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1
Bartlett, M. L. "Automatic analysis of intrapartum fetal monitoring." Thesis, University of Newcastle Upon Tyne, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.377449.
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Bai, Yang. "Object tracking and fetal signal monitoring." OpenSIUC, 2016. https://opensiuc.lib.siu.edu/dissertations/1244.
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This dissertation focuses on detecting and tracking small objects in complex backgrounds and on classifying ultra-sound fetal movement signals. The first part of this dissertation focuses on detecting and tracking laser spots which are small objects in a video frames. Many factors make this particular problem extremely challenging. Examples include, irregular shapes, intensity variations, color variations, speckle noise, obstacles, and background complexity. The new method developed combines the advantages of pyramid Lucas-Kanade (PLK) optical flow and optimal recursive Bayesian filters for detection and tracking. The detection and tracking results of the developed method are compared with the Kalman filter, extended Kalman filter, unscented Kalman filter, and the particle filter. It is shown that the new method yields better results. Monitoring fetal movements is crucial for the early detection of abnormalities in the fetus. The second part of this dissertation focuses on segmenting and classifying fetal movements which are aquired using six ultra-sound sensors strapped onto the stomachs of pregnant women. The goal is to classify the signals into two categories: general and startle. Segmentation is conducted using a signal-energy based algorithm and the signals are classified using features extracted from the segmented signals. Three supervised classifiers, the k nearest neighbor, nearest mean, and a support vector machine, are implemented and their performances are compared. The results show that the method developed is able to effectively classify the dichotomous signals.
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East, Christine Elizabeth. "Fetal intrapartum pulse oximetry /." [St. Lucia, Qld.], 2006. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe19387.pdf.
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Peddaneni, Hemanth. "Comparison of algorithms for fetal ECG extraction." [Gainesville, Fla.] : University of Florida, 2004. http://purl.fcla.edu/fcla/etd/UFE0007480.
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Herbert, Julian Michael. "Multichannel monitoring of the abdominal fetal electrocardiogram and the electrohysterogram." Thesis, University of Nottingham, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.339682.
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Hall, Angus John. "Electronic measurements of area and perimeter in ultrasonic images." Thesis, University of Leeds, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.328883.
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Dempster, J. "A Doppler ultrasound study of the umbilical artery." Thesis, University of Aberdeen, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.234028.
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Analysis of the waveforms obtained from the umbilical artery using Doppler ultrasound has been claimed in a number of recent reports to be a highly specific method of identifying babies with intrauterine growth retardation. Because of the morbidity and mortality associated with this condition it was important to evaluate the validity of those claims before introducing the method into obstetric practise. The work in this thesis was carried out in four parts. Firstly the technique was found to be reproducible with small intra and inter-observer errors. Secondly, possible influencing factors were studied, and it was found that the fetal heart rate and fetal breathing movements have a significant effect on the waveform. Thirdly, a longitudinal study of 50 healthy women with normal pregnancies was performed to define the normal range of A/B ratios (the principle method of analysis of the waveforms was the A/B ratio: ratio of peak systolic to end-diastolic frequency). Finally, Doppler ultrasound was performed in 205 women with high risk pregnancies, and results were compared to the normal reference data. When high risk cases with abnormal Doppler results (A/B ratio > 95th centile) were compared with high risk cases with normal Doppler results (A/B ratio < 95th centile) the Doppler abnormal group were found to have a significantly increased incidence of preterm delivery, operative delivery, late fetal heart rate decelerations in labour, increased admission to the special care baby unit, and increased neonatal morbidity. Although an abnormal Doppler result was associated with small for gestational age in 61% of cases, only 41% of cases of small for gestational age had abnormal Doppler results. The conclusion from this thesis is that Doppler flow velocity waveform analysis, although lacking the previously claimed diagnostic precision of detecting intrauterine growth retardation, could contribute to fetal management by identifying babies at high risk of intrapartum complications.
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Aldrich, Clive Jeffrey. "Intrapartum fetal cerebral oxygenation and haemodynamics assessed by near infrared spectroscopy (NIRS)." Thesis, University of Southampton, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.320699.
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Hláčiková, Michaela. "Analýza fetálních EKG záznamů." Master's thesis, Vysoké učení technické v Brně. Fakulta elektrotechniky a komunikačních technologií, 2020. http://www.nusl.cz/ntk/nusl-413165.
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This thesis is focused on the analysis of fetal ECG records measured by indirect method from mother´s abdomen. The thesis consists of the theoretical part is focused on fetal, heart development and description of fetal ECG signal. This thesis also offers an overview of fECG signal processing methods used nowadays. The practical part of the thesis deals with the implementation of algorithms based on wavelet transformation and Least Mean Square LMS method in Matlab programming environment. The final part of the thesis consists of the analysis of achieved results.
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Keith, Robert Duncan Falconer. "Intelligent fetal monitoring and decision support in the management of labour." Thesis, University of Plymouth, 1993. http://hdl.handle.net/10026.1/339.
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The condition of the fetus during labour is inferred from the continuous plot of fetal heart rate and uterine contractions (cardiotocogram, CTG). This can be _ difficult to interpret which results in both unnecessary intervention and a failure to intervene when necessary causing potentially preventable neurological damage and mortality. Conventional computing approaches have not been successful in addressing these problems. This is perhaps because the correct interpretation of fetal condition requires physiological knowledge, considerable practical experience and knowledge of the specific patient. The work described in this thesis is concerned with the investigation of artificial intelligence techniques to assist in the interpretation of fetal condition and advise on labour management. A fundamental investigation examined the performance of five types of scalp electrodes for obtaining the fetal electrocardiogram (ECG), from which heart rate is derived, and examined the factors which hamper fetal ECG data acquisition. New methods were developed to classify the important features from the CTG and included an investigation using neural networks. Other CTG features were classified using novel numerical algorithms developed closely with experts. An expert system, guided by a database of rules obtained from experts, was used to process and interpret changes in the CTG features by taking account of patient specific information. This hybrid approach was adopted to improve performance and reliability. After two internal evaluations had found the system obtained a performance comparable with local experts, an extensive external validation was undertaken. This study involved 17 experts from 16 leading centres within the UK. Each expert and the system reviewed 50 cases twice, at least one month apart which contained those considered most difficult to interpret selected from a database of 2400 high risk labours. A novel method was developed to present all the relevant clinical information in a way which approximated the clinical situation. The reviewers scored each 15 minutes of recording according to the concern they had for the fetus and the management they considered appropriate. In this respect, this is the first reported study to examine the performance of expert obstetricians in the management of labour. A new method was derived to measure the agreement between the scores obtained and is applicable to other areas where it is required to measure the similarity between time related sequences. This study found that the experts agreed well and were consistent in their management of the cases. The system was indistinguishable from the experts, except it was more consistent, even when used by an engineer with little knowledge of labour management. This study has shown that expertise in fetal monitoring is achievable in which case the current evidence suggests that this is not being adequately transferred to clinicians. The challenge remains to formulate a method to effectively transfer knowledge to the labour ward and thereby address the real and practical problems which face fetal monitoring today. This study demonstrates that intelligent systems could provide the vehicle to achieve this. I dedicate this work to the memory of my father, Bradley Kenneth Keith with a hope that he always believed it possible. I know he would have had some interesting comments to make and I sadly miss the opportunity of discussing them with him. I also dedicate this work to my mother for always being there, and to my wife Michelle for her unwavering support, patience and most of all her encouragement throughout this work.
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Sharif, Bayan Salim. "The monitoring and analysis of fetal and neonatal heart rate variability." Thesis, University of Ulster, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.328225.
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Monincx, Wilhelmina Maria Birnie Erwin. "Fetal monitoring at home in high-risk pregnancy an integrated clinical and economic evaluation /." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2000. http://dare.uva.nl/document/55655.
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Janjarasjitt, Suparerk. "A NEW QRS DETECTION AND ECG SIGNAL EXTRACTION TECHNIQUE FOR FETAL MONITORING." Case Western Reserve University School of Graduate Studies / OhioLINK, 2006. http://rave.ohiolink.edu/etdc/view?acc_num=case1144263231.
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Stuart, Ian Peter. "An assessment of the role of Doppler ultrasound velocity waveform analysis of the umbilical artery in the diagnosis of fetal distress in labour." Master's thesis, University of Cape Town, 1993. http://hdl.handle.net/11427/27136.
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Introduction: An assessment of the role of Doppler ultrasound velocity waveform analysis of the fetal umbilical arteries in the diagnosis of fetal distress in labour is made from a review of the literature and clinical study. Study objectives: 1) To determine the value of screening with Doppler ultrasound in high-risk labours in the prediction of the development of indicators of fetal distress. 2) To determine whether Doppler velocimetry indices of the umbilical arteries change with the development of indicators of fetal distress in labour. Design: Repeated Doppler velocimetry in selected high risk labours. Setting: Groote Schuur Hospital, Cape Town, South Africa, a large tertiary referral centre. Subjects: Thirty six women with singleton pregnancies complicated either by gestational proteinuric hypertension or by intrauterine growth retardation or both with a normal cardiotocographic tracing at the onset of labour. Main outcome measures: 1) Acid-base status of the fetus was assessed after deli very by analysis of umbilical artery blood. 2) Apgar score was recorded at 1 and 5 minutes. 3) Neonates were carefully examined for clinical signs of perinatal hypoxia. Results: Twenty seven fetuses were followed through labour. No relation was found between umbilical artery Pourcelot ratio (resistance index) on admission in labour and umbilical artery base deficit. Six fetuses were born with an umbilical artery base deficit of more than 10 mmol 1-1. Zero change in mean Pourcelot ratio was noted in both normal and acidotic fetuses. None of the acidotic fetuses showed a change in Pourcelot ratio of more than 0.03. The study had an 80% power to detect a change in mean Pourcelot ratio of 0.07 in the normal fetuses and 0.16 in the acidotic fetuses at a 95% confidence level. No relation was found between Pourcelot ratio on admission in labour or change in Pourcelot ratio during labour and Apgar score. None of the neonates showed clinical signs of perinatal hypoxia. Conclusions: Doppler velocimetry of the umbilical arteries in labour as measured by the Pourcelot ratio does not contribute to the diagnosis of fetal distress in labour.
