OBJECTIVE: The purpose of this study was to analyze the inclination, pertinence and influential factor in emergent cesarean section according to the assortment and analysis of the indication of emergent cesarean section. METHODS: The retrospective study was performed with the review of 360 emergent cesarean section cases from January 2003 to December 2003. RESULTS: The indication of cesarean section was followed by the order of progress failure (47.5%), previous cesarean section (19.2%), and fetal distress (15.8%). The improper operation of emergent cesarean section was done in fetal distress (28.1%), progress failure (8.6%), and induction failure (16.7%). The absence of acceleration with prolonged bradycardia was the most common (50.0%) type of fetal distress. The emergent cesarean section were done more commonly on Tuesday and Friday during weekdays and it was the peak time in a whole day of cesarean section from 11 o'clock to 12 o'clock and 16 o'clock to 17 o'clock. CONCLUSION: It was proved that twenty six (7.2%) cases of emergent cesarean section were done improperly. Now, work through the non-medical factors are considered more important to reduce improper section rate.
Acceleration ; Bradycardia ; Cesarean Section* ; Female ; Fetal Distress ; Pregnancy ; Retrospective Studies

OBJECTIVE: The purpose of this study was to evaluate of course of delivery & perinatal outcomes for postterm pregnancy compared with fullterm pregnancy. METHODS: This study included 360 cases of postterm pregnancy out of 16,992 cases delivered at Department of Obstetrics and Gynecology from January 1, 1993 to December 31, 1997. 16,143 cases of full term deliveries of 38 to 42 gestational weeks conducted in same period were used as the control group. Postterm pregnancy was defined as a pregnancy that it exceeds 295 days calculated from first day of the last menstrual period. RESULTS: The incidence of postterm pregnancy was 2.13% with the highest incidence occurring in the 26 ~30 years age group. This study group was significantly different from the control group in the incidence of fetal distress (10.28% vs. 2.20%), large fetus (10.83% vs. 6.95%), perinatal death (1.67% vs. 0.27%). CONCLUSIONS: Adverse perinatal outcomes were increased markedly as the gestational weeks to be prolonged. Therefore, careful prenatal care, accurate determination of delivery date is very important.
Fetal Distress ; Fetus ; Gynecology ; Humans ; Incidence ; Obstetrics ; Pregnancy* ; Prenatal Care

Spontaneous umbilical cord hematoma is a rare cause of fetal distress and intrauterine fetal death. The perinatal mortality rate approaches 50%. Various causes of the cord hematoma have been suggested as congenital abnormalities, short cord, trauma, cord around neck, torsion, syphilis, or postmature pregnancy. We have experienced one case of the fetal distress from umbilical cord hematoma, which is presented with a brief review of the literatures.
Congenital Abnormalities ; Fetal Death ; Fetal Distress* ; Hematoma* ; Neck ; Perinatal Mortality ; Pregnancy ; Syphilis ; Umbilical Cord*

OBJECTIVE: To evaluate the usefulness of power spectral analysis on fetal heart rate variability as a new diagnostic method of fetal distress. STUDY DESIGN: Among 76 pregnant women who underwent computerized electronic fetal monitoring and cord blood gas analysis, we divided them into 3 groups, i.e.; normal fetus group (36), presumed distress group (26) and acidemic distress group (14). In order to perform linear analysis on the raw data of the fetal heart rate, after resampling, we performed Fourier transformation and investigated power distributions among very low frequency (VLF), low frequency (LF), high frequency (HF) bands, and autonomic balance (LF/HF). RESULTS: The results of the spectral analysis showed that in normal fetus group, the difference in the distribution of power spectrums of VLF, LF and HF was significantly higher than in presumed distress group and acidemic distress group. In fetal distress, the LF and VLF value (0.0023, 0.0437) were good predictors (sensitivity 97.5%, 75.0% and specificity 86.1%, 94.4%). The LF value (0.0013) was a good predictor in fetal acidemia (sensitivity 97.5% and specificity 86.1%). CONCLUSIONS: A computerized spectral analysis of fetal heart rate variation is a good predictor of fetal distress, which is made automatically and objectively.
Female ; Fetal Blood ; Fetal Distress* ; Fetal Heart* ; Fetal Monitoring ; Fetus ; Fourier Analysis ; Heart Rate, Fetal* ; Humans ; Pregnancy ; Pregnant Women ; Sensitivity and Specificity

