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

Currently, the rate of cesarean sections being performed in Korea is approximately 40%, with Korea ranking 4th among the Organization for Economic Co-operation and Development countries with respect to cesarean deliveries. Breech presentation at term is an important indication for cesarean section among other factors, including medicolegal concerns and pregnancies in women of advanced maternal age. Term breech presentation is associated with a higher fetal mortality rate than that associated with a cephalic presentation. Therefore, in Korea, most of these women deliver by cesarean section to avoid the complications of vaginal breech delivery. However, cesarean section is itself associated with considerable obstetric morbidity and sometimes, mortality. External cephalic version (ECV) is a useful method to reduce the cesarean section rate in women with breech presentation and therefore to reduce the incidence of breech presentation at delivery. Studies have shown that routine use of ECV reduces the cesarean section rate by approximately two-thirds in term pregnancies with breech presentation. ECV is accepted as a safe, efficacious, and cost-effective method and is recommended by both the American College of Obstetricians and Gynecologists and the Royal College of Obstetricians and Gynecologists in all pregnancies with term breech presentation, if not contraindicated. In Korea, although most clinicians are aware of the option of ECV, their relative lack of experience in performing the procedure and fear of complications render them hesitant to perform ECV. This review is aimed at guiding obstetricians by describing the efficacy, safety concerns, and technical aspects of this procedure.
Breech Presentation ; Cardiotocography ; Cesarean Section ; Female ; Fetal Mortality ; Humans ; Incidence ; Korea ; Maternal Age ; Methods ; Mortality ; Pregnancy ; Version, Fetal

PURPOSE: This study examined the effect on uterine contraction frequency (UCF), blood pressure (BP), heart rate (HR), fetal heart rate (FHR) patterns and psychophysical symptoms (physical discomfort, anxiety, and depression) of structured bed exercise (SBE) in hospitalized high-risk pregnant women prescribed bed rest. METHODS: Forty-five hospitalized high risk pregnant women at >24 weeks of pregnancy prescribed bed rest were randomly assigned to the experimental or control group. From January to May 2014, data were collected using electronic fetal monitoring and patient monitoring of UCF, BP, HR and FHR patterns, and psychophysical symptoms were measured using the antenatal physical discomfort scale, state-trait anxiety scale, and Edinburgh postnatal depression scale. RESULTS: UCF, BP, HR, and FHR patterns (rate, variability, acceleration, and deceleration) did not differ significantly between the experimental and control groups. The experimental group showed a significant increase in baseline FHR after SBE within the normal range, and after SBE, it reduced to the FHR before SBE. The variability, acceleration and deceleration of FHR before and after SBE did not differ significantly between two groups. Moreover, there was no statistically significant difference before and after SBE in the experimental group. Also, the experimental group showed statistically significant decreases in physical discomfort score. However, there were no significant differences in depression and anxiety score between two groups. CONCLUSIONS: SBE in hospitalized high-risk pregnant women under bed rest did not increase the risk to the fetus, and relieved physical discomfort and anxiety. Therefore, SBE should be considered as a nursing intervention in hospitalized high-risk pregnant women.
Acceleration ; Anxiety ; Bed Rest ; Blood Pressure ; Cardiotocography ; Deceleration ; Depression ; Depression, Postpartum ; Female ; Fetal Heart* ; Fetus ; Heart Rate ; Heart Rate, Fetal* ; Humans ; Monitoring, Physiologic ; Nursing ; Pregnancy ; Pregnancy, High-Risk ; Pregnant Women* ; Reference Values ; Uterine Contraction*

