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PubMed1978

Deceleration/contraction ratios as an index of fetal health during labor.

Internal FHR tracings of 259 patients with variable decelerations and 49 with late decelerations were analyzed for frequency and severity of the pattern in an attempt to correlate with fetal pH or Apgar score at 1 minute. A significant increase in the risk of fetal acidosis was associated with a frequency of greater than 30% variable decelerations and 20% late decelerations. It also increased with the increase of severity of the pattern. Variable decelerations are not good predictors of Apgar scores less than or equal to 6 at 1 minute, but late decelerations are predictive when they occur more than 20% of the time. The fetus with variable decelerations a normal pH can be observed through the first stage of labor with a high degree of confidence. However, when a 20% or more moderate-to-severe late deceleration/contraction ratio is present, intervention is necessary even if scalp blood pH is normal. The FHR deceleration/uterine contraction (UC) ratio is a simple bedside technique for assessing fetal outcome.

Acidosis↗
PubMed1998

The effect of maternal position on fetal heart rate during epidural or intrathecal labor analgesia.

OBJECTIVE: This study was designed to determine the relationship between maternal position and the incidence of prolonged decelerations after epidural bupivacaine or intrathecal sufentanil analgesia for labor. STUDY DESIGN: Laboring, healthy, term parturient women, with reassuring fetal heart rate tracings, requesting either epidural (n = 145) or intrathecal (n = 160) analgesia were randomly assigned to lie either supine with measured 30-degree left uterine displacement (n = 136) or in the left lateral decubitus position (n = 145). Patients received either intrathecal sufentanil, 10 microg, or epidural 0.25% bupivacaine, 13 mL. An obstetrician, unaware of patient position or type of anesthesia, examined the fetal heart rate tracings. RESULTS: No demographic differences were noted among the groups. Prolonged decelerations occurred with equal frequency after epidural bupivacaine and intrathecal sufentanil (3.9%). Prolonged decelerations were not related to maternal position. No emergency cesarean deliveries were performed as a result of prolonged decelerations. Prolonged decelerations correlated with the frequency of contractions before induction of analgesia (P < .05). Fewer fetal heart rate accelerations were noted after intrathecal sufentanil than after epidural bupivacaine (P < .005). More ephedrine was used after epidural bupivacaine (P < .001). Patients who received epidural analgesia in the left lateral position were more likely to have an asymmetric block (P < .05). CONCLUSIONS: The risk of prolonged deceleration after epidural bupivacaine or intrathecal sufentanil labor analgesia is unrelated to maternal position or analgesic technique.

Analgesia, Epidural↗
PubMed1993

Left ventricular diastolic function in end-stage renal disease and the impact of hemodialysis.

Twenty-one patients (17 men and 4 women, aged 20 to 40 years) with end-stage renal disease (creatinine clearance persistently < 5 ml/min for > 3 months) were evaluated for left ventricular (LV) diastolic function by Doppler echocardiography before and after hemodialysis. Fifteen patients were on maintenance hemodialysis (group A) and 6 were studied before and after their first hemodialysis (group B). The following indexes of LV diastolic function were studied: (1) isovolumic relaxation time; and (2) Doppler indexes from mitral inflow signal--peak early velocity, peak late velocity (atrial), deceleration of early filling phase, and deceleration time of early filling phase. LV systolic function in groups A and B (LV ejection fraction 68 +/- 6 and 77 +/- 5%, fractional shortening 0.39 +/- 0.06 and 0.46 +/- 0.05%) was normal and did not change after hemodialysis. Group A had a prolonged isovolumic relaxation time of 80 +/- 22 ms, which decreased to 57 +/- 14 ms (p < 0.005). Deceleration time decreased from 248 +/- 58 to 184 +/- 38 ms (p < 0.00005) and the deceleration slope increased from 4.3 +/- 1.8 to 5.1 +/- 1.6 m/s2 (p < 0.005) after hemodialysis. In group B, isovolumic relaxation time decreased from 87 +/- 21 to 73 +/- 15 ms (p < 0.05), deceleration time decreased from 256 +/- 43 to 185 +/- 34 ms (p < 0.05), and deceleration slope increased from 3.5 +/- 0.8 to 4.2 +/- 1.1 m/s2 (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Antepartum surveillance in diabetic pregnancies: predictors of fetal distress in labor.

