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van Haren JS, van der Hout-van der Jagt MB, Meijer N, Monincx M, Delbressine FLM, Griffith XLG, Oei SG. Simulation-based development: shaping clinical procedures for extra-uterine life support technology. Adv Simul (Lond) 2023; 8:29. [PMID: 38042828 PMCID: PMC10693037 DOI: 10.1186/s41077-023-00267-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/26/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Research into Artificial Placenta and Artificial Womb (APAW) technology for extremely premature infants (born < 28 weeks of gestation) is currently being conducted in animal studies and shows promising results. Because of the unprecedented nature of a potential treatment and the high-risk and low incidence of occurrence, translation to the human condition is a complex task. Consequently, the obstetric procedure, the act of transferring the infant from the pregnant woman to the APAW system, has not yet been established for human patients. The use of simulation-based user-centered development allows for a safe environment in which protocols and devices can be conceptualized and tested. Our aim is to use participatory design principles in a simulation context, to gain and integrate the user perspectives in the early design phase of a protocol for this novel procedure. METHODS Simulation protocols and prototypes were developed using an iterative participatory design approach; usability testing, including general and task-specific feedback, was obtained from participants with clinical expertise from a range of disciplines. The procedure made use of fetal and maternal manikins and included animations and protocol task cards. RESULTS Physical simulation with the active participation of clinicians led to the diffusion of tacit knowledge and an iteratively formed shared understanding of the requirements and values that needed to be implemented in the procedure. At each sequel, participant input was translated into simulation protocols and design adjustments. CONCLUSION This work demonstrates that simulation-based participatory design can aid in shaping the future of clinical procedure and product development and rehearsing future implementation with healthcare professionals.
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Affiliation(s)
- J S van Haren
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands.
- Department of Obstetrics & Gynecology, Máxima Medisch Centrum, Veldhoven, The Netherlands.
| | - M B van der Hout-van der Jagt
- Department of Obstetrics & Gynecology, Máxima Medisch Centrum, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - N Meijer
- Department of Obstetrics & Gynecology, Máxima Medisch Centrum, Veldhoven, The Netherlands
| | - M Monincx
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - F L M Delbressine
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - X L G Griffith
- Department of Obstetrics & Gynecology, Máxima Medisch Centrum, Veldhoven, The Netherlands
| | - S G Oei
- Department of Obstetrics & Gynecology, Máxima Medisch Centrum, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Frenken MWE, Hubers S, Oei SG, Niemarkt HJ, van Laar JOEH, van der Woude DAA. Accidental rupture of membranes and neonatal infection after labor induction with silicone or latex balloon catheters: A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2023; 291:123-127. [PMID: 37866275 DOI: 10.1016/j.ejogrb.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/15/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE(S) Accidental rupture of membranes (acROM), an insertion-related complication of the balloon catheter for labor induction, may prolong the duration of ruptured membranes. Prolonged rupture of membranes is associated with an increased risk of intra-uterine infection with possibly neonatal infection as result. Little is known about safety profiles of different catheters regarding the occurrence of these complications. This study compares the incidence of neonatal early-onset sepsis (EOS) and acROM in women receiving either silicone or latex balloon catheters. STUDY DESIGN A retrospective cohort study was performed including 2200 women (silicone balloon catheter, n = 1100 vs. latex balloon catheter, n = 1100). The primary outcomes were the incidence of acROM, and suspected and proven neonatal EOS. Secondary outcomes were: prolonged rupture of membranes, intrapartum fever, pre- or postnatal neonatal exposure to antibiotics, and perinatal outcomes. A subgroup analysis was performed between women with and without acROM. RESULTS No statistically significant difference with regard to suspected or proven EOS was seen between the silicone and latex groups. The acROM rate was significantly higher in the silicone group compared to the latex group (2.9 % and 0.3 %, p < 0.01). Prolonged rupture of membranes was significantly more common in the silicone group compared to the latex group (5.0 % and 2.4 %, p < 0.01), as was the use of intrapartum antibiotics (12.7 % and 9.6 %, p = 0.02). Neonates were significantly more often exposed to pre- or postnatal antibiotics in the silicone group compared to the latex group (17.6 % and 13.6 %, p = 0.01). Subgroup analysis showed significantly more suspected and proven neonatal EOS when catheter-insertion was complicated with acROM (11.4 % and 20.0 %), compared to cases without acROM (3.8 % and 2.5 %), irrespective of the type of catheter used. CONCLUSION(S) The use of silicone balloon catheters for labor induction results in higher rates of acROM, prolonged rupture of membranes and use of intrapartum antibiotics, compared to latex balloon catheters. No statistically significant differences were found in the occurrence of suspected or proven neonatal EOS, however neonates from the silicone group were more often exposed to pre- or postnatal antibiotics. When acROM occurs, irrespective of type of catheter used, suspected and proven neonatal EOS was seen more often.
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Affiliation(s)
- M W E Frenken
- Department of Obstetrics and Gynaecology, Máxima MC, P.O. Box 7777, 5500 MB Veldhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; Eindhoven MedTech Innovation Centre (e/MTIC), P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - S Hubers
- Department of Obstetrics and Gynaecology, Máxima MC, P.O. Box 7777, 5500 MB Veldhoven, The Netherlands
| | - S G Oei
- Department of Obstetrics and Gynaecology, Máxima MC, P.O. Box 7777, 5500 MB Veldhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; Eindhoven MedTech Innovation Centre (e/MTIC), P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - H J Niemarkt
- Department of Paediatrics, Máxima MC, P.O. Box 7777, 5500 MB Veldhoven, The Netherlands
| | - J O E H van Laar
- Department of Obstetrics and Gynaecology, Máxima MC, P.O. Box 7777, 5500 MB Veldhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; Eindhoven MedTech Innovation Centre (e/MTIC), P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - D A A van der Woude
- Department of Obstetrics and Gynaecology, Máxima MC, P.O. Box 7777, 5500 MB Veldhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; Eindhoven MedTech Innovation Centre (e/MTIC), P.O. Box 513, 5600 MB Eindhoven, The Netherlands
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de Vet CM, van Oostrum NHM, Clur SB, Oei SG, van Laar JOEH. Reply. Ultrasound Obstet Gynecol 2023; 62:448-449. [PMID: 37647041 DOI: 10.1002/uog.26317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 09/01/2023]
Affiliation(s)
- C M de Vet
- Department of Gynecology and Obstetrics, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - N H M van Oostrum
- Department of Gynecology and Obstetrics, Ghent University Hospital, Ghent, Belgium
| | - S B Clur
- Department of Pediatric Cardiology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart - ERN GUARD-Heart (ERN GUARDHEART)
| | - S G Oei
- Department of Gynecology and Obstetrics, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - J O E H van Laar
- Department of Gynecology and Obstetrics, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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de Vet CM, van Oostrum NHM, Clur SB, van der Woude DAA, Oei SG, van Laar JOEH. Reply. Ultrasound Obstet Gynecol 2023; 61:275-277. [PMID: 36722426 DOI: 10.1002/uog.26151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 05/27/2023]
Affiliation(s)
- C M de Vet
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - N H M van Oostrum
- Department of Gynaecology and Obstetrics, Ghent University Hospital, Ghent, Belgium
| | - S B Clur
- Department of Paediatric Cardiology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - D A A van der Woude
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands
| | - S G Oei
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - J O E H van Laar
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Noben L, Lempersz C, van den Heuvel ER, Zhan Z, Vandenbussche FPHA, Coumans ABC, Haak MC, Vullings R, Oei SG, Clur SAB, van Laar JOEH. The electrical heart axis in fetuses with congenital heart disease, measured with non-invasive fetal electrocardiography. PLoS One 2022; 17:e0275802. [PMID: 36264863 PMCID: PMC9584524 DOI: 10.1371/journal.pone.0275802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To determine if the electrical heart axis in different types of congenital heart defects (CHD) differs from that of a healthy cohort at mid-gestation. METHODS Non-invasive fetal electrocardiography (NI-fECG) was performed in singleton pregnancies with suspected CHD between 16 and 30 weeks of gestation. The mean electrical heart axis (MEHA) was determined from the fetal vectorcardiogram after correction for fetal orientation. Descriptive statistics were used to determine the MEHA with corresponding 95% confidence intervals (CI) in the frontal plane of all fetuses with CHD and the following subgroups: conotruncal anomalies (CTA), atrioventricular septal defects (AVSD) and hypoplastic right heart syndrome (HRHS). The MEHA of the CHD fetuses as well as the subgroups was compared to the healthy control group using a spherically projected multivariate linear regression analysis. Discriminant analysis was applied to calculate the sensitivity and specificity of the electrical heart axis for CHD detection. RESULTS The MEHA was determined in 127 fetuses. The MEHA was 83.0° (95% CI: 6.7°; 159.3°) in the total CHD group, and not significantly different from the control group (122.7° (95% CI: 101.7°; 143.6°). The MEHA was 105.6° (95% CI: 46.8°; 164.4°) in the CTA group (n = 54), -27.4° (95% CI: -118.6°; 63.9°) in the AVSD group (n = 9) and 26.0° (95% CI: -34.1°; 86.1°) in the HRHS group (n = 5). The MEHA of the AVSD and the HRHS subgroups were significantly different from the control group (resp. p = 0.04 and p = 0.02). The sensitivity and specificity of the MEHA for the diagnosis of CHD was 50.6% (95% CI 47.5% - 53.7%) and 60.1% (95% CI 57.1% - 63.1%) respectively. CONCLUSION The MEHA alone does not discriminate between healthy fetuses and fetuses with CHD. However, the left-oriented electrical heart axis in fetuses with AVSD and HRHS was significantly different from the control group suggesting altered cardiac conduction along with the structural defect. TRIAL REGISTRATION Clinical trial registration number: NL48535.015.14.