PURPOSE: The purpose of this cross-over experimental study was to examine effects of music intervention on maternal anxiety, fetal heart rate pattern and testing time during non-stress tests (NST) for antenatal fetal assessment. METHODS: Sixty pregnant women within 28 to 40 gestational weeks were randomly assigned to either the experimental group (n=30) or control group (n=30). Music intervention was provided to pregnant women in the experimental group during NST. Degree of maternal anxiety and fetal heart rate pattern were our primary outcomes. State-trait anxiety inventory, blood pressure, pulse rate, and changes in peripheral skin temperature were assessed to determine the degree of maternal anxiety. Baseline fetal heart rate, frequency of acceleration in fetal heart rate, fetal movement test and testing time for reactive NST were assessed to measure the fetal heart rate pattern. RESULTS: The experimental group showed significantly lower scores in state anxiety than the control group. There were no significant differences in systolic blood pressure and pulse rate between the two groups. Baseline fetal heart rate was significantly lower in the experimental group than in the control group. Frequency of acceleration in fetal heart rate was significantly increased in the experimental group compared to the control group. There were no significant differences in fetal movement and testing time for reactive NST between the two groups. CONCLUSION: Present results suggest that music intervention could be an effective nursing intervention for alel viating anxiety during non-stress test.
Acceleration ; Anxiety* ; Blood Pressure ; Cardiotocography ; Female ; Fetal Heart* ; Fetal Movement ; Heart Rate ; Heart Rate, Fetal* ; Humans ; Music* ; Nursing ; Pregnancy ; Pregnant Women ; Skin Temperature

The monitoring of fetal heart rate (FHR) status is an important method to check well-being of the baby during labor. Since the electronic FHR monitoring was introduced 40 years ago, it has been expected to be an innovative screening test to detect fetuses who are becoming hypoxic and who may benefit from cesarean delivery or operative vaginal delivery. However, several randomized controlled trials have failed to prove that electronic FHR monitoring had any benefit of reducing the perinatal mortality and morbidity. Also it is now clear that the FHR monitoring had high intra- and interobserver disagreements and increased the rate of cesarean delivery. Despite such limitations, the FHR monitoring is still one of the most important obstetric procedures in clinical practice, and the cardiotocogram is the most-used equipment. To supplement cardiotocogram, new methods of computerized FHR analysis and electrocardiogram have been developed, and several clinical researches have been currently performed. Computerized equipment makes us to analyze beat-to-beat variability and short term heart rate patterns. Furthermore, researches about multiparameters of FHR variability will be ongoing.
Cardiotocography ; Electrocardiography ; Female ; Fetal Heart* ; Fetus ; Heart Rate ; Heart Rate, Fetal* ; Mass Screening ; Perinatal Mortality ; Pregnancy

The number of women with major congenital heart defects reaching reproductive age is likely increasing. We herein describe the anesthetic management of a 33-year-old woman at 37 gestational weeks with a history of Glenn surgery who was undergoing an urgent cesarean section due to pathological cardiotocography. Combined spinal-epidural anesthesia was the most suitable technique for urgent cesarean section in our patient with a single ventricle and phasic flow in the pulmonary artery because it provided rapid-onset anesthesia with negligible hemodynamic effects.
Adult ; Anesthesia* ; Anesthesia, Obstetrical ; Cardiotocography ; Cesarean Section* ; Female ; Heart Defects, Congenital ; Hemodynamics ; Humans ; Pregnancy ; Pulmonary Artery

INTRODUCTIONFetal distress is a result of acute or chronic disturbances in the system of "mother-placenta-fetus" in pre-eclampsia (PE). The aim of the investigation was to compare the accuracy of antenatal fetal distress diagnostics in cases of traditional cardiotocography (CTG) waveform evaluation and analysis of morphological non-invasive electrocardiogram (ECG) parameters in anterpartum patients with PE.

MATERIALS AND METHODSFetal non-invasive ECG antenatal recordings of 122 pregnant patients at 34 to 40 weeks of gestation were examined. In Group I, there were 32 women with physiological gestation and normal fetal condition according to haemodynamic Doppler values. Group II involved 48 patients with mild and moderate PE whom were performed Doppler investigation. In Group III, 42 patients with severe PE were monitored with haemodynamic Doppler.