OBJECTIVE: The purpose of this study was to evaluate the usefulness of approximate entropy on fetal heart rate variability of electronic fetal monitoring taken during antepartum and intrapartum periods as a new diagnostic method of fetal distress. METHODS: Among 76 pregnant women who underwent computerized electronic fetal monitoring and cord blood gas analysis, we divided them into 3 groups, i.e.; 36 into normal fetus group, 26 into presumed distress group and 14 into acidemic distress group. We performed a frequency analysis on time series of heart rate variability in three groups. In order to perform non-linear analysis on the raw data of the fetal heart rate, after resampling and low pass filtering, we investigated approximate entropy. RESULTS: The results of the approximate entropy showed that the value in normal fetus group was significantly high than the value in distress group. But in the distress group, ApEn value was not difference between acidemic and non-acidemic subgroup. ApEn of HRV was confirmed in nonlinear parameter without low pass filtering and resampling. CONCLUSION: The results show that the fetal heart rate variability has nonlinear characteristics and could distinguish normal fetal heart rate pattern and distress pattern numerically and objectively. And these ApEn value are useful for prediction and diagnosis of fetal distress in ante and prenatal periods.
Ants ; Diagnosis ; Entropy* ; Female ; Fetal Blood ; Fetal Distress* ; Fetal Heart* ; Fetal Monitoring ; Fetus ; Heart Rate ; Heart Rate, Fetal* ; Humans ; Pregnancy ; Pregnant Women

Fetal growth restriction (FGR) is characterized by fetal compromise and delayed neurological maturation. We report 3 cases of early FGR in the 26th week of gestation, based on hemodynamic Doppler monitoring, conventional cardiotocography, and non-invasive fetal electrocardiography (NI-FECG). Fetal heart rate variability (HRV), beat-to-beat variations, and fetal autonomic brain age scores (fABASs) were normal despite the absence of umbilical diastolic flow in the first case and the pregnancy continued to 30 weeks. NI-FECG helped achieve better fetal maturity. Fetal HRV and fABASs were low in the second and third cases. Fetal demise occurred soon in both cases. We conclude that NI-FECG could be a prospective method for the detection of fetal distress in early FGR.
Brain ; Cardiotocography ; Electrocardiography ; Embryonic and Fetal Development ; Female ; Fetal Death ; Fetal Development ; Fetal Distress ; Fetus ; Heart Rate, Fetal ; Hemodynamics ; Methods ; Pregnancy ; Prospective Studies

OBJECTIVE: This study was done to propose a new method of determining the cutoff frequency against measurement noise in fetal heart rate signal and to analyze the discriminating value for normal fetus (pH>7.15) and abnormal fetus (pH< or =7.15) by nonlinear method. METHODS: The patients were classified by umbilical artery pH (7.15) or base excess (-10 mEq/L). After removing the high frequency noise components at the cutoff frequency determined in this study, we calculated correlation dimension as a discriminating value for the normal and abnormal fetuses. RESULTS: After low pass filtering of fetal heart rate signal at the cutoff frequency, the numerical result of embedding dimension was 5.47+/-0.67 (normal), 4.43+/-0.60 (abnormal) (p<0.001), and correlation dimension was 2.51+/-0.43 (normal), 1.79+/-0.15 (abnormal). CONCLUSION: We could determine the cutoff frequency from the different fluctuation level between high frequency noise and principal signal according the cutoff frequency function. The detection of fetal distress was done objectively by this method. We could discriminate between normal fetus and abnormal fetus by correlation dimension as indicator for the nonlinear complexity.
Female ; Fetal Distress ; Fetal Heart* ; Fetus ; Heart Rate, Fetal* ; Humans ; Hydrogen-Ion Concentration ; Noise* ; Pregnancy ; Umbilical Arteries

