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Antenatal fetal surveillance is a field of increasing importance in modern obstetrics. Measurements extracted (such as fetal heart rate) from antenatal fetal monitoring techniques have the potential to reduce the social, personal and financial burdens of fetal death on families, health care systems and the community. Techniques to monitor the fetus through pregnancy have been developed with the aim of providing information to enable the clinician to diagnose fetal wellbeing, characterise development and detect abnormality. An early diagnosis before delivery may increase the effectiveness of the appropriate treatment. Over the years, various research efforts have been carried out in the field of fetal electrocardiography by attaching surface electrodes to the maternal body. Unfortunately the desired fetal heartbeat signals at the electrode output are buried in an additive mixture of undesired interference disturbances. In this thesis, a non-invasive fetal electrocardiogram machine has been designed, constructed and implemented. This machine is composed of three modified electrocardiogram circuits and an external soundcard. Data was acquired from four surface electrodes placed on the maternal body. Eleven pregnant subjects, with a gestation age between the 30th and 40th weeks of pregnancy, were used to investigate the validity of this machine. Fetal R-waves were detected in 72.7 percent of subjects. The development of a non-invasive machine, capable of detecting and recording valuable anatomic and electrophysiological information of a fetus, represents an important tool in clinical and investigative obstetrics.

Monitoring of women in labour is an important aspect of the practice of the health care professionals working in the labour ward. The pregnancy of a woman mightappear to be normal but it is not possible to predict the positive outcome of labour until the baby is born because foetal distress can occur suddenly or other problems can arise during the course of labour. Doctors need to closely monitor the progress of labour of all the women regardless of whether he pregnancy is rated low risk or not. The use of Cardiotocography (CTG) during labour thus becomes critical. In the current study the perceptions of the doctors working in labour ward units will be explored and described in order to recommend activities that could optimize the use of CTG by doctors as an intrapartum monitoring tool. A qualitative research design will be used and the data collection method will be by means of semi-structured audio-taped one-on-one interviews.

Thesis (MMed)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Introduction - Accurate computerized analysis of the fetal heart rate (FHR) pattern has become more feasible and clinically relevant in recent years. Taking into account advances in neonatal care resulting in a declining lower limit for fetal viability as well as research into fetal effects of maternal high risk behaviour and escalating intra-uterine exposure to harmful toxins and drugs, fetal heart rate patterns need to be more accurately described in earlier gestations than what is currently available in literature. With advancing technology it is becoming possible to accurately record and interpret the FHR patterns from gestations as early as 20 weeks' gestation. By using the Monica AN24 transabdominal electrocardiographic fetal monitor and product specific software, we analysed early FHR patterns according to the Dawes-Redman criteria, as used in later gestations. Methods - The aim of our study was to describe patterns of FHR (short-term variability, basal heart rate, accelerations and decelerations) at 20-24 weeks' gestation. Physiological data were obtained from the routine second trimester fetal assessment by the Monica AN24 monitor as used in the Safe Passage Study. As of December 31, 2009, 411 participants completed their first fetal assessment and met our inclusion criteria. Because our aim was the description of patterns in pregnancies with a normal outcome, we excluded all adverse neonatal outcomes, preterm deliveries, babies with low birth weights as well as cases where delivery data were lost. After recordings of poor technical quality were also removed from our data pool, 281 recordings remained for analysis. Results - Distinct FHR patterns and quantifiable parameters of heart rate variability were consistently observed. In contrast to what has previously been published, accelerations of the FHR and reassuring baseline variation are present from as early as 20 weeks. Conclusion - Information from this study provides an important foundation for further studies of early FHR patterns and it will help us better assess the fetus at a crucial age for indicators of good outcome at early delivery. / AFRIKAANSE OPSOMMING: Inleiding - Akkurate gerekenariseerde ontleding van die fetale hartpatroon het in die afgelope paar jaar meer tegnologies haalbaar met toenemende kliniese toepassing geword. Tans ervaar ons besondere vooruitgang in neonatale sorg en dus dalende grense vir vroeë lewensvatbaarheid in kliniese praktyk. Daar is ook 'n toename in navorsing oor moederlike hoë risiko gedrag tydens swangerskap en die effek hiervan op die ontwikkeling die fetus asook die neonatale uitkomste. Akkurater beskrywing van fetale hartpatrone in vroeëre gestasies as wat huidiglik in die literatuur beskikbaar is, is dus genoodsaak om die effekte van blootstelling op die fetus waar te neem. Met vooruitgang in tegnologie is dit nou moontlik om deur nie-indringende elektrokardiografie, fetale hartpatrone te registreer en te interpreteer van so vroeg as 'n swangerskapsdurte van 20 weke. Deur die gebruik van die Monica AN24 transabdominale monitor en produk-spesifieke programmatuur, kon ons vroeë fetale hartpatrone ontleed volgens die Dawes-Redman kriteria wat gewoonlik in later swangerskapsduurtes gebruik word. Metodes - Die doel van ons studie was die beskrywing van verskeie fetale hartpatrone (naamlik korttermyn variasie, basale hartspoed, versnellings asook vestadigings) rondom 20 – 24 weke swangerskapsduurte. Fisiologiese data is in die tweede trimester verkry deur die Monica AN24 monitor, soos gebruik word in die voortgaande Veilige Geboorte Studie by Tygerberg hospitaal. Tot en met 31 Desember 2009, het 411 deelnemers hulle eerste fetale evaluasie vir die Veilige Geboorte Studie gehad en ook voldoen aan die insluitingskriteria van hierdie projek. Aangesien ons fokus die beskrywing van hartpatrone in normale swangerskappe was, het ons alle nie-wenslike neonatale uitkomste, voortydse verlossings, babas met lae geboorte gewig asook gevalle waarvan die geboortedata nie beskikbaar was nie, uitgesluit. Alle opnames met sub-standaard tegniese kwaliteit is ook verwyder uit ons finale data vir ontleding, wat ons met 281 opnames gelaat het vir hierdie studie. Resultate - Duidelike fetale hartpatrone en meetbare afmetings is deurgangs opgemerk. In teenstryd met wat voorheen gedokumenteer is, is die teenwoordigheid van versnellings asook gerusstellende basislyn variasie meetbaar vanaf 20 weke gestasie. Samevatting - Informasie vanaf hierdie studie verskaf 'n belangrike grondslag vir verdere projekte in die ontleding van fetale hartpatrone met die fokus op ondersoek van vroeë voorspelling van goeie neonatale uitkomste.

Thesis (MMed)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: Misoprostol is often used for the purpose of induction of labour. However, its effect on fetal heart rate has not been systematically studied. Objective To assess the effect of misoprostol on fetal heart rate parameters during induction of labour from 38 completed weeks in women with previous intrauterine death or postterm pregnancy. Study design A retrospective descriptive study of 127 women for a period of 18 months. Method Women who underwent induction of labour with misoprostol for either previous intrauterine death or postterm pregnancy at Tygerberg hospital were eligible. The selected process of induction of labour happened according to the departmental protocol. The primary outcomes were changes in fetal heart rate (variability, accelerations and decelerations) pre-and post-administration of misoprostol. Secondary outcomes were neonatal highcare or intensive care unit (ICU) admissions. Results There was no statistical difference in the mean fetal heart rate and baseline variability in relation to time recordings after administration of misoprostol. There were no statistically significant differences in the distribution of accelerations and decelerations in different time intervals before and after administration. There were more reactive patterns at all time intervals after the administration of misoprostol, but these differences did not quite reach statistical significance. In both study groups no neonatal complications or intensive care admissions were reported. Conclusion In the absence of contra indications, 50mcg of oral misoprostol can be given to mothers for induction of labour as no harmful fetal heart tracing abnormalities were found for 45 minutes; however large prospective randomized controlled trials are still needed to confirm effectiveness and evaluate further maternal and neonatal safety issues. Optimal dose and frequency also still need robust interrogation. Based on this thesis it does appear that misoprostol is probably not harmful to the fetus under these circumstances. / AFRIKAANSE OPSOMMING: Misoprostol word dikwels gebruik vir induksie van kraam. Die effek daarvan op fetale hartspoed is egter nie sistematies ondersoek nie. Doel Om die effek van misoprostol op fetale hartspoedparameters gedurende die induksie van kraam van 38 voltooide weke in vroue met vorige intra-uteriene dood or oortyd swangerskap te evalueer. Studei-ontwerp „n Retrospektiewe beskrywende studie van 127 vroue oor „n periode van 18 maande. Metode Vroue wat induksie van kraam met misoprostol ondergaan het vir of vorige intra-uteriene dood of oortyd swangerskap by Tygerberg Hospitaal is ingesluit. Die proses van induksie van kraam is volgens departementele protokol uitgevoer. Die primêre uitkomste was veranderinge in fetale hartspoed (variasie, versnellings en verstadigings) pre- en post-toediening van misoprostol. Neonatale hoësorg of intensiewe sorg toelatings was sekondêre uitkomste. Resultate Ons het geen statistiese verskille in gemiddelde fetale hartspoed en basislynvariasie in verhouding tot die tyd na toediening van misoprostol gevind nie. Daar was geen statisties betekenisvolle verskille in die verspreiding van versnellings en verstadigings in verskillende tydsintervalle nie. Daar was meer reaktiewe patrone gedurende alle tydsintervalle na die toediening van misoprostol, maar hierdie verskille was nie statisties betekenisvol nie. In beide studiegroepe was daar geen neonatale komplikasies of intensiewe sorg toelatings nie. Gevolgtrekking In die afwesigheid van kontra-indikasies kan 50 mcg misoprostol aan moeders toegedien word vir induksie van kraam aangesien geen skadelike fetale hartsped abnormaliteite gevind is nie. Groot prospektiewe gerandomiseerde gekontroleerde studies word steeds benodig om effektiwiteit te bevestig en om moederlike en fetale veiligheidskwessies verder te evalueer. Optimale dosis en frekwensie benodig ook robuuste ondersoek. Gebaseer op hierdie tesis kom dit voor of misoprostol waarskynlik nie skadelik vir die fetus onder hierdie omstandighede nie.

Os efeitos da glicemia materna na regulação da freqüência cardíaca fetal (FCF) constituem aspecto controverso na literatura, principalmente em gestações complicadas pelo diabetes mellitus. O objetivo deste trabalho foi estudar a influência da glicemia materna na FCF analisada pela cardiotocografia computadorizada. Método: Trinta e nove gestantes com diabetes mellitus pré-gestacional foram avaliadas prospectivamente na Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período compreendido entre julho de 2003 e fevereiro de 2005. As pacientes incluídas possuíam o diagnóstico de diabetes pré-gestacional, gestação única, idade gestacional entre 36 e 40 semanas e ausência de malformações fetais. Para a realização do estudo, cada paciente foi avaliada pela cardiotocografia computadorizada, durante uma hora, sendo analisados os seguintes parâmetros da FCF: freqüência basal, tempo para atingir os critérios de normalidade, freqüência de movimentos fetais, número de contrações uterinas, número de acelerações e desacelerações, episódios de alta e baixa variação, variação de curto prazo. Realizou-se a glicemia capilar imediatamente antes do início da cardiotocografia, 30 e 60 minutos após o começo do exame. Utilizou-se a média glicêmica para análise das relações com os achados cardiotocográficos, com os valores de corte de 100 mg/dL e 120mg/dL. Resultados: Do total de 39 pacientes analisadas, 25 (64,1%) apresentavam média glicêmica &#8805; a 100 mg/dL e 19 (48,7%) &#8805; a 120 mg/dL. A média da FCF mostrou aumento significativo nos grupos com a média glicêmica &#8805; a 100 mg/dL (p<0,05) e a 120mg/dL (p<0,05). Houve correlação positiva significativa (p<0,05 e r=0,57) da FCF com a média glicêmica no exame. Verificou-se correlação negativa significativa (p<0,05) da quantidade de acelerações transitórias acima de 10 bpm (r=-0,32) e de 15 bpm (r=-0,44) com a média glicêmica no exame. A variação de curto prazo da FCF apresentou associação significativa (p<0,05) com a média glicêmica acima de 120mg/dL. Ocorreu correlação negativa significativa (p<0,05) da variação de curto prazo da FCF (r=-0,47) com a média glicêmica no exame. Os demais parâmetros avaliados pela cardiotocografia computadorizada não mostraram diferença significativa com a média glicêmica. Conclusão: os níveis glicêmicos maternos, durante o exame, exercem influência sobre parâmetros da FCF analisada pela cardiotocografia computadorizada. / The effects of maternal glycemia over the of fetal heart rate (FHR) regulation appoint a controversial subject in the literature, mainly in pregnancies affected by diabetes mellitus. The objective of this research was to investigate the influence of maternal glycemia in the FHR indices analysed by computerized cardiotocography. Methods: Thirty nine patients with pre-gestational diabetes mellitus were examined prospectively in the Obstetrics Department of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo- Brazil in a period of time between July of 2003 and February of 2005. The patients included had pre-gestational diabetes diagnosis, single pregnancy, gestational age between 36 and 40 weeks and absent of fetal malformations. Each patient were evaluated by computerized cardiotocography during 60 minutes, with analysis of these follow FHR parameters: basal FHR, time necessary to reach normality criteria, fetal movements rate, contraction peaks, accelerations and decelerations, episodes of high and low FHR variation, short-term FHR variation. The capillary glycemia were colleted immediately before the cardiotocography be performed, 30 and 60 minutes after the beginning of the exam. The glicemic mean level was used for analysis with the cardiotocografics results, with the cut values of 100 mg/dL and 120mg/dL. Results: From 39 patients studied, 25 (64,1%) presented glicemic mean &#8805; to 100 mg/dL and 19 (48,7%) &#8805; to 120 mg/dL. 1) The mean of FHR showed significant elevation in the groups with the glicemic mean &#8805; to 100 mg/dL and to 120mg/dl (p<0,05); 2) There was significant positive correlation (p<0,05 and r=0,57) between the FHR and the mean glicemic; 3) There was significant negative correlation (p<0,05) between the number of transitory accelerations &#8805; than 10bpm (r=-0,32) and &#8805; than 15 bpm (r=-0,44) and the mean glicemic; 4) The short-term FHR variation presented significant association (p<0,05) with the mean glicemic &#8805; 120mg/dL; 5) There was significant negative correlation (p<0,05) between short-term FHR variation (r=-0,47) and the mean glicemic. The others indices evaluated by computerized cardiotocography didn’t exhibit significant difference with the mean glicemic. Conclusions: The maternal glicemic levels during computerized cardiotocography seem to have influence over these analised FHR parameters.