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Affiliation(s)
- L. Noben
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
- * E-mail:
| | - C. Lempersz
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
| | - E. R. van den Heuvel
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Z. Zhan
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - F. P. H. A. Vandenbussche
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A. B. C. Coumans
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M. C. Haak
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - R. Vullings
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - S. G. Oei
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - S. A. B. Clur
- Department of Pediatric Cardiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - J. O. E. H. van Laar
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
- Department of Pediatric Cardiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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van Oostrum NHM, de Vet CM, Clur SB, van der Woude DAA, van den Heuvel ER, Oei SG, van Laar JOEH. Fetal myocardial deformation measured with two-dimensional speckle-tracking echocardiography: longitudinal prospective cohort study of 124 healthy fetuses. Ultrasound Obstet Gynecol 2022; 59:651-659. [PMID: 34558747 PMCID: PMC9321172 DOI: 10.1002/uog.24781] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Two-dimensional speckle-tracking echocardiography (2D-STE) is a promising technique which allows assessment of fetal cardiac function, and can be used in the evaluation of cardiac and non-cardiac diseases in pregnancy. However, reliable fetal reference values for deformation parameters measured using 2D-STE are needed before it can be introduced into clinical practice. This study aimed to obtain reference values for fetal global longitudinal strain (GLS) and GLS rate (GLSR) measured using 2D-STE and compare right and left ventricular values. METHODS This was a prospective longitudinal cohort study of uncomplicated pregnancies that underwent echocardiography every 4 weeks from inclusion at 18-21 weeks until delivery to obtain four-chamber loops of the fetal heart. Left and right ventricular GLS and GLSR were measured using 2D-STE at each examination. Using Bayesian mixed-effects models, reference values with lower and upper 5% prediction limits were calculated according to gestational age. Right and left ventricular GLS values according to gestational age were compared using the Wilcoxon signed-rank test. RESULTS A total of 592 left ventricular and 566 right ventricular GLS and GLSR measurements were obtained from 124 women with uncomplicated pregnancy and non-anomalous, appropriately grown fetuses. Reference values were obtained for both fetal ventricles according to gestational week. GLS and GLSR values of both ventricles increased (i.e. became less negative) significantly during pregnancy. Right ventricular GLS values were significantly higher (i.e. less negative) than the respective left ventricular values at every gestational week. CONCLUSIONS Reference values were obtained for fetal GLS and GLSR measured using 2D-STE. GLS and GLSR values increased significantly for both ventricles from the second trimester until delivery. GLS values were significantly higher for the right ventricle compared with the left ventricle. Future studies are needed to assess whether the obtained reference values are helpful in clinical practice in the assessment of pregnancy complications, such as fetal growth restriction or cardiac anomaly. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N. H. M. van Oostrum
- Eindhoven MedTech Innovation Centre (e/MTIC)EindhovenThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Gynaecology and ObstetricsGhent UniversityGhentBelgium
| | - C. M. de Vet
- Eindhoven MedTech Innovation Centre (e/MTIC)EindhovenThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Gynaecology and ObstetricsMáxima Medical CentreVeldhovenThe Netherlands
| | - S. B. Clur
- Department of Paediatric Cardiology, Emma Children's Hospital, Academic Medical CenterAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - D. A. A. van der Woude
- Eindhoven MedTech Innovation Centre (e/MTIC)EindhovenThe Netherlands
- Department of Gynaecology and ObstetricsMáxima Medical CentreVeldhovenThe Netherlands
| | - E. R. van den Heuvel
- Eindhoven MedTech Innovation Centre (e/MTIC)EindhovenThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Mathematics & Computer ScienceEindhoven University of TechnologyEindhovenThe Netherlands
| | - S. G. Oei
- Eindhoven MedTech Innovation Centre (e/MTIC)EindhovenThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Gynaecology and ObstetricsMáxima Medical CentreVeldhovenThe Netherlands
| | - J. O. E. H. van Laar
- Eindhoven MedTech Innovation Centre (e/MTIC)EindhovenThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Department of Gynaecology and ObstetricsMáxima Medical CentreVeldhovenThe Netherlands
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Hulsenboom ADJ, Van der Hout-van der Jagt MB, van den Akker ESA, Bakker PCAM, van Beek E, Drogtrop AP, Kwee A, Westerhuis MEMH, Rijnders RJP, Schuitemaker NWE, Willekes C, Vullings R, Oei SG, van Laar JOEH. New possibilities for ST analysis - A post-hoc analysis on the Dutch STAN RCT. Early Hum Dev 2022; 166:105537. [PMID: 35091162 DOI: 10.1016/j.earlhumdev.2021.105537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The diagnostic value of ST analysis of the fetal electrocardiogram (fECG) during labor is uncertain. False alarms (ST events) may be explained by physiological variation of the fetal electrical heart axis. Adjusted ST events, based on a relative rather than an absolute rise from baseline, correct for this variation and may improve the diagnostic accuracy of ST analysis. AIMS Determine the optimal cut-off for relative ST events in fECG to detect fetal metabolic acidosis. STUDY DESIGN Post-hoc analysis on fECG tracings from the Dutch STAN trial (STAN+CTG branch). SUBJECTS 1328 term singleton fetuses with scalp ECG tracing during labor, including 10 cases of metabolic acidosis. OUTCOME MEASURES Cut-off value for relative ST events at the point closest to (0,1) in the receiver operating characteristic (ROC) curve with corresponding sensitivity and specificity. RESULTS Relative baseline ST events had an optimal cut-off at an increment of 85% from baseline. Relative ST events had a sensitivity of 90% and specificity of 80%. CONCLUSIONS Adjusting the current definition of ST events may improve ST analysis, making it independent of CTG interpretation.
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Affiliation(s)
- A D J Hulsenboom
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands.
| | - M B Van der Hout-van der Jagt
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands; Faculty of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands; Faculty of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands
| | - E S A van den Akker
- Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, the Netherlands
| | - P C A M Bakker
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, location VUmc, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands
| | - E van Beek
- Department of Obstetrics and Gynecology, St. Antonius Hospital, P.O. Box 2500, 3430 EM Nieuwegein, the Netherlands
| | - A P Drogtrop
- Department of Obstetrics and Gynecology, Elisabeth Tweesteden Hospital, P.O. Box 90151, LC 5000 Tilburg, the Netherlands
| | - A Kwee
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, the Netherlands
| | - M E M H Westerhuis
- Department of Obstetrics and Gynecology, Catharina Hospital, P.O. Box 1350, ZA 5602 Eindhoven, the Netherlands
| | - R J P Rijnders
- Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME Hertogenbosch, the Netherlands
| | - N W E Schuitemaker
- Department of Obstetrics and Gynecology, Diakonessenhuis, P.O. Box 80250, 3508 TG Utrecht, the Netherlands
| | - C Willekes
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - R Vullings
- Faculty of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands
| | - S G Oei
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands; Faculty of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands
| | - J O E H van Laar
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands
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8
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Nichting TJ, Frenken MWE, van der Woude DAA, van Oostrum NHM, de Vet CM, van Willigen BG, van Laar JOEH, van der Ven M, Oei SG. Non-invasive fetal electrocardiography, electrohysterography and speckle-tracking echocardiography in the second trimester: study protocol of a longitudinal prospective cohort study (BEATS-study). BMC Pregnancy Childbirth 2021; 21:791. [PMID: 34823483 PMCID: PMC8613985 DOI: 10.1186/s12884-021-04265-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/10/2021] [Indexed: 11/20/2022] Open
Abstract
Background Worldwide, hypertensive disorders of pregnancy (HDP), fetal growth restriction (FGR) and preterm birth remain the leading causes of maternal and fetal pregnancy-related mortality and (long-term) morbidity. Fetal cardiac deformation changes can be the first sign of placental dysfunction, which is associated with HDP, FGR and preterm birth. In addition, preterm birth is likely associated with changes in electrical activity across the uterine muscle. Therefore, fetal cardiac function and uterine activity can be used for the early detection of these complications in pregnancy. Fetal cardiac function and uterine activity can be assessed by two-dimensional speckle-tracking echocardiography (2D-STE), non-invasive fetal electrocardiography (NI-fECG), and electrohysterography (EHG). This study aims to generate reference values for 2D-STE, NI-fECG and EHG parameters during the second trimester of pregnancy and to investigate the diagnostic potential of these parameters in the early detection of HDP, FGR and preterm birth. Methods In this longitudinal prospective cohort study, eligible women will be recruited from a tertiary care hospital and a primary midwifery practice. In total, 594 initially healthy pregnant women with an uncomplicated singleton pregnancy will be included. Recordings of NI-fECG and EHG will be made weekly from 22 until 28 weeks of gestation and 2D-STE measurements will be performed 4-weekly at 16, 20, 24 and 28 weeks gestational age. Retrospectively, pregnancies complicated with pregnancy-related diseases will be excluded from the cohort. Reference values for 2D-STE, NI-fECG and EHG parameters will be assessed in uncomplicated pregnancies. After, 2D-STE, NI-fCG and EHG parameters measured during gestation in complicated pregnancies will be compared with these reference values. Discussion This will be the a large prospective study investigating new technologies that could potentially have a high impact on antepartum fetal monitoring. Trial registration Registered on 26 March 2020 in the Dutch Trial Register (NL8769) via https://www.trialregister.nl/trials and registered on 21 October 2020 to the Central Committee on Research Involving Human Subjects (NL73607.015.20) via https://www.toetsingonline.nl/to/ccmo_search.nsf/Searchform?OpenForm.
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Affiliation(s)
- T J Nichting
- Department of Gynaecology and Obstetrics, Máxima MC, P.O. Box 7777, 5500 MB, Veldhoven, The Netherlands. .,Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands. .,Eindhoven MedTech Innovation Centre, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.
| | - M W E Frenken
- Department of Gynaecology and Obstetrics, Máxima MC, P.O. Box 7777, 5500 MB, Veldhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.,Eindhoven MedTech Innovation Centre, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
| | - D A A van der Woude
- Department of Gynaecology and Obstetrics, Máxima MC, P.O. Box 7777, 5500 MB, Veldhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.,Eindhoven MedTech Innovation Centre, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
| | - N H M van Oostrum
- Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.,Eindhoven MedTech Innovation Centre, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.,Department of Gynaecology and Obstetrics, University Hospital Gent, 9000, Gent, Belgium
| | - C M de Vet
- Department of Gynaecology and Obstetrics, Máxima MC, P.O. Box 7777, 5500 MB, Veldhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.,Eindhoven MedTech Innovation Centre, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
| | - B G van Willigen
- Department of Gynaecology and Obstetrics, Máxima MC, P.O. Box 7777, 5500 MB, Veldhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.,Eindhoven MedTech Innovation Centre, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
| | - J O E H van Laar
- Department of Gynaecology and Obstetrics, Máxima MC, P.O. Box 7777, 5500 MB, Veldhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.,Eindhoven MedTech Innovation Centre, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
| | - M van der Ven
- Department of Gynaecology and Obstetrics, Máxima MC, P.O. Box 7777, 5500 MB, Veldhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.,Eindhoven MedTech Innovation Centre, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
| | - S G Oei
- Department of Gynaecology and Obstetrics, Máxima MC, P.O. Box 7777, 5500 MB, Veldhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.,Eindhoven MedTech Innovation Centre, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
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9
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Moors S, Joshi R, Bullens LM, van Oostrum NHM, Regis M, van den Heuvel ER, Oei SG, van Laar JOEH, van der Hout-van der Jagt MB. A randomized controlled trial studying the effect of maternal hyperoxygenation on fetal heart rate in suspected fetal distress. Physiol Meas 2020; 41:115002. [PMID: 33049730 DOI: 10.1088/1361-6579/abc0b6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the effect of maternal hyperoxygenation on fetal heart rate (FHR) when applied for suspected fetal distress during the second stage of term labor. APPROACH A single-center randomized controlled trial was conducted in a tertiary care hospital in The Netherlands. Participants were included during the second stage of labor in case of an intermediary or abnormal FHR pattern. Patients were randomized to receive either 100% oxygen at 10 l/min until delivery, or conventional care without additional oxygen. The primary outcome was the change in FHR pattern before and after the onset of the study, measured as the change in depth and duration of FHR decelerations. Secondary outcome measures were features based on phase-rectified signal averaging (PRSA), baseline assignability, and deceleration characteristics of the FHR pattern. MAIN RESULTS Between March 2016 and April 2018, 117 women were included. The FHR pattern could be analyzed for 71 participants, the other 46 women delivered before the end of the post time-frame. A 2.3% reduction in depth and duration of FHR decelerations was found after maternal hyperoxygenation, compared to a 10% increase in the control group (p = 0.24). Maternal hyperoxygenation had a significantly positive effect on PRSA metrics, with a decrease in PRSA-acceleration capacity (p = 0.03) and PRSA-deceleration capacity (p = 0.02) in the intervention group compared to the control group. SIGNIFICANCE The difference in depth and duration of decelerations after the start of the study was not significantly different between both study groups. A statistically significant positive effect on PRSA-deceleration capacity and PRSA-acceleration capacity was found after maternal hyperoxygenation, which might be associated with a positive effect on neonatal outcome.
