Biophysical methods in diagnosis of intrapartal fetal hypoxia

Czech version

Authors: K. Biringer ¹; J. Danko ¹; P. Žúbor ¹; K. Maťašová ²; M. Zibolen ²; R. Pullmann ³
Authors‘ workplace: Gynekologicko-pôrodnícka klinika JLF UK a UNM, Martin, prednosta prof. MUDr. J. Danko, CSc. ¹; Neonatologická klinika JLF UK a UNM, Martin, prednosta prof. MUDr. M. Zibolen, CSc. ²; Ústav klinickej biochémie JLF UK a UNM, Martin, prednosta prof. MUDr. RNDr. R. Pullmann, PhD. ³
Published in: Ceska Gynekol 2011; 76(3): 222-229

Overview

Objective:
To evaluate validity of biophysical diagnostic methods of fetal hypoxia.

Design:
A case-control study.

Setting:
Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic.

Methods:
We divided the patients according to pH in umbilical artery (UA) <7.15 into two groups: controls (n=36), and studied (n=31), retrospectively. We performed continuous simultaneous fetal monitoring with cardiotocography (CTG), fetal pulse oxymetry (IFPO), and ST segment analysis of fetal electrocardiogram (STAN). Statistics: histograms, Kolmogorov-Smirnovov test, Mann-Whitney test, Spearman’s rho; statistical significance: p<0.05, Receiver Operating Characteristic curves, Area Under the Curve.

Results:
The most frequent was intermediary CTG pattern (n=32; 47.76%). Non-reassuring IFPO was in 22 cases (32.86%), and ST events were present in 4 cases (5.97%). CTG validity in prediction of pH in UA<7.15: sensitivity 80.0%, specificity 50.0%, positive predictive value (PPV) 22.1%, and negative predictive value (NPV) 93.4%, respectively; IFPO sensitivity was 76.3%, specificity 71.4%, PPV 32.2%, and NPV was 94.4%. Validity of STAN was not significant, because of low frequency of ST events in our study. Satisfactory accuracy (AUC>0.8) had combined continuous monitoring with CTG, IFPO and STAN. Good accuracy (AUC>0.7) had CTG by itself, and combined monitoring with IFPO and STAN, respectively. IFPO by itself had only sufficient accuracy (AUC>0.6).

Conclusion:
The most valid method of fetal wellbeing objectification is combined simultaneous monitoring with CTG, IFPO and STAN. Our results support the effort in the development of integrated sensor for CTG, IFPO, and STAN.

Key words:
fetal hypoxia, cardiotocography, pulse oxymetry, STAN.

Sources

1. Amer-Wahlin, I., Arulkumaran, S., Hagberg, H., et al. Fetal electrocardiogram: ST waveform analysis in intrapartum surveillance. BJOG, 2007, 114, 10, p. 1191-1193.

2. Amer-Wahlin, I., Bördahl, P., Eikeland, T., et al. ST analysis of the fetal electrocardiogram during labor: Nordic observational multicenter study. J Mat Fet Neonat Med, 2002, 12, 4, p. 260-266.

3. Amer-Wahlin, I., Ingemarsson, I., Marsal, K., et al. Fetal heart rate patterns and ECG ST segment changes preceeding metabolic acidaemia at birth. BJOG, 2005, 112, 2, p. 160-165.

4. Bloom, SL., Swindle, RG., McIntire, DD., et al. Fetal pulse oximetry: duration of desaturation and intrapartum outcome. Obstet Gynecol, 1999, 93, 6, p. 1036-1040.

5. Buhimschi, CS., Abdel-Razeq, S., Cackovic, M., et al. Fetal heart rate monitoring patterns in women with amniotic fluid proteomic profiles indicative of inflammation. Am J Perinatol, 2008, 25, 6, p. 359-372.

6. Dervaitis, KL., Poole, M., Schmidt, G., et al. ST segment analysis of the fetal electrocardiogram plus electronic fetal heart rate monitoring in labor and its relationship to umbilical cord arterial blood gases. Am J Obstet Gynecol, 2004, 191, 3, p. 879‑884.

7. Dildy, GA., van den Berg, PP., Katz, M., et al. Intrapartum fetal pulse oximetry: Fetal oxygen saturation trends during labor and relation to delivery outcome. Am J Obstet Gynecol, 1994, 171, 3, p. 679.

8. Hájek, Z., Srp, B., Haddad El, R., a kol. Analýza současných diagnostických metod intrapartální hypoxie plodu. Čes Gynek, 2005, 70, 4, s. 22-26.

9. Jongsma, HW., Nijhuis, JG. Critical analysis of the validity of electronic fetal monitoring. J Perinat Med, 1991, 19, 1-2, p. 33‑37.

10. Kwee, A., Dekkers, AH., van Wijk, HP., et al. Occurrence of ST-changes recorded with the STAN S21-monitor during normal and abnormal fetal heart rate patterns during labour. Eur J Obstet Gynecol Reprod Biol, 2007, 135, 1, p. 28-34.

11. Luttkus, AK., Callsen, TA., Stupin, JH., et al. Pulse oximetry during labour - does it give rise to hope? Value of saturation monitoring in comparison to fetal blood gas status. Eur J Obstet Gynecol Reprod Biol, 2003, 110, Suppl. 1, p. 132-138.

12. Palomäki, O., Luukkaala, T., Luoto, R., et al. Intrapartum cardiotocography - the dilemma of interpretational variation. J Perinat Med, 2006, 34, 4, p. 298-302.

13. Rijnders, RJ., Mol, BV., Reuwer, PJ., et al. Is the correlation between fetal oxygen saturation and blood pH sufficient for the use of fetal pulse oximetry? J Matern Fetal Neonatal Med, 2002, 11, 2, p. 80-83.

14. Schiermeier, S., Pildner von Steinburg, S., Thieme, A., et al. Sensitivity and specificity of intrapartum computerised FIGO criteria for cardiotocography and fetal scalp pH during labour: multicentre, observational study. BJOG, 2008, 115, 12, p. 1557‑1563.

15. Schlotter, CM. Pre-pathologic-pathologic cardiotocographic pattern in second stage of labor. Analysis of the incidence of acidosis and recommendations for fetal blood gas analysis. Zentralbl Gynekol, 1997, 119, 3, p. 117-122.

16. Spencer, JA., Badawi, N., Burton, P., et al. The intrapartum CTG prior to neonatal encephalopathy at term: a case-control study. BJOG, 1997, 104, 1, p. 25-28.

17. Stiller, R., von Mering, R., König, V., et al. How well does reflectance pulse oximetry reflect intrapartum fetal acidosis? Am J Obstet Gynecol, 2002, 186, 6, p. 1351-1357.

18. Sundström, AK., Rosén, D., Rosén, KG. Fetal surveillance. Goteborg: Neoventa Medical AB, 2000, p. 25-30.

19. Vardon, D., Hors, Y., Grossetti, E., et al. Fetal pulse oximetry: clinical practice. J Gynecol Obstet Biol Reprod (Paris), 2008, 37, 7, p. 697-704.

20. Vayssiere, C., Haberstich, R., Sebahoun, V., et al. Fetal electrocardiogram ST-segment analysis and prediction of neonatal acidosis. Int J Gynaecol Obstet, 2007, 97, 2, p. 110-114.

21. Yli, BM., Källén, K., Stray-Pedersen, B., et al. Intrapartum fetal ECG and diabetes. J Matern Fetal Neonatal Med, 2008, 21, 4, p. 231-238.