Os efeitos da glicemia materna na regulação da freqüência cardíaca fetal (FCF) constituem aspecto controverso na literatura, principalmente em gestações complicadas pelo diabetes mellitus. O objetivo deste trabalho foi estudar a influência da glicemia materna na FCF analisada pela cardiotocografia computadorizada. Método: Trinta e nove gestantes com diabetes mellitus pré-gestacional foram avaliadas prospectivamente na Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período compreendido entre julho de 2003 e fevereiro de 2005. As pacientes incluídas possuíam o diagnóstico de diabetes pré-gestacional, gestação única, idade gestacional entre 36 e 40 semanas e ausência de malformações fetais. Para a realização do estudo, cada paciente foi avaliada pela cardiotocografia computadorizada, durante uma hora, sendo analisados os seguintes parâmetros da FCF: freqüência basal, tempo para atingir os critérios de normalidade, freqüência de movimentos fetais, número de contrações uterinas, número de acelerações e desacelerações, episódios de alta e baixa variação, variação de curto prazo. Realizou-se a glicemia capilar imediatamente antes do início da cardiotocografia, 30 e 60 minutos após o começo do exame. Utilizou-se a média glicêmica para análise das relações com os achados cardiotocográficos, com os valores de corte de 100 mg/dL e 120mg/dL. Resultados: Do total de 39 pacientes analisadas, 25 (64,1%) apresentavam média glicêmica &#8805; a 100 mg/dL e 19 (48,7%) &#8805; a 120 mg/dL. A média da FCF mostrou aumento significativo nos grupos com a média glicêmica &#8805; a 100 mg/dL (p<0,05) e a 120mg/dL (p<0,05). Houve correlação positiva significativa (p<0,05 e r=0,57) da FCF com a média glicêmica no exame. Verificou-se correlação negativa significativa (p<0,05) da quantidade de acelerações transitórias acima de 10 bpm (r=-0,32) e de 15 bpm (r=-0,44) com a média glicêmica no exame. A variação de curto prazo da FCF apresentou associação significativa (p<0,05) com a média glicêmica acima de 120mg/dL. Ocorreu correlação negativa significativa (p<0,05) da variação de curto prazo da FCF (r=-0,47) com a média glicêmica no exame. Os demais parâmetros avaliados pela cardiotocografia computadorizada não mostraram diferença significativa com a média glicêmica. Conclusão: os níveis glicêmicos maternos, durante o exame, exercem influência sobre parâmetros da FCF analisada pela cardiotocografia computadorizada. / The effects of maternal glycemia over the of fetal heart rate (FHR) regulation appoint a controversial subject in the literature, mainly in pregnancies affected by diabetes mellitus. The objective of this research was to investigate the influence of maternal glycemia in the FHR indices analysed by computerized cardiotocography. Methods: Thirty nine patients with pre-gestational diabetes mellitus were examined prospectively in the Obstetrics Department of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo- Brazil in a period of time between July of 2003 and February of 2005. The patients included had pre-gestational diabetes diagnosis, single pregnancy, gestational age between 36 and 40 weeks and absent of fetal malformations. Each patient were evaluated by computerized cardiotocography during 60 minutes, with analysis of these follow FHR parameters: basal FHR, time necessary to reach normality criteria, fetal movements rate, contraction peaks, accelerations and decelerations, episodes of high and low FHR variation, short-term FHR variation. The capillary glycemia were colleted immediately before the cardiotocography be performed, 30 and 60 minutes after the beginning of the exam. The glicemic mean level was used for analysis with the cardiotocografics results, with the cut values of 100 mg/dL and 120mg/dL. Results: From 39 patients studied, 25 (64,1%) presented glicemic mean &#8805; to 100 mg/dL and 19 (48,7%) &#8805; to 