OBJECTIVES: For estimating the antenatal fetal wellbeing to develop new analysis method of fetal heart rate(FHR) with electronic Fetal Heart Rate Monitoring(eFHRM) and computer. METHODS: Heart rate signal is received from distressed fetus using eFHRM. It is necessary to carry out low pass filtering as a preprocess for the nonlinear method. Nonlinear parameters are calculated and classified to investigate the relations between these parameters and values of umbilical cord blood gas. RESULTS: By dividing values of the umbilical cord blood gas into 5 fetuses of acidemic group and 17 fetuses of non-acidemic group after 22 neonates who presented fetal distress were born, the following results as compared with nonlinear chaotic analysis result were obtained. 1. Delay time through AMI for acidemic group was 16.80+/-3.11, and was higher than 15.41+/-2.27 for non-acidemic group, and is not significant in statistics. 2. Embedding Dimension calculated with FNN method was 5.60+/-2.07 for acidemic group, and 4.71+/-1.26 for non-acidemic group, and it was not significant statistically. 3. Correlation dimension for acidemic group was 1.41+/-0.20, and was higher than 1.10+/-0.38 for non-acidemic group, and is not significant in statistics. 4. Mean crossing value by isoangular return map was 28.80+/-11.34 for acidemic group, and 16.65+/-7.00 for non-acidemic group, and it was significant statistically(P=0.008). 5. In comparison of information entropy in 1-D ED, acidemic group was 6.32+/-0.38 and non-acidemic group was 6.20+/-0.28 and it was not significant statistically. Also, in comparison of value in 2-D ED, acidemic group was 10.20+/-0.34. It was higher than non-acidemic group of 9.51+/-0.43 significantly in statistics(P=0.004). But, in comparison of value in 2-D EP, acidemic group was 8.78+/-0.86 and non-acidemic group is of 9.22+/-0.74 and it wasn't significant statistically. And, 2-D ED(DI) value was 10.64+/-0.14 for acidemic group and 10.51+/-0.18 for non-acidemic group, and it wasn't significant statistically. CONCLUSIONS: By the above result, nonliner dynamics and chaotic analysis of heart rate data with computer can serve as a new diagnosis method which may estimate the fetal wellbeing with real time. Through further studies for establishment of diagnosis standard and computer programming, real time diagnosis method shall be applied to clinical practice.
Diagnosis ; Entropy ; Female ; Fetal Blood ; Fetal Distress* ; Fetal Heart* ; Fetus ; Heart Rate ; Heart Rate, Fetal* ; Humans ; Infant, Newborn ; Nonlinear Dynamics* ; Pregnancy

OBJECTIVE: To investigate the relationship between umbilical plasma erythropoietin(epo) concentrations and umbilical cord pH in high risk pregnancies. METHODS: We measured epo concentrations and gas in 103 cases of cord blood obtained from 88 cesarean section (15 of twin) composed of 39 cases of normal control (12 of normal twins), 45 cases of high risk pregnancies and 4 cases of unclassified group using an RIA kit from december,1998 to December, 1999. Statistical analysis was performed using the student's t test and regression analysis. P values less than 0.05 were considered statistically significant. RESULTS: Umbilcal plasma epo concentrations revealed significant inverse correlation (P<0.05) with umbilical acidosis and cord blood epo levels, and it were significantly higher in GDM and IUGR than normal pregnancies (control: 1.60 1.15, n=39 versus GDM: 7.78 7.18, n=11 versus IUGR: 64.77 90.57 n=10, p<0.05), but 11 cases of fetal distress and 13 cases of preeclampsia did not differ significantly from umbilical plasma epo of normal control. CONCLUSIONS: Elevated epo concentrations in cord blood indicate fetal hypoxia and It is significantly increased in IUGR and GDM, these findings show that cord blood epo may serve as a clinically useful marker for chronic fetal hypoxia.
Acidosis ; Cesarean Section ; Erythropoietin* ; Female ; Fetal Blood* ; Fetal Distress ; Fetal Growth Retardation ; Fetal Hypoxia ; Hydrogen-Ion Concentration ; Plasma ; Pre-Eclampsia ; Pregnancy* ; Umbilical Cord

To introduce approximate entropy (ApEn) in the analysis of fetal heart rate variability (FHRV) and to discuss the relationship between the ApEn values and perinatal outcomes, 67 computerized cardiotocographs were recorded. Approximate entropy and index in time domain were used to analyze FHRV. After childbirth, the neonatal Apgar scores were recorded and umbilical cord arterial blood gas analyses were performed. The results showed the ApEn values of FHRV were correlated with pH, Pco2, Po2, HCO3-, ABE, SO2 and neonatal Apgar scores (r = 0.51, -0.29, 0.49, 0.29, 0.45, 0.56, 0.28, respectively, P < 0.05). The ApEn values for acidotic fetuses (pH less than 7.20) were significantly different from those of normal fetuses (P < 0.01), however the time domain parameters of FHRV were unable to identify the difference. The results suggest that the ApEn values of FHRV are closely related to the fetal hypoxia and acidemia. Thus the ApEn analysis appears to be useful for improving the sensitivity in the diagnosis of fetal distress.
Apgar Score ; Blood Gas Analysis ; Entropy ; Female ; Fetal Distress ; diagnosis ; Heart Rate, Fetal ; Humans ; Infant, Newborn ; Pregnancy