OBJECTIVE: Our purpose was to evaluate an antepartum testing program based on twice-weekly nonstress testing and amniotic fluid evaluation in pregnancies complicated by diabetes mellitus and to weight the test components in the prediction of fetal distress requiring cesarean delivery. STUDY DESIGN: During the 4-year period of 1987 through 1990, 2134 women with pregnancies complicated by diabetes underwent antepartum testing. Of these 1501 women (class A1, n = 505; A2-diet, n = 305; A2-insulin, n = 580; B, n = 71; C to D, n = 29; R to F, n = 11) were delivered within 4 days of their last test. Categoric analysis of data was performed according to diabetic class, fetal heart rate results, and the presence of decreased, normal, or increased amniotic fluid assessment. A univariate logistical regression was first conducted with cesarean delivery for fetal distress as outcome variable by use of the following variables: fetal weight and sex, diabetic class, gestational age at delivery, presence of additional indications for antepartum testing, largest vertical pocket, amniotic fluid index (summation of the four quadrants of the largest vertical pocket), nonstress test reactivity (two accelerations of > or = 15 beats/min of 15 seconds' duration), presence of decelerations (> or = 15 beats/min for 15 seconds) during the nonstress test, and the interactions of the nonstress test with deceleration, largest vertical pocket, and amniotic fluid index. Multivariate analysis was then applied to predict the best model. RESULTS: No stillbirths occurred within 4 days of the last antepartum test. However, the corrected stillbirth rate of the entire tested population was 1.4 per 1000. Eighty-five women required cesarean delivery for fetal distress. The factors most predictive of cesarean delivery for fetal distress (p < 0.05, odds ratio and 95% confidence interval) were a deceleration (3.60, 2.14 to 6.06), nonreactive nonstress test (2.68, 1.60 to 4.49), and the interaction of both a nonreactive nonstress test and decelerations (5.63, 2.67 to 11.9). Amniotic fluid assessment by largest vertical pocket or amniotic fluid index were not statistically significant. The multivariate analysis selected the interaction of nonstress test and deceleration as the best significant predictor for cesarean delivery for fetal distress. CONCLUSION: An antepartum fetal surveillance program using twice-weekly nonstress test and fluid index assessment in pregnancies complicated by diabetes was successful in preventing stillbirth. The absence of fetal heart rate reactivity and the presence of decelerations were predictive of the diagnosis of fetal distress in labor requiring cesarean delivery. Ultrasonographic assessment of amniotic fluid volume was not a significant predictor of fetal distress in labor in the diabetic pregnancy.

Amniotic Fluid↗
PubMed1996

Changes in effective aortic valve area during ejection in adults with aortic stenosis.