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Affiliation(s)
- S Moors
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands. Eindhoven MedTech Innovation Center (e/MTIC), Groene Loper 19, Eindhoven 5600 MB, The Netherlands. Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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10
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van Tetering AAC, van Meurs A, Ntuyo P, van der Hout-van der Jagt MB, Mulders LGM, Nolens B, Namagambe I, Nakimuli A, Byamugisha J, Oei SG. Study protocol training for life: a stepped wedge cluster randomized trial about emergency obstetric simulation-based training in a low-income country. BMC Pregnancy Childbirth 2020; 20:429. [PMID: 32723330 PMCID: PMC7388496 DOI: 10.1186/s12884-020-03050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 06/09/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Globally perinatal and maternal mortality rates remain unacceptably high. There is increasing evidence that simulation-based training in obstetric emergencies is associated with improvement in clinical outcomes. However, the results are not entirely consistent. The need for continued research in a wide variety of clinical settings to establish what works, where and why was recommended. The aim of this study is to investigate the effectiveness of an emergency obstetric simulation-based training program with medical technical and teamwork skills on maternal and perinatal mortality in a low-income country. METHODS A stepped wedge cluster randomized trial will be conducted at the medium to high-risk labour ward at Mulago Hospital, Kampala, Uganda, with an annual delivery rate of over 23,000. The training will be performed using a train-the-trainers model in which training is cascaded down from master trainers to local facilitators (gynaecologists) to learners (senior house officers). Local facilitators will be trained during a four-day train-the-trainers course with an annual repetition. The senior house officers will be naturally divided in seven clusters and randomized for the moment of training. The training consists of a one-day, monodisciplinary, simulation-based training followed by repetition training sessions. Scenarios are based on the main local causes of maternal and neonatal mortality and focus on both medical technical and crew resource management skills. Kirkpatrick's classification will be used to evaluate the training program. Primary outcome will be the composite of maternal and neonatal mortality ratios. Secondary outcome will comprise course perception, evaluation of the instructional design of the training, knowledge, technical skills, team performance, percentage of ventouse deliveries, percentage of caesarean sections, and a Weighted Adverse Outcome Score. DISCUSSION This stepped wedge cluster randomized trial will investigate the effect of a monodisciplinary simulation-based obstetric training in a low-income country, focusing on both medical technical skills and crew resource management skills, on patient outcome at one of the largest labour wards worldwide. We will use a robust study design which will allow us to better understand the training effects, and difficulties in evaluating training programs in low-income countries. TRIAL REGISTRATION ISRCTN98617255 , retrospectively registered July 23, 2018.
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Affiliation(s)
- A A C van Tetering
- Department of Obstetrics and Gynaecology, MUMC+, Maastricht, The Netherlands.
| | - A van Meurs
- Department of Obstetrics and Gynaecology, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - P Ntuyo
- Department of Obstetrics and Gynaecology, Makerere University and Mulago National Referral Hospital, Kampala, Uganda
| | - M B van der Hout-van der Jagt
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - L G M Mulders
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - B Nolens
- Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - I Namagambe
- Department of Obstetrics and Gynaecology, Makerere University and Mulago National Referral Hospital, Kampala, Uganda
| | - A Nakimuli
- Department of Obstetrics and Gynaecology, Makerere University and Mulago National Referral Hospital, Kampala, Uganda
| | - J Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University and Mulago National Referral Hospital, Kampala, Uganda
| | - S G Oei
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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11
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Rooijakkers MJ, Rabotti C, Oei SG, Mischi M. Critical analysis of electrohysterographic methods for continuous monitoring of intrauterine pressure. Math Biosci Eng 2020; 17:3019-3039. [PMID: 32987514 DOI: 10.3934/mbe.2020171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Monitoring the progression of uterine activity provides important prognostic information during pregnancy and delivery. Currently, uterine activity monitoring relies on direct or indirect mechanical measurements of intrauterine pressure (IUP), which are unsuitable for continuous long-term observation. The electrohysterogram (EHG) provides a non-invasive alternative to the existing methods and is suitable for long-term ambulatory use. Several published state-of-the-art methods for EHG-based IUP estimation are here discussed, analyzed, optimized, and compared. By means of parameter space exploration, key parameters of the methods are evaluated for their relevance and optimal values. We have optimized all methods towards higher IUP estimation accuracy and lower computational complexity. Their accuracy was compared with the gold standard accuracy of internally measured IUP. Their computational complexity was compared based on the required number of multiplications per second (MPS). Significant reductions in computational complexity have been obtained for all published algorithms, while improving IUP estimation accuracy. A correlation coefficient of 0.72 can be obtained using fewer than 120 MPS. We conclude that long-term ambulatory monitoring of uterine activity is possible using EHG-based methods. Furthermore, the choice of a base method for IUP estimation is less important than the correct selection of electrode positions, filter parameters, and postprocessing methods. The presented review of state-of-the-art methods and applied optimizations show that long-term ambulatory IUP monitoring is feasible using EHG measurements.
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Affiliation(s)
| | - C Rabotti
- Signal Processing Systems, University of Technology Eindhoven, Eindhoven 5612 AZ, Netherlands
| | - S G Oei
- Perinatology and Obstetrics department, Maxima Medical Center, Veldhoven 5504 DB, Netherlands
| | - M Mischi
- Signal Processing Systems, University of Technology Eindhoven, Eindhoven 5612 AZ, Netherlands
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12
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Moors S, Staaks KJJ, Westerhuis MEMH, Dekker LRC, Verdurmen KMJ, Oei SG, van Laar JOEH. Heart rate variability in hypertensive pregnancy disorders: A systematic review. Pregnancy Hypertens 2020; 20:56-68. [PMID: 32179490 DOI: 10.1016/j.preghy.2020.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hypertensive pregnancy disorders (HPD) are associated with dysfunction of the autonomic nervous system. Cardiac autonomic functions can be assessed by heart rate variability (HRV) measurements. OBJECTIVE To study whether HRV detects differences in the function of the autonomic nervous system between pregnant women with HPD compared to normotensive pregnant women and between women with a history of a pregnancy complicated by HPD compared to women with a history of an uncomplicated pregnancy. METHODS A systematic search was performed in Medline, EMBASE, and CENTRAL to identify studies comparing HRV between pregnant women with HPD or women with a history of HPD to women with (a history of) normotensive pregnancies. RESULTS The search identified 523 articles of which 24 were included in this review, including 850 women with (a history of) HPD and 1205 normotensive controls. The included studies showed a large heterogenicity. A decrease in overall HRV was found in preeclampsia (PE), compared to normotensive pregnant controls. A trend is seen towards increased low frequency/high frequency-ratio in women with PE compared to normotensive pregnant controls. CONCLUSION Our systematic review supports the hypothesis a sympathetic overdrive is found in HPD which is associated with a parasympathetic withdrawal. However, the included studies in our review showed a large diversity in the methods applied and their results.
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Affiliation(s)
- S Moors
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - K J J Staaks
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - M E M H Westerhuis
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - L R C Dekker
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - K M J Verdurmen
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - S G Oei
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - J O E H van Laar
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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13
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Noben L, Verdurmen KMJ, Warmerdam GJJ, Vullings R, Oei SG, van Laar JOEH. The fetal electrocardiogram to detect the effects of betamethasone on fetal heart rate variability. Early Hum Dev 2019; 130:57-64. [PMID: 30677639 DOI: 10.1016/j.earlhumdev.2019.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Betamethasone is widely used to enhance fetal lung maturation in case of threatened preterm birth. Antenatal corticosteroids are known to reduce fetal heart rate variability (fHRV) in the days following administration. Since decreased fHRV is a marker for fetal distress, this transient decrease of fHRV can cause unnecessary medical intervention. AIM To describe the effect of betamethasone on fHRV, by applying spectral analysis on non-invasive fetal electrocardiogram (fECG) recordings. STUDY DESIGN Secondary analysis of a prospective cohort study. SUBJECTS Women with a singleton pregnancy, at risk for preterm delivery and receiving betamethasone, admitted to the obstetric high care unit in the period from March 2013 until July 2016. OUTCOME MEASURES The primary outcome measure was fHRV in both time- and frequency-domain. Secondary outcome measures included basal fetal heart rate (fHR) and fHR variance. FHRV parameters were then calculated separately for the quiet and active state. RESULTS Following 68 inclusions, 22 patients remained with complete series of measurements and sufficient data quality. FHRV parameters and fHR showed a decrease on day 2 compared to day 1, significant for short-term variability and high-frequency power. Similar results were found when analyzing for separate behavioral states. The number of segments in quiet state increased during days 1 and 2. Normalized values showed no difference for all behavioral states. CONCLUSION FHRV decreases on day 2 after betamethasone administration, while periods of fetal quiescence increase. No changes were found in the normalized values, indicating that the influence of autonomic modulation is minor. Clinical trial registration number NL43294.015.13.
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Affiliation(s)
- L Noben
- Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands.
| | - K M J Verdurmen
- Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands
| | - G J J Warmerdam
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands
| | - R Vullings
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands
| | - S G Oei
- Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - J O E H van Laar
- Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands
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14
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Fotiadou E, van Laar JOEH, Oei SG, Vullings R. Enhancement of low-quality fetal electrocardiogram based on time-sequenced adaptive filtering. Med Biol Eng Comput 2018; 56:2313-2323. [PMID: 29938302 PMCID: PMC6245004 DOI: 10.1007/s11517-018-1862-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/10/2018] [Indexed: 12/05/2022]
Abstract
Extraction of a clean fetal electrocardiogram (ECG) from non-invasive abdominal recordings is one of the biggest challenges in fetal monitoring. An ECG allows for the interpretation of the electrical heart activity beyond the heart rate and heart rate variability. However, the low signal quality of the fetal ECG hinders the morphological analysis of its waveform in clinical practice. The time-sequenced adaptive filter has been proposed for performing optimal time-varying filtering of non-stationary signals having a recurring statistical character. In our study, the time-sequenced adaptive filter is applied to enhance the quality of multichannel fetal ECG after the maternal ECG is removed. To improve the performance of the filter in cases of low signal-to-noise ratio (SNR), we enhance the ECG reference signals by averaging consecutive ECG complexes. The performance of the proposed augmented time-sequenced adaptive filter is evaluated in both synthetic and real data from PhysioNet. This evaluation shows that the suggested algorithm clearly outperforms other ECG enhancement methods, in terms of uncovering the ECG waveform, even in cases with very low SNR. With the presented method, quality of the fetal ECG morphology can be enhanced to the extent that the ECG might be fit for use in clinical diagnostics. The extracted fetal ECG signals from non-invasive abdominal recordings still contain a substantial amount of noise. The time-sequenced adaptive filter provides a relatively accurate estimate of the underlying fetal ECG signal when the quality of the reference channels is enhanced prior to filtering. ![]()
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Affiliation(s)
- E Fotiadou
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP, Eindhoven, Netherlands.
