Labour is a vital period for the labouring mothers, as it should bring with it the fulfilment of an expectation of having the baby that has been awaited. The health of the foetus which is to be born and that of the labouring mother are inextricably linked with each other which is why the labouring mother needs to be assessed and monitored carefully. The cardio-tocograph, which is a globally accepted method of diagnosis and assessment of the foetal status during labour is preferred to be used in monitoring labouring mothers, especially high- risk patients. Despite the evidence and information regarding the effectiveness of the use of the cardio-tocograph, midwives are still found not to be using it correctly, the reasons given that the women not always co-operate; do not keep the electrode and belt in place or cite the discomfort they experience from contraction. The objectives of this study were to: explore and describe the perceptions and current practice of Namibian midwives regarding the use of the cardio-tocograph as an informative labour- monitoring tool. Explore and describe how midwives working in labour wards in Namibia perceive informing laboring women of the use of the cardio-tocograph as an informative labour- monitoring tool and based on the results, develop an instruction guide for midwives working in the labour ward in intermediate hospital in Namibia that would serve as a guide on how to teach labouring women about the use of the cardio-tocograph as a labour- monitoring tool and enhance positive labor and delivery outcomes The study was conducted between May and June 2016, using a qualitative, explorative, descriptive and contextual design, following the necessary university approval and approval from other relevant authorities. The research population was midwives who work in labour wards at a public hospital in Namibia. Semi-structured interviews were used to collect data from purposively sampled participants using set criteria. A voice recorder was used to capture the interview with the permission of the participants. Seventeen midwives were interviewed of whom two were used for the pilot study. Data saturation determined the sufficient sample size. The collected data was analyzed using Tesch’s spiral method of data analysis with the assistance of an independent coder From the research findings, it emerged that midwives had varying perceptions regarding the use of the CTG machine. Midwives still perceive CTG interpretation as a challenge as a labour -monitoring tool and expressed a need for updates. Furthermore, midwives expressed the fact that they had limited communication with labouring women regarding the use of CTG. Based on the research findings and guided by Health Belief Model principles, three main guidelines were developed for midwives working in the labour ward in a public hospital in Namibia. These guidelines will serve as a tool to assist midwives in their teaching of labouring women about the use of the cardio-tocograph as a labour- monitoring tool, and the role to be played by labouring women during that monitoring period. Furthermore, recommendations for clinical nursing practice, nursing education and nursing research were developed. The researcher used literature control to ensure validation and integrity of the study. Trustworthiness, which was used to ensure rigour of the study, was guided by the principles of truth-value, transferability, dependability and confirmability. Ethical considerations were guided by the Belmont report adopting the principles of beneficence, respect for human dignity, justice and non-maleficence.

Thesis (M.A. (Nursing Science)) -- University of Limpopo, 2020 / The aim of the study is to determine the knowledge and practices of midwives regarding the utilization of cardiotocography in labour units, at Hospital A and Hospital B, Waterberg District in Limpopo Province. Further, the objective of the study is to explore and describe the knowledge and practices of midwives regarding the utilization of cardiotocography in labour units and to develop strategies to enhance midwifery practices and knowledge regarding the utilization of cardiotocography in the labour units of Hospital A and Hospital B. The research question is:” What is the knowledge and practices of midwives regarding the utilization of cardiotocography in the labour units of Hospital A and Hospital B?” The Donabedian Model has been used as a theoretical framework. A qualitative exploratory, descriptive and contextual research design has been used in this study. Purposive sampling was used to sample eighteen (18) participants from Hospital A and Hospital B. Data was collected using semi-structured interviews. Tesch’s eight steps of qualitative data analysis were followed and two themes and ten sub-themes emerged. The study found that there were several challenges encountered by participants such as a shortage of material and human resources and lack of continuous training which has a negative impact on the provision of midwifery care. The study recommends that the Department of Health should appointment new skilled midwives as there is shortage of staff, to improve service delivery. It should ensure that there is a guaranteed supply and availability of equipment, such as CTG. The nursing administration should ensure that there is adequate training for midwives. This includes in-service training, workshops and a post basic advanced midwifery course.

Simultaneous maternal indirect blood pressure measurements, electronic fetal heart rate monitoring, and ultrasonographic biophysical profile testing were used to assess maternal-fetal homeostasis in gravid ewes during gestational days 127 to 134 (term 146), during a 72-hour fast, and during treatment with thromboxane synthetase inhibitors CGS13080 and CGS12970. Seventy-five percent of the ewes (12 of 16) developed clinical signs of ovine pregnancy-induced hypertension, including maternal hypertension and fetal depression. In three untreated hypertensive ewes, pregnancy was terminated by spontaneous premature delivery, and one maternal death occurred after an eclamptic seizure. All nine ewes treated with one of the two thromboxane synthetase inhibitors responded to therapy with decreases in blood pressure and resolution of fetal depression. These nine ewes completed gestation, and were delivered at term. These data indicate that therapy with thromboxane synthetase inhibitors in this animal model of preeclampsia results in profoundly beneficial effects and suggest that further studies of thromboxane synthetase inhibitors are warranted in preeclampsia.

This thesis presents a comprehensive work on computerised analysis of fetal heart rate (FHR) features, including feature extraction, feature selection, analysis of influencing factors and setting up/validation of a computerised decision support system. Firstly, a novel feature – pattern readjustment – was extracted and tested. Clinical data were used to train a Support Vector Machine (SVM) to detect pattern readjustment. Then, the association of pattern readjustment and adverse labour outcome was investigated. The validation results with clinical experts show that the pattern readjustment can be accurately detected, while the study on labour outcome shows that the feature is related to fetal acidemia at birth. Secondly, Genetic Algorithms were employed as a feature selection method to select a best subset of FHR features and to use them to predict fetal acidemia with linear and nonlinear SVM. The diagnostic power of the classifier output using selected features was tested on the total set of 7,568 cases. As the classifier output increases, there is a consistent increase of the risk of fetal acidemia. Thirdly, an important influencing factor on FHR features - signal loss – was investigated. A bivariate model was built to estimate error based on signal loss. Validation results show that the bivariate model can accurately predict the error generated by signal loss. The influence of signal loss on labour outcome classification was also investigated. Finally, a computerised decision support system to estimate the risk of fetal acidemia was set up based on the above studies. The system was validated using new retrospective data. Validation results show that the system is capable of predicting adverse labour outcome and providing timely decision support. It is the first time an intrapartum computerised FHR decision support system has been built and validated on this size of dataset. With further improvements, such a system could be implemented clinically in the long term.

More than one million fetal deaths occur in the United States every year [1]. Monitoring the long-term heart rate variability provides a great amount of information about the fetal health condition which requires continuous monitoring of the fetal heart rate. All the existing technologies have either complex instrumentation or need a trained professional at all times or both. The existing technologies are proven to be impractical for continuous monitoring [2]. Hence, there is an increased interest towards noninvasive, continuous monitoring, and less expensive technologies like fetal phonocardiography. Fetal Phonocardiography (FPCG) signal is obtained by placing an acoustic transducer on the abdomen of the mother. FPCG is rich in physiological bio-signals and can continuously monitor the fetal heart rate non-invasively. Despite its high diagnostic potential, it is still not being used as the secondary point of care. There are two challenges as to why it is still being considered as the secondary point of care; in the data acquisition system and the signal processing methodologies. The challenges pertaining to data acquisition systems are but not limited to sensor placement, maternal obesity and multiple heart rates. While, the challenges in the signal processing methodologies are dynamic nature of FPCG signal, multiple known and unknown signal components and SNR of the signal. Hence, to improve the FPCG based care, challenges in FPCG signal processing methodologies have been addressed in this study. A comparative evaluation was presented on various advanced signal processing techniques to extract the bio-signals with fidelity. Advanced signal processing approaches, namely empirical mode decomposition, spectral subtraction, wavelet decomposition and adaptive filtering were used to extract the vital bio-signals. However, extracting these bio-signals with fidelity is a challenging task in the context of FPCG as all the bio signals and the unwanted artifacts overlap in both time and frequency. Additionally, the signal is corrupted by noise induced from the fetal and maternal movements as well the background and the sensor. Empirical mode decomposition algorithm was efficient to denoise and extract the maternal and fetal heart sounds in a single step. Whereas, spectral subtraction was used to denoise the signal which was later subjected to wavelet decomposition to extract the signal of interest. On the other hand, adaptive filtering was used to estimate the fetal heart sound from a noisy FPCG where maternal heart sound was the reference input. The extracted signals were validated by obtaining the frequency ranges computed by the Short Time Fourier Transform (STFT). It was observed that the bandwidths of extracted fetal heart sounds and maternal heart sounds were consistent with the existing gold standards. Furthermore, as a means of additional validation, the heart rates were calculated. Finally, the results obtained from all these methods were compared and contrasted qualitatively and quantitatively.

No description available.

Η εργασία αυτή σκοπό έχει στην επίτευξη ενός συστήματος,η συμπεριφορά του οποίου καθορίζεται βάσει του ιατρικού πρωτοκόλλου του καρδιοτοκογραφήματος ηρεμίας. Έμφαση δίνεται, στον τρόπο προσέγγισης του εμβρυικού καρδιακού ρυθμού (ΕΚΡ). Επιπλέον, αναπτύσσεται ένα πρόγραμμα που αναγνωρίζει τις τέσσερις βασικές παραμέτρους του ΕΚΡ, οι οποίες είναι:η βασική γραμμή του ΕΚΡ,η μεταβλητότητα του ΕΚΡ,ο αριθμός των επιταχύνσεων και επιβραδύνσεων . / This project is designed to create a system whose behaviour is based on the structure of non stress test (NST) protocol. Emphasis is given on the way of approaching the fetal heart rate(FHR). Moreover ,I would like to submit that a program has been developed for recognition of the four basic parameters of the FHR,which are:the FHR baseline,the FHR variability,the number of accelerations and decelerations.