Measurements of valve orifice area in aortic stenosis are based on the assumption that orifice area remains constant throughout ejection and is independent of transvalvular gradients and flow. Recent studies, however, have suggested that the calculated valve area of calcific aortic stenosis may change in different flow conditions. Therefore, we tested the hypothesis that in vivo effective orifice area of a stenotic aortic valve changes continuously during ejection, which would make a single area measurement a potentially inadequate indicator of the severity of the stenosis. Doppler measurements of flow velocity in the ascending aorta and in the left ventricular outflow tract at peak velocity, at half-peak velocity during acceleration (midacceleration), and at half-peak velocity during deceleration (mid-deceleration) were obtained in 26 patients with aortic stenosis (mean gradient 50 +/- 19 mm Hg and effective aortic orifice are 0.7 +/- 0.3 dcm2) and in 14 normal subjects of similar age and gender, to calculate instantaneous effective aortic orifice area at midacceleration, at peak velocity and at mid-deceleration. In the 26 patients with aortic stenosis, aortic valve area at midacceleration was 84 +/- 15% of valve area at peak velocity (p < 0.0001), and valve area at mid-deceleration was 113 +/- 17% of that measured at peak velocity (p < 0.01). Conversely, in normal subjects, aortic valve area remained constant during ejection and was 97 +/- 5% and 99 +/- 6% of valve area at peak velocity, respectively, at midacceleration and mid-deceleration (p > 0.05). In addition, in patients with aortic stenosis the percentage of change in effective aortic valve area from midacceleration to mid-deceleration varied widely, from -17% to +49% (mean change +26 +/- 14%). There was no relation between percentage of change in effective valve area and mean transaortic gradient (r = 0.05; p = 0.30) or effective valve area at peak velocity (r = -0.11; p = 0.14). Our results indicate that effective aortic valve area continues to change during ejection in patients with aortic stenosis, and that the magnitude of this change is independent of the usual indexes of severity of the stenosis. Conversely, effective aortic valve area remains constant during ejection in normal subjects.

Aged↗
PubMed1994

Prophylactic amnioinfusion for meconium-stained amniotic fluid.

OBJECTIVE: Previous studies have demonstrated reduced perinatal morbidity in patients receiving amnioinfusion for meconium-stained amniotic fluid compared with control patients receiving no amnioinfusion. Because amnioinfusion for variable fetal heart rate decelerations has become accepted care, we sought to determine the benefit of prophylactic amnioinfusion for meconium compared with standard care, incorporating therapeutic amnioinfusion for variable decelerations. STUDY DESIGN: Ninety-three term patients with moderate to heavy meconium and no variable fetal heart rate decelerations were randomized to immediate prophylactic amnioinfusion (600 ml saline solution bolus followed by 3 ml/min) or to standard care (including therapeutic amnioinfusion for variable decelerations developing later). All babies had DeLee suctioning on delivery of the head. Laryngeal cords were visualized and tracheal suctioning performed when meconium was seen below the cords. Statistical comparisons were performed using Student t test, Fisher's exact test, or chi 2 analysis. RESULTS: There were no significant differences in the incidence of operative delivery, fetal distress, or meconium below the cords or in newborn Apgar scores and umbilical artery gas values between the amnioinfusion (n = 43) and control (n = 50) patients. There were four cases of meconium aspiration, three in the amnioinfusion group, one in the standard care group. The rate of endometritis-chorioamnionitis was higher (p = 0.3) in the amnioinfusion (16%) than in the control group (8%), although time from ruptured membranes to delivery (8.5 hours vs 7.3 hours) and duration of intrauterine monitoring (6.1 hours vs 5.3 hours) were not different. CONCLUSIONS: Although amnioinfusion does dilute amniotic meconium, prophylactic amnioinfusion for meconium in the absence of variable decelerations remains controversial. Prophylactic amnioinfusion in term pregnancies did not improve perinatal outcome and increased the risk for chorioamnionitis-endometritis. Together with recent reports, the current data suggest that the benefit of amnioinfusion for meconium-stained amniotic fluid is a result of the alleviation of variable fetal heart rate decelerations rather than meconium dilution.

Adult↗
PubMed1998

The fractionation experiment: reducing heterogeneity to investigate age-specific mortality in Drosophila.