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Mabenge, Mfundiso Samson. "Perceptions of the doctors working in labour wards related to the use of cardiotocograph as an intrapartum monitoring tool." Thesis, Nelson Mandela Metropolitan University, 2013. http://hdl.handle.net/10948/d1020345.
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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.
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Challis, Kenneth. "Monitoring pregnancy for improved perinatal outcome in Mozambique /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-406-2/.
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Hindley, Carol. "Intrapartum fetal monitoring for woman at low obstetric risk : enabling evidence based midwifery practice." Thesis, University of Manchester, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.499833.
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Westgate, Jennifer Ann. "An evaluation of electronic fetal monitoring with clinical validation of ST waveform analysis during labour." Thesis, University of Plymouth, 1993. http://hdl.handle.net/10026.1/2439.
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Dissatisfaction with the electronic recording of fetal heart rate and uterine contractions (the cardiotocogram or CTG) has resulted in a search for new techniques of monitoring the fetus during labour. It is important that each method has a sound physiological and pathophysiological basis, that a model for the interpretation of changes is elucidated and that each method is thoroughly evaluated before introduction into clinical practice. Analysis of the ST waveform of the fetal electrocardiogram (FECG) is the most advanced of the new techniques under investigation. Experimental studies have shown that elevation of the ST waveform occurs with a switch to myocardial anaerobic metabolism and a negative waveform occurs during direct myocardial ischaemia. Human observational studies have suggested that a combination of ST waveform and CTG analysis may improve the specificity of intrapartum monitoring and reduce unnecessary intervention. A high quality FECG signal is necessary for waveform analysis. The FECG can be recorded from a scalp electrode (FSE) during labour. The suitability of 5 commonly available FSEs for ECG waveform analysis was compared. Single spiral FSEs had the most favourable physical and electrical properties and produced the best quality signals in a randomised clinical trial of 50 fetuses in labour. Intervention rates and neonatal outcome in labours monitored with CTG alone were compared with those monitored with the combination of ST waveform analysis plus CTG (ST+CTG) in a randomised clinical trial of 2434 high risk labours in a large district general hospital over an 18 month period. There was a 46% reduction in operative intervention for fetal distress in the ST+CTG group (p<0.001, OR 1.96 [1.42-2.71]). There was a trend to less neonatal metabolic acidemia (p = 0.09, OR 2.63 [0.93-7.39]) and fewer low five minute Apgar scores (p = 0.12, OR 1.62 [0.92-2.85]) in the ST+CTG arm. All recordings were reviewed retrospectively, blind to outcome and the CTG classified as normal, intermediate or abnormal according to the trial protocol. There was no significant difference in the proportion of recordings in each category between the trial arms. Operative intervention in the ST+CTG arm was significantly reduced in recordings classified as normal and intermediate by the review (12/1043 ST+CTG arm versus 48/1066 CTG arm, p <0.001). Three patterns of ST+CTG change were identified. 1. Normal CTG, persistent stable ST waveform elevation. These fetuses had good outcome and a significantly higher mean pH (7.29) and lower base deficit (1.1 rnmol/1) at delivery. The raised ST waveform may reflect sympathoadrenal stimulation from the general arousal of labour or a response to mild but compensated hypoxaemia and is in keeping with experimental data. 2. CTG abnormal, progressive elevation in ST waveform. All cases occurred towards the end of second stage. These fetuses had a significantly lower mean pH (7.05) and higher base deficit (7.6 mmol/1) than all other groups. This combination identified fetuses who were developing a metabolic acidosis as a result of significant hypoxia. 3. Abnormal CTG and a negative ST waveform. All cases with persistently negative waveforms were depressed at birth, required resuscitation and had low arterial pHs (where available). This high risk group probably had depleted myocardial glycogen reserves and suffered direct myocardial hypoxia, as seen in animal studies. These findings indicate that ST waveform analysis can discriminate CTG change during labour, the combination can result in a reduction in unnecessary intervention and has the potential to more accurately identify fetuses at risk of neonatal morbidity. The term 'monitoring' implies a degree of automatic surveillance but this is not the case as CTG and ST+CTG records are subjectively interpreted, frequently by junior, inexperienced staff. The retrospective review of cases in the trial revealed significant errors in the use of fetal blood sampling and the interpretation of both CTG and ST+CTG recordings during the study. The feasibility of representing expert clinical knowledge in a decision support tool to provide consistent, accurate interpretation of the CTG was demonstrated in two clinical studies. The full potential of ST+CTG analysis may only be achieved with some degree of automatic data processing and interpretation. The randomised trial also demonstrated the lack of appropriate measures of neonatal outcome with which to judge the effectiveness of fetal monitoring. Analysis of cord artery and vein blood gas status at delivery can provide useful information about fetal oxygenation prior to delivery but currently the information is poorly used, if at all. Use of erroneous data, inappropriate measures of 'acidemia', failure to distinguish between respiratory and metabolic components and unphysiological expectations about relationships to other measures of neonatal outcome were some of the problems highlighted. The use of generic terminology such as 'birth asphyxia' or 'acidosis' which have varying definitions has caused much confusion and should be avoided. There is unlikely to be one 'gold standard' measure of neonatal condition at delivery.
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Small, Kirsten A. "Social Organisation of the Work of Maternity Clinicians Related to a Central Fetal Monitoring System." Thesis, Griffith University, 2020. http://hdl.handle.net/10072/392850.
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The use of cardiotocograph (CTG) monitoring technology is ubiquitous in highincome countries. Central fetal monitoring technology has made it possible to observe a birthing woman’s CTG outside her birth room. Research regarding CTG monitoring demonstrates no significant benefits for the baby and increased rates of surgical birth for women. Very little evidence specifically addresses central fetal monitoring. Despite claims that obstetrics is evidence-based, obstetric organisations continue to recommend CTG monitoring.
My research took a critical feminist stance, questioning the relationships between obstetric power and central fetal monitoring. Using Institutional Ethnography, I examined how maternity clinicians’ intrapartum care provision was organised by, and in relation to, a central fetal monitoring system (K2) in an Australian maternity service. Four focus group interviews, 27 one-on-one interviews and 97 hours of observation were conducted. Relevant texts were also collected.
Midwives described a troubling social event, which they named being K2ed. Obstetric or senior midwifery staff would come into the birth room without the midwife requesting their presence. The staff member entering the room was almost always responding to a CTG interpreted as abnormal when viewed at the central monitoring screen. Midwives experienced being K2ed as intrusive and disruptive. I defined this event as the problematic for my inquiry. Interviews and observations were transcribed, and along with texts, were indexed to identify and collate work processes, social relations and texts. Indexed data were analysed by questioning what they demonstrated about how being K2ed happened. The goal of analysis was to explicate the social and textual organisation of maternity clinicians’ work which made being K2ed possible.
The structure of the K2 system shaped the nature of data entered into K2 and midwives’ documentation work. Midwives worked with K2 to build a representation of the birthing woman, make decisions about initiating CTG monitoring, generate an interpretable CTG recording, interpret the CTG and take action in response to abnormalities. Obstetricians and the midwifery team leader read the data in K2 at the central monitoring screen. Contextual information available to the midwife working with the birthing woman was not visible at the central monitor.
The decision to use CTG monitoring increased the probability of being K2ed. This decision was usually made by the midwife and was strongly structured by a set of texts. These texts also shaped expectations of midwives’ work in generating an interpretable CTG, defined how to interpret the CTG and structured the actions taken when the CTG was categorised as abnormal. Tasks completed by obstetricians, such as fetal blood sampling, were not as strongly coordinated, leaving obstetricians with a degree of autonomy. Midwives were expected to escalate care to senior staff when the CTG was abnormal. This expectation supported being K2ed as a logical behaviour. If the clinician at the central monitor saw an abnormal CTG, and in the absence of contextual information to explain why escalation was not required, the clinician felt justified in going to the birth room when the midwife had not requested their presence. The Intrapartum Fetal Surveillance guideline produced by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists established the discursive territory for other policy texts relating to intrapartum fetal heart rate monitoring. Research regarding intrapartum CTG monitoring incorporated assumptions regarding birthing women (passive, risky), the fetus (precious, at risk) and midwives (lacking competence, needing supervision). These beliefs were translated from research into policy texts, the design of K2, and fetal monitoring education, and therefore entered the everyday work of midwives.
Using Institutional Ethnography to generate a map of social relations, I demonstrate that obstetric ideology acted as a ruling relation, structuring midwives work and reinforcing obstetric dominance in maternity care. Patriarchal views embedded within the textual organisation of the workplace shaped the way that birthing women were knowable and how maternity clinicians acted in relation to that knowledge. Honest conversations within obstetrics and more widely in maternity care are required to acknowledge the harms currently occurring from the use of central fetal monitoring systems. I conclude by suggesting that it is time that maternity clinicians challenged obstetric ideology and focused on growing midwifery as a better model for the future.<br>Thesis (PhD Doctorate)<br>Doctor of Philosophy (PhD)<br>School of Nursing & Midwifery<br>Griffith Health<br>Full Text
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AGOSTINELLI, ANGELA. "Estrazione non invasiva del segnale elettrocardiografico fetale da registrazioni con elettrodi posti sull’addome della gestante (Non-invasive extraction of the fetal electrocardiogram from abdominal recordings by positioning electrodes on the pregnant woman’s abdomen)." Doctoral thesis, Università Politecnica delle Marche, 2017. http://hdl.handle.net/11566/245702.