| | - J O E H van Laar
- Department of Obstetrics and Gynaecology, Máxima Medical Center, 5504 DB, Veldhoven, Netherlands
| | - S G Oei
- Department of Obstetrics and Gynaecology, Máxima Medical Center, 5504 DB, Veldhoven, Netherlands
| | - R Vullings
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP, Eindhoven, Netherlands
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15
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Warmerdam GJJ, Vullings R, Van Laar JOEH, Van der Hout-Van der Jagt MB, Bergmans JWM, Schmitt L, Oei SG. Detection rate of fetal distress using contraction-dependent fetal heart rate variability analysis. Physiol Meas 2018; 39:025008. [PMID: 29350194 DOI: 10.1088/1361-6579/aaa925] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Monitoring of the fetal condition during labor is currently performed by cardiotocograpy (CTG). Despite the use of CTG in clinical practice, CTG interpretation suffers from a high inter- and intra-observer variability and a low specificity. In addition to CTG, analysis of fetal heart rate variability (HRV) has been shown to provide information on fetal distress. However, fetal HRV can be strongly influenced by uterine contractions, particularly during the second stage of labor. Therefore, the aim of this study is to examine if distinguishing contractions from rest periods can improve the detection rate of HRV features for fetal distress during the second stage of labor. APPROACH We used a dataset of 100 recordings, containing 20 cases of fetuses with adverse outcome. The most informative HRV features were selected by a genetic algorithm and classification performance was evaluated using support vector machines. MAIN RESULTS Classification performance of fetal heart rate segments closest to birth improved from a geometric mean of 70% to 79%. If the classifier was used to indicate fetal distress over time, the geometric mean at 15 minutes before birth improved from 60% to 72%. SIGNIFICANCE Our results show that combining contraction-dependent HRV features with HRV features calculated over the entire fetal heart rate signal improves the detection rate of fetal distress.
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Affiliation(s)
- G J J Warmerdam
- Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
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van de Ven J, van Baaren GJ, Fransen AF, van Runnard Heimel PJ, Mol BW, Oei SG. Cost-effectiveness of simulation-based team training in obstetric emergencies (TOSTI study). Eur J Obstet Gynecol Reprod Biol 2017; 216:130-137. [PMID: 28763738 DOI: 10.1016/j.ejogrb.2017.07.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/16/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Team training is frequently applied in obstetrics. We aimed to evaluate the cost-effectiveness of obstetric multi-professional team training in a medical simulation centre. STUDY DESIGN We performed a model-based cost-effectiveness analysis to evaluate four strategies for obstetric team training from a hospital perspective (no training, training without on-site repetition and training with 6 month or 3-6-9 month repetition). Data were retrieved from the TOSTI study, a randomised controlled trial evaluating team training in a medical simulation centre. We calculated the incremental cost-effectiveness ratio (ICER), which represent the costs to prevent the adverse outcome, here (1) the composite outcome of obstetric complications and (2) specifically neonatal trauma due to shoulder dystocia. RESULTS Mean costs of a one-day multi-professional team training in a medical simulation centre were €25,546 to train all personnel of one hospital. A single training in a medical simulation centre was less effective and more costly compared to strategies that included repetition training. Compared to no training, the ICERs to prevent a composite outcome of obstetric complications were €3432 for a single repetition training course on-site six months after the initial training and €5115 for a three monthly repetition training course on-site after the initial training during one year. When we considered neonatal trauma due to shoulder dystocia, a three monthly repetition training course on-site after the initial training had an ICER of €22,878. CONCLUSION Multi-professional team training in a medical simulation centre is cost-effective in a scenario where repetition training sessions are performed on-site.
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Affiliation(s)
- J van de Ven
- Department of Obstetrics and Gynaecology, Elkerliek Hospital, Helmond, The Netherlands.
| | - G J van Baaren
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - A F Fransen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P J van Runnard Heimel
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Eindhoven, Veldhoven, The Netherlands
| | - B W Mol
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, and The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - S G Oei
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Eindhoven, Veldhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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17
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van de Ven J, Fransen AF, Schuit E, van Runnard Heimel PJ, Mol BW, Oei SG. Does the effect of one-day simulation team training in obstetric emergencies decline within one year? A post-hoc analysis of a multicentre cluster randomised controlled trial. Eur J Obstet Gynecol Reprod Biol 2017; 216:79-84. [PMID: 28738295 DOI: 10.1016/j.ejogrb.2017.07.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 06/06/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
Does the effect of one-day simulation team training in obstetric emergencies decline within one year? A post-hoc analysis of a multicentre cluster randomised controlled trial. J van de Ven, AF Fransen, E Schuit, PJ van Runnard Heimel, BW Mol, SG Oei OBJECTIVE: To investigate whether the effect of a one-day simulation-based obstetric team training on patient outcome changes over time. STUDY DESIGN Post-hoc analysis of a multicentre, open, randomised controlled trial that evaluated team training in obstetrics (TOSTI study).We studied women with a singleton pregnancy beyond 24 weeks of gestation in 24 obstetric units. Included obstetric units were randomised to either a one-day, multi-professional simulation-based team training focusing on crew resource management in a medical simulation centre (12 units) or to no team training (12 units). We assessed whether outcomes differed between both groups in each of the first four quarters following the team training and compared the effect of team training over quarters. Primary outcome was a composite outcome of low Apgar score, severe postpartum haemorrhage, trauma due to shoulder dystocia, eclampsia and hypoxic-ischemic encephalopathy. RESULTS During a one year period after the team training the rate of obstetric complications, both on the composite level and the individual component level, did not differ between any of the quarters. For trauma due to shoulder dystocia team training led to a significant decrease in the first quarter (0.06% versus 0.26%, OR 0.19, 95% CI 0.03 to 0.98) but in the subsequent quarters no significant reductions were observed. Similar results were found for invasive treatment for severe postpartum haemorrhage where a significant increase was only seen in the first quarter (0.4% versus 0.03%, OR 19, 95% CI 2.5-147), and not thereafter. CONCLUSION The beneficial effect of a one-day, simulation-based, multiprofessional, obstetric team training seems to decline after three months. If team training is further evaluated or implemented, repetitive training sessions every three months seem therefore recommended.
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Affiliation(s)
- J van de Ven
- Department of Obstetrics and Gynaecology, Elkerliek Hospital, Helmond, The Netherlands.
| | - A F Fransen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - P J van Runnard Heimel
- Department of Obstetrics and Gynaecology, Máxima Medical Centre Eindhoven-Veldhoven, The Netherlands
| | - B W Mol
- The Robinson Research Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Australia
| | - S G Oei
- Department of Obstetrics and Gynaecology, Máxima Medical Centre Eindhoven-Veldhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Warmerdam GJJ, Vullings R, Van Laar JOEH, Van der Hout-Van der Jagt MB, Bergmans JWM, Schmitt L, Oei SG. Selective heart rate variability analysis to account for uterine activity during labor and improve classification of fetal distress. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:2950-2953. [PMID: 28268931 DOI: 10.1109/embc.2016.7591348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiotocography (CTG) is currently the most often used technique for detection of fetal distress. Unfortunately, CTG has a poor specificity. Recent studies suggest that, in addition to CTG, information on fetal distress can be obtained from analysis of fetal heart rate variability (HRV). However, uterine contractions can strongly influence fetal HRV. The aim of this study is therefore to investigate whether HRV analysis for detection of fetal distress can be improved by distinguishing contractions from rest periods. Our results from feature selection indicate that HRV features calculated separately during contractions or during rest periods are more informative on fetal distress than HRV features that are calculated over the entire fetal heart rate. Furthermore, classification performance improved from a geometric mean of 69.0% to 79.6% when including the contraction-dependent HRV features, in addition to HRV features calculated over the entire fetal heart rate.
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Kommers DR, Broeren MAC, Andriessen P, Oei SG, Feijs L, Bambang Oetomo S. Pilot study demonstrates that salivary oxytocin can be measured unobtrusively in preterm infants. Acta Paediatr 2017; 106:34-42. [PMID: 27666329 PMCID: PMC5215538 DOI: 10.1111/apa.13606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/08/2016] [Accepted: 09/21/2016] [Indexed: 12/16/2022]
Abstract
Aim This study assessed the feasibility and obtrusiveness of measuring salivary oxytocin in preterm infants receiving Kangaroo care, because this is a period of maximal bonding or co‐regulation. We also analysed possible influential determinants, including maternal oxytocin. Methods The saliva of preterm infants and their mothers was collected prior to, and during, Kangaroo care using cotton swabs and pooled into vials until sufficient volumes were obtained to measure oxytocin levels using a radioimmunoassay. The obtrusiveness of the infants’ collections was measured with a Likert scale. Results Saliva was collected unobtrusively prior to, and during, 30 Kangaroo care sessions in 21 preterm infants. This resulted in three vials with sufficient volumes of before‐Kangaroo care saliva and three with during‐Kangaroo care saliva. Oxytocin was detectable in all six vials. The Kangaroo care duration and the intensity of the mother–infant interaction before and during Kangaroo care seemed to be the most important determinants, and these should preferably be standardised in any future trials. Conclusion Oxytocin was measured unobtrusively in the pooled saliva of preterm infants both before and during Kangaroo care and could therefore be investigated as a biomarker in future studies.
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Affiliation(s)
- DR Kommers
- Department of Neonatology; Máxima Medical Centre; Veldhoven The Netherlands
- Department of Industrial Design; Eindhoven University of Technology; Eindhoven The Netherlands
| | - MAC Broeren
- Clinical Chemistry Laboratory; Máxima Medical Centre; Veldhoven The Netherlands
| | - P Andriessen
- Department of Neonatology; Máxima Medical Centre; Veldhoven The Netherlands
- Department of Pediatrics; School for Mental Health and Neuroscience; Faculty of Health, Medicine and Life Sciences; Maastricht University Medical Center; Maastricht The Netherlands
| | - SG Oei
- Department of Electrical Engineering; Eindhoven University of Technology; Eindhoven The Netherlands
- Department of Gynaecology; Máxima Medical Centre; Veldhoven The Netherlands
| | - L Feijs
- Department of Industrial Design; Eindhoven University of Technology; Eindhoven The Netherlands
| | - S Bambang Oetomo
- Department of Neonatology; Máxima Medical Centre; Veldhoven The Netherlands
- Department of Industrial Design; Eindhoven University of Technology; Eindhoven The Netherlands
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20
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Vermeulen-Giovagnoli B, Peters C, van der Hout-van der Jagt MB, Mischi M, van Pul C, Cottaar EJE, Oei SG. The development of an obstetric tele-monitoring system. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:177-80. [PMID: 26736229 DOI: 10.1109/embc.2015.7318329] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Fetal growth restriction and preterm uterine contractions can turn a normal pregnancy into a problematic one. In previous work, we have developed a system for electrophysiological measurement of fetal heart rate (fHR), fetal electrocardiogram (fECG) and (premature) uterine contractions to enable early detection of foetal problems. In this work we have expanded this system into a tele-monitoring system for measurement at home. In order to permit home monitoring, the communication chain of the data has to be designed such that home-measured signals (fHR, fECG, uterine activities) are available in the hospital in real-time. Furthermore, the data must be transferred wirelessly to any location (worldwide) for interpretation by gynaecologists. A web application helps the gynaecologist or midwife to access the signals everywhere, provided that internet access is available. We developed a webserver as the heart of the entire system; it manages the patient database, transforms the signals in a graphical representation similar to that of the cardiotocography and manages the data communication with the proper data security policy. This tele-monitoring system can be used also during home deliveries enabling prompt transfer and proper intervention in the hospital when complications occur.
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Fransen AF, van de Ven J, Schuit E, van Tetering A, Mol BW, Oei SG. Simulation-based team training for multi-professional obstetric care teams to improve patient outcome: a multicentre, cluster randomised controlled trial. BJOG 2016; 124:641-650. [PMID: 27726304 DOI: 10.1111/1471-0528.14369] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate whether simulation-based obstetric team training in a simulation centre improves patient outcome. DESIGN Multicentre, open, cluster randomised controlled trial. SETTING Obstetric units in the Netherlands. POPULATION Women with a singleton pregnancy beyond 24 weeks of gestation. METHODS Random allocation of obstetric units to a 1-day, multi-professional, simulation-based team training focusing on crew resource management (CRM) in a simulation centre or to no such team training. Intention-to-treat analyses were performed at the cluster level, including a measurement 1 year prior to the intervention. MAIN OUTCOME MEASURES Primary outcome was a composite outcome of obstetric complications during the first year post-intervention, including low Apgar score, severe postpartum haemorrhage, trauma due to shoulder dystocia, eclampsia and hypoxic-ischaemic encephalopathy. Maternal and perinatal mortality were also registered. RESULTS Each study group included 12 units with a median unit size of 1224 women, combining for a total of 28 657 women. In total, 471 medical professionals received the training course. The composite outcome of obstetric complications did not differ between study groups [odds ratio (OR) 1.0, 95% confidence interval (CI) 0.80-1.3]. Team training reduced trauma due to shoulder dystocia (OR 0.50, 95% CI 0.25-0.99) and increased invasive treatment for severe postpartum haemorrhage (OR 2.2, 95% CI 1.2-3.9) compared with no intervention. Other outcomes did not differ between study groups. CONCLUSION A 1-day, off-site, simulation-based team training, focusing on teamwork skills, did not reduce a composite of obstetric complications. TWEETABLE ABSTRACT 1-day, off-site, simulation-based team training did not reduce a composite of obstetric complications.
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Affiliation(s)
- A F Fransen
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Eindhoven-Veldhoven, the Netherlands.,Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J van de Ven
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Eindhoven-Veldhoven, the Netherlands
| | - E Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.,Stanford Prevention Research Center, Stanford University, Stanford, California, USA
| | - Aac van Tetering
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Eindhoven-Veldhoven, the Netherlands
| | - B W Mol
- The Robinson Institute, School of Paediatrics and Reproductive Health University of Adelaide and the South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - S G Oei
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Eindhoven-Veldhoven, the Netherlands.,Department of Electrotechnical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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22
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Rooijakkers MJ, de Lau H, Rabotti C, Oei SG, Bergmans JWM, Mischi M. Fetal movement detection based on QRS amplitude variations in abdominal ECG recordings. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2014:1452-5. [PMID: 25570242 DOI: 10.1109/embc.2014.6943874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Evaluation of fetal motility can give insight in fetal health, as a strong decrease can be seen as a precursor to fetal death. Typically, the assessment of fetal health by fetal movement detection relies on the maternal perception of fetal activity. The percentage of detected movements is strongly subject dependent and with undivided attention of the mother varies between 37% to 88%. Various methods to assist in fetal movement detection exist based on a wide spectrum of measurement techniques. However, these are typically unsuitable for ambulatory or long-term observation. In this paper, a novel method for fetal motion detection is presented based on amplitude and shape changes in the abdominally recorded fetal ECG. The proposed method has a sensitivity and specificity of 0.67 and 0.90, respectively, outperforming alternative fetal ECG-based methods from the literature.
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Warmerdam GJJ, Vullings R, Van Laar JOEH, Van der Hout-Van der Jagt MB, Bergmans JWM, Schmitt L, Oei SG. Using uterine activity to improve fetal heart rate variability analysis for detection of asphyxia during labor. Physiol Meas 2016; 37:387-400. [PMID: 26862891 DOI: 10.1088/0967-3334/37/3/387] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
During labor, uterine contractions can cause temporary oxygen deficiency for the fetus. In case of severe and prolonged oxygen deficiency this can lead to asphyxia. The currently used technique for detection of asphyxia, cardiotocography (CTG), suffers from a low specificity. Recent studies suggest that analysis of fetal heart rate variability (HRV) in addition to CTG can provide information on fetal distress. However, interpretation of fetal HRV during labor is difficult due to the influence of uterine contractions on fetal HRV. The aim of this study is therefore to investigate whether HRV features differ during contraction and rest periods, and whether these differences can improve the detection of asphyxia. To this end, a case-control study was performed, using 14 cases with asphyxia that were matched with 14 healthy fetuses. We did not find significant differences for individual HRV features when calculated over the fetal heart rate without separating contractions and rest periods (p > 0.30 for all HRV features). Separating contractions from rest periods did result in a significant difference. In particular the ratio between HRV features calculated during and outside contractions can improve discrimination between fetuses with and without asphyxia (p < 0.04 for three out of four ratio HRV features that were studied in this paper).
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Affiliation(s)
- G J J Warmerdam
- Faculty of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
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Warmerdam GJJ, Vullings R, Bergmans JWM, Oei SG. Reliability of spectral analysis of fetal heart rate variability. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:2817-20. [PMID: 25570577 DOI: 10.1109/embc.2014.6944209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Spectral analysis of fetal heart rate variability could provide information on fetal wellbeing. Unfortunately, fetal heart rate recordings are often contaminated by artifacts. Correction of these artifacts affects the outcome of spectral analysis, but it is currently unclear what level of artifact correction facilitates reliable spectral analysis. In this study, a method is presented that estimates the error in spectral powers due to artifact correction, based on the properties of the Continuous Wavelet Transformation. The results show that it is possible to estimate the error in spectral powers. The information about this error makes it possible for clinicians to assess the reliability of spectral analysis of fetal heart rate recordings that are contaminated by artifacts.
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Monen L, Pop VJ, Hasaart TH, Wijnen H, Oei SG, Kuppens SM. Increased maternal TSH and decreased maternal FT4 are associated with a higher operative delivery rate in low-risk pregnancies: A prospective cohort study. BMC Pregnancy Childbirth 2015; 15:267. [PMID: 26475700 PMCID: PMC4609102 DOI: 10.1186/s12884-015-0702-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 10/08/2015] [Indexed: 01/11/2023] Open
Abstract
Background The increasing number of operative deliveries is a topic of major concern in modern obstetrics. Maternal thyroid function is of known influence on many obstetric parameters. Our objective was to investigate a possible relation between maternal thyroid function, and operative deliveries. Secondary aim was to explore whether thyroid function was related to specific reasons for operative deliveries. Methods In this prospective cohort study, low-risk Caucasian women, pregnant of a single cephalic fetus were included. Women with known auto-immune disease, a pre-labour Caesarean section, induction of labour, breech presentation or preterm delivery were excluded. In all trimesters of pregnancy the thyroid function was assessed. Differences in mean TSH and FT4 were assessed using t-test. Mean TSH and FT4 levels for operative deliveries were determined by one way ANOVA. Repeated measurement analyses were performed (ANOVA), adjusting for BMI, partiy, maternal age and gestational age at delivery. Results In total 872 women were included, of which 699 (80.2 %) had a spontaneous delivery. At 36 weeks gestation women who had an operative delivery had a significantly higher mean TSH (1.63mIU/L versus 1.46mIU/L, p = 0.025) and lower mean FT4 (12.9pmol/L versus 13.3pmol/L, p = 0.007)) compared to women who had a spontaneous delivery. Mean TSH was significantly higher (p = 0.026) and mean FT4 significantly lower (p = 0.030) throughout pregnancy for women with an operative delivery due to failure to progress in second stage of labour, compared to women with a spontaneous delivery or operative delivery for other reasons. Conclusions Increased TSH and decreased FT4 seem to be associated with more operative vaginal deliveries and Caesarean sections. After adjusting for several confounders the association remained for operative deliveries due to failure to progress in second stage of labour, possibly to be explained by less efficient uterine action.
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Affiliation(s)
- L Monen
- Department of Medical Health Psychology, Tilburg University Warandelaan, 2, 5037 AB, Tilburg, The Netherlands. .,Department of Obstetrics and Gynaecology, Catharina Hospital, Michelangelolaan 2, 5613 EJ, Eindhoven, The Netherlands. .,Present: Department of Obstetrics and Gynaecology, Zuyderland MC, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands.
| | - V J Pop
- Department of Medical Health Psychology, Tilburg University Warandelaan, 2, 5037 AB, Tilburg, The Netherlands.
| | - T H Hasaart
- Department of Obstetrics and Gynaecology, Catharina Hospital, Michelangelolaan 2, 5613 EJ, Eindhoven, The Netherlands.
| | - H Wijnen
- Midwifery Academy Maastricht, Universiteitssingel 60, 6229 ER, Maastricht, The Netherlands.
| | - S G Oei
- Department of Obstetrics and Gynaecology, Maxima Medical Centre Veldhoven, De Run 4600, 5504 DB, Veldhoven, The Netherlands.
| | - S M Kuppens
- Department of Obstetrics and Gynaecology, Catharina Hospital, Michelangelolaan 2, 5613 EJ, Eindhoven, The Netherlands.
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Bajlekov GI, Rabotti C, Oei SG, Mischi M. Electrohysterographic detection of uterine contractions in term pregnancy. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2015:5851-5854. [PMID: 26737622 DOI: 10.1109/embc.2015.7319722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Uterine-contraction detection is a fundamental component of pregnancy monitoring. Electrohysterography (EHG) provides a non-invasive and accurate alternative to intrauterine pressure (IUP) measurements, and several techniques provide an estimated IUP (eIUP) based on the EHG alone. Commonly, EHG contraction detection is based on amplitude thresholding of the eIUP. We aim at improving the reliability of contraction detection, such that automatic contraction detection can be realized. An algorithm for template-matching of the eIUP signal is proposed. This method is based on Bayesian evidence using a Gaussian likelihood function to classify uterine activity. Gaussian templates are matched to the input signal, with weights obtained empirically from manually-annotated contraction events in a training data-set. The results show an improvement in contraction detection accuracy compared to threshold-based methods. The template-matching method is adaptable to relevant features in the input training data, and is thus less sensitive to differences in eIUP derivation or measurement variability. The method allows for improved automatic uterine contraction detection in labor EHG data, while being extensible to e.g. preterm contraction detection.