Age-specific mortality rates decelerate at older ages in both genetically homogenous and heterogeneous populations of Drosophila. One explanation proposed for deceleration is population heterogeneity. This hypothesis suggests that a population consists of sub-populations that differ in mortality characteristics and that the deceleration is the result of selective survival of stronger individuals. Here we describe an experiment that fractionates populations into several sub-populations without changing the physiological characteristics of the post-fractionated populations. Through a careful process of selection of Drosophila eggs, larvae, pupae and adults, we attempt to reduce as much as possible the degree of pre-adult, environmentally induced heterogeneity among individuals of a genetically identical cohort. We then ask whether such cohorts, when compared to non-fractionated populations, exhibit a lesser degree of mortality deceleration at advanced ages. From a total of 106 fractionated and control populations, consisting of 51331 individuals, 101 populations (93% of the fractionated populations and 100% of the control populations) exhibit a significant amount of mortality deceleration late in life. These observations suggest that environmental heterogeneity accrued during larval development is not a major factor contributing to mortality deceleration at older ages.

Aging↗
PubMed2002

Influence of maternal, obstetric and fetal risk factors on the prevalence of birth asphyxia at term in a Swedish urban population.

BACKGROUND: The influence of maternal, obstetric and fetal risk factors on the prevalence of birth asphyxia at term in a Swedish urban population. OBJECTIVE: To investigate risk factors for Apgar score-defined birth asphyxia, birth asphyxia with hypoxic-ischemic encephalopathy and birth asphyxia-related death/disability. MATERIAL AND METHODS: Retrospective case-control study in term neonates with birth asphyxia defined as Apgar score < 7 at 5 min. Cases originating from nonasphyctic causes (e.g. infection, maternal sedation) were excluded. Hypoxic-ischemic encephalopathy was diagnosed according to criteria by Sarnat. Maternal, obstetric and fetal risk factors were registered in 225 cases of birth asphyxia diagnosed in 42 203 live births occurring in the urban Swedish population studied. A matched control group was used for statistical evaluation. RESULTS: Asphyxia was associated with single civil status, OR = 7.1 (95%CI 2.0, 27.6); intrauterine meconium release, OR = 4.1 (95%CI 1.8, 9.8); operative delivery, OR = 8.7 (95%CI 3.4, 24.6); breech delivery, OR = 20.3 (95%CI 3.0, 416.5); oxytocin augmentation, OR = 2.9 (95%CI 1.4, 6.3); cord complication, OR = 15.8 (95%CI 2.1, 341.5); external compression to assist delivery OR = 6.2 (95%CI 1.3, 45.7); and cardiotocography score, OR = 0.5 (95%CI 0.4, 0.6). Normal fetal heart rate variability, OR = 0.4 (95%CI 0.2, 0.6), repeated late decelerations irrespective of amplitude or repeated variable decelerations, OR = 29.4 (95%CI 5.7, 540.8) or occasional late or variable decelerations, OR = 2.2 (95%CI 1.3, 3.8), and no accelerations, OR = 5.2 (95%CI 2.0, 16.4), were associated with asphyxia. Operative or instrumental delivery was more common in all three asphyxia groups compared with controls. Leanness was a risk factor for asphyxia and for hypoxic-ischemic encephalopathy. Maternal age, smoking and illnesses, time of delivery (day/night, seasonal) and previous caesarean section were not associated with birth asphyxia. CONCLUSIONS: An association between neonatal asphyxia and cardiotocography parameters, intrauterine meconium release, operative delivery, breech delivery, single civil status, oxytocin augmentation, cord complication, external compression to assist delivery and neonatal leanness was found. Abnormal fetal heart rate variability, repeated late decelerations irrespective of amplitude or repeated variable decelerations, occasional late or variable decelerations and no accelerations were associated with asphyxia.

Apgar Score↗
PubMedDate not supplied

[Doppler sonographic flow measurement in the anterior cerebral artery and celiac trunk in infants with coarctation syndrome in comparison with healthy infants].