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Il cuore è il primo organo che si sviluppa nel feto, particolarmente nelle primissime settimane di
gestazione. Rispetto al cuore adulto, quello fetale ha una fisiologia ed un’anatomia significativamente
differenti, a causa della differente circolazione cardiovascolare. Il benessere fetale si valuta
monitorando l’attività cardiaca mediante elettrocardiografia fetale (ECGf). L’ECGf invasivo (acquisito
posizionando elettrodi allo scalpo fetale) è considerato il gold standard, ma l’invasività che lo
caratterizza ne limita la sua applicabilità. Al contrario, l’uso clinico dell’ECGf non invasivo (acquisito
posizionando elettrodi sull’addome della gestante) è limitato dalla scarsa qualità del segnale risultante.
L’ECGf non invasivo si estrae da registrazioni addominali, che sono corrotte da differenti tipi di rumore,
fra i quali l’interferenza primaria è rappresentata dall’ECG materno. Il Segmented-Beat Modulation
Method (SBMM) è stato da me recentemente proposto come una nuova procedura di filtraggio basata
sul calcolo del template del battito cardiaco. SBMM fornisce una stima ripulita dell’ECG estratto da
registrazioni rumorose, preservando la fisiologica variabilità ECG del segnale originale. Questa
caratteristica è ottenuta grazie alla segmentazione di ogni battito cardiaco per indentificare i segmenti
QRS e TUP, seguito dal processo di modulazione/demodulazione (che include strecciamento e
compressione) del segmento TUP, per aggiustarlo in modo adattativo alla morfologia e alla durata di
ogni battito originario. Dapprima applicato all’ECG adulto al fine di dimostrare la sua robustezza al
rumore, l’SBMM è stato poi applicato al caso fetale. Particolarmente significativi sono i risultati relativi
alle applicazioni su ECGf non invasivo, dove l’SBMM fornisce segnali caratterizzati da un rapporto
segnale-rumore comparabile a quello caratterizzante l’ECGf invasivo. Tuttavia, l’SBMM può
contribuire alla diffusione dell’ECGf non invasiva nella pratica clinica.<br>The heart is the first organ that develops in the fetus, particularly in the very early stages
of pregnancy. Compared to the adult heart, the physiology and anatomy of the fetal heart
exhibit some significant differences. These differences originate from the fact that the fetal
cardiovascular circulation is different from the adult circulation. Fetal well-being
evaluation may be accomplished by monitoring cardiac activity through fetal
electrocardiography (fECG). Invasive fECG (acquired through scalp electrodes) is the
gold standard but its invasiveness limits its clinical applicability. Instead, clinical use of
non-invasive fECG (acquired through abdominal electrodes) has so far been limited by its
poor signal quality. Non-invasive fECG is extracted from the abdominal recording and is
corrupted by different kind of noise, among which maternal ECG is the main interference.
The Segmented-Beat Modulation Method (SBMM) was recently proposed by myself as a
new template-based filtering procedure able to provide a clean ECG estimation from a
noisy recording by preserving physiological ECG variability of the original signal. The
former feature is achieved thanks to a segmentation procedure applied to each cardiac
beat in order to identify the QRS and TUP segments, followed by a
modulation/demodulation process (involving stretching and compression) of the TUP
segments to adaptively adjust each estimated cardiac beat to the original beat morphology
and duration. SBMM was first applied to adult ECG applications, in order to demonstrate
its robustness to noise, and then to fECG applications. Particularly significant are the
results relative to the non-invasive applications, where SBMM provided fECG signals
characterized by a signal-to-noise ratio comparable to that characterizing invasive fECG.
Thus, SBMM may contribute to the spread of this noninvasive fECG technique in the
clinical practice.
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Hofmeyr, Franelise. "Description of fetal heart rate patterns at 20 to 24 weeks gestation." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71753.
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Thesis (MMed)--Stellenbosch University, 2012.<br>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.<br>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.
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Pennell, Craig Edward. "The role of lactate measurement in the prediction of fetal hypoxic-ischaemic brain injury during labour." University of Western Australia. School of Women's and Infants' Health, 2004. http://theses.library.uwa.edu.au/adt-WU2003.0037.
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[Truncated abstract] In this thesis the role of lactate measurement has been evaluated in intrapartum assessment of fetal wellbeing. Specifically, I have addressed the question of whether fetal lactate measurement is better than the assessment of fetal heart rate patterns or the measurement of pH at predicting fetal brain injury after intrapartum asphyxia. Using an ovine model of repeated umbilical cord occlusion designed to mimic events which may occur during human labour, I have shown that the measurement of fetal lactate levels after repeated cord occlusion is significantly associated with the severity of brain injury after the asphyxial insult. No significant associations were identified with fetal pH measurements or with the duration of decelerative or compound fetal heart rate patterns; however, this is the first study to describe an association between the duration of both increased fetal heart rate variability and fetal heart rate overshoot with the severity of subsequent brain injury. Although no significant association was identified between fetal arterial pressure measured between umbilical cord occlusions and the grade of brain injury, the studies performed in this thesis are the first to show a strong correlation between the duration of specific arterial pressure responses during cord occlusions and the grade of brain injury, accounting for approximately 90% of the variability seen in the severity of injury. The mechanism responsible for the improved ability of lactate measurement to predict fetal brain injury is unknown. It may be because fetal lactate levels are a more stable marker of anaerobic metabolism of glucose than fetal pH levels, which are influenced by both increasing levels of carbon dioxide and anaerobic metabolism of amino-acids and fatty acids. In addition fetal pH levels can be rapidly normalised through placental exchange of carbon dioxide whereas fetal lactate levels are slow to normalise across the placenta as they rely on facilitated diffusion.
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Costa, Maria Antónia Moreira Nunes da. "Development and evaluation of a combination of computer analysis of cardiotocografy and electrocardiography for intrapartum fetal monitoring." Doctoral thesis, Faculdade de Medicina da Universidade do Porto, 2009. http://hdl.handle.net/10216/26571.
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Costa, Maria Antónia Moreira Nunes da. "Development and evaluation of a combination of computer analysis of cardiotocografy and electrocardiography for intrapartum fetal monitoring." Tese, Faculdade de Medicina da Universidade do Porto, 2009. http://hdl.handle.net/10216/26571.
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Baradoy, Daniel Alexander. "Composition Based Modaling of Silicone Nano-Composite Strain Gauges." BYU ScholarsArchive, 2015. https://scholarsarchive.byu.edu/etd/5483.
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In this work a review of the technology surrounding high deflection strain sensing with an emphasis on that of a recently developed nickel nano-composite strain sensor is presented. A new base silicone material was identified for the nickel nano-composite strain sensor that improves its mechanical stiffness and conductive properties. A previously identified cyclic creep concern was mitigated through preconditioning and the use of adhered backing materials. Through a block design experiment the strain/resistance curves for the strain sensors were characterized over a wide range of nano-filler material compositions. An analytical model was developed based on observation that the resistance of the sensors follows a log-normal response with respect to applied strain. The model demonstrated high fidelity in representing the resistance-strain relationship of the sensors yielding an average R2 value of .93. A standard least squares statistical analysis confirmed strong relationships between curve fit parameters of the modified log-normal model and additive volume fractions with significance at the .05 level for each case. A suitable strain gauge composition was selected for a specific application: a fetal monitoring device. A prototype belt was developed that is worn over the abdomen to detect deflections cause by labor contractions and other fetal movements. Simulation testing on the device was performed and the device was found to be a feasible option for fetal monitoring.
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Souza, Adriana Cristina de. ""Cardiotocografia estimulada em gestações de baixo risco: estudo comparativo da resposta cardíaca fetal à estimulação vibratória e sônica"." Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-07082006-093452/.
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Trata-se de estudo prospectivo, comparativo da resposta da freqüência cardíaca fetal (FCF) à estimulação vibratória e sônica, quanto à amplitude e duração, em 113 fetos de gestações de baixo risco. A população estudada foi discriminada em quatro grupos: 1) 25 semanas a 28 semanas e seis dias; 2) 29 semanas a 32 semanas e seis dias; 3) 33 semanas a 36 semanas e seis dias e 4) 37 a 42 semanas. Comparando-se a amplitude e a duração da resposta da FCF na faixa três e na faixa quatro, a resposta à estimulação vibratória foi menor que a sônica. Nas faixas um e dois não houve diferença nas respostas. Conclui-se que a estimulação vibratória promove resposta fetal (FCF) menos intensa com amplitude e duração de resposta menor quando comparada à estimulação sônica em faixa de idade gestacional mais tardia<br>This prospective study compares the response in terms of fetal heart rate acceleration after vibratory and sonic stimulation, in a sample of 113 fetuses of low-risk pregnancies. The study population was divided into four groups according to gestational age: group 1 - 25 weeks to 28 weeks and 6 days; group 2 - 29 weeks to 32 weeks and 6 days; group 3 - 33 weeks to 36 weeks and 6 days, and group 4 - 37 to 42 weeks. Comparing the amplitude and duration of the cardioacceleratory response between group 3 and 4, the response after vibratory stimulation was lower than sonic. In the groups 1 and 2, the response was similar. The study concludes that vibratory stimulation promotes a less intense response with amplitude and duration lower than sonic stimulation in latter gestational age
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Lopes, Marco Antonio Borges. "Estudo da gestação no período de 40 a 42 semanas: avaliação da vitalidade fetal e resultados neonatais." Universidade de São Paulo, 1996. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-29092011-190201/.
