Περίληψη:
Aim: Previous studies indicate that the addition of wavelet analysis of
the fetal pulse oximetry tracings (FSPO2) and fetal heart rate (FHR)
variability to cardiotocography (CTG), for intrapartum fetal monitoring,
provides useful information on the fetal response to hypoxia. We applied
the new procedure in non-reassuring CTG patterns, in which cesarean
section was performed, and tested its accuracy in the diagnosis of the
intrapartum fetal compromise.
Methods: At the ‘Aretaieion’ University Hospital labor ward, 318 women
with term fetuses in the cephalic presentation entered the trial during
labor. They all were monitored with external CTG and fetal pulse
oximetry. In the cases that cesarean section was applied, because of
abnormal CTG tracings, we applied a method based on the multiresolution
wavelet analysis and a self-organized map neural network on the first
and second stage of labor. The main outcome parameter was the rate of
cord metabolic acidosis at birth (pH < 7.05). Secondary outcomes
included Apgar scores at 5 min, fetal transmission to neonatal intensive
care unit (NICU) and neonatal encephalopathy.
Results: Fifty out of 318 cases delivered operatively because of
abnormal CTG patterns (rate 15.72%). In 30 cases, cord pH was > 7.05,
while in 11 Apgar scores at 5 min were < 7, while none of those neonates
were transferred to NICU. In the rest 20 cases cord pH was < 7.05; in
all of these cases Apgar scores at 5 min were < 7, while four neonates
were transferred to NICU. In one of them, neonatal encephalopathy was
diagnosed. After the offline application of wavelet analysis and neural
networks to the pulse oximetry and FHR variability readings of the 50
cases, statistics calculated that the system showed a sensitivity of
85% and a specificity of 93%, while false negative and false positive
rates were 15% and 7%, respectively.
Conclusion: Computerized FHR and FSPO2 monitoring shows an excellent
efficacy and reliability in interpreting non-reassuring FHR recordings.
Συγγραφείς:
Salamalekis, E
Siristatidis, C
Vasios, G
Saloum, J and
Giannaris, D
Chrelias, C
Prentza, A
Koutsouris, D