120 mg/dL. 1) The mean of FHR showed significant elevation in the groups with the glicemic mean &#8805; to 100 mg/dL and to 120mg/dl (p<0,05); 2) There was significant positive correlation (p<0,05 and r=0,57) between the FHR and the mean glicemic; 3) There was significant negative correlation (p<0,05) between the number of transitory accelerations &#8805; than 10bpm (r=-0,32) and &#8805; than 15 bpm (r=-0,44) and the mean glicemic; 4) The short-term FHR variation presented significant association (p<0,05) with the mean glicemic &#8805; 120mg/dL; 5) There was significant negative correlation (p<0,05) between short-term FHR variation (r=-0,47) and the mean glicemic. The others indices evaluated by computerized cardiotocography didn’t exhibit significant difference with the mean glicemic. Conclusions: The maternal glicemic levels during computerized cardiotocography seem to have influence over these analised FHR parameters.

Thesis (Ph. D.)--University of North Texas, August, 2008. / Title from title page display. Includes bibliographical references.

This Thesis compares CTG classification techniques proposed in the literature and their potential extensions. A comparison between four classifiers previously assessed - Adaboost, Artificial Neural Networks (ANN), Random Forest (RF), Support Vector Machine (SVM) - and two proposed classifiers - Bayesian ANN (BANN), Relevance Vector Machine - was conducted using a database of 7,568 cases and two open source databases. The Random Forest (RF) achieved the highest average result and was proposed as a benchmark classifier. The proposal to use model certainty to introduce a third, unclassified, class was investigated using the BANN. An increase in the classification accuracy was demonstrated, however the proportion of cases in the unclassified class was too great to be of practical value. The information content of time series was explored using a Hidden Markov Model (HMM). The average performance of the HMM was comparable with the performance of the benchmark with a smaller distribution across validation folds, demonstrating that time-series information provides more stable estimates of class than stationary methods. Finally a method of system identification was implemented. Significant differences between feature trends and histograms in low pH (&LT; 7.1) and healthy pH (&ge; 7.1) cases were observed. These features were used as classifier inputs, and achieved performance similar to existing feature sets. When these features were aligned according the onset of stage 2 labour three unique trend patterns were discovered.

L’objectif de ce travail est d’obtenir, grâce à un mélange de différentes informations, un monitorage de l’activité du fœtus pour apprécier son état de bien-être ou de souffrance.Actuellement, les paramètres qui caractérisent la souffrance fœtale, issus du rythme cardiaque et des mouvements fœtaux, sont évalués par le médecin et ils sont réunis dans le score de Manning. Deux inconvénients majeurs existent: a) l’évaluation du score est trop longue puisqu’elle dure 1 heure b) il existe des variations inter et intra-opérateur conduisant à différentes interprétations du bilan médical de la patiente.Pour s’affranchir de ces désavantages nous évaluons le bien-être fœtal d’une façon objective, à travers le calcul d’un score. Pour atteindre ce but, nous avons développé une technologie ultrasonore mufti-capteurs permettant de recueillir une soixantaine de signaux Doppler en provenance du cœur, des membres inférieurs et supérieurs. / The objective of this work is to assess the fetal parameters and the fetal well-being using a mixture of fetal parameters. In our days, the parameters derived from heart rate and fetal movements that characterize the fetal distress are assessed by the physician and unified in the score of Manning. Two major disadvantages of Manning’s score exist: a) the assessment of the score is time consuming; b) there are variations inter and intra operators leading to different interpretations of the patients medical record. To overcome these disadvantages we assess the fetal well-being objectively, by computing an automatic/electronic score. To achieve this goal, we developed an ultrasonic multi-sensor unit with 12 sensors allowing to collect sixty Doppler signals from the heart, lower and upper limbs.