Non-invasive Foetal ECG - a Comparable Alternative to the Doppler CTG?

Is portable foetal electrocardiogram monitor feasible for foetal heart rate monitoring of small for gestational age foetuses in the home environment

Small-for-gestational-age (SGA) foetuses are at greater risk of complications than normal foetuses. Studies have demonstrated that foetal electrocardiogram (ECG) device (Monica-AN24) can be employed for monitoring foetal heart rate (FHR). However, its reliability and acceptability has not been assessed in SGA foetuses. This study was aimed at: (a) determining the acceptability of wearing the device more than once, (b) investigating the reliability of acquiring successful FHR data at different gestation. Patients with singleton non-anomalous foetus >24 weeks gestation and an estimated foetal weight below tenth percentile were recruited. Thirty-five women wore the device once. Twenty-four of these wore second time (68.6%). Overall, success-rate of FHR signals was 48.6% and increased to 68.8% beyond 34 weeks gestation. Foetal ECG is a promising method for monitoring SGA foetus >34 weeks gestation. Compared to day recordings, foetal signals were more reliable at night. Further studies are required before its clinical utility can be ascertained. IMPACT STATEMENT What is already known on this subject? Pregnancies that are affected by small-for-gestational-age (SGA) foetus pose a major public health problem and are associated with increased perinatal morbidity and mortality. There is no consensus on the optimal timing of delivery. Current methods employed for monitoring SGA foetuses include ultrasound scans for foetal-biometry and Doppler assessments. However, they provide a snapshot of information on foetal well-being, restrict patient mobility and cannot be employed over long-time periods. It is plausible that ambulatory foetal-ECG device that enable monitoring over a longer time period may better inform decisions about the timing of delivery. What do the results of this study add? Trans-abdominal foetal-ECG is a promising method of monitoring SGA foetus in the home setting with a success rate of acquiring reliable foetal heart rate (FHR) data over 90% at night time. What are the implications of these findings for clinical practice and/or further research? Overall, the study approved the concept of long-term home monitoring and has highlighted the facilitators and barriers to wearing the monitor in clinical care. These observations can be used to undertake robust research to assess the use of foetal-ECG monitor singly or in conjunction with current monitoring techniques for optimal foetal surveillance.

Signal quality of non-invasive fetal electrocardiogram in vaginal breech delivery: a case-controlled study

OBJECTIVE

Recently, a non-invasive fetal electrocardiogram monitor has been approved for clinical usage in labour and delivery. To determine the fetal signal quality of vaginal breech deliveries in comparison with a case-controlled cephalic group during labour.

STUDY DESIGN

This case-control study was carried out at the Department of Obstetrics and Gynecology of the University Hospital Frankfurt between 1st July 2012 and 30th September 2012. A total of seven breech deliveries were evaluated. A case-controlled cephalic group with same gestational age and parity were selected from a previous trial.

RESULTS

During first stage of labour, vaginal breech and cephalic delivery had no significant different fetal signal success rates (mean 87.8 vs. 85.7 %; p > 0.05). There was a trend of higher fetal signal success rates in the vaginal breech delivery group during second stage of labour (78.4 vs. 55.4 %; p = 0.08).

CONCLUSION

Similar fetal signal success rates in vaginal breech delivery in comparison to cephalic presentation were demonstrated using the new commercially available non-invasive abdominal fECG device (the Monica AN24(TM)).