15 infants (gestational age 47 +/- 11 weeks; weight 3180 +/- 1082 g) with angiocardiographically proven coarctation of the aorta and 53 healthy infants (gestational age 39 +/- 8 weeks; weight 2830 +/- 1418 g) were investigated by echocardiography and pulsed doppler sonography. In all children pulsed doppler recordings were obtained in the anterior cerebral artery (prestenotic reference vessel) and the truncus coeliacus (poststenotic reference vessel). Nine variables were measured from each doppler signal: The maximal systolic velocity, the endsystolic and enddiastolic velocity, the pulsatility-index, the acceleration slope (peak rate of acceleration), the deceleration slope (peak rate of deceleration), the antegrade flow time and the acceleration and deceleration time. The healthy infants showed a pulsatile flow profile in the anterior cerebral artery and the truncus coeliacus. In normal subjects the maximal systolic velocity and the acceleration slope in the truncus coeliacus were always higher than in the anterior cerebral artery. There was no difference in the endsystolic and enddiastolic velocity, the pulsatility-index, the flow times and the deceleration slope. In children with coarctation of the aorta a decreased and nonpulsatile flow in the truncus coeliacus could be shown. The following variables were significantly lower than in the healthy control group: The maximal systolic velocity, the pulsatility-index, the acceleration and deceleration slope and the antegrade flow time and acceleration time. In the anterior cerebral arteries of children with coarctation the maximal systolic and enddiastolic velocity were significantly higher than in the healthy control group. Pulsed doppler recordings were obtained in 9 patients after surgical correction: The maximal systolic and endsystolic velocity, the pulsatility-index, the acceleration and deceleration slope in the truncus coeliacus increased significantly although these values were lower than in the healthy control group. The flow parameters in the anterior cerebral arteries postoperatively showed no significant difference from the preoperative values. Pulsed dopplersonography of the flow in the anterior cerebral artery and the truncus coeliacus is a good method for diagnosis of coarctation of the aorta and postoperative controls.

Aortic Coarctation↗
PubMed1997

Clinical course of untreated tonic-clonic seizures in childhood: prospective, hospital based study.

OBJECTIVE: To assess decleration and acceleration in the disease process in the initial phase of epilepsy in children with new onset tonic-clonic seizures. STUDY DESIGN: Hospital based follow up study. SETTING: Two university hospitals, a general hospital, and a children's hospital in the Netherlands. PATIENTS: 204 children aged 1 month to 16 years with idiopathic or remote symptomatic, newly diagnosed, tonic-clonic seizures, of whom 123 were enrolled at time of their first ever seizure; all children were followed until the start of drug treatment (78 children), the occurrence of the fourth untreated seizure (41 children), or the end of the follow up period of two years (85 untreated children). MAIN OUTCOME MEASURES: Analysis of disease pattern from first ever seizure. The pattern was categorised as decelerating if the child became free of seizures despite treatment being withheld. In cases with four seizures, the pattern was categorised as decelerating if successive intervals increased or as accelerating if intervals decreased. Patterns in the remaining children were classified as uncertain. RESULTS: A decelerating pattern was found in 83 of 85 children who became free of seizures without treatment. Three of the 41 children with four or more untreated seizures showed a decelerating pattern and eight an accelerating pattern. In 110 children the disease process could not be classified, mostly because drug treatment was started after the first, second, or third seizure. The proportion of children with a decelerating pattern (42%, 95% confidence interval 35% to 49%) may be a minimum estimate because of the large number of patients with an uncertain disease pattern. CONCLUSIONS: Though untreated epilepsy is commonly considered to be a progressive disorder with decreasing intervals between seizures, a large proportion of children with newly diagnosed, unprovoked tonic-clonic seizures have a decelerating disease process. The fear that tonic-clonic seizures commonly evolve into a progressive disease should not be used as an argument in favour of early drug treatment in children with epilepsy.

Adolescent↗
PubMed1990

Movement-related phasic muscle activation. I. Relations with temporal profile of movement.