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Rooijakkers MJ, Rabotti C, de Lau H, Oei SG, Bergmans JWM, Mischi M. Feasibility Study of a New Method for Low-Complexity Fetal Movement Detection From Abdominal ECG Recordings. IEEE J Biomed Health Inform 2015; 20:1361-8. [PMID: 26151947 DOI: 10.1109/jbhi.2015.2452266] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Fetal movement counting can provide valuable information on the fetal health, as a strong decrease in the number of movements can be seen as a precursor to fetal death. Typically, assessment of fetal health by fetal movement counting relies on the maternal perception of fetal activity. The percentage of detected movements is strongly subject dependent and with undivided attention of the mother varies between 37% and 88%. Various methods to assist in fetal movement detection exist based on a wide spectrum of measurement techniques. However, these are unsuitable for ambulatory or long-term observation. In this paper, a novel low-complexity method for fetal movement detection is presented based on amplitude and shape changes in the abdominally recorded fetal ECG. This method was compared to a state-of-the-art method from the literature. Using ultrasound-based movement annotations as ground truth, the presented method outperforms the state-of-the-art abdominal-ECG based method, with a sensitivity, specificity, and accuracy of 56%, 68%, and 63%, respectively. Additionally, a significant reduction in algorithm complexity is achieved, possibly enabling continuous ambulatory fetal movement detection and early detection of reduced fetal motility.
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28
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Monen L, Kuppens SM, Hasaart TH, Oosterbaan HP, Oei SG, Wijnen H, Hutton EK, Vader HL, Pop VJ. Maternal thyrotropin is independently related to small for gestational age neonates at term. Clin Endocrinol (Oxf) 2015; 82:254-9. [PMID: 25103873 DOI: 10.1111/cen.12578] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 06/15/2014] [Accepted: 07/31/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Small for gestational age (SGA) newborns constitute still a major cause of perinatal morbidity and mortality. Overt thyroid disease is a known cause of preterm birth and low birthweight but in its untreated condition it is rare today. In this study, we investigated the possible relation between maternal thyroid function assessed in euthyroid women at each trimester and the incidence of term born SGA neonates. DESIGN A prospective cohort study was performed. PATIENTS Thyroid function was assessed at 12, 24 and 36 weeks gestation in 1051 healthy Caucasian women who delivered at ≥ 37 weeks gestation. MEASUREMENTS One-way anova was used to compare mean TSH and FT4 levels between women with SGA neonates and controls. Multiple logistic regression analysis was performed to adjust for known risk factors of SGA. RESULTS Seventy (6·7%) SGA neonates were identified and they were significantly more often born to women with a TSH ≥ 97·5th at first and third trimester. Multiple logistic regression analysis showed that smoking (OR: 4·4, 95% CI: 2·49-7·64), pre-eclampsia (OR: 2·8, 95% CI: 1·19-6·78) and TSH ≥ 97·5th percentile (OR 3·3, 95% CI 1·39-7·53) were significantly related to SGA. Maternal FT4 levels and TPO-Ab status were not associated with SGA offspring. CONCLUSIONS Our data show that TSH levels in the upper range of the reference interval at different trimesters (3·0-3·29 mIU/l) are independently related to an increased risk of delivering SGA neonates at term.
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Affiliation(s)
- L Monen
- Department of Obstetrics and Gynaecology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Department of Medical Health Psychology, Tilburg University, Tilburg, The Netherlands
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29
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van Eerden L, Zeeman GG, Page-Christiaens GCM, Vandenbussche F, Oei SG, Scheepers HCJ, van Eyck J, Middeldorp JM, Pajkrt E, Duvekot JJ, de Groot CJM, Bolte AC. Termination of pregnancy for maternal indications at the limits of fetal viability: a retrospective cohort study in the Dutch tertiary care centres. BMJ Open 2014; 4:e005145. [PMID: 24939810 PMCID: PMC4067813 DOI: 10.1136/bmjopen-2014-005145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Maternal morbidity, either pregnancy related or pre-existent, can become life threatening and of such severity as to warrant termination of pregnancy (TOP). In this situation, chances of fetal survival are usually poor, either because of low gestational age and/or because of the fetal effects of the maternal condition. Examples include severe growth restriction in pre-eclampsia and intrauterine infection due to the very early preterm prelabour rupture of membranes. There are very few reports on the prevalence of TOP for maternal indication at the limits of fetal viability. We investigated the prevalence of and indications for TOP on maternal indication in the 10 tertiary care centres in the Netherlands during the past decade. STUDY DESIGN We conducted a retrospective review of the medical records of all women who underwent TOP for maternal indications between 22 and 27 completed weeks of gestation in all 10 tertiary care centres from 2000 to 2009. RESULTS During the study period, there were 1 929 470 deliveries; 163 052 (8.4%) of these took place in one of the 10 tertiary care centres and 177 pregnancies were terminated for severe maternal disease, 131 for hypertensive disorders, 29 for intrauterine infection and 17 for other reasons. The mean gestational age at TOP was 171 days (24(3/7))±10 days. No maternal deaths were recorded. The overall perinatal mortality was 99.4%. CONCLUSIONS Over a 10-year period, TOP for maternal indications was performed in 1 in 1000 deliveries in the 10 Dutch tertiary care centres. Hypertensive disorders comprised three-quarters of the cases.
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Affiliation(s)
- L van Eerden
- Department of Obstetrics and Gynecology, VU Medical Center,Amsterdam, The Netherlands
| | - G G Zeeman
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Groningen, The Netherlands
| | | | - F Vandenbussche
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S G Oei
- Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, The Netherlands
| | - H C J Scheepers
- Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - J M Middeldorp
- Leiden University Medical Center, Leiden, The Netherlands
| | - E Pajkrt
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - J J Duvekot
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Groningen, The Netherlands
| | - C J M de Groot
- Department of Obstetrics and Gynecology, VU Medical Center,Amsterdam, The Netherlands
| | - A C Bolte
- Department of Obstetrics and Gynecology, VU Medical Center,Amsterdam, The Netherlands
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Verhoeven CJM, Opmeer BC, Oei SG, Latour V, van der Post JAM, Mol BWJ. Transvaginal sonographic assessment of cervical length and wedging for predicting outcome of labor induction at term: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2013; 42:500-8. [PMID: 23533137 DOI: 10.1002/uog.12467] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 03/02/2013] [Accepted: 03/14/2013] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To perform a systematic review and meta-analysis to assess the predictive capacity of transvaginal sonographic assessment of the cervix for the outcome of induction of labor. METHODS We searched MEDLINE, EMBASE and the Cochrane Library, and manually searched reference lists of review articles and eligible primary articles. Studies in all languages were eligible if published in full. Two reviewers independently selected studies and extracted data on study characteristics, quality and test accuracy. We then calculated pooled sensitivities and specificities (with 95% CIs) and summary receiver-operating characteristics (sROC) curves. Outcome measures were test accuracy of sonographically measured cervical length and cervical wedging for Cesarean section, not achieving vaginal delivery within 24 h and not achieving active labor. RESULTS We included 31 studies reporting on both cervical length and outcome of delivery. The quality of the included studies was mediocre. Sensitivity of cervical length in the prediction of Cesarean delivery ranged from 0.14 to 0.92 and specificity ranged from 0.35 to 1.00. The estimated sROC curve for cervical length indicated a limited predictive capacity in the prediction of Cesarean delivery. Summary estimates of sensitivity/specificity combinations of cervical length at different cut-offs for Cesarean delivery were 0.82/0.34, 0.64/0.74 and 0.13/0.95 for 20, 30 and 40 mm, respectively. For cervical wedging in the prediction of failed induction of labor summary point estimates of sensitivity/specificity were 0.37/0.80. CONCLUSIONS Cervical length and cervical wedging as measured sonographically at or near term have moderate capacity to predict the outcome of delivery after induction of labor.
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Affiliation(s)
- C J M Verhoeven
- Department of Obstetrics & Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
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31
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Warmerdam G, Vullings R, Van Pul C, Andriessen P, Oei SG, Wijn P. QRS classification and spatial combination for robust heart rate detection in low-quality fetal ECG recordings. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:2004-7. [PMID: 24110110 DOI: 10.1109/embc.2013.6609923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Non-invasive fetal electrocardiography (ECG) can be used for prolonged monitoring of the fetal heart rate (FHR). However, the signal-to-noise-ratio (SNR) of non-invasive ECG recordings is often insufficient for reliable detection of the FHR. To overcome this problem, source separation techniques can be used to enhance the fetal ECG. This study uses a physiology-based source separation (PBSS) technique that has already been demonstrated to outperform widely used blind source separation techniques. Despite the relatively good performance of PBSS in enhancing the fetal ECG, PBSS is still susceptible to artifacts. In this study an augmented PBSS technique is developed to reduce the influence of artifacts. The performance of the developed method is compared to PBSS on multi-channel non-invasive fetal ECG recordings. Based on this comparison, the developed method is shown to outperform PBSS for the enhancement of the fetal ECG.
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Rooijakkers MJ, Rabotti C, Oei SG, Aarts RM, Mischi M. Low-complexity intrauterine pressure monitoring by Teager energy estimation. 2013 35TH ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY (EMBC) 2013; 2013:7424-7. [PMID: 24111461 DOI: 10.1109/embc.2013.6611274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Fransen AF, van de Ven J, Merién AER, de Wit-Zuurendonk LD, Houterman S, Mol BW, Oei SG. Effect of obstetric team training on team performance and medical technical skills: a randomised controlled trial. BJOG 2012; 119:1387-93. [DOI: 10.1111/j.1471-0528.2012.03436.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schuit E, Kwee A, Westerhuis MEMH, Van Dessel HJHM, Graziosi GCM, Van Lith JMM, Nijhuis JG, Oei SG, Oosterbaan HP, Schuitemaker NWE, Wouters MGAJ, Visser GHA, Mol BWJ, Moons KGM, Groenwold RHH. A clinical prediction model to assess the risk of operative delivery. BJOG 2012; 119:915-23. [PMID: 22568406 DOI: 10.1111/j.1471-0528.2012.03334.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To predict instrumental vaginal delivery or caesarean section for suspected fetal distress or failure to progress. DESIGN Secondary analysis of a randomised trial. SETTING Three academic and six non-academic teaching hospitals in the Netherlands. POPULATION 5667 labouring women with a singleton term pregnancy in cephalic presentation. METHODS We developed multinomial prediction models to assess the risk of operative delivery using both antepartum (model 1) and antepartum plus intrapartum characteristics (model 2). The models were validated by bootstrapping techniques and adjusted for overfitting. Predictive performance was assessed by calibration and discrimination (area under the receiver operating characteristic), and easy-to-use nomograms were developed. MAIN OUTCOME MEASURES Incidence of instrumental vaginal delivery or caesarean section for fetal distress or failure to progress with respect to a spontaneous vaginal delivery (reference). RESULTS 375 (6.6%) and 212 (3.6%) women had an instrumental vaginal delivery or caesarean section due to fetal distress, and 433 (7.6%) and 571 (10.1%) due to failure to progress, respectively. Predictors were age, parity, previous caesarean section, diabetes, gestational age, gender, estimated birthweight (model 1) and induction of labour, oxytocin augmentation, intrapartum fever, prolonged rupture of membranes, meconium stained amniotic fluid, epidural anaesthesia, and use of ST-analysis (model 2). Both models showed excellent calibration and the receiver operating characteristics areas were 0.70-0.78 and 0.73-0.81, respectively. CONCLUSION In Dutch women with a singleton term pregnancy in cephalic presentation, antepartum and intrapartum characteristics can assist in the prediction of the need for an instrumental vaginal delivery or caesarean section for fetal distress or failure to progress.
