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Niu C, Xie Y, Zhou W, Ren Y, Zheng Y, Li L. Effect of social support on fetal movement self-monitoring behavior in Chinese women: a moderated mediation model of health beliefs. J Psychosom Obstet Gynaecol 2024; 45:2291632. [PMID: 38095324 DOI: 10.1080/0167482x.2023.2291632] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE Strengthening the management of women's self-monitoring during pregnancy is important to reduce fetal death in utero and improve maternal and infant outcomes. However, due to the lack of awareness among pregnant women about the importance of self-monitoring fetal movement, resulting in low behavioral compliance, adverse pregnancy outcomes remain common in China. This study aimed to investigate the relationship between social support and health beliefs and the self-monitoring behavior of fetal movement. In addition, we examined the moderating and mediating effects of health beliefs on fetal movement self-monitoring. METHODS This cross-sectional study was conducted on 200 postpartum mothers in a tertiary hospital in China. The mothers were asked to complete a socio-demographic questionnaire, the fetal movement self-monitoring behavior questionnaire, the fetal movement self-monitoring health beliefs questionnaire, and the social support rating scale. Data from the questionnaires were analyzed and compared using SPSS 24.0 and PROCESS 3.2. RESULTS The results of this study showed that the total scores of social supports, health beliefs, fetal movement self-monitoring were 42.98 ± 11.65, 78.605 ± 13.73, and 11.635 ± 2.86, respectively. The study found that when social support and health beliefs were included in the regression equation, both social support and health beliefs showed a positive correlation with fetal movement self-monitoring. Health beliefs partially mediated the effect of social support on fetal movement self-monitoring, accounting for 37.5% of the total effect. CONCLUSION Social support and health beliefs play a crucial role in influencing the self-monitoring behavior of fetal movements. Therefore, strengthening social support and health beliefs during pregnancy has the potential to improve compliance with fetal movement self-monitoring behaviors for pregnant women.
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Affiliation(s)
- Changmin Niu
- School of Nursing·School of Public Health, Yangzhou University, Yangzhou, China
| | - Yue Xie
- School of Nursing·School of Public Health, Yangzhou University, Yangzhou, China
| | - Wangxuan Zhou
- School of Nursing·School of Public Health, Yangzhou University, Yangzhou, China
| | - Yue Ren
- School of Nursing·School of Public Health, Yangzhou University, Yangzhou, China
| | - Ying Zheng
- School of Nursing·School of Public Health, Yangzhou University, Yangzhou, China
| | - Lin Li
- Affiliated Hospital of Yangzhou University, Yangzhou, China
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Bradford BF, Hayes DJL, Damhuis S, Shub A, Akselsson A, Radestad I, Heazell AEP, Flenady V, Gordijn SJ. Decreased fetal movements: Report from the International Stillbirth Alliance conference workshop. Int J Gynaecol Obstet 2024; 165:579-585. [PMID: 38064233 DOI: 10.1002/ijgo.15242] [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: 05/28/2023] [Revised: 10/15/2023] [Accepted: 10/24/2023] [Indexed: 04/17/2024]
Abstract
Maternal reports of decreased fetal movement (DFM) are a common reason to present to maternity care and are associated with stillbirth and other adverse outcomes. Promoting awareness of fetal movements and prompt assessment of DFM has been recommended to reduce stillbirths. However, evidence to guide clinical management of such presentations is limited. Educational approaches to increasing awareness of fetal movements in pregnant women and maternity care providers with the aim of reducing stillbirths have recently been evaluated in a several large clinical trials internationally. The International Stillbirth Alliance Virtual Conference in Sydney 2021 provided an opportunity for international experts in fetal movements to share reports on the findings of fetal movement awareness trials, consider evidence for biological mechanisms linking DFM and fetal death, appraise approaches to clinical assessment of DFM, and highlight research priorities in this area. Following this workshop summaries of the sessions prepared by the authors provide an overview of understandings of fetal movements in maternity care at the current time and highlights future directions in fetal movement research.
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Affiliation(s)
- Billie F Bradford
- Department of Obstetrics and Gynecology, Monash University, Melbourne, Australia
- Center of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Queensland, Australia
| | - Dexter J L Hayes
- Tommy's Stillbirth Research Center, University of Manchester, Manchester, UK
| | - Stefanie Damhuis
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alexis Shub
- University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | | - Vicki Flenady
- Center of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Queensland, Australia
| | - Sanne J Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Carroll L, Gallagher L, Smith V. Response to "Concerns regarding the analysis of studies on reduced fetal movements". Midwifery 2024; 132:103765. [PMID: 37393109 DOI: 10.1016/j.midw.2023.103765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
Affiliation(s)
- Lorraine Carroll
- Assistant Professor in Midwifery, School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland¹.
| | - Louise Gallagher
- Assistant Professor in Midwifery, School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland²
| | - Valerie Smith
- Professor in Midwifery, School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland²
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Chen WG, Edwards E, Iyengar S, Finkelstein R, Rutter DF, Fleming R, Collins FS. Music and medicine: quickening the tempo of progress. Lancet 2024; 403:1213-1215. [PMID: 38513679 DOI: 10.1016/s0140-6736(24)00477-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Wen G Chen
- Division of Extramural Research, National Center for Complementary and Integrative Health, NIH, Bethesda, MD 20892, USA.
| | - Emmeline Edwards
- Division of Extramural Research, National Center for Complementary and Integrative Health, NIH, Bethesda, MD 20892, USA
| | - Sunil Iyengar
- National Endowment for the Arts, Washington, DC, USA
| | - Robert Finkelstein
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Deborah F Rutter
- John F Kennedy Center for the Performing Arts, Washington, DC, USA
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Ferraro ZM, Silverberg OM, Kingdom JC, Shirreff L. Cordon ombilical coincé dans une présentation du siège en mode des pieds avec diminution des mouvements fœtaux. CMAJ 2024; 196:E352-E354. [PMID: 38499301 PMCID: PMC10948184 DOI: 10.1503/cmaj.221264-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Affiliation(s)
- Zachary M Ferraro
- Département d'obstétrique et de gynécologie (Ferraro, Silverberg, Kingdom, Shirreff), Université de Toronto; Département de médecine (Ferraro, Silverberg), Université de Toronto; Département d'obstétrique et de gynécologie (Kingdom, Shirreff), Hôpital Mount Sinai, Toronto, Ont
| | - Orli M Silverberg
- Département d'obstétrique et de gynécologie (Ferraro, Silverberg, Kingdom, Shirreff), Université de Toronto; Département de médecine (Ferraro, Silverberg), Université de Toronto; Département d'obstétrique et de gynécologie (Kingdom, Shirreff), Hôpital Mount Sinai, Toronto, Ont
| | - John C Kingdom
- Département d'obstétrique et de gynécologie (Ferraro, Silverberg, Kingdom, Shirreff), Université de Toronto; Département de médecine (Ferraro, Silverberg), Université de Toronto; Département d'obstétrique et de gynécologie (Kingdom, Shirreff), Hôpital Mount Sinai, Toronto, Ont
| | - Lindsay Shirreff
- Département d'obstétrique et de gynécologie (Ferraro, Silverberg, Kingdom, Shirreff), Université de Toronto; Département de médecine (Ferraro, Silverberg), Université de Toronto; Département d'obstétrique et de gynécologie (Kingdom, Shirreff), Hôpital Mount Sinai, Toronto, Ont.
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Association of Women’s Health, Obstetric and Neonatal Nurses. Decreased Fetal Movement: AWHONN Practice Brief #20. J Obstet Gynecol Neonatal Nurs 2023; 53:e1-3. [PMID: 38127036 DOI: 10.1016/j.jogn.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
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Cohen G, Pinchas-Cohen T, Blickstein O, Ben Zion M, Schreiber H, Biron-Shental T, Shechter-Maor G. Are reduced fetal movements "merely" a maternal perception or truly a reflection of umbilical cord complications? A clinical trial. Int J Gynaecol Obstet 2024; 164:933-941. [PMID: 37688370 DOI: 10.1002/ijgo.15076] [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: 04/18/2023] [Revised: 07/31/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE To characterize obstetric outcomes and the association with umbilical cord (UC) complications among women complaining of reduced fetal movements (RFMs). METHODS This retrospective cohort compared women with a perception of RFMs within 2 weeks prior to delivery with women who reported no changes in fetal movements in terms of maternal characteristics and neonatal outcomes. A primary outcome of UC complications at delivery was defined. Multivariable regression analysis was performed to identify independent associations with RFMs and UC complications. RESULTS In all, 46 103 women were included, 2591 (5.6%) of whom reported RFMs and 43 512 (94.4%) in the control group. Compared with controls, the RFM group was more likely to be nulliparous (42.6% vs 32.2%, P < 0.001), smokers (6.4% vs 5.4%, P = 0.029), or obese (body mass index >30) (16.4% vs 11.6%, P < 0.001). They were also more likely to have an anterior placenta (56.2% vs 51.8%, P < 0.001) and poly/oligohydramnios (0.7% vs 0.4%, P = 0.015 and 3.6% vs 2.1%, P < 0.001, respectively). Induction of labor was more common in the RFM group (33.9% vs 19.7%, P < 0.001), as well as meconium (16.8% vs 15.0%, P = 0.026) and vacuum extractions (10.1% vs 8.0%, P < 0.001). Higher rates of stillbirth and the severe composite neonatal outcome were observed in the RFM group (1.5% vs 0.2%, P < 0.001 and 0.6% vs 0.3%, P = 0.010, respectively). The RFM group was characterized by higher rates of triple nuchal cord (P = 0.015), UC around body or neck (32.2% vs 29.6%, P = 0.010), and true knot (2.3% vs 1.4%, P = 0.002). Multivariable logistic regression found RFMs to be independently associated with triple nuchal cord and with a true cord knot. A sub-analysis including only cases of stillbirth (n = 127) revealed even higher rates of UC complications: 7% of all stillbirths presented with a true cord knot (20% true knots were found in stillbirths preceded by RFMs vs 6.1% in stillbirth cases without RFMs). Additionally, 33.8% of all stillbirths presented with nuchal cord (40% preceded by RFMs vs 33.3% without RFMs). CONCLUSIONS RFMs are associated with increased risk of UC complications observed at delivery, as well as increased risk of stillbirth and neonatal adverse outcomes.
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Affiliation(s)
- Gal Cohen
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tally Pinchas-Cohen
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Ophir Blickstein
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Maya Ben Zion
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Schreiber
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Shechter-Maor
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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8
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Ayala K, Voegtline K, Rutherford HJ. Letter to the Editor: Does fetal movement shape the maternal brain? Dev Psychobiol 2024; 66:e22467. [PMID: 38339781 DOI: 10.1002/dev.22467] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/18/2024] [Indexed: 02/12/2024]
Abstract
Here, we debate that fetal behavior may contribute to the dynamic changes observed in the maternal brain during the perinatal period. We call for future research to explore this perspective to understand the complex maternal-fetal relationship and how fetal signals influence the preparation for parenthood.
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Affiliation(s)
- Kathy Ayala
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
- Interdepartmental Neuroscience Program, Yale University, New Haven, Connecticut, USA
| | - Kristin Voegtline
- Department of Population, Family and ReproductiveHealth, Johns Hopkins Bloomberg School of Public Health, Family and Reproductive Health, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Helena Jv Rutherford
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
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9
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Clark JA, Smith LK, Armstrong N. Midwives' and obstetricians' practice, perspectives and experiences in relation to altered fetal movement: A focused ethnographic study. Int J Nurs Stud 2024; 150:104643. [PMID: 38043485 DOI: 10.1016/j.ijnurstu.2023.104643] [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: 01/16/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Reducing avoidable stillbirth is a global priority. The stillbirth rate in England compares unfavourably to that of some other high-income countries. Poorly-managed episodes of altered fetal movement have been highlighted as a key contributor to avoidable stillbirth, and strategies introduced in England in 2016 to reduce perinatal mortality included recommendations for the management of reduced fetal movement. Despite a downward trend in stillbirth rates across the UK, the effects of policies promoting awareness of fetal movement remain uncertain. OBJECTIVE To provide in-depth knowledge of how practice and clinical guidance relating to altered fetal movement are perceived, enacted and experienced by midwives and obstetricians, and explore the relationship between recommended fetal movement care and actual fetal movement care. DESIGN A focused ethnographic approach comprising over 180 h of observation, 15 interviews, and document analysis was used to explore practice at two contrasting UK maternity units. SETTINGS Antenatal services at two UK maternity units, one in the Midlands and one in the North of England. PARTICIPANTS Thirty-six midwives, obstetricians and sonographers and 40 pregnant women participated in the study across 52 observed care episodes and relevant unit activity. Twelve midwives and three obstetricians additionally participated in formal semi-structured interviews. METHODS Fieldnotes, interview transcripts, policy documents, maternity notes and clinical guidelines were analysed using a modified constant comparison method to identify important themes. RESULTS fetal movement practice was mostly consistent and in line with guideline recommendations. Notwithstanding, most midwives and obstetricians had concerns about this area of care, including challenges in diagnosis, conflicting evidence about activity, heightened maternal anxiety, and high rates of monitoring and intervention in otherwise low-risk pregnancies. To address these issues, midwives spent considerable time reassuring women through information and regular monitoring, and coaching them to perceive fetal movement more accurately. CONCLUSIONS Practice relating to altered fetal movement might be more uniform than in the past. However, a heightened focus on fetal movement is associated by some midwives and obstetricians with potential harms, including increased anxiety in pregnancy, and high rates of monitoring and intervention in pregnancies where there are no 'objective concerns'. Challenges in diagnosing a significant change in fetal movement with accuracy might mean that interventions and resources are not being directed towards those pregnancies most at risk. More research is needed to determine how healthcare professionals can engage in conversations about fetal movement and stillbirth to support safe outcomes and positive experiences in pregnancy and birth. REGISTRATION Not registered. TWEETABLE ABSTRACT Midwives and obstetricians take #reducedfetalmovement seriously but worry this 'unreliable' symptom increases anxiety, monitoring and intervention in many 'low risk' pregnancies.
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Affiliation(s)
- Julia A Clark
- Department of Population Health Sciences, University of Leicester, Leicester, UK; School of Health Science, The University of Nottingham, Nottingham, UK.
| | - Lucy K Smith
- Department of Population Health Sciences, University of Leicester, Leicester, UK.
| | - Natalie Armstrong
- Department of Population Health Sciences, University of Leicester, Leicester, UK
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10
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Association of Women’s Health, Obstetric and Neonatal Nurses. Decreased Fetal Movement: AWHONN Practice Brief #20. Nurs Womens Health 2023; 28:e1-3. [PMID: 38127050 DOI: 10.1016/j.nwh.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
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11
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Reissland N, Ustun B, Einbeck J. The effects of lockdown during the COVID-19 pandemic on fetal movement profiles. BMC Pregnancy Childbirth 2024; 24:56. [PMID: 38212680 PMCID: PMC10782783 DOI: 10.1186/s12884-024-06259-8] [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: 09/10/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
PURPOSE The current study investigated the direct impact of the COVID-19 lockdown on fetal movements, addressing a critical research gap. While previous research has predominantly examined the effects of lockdown on maternal health and postnatal outcomes, little attention has been paid to the direct consequences on fetal well-being as indicated by their movement profile. METHODS We conducted analysis of movement profiles in 20 healthy fetuses during the COVID-19 pandemic lockdown (third national UK lockdown period between January and March 2021) and compared them with 20 healthy fetuses from pre-covid pregnancies, all at 32 weeks gestation. We controlled for maternal stress, depression, and anxiety. RESULTS Pregnant mothers during pre-covid compared with those during the COVID-19 lockdown reported similar levels of stress (p = 0.47), depression (p = 0.15), and anxiety (p = 0.07). Their fetuses, however, differed in their movement profiles with mouth movement frequencies significantly higher during COVID-19 lockdown (COVID-19 lockdown: mean of 5.909) compared to pre-Covid pregnancies (mean of 3.308; p = 0.029). Furthermore, controlling for maternal anxiety a regression analysis indicated that frequency of fetal mouth movements (p = 0.017), upper face movements (p = 0.008), and touch movements (p = 0.031) were all significantly higher in fetuses observed during lockdown compared to fetuses before the Covid period. CONCLUSION Fetuses show an effect of lockdown independent of maternal anxiety, stress, or depression. These findings contribute to our understanding of fetal development during extraordinary circumstances, raising questions about the potential effects of having to stay indoors during lockdowns.
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Affiliation(s)
- N Reissland
- Department of Psychology, Durham University, Science Site, South Road, Durham, UK.
| | - B Ustun
- Division of Human Nutrition and Health, Wageningen University & Research, Stippeneng 4, Wageningen, 6708 WE, The Netherlands
| | - J Einbeck
- Department of Mathematical Sciences, Durham University, Durham, UK
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12
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Morales-Roselló J, Martínez-Varea A. Fetal activity modifies middle cerebral artery pulsatility index: physiology of frequent pitfall in evaluation of fetal cerebral flow. Ultrasound Obstet Gynecol 2024; 63:117-118. [PMID: 37670590 DOI: 10.1002/uog.27468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 09/07/2023]
Affiliation(s)
- J Morales-Roselló
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, Universidad de Valencia, Valencia, Spain
| | - A Martínez-Varea
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Hayes DJL, Devane D, Dumville JC, Gordijn SJ, Smith V, Walsh T, Heazell AEP. Development of core outcome sets for studies relating to awareness and clinical management of reduced fetal movement. BJOG 2024; 131:64-70. [PMID: 37394688 DOI: 10.1111/1471-0528.17589] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/26/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE This study aimed to create core outcome sets (COSs) for use in research studies relating to the awareness and clinical management of reduced fetal movement (RFM). DESIGN Delphi survey and consensus process. SETTING International. POPULATION A total of 128 participants (40 parents, 19 researchers and 65 clinicians) from 16 countries. METHODS A systematic literature review was conducted to identify outcomes in studies of interventions relating to the awareness and the clinical management of RFM. Using these outcomes as a preliminary list, stakeholders rated the importance of these outcomes for inclusion in COSs for studies of: (i) awareness of RFM; and (ii) clinical management of RFM. MAIN OUTCOME MEASURES Preliminary lists of outcomes were discussed at consensus meetings where two COSs (one for studies of RFM awareness and one for studies of clinical management of RFM). RESULTS The first round of the Delphi survey was completed by 128 participants, 66% of whom (n = 84) completed all three rounds. Fifty outcomes identified by the systematic review, after multiple definitions were combined, were voted on in round one. Two outcomes were added in round one, and as such 52 outcomes were voted on in two lists in rounds two and three. The COSs for studies of RFM awareness and clinical management are comprised of eight outcomes (four maternal and four neonatal) and 10 outcomes (two maternal and eight neonatal), respectively. CONCLUSIONS These COSs provide researchers with the minimum set of outcomes to be measured and reported in studies relating to the awareness and the clinical management of RFM.
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Affiliation(s)
- Dexter J L Hayes
- Tommy's Stillbirth Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Declan Devane
- Health Research Board Trials Methodology Research Network, School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Science Centre, University of Manchester, Manchester, UK
| | - Sanne J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Valerie Smith
- School of Nursing & Midwifery, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alexander E P Heazell
- Tommy's Stillbirth Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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14
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Luu P, Tucker DM. Continuity and change in neural plasticity through embryonic morphogenesis, fetal activity-dependent synaptogenesis, and infant memory consolidation. Dev Psychobiol 2023; 65:e22439. [PMID: 38010309 DOI: 10.1002/dev.22439] [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: 03/31/2023] [Revised: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 11/29/2023]
Abstract
There is an apparent continuity in human neural development that can be traced to venerable themes of vertebrate morphogenesis that have shaped the evolution of the reptilian telencephalon (including both primitive three-layered cortex and basal ganglia) and then the subsequent evolution of the mammalian six-layered neocortex. In this theoretical analysis, we propose that an evolutionary-developmental analysis of these general morphogenetic themes can help to explain the embryonic development of the dual divisions of the limbic system that control the dorsal and ventral networks of the human neocortex. These include the archicortical (dorsal limbic) Papez circuits regulated by the hippocampus that organize spatial, contextual memory, as well as the paleocortical (ventral limbic) circuits that organize object memory. We review evidence that these dorsal and ventral limbic divisions are controlled by the differential actions of brainstem lemnothalamic and midbrain collothalamic arousal control systems, respectively, thereby traversing the vertebrate subcortical neuraxis. These dual control systems are first seen shaping the phyletic morphogenesis of the archicortical and paleocortical foundations of the forebrain in embryogenesis. They then provide dual modes of activity-dependent synaptic organization in the active (lemnothalamic) and quiet (collothalamic) stages of fetal sleep. Finally, these regulatory systems mature to form the major systems of memory consolidation of postnatal development, including the rapid eye movement (lemnothalamic) consolidation of implicit memory and social attachment in the first year, and then-in a subsequent stage-the non-REM (collothalamic) consolidation of explicit memory that is integral to the autonomy and individuation of the second year of life.
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Affiliation(s)
- Phan Luu
- Brain Electrophysiology Laboratory Company, Eugene, Oregon, USA
- Department of Psychology, University of Oregon, Eugene, Oregon, USA
| | - Don M Tucker
- Brain Electrophysiology Laboratory Company, Eugene, Oregon, USA
- Department of Psychology, University of Oregon, Eugene, Oregon, USA
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15
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Murdaugh KL, Florescue H. Small estimated placental volume (EPV) in the setting of decreased fetal movement. Clin Imaging 2023; 104:110027. [PMID: 37984265 DOI: 10.1016/j.clinimag.2023.110027] [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: 04/18/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Abstract
Although 60.5 % of clinically unexplained stillbirths can be attributed to placental insufficiency and/or fetal growth restriction, clinicians rarely calculate estimated placental volume (EPV). We present a scenario in which EPV was used to inform patient care of a 28-year-old with decreased fetal movement at 32 weeks and 1 day gestation. Although estimated fetal weight (EFW), amniotic fluid index (AFI), and nonstress test (NST) were normal, EPV was low (<0.1st percentile), which prompted more frequent patient follow-up. Oligohydramnios was detected at 38 weeks and 1 day, and labor was induced. An infant with birthweight in the 12th percentile for gestational age was born. We learned that EPV can precede intrauterine growth restriction (IUGR), oligohydramnios, and low birthweight.
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Affiliation(s)
- Kimberly Lovie Murdaugh
- Women Gynecology & Childbirth Associates, P.C., University of Rochester Medical Center, Rochester, NY, United States of America.
| | - Heather Florescue
- Women Gynecology & Childbirth Associates, P.C., University of Rochester Medical Center, Rochester, NY, United States of America
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16
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Ferraro ZM, Silverberg OM, Kingdom JC, Shirreff L. Cord entrapment in a footling breech presentation with decreased fetal movements. CMAJ 2023; 195:E1577-E1579. [PMID: 38011923 PMCID: PMC10681679 DOI: 10.1503/cmaj.221264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Affiliation(s)
- Zachary M Ferraro
- Department of Obstetrics and Gynaecology (Ferraro, Silverberg, Kingdom, Shirreff), University of Toronto; Department of Medicine (Ferraro, Silverberg), University of Toronto; Department of Obstetrics & Gynecology (Kingdom, Shirreff), Mount Sinai Hospital, Toronto, Ont
| | - Orli M Silverberg
- Department of Obstetrics and Gynaecology (Ferraro, Silverberg, Kingdom, Shirreff), University of Toronto; Department of Medicine (Ferraro, Silverberg), University of Toronto; Department of Obstetrics & Gynecology (Kingdom, Shirreff), Mount Sinai Hospital, Toronto, Ont
| | - John C Kingdom
- Department of Obstetrics and Gynaecology (Ferraro, Silverberg, Kingdom, Shirreff), University of Toronto; Department of Medicine (Ferraro, Silverberg), University of Toronto; Department of Obstetrics & Gynecology (Kingdom, Shirreff), Mount Sinai Hospital, Toronto, Ont
| | - Lindsay Shirreff
- Department of Obstetrics and Gynaecology (Ferraro, Silverberg, Kingdom, Shirreff), University of Toronto; Department of Medicine (Ferraro, Silverberg), University of Toronto; Department of Obstetrics & Gynecology (Kingdom, Shirreff), Mount Sinai Hospital, Toronto, Ont.
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17
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Thompson JMD, Heazell AEP, Cronin RS, Wilson J, Li M, Gordon A, Askie LM, O'Brien LM, Raynes‐Greenow C, Stacey T, Mitchell EA, McCowan LME, Bradford BF. Does fetal size affect maternal perception of fetal movements? Evidence from an individual participant data meta-analysis. Acta Obstet Gynecol Scand 2023; 102:1586-1592. [PMID: 37553853 PMCID: PMC10577624 DOI: 10.1111/aogs.14652] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 07/04/2023] [Accepted: 07/14/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Maternal perception of fetal movements during pregnancy are reassuring; however, the perception of a reduction in movements are concerning to women and known to be associated with increased odds of late stillbirth. Prior to full term, little evidence exists to provide guidelines on how to proceed unless there is an immediate risk to the fetus. Increased strength of movement is the most commonly reported perception of women through to full term, but perception of movement is also hypothesized to be influenced by fetal size. The study aimed to assess the pattern of maternal perception of strength and frequency of fetal movement by gestation and customized birthweight quartile in ongoing pregnancies. A further aim was to assess the association of stillbirth to perception of fetal movements stratified by customized birthweight quartile. MATERIAL AND METHODS This analysis was an individual participant data meta-analyses of five case-control studies investigating factors associated with stillbirth. The dataset included 851 cases of women with late stillbirth (>28 weeks' gestation) and 2257 women with ongoing pregnancies who then had a liveborn infant. RESULTS The frequency of prioritized fetal movement from 28 weeks' gestation showed a similar pattern for each quartile of birthweight with increased strength being the predominant perception of fetal movement through to full term. The odds of stillbirth associated with reduced fetal movements was increased in all quartiles of customized birthweight centiles but was notably greater in babies in the lowest two quartiles (Q1: adjusted OR: 9.34, 95% CI: 5.43, 16.06 and Q2: adjusted OR: 6.11, 95% CI: 3.11, 11.99). The decreased odds associated with increased strength of movement was present for all customized birthweight quartiles (adjusted OR range: 0.25-0.56). CONCLUSIONS Increased strength of fetal movements in late pregnancy is a positive finding irrespective of fetal size. However, reduced fetal movements are associated with stillbirth, and more so when the fetus is small.
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Affiliation(s)
- John M. D. Thompson
- Department of Obstetrics and GynecologyUniversity of AucklandAucklandNew Zealand
- Department of Pediatrics: Child and Youth HealthUniversity of AucklandAucklandNew Zealand
| | | | - Robin S. Cronin
- Department of Obstetrics and GynecologyUniversity of AucklandAucklandNew Zealand
| | - Jessica Wilson
- Department of Obstetrics and GynecologyUniversity of AucklandAucklandNew Zealand
| | - Minglan Li
- Department of Obstetrics and GynecologyUniversity of AucklandAucklandNew Zealand
| | - Adrienne Gordon
- Discipline of Obstetrics, Gynecology and NeonatologyUniversity of SydneySydneