Some simple computers for fetal monitoring are already commercially available. These systems are designed to alarm when abnormalities reflected by the fetal heart are detected during labor. Unfortunately, the problems of fetal heart rate/intrauterine pressure data analysis have been oversimplified. An "ideal" obstetric computer-based data management system would begin, as the clinician should, with the assessment of risk from the patient's past history, pregnancy course, and labor progress as a basis for analyzing the condition of the fetus during labor. Systems available now are of limited scope, expensive, and of unproved clinical value. Premature attempts at clinical computerization will accomplish little, except to give computers a bad name. Let the buyer beware!

Computers↗

PubMed1978

Clinical estimation of gestational age: rules for avoiding preterm delivery.

Reliable knowledge of the duration of pregnancy prior to birth is often of crucial importance in making obstetric care decisions. Laboratory methods for estimating fetal maturity have received considerable attention, but the usefulness of historical information has only rarely been addressed. In order to examine the value of clinical estimators of fetal gestational age (GA) in 690 pregnancies, the correlations of menstrual history (LMP), first unamplified audible fetal heart tones (FFH), and quickening (Q), with GA, based on the modified Dubowitz examination at birth, were examined. Evaluation of each of the data sets used alone reveals that in order to be 90% certain that an infant will be mature at delivery (greater than or equal to 38 weeks), a reliable LMP must have been noted for 42 weeks prior to birth, the FFH heard for 21 weeks, and Q felt for 25 weeks. These findings suggest that carefully obtained historical and physical examination information remains a cornerstone of appropriate obstetric care.

Delivery, Obstetric↗

PubMed1977

Clinical application of high-risk scoring on an obstetric service.

Obstetric risk scoring is a formalized way of recognizing, documenting, and cumulating antepartum and intrapartum factors to predict later complications for mother, fetus, and infant. If simple, practical, and reliable, risk scoring can be clinically useful in determining appropriate levels of care. In this prospective study, antepartum and intrapartum risk scales were integrated into the clinical record, and the relationship of risk scores to outcome was evaluated for 1,275 consecutively delivered gravid women. The forms could be simply and quickly filled out by the staff. Increased risk on both scales was significantly related to lowered one- and five-minute Apgar scores. The perinatal mortality rate increased from 0 to 93.4 per thousand from the lowest to the highest risk group. More than 80% of all perinatal deaths occurred in the one quarter of patients in the highest risk group. These results suggest that this risk scoring system can be used effectively in a clinical setting to identify patients at increased risk for neonatal depression and perinatal death.

Apgar Score↗

PubMed1977

Fetal electroencephalographic monitoring related to infant outcome.

Explore the source record for details and available documents.

Electroencephalography↗

PubMed1977

Computer interpreted fetal electroencephalogram: sharp wave detection and classification of infants for one year neurological outcome.

The presence of visually discernible sharp waves (SWs) in the fetal electroencephalogram (FEEG) has been found to be associated with abnormal neurological infant outcome, but no method of programmed SW detection for FEEG was available. In order to develop an algorithm for SW detection, the first and second derivatives for visually identified SWs and non-SWs were examined and five random variables chosen for discriminant function analysis (DFA). The resulting equation, incorporated into program logic along with logic for artifact rejection, produced classifications from 85% to 89% consistent with visual identifications, suggesting that the number of SWs/epoch (NSW) corresponds with visually identified SWs. In addition, in 61 cases using a threshold for NSW derived by DFA, computer recognized SWs were found to be significantly related to the overall visual interpretation of the tracings (P less than 0.005). Finally, NSW alone produced correct classification of 65.5% of infants for 1 year neurological outcome. The overall consistency was increased to as high as 80% using additional FEEG and neonatal data. These findings imply that some forms of brain damage are present before birth and can be detected during labor using FEEG.

Brain Diseases↗

PubMed1977

Computer interpreted fetal monitoring data. Discriminant analysis or perinatal data as a model for prediction of neurologic status at one year of age.