1. The role of phasic muscle activation in determining the temporal properties of human arm movements was studied. The experiments show that subjects can modulate the triphasic electromyographic (EMG) pattern to produce movements of varied temporal structures. 2. Subjects performed horizontal forearm movements in which they varied movement accelerations and decelerations. All movements were of the same amplitude, duration, and peak velocity. A phase-plane (velocity vs. position) template of the desired movement was presented to the subject, who had to reproduce the template by appropriate movement of the forearm. 3. The ratio of the durations of acceleration to deceleration (termed the symmetry ratio, SR) was used as a measure of the temporal structure of the movements. Movements with SRs ranging from 0.4 (short acceleration-long deceleration) to 2.0 (long acceleration-short deceleration) were studied. 4. Subjects modulated the components of the triphasic EMG pattern to produce movements with different temporal profiles. As the SR was increased (increasing acceleration duration-decreasing deceleration duration), the following changes occurred: 1) the duration of the initial agonist burst (AG1) increased while its magnitude decreased; 2) the antagonist burst (ANT1) was progressively delayed relative to movement onset. ANT1 magnitude increased while its duration remained constant; and 3) the magnitude of the second agonist burst (AG2) increased and its duration decreased. 5. The triphasic EMG pattern can be modified to produce movements whose velocity profiles are not the same under simple scaling of duration or magnitude. It is concluded that previously described relations between components of the triphasic EMG pattern and movement parameters, such as amplitude, speed, and duration, are secondary to associated changes in their acceleration and deceleration characteristics.

Acceleration↗
PubMed1994

Mechanism of altered patterns of left ventricular filling during the development of congestive heart failure.

BACKGROUND: The mechanism of the alterations in the pattern of left ventricular (LV) filling during the development of congestive heart failure (CHF) is not fully understood. METHODS AND RESULTS: We studied six conscious dogs instrumented to measure LV and left atrial (LA) pressures and LV volume as CHF was induced by rapid pacing. Diastolic filling dynamics were serially measured over 4 weeks during normal sinus rhythm. Four days after we initiated pacing, the peak early diastolic filing rate decreased from 108 +/- 24 to 88 +/- 27 mL/s (P < .05) as the maximal early diastolic LA-LV pressure gradient decreased associated with a slowing of the rate of LV relaxation. Subsequently, the peak early filling rate progressively increased, returning to control at 1 week, and by the fourth week, it had increased to 168 +/- 39 mL/s (P < .05). These changes in early filling rates occurred as the maximal early diastolic LA-LV pressure gradient increased in association with a progressive increase in LV pressure despite further progressive slowing of the rate of LV relaxation. Throughout the development of CHF, peak early filling rate and the maximal LA-LV pressure gradient correlated (r = .99, P < .001). The early filling deceleration rate increased and deceleration time progressively decreased over the 4 weeks as LV stiffness and net LA plus LV stiffness increased (P < .05). As predicted by a theoretical analysis, the deceleration time was linearly related to the reciprocal of the square root of LV stiffness (r = .94, P < .01). CONCLUSIONS: Early in CHF, slowing of LV relaxation reduces the maximal early diastolic LA-LV pressure gradient, decreasing the peak early filling rate. As CHF progresses, this is overcome by an increase in LA pressure that augments the early diastolic LA-LV pressure gradient, increasing peak early filling rate. Increasing LV stiffness during the development of CHF progressively shortens the early filling deceleration time and augments the early filling deceleration rate. These observations suggest that the early filling deceleration time reflects LV stiffness.

Animals↗
PubMed1994

Systolic and diastolic dysfunction in patients with clinical diagnosis of dilated cardiomyopathy. Relation to symptoms and prognosis.