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Neste trabalho foi proposto o estudo prospectivo de gestações após a 40a semana, objetivando: a) verificar os índices de morbidade e mortalidade perinatais; b) identificar os testes de avaliação da vitalidade fetal mais adequados para a vigilância destas gestações; c) comparar os resultados dos testes de avaliação da vitalidade fetal com os resultados perinatais na 1a e 2a semana, após a 40a semana de gestação, para testar o protocolo do Serviço. Para a realização do estudo, selecionaram-se 52, gestantes divididas em 2 grupos: GI (1a semana) com 32 gestantes e GIl (2a semana) com 20 gestantes. Acompanhou-se a vitalidade fetal com a Cardiotocografia de Repouso e Intraparto, Teste da Estimulação Sônica, Avaliação do Volume do Líquido Amniótico através da Técnica dos Quatro Quadrantes, Perfil Biofisico Fetal e Dopplerfluxometria Uterina e Umbilical, realizados 2 vezes na semana. Os resultados neonatais e os índices de morbidade foram: Índices de Apgar no 10 e 50 minutos (alterados < 7), pH da artéria umbilical (alterado < 7,20), peso dos recém-nascidos, tempo de internação dos recém-nascidos, oligoidrâmnia, líquido amniótico meconial, alterações na cardiotocografia com presença de desacelerações e índices de cesárea. O estudo permitiu como resultados e conclusões: a) a incidência de oligoidrâmnio foi de 44,23%, líquido meconial de 28,85%, cardiotocografia alterada, 50,00% e partos cesáreos, 57,70%, não havendo óbito fetal ou neonatal. Não houve alterações significativas nos índices de Apgar, pH da artéria umbilical e tempo de internação dos recém-nascidos. b) A cardiotocografia e, principalmente, a avaliação do volume do líquido amniótico, pelo índice de líquido amniótico, foram os métodos mais adequados na detecção de alterações verificadas neste grupo de gestantes. Do parâmetro ultra-sonográfico do Perfil Biofisico Fetal, apenas o Volume do Líquido Amniótico demonstrou ser importante. A Dopplerfluxometria (uterina e umbilical) não revelou nenhuma utilidade na vigilância destas gestações. c) A distribuição dos casos com oligoidramnia, líquido meconial, cardiotocografia alterada, índices de cesárea e pH da artéria umbilical < 7,20, semelhante na 41a semana (GI) e 42a semana (GIl), valida o protocolo do Serviço. d) Adicionalmente, este estudo permite ainda as seguintes observações: 1) importância da oligoidrâmnia e líquido meconial na determinação dos elevados índices de cesáreas; 2) incidência elevada (50,00) de nulíparas nesta casuística.<br>This study proposed pros.pectively the evaluation of the gestations after 40 weeks with these objectives: a) Analysis of the perinatal outcome. b) Identification of the proper test for fetal well-being assessment for this gestation. c) Comparation of these tests results with perinatal outcome at the first and second weeks after 40 weeks, therefore, testing the protocol of this Service. It recruited 52 patients divided in two groups: GI (1st week) with 32 patients and Gil (2nd week) with 20 patients. The fetal surveillance was assessed by antepartum and intrapartum cardiotocography, acoustic stimulation test, amniotic fluid volume assessment by the ultrasonographic four quadrant technique (amniotic fluid index), fetal biophysical profile and umbilical and uterine doppler velocimetry, ali tests were performed twice weekly. The neonatal outcome results and morbidity parameters were: Apgar index in 1st and s\" minutes (alterated < 7), umbilical artery pH (alterated < 7,20), the new born weight, oligohydramnios, meconium stained, deceleration (DIP 11 or umbilical deceleration) and cesarean section rates. The study permitted these results and conclusions: a) The oligohydramnios, meconium stained, cardiotocography alterations and cesarean section incidences were 44,23%, 28,85%, 50,00% and 57,70%, respectively. There was no fetal death. b) The cardiotocography and amniotic fluid assessment by the amniotic fluid index, were the best tests to detect the alterations verified. The amniotic fluid volume was the most important parameter in the fetal biophysical profile. Doppler (uterine and umbilical) revealed no utility. c) The equal distribution of the oligohydramnios, meconium stained, altereted cardiotocography, cesarean section and umbilical artery pH < 7,20 cases in the group studied reassure the Service protocol. d) In addition this study also permitted observation of: 1) The importance of the meconium stained in the cesarean section rate. 2) The nuliparus elevated incidence (50,00%) in this group.
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Feketshane, Anthony M. "The effect of misoprostol on fetal heart rate parameters during induction of labour from 38 weeks gestation : a retrospective audit." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/85819.
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Thesis (MMed)-- Stellenbosch University, 2013.<br>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.<br>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.
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Keeney, Janice E. Chandler Cynthia K. "Effects of heart rate variability biofeedback-assisted stress management training on pregnant women and fetal heart rate measures." [Denton, Tex.] : University of North Texas, 2008. http://digital.library.unt.edu/permalink/meta-dc-9073.
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Abrão, Karen Cristine. "Efeito da analgesia obstétrica combinada raqui-peridural no tônus uterino e na freqüência cardíaca fetal: ensaio clínico randomizado comparativo com a analgesia peridural." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-06052009-162539/.
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A fim de investigar a associação entre alterações do tônus uterino e a ocorrência de anormalidades da freqüência cardíaca fetal (FCF) após analgesia obstétrica, em especial após o bloqueio combinado raqui-peridural, foi conduzido estudo prospectivo randomizado e encoberto, com setenta e sete parturientes que solicitaram analgesia regional durante o trabalho de parto. As pacientes do grupo estudo (41 casos) receberam duplo bloqueio com sufentanil e bupivacaína e as do grupo controle (36 casos) foram submetidas à peridural com as mesmas drogas. Monitorizou-se o tônus uterino por meio de cateter intra-amniótico de aferição da pressão intra-uterina e a freqüência cardíaca fetal durante 15 minutos antes e 30 minutos após a indução da analgesia. Pesquisaram-se os seguintes desfechos após a administração da analgesia: ocorrência de aumento do tônus uterino superior ou igual a 10mmHg em relação aos valores pré-analgesia e presença de desacelerações prolongadas da FCF ou bradicardia. Foram ainda quantificados os escores maternos de dor, a pressão arterial materna e o uso de ocitocina, antes e após o bloqueio. Observou-se associação significativa tanto do aumento de tônus uterino quanto das alterações da FCF com a analgesia combinada, nos primeiros 15 minutos após sua administração. O aumento de tônus foi encontrado em 17 de 41 casos no grupo estudo e em 6 de 36 pacientes nos controles (p=0,02). Alterações da FCF foram vistas em 11 dos 17 casos de aumento de tônus nas parturientes que receberam analgesia combinada, versus 1 de 6 no grupo peridural (p<0,001) A análise de regressão logística apontou o tipo de analgesia como fator independentemente associado ao aumento de tônus uterino, mesmo inserindo-se o uso de ocitocina como covariável. Também revelou o aumento de tônus como único fator independentemente associado ao desenvolvimento de anormalidades da FCF, mesmo com a hipotensão materna como covariável. Demonstrou-se ainda correlação entre o rápido declínio da dor com a técnica combinada e a probabilidade estimada de ocorrência simultânea de aumento do tônus e alterações da FCF. Os presentes achados reforçam a teoria de que o duplo bloqueio pode levar a aumento transitório de tônus uterino e culminar em anormalidades da FCF<br>In order to investigate the association between uterine tone elevation and fetal heart rate (FHR) abnormalities following labor analgesia - mainly with combined spinal-epidural (CSE) technique - a prospective double-blinded randomized study was conducted with seventy seven parturients who requested labor analgesia. Study group (41 cases) received CSE with sufentanil and bupivacaine and control group (36 cases) received epidural analgesia with the same drugs. Intra-uterine pressure was monitored with intra-amniotic pressure device and FHR with external transducer, both for at least 15 minutes before and 30 minutes after analgesia induction. The primary outcomes were the occurrence of an elevation of 10mmHg or more on uterine tone compared to the values before analgesia and the presence of prolonged fetal heart rate decelerations or fetal bradycardia. Maternal pain scores, blood pressure and use of oxytocin were also computed. A significant association was noticed between elevation of uterine tone and fetal heart rate abnormalities with combined spinal-epidural analgesia, at the first 15 minutes of administration. Uterine tone elevation was observed in 17 out of 41 CSE subjects and only 6 out of 36 controls (p=0.02). Fetal heart rate abnormalities were seen in 11 out of 17 cases that had hypertonus with combined analgesia and in only one of the 6 epidural patients (p<0.001). Logistic regression analysis revealed the mode of analgesia as the independent factor for the elevation of uterine tone, even with oxytocin use as a covariate. It also pointed out the uterine tone elevation as the only independent factor related to the development of fetal heart rate abnormalities, even with maternal hipotension as a covariate. A correlation was found between the fast onset pain relief provided by CSE analgesia and the estimated probability of uterine tone elevation and simultaneous fetal heart rate abnormalities. The present results strengthen the hypothesis that CSE analgesia can lead to a transient increase in uterine tone, leading to fetal bradycardia
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Davies, Barbara Lynn. "Evaluation of two strategies for the transfer of research results about labour support and electronic fetal monitoring into practice." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0004/NQ41136.pdf.
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Clibbon, Alex P. "Methods of classification of the cardiotocogram." Thesis, University of Oxford, 2016. https://ora.ox.ac.uk/objects/uuid:550bb5ea-bee8-4eb8-95e2-f16c54d7cd68.
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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 (< 7.1) and healthy pH (≥ 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.
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Bassett, Kenneth 1952. "Taming chance and taking chances : the electronic fetal heart monitor in a rural Canadian hospital and community." Thesis, McGill University, 1993. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=39820.
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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.<br>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.<br>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.
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Cruz, Lemini Mónica Cristina. "Fetal cardiovascular dysfunction in intrauterine growth restriction as a predictive marker of perinatal outcome and cardiovascular disease in childhood." Doctoral thesis, Universitat de Barcelona, 2013. http://hdl.handle.net/10803/134221.