Intrapartum fetal monitoring may be useful in discriminating short-term and long-term infant outcomes. In order to develop a model for the classification of infants for measures of outcome and to evaluate the discriminatory value of selected perinatal data, 61 data files, which included computer interpreted fetal electroencephalogram and fetal heart rate, one and five minute Apoar scores, results of neonatal neurologic examination, and results of neurologic examination at one year of age, were submitted to computerized discriminant function analysis. For the classification of infants for neurologic status at one year, using FEEG patterns alone, 64% of the 42 normal infnats and 63% of the 19 abnormal infants were correctly classified. Using intrapartum FEEG and FHR patterns simultaneously, 69% of the 42 normal infants and 63% of the 19 abnormal infants were correctly classified. Combining intrapartum data with postpartum data, including one minute and five minute Apgar scores and neonatal neurologic examinations, 81% of the 42 normal infants and 79% of the 19 abnormal infants could be correctly classified. These results suggest that brain damage may already be present before birth, during labor, and that the risk of abnormal neurologic outcome at one year can be detected for a large percentage of infants using computer interpreted monitoring data during labor.

Apgar Score↗

PubMed1977

Normal and abnormal labor progress: I. A quantitative assessment and survey of the literature.

Quantitative labor data have been reported piecemeal in the literature; there is no previous unified report of the frequencies of each of the dysfunctional labor patterns (DLPs). In order to describe the labor process more clearly a labor diagnostic computer program was used to prospectively study an unselected series of 3,682 nearly consecutive labors from one institution. Cervicometric data for nulliparous and multiparous labor were very similar to the results of others. The absolute frequency with which each DLP was found to occur is compared with results in the literature. Protracted active phase dilatation was the most frequently occurring DLP and prolonged deceleration phase the least frequently occurring one. The relative frequencies of the DLPs, defined as the percentage of all DLPs that occurred, remained reasonably constant, regardless of parity or the absolute frequencies of the DLPs in a group of patients.

Adolescent↗

PubMed1976

Computer interpreted fetal electroencephalogram. I. Relative frequency of patterns.

Fetal electroencephalography (FEEG) is a clinical research technique for monitoring the electrical activity of the fetal brain during labor. Because of the massive volume of data, it has not previously been practicable to quantify the frequency of occurrence of the various patterns by visual analysis. With the use of a computer program, which has been shown to be consistent with visual interpretations, records for 11 fetuses, known to be neurologically normal at 1 year of age, were analyzed. Adequate FEEG had been recorded 73.6 per cent of the time during which the fetuses were monitored. In 10,511 10 second epochs of adequate FEEG, the Mixed pattern was found to be dominant, with a relative frequency of 41.2 per cent. The relative frequencies of Trace Alternant and High Voltage Slow activity were 32.3 per cent and 21.5 per cent, respectively. Low Voltage Irregular, Voltage Depression, and Isoelectricity occurred infrequently, accounting for approximately 4.6 per cent of the epochs. The relative frequencies of the various patterns were stable from the onset of monitoring of FEEG through neonatal EEG obtained in the delivery room. These data will form the basis for subsequent studies of FEEG changes associated with various endogenous and exogenous factors.

Computers↗

PubMed1976

Computer interpreted fetal electroencephalogram. II. Patterns in infants who were neurologically abnormal at 1 year of age.

A computer program for pattern recognition of fetal electroencephalogram has been used to analyze the records of nine fetuses, known to be neurologically abnormal at 1 year of age. In 4,913 10 second epochs of adequate FEEG, Low Voltage Irregular (LVI) accounted for 17.8 per cent, Mixed activity (MIX) for 30.5 per cent, High Voltage Slow (HVS) for 18.1 per cent, and Trace Alternant (T/A) for 33.2 per cent of the epochs. The numbers of observed FEEG patterns in these abnormal cases appear to be significantly different from those in 11 normal cases (p less than 0.001)3. Specifically, the relative frequency of LVI was found to be increased in the abnormal cases (p congruent to 0.05). Moreover, LVI was significantly associated with visually interpreted prolonged voltage suppression (p less than 0.025) and lowered one-minute Apgar score (p congruent to 0.025). Using discriminant function analysis for LVI, MIX, HVS, and T/A patterns from FEEG recorded during labor, 10 of 11 infants were correctly classified as being neurologically normal at one year of age and 6 of 9 infants were correctly classified as being neurologically abnormal at 1 year of age. These studies confirm previous associations based on visual analysis of FEEG and suggest that the relative frequencies of FEEG patterns may be useful in the prediction of neurologic outcome 1 year later.