RESULTSFetal autonomic tone was lower with the relative increase of low frequency (LF) branch in the patients of pre-eclamptic group. The increased value of the amplitude of mode (AMo) and stress index (SI) was associated with adrenergic overactivity. It has induced pQ and QT shortening, increased T/QRS ratio and decelerations appearance. The rate of antenatal fetal distress retrospectively was 31.1 % in PE. The traditional analysis of CTG parameters has showed sensitivity (72.7%) and specificity (87.1%). In addition to the conventional CTG analysis, evaluation of ECG parameters has contributed to better diagnostics of fetal distress. Sensitivity and specificity of non-invasive fetal ECG were absolutely equal in this study (100%).

CONCLUSIONThe results suggest that fetal non-invasive ECG monitoring is more objective than conventional CTG.

Cardiotocography ; methods ; Cross-Sectional Studies ; Electrocardiography ; methods ; Female ; Fetal Distress ; diagnosis ; physiopathology ; Fetal Monitoring ; Heart Rate, Fetal ; Humans ; Pre-Eclampsia ; Pregnancy ; Pregnancy Trimester, Third ; Retrospective Studies ; Sensitivity and Specificity ; Severity of Illness Index ; Ultrasonography, Doppler ; Ultrasonography, Prenatal

OBJECTIVE: To determine the effect of exercise stress test (EST) through brisk walking on the cardiotocogram tracings (CTGs) and the association of the tracings to neonatal outcomes.

METHODOLOGY: This one-group pretest-post test experimental study involved 65 term pregnant women (mean age = 25.94 + 4.66 years) who underwent brisk walking exercise using a motorized treadmill for 30 minutes, following American College of Obstetricians and Gynecologists (ACOG) guidelines for exercise among pregnant women. Pre- and post- walk CTGs were assessed, with presence of post-walk decelerations taken to mean a positive EST. Sensitivity (positive EST in sick / meconium-stained / cord coil babies), specificity (negative EST in well babies), positive predictive value (PPV) (probability of sick / meconium-stained / cord coil babies given positive EST) and negative predictive value (NPV) (probability of well babies given negative EST) were computed.

RESULTS: A significant difference in the proportion of subjects with pre- and post- walk decelerations was noted (p-value = 0.000) wherein 18 subjects (28.13%) without decelerations in the baseline CTG had decelerations in the post-walk CTG. These decelerations were significantly associated to having sick, meconium-stained, or cord coil babies (p-values < 0.05). EST had 80% sensitivity, 75% specificity, 21.1% PPV and 97.8% NPV for detecting sick babies; 75% sensitivity, 77.2% specificity, 31.6% PPV and 95.7% NPV for detecting meconium-stained babies; and 75% sensitivity, 85.7% specificity, 63.2% PPV and 91.3% NPV for detecting nuchal cord.

CONCLUSION: Exercise stress testing is a complementary way of assessing fetal well-being due to manifestation of decelerations in the post-walk CTG which could have gone undetected if only the resting CTG was done. The EST had high sensitivity for detecting sick / meconium-stained / cord coil babies and has the advantage of reinforcing a reassuring fetal condition due to its high NPV for detecting well babies.

Human ; Female ; Adult ; Cardiotocography ; EXERCISE TEST ; Heart Rate, Fetal

We report the case of a 33-year-old primigravida who presented at 37 weeks of gestation with symptoms suggestive of acute fatty liver of pregnancy, but was later diagnosed with leptospirosis (i.e. Weil’s disease or syndrome) on serological testing. Cardiotocography showed fetal distress, and an emergency Caesarean section was performed. A healthy neonate with no evidence of congenital leptospirosis was delivered. The patient was treated with intravenous ceftriaxone and discharged well 13 days after admission. Herein, we discuss the patient’s clinical presentation and the cardiotocography changes observed in leptospiral infection, and review the current literature.
Adult ; Cardiotocography ; Ceftriaxone ; therapeutic use ; Cesarean Section ; Diagnosis, Differential ; Fatty Liver ; diagnosis ; Female ; Fetal Distress ; Humans ; Leptospira ; Leptospirosis ; diagnosis ; diagnostic imaging ; Pregnancy ; Pregnancy Complications, Infectious ; diagnosis ; diagnostic imaging ; Pregnancy Outcome ; Treatment Outcome ; Ultrasonography