BACKGROUND: Dilated cardiomyopathy is an important cause of morbidity and mortality among patients with congestive heart failure. Hemodynamic and prognostic characterization are critical in guiding selection of medical and surgical therapies. METHODS AND RESULTS: A cohort of 102 patients with the clinical diagnosis of dilated cardiomyopathy who underwent echocardiographic examination between 1986 and 1990 was identified and followed up through July 1, 1991. Patients with moderate or severe symptoms had lower indices of systolic function and greater left atrial and right ventricular dilation. Mitral inflow Doppler signals were characterized by a restrictive left ventricular filling pattern. In multivariate logistic regression analysis, deceleration time, ejection fraction, and peak E velocity were independently associated with symptom status. Over a mean follow-up of 36 months, 35 patients died. Kaplan-Meier estimated survival at 1, 2, and 4 years was 84%, 73%, and 61%, respectively, and was significantly poorer than that of an age- and sex-matched population. The subgroup with an ejection fraction < 0.25 and deceleration time < 130 milliseconds had a 2-year survival of only 35%. The subgroup with ejection fraction < 0.25 and deceleration time > 130 milliseconds had an intermediate 2-year survival of 72%, whereas patients with an ejection fraction > or = 0.25 had 2-year survivals > or = 95% regardless of deceleration time. In multivariate analysis, ejection fraction and systolic blood pressure were independently predictive of subsequent mortality. Mitral deceleration time was significant in univariate analysis. CONCLUSIONS: In patients with the clinical diagnosis of dilated cardiomyopathy, markers of diastolic dysfunction correlated strongly with congestive symptoms, whereas variables of systolic function were the strongest predictors of survival. Consideration of both ejection fraction and deceleration time allowed identification of subgroups with divergent long-term prognoses.

Aged↗
PubMed2003

[Cardiotocography in pregnancies with absent or reversed end-diastolic velocity in the umbilical arteries: analisys of perinatal outcome].

OBJECTIVES: To study the correlation between cardiotocography parameters and perinatal outcome in pregnancies with absent or reversed end-diastolic velocity (AERDV) in the umbilical arteries. METHODS: One hundred and twenty-seven cases presenting with AREDV followed between 1993 and 2000 were selected for analysis. The last cardiotocographic tracing performed on the day of delivery was reviewed and the following parameters were considered: magnitude of long-term variability, presence or absence of acceleration, late deceleration, variable deceleration, prolonged deceleration, pseudo sinusoidal pattern and the classification in normal, suspected and abnormal tracing. RESULTS: A significant (p<0.05) association was found between abnormal tracing and acidemia at birth (pH inferior to 7.20) with 71.9%, first minute Apgar score inferior to seven (73.4%), newborn intubation at delivery (64.1%), and early neonatal death (20.3%). The absence of acceleration was associated (p<0.05) to acidemia at birth (58.8%), first minute Apgar score inferior to seven (67.7%), newborn intubation at delivery (51%) and neonatal death (29.4%). Low FHR variability (<5bpm) was associated to (p<0.05): acidemia at birth (88.5%), newborn intubation at delivery (69.2%), early neonatal death (34.6%) and neonatal death (42.3%). Late decelerations were significantly (p<0,05) related to acidemia at birth.(78.2%). The severe variable deceleration was associated to (p<0.05): acidemia at birth (79.3%), newborn intubation at delivery (69%) and early neonatal death (17.2%). Prolonged deceleration was associated to (p<0.05) newborn intubation at delivery (70.6%). Pseudo sinusoidal pattern was associated to (p<0.05) early neonatal death (60%). CONCLUSION: The AREDV represents a severe fetal compromise with high risk to neonatal morbidity and mortality, and correlation between cardiotocography abnormalities and adverse perinatal outcome was demonstrated.

Acidosis↗
PubMed1988

A modified biophysical profile for antenatal fetal surveillance.

Three hundred thirty-seven high-risk pregnancies were screened using a modified biophysical profile consisting of nonstress testing (NST) and ultrasound evaluation of amniotic fluid volume. Ultrasound assessment of fetal breathing and body movements was performed only to evaluate the nonreactive NST. Decreased amniotic fluid volume and spontaneous fetal heart rate (FHR) decelerations were considered abnormal findings during antenatal testing, and served as indications for delivery regardless of FHR reactivity. Despite intervention, decreased amniotic fluid volume and spontaneous decelerations were associated with an increased incidence of meconium staining, decelerations during labor, cesarean section for fetal distress, and small for gestational age infants. Perinatal morbidity also occurred in patients with spontaneous decelerations and normal amniotic fluid volume. The search for spontaneous FHR decelerations by electronic fetal monitoring should continue during antepartum testing because FHR decelerations cannot be identified by conventional ultrasound assessment. The modified profile seems practical for routine assessment of fetal well-being in high-risk pregnancy, and affords insights unavailable with ultrasound surveillance alone.