Apgar Score↗

PubMed1976

"Prediction" of the one-minute Apgar score from fetal heart rate data.

The value of any fetal monitoring technic is in its ability to predict infant outcome. In the present study, the ability of fetal heart rate (FHR) monitoring data to "predict" a measure of short-term infant outcome, the 1-minute Apgar score, was evaluated using univariate and multivariate statistical analyses. Of 61 monitored high-risk infants, 46 had high (7 to 10) and 15 had low (1 to 6) 1-minute Apgar scores. Computer analysis of FHR/intrauterine pressure (IUP) data for these 61 infants revealed that the infants with low Apgar scores had more than the expected number of late decelerations (LD). Using a threshold of ten LD and univariate analysis, 74% of the infants could be properly classified for high or low Apgar scores, but 60% of the infants with low Apgar scores were not identified. Using discriminant function (multivariate) analysis for the numbers of LD and uterine contractions, 47% of the depressed infants were appropriately identified and simple risk scoring equations were devised. Using additional observation vectors, including the number of accelerations and early decelerations, 67% of the depressed infants could be identified. The results of this study suggest that using multiple observation vectors improves the predictive capacity and, thus, the value of fetal monitoring data. Clinical experience suggests that the value of monitoring data can be further enhanced by simultaneous evaluation of other observation vectors from additional perinatal data sets using the technics of this study.

Analysis of Variance↗

PubMed1975

Fetal electroencephalography. Relationship to neonatal and one-year developmental neurological examinations in high-risk infants.

Sharp wave activity in fetal electroencephalograms was found to have a significant relation to neurological findings at 1 year of age but not to neurological findings obtained during the neonatal period. Neonatal neurological findings were significantly related to those at 1 year of age.

Brain Diseases↗

PubMed1975

An optimized algorithm for the detection of uterine contractions in intrauterine pressure recordings.

Explore the source record for details and available documents.

Computers↗

PubMed1975

An interactive computer program for studying fetal electroencephalograms.

Fetal electroencephalogram (FEEG), recorded during labor, produces very large volumes of data for visual interpretation. An established terminology, developed for the interpretation of neonatal electroencephalogram, has been found to be useful for visual pattern recognition of FEEG. A program, which identifies FEEG patterns within ten second epochs and provides direct comparison between visual and programmed analysis, has been developed using an interactive computer system. This program provides 85-90 percent consistency with visual interpretation.

Brain↗

PubMedDate not supplied

Approaching the millennium: perinatal problems and software solutions.

Strategic planning for rational development of perinatal computing capabilities for the year 2000 should be driven by anticipated trends in (1) the health care business, (2) computer technology and (3) medicine, as well as (4) the needs of perinatal practitioners. In the USA, health care is the fastest growing segment of the economy. This will produce increasing attention from hardware and software developers, and vendors, and will lead to a proliferation of computing platforms, operating systems and specific medical application software. Desktop computers, already capable of 20 million instructions per second (MIPS) with massive storage capacities, will continue to evolve and fall in price. Increasingly, perinatologists will develop software packages to facilitate patient care in their own environments. All of these trends will lead to severe fragmentation in medical computing. Simultaneously, however, the need for integrated institutional computer-based data access for quality assurance and fiscal and operations management will increase. Perinatal care will be more regionalized, complex and rigorous with new clinical trial- and effectiveness research-based interventions, as well as molecular diagnosis and therapy. To practice appropriately, clinicians will need to be familiar with computer capabilities. Having been exposed to computer-aided instruction (CAI) at the undergraduate and postgraduate levels, they will except on-line access to detailed and accurate patient information with linkage to laboratory, radiology and other medical databases, as well as to reference databases, such as Medlines and the Oxford Database of Perinatal Trials. Artificial intelligence (AI) software may support perinatal decision making; computerized professional and facility billing will be available.

Forecasting↗