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Most risk factors leading to cardiovascular disease are already present in childhood and the importance of early identification of pediatric cardiovascular risk factors is now well recognized. Hypertension in the child has been associated with substantial long-term health risks and considered an indication for lifestyle modifications. Current clinical guidelines contemplate screening for hypertension in children over 3 years of age, in order to provide strategies for promoting cardiovascular health, which can be integrated into comprehensive pediatric care. Interventions in the IUGR group could go from blood pressure monitoring before 3 years of age, recommending lack of exposure to other risk factors (secondary smoking, obesity), surveillance of catch-up growth or administration of hypotensors and specially, promoting exercise and physical activity. A recent randomized trial in a large cohort of children suggest that the inverse association of fetal growth with arterial wall thickness in childhood can be prevented by dietary ω-3 fatty acid supplementation over the first 5 years of life. IUGR is not listed among those conditions presumed to increase cardiovascular risk, in current guidelines. Considering IUGR affects 5-10% of all newborns, the findings of this study would affect thousands of children per year. Currently, there are no prenatal parameters described that may aid in selecting those fetuses with later hypertension and arterial remodeling that may benefit for early screening in infancy and other preventive measures or interventions.
Both fetal and child cardiovascular evaluations have proven to be reliable techniques for describing changes in IUGR; cardiovascular dysfunction has been found subclinically and may have implications for cardiovascular risk in future life. The main aim of this work was to evaluate cardiovascular function parameters in IUGR fetuses as predictors of perinatal and postnatal cardiovascular outcome. In order to do this, we looked to validate the reproducibility of measurements and techniques not previously described in IUGR fetuses (studies 1 and 2), to evaluate whether fetal cardiovascular parameters could help us predict perinatal outcome (study 3) and finally to assess the value of fetal echocardiography for prediction of postnatal cardiovascular risk factors, specifically hypertension and arterial remodeling (study 4). This thesis confirms previous studies showing fetal cardiac dysfunction can be documented by fetal echocardiography; it validates different methods for evaluating cardiac function in the fetus and demonstrates the predictive value of these parameters for perinatal and postnatal cardiovascular outcome. Our first study demonstrates for the first time the validity of M-mode to assess longitudinal axis motion in IUGR. It further confirms previous research that IUGR fetuses have a significant decrease in longitudinal myocardial motion, as part of the fetal cardiovascular adaptation to placental insufficiency. In our second study, both TDI and 2D-derived strain analysis demonstrated to be feasible and reproducible to evaluate deformation parameters in the fetal heart. Our third study evaluated the independent and combined contribution of fetal cardiovascular parameters to the prediction of early-onset IUGR perinatal mortality. The study suggests an algorithm illustrating the chances of perinatal death against gestational age and DV, which might help clinical decisions in the management of early-onset IUGR fetuses.
The fourth study provides, for the first time, evidence that fetal echocardiographic parameters are strongly associated to postnatal hypertension and arterial remodeling, which are recognized cardiovascular risk factors and surrogates for early-onset cardiovascular disease. It supports that a fetal cardiovascular score is strongly associated with the presence of postnatal hypertension and arterial remodeling at 6 months of age in IUGR. Echocardiographic parameters demonstrated a far better performance than perinatal factors and fetoplacental Doppler used for establishing the severity of IUGR.<br>Los fetos con restricción del crecimiento intrauterino (RCIU) presentan remodelamiento cardiovascular el cual persiste en la infancia y se ha asociado a enfermedades cardiovasculares en el adulto. La hipertensión en la infancia se ha demostrado como un factor de riesgo cardiovascular para la enfermedad adulta. Un seguimiento estricto junto con intervenciones en la dieta se ha demostrado mejora la salud cardiovascular en estos niños, sin embargo no todas las restricciones del crecimiento tienen hipertensión en la infancia. El objetivo principal de esta tesis es definir los parámetros con mayor utilidad de la ecocardiografía fetal para predecir hipertensión y remodelamiento arterial en infantes de 6 meses de edad con restricción del crecimiento intrauterino. Para esto, se realizó un estudio de cohorte incluyendo fetos con RCIU y controles, seguidos desde vida prenatal hasta los 6 meses de edad. La evaluación prenatal consistió en una ecocardiografía funcional completa. A los 6 meses de edad estos niños fueron evaluados para hipertensión y remodelamiento arterial. Posteriormente se realizó la construcción de un score cardiovascular para determinar desde vida prenatal aquellos niños con mayor riesgo a presentar hipertensión en vida postnatal y que pudieran requerir vigilancia o intervenciones.
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Keeney, Janice E. "Effects of Heart Rate Variability Biofeedback-assisted Stress Management Training on Pregnant Women and Fetal Heart Rate Measures." Thesis, University of North Texas, 2008. https://digital.library.unt.edu/ark:/67531/metadc9073/.
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This study examined effectiveness of heart rate variability (HRV) biofeedback-assisted stress management training in reducing anxiety and stress in pregnant women and the effect of maternal stress management skills practice on fetal heart rate measures in real time. Participants were seven working pregnant women who volunteered in response to recruitment announcements and invitations from cooperating midwives. Reported state and trait anxiety and pregnancy specific stress were measured during five 45- to 50-minute training sessions. Training included bibliotherapy, instruction in the use of emotion-focused stress management techniques, and HRV biofeedback. Subjects used portable biofeedback units for home practice and were encouraged to practice the skills for 20 minutes a day and for short periods of time during stressful life events. At the end of training, fetal heart rate was monitored and concurrent maternal HRV measures were recorded. Repeated measures ANOVA and paired samples t-test analysis of study data revealed no statistically significant reductions in state or trait anxiety measures or in pregnancy specific stress measures. Partial eta squared (n²) and Cohen's d calculations found small to medium effect sizes on the various test scales. Friedman's analysis of variance of biofeedback measures showed a statistically significant decrease in low HRV coherence scores (X2 = 10.53, p = .03) and medium HRV coherence scores (X2 = 11.58, p = .02) and a statistically significant increase in high HRV coherence scores (X2 = 18.16, p = .001). This change is an indication of improved autonomic function. Results of concurrent maternal and fetal HRV recordings were generally inconclusive. A qualitative discussion of individual subject results is included. During follow-up interviews five subjects reported that they felt they were better able to cope with stress at the end of the study than at the beginning, that they used the stress management skills during labor, and that they continue to practice the skills in their daily lives.
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Rossi, G. "L'INTERPRETAZIONE DEL MONITORAGGIO CARDIOTOGRAFICO IN TRAVAGLIO DI PARTO: CLASSIFICAZIONI A CONFRONTO NELL'IDENTIFICAZIONE DEL DISTRESS FETALE." Doctoral thesis, Università degli Studi di Milano, 2014. http://hdl.handle.net/2434/233146.
Full textAbstract:
Title
Comparison of two classification systems for interpreting electronic fetal monitoring in predicting fetal distress
Abstract
Background. With the diffusion of the cardiotocography (CTG) many attempts have been made to correlate the traces with the neonatal outcome with the aim to promptly predict any neonatal distress. However, no definitive agreement exists on its clinical role. The aim of this study was the analysis in a case-control fashion of a series of CTG traces in regards to their capability to detect corresponding values of pH.
Methods. A series of 71 cases of operative deliveries for neonatal distress were compared with a series of 68 controls of operative deliveries performed not for neonatal distress. A senior and a junior consultant retrospectively analyzed the CTG traces based on two classifications, the Royal College of Obstetricians and Gynecologists (RCOG), and the American College of Obstetricians and Gynecologists (ACOG). Sensitivity, specificity, positive and negative predictive values were calculated. The accuracy of these classifications to predict a pH≤7 was tested using the receiver-operating characteristic (ROC) curves. Agreement between the two consultants and the two classifications was calculated with the Cohen’s kappa test. Univariate and multivariate analyses of prognostic factors were also performed.
Results. Considering pH ≤7 the sensitivity, specificity, positive and negative predictive values were 78%, 73%, 25%, 97% and 78%, 87%, 47%, 96% for RCOG and ACOG respectively. At the ROC curves ACOG had a slight better AUC (0,684 versus 0,649). A fair to good agreement resulted between the two consultants even if in control group the agreement was better for two classification (Weighted k value case group RCOG 0.59/ACOG 0.49; control group Weighted k value RCOG 0.66 /ACOG 0.62). It was a low agreement between two consultants to give the same classification. Major experience of senior-consultant showed better results in term of providing pH at birth. At univariate analysis no specific factors were found to be associated with neonatal distress.
Conclusions. The study demonstrate that the two classification used to evaluate EFM in labor have a good sensibility in predicting fetal distress even if the low prevalence of the target condition. Intra/inter-operator disagreement is an important limiting factor.
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Uusiku, Laura Ingashipwa. "Perceptions and current practices of Namibian midwives regarding the use of the cardio-tocograph as an informative labour monitoring tool for labouring women." Thesis, Nelson Mandela Metropolitan University, 2017. http://hdl.handle.net/10948/21318.
Full textAbstract:
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.
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Wright, Andrew William. "Umbilical arterial flow analysis to determine an index of placental impedance." Master's thesis, University of Cape Town, 1994. http://hdl.handle.net/11427/27050.
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Umbilical flow velocity waveforms (FVW' s) can be measured non-invasively using Doppler ultrasound. Changes in the FVW's occur long before the warning signs from other conventional monitoring methods. Correct interpretation of the changes in the FVW has the potential of providing the clinician with an early warning of foetal distress. A number of indices have been described in the literature to characterise the FVW including the Pulsatility Index (PI), the Resistance Index (RI) and more recently, the High Resistance State Index (HRSI). Researchers have shown a dependence of the FVW, and thus the indices which describe it, on factors such as the placental resistance (Muijsers et al 1990a) blood pressure pulsatility (Mulders et al 1986), and the foetal heart rate (Downing et al 1991). In order to model the foetal circulation, the dimensions of the foetal vessels were required. These were taken from the literature when available, but had to be supplemented by measurements on post mortem specimens. This information, together with blood pressures and flow rates taken from the literature, was used to design electrical analogous models of the foetal arterial circulation (model 1 and model 2), which were implemented using PSpice, which is an electronic circuit simulator package. The Flow Velocity Waveforms (FVW's) simulated were stored and then analyzed using MATLAB, which is a mathematical package to calculate the waveform indices and both the blood pressure and percentage blood flow to the different anatomical regions of the foetus. Model 1 is a simple model of the umbilical placental unit only, which assumes a rectified sine wave with a D.C. offset as an input waveform while Model 2 is a distributed element model of the complete foetal arterial system, including a realistic representation of the foetal heart. AIM: Simulations of the FVW were used to examine the effects of placental obliteration (raised placental resistance), placental size, foetal heart rate (FHR), blood pressure pulsatility (BPPI), mean blood pressure (BP), and site of measurement of the FVW along the umbilical artery and thus on the waveform indices which are used to describe it (RI, PI and HRSI). RESULTS/ DISCUSSION: The investigations using models 1 and 2 showed that the indices were significantly dependent on the placental resistance, the size of the placenta and the type of placental obliteration. Model 1 was also used to investigate the effect of FHR variations on the indices under the original assumption that the input waveform to the umbilical/placental unit was a rectified sinusoid offset by a constant voltage (D.C.) (Thompson and Trudinger 1990). The result obtained, that is, the FHR does not affect the indices (in particular the PI) needed further investigation because the assumption for the input waveform is not true under all conditions. For this reason, the simulations were repeated using model 2, with the interesting result that there is a difference between short term FHR variations and long-term FHR variation. Short term FHR variations had a pronounced effect on the indices. The blood pressure pulsatility and the indices concerned varied by large amounts in this case, which indicated a link between the blood pressure pulsatility and all the indices. Long term FHR variations had an inconsistent but small effect on the blood pressure pulsatility and in turn had a small effect on the RI and PI. The mean blood pressure in these simulations decreased with increasing FHR which resulted in a pronounced increase in the HRSI which indicated the dependency of this index on the mean blood pressure rather than on the blood pressure pulsatility. It was found that the HRSI is a good index of placental resistance and may be particularly useful in evaluating high placental resistance in cases of absent flow during diastole, since, in these cases it is only slightly affected by the FHR. A value of greater than 34 percent is the recommended HRSI value to indicate severe foetal distress. The results also indicate that the FVW shape varies along the umbilical artery and is far more pulsatile at the aortic (proximal) end than the placental end. This is reflected in the indices which thus have worst case values at the placental end. It is thus recommended that, where possible, the indices are measured at the placental end of the umbilical artery.
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Neves, Itamara Lucia Itagiba. "Monitorização materno-fetal da portadora de doença valvar reumática durante procedimento odontológico sob anestesia local." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-18042007-090959/.
Full textAbstract:
Modificações na fisiologia do organismo da mulher ocorrem durante a gravidez em conseqüência às alterações hormonais, anatômicas e metabólicas. No sistema circulatório a modificação mais significativa é o aumento do débito cardíaco a partir do primeiro trimestre da gestação. Mulheres portadoras de cardiopatias podem apresentar graves complicações durante o período gestacional devido à inapropriada adaptação à sobrecarga hemodinâmica, mesmo em pacientes consideradas em capacidade funcional favorável, no início da gestação. A literatura carece de estudos dos efeitos dos anestésicos locais com ou sem vasoconstritor utilizados nos procedimentos odontológicos, sobre os parâmetros cardiovasculares de mulheres gestantes portadoras de valvopatias e seus conceptos. A escassez científica fez deste tema nosso objetivo de estudo: avaliar e analisar parâmetros da cardiotocografia, como freqüência cardíaca, motilidade fetal e contrações uterinas e de pressão arterial e eletrocardiográficos da gestante portadora de doença valvar reumática quando submetida à anestesia local com lidocaína, com e sem vasoconstritor, durante procedimento odontológico restaurador. Para tanto, a monitorização ambulatorial da pressão arterial (MAPA) e a eletrocardiografia ambulatorial (Holter) materna, ambas obtidas durante 24 horas e a cardiotografia (CTG) de 31 portadoras de cardiopatia reumática entre a 28ª e 37ª semana de gestação, nos períodos: (1) basal - 60 minutos antes do procedimento para MAPA e Holter e 20 minutos para CTG; (2) procedimento - 56+15,5minutos (média+desvio padrão); (3) pós-procedimento - 20 minutos; e (4) média das 24 horas para freqüência cardíaca e extra-sístoles e média da vigília e do sono para pressão arterial, permitiu a análise da variação desses parâmetros, utilizando-se lidocaína 2% sem vasoconstritor e lidocaína 2% com epinefrina 1:100.000, compondo-as em dois grupos. Demonstrou-se redução significativa nos valores de freqüência cardíaca materna durante o procedimento somente quando comparado aos demais períodos (p<0,001). Quando comparados os dois grupos, não houve diferença (p>0,05). Houve ocorrência de arritmia cardíaca em 9 (29,0%) pacientes, sendo 7 (41,8%) do grupo que recebeu anestesia com adrenalina. A pressão arterial materna não apresentou diferença quando comparamos os períodos ou os grupos (p>0,05). O mesmo ocorreu (p>0,05) nas análises comparativas dos parâmetros fetais obtidos por meio da CTG - número de contrações, nível e variabilidade da linha de base, número de acelerações da freqüência cardíaca fetal e padrão de reatividade fetal. Concluiu-se que o uso da lidocaína 2% associado à adrenalina mostrou-se seguro em procedimento odontológico durante a gestação de mulheres com cardiopatia valvar reumática.<br>During pregnancy, the organic systems of a woman are subjected to physiological modifications consequential to hormonal, anatomic and metabolical alterations. The most significant modification in the circulatory system is an increased cardiac output from the first three months of gestation. Women with heart disease may present with severe complications during the gestational period, because of inappropriate adaptation of her body to this hemodynamic overload, even those patients who are thought to have an appropriate functional capacity during early pregnancy. There are scant studies in the literature on the effects of local anesthetics, with and without vasoconstrictor, used in dental procedures on the cardiovascular variables of pregnant women with valvar disease, as well as on their concepti. Driven by this shortage, we decided to have this subject studied, by assessing and analyzing cardiotachographic parameters, such as heart rate, fetal motility and uterine contractions, in addition to blood pressure and electrocardiographic variables, in pregnant women with rheumatic valvar disease who undergo local anesthesia with lidocaine, with and without vasoconstrictor, during restorative dental procedure. For this, 31 rheumatic heart disease patients who were in their 28th to 37th week of gestation, had 24-hour ambulatory monitoring of their blood pressure (BP) and Holter electrocardiography (Holter-ECG), and cardiotocography (CTG), performed during: (1) baseline - 60 minutes before the procedure for BP and Holter- ECG monitoring, and 20 minutes before the procedure for CTG; (2) procedure - 56±15.5 minutes (mean±SD); (3) post-procedure - 20 minutes; and (4) mean 24-hour heart rate and extrasystoles measurement, and mean wake and sleeping periods BP monitoring. Variation of the above variables was analyzed in two groups, one with infusion of a 2% solution of lidocaine with vasoconstrictor, and the other with infusion of a 2% solution of lidocaine with epinephrine 1:100.000. The maternal heart rate values obtained during the procedure showed a significant reduction only in comparison with the other time periods (P<0.001). The comparison of the two groups did not reveal any significant difference (P>0.05). Cardiac arrhythmia was detected in 9 (29.0%) patients, 7 of them (41.8%) from the group who received anesthetics with epinephrine. Maternal blood pressure did not show any significant difference neither between time periods, nor between groups (P>0.05). The same occurred in the comparative analysis of the fetal parameters obtained during CTG -number of contractions, level and variability from baseline, number of fetal heart rate accelerations and fetal reactivity pattern. Our conclusion was that the use of 2% solution of lidocaine in association with epinephrine proved safe during dental procedure in pregnant women with rheumatic valvar cardiopathy.
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Maduna, Ntsepiseng Elizabeth. "Midwives' perceptions in KwaZulu-Natal public hospitals regarding their level of competence related to cardiotocography." Thesis, Nelson Mandela Metropolitan University, 2016. http://hdl.handle.net/10948/5698.
Full textAbstract:
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.
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Vítek, Milan. "Kardiotokograf - sledování kontrakcí." Master's thesis, Vysoké učení technické v Brně. Fakulta elektrotechniky a komunikačních technologií, 2015. http://www.nusl.cz/ntk/nusl-221358.
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Purpose of this thesis is to study the principle of operation of cardiotocography in monitoring fetal life, further defining the main requirements for this equipment and defining the parameters of monitored biosignals. These findings are supported by the literature. Based on the gained knowledge, the system design of cardiotocography is made with focus on reading contractions. Main parameters of the function blocks are defined. Circuit solution for sensing contractions is suggested, including the design of the sensor. Designed circuits are verified on a prototype.
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Aleksandra, Ilić. "Funkcija miokarda leve komore i dnevno-noćni ritam arterijskog krvnog pritiska kod gestacijske hipertenzije." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2015. https://www.cris.uns.ac.rs/record.jsf?recordId=94139&source=NDLTD&language=en.
