labor is of extreme importance in obstetric care to allow for preventive measures, assuring that both baby and mother have the best possible care. In this work, the authors studied how important nonlinear parameters (entropy and compression) can be as labor predictors. Linear features retrieved from the SisPorto system for cardiotocogram analysis and nonlinear measures were used to predict labor in a dataset of 1072 antepartum tracings, at between 30 and 35 weeks of gestation. Two groups were defined: Group A—fetuses whose traces date was less than one or two weeks before labor, and Group B—fetuses whose traces date was at least one or two weeks before labor. Results suggest that, compared with linear features such as decelerations and variability indices, compression improves labor prediction both within one (C-Statistics of 0.728) and two weeks (C-Statistics of 0.704). Moreover, the correlation between compression and long-term variability was significantly different...

Computer‐based intrapartum fetal monitoring and beyond: a review of the 2 nd Workshop on Signal Processing and Monitoring in Labor (Oct 2017, Oxford UK )

Acta Obstetricia et Gynecologica Scandinavica

Central Fetal Monitoring With and Without Computer Analysis: A Randomized Controlled Trial

Obstetrics and gynecology, 2017

To evaluate whether intrapartum fetal monitoring with computer analysis and real-time alerts decr... more To evaluate whether intrapartum fetal monitoring with computer analysis and real-time alerts decreases the rate of newborn metabolic acidosis or obstetric intervention when compared with visual analysis. A randomized clinical trial carried out in five hospitals in the United Kingdom evaluated women with singleton, vertex fetuses of 36 weeks of gestation or greater during labor. Continuous central fetal monitoring by computer analysis and online alerts (experimental arm) was compared with visual analysis (control arm). Fetal blood sampling and electrocardiographic ST waveform analysis were available in both arms. The primary outcome was incidence of newborn metabolic acidosis (pH less than 7.05 and base deficit greater than 12 mmol/L). Prespecified secondary outcomes included operative delivery, use of fetal blood sampling, low 5-minute Apgar score, neonatal intensive care unit admission, hypoxic-ischemic encephalopathy, and perinatal death. A sample size of 3,660 per group (N=7,320)...

SisPorto 4.0 - computer analysis following the 2015 FIGO Guidelines for intrapartum fetal monitoring

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 3, 2016

SisPorto 4.0 is the most recent version of a program for computer analysis of cardiotocographic s... more SisPorto 4.0 is the most recent version of a program for computer analysis of cardiotocographic signals and ST events, which has been adapted to the 2015 International Federation of Gynecology and Obstetrics (FIGO) guidelines for intrapartum fetal monitoring. This paper provides a detailed description of the analysis performed by the system, including the signal processing algorithms involved in identification of basic CTG features and the resulting real-time alerts.

Computer analysis of foetal monitoring signals

Best Practice & Research Clinical Obstetrics & Gynaecology, 2015

Five systems for computer analysis of foetal monitoring signals are currently available, incorpor... more Five systems for computer analysis of foetal monitoring signals are currently available, incorporating the evaluation of cardiotocographic (CTG) or combined CTG with electrocardiographic ST data. All systems have been integrated with central monitoring stations, allowing the simultaneous monitoring of several tracings on the same computer screen in multiple hospital locations. Computer analysis elicits real-time visual and sound alerts for health care professionals when abnormal patterns are detected, with the aim of prompting a re-evaluation and subsequent clinical action, if considered necessary. Comparison between the CTG analyses provided by the computer and clinical experts has been carried out in all systems, and in three of them, the accuracy of computer alerts in predicting newborn outcomes was evaluated. Comparisons between these studies are hampered by the differences in selection criteria and outcomes. Two of these systems have just completed multicentre randomised clinical trials comparing them with conventional CTG monitoring, and their results are awaited shortly. For the time being, there is limited evidence regarding the impact of computer analysis of foetal monitoring signals on perinatal indicators and on health care professionals&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; behaviour.

Differences between external and internal fetal heart rate monitoring during the second stage of labor: a prospective observational study

Journal of Perinatal Medicine, 2000

To compare fetal heart rate (FHR) signals acquired simultaneously by an external ultrasound probe... more To compare fetal heart rate (FHR) signals acquired simultaneously by an external ultrasound probe and a scalp electrode during the second stage of labor.This was a prospective observational study in a labor ward of a tertiary care university hospital. The population was women in labor with uneventful singleton pregnancies at term. Simultaneous external and internal FHR monitoring was performed in 67 consecutively recruited women during the second stage of labor. Cases were subsequently excluded if the trace length was under 40 min, cesarean birth occurred, or the interval between trace-end and birth exceeded 5 min, leaving a total of 33 traces for analysis. The last 40–60 min of these traces were analyzed by a computer system (Omniview-SisPortoA higher signal loss was observed with external monitoring [10% vs. 4%; P<0.001, LoA=(–6, 18)]. No differences were found in mean FHR baseline [129 bpm vs. 130 bpm, P=0.245, LoA=(–15, 12)], but more accelerations [12 vs. 8, P<0.001, LoA=...

An overview of central fetal monitoring systems in labour

Journal of Perinatal Medicine, 2000

ABSTRACT Abstract A variety of systems for centralised viewing of fetal signals during labour are... more ABSTRACT Abstract A variety of systems for centralised viewing of fetal signals during labour are currently available, allowing simultaneous monitoring of multiple tracings in one or more locations. Display of maternal vital signs, ST signals and an electronic partogram are available in the majority of these systems. A few of them have incorporated computer analysis of cardiotocographic signals or combined cardiotocographic and ST data analysis. Computer analysis may elicit real-time alerts for healthcare professionals when changes associated with fetal hypoxia are detected. Central fetal monitoring systems have been installed in a large number of maternity hospitals in industrialised countries, but there is still limited evidence of their impact on perinatal indicators, on the behaviour of healthcare professionals and on related health costs.

O504 Prolonged Saltatory Fetal Heart Rate Pattern Leading to an Adverse Neonatal Outcome

by Inês Nunes and D. Ayres-De-Campos

International Journal of Gynecology & Obstetrics, 2012