Die nicht-invasive Analyse der fetalen Herzratenvariabilität mittels abdominaler Elektrokardiographie stellt eine neue Methode zur Beurteilung des fetalen Zustandes dar. Die Herzratenvariabilität gilt hier als ein sensitives Maß der autonomen Regulation. Bereits mit Beginn der zweiten Schwangerschaftshälfte ist es möglich, über das mütterliche Abdomen ein fetales Elektrokardiogramm abzuleiten und einer Herzratenvariabilitätsanalyse zuzuführen. Das Untersuchungskollektiv dieser Arbeit umfasste Frauen mit frühem vorzeitigem Blasensprung als Modell einer pathologischen Alteration des fetalen Zustandes sowie Frauen mit normalen Schwangerschaften zwischen der 20. und 28. Schwangerschaftswoche. Die technische Umsetzung und Analyse der fetalen Herzratenvariabilität erfolgte in Kooperation mit dem Institut für Biomedizinische Technik der TU Dresden. Insgesamt wurden 25 Datensätze der Auswertung zugeführt. Eine Reifung des autonomen Nervensystems des Feten mit ansteigendem Gestationsalter konnte mittels der Herzratenvariabilitätsanalyse gezeigt werden. Zur Risikostratifizierung der Feten bei frühem vorzeitigem Blasensprung konnten bei der Betrachtung der Herzratenvariabilitätsparameter keine signifikanten Unterschiede zum Normalkollektiv erhoben werden. Die Analyse der Parameter erfolgte hierbei unabhängig von den fetalen Verhaltenszuständen. Es konnte gezeigt werden, dass die nicht-invasive Analyse der Herzratenvariabilitätsanalyse methodisch und technisch in der Lage ist, den Fetalzustand und dessen Alterationen zu erfassen.

In this thesis, I examine the use of medical technology as the product of, among other things, value systems and individual and collective needs; technological use therefore is shown to be culturally influenced and subject to change according to historical and social context. / I describe and discuss the use of the Electronic Fetal Heart Rate Monitor (EFM)--a state of the art form of electronic information technology--in obstetrical care in a rural Canadian hospital and community. The central issue I examine is why this technology was obtained and repeatedly used despite local medical opinion and scientific evidence that it was ineffective as a tool to improve obstetrical outcome, and also had been shown to put pregnant women at considerable risk of unnecessary and potentially harmful interventions during birth. / I describe how EFM use appeared contradictory because medical understanding of EFM use was limited to what I define as "case centered" research; research limited to measuring the impact of the EFM on individual patient outcome. Case centered studies were not examinations either of the EFM itself, or of its associated technical regimens. Moreover, case centered studies were not used to relate the EFM to women's experiences during birth, hospital traditions, or community expectations. These latter relationships, which are ignored in case studies, form the focus of this research and explain why an EFM was used in this community.

The primary purpose of CTG is to detect early signs of intrapartum hypoxia and improve foetal outcomes. Intrapartum hypoxia remains the major cause of perinatal deaths mainly in monitored labours. This is attributed to the midwives’ lack of skills in the foetal implementation and interpretation of CTG. Midwives interpret foetal heart rate patterns erroneously hence they fail to detect early signs of severe foetal compromise. Accurate interpretation of CTG is the cornerstone for clinical decision during intra-partum foetal surveillance. Therefore, it is mandatory that midwives are competent in CTG. The purpose of the study was to explore and describe the perceptions of midwives in KwaZulu-Natal public hospitals regarding their level of competence related to the CTG. The purpose of the study was to explore and describe the perceptions of midwives in KwaZulu-Natal public hospitals regarding their level of competence related to the CTG. The objectives of this study were: -to explore and describe the perceptions of the midwives regarding their level of competence relating to cardiotocography. -to establish the levels of competence of midwives in relation to CTG. -to develop clinical guidelines that could be utilised by midwives in the implementation and interpretation of the cardiotocograph. The study utilised a quantitative non-experimental comparative descriptive research design. A self-developed and self-administered questionnaire was developed under the supervision of a statistician and was to collect data from a purposively selected sample of midwives who work in labour wards in Kwa-Zulu Natal public hospitals. A sample of 226 practicing midwives working in labour wards of the nine KZN public hospitals was selected using a non-probability convenience sampling method; only 125 responded. Data were collected on an excel spread sheet and analysed under the supervision of the statistician and research supervisor. The researcher assured of validity and reliability of the data collection method and data as well as of the data collection instrument. The findings revealed that the midwives in KZN public hospitals perceived themselves as being competent regarding CTG tasks; however they lack knowledge and skills in the implementation and interpretation of CTG. It was also evident that the midwives’ years of midwifery clinical experience, labour ward experience, possession of additional post basic midwifery qualification and the perceived level of competence related to CTG tasks number of years of the midwives did not influence their level of competence in the implementation and interpretation of CTG. Literature control supported these findings and there was consistency with that literature. Recommendations were made and clinical guidelines were developed to assist midwives with the assessment of foetal heart rate and the interpretation of the cardiotocograph results.