BACKGROUND: Continuous electronic fetal monitoring has been under close scrutiny due to lack of consistent interpretation of fetal heart rate tracings, even by perinatologists. In 2008, NICHD revised their definitions, interpretation and research guidelines. ACOG incorporated these guidelines into a 2009 practice bulletin on EFM definitions and the three-tiered fetal heart rate interpretation. After a year of adapting the new classification, the Department of Obstetrics and Gynecology of tertiary hospitals has yet to evaluate locally its use in fetal surveillance during labor and subsequently its value in decision-making. To date, no local study has been published regarding the neonatal outcome of those women whose intrapratal tracings were categorized under the three-tier system.
OBJECTIVES: This study aimed to describe the neonatal outcomes of patients with Category I, II, and III traces among pregnant patients admitted in a tertiary hospital. This included APGAR score and disposition of the neonate as primary outcomes.
METHODS: This was a prospective cohort study. It was conducted in a tertiary hospital from December 2012 to July 2013. The population consisted of women admitted in the labor room for delivery and underwent intrapartal monitoring and eventually delivered. Inclusions were term or preterm pregnancy ? 34 weeks, singleton pregnancy with no known congenital or lethal fetal anomalies. Exclusions were women with clinically evident chorioamnionitis on admission, multifetal gestations, preterm pregnancy (less than 34 weeks), post-term pregnancy, women who were mentally incapacitated to give consent, and those for outright cesarean section indications. There was no specified number of subjects but all laboring patients who underwent trial of labor in were included. Data was analyzed using descriptive analysis and z-test for proportion. And these data were held confidential. Reading and interpretation of the traces was made by perinatologist fellow on duty. Neonatal outcomes, on the one hand, including the APGAR score were analyzed by pediatrician on duty.
RESULTS: There were a total of 163 subjects included in the study, with age range of 19-33 years old. Subjects were G1P0 to G9P6, with a mean prenatal check-up of 5 times. Among the 163 subjects, 134 had a Category I trace and 17 had Category II traces all through- out their laboring period, and the remainder had combination of category I and II traces. There was no Category III trace observed. For Category I trace, 97.8% of babies had a one minute APGAR score of 7-9, 1.5% had a one minute APGAR score of 4-6, and 0.7% had a one minute APGAR score of 1-3. The five-minute APGAR score with Category I trace were as follows: 99.3% had APGAR score of 7-9, 0.7% had APGAR score of 4-6, but there was none with a five-minute APGAR score of 1-3. Majority (63.4%) of the babies in Category I were direct room-in, 14.9 % were high-risk direct room-in, 10.4% babies were admitted in Neonatal Intensive Care Unit 2 (NICU2) and 11.2% in NICU3. Three (2.2%) of the babies in NICU3 were intubated. For the Category II trace, 100% of babies had one and five minute APGAR score of 7-9. Thirteen (54.2%) of the babies were direct-room in. 37.5% of the babies were admitted in NICU2. One baby (4.2%) was admitted in NICU3 but not intubated. The resuscitative measures done were as follows: tactile stimulation, thermoregulation, suctioning, inhalation, and intubation. Among these measures, suctioning (with a p-value of .02) showed a significant difference between Category I and Category II traces. Category II traces were associated more with abdominal delivery. Spinal anesthesia which was usually used in abdominal deliveries is also significantly different from the two traces, with a p-value of 0.02. Category I traces had a significantly higher morbidity and mortality compared to Category II traces.
CONCLUSION: There was no significant difference between the one-minute and five-minute APGAR score and disposition of babies between Category I and Category II traces. Abdominal delivery, spinal anesthesia and suctioning were higher in Category II trace than in Category I trace.

Human ; Female ; Adult ; Pregnancy ; Cardiotocography ; Heart Rate, Fetal ; Apgar Score ; Gynecology ; Obstetrics ; Anesthesia, Spinal ; Intensive Care Units, Neonatal ; Chorioamnionitis ; Delivery, Obstetric ; Term Birth