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Cilj: Svrha ovog istraživanja je da se odredi uticaj promena u funkciji, morfologiji i geometriji leve komore (LK) i odusustva očuvanog dnevno-noćnog profila krvnog pritiska (KP) na intrauterini zastoj u rastu fetusa (IUGR) i preterminsko završavanje trudnoće kod gestacijske hipertenzije (GH), reverzibilnost tih promena posle porođaja i povezanost GH sa prisustvom arterijske hipertenzije u porodici. Metodologija: U ovu studiju, koja je koncipirana kao prospektivna, uključeno je 90 trudnica, 30 normotenzivnih, 30 sa GH i dipping profilom KP i 30 sa GH i non-dipping profilom KP. Svim ispitanicama urađen je kompletan dvo-dimenzionalni, pulsni i tkivni Doppler ehokardiografski pregled i ambulatorni 24-h monitoring KP u trećem trimestru trudnoće i 6 nedelja posle porođaja. Rezultati i diskusija: U grupi trudnica sa GH značajno više su bili poremećeni parametri sistolne, dijastolne i globalne funkcije (EF, s’, E, A, E/A, E/e’, DTE, IVRT, IVCT, ET, Tei indeks, CO, CW, Ees), morfologije (IVSd, PLWd, RWT, masa miokarda, p<0,0005) i geometrije LK (abnormalna geometrija 67,7% vs 3,3% kod normotenzivnih, p<0,0005). Najizraženije promene bile su u podgrupi non-dippera. Posle porođaja registrovano je značajno popravljanje svih promenjenih ehokardiografskih parametara, a 96,7% ispitanica iz non-dipper podgrupe imale su očuvan dnevno-noćni ritam posle porođaja. U grupi sa GH utvrđeno je postojanje arterijske hipertenzije u porodici u 80% slučajeva u odnosu na 26,7% u kontrolnoj grupi (p<0,0005). Analizom rezultata utvrđeno je da su povećanje maksimalne vrednosti noćnog dijastolnog KP, indeksa mase miokarda i totalne vaskularne rezistence nezavisni prediktori IUGR-a, dok su povećanje prosečne vrednosti noćnog sistolnog KP i indeksa mase miokarda i smanjenje EF nezavisni prediktori preterminskog porođaja. Zaključak: Promene u funkciji i morfologiji leve komore i non-dipping profil KP kod GH imaju prognostički uticaj na pojavu IUGR-a i preterminsko završavanje trudnoće.<br>Objective: The purpose of this study was to determine the influence of changes in function, morphology, and geometry of the left ventricle (LV) and a non-dipping arterial blood pressure (BP) pattern on the intrauterine growth restriction (IUGR) and preterm delivery in pregnant women with gestational hypertension (GH), reversibility of these changes after delivery and connection between BP in family with GH. Methods: This prospective study included 90 pregnant women, 30 normotensive, 30 with GH and dipping BP pattern and 30 with GH and non-dipping BP pattern. All participants underwent a complete two-dimensional, pulsed and tissue Doppler echocardiography and 24-h ambulatory blood pressure monitoring in the third trimester and 6 weeks after delivery. Results and discussion: Participants with GH had more impaired parameters of the LV systolic, diastolic and global function (EF, s’, E, A, E/A, E/e’, DTE, IVRT, IVCT, ET, Tei index, CO, CW, Ees), morphology (IVSd, PLWd, RWT, myocardial mass, p<0,0005) and geometry (abnormal geometry 67,7% vs 3,3% in normotensive, p<0,0005). The greatest changes were noticed in non-dippers. All changed echocardiographic parameters became improved, while 96,7 % non-dipper participants became dipper after delivery. Arterial hypertension in family was present in 80% women with GH vs 26,7% in normotensive (p<0,0005). Analyses revealed that maximum night-time diastolic BP, mass index and total vascular resistance were identified as independent predictors of IUGR. Average systolic night-time BP, mass index and EF were identified as independent predictors of preterm delivery. Conclusion: Changes in LV function, morphology and geometry and a non-dipping pattern of BP in GH predicts IUGR and preterm delivery.
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Pfeiler, Stephen S. "Monitoring Desert Ungulates via Fecal DNA-Based Capture Recapture." DigitalCommons@USU, 2019. https://digitalcommons.usu.edu/etd/7505.
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Estimates of population abundance and survival are critical for effective wildlife management. Obtaining estimates of these kind using traditional wildlife monitoring techniques (i.e. ground and aerial surveys) has proven to be difficult, especially for species that are wide ranging and exist in small, patchily distributed populations.
My objective was to implement fecal DNA-based capture-recapture surveys to estimate abundance and survival of two different ungulate populations that inhabit the deserts of southeastern California. I also compared fecal DNA-based capture-recapture techniques to traditional methods by evaluating the costs and precision associated with both methods. Using artificial water sources as focal sampling sites, I performed sampling during the summers of 2015, 2016, and 2017 in the Mojave and Sonoran Deserts of California. I was able to obtain reasonably precise estimates of abundance and survival for both species.
To my knowledge, my study provides the first abundance and survival estimates of desert mule deer in California in over 13 years. Additionally, my study shows that when compared to traditional methods, fecal DNA-based capture recapture techniques can achieve much higher precision at a fraction of the cost.
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KC, Ashish. "Neonatal Resuscitation : Understanding challenges and identifying a strategy for implementation in Nepal." Doctoral thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-267917.
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Despite the unprecedented improvement in child health in last 15 years, burden of stillbirth and neonatal death remain the key challenge in Nepal and the reduction of these deaths will be crucial for reaching the health targets for Sustainable development goal by 2030. The aim of this thesis was to explore the risk factors for stillbirth and neonatal death and change in perinatal outcomes after the introduction of the Helping Babies Breathe Quality Improvement Cycle (HBB QIC) in Nepal. This was a prospective cohort study with a nested case-control design completed in a tertiary hospital in Nepal. Information were collected from the women who had experienced perinatal death and live birth among referent population; a video recording was done in the neonatal resuscitation corner to collect information on the health workers’ performance in neonatal resuscitation. Lack of antenatal care had the highest association with antepartum stillbirth (aOR 4.2, 95% CI 3.2–5.4), births that had inadequate fetal heart rate monitoring were associated with intrapartum stillbirth (aOR 1.9, CI 95% 1.5–2.4), and babies who were born premature and small-for-gestational-age had the highest risk for neonatal death in the hospital (aOR 16.2, 95% CI 12.3–21.3). Before the introduction of the HBB QIC, health workers displayed poor adherence to the neonatal resuscitation protocol. After the introduction of HBB QIC, the health workers demonstrated improvement in their neonatal resuscitation skills and these were retained until six months after training. Daily bag-and-mask skill checks (RR 5.1 95% CI 1.9–13.5), preparation for birth (RR 2.4, 95% CI 1.0–5.6), self-evaluation checklists (RR 3.8, 95% CI 1.4–9.7) and weekly review and reflection meetings (RR 2.6, 95% 1.0–7.4) helped the health workers to retain their neonatal resuscitation skills. The health workers demonstrated improvement in ventilation of babies within one minute of birth and there was a reduction in intrapartum stillbirth (aOR 0.46, 95% CI 0.32–0.66) and first-day neonatal mortality (aOR 0.51, 95% CI 0.31–0.83). The study provides information on challenges in reducing stillbirth and neonatal death in low income settings and provides a strategy to improve health workers adherence to neonatal resuscitation to reduce the mortality. The HBB QIC can be implemented in similar clinical settings to improve quality of care and survival in Nepal, but for primary care settings, the QIC need to be evaluated further.
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Houzé, de l'Aulnoit Agathe. "Acquisition du rythme cardiaque fœtal et analyse de données pour la recherche de facteurs prédictifs de l’acidose fœtale." Thesis, Lille, 2019. http://www.theses.fr/2019LIL2S007.
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L’analyse visuelle du rythme cardiaque fœtal (RCF) est une excellente méthode de dépistage de l’hypoxie fœtale. Cette analyse visuelle est d’autre part sujette à une variabilité inter- et intra-individuelle importante. L’hypoxie fœtale au cours du travail s’exprime par des anomalies du RCF. La sous-évaluation de la gravité d’un RCF entraine une prise de risque indue pour le fœtus avec une augmentation de sa morbi-mortalité et sa surévaluation entraine un interventionnisme obstétrical inutile avec une augmentation du taux de césariennes. Ce dernier point pose par ailleurs en France un problème de santé publique.L’analyse automatisée du signal RCF permet de diminuer la variabilité inter- et intra-individuelle et d’accéder à d’autres paramètres calculés visant à augmenter la valeur diagnostique. Les critères d’analyse morphologiques du RCF (ligne de base, nombre d’accélérations, nombre et typage des ralentissements, variabilité à long terme (VLT)) ont été décrits ainsi que d’autres tels que les surfaces des ralentissements, les indices de variabilité à court terme (VCT) et les analyses fréquentielles. Il n’en demeure pas moins que la définition de la ligne de base, à partir de laquelle sont repérés les accélérations et les ralentissements reste, dans certains cas, difficile à établir.L’objectif principal de la thèse est d’établir un modèle prédictif de l’acidose fœtale à partir d’une analyse automatisée du RCF. L’objectif secondaire est de déterminer la pertinence des différents paramètres élémentaires classiques (CNGOF 2007) (fréquence de base, variabilité, accélérations, ralentissements) et celle d’autres paramètres inaccessible à l’œil (indices de variabilité à court terme, surfaces des ralentissements, analyse fréquentielle…). Par la suite, nous voulons identifier des critères de décision qui aideront à la prise en charge obstétricale.Nous proposons d’aborder l’analyse automatisée du RCF pendant le travail par l’intermédiaire d’une étude cas-témoins ; les cas étant des tracés RCF de nouveau-nés en acidose néonatale (pH artériel au cordon inférieur ou égal à 7,15) et les témoins, des tracés RCF de nouveau-nés sans acidose (pH artériel au cordon supérieur ou égal à 7,25). Il s’agit d’une étude monocentrique à la maternité de l’hôpital Saint Vincent de Paul, GHICL – Lille, sur notre base de données « Bien Naitre » (archivage numérique des tracés RCF depuis 2011), comptant un un nombre suffisant de cas sur ce seul centre. La maternité Saint Vincent de Paul (GHICL) présente depuis 2011 environ 70 cas par an d’acidose néonatale (pHa ≤ 7,10) (3,41%). Le logiciel R sera utilisé pour l’analyse statistique<br>Visual analysis of the fetal heart rate FHR is a good method for screening for fetal hypoxia but is not sufficiently specific. The visual morphological analysis of the FHR during labor is subject to inter- and intra-observer variability – particularly when the FHR is abnormal. Underestimating the severity of an FHR leads to undue risk-taking for the fetus with an increase in morbidity and mortality and overvaluation leads to unnecessary obstetric intervention with an increased rate of caesarean section. This last point also induces a French public health problem.FHR automated analysis reduces inter and intra-individual variability and accesses other calculated parameters aimed at increasing the diagnostic value. The FHR morphological analysis parameters (baseline, number of accelerations, number and typing of decelerations, long-term variability (LTV)) were described as well as others such as the decelerations surfaces, short-term variability (STV) and frequency analyzes. Nevertheless, when attempting to analyze the FHR automatically, the main problem is computation of the baseline against which all the other parameters are determined.Automatic analysis provides information on parameters that cannot be derived in a visual analysis and that are likely to improve screening for fetal acidosis during labor.The main objective of the thesis is to establish a predictive model of fetal acidosis from a FHR automated analysis. The secondary objective is to determine the relevance of the classical basic parameters (CNGOF 2007) (baseline, variability, accelerations, decelerations) and that of other parameters inaccessible to the eye (indices of short-term variability, surfaces of decelerations, frequency analysis ...). Later, we want to identify decision criteria that will help in the obstetric care management.We propose to validate FHR automated analysis during labor through a case-control study; cases were FHR recordings of neonatal acidosis (arterial cord pH less than or equal to 7.15) and controls, FHR recordings of neonatal without acidosis (arterial cord pH upper than or equal to 7.25). This is a monocentric study at the maternity hospital of Saint Vincent de Paul Hospital, GHICL - Lille, on our « Well Born » database (digital archiving of RCF plots since 2011), with a sufficient number of cases on this only center. Since 2011, the Saint Vincent de Paul hospital (GHICL) has had about 70 cases per year of neonatal acidosis (pHa less than or equal to 7.10) (3.41%). The R software will be used for statistical analysis
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Chinnadurai, Sathya K. "Evaluation of fecal glucocorticoid metabolite assays for short-term stressors and validation for stress monitoring in African herbivores." Diss., Columbia, Mo. : University of Missouri-Columbia, 2006. http://hdl.handle.net/10355/4611.