Amniotic Fluid↗
PubMed1984

Continuing role of the nonstress test in the management of postdates pregnancy.

A retrospective analysis of 239 postdate patients who delivered within seven days of their last nonstress test between 1 July 1980 and 30 June 1981 was done to determine whether or not there was a relationship between variable fetal heart rate (FHR) decelerations, a decline in the FHR of at least 15 beats per minute and lasting 15 seconds, on the nonstress test and pregnancy outcome. Of the 505 nonstress tests, the results were considered either reactive (424 to 84%) or nonreactive (81 to 16%). Variable FHR decelerations or bradycardias were encountered on 95 nonstress tests (18.8%) in 80 (33.5%) postdate patients. Fetal heart rate bradycardia was encountered in nine patients (3.8%). Based on the last nonstress test, pregnancy outcome for the nonreactive group was less favorable than for the reactive group. However, when the reactive group was separated as to whether FHR decelerations or bradycardias were present or absent on the last test, the reactive group with FHR decelerations had a significant increase in meconium passage, cesarean delivery for fetal distress, and Apgar scores less than 7 at one minute. This group also had a similarly poor outcome as the nonreactive group of postdates patients. These data suggest that the nonstress test, when reactive without evidence of FHR decelerations, is a reliable indicator of fetal well-being in the postdate pregnancy. However, a reactive nonstress test with evidence of FHR decelerations is associated with a significant increase in perinatal morbidity.

Adolescent↗
PubMed1984

The significance of nonstress test from 24 to 42 weeks' gestation.

On 811 pregnant subjects, a sampling that included high-risk pregnancies, NST was performed 3,015 times from 24 to 42 weeks' gestation. Reactive NST and nonreactive NST accounted for 67.9% and 26.1%, respectively. Both amplitude and duration of acceleration showed an increase with the advance of pregnancy. The number of accelerations which occurred in the examination period increased as well. V-shaped decelerations were sometimes found in the NST recordings of normal fetuses accompanied by fetal movements, but the incidence of this type of deceleration tended to decrease as the subjects reached full term. No correlation was found between the occurrence of V-shaped deceleration during antepartum NST and that of variable deceleration during intrapartum monitoring. Taking 10 bpm and 10 seconds as the standard values of the acceleration amplitude and the duration of acceleration, respectively, there was found a significantly higher incidence of late deceleration during labor in the fetuses who showed nonreactive NST antepartally than those showed reactive NST. The incidence of persistent late deceleration was significantly higher in the nonreactive fetuses under the 10 bpm/10 second criteria than in those under the conventional 15 bpm/15 second criteria.

Female↗
PubMed1980

Prediction of abnormal umbilical cord position and intrapartum cord problems from the nonstress test.

A prospective analysis of the nonstress test revealed a group of patients who demonstrate typical variable decelerations associated with fetal movement. Such variable decelerations were observed only in patients who had the test performed for suspected intrauterine growth retardation or for postdatism. Almost half of the suspected small-for-gestational-age fetuses and fetuses of a postdate gestation who demonstrated variable deceleration at nonstress testing also demonstrated an umbilical cord in an abnormal position at delivery. The position of the cord in utero of the remaining patients with variable deceleration at nonstress testing was not determined; however, 88% of this group demonstrated significant variable deceleration during labor. An abnormally positioned cord was noted in half of the patients undergoing cesarean section. It appears that patients with small-for-gestational-age fetuses and those with postdate gestation are at higher risk of intrapartum cord compression problems when variable decelerations are noted with fetal movements during a nonstress test.

Female↗