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Affiliation(s)
- E Schuit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
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van Teeffelen ASP, Van Der Heijden J, Oei SG, Porath MM, Willekes C, Opmeer B, Mol BWJ. Accuracy of imaging parameters in the prediction of lethal pulmonary hypoplasia secondary to mid-trimester prelabor rupture of fetal membranes: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2012; 39:495-499. [PMID: 21793083 DOI: 10.1002/uog.10047] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In women who have suffered mid-trimester prelabor rupture of membranes (PPROM), prediction of pulmonary hypoplasia is important for optimal management. We performed a systematic review to assess the capacity of imaging parameters to predict pulmonary hypoplasia. We searched for published articles that reported on biometric parameters and allowed the construction of a 2 × 2 table, comparing at least one of these parameters with the occurrence of pulmonary hypoplasia. The selected studies were scored on methodological quality and we calculated sensitivity and specificity of the tests in the prediction of pulmonary hypoplasia and lethal pulmonary hypoplasia. Overall performance was assessed by summary receiver-operating characteristics (sROC) analyses that were performed with bivariate meta-analysis. We detected 13 studies that reported on the prediction of lethal pulmonary hypoplasia. The quality of the included studies was poor to mediocre. The estimated sROC curves for the chest circumference/abdominal circumference ratio and other parameters showed limited accuracy in the prediction of pulmonary hypoplasia. In women with mid-trimester PPROM, the available evidence indicates limited accuracy of biometric parameters in the prediction of pulmonary hypoplasia.
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Affiliation(s)
- A S P van Teeffelen
- Department of Obstetrics and Gynaecology, Máxima Medical Center Veldhoven, Veldhoven, The Netherlands.
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Kuppens SMI, Kooistra L, Wijnen HA, Vader HL, Hasaart THM, Oei SG, Vulsma T, Pop VJ. Neonatal thyroid screening results are related to gestational maternal thyroid function. Clin Endocrinol (Oxf) 2011; 75:382-7. [PMID: 21521349 DOI: 10.1111/j.1365-2265.2011.04083.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study the relationship between maternal thyroid function at each pregnancy trimester and neonatal screening results. BACKGROUND Overt maternal thyroid dysfunction during gestation is associated with poor neonatal thyroid function. However, research on the relationship between suboptimal maternal thyroid function (assessed at three trimesters) and neonatal thyroid screening outcome is scarce. DESIGN/PATIENTS Prospective follow-up study during three trimesters of gestation in 886 Dutch Caucasian healthy pregnant women followed from 12-week gestation until term delivery (>37 weeks) and their neonates. MEASUREMENTS The relation between neonatal data from the Congenital Hypothyroidism (CH) screening and maternal thyroid determinants [TSH, FT4 and thyroid peroxidase (TPO)-Ab] assessed at 12-, 24- and 36-week gestation. RESULTS Boys have lower screening TT4 levels and their mothers have higher TSH levels at 24- and 36-week gestation. Higher maternal TSH levels (>97·5th percentile, as defined in 810 women without TPO-Ab at 12 weeks) at one or more times during pregnancy (O.R: 2·26, 95% CI: 1·20-4·29) and lower gestational age (O.R: 1·22, 95% CI: 1·05-1·41) are independently related to lower screening TT4 levels. CONCLUSIONS Maternal thyroid function during gestation is related to neonatal TT4 at screening. The finding of both lower neonatal TT4 levels in boys and higher TSH levels in mothers carrying boys is worthy of further investigation, as both observations may be meaningfully related.
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Affiliation(s)
- S M I Kuppens
- Department of Obstetrics & Gynecology, Catharina Hospital, Eindhoven, the Netherlands
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Peters CHL, Vullings R, Rooijakkers MJ, Bergmans JWM, Oei SG, Wijn PFF. A continuous wavelet transform-based method for time-frequency analysis of artefact-corrected heart rate variability data. Physiol Meas 2011; 32:1517-27. [PMID: 21849721 DOI: 10.1088/0967-3334/32/10/001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Time-frequency analysis of heart rate variability (HRV) provides relevant clinical information. However, time-frequency analysis is very sensitive to artefacts. Artefacts that are present in heart rate recordings may be corrected, but this reduces the variability in the signal and therefore adversely affects the accuracy of calculated spectral estimates. To overcome this limitation of traditional techniques for time-frequency analysis, a new continuous wavelet transform (CWT)-based method was developed in which parts of the scalogram that have been affected by artefact correction are excluded from power calculations. The method was evaluated by simulating artefact correction on HRV data that were originally free of artefacts. Commonly used spectral HRV parameters were calculated by the developed method and by the short-time Fourier transform (STFT), which was used as a reference. Except for the powers in the very low-frequency and low-frequency (LF) bands, powers calculated by the STFT proved to be extremely sensitive to artefact correction. The CWT-based calculations in the high-frequency and very high-frequency bands corresponded well with their theoretical values. The standard deviations of these powers, however, increase with the number of corrected artefacts which is the result of the non-stationarity of the R-R interval series that were analysed. The powers calculated in the LF band turned out to be slightly sensitive to artefact correction, but the results were acceptable up to 20% artefact correction. Therefore, the CWT-based method provides a valuable alternative for the analysis of HRV data that cannot be guaranteed to be free of artefacts.
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Affiliation(s)
- C H L Peters
- Department of Clinical Physics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
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39
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Becker JH, Westerhuis MEMH, Sterrenburg K, van den Akker ESA, van Beek E, Bolte AC, van Dessel TJHM, Drogtrop AP, van Geijn HP, Graziosi GCM, van Lith JMM, Mol BWJ, Moons KGM, Nijhuis JG, Oei SG, Oosterbaan HP, Porath MM, Rijnders RJP, Schuitemaker NWE, Wijnberger LDE, Willekes C, Visser GHA, Kwee A. Fetal blood sampling in addition to intrapartum ST-analysis of the fetal electrocardiogram: evaluation of the recommendations in the Dutch STAN® trial. BJOG 2011; 118:1239-46. [DOI: 10.1111/j.1471-0528.2011.03027.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Koops W, Van der Vleuten C, De Leng B, Oei SG, Snoeckx L. Computer-supported collaborative learning in the medical workplace: Students' experiences on formative peer feedback of a critical appraisal of a topic paper. Med Teach 2011; 33:e318-23. [PMID: 21609168 DOI: 10.3109/0142159x.2011.575901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Medical workplace learning consists largely of individual activities, since workplace settings do not lend themselves readily to group learning. An electronic Learning Management with System Computer-Supported Collaborative Learning (CSCL) could enable learners at different workplace locations to discuss personal clinical experiences at a distance to enhance learning. AIM To explore whether CSCL-enabled structured asynchronous discussions on an authentic task has additional value for learning in the medical workplace. METHODS Between January 2008 and June 2010, we conducted an exploratory evaluation study among senior medical students that were engaged in clinical electives. Students wrote a Critical Appraisal of a Topic paper about a clinical problem they had encountered and discussed it in discipline homogeneous subgroups on an asynchronous forum in a CSCL environment. A mixed method design was used to explore students' perceptions of the CSCL arrangement with respect to their preparation and participation, the design and knowledge gains. We analysed the messages recorded during the discussions to investigate which types of interactions occurred. RESULTS Students perceived knowledge improvement of their papers. The discussions were mostly task-focused. The students considered an instruction session and a manual necessary to prepare for CSCL. A high amount of sent messages and a high activity in discussion seem to influence scores on perceptions: 'participation' and 'knowledge gain' positively. CONCLUSION CSCL appears to offer a suitable environment for peers to provide formative feedback on a Critical Appraisal of a Topic paper during workplace learning. The CSCL environment enabled students to collaborate in asynchronous discussions, which positively influenced their learning.
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Affiliation(s)
- W Koops
- Maxima Medical Center, Veldhoven, The Netherlands.
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Abstract
OBJECTIVE To study the relationship between maternal thyrotrophin (TSH) and breech presentation at term. DESIGN Combined data sets of two prospective studies to obtain adequate epidemiological power. PATIENTS One thousand and fifty-eight healthy pregnant women (58 breech, 1000 cephalic) and 131 women who presented in breech at an obstetrical outpatient clinic. MEASUREMENTS Maternal thyroid parameters [TSH, free thyroid hormone (FT4), thyroid peroxidase antibody (TPO-Ab)] and foetal presentation were assessed in both groups between 35 and 38 weeks gestation. Power calculations suggested that at least 148 breech cases were required. RESULTS The characteristics of the women in breech in both samples were similar. Women in breech (n = 58 + 131) had significantly higher TSH (but not FT4) than those (n = 1000) with cephalic presentation (Mann-Whitney U-test, P = 0·003). Different cut-offs were used to define high TSH in the 916 TPO-Ab-negative women with cephalic presentation: the 90th, 95th and 97·5th percentiles were 2·4 mIU/l (n = 149), 2·7 mIU/l (n = 77) and 3·2 mIU/l (n = 37). The prevalence rates of breech presentation in these women were all higher compared to the prevalence of breech in women below these cut-offs (df = 1, P < 0·01). The relative risk of the 149 women with a TSH >90th percentile (>2·4 mIU/l) to present in breech was 1·82 (95% CI: 1·30-2·56). CONCLUSIONS Women with high TSH at end term are at risk for breech presentation. Substantial evidence for a relation between breech presentation and neurodevelopmental delay exists. As high TSH during gestation has also been linked to poor neurodevelopment, the relation between breech presentation and poor neurodevelopment might be thyroid-related.
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Affiliation(s)
- L Kooistra
- Deptartment of Pediatrics, Alberta Children's Hospital, University of Calgary, Canada
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Vullings R, Peters CHL, Hermans MJM, Wijn PFF, Oei SG, Bergmans JWM. A robust physiology-based source separation method for QRS detection in low amplitude fetal ECG recordings. Physiol Meas 2010; 31:935-51. [PMID: 20530846 DOI: 10.1088/0967-3334/31/7/005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The use of the non-invasively obtained fetal electrocardiogram (ECG) in fetal monitoring is complicated by the low signal-to-noise ratio (SNR) of ECG signals. Even after removal of the predominant interference (i.e. the maternal ECG), the SNR is generally too low for medical diagnostics, and hence additional signal processing is still required. To this end, several methods for exploiting the spatial correlation of multi-channel fetal ECG recordings from the maternal abdomen have been proposed in the literature, of which principal component analysis (PCA) and independent component analysis (ICA) are the most prominent. Both PCA and ICA, however, suffer from the drawback that they are blind source separation (BSS) techniques and as such suboptimum in that they do not consider a priori knowledge on the abdominal electrode configuration and fetal heart activity. In this paper we propose a source separation technique that is based on the physiology of the fetal heart and on the knowledge of the electrode configuration. This technique operates by calculating the spatial fetal vectorcardiogram (VCG) and approximating the VCG for several overlayed heartbeats by an ellipse. By subsequently projecting the VCG onto the long axis of this ellipse, a source signal of the fetal ECG can be obtained. To evaluate the developed technique, its performance is compared to that of both PCA and ICA and to that of augmented versions of these techniques (aPCA and aICA; PCA and ICA applied on preprocessed signals) in generating a fetal ECG source signal with enhanced SNR that can be used to detect fetal QRS complexes. The evaluation shows that the developed source separation technique performs slightly better than aPCA and aICA and outperforms PCA and ICA and has the main advantage that, with respect to aPCA/PCA and aICA/ICA, it performs more robustly. This advantage renders it favorable for employment in automated, real-time fetal monitoring applications.
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Affiliation(s)
- R Vullings
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
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43
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Kuppens SMI, Kooistra L, Wijnen HA, Crawford S, Vader HL, Hasaart THM, Oei SG, Pop VJ. Maternal thyroid function during gestation is related to breech presentation at term. Clin Endocrinol (Oxf) 2010; 72:820-4. [PMID: 19832853 DOI: 10.1111/j.1365-2265.2009.03729.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study the relationship between suboptimal maternal thyroid function during gestation and breech presentation at term. DESIGN Prospective follow-up study during three trimesters of gestation. PATIENTS A total of 1058 Dutch Caucasian healthy pregnant women were prospectively followed from 12 weeks gestation until term (>or=37 weeks) delivery. MEASUREMENTS Maternal thyroid parameters [TSH, free T4 (FT4) and auto-antibodies to thyroid peroxidase] were assessed at 12, 24 and 36 weeks gestation as well as foetal presentation at term. RESULTS At term, 58 women (5.5%) presented in breech. Compared with women with foetuses in the cephalic position, those women who presented in breech at term had significantly higher TSH concentrations, but only at 36 weeks gestation (P = 0.007). No between group differences were obtained for FT4 level at any assessment. The prevalence of breech presentation in the subgroup of women with TSH >or= 2.5 mIU/l (90th percentile) at 36 weeks gestation was 11%, compared with 4.8% in the women with TSH < 2.50 mIU/l (P = 0.006). Women with TSH below the 5th percentile had no breech presentations. Breech position was significantly and independently related to high maternal TSH concentration (>or=2.5 mIU/l) at 36 weeks gestation (O.R.: 2.23, 95% CI: 1.14-4.39), but not at 12 and 24 weeks gestation. CONCLUSIONS Women with TSH levels above 2.5 mIU/l during end gestation are at risk for breech presentation, and as such for obstetric complications.
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Affiliation(s)
- S M I Kuppens
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven
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Mischi M, Rabotti C, Vosters LJ, Oei SG, Bergmans JM. Electrohysterographic conduction velocity estimation. Annu Int Conf IEEE Eng Med Biol Soc 2010; 2009:6934-7. [PMID: 19964460 DOI: 10.1109/iembs.2009.5333636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Monitoring and analysis of the fetal-heart and the uterine-muscle activity, referred to as electrohysterogram (EHG), is essential to permit timely treatment during pregnancy. While remarkable progress is reported for monitoring of the fetal cardiac activity, the EHG measurement and interpretation remains challenging, and limited knowledge is available on the underlying physiological processes. In particular, little attention has been paid to the analysis of the EHG propagation, whose characteristics might indicate the presence of coordinated uterine contractions leading to intrauterine pressure increase. Therefore, this study focuses for the first time on the noninvasive estimation of the conduction velocity of EHG action potentials by means of multichannel EHG recording and surface high-density electrodes. A maximum likelihood algorithm, initially proposed for skeletal-muscle electromyog-raphy, is modified for the required EHG analysis. The use of clustering and weighting is introduced to deal with poor signal similarity between different channels. The presented methods were evaluated by specific simulations, proving the combination of weighting and clustering to be the most accurate method. A preliminary EHG measurement during labor confirmed the feasibility of the method. An extensive clinical validation will however be necessary to optimize the method and assess the relevance of the EHG conduction velocity for pregnancy monitoring.
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Affiliation(s)
- M Mischi
- Faculty of Electrical Engineering, Eindhoven University of Technology, the Netherlands.
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45
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Rabotti C, Mischi M, van Laar JOEH, Oei SG, Bergmans JWM. Myometrium electromechanical modeling for internal uterine pressure estimation by electrohysterography. Annu Int Conf IEEE Eng Med Biol Soc 2010; 2009:6259-62. [PMID: 19963667 DOI: 10.1109/iembs.2009.5332397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
During delivery, quantitative information on the uterine activity can be provided by internal uterine pressure (IUP) recordings using an invasive intrauterine pressure catheter (IUPC). The electrohysterogram, which measures the electrical signal that drives the mechanical contraction of the uterine muscle and the consequent IUP increase, is recorded by electrodes placed on the abdomen. Recent work demonstrated the possibility of reliably estimating the IUP noninvasively by electrohysterographic (EHG) signal analysis. To further improve the accuracy of IUP estimates, we investigated the use of three nonlinear functions for modeling the relationship between the electrical activation measured by the EHG signal and the mechanical response of the uterine muscle. The feature employed for obtaining a first estimate of the IUP is the unnormalized first statistical moment of the EHG spectrum. The relationship between the extracted feature and the IUP is modeled by a second-order polynomial, a logarithmic, and an exponential function. For validation, the IUPC and the EHG signals were recorded on nine women in labor. A second-order polynomial model already provided estimates that are highly correlated with the IUPC signal (r = 0.73). However, the logarithmic model resulted to be the most accurate, especially in terms of root mean squared error (RMSE = 5.13 mmHg).
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Affiliation(s)
- C Rabotti
- Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
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46
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van Laar JOEH, Peters CHL, Vullings R, Houterman S, Oei SG. Power spectrum analysis of fetal heart rate variability at near term and post term gestation during active sleep and quiet sleep. Early Hum Dev 2009; 85:795-8. [PMID: 19931326 DOI: 10.1016/j.earlhumdev.2009.11.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 11/03/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND Spectral analysis of fetal heart rate variability is promising for assessing fetal condition. Before using spectral analysis for fetal monitoring it has to be determined whether there should be a correction for gestational age or behavioural state. AIMS Compare spectral values of heart rate variability between near term and post term fetuses during active and quiet sleep. STUDY DESIGN Case-control. Cases had a gestational age of > or =42 weeks; controls were 36 to 37 weeks. Fetuses were matched for birth weight percentile. SUBJECTS STAN registrations from healthy fetuses. For each fetus one 5-minute segment was selected during active and one during quiet sleep. OUTCOME MEASURES Absolute and normalized low (0.04-0.15 Hz) and high frequency power (0.4-1.5 Hz) of heart rate variability. RESULTS Twenty fetuses were included. No significant differences were found between cases and controls in absolute (481 and 429 respectively, P=0.88) or normalized low (0.78 and 0.80 respectively, P=0.50) or absolute (41 and 21 respectively, P=0.23) or normalized high frequency power (0.08 and 0.07 respectively, P=0.20) during active state. During rest, normalized low frequency power was lower (0.58 and 0.69 respectively, P=0.03) and absolute (16 and 10 respectively, P=0.04) and normalized high frequency power were higher (0.21 and 0.14 respectively, P=0.01) in cases compared to controls. Absolute and normalized low frequency power were higher during active state compared to rest in both groups (all P values <0.05). CONCLUSIONS We found sympathetic predominance during active state in fetuses around term. Post term parasympathetic modulation during rest was increased compared to near term.
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Affiliation(s)
- J O E H van Laar
- Department of Obstetrics and Gynecology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands.
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Verhoeven CJM, Oudenaarden A, Hermus MAA, Porath MM, Oei SG, Mol BWJ. Validation of models that predict Cesarean section after induction of labor. Ultrasound Obstet Gynecol 2009; 34:316-321. [PMID: 19670397 DOI: 10.1002/uog.7315] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Models for the prediction of Cesarean delivery after induction of labor can be used to improve clinical decision-making. The objective of this study was to validate two existing models, published by Peregrine et al. and Rane et al., for the prediction of Cesarean section after induction of labor. METHODS We studied consecutive women in whom labor was induced. In all women, we recorded maternal age, height, body mass index, parity, gestational age and the Bishop score prior to induction. Cervical length was measured by transvaginal ultrasound immediately prior to induction of labor. The primary end-point was delivery by Cesarean section. The calibration of the two prediction models was assessed by comparison of predicted and observed Cesarean delivery rates. The discriminative capacity of the models, i.e. the ability of the models to distinguish subjects who had Cesarean section from those who did not (discrimination), was assessed by receiver-operating characteristics (ROC) analysis. RESULTS We included 240 women in the study, of whom 27 (11%) had Cesarean delivery. The capacity of cervical length in the prediction of Cesarean delivery was limited. In our study population, both prediction models overestimated the risk of Cesarean delivery. Calibration was better for the Peregrine et al. model than for the Rane et al. model, and the two models had areas under the ROC curve of 0.76 and 0.67, respectively. CONCLUSION Current models that predict the occurrence of Cesarean section after induction of labor have only a moderate predictive capacity when applied within a Dutch practice. We do not recommend the use of these prediction models in clinical practice.
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Affiliation(s)
- C J M Verhoeven
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, De Run 4600, PO Box 7777, 5500 MB Veldhoven, The Netherlands.
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Vullings R, Peters CHL, Sluijter RJ, Mischi M, Oei SG, Bergmans JWM. Dynamic segmentation and linear prediction for maternal ECG removal in antenatal abdominal recordings. Physiol Meas 2009; 30:291-307. [DOI: 10.1088/0967-3334/30/3/005] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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van Eyck J, Bloemenkamp KWM, Bolte AC, Duvekot JJ, Heringa MP, Lotgering FK, Oei SG, Offermans JPM, Schaap AHP, Sollie-Szarynska KM. [Tertiary obstetric care: the aims of the planning decree on perinatal care of 2001 have not yet been achieved]. Ned Tijdschr Geneeskd 2008; 152:2121-2125. [PMID: 18856029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To compare the actual situation in tertiary perinatal care in the Netherlands with the objectives laid down in the 2001 decree on perinatal care by the Dutch Ministry of Health, Welfare and Sport. DESIGN Descriptive, retrospective. METHOD Data on tertiary perinatal care, the transfer or refusal of women with very endangered pregnancies and the personnel of obstetric high care (OHC) units in 2006 were compared with the targets laid down in the planning decree on perinatal care and in a report by the Dutch Health Council from 2000. Parameters of tertiary perinatal care output were the number of admissions, and the number of beds in OHC units and neonatal intensive care units (NICU). RESULTS In 2006, 128 of the 250 beds intended for OHC had been obtained. The degree of capacity utilisation was 94%, while the norm is 80%. 312 women were transferred due to lack of capacity of OHC units and NICU. The number of staff, specialised physicians as well as nurses, was considerably lower than the planned capacity. But training for obstetric perinatologists and OHC nurses was given. CONCLUSION The targets for the number of beds for tertiary obstetric care and associated medical personnel have not been achieved as yet. As a consequence, the number of transfers is still too high. The funding of OHC units is not attuned to the complexity of tertiary perinatal care. Closer supervision of the execution of the planning decree and an adequate financing system are needed to achieve the objectives of the planning decree in the next 3 years.
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Affiliation(s)
- J van Eyck
- Isala klinieken, locatie Sophia, afd. Gynaecologie en Verloskunde, Dr.Van Heesweg 2, 8025 AB Zwolle.
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