Full textAbstract:
Thesis (M.S.) University of Missouri-Columbia, 2006.<br>The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file viewed on (May 18, 2007) Includes bibliographical references.
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Christofoletti, Mauricio Durante. "Perfil de progestinas fecais durante a gestação de veado-campeiro (Ozotoceros bezoarticus) no Pantanal /." Jaboticabal : [s.n.], 2010. http://hdl.handle.net/11449/98203.
Full textAbstract:
Resumo: A constante ameaça às populações de veado-campeiro (Ozotoceros bezoarticus) faz deste cervídeo uma espécie ameaçada de extinção, trazendo à tona uma necessidade eminente de mais estudos, principalmente relacionado à biologia e fisiologia reprodutiva. Sendo assim, os objetivos deste trabalho foram: definir o padrão de excreção de progestágenos fecais durante a gestação do veado-campeiro e validar possível método não-invasivo para diagnóstico de gestação da espécie, com uso de análises endócrinas. Para isso, onze fêmeas da espécie foram capturadas, marcadas e receberam colares radiotransmissores no Pantanal, região da Nhecolândia. Elas foram acompanhadas mensalmente e tiveram sua fezes colhidas para caracterização hormonal da gestação, entre o período de agosto de 2008 a novembro de 2009. Foi observada a ocorrência de parto em apenas sete fêmeas, as quais foram utilizadas na caracterização endócrina da gestação. As dosagens das progestinas fecais foram feitas por ensaio imunoenzimático. Os nascimentos observados ocorreram entre agosto e outubro, com pico entre agosto e setembro. Os níveis das progestinas fecais durante o início da gestação foram semelhantes aos períodos não-gestantes, com aumento progressivo a partir do segundo terço da gestação até o momento do parto, decaindo após esse período aos níveis não-gestantes. Os níveis de progestinas fecais acima de 6000 ng/g de fezes são sugestivos de gestação.<br>Abstract: The constant risk of pampas deer populations (Ozotoceros bezoarticus) makes these threatened specie, bringing an eminent necessity of more studies, mainly related to biology and reproductive physiology. Being thus, the objectives of this work were: obtain the profile of fecal progestins excretion during the pampas deer gestation and to validate a possible noninvasive diagnosis method of gestation for the species, using endocrine analysis. For this, eleven females had been captured, marked and received necklaces radiotransmitters in Pantanal, region of Nhecolândia. They had been followed and their excrements were collected monthly for hormonal characterization between August, 2008 - November, 2009. Was observed the occurrence of birth in only seven females, which had been used in the endocrine characterization of gestation. The levels of fecal progestins during the beginning of gestation had been similar to those at nogestational periods, with gradual increase from the second part of gestation until the moment of birth, decaying after this period to no-gestation levels. The levels of fecal progestins above 6000 ng/g of excrements are suggestive of gestation.<br>Orientador: José Maurício Barbanti Duarte<br>Coorientador: Ubiratan Piovezan<br>Banca: Paulo Henrique Franceschini<br>Banca: Rosana Nogueira de Morais<br>Mestre
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Dulaney, Douglas Ron. "Monitoring of selected bacteriological parameters associated with the Sinking Creek total maximum daily load (TMDL)." [Johnson City, Tenn. : East Tennessee State University], 2003. https://dc.etsu.edu/etd/786.
Full textAbstract:
Thesis (M.S.E.H.)--East Tennessee State University, 2003.<br>Title from electronic submission form. ETSU ETD database URN: etd-0708103-090955. Includes bibliographical references. Also available via Internet at the UMI web site.
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Turner, Rachel Joy, and Rachel Joy Turner. "Monitoring Diet Quality and Projecting Body Condition Score in Cattle Using Fecal Near Infrared Spectroscopy and NUTBAL on a Southern Arizona Rangeland." Thesis, The University of Arizona, 2017. http://hdl.handle.net/10150/626720.
Full textAbstract:
Range cattle grazing in semi-arid regions are commonly limited by lack of nutrients from low-quality forage. Due to this, ranchers are faced with the challenge of monitoring diet quality in order to address nutrient limitations. Near infrared spectroscopy (NIRS) of fecal samples is a method used to determine diet quality values like crude protein (CP) and digestible organic matter (DOM) in grazing animals. When combined with a nutritional balance analyzer such as the NUTBAL system, fecal NIRS can be used to monitor diet quality and project animal performance. Our research aimed to test the ability of NUTBAL to project animal performance as represented by body condition score (BCS) in cattle (n=82 Animal Units) grazing on the Santa Rita Experimental Range (SRER) in southern Arizona. Previous work conducted on other Arizona rangelands led to the hypothesis that fecal NIRS coupled with NUTBAL can be used to monitor diet quality and project BCS in a southern Arizona commercial grazing operation. Data collection occurred between June 2016 and June 2017. Standing biomass and botanical composition were measured before each grazing period, and relative utilization was measured following each grazing period. During the midpoint of grazing in each pasture, 30 body condition scores and a fecal composite of 15 samples were collected. Fecal derived diet quality varied between a maximum of 10.75% CP and 61.25% DOM in early August 2016, to a minimum value of 4.00 % CP and 58.40 % DOM in March 2017. This study confirmed the ability of fecal NIRS paired with NUTBAL to project future BCS within 0.5 a score point more than 80% of the time in cattle grazing on the SRER. With this information, cattle managers in southern Arizona can better address animal performance needs and nutrient deficiencies.
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Christofoletti, Maurício Durante [UNESP]. "Perfil de progestinas fecais durante a gestação de veado-campeiro (Ozotoceros bezoarticus) no Pantanal." Universidade Estadual Paulista (UNESP), 2010. http://hdl.handle.net/11449/98203.
Full textAbstract:
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christofoletti_md_me_jabo.pdf: 728449 bytes, checksum: c3e0031c932c62484c010871b451c29b (MD5)<br>Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)<br>A constante ameaça às populações de veado-campeiro (Ozotoceros bezoarticus) faz deste cervídeo uma espécie ameaçada de extinção, trazendo à tona uma necessidade eminente de mais estudos, principalmente relacionado à biologia e fisiologia reprodutiva. Sendo assim, os objetivos deste trabalho foram: definir o padrão de excreção de progestágenos fecais durante a gestação do veado-campeiro e validar possível método não-invasivo para diagnóstico de gestação da espécie, com uso de análises endócrinas. Para isso, onze fêmeas da espécie foram capturadas, marcadas e receberam colares radiotransmissores no Pantanal, região da Nhecolândia. Elas foram acompanhadas mensalmente e tiveram sua fezes colhidas para caracterização hormonal da gestação, entre o período de agosto de 2008 a novembro de 2009. Foi observada a ocorrência de parto em apenas sete fêmeas, as quais foram utilizadas na caracterização endócrina da gestação. As dosagens das progestinas fecais foram feitas por ensaio imunoenzimático. Os nascimentos observados ocorreram entre agosto e outubro, com pico entre agosto e setembro. Os níveis das progestinas fecais durante o início da gestação foram semelhantes aos períodos não-gestantes, com aumento progressivo a partir do segundo terço da gestação até o momento do parto, decaindo após esse período aos níveis não-gestantes. Os níveis de progestinas fecais acima de 6000 ng/g de fezes são sugestivos de gestação.<br>The constant risk of pampas deer populations (Ozotoceros bezoarticus) makes these threatened specie, bringing an eminent necessity of more studies, mainly related to biology and reproductive physiology. Being thus, the objectives of this work were: obtain the profile of fecal progestins excretion during the pampas deer gestation and to validate a possible noninvasive diagnosis method of gestation for the species, using endocrine analysis. For this, eleven females had been captured, marked and received necklaces radiotransmitters in Pantanal, region of Nhecolândia. They had been followed and their excrements were collected monthly for hormonal characterization between August, 2008 - November, 2009. Was observed the occurrence of birth in only seven females, which had been used in the endocrine characterization of gestation. The levels of fecal progestins during the beginning of gestation had been similar to those at nogestational periods, with gradual increase from the second part of gestation until the moment of birth, decaying after this period to no-gestation levels. The levels of fecal progestins above 6000 ng/g of excrements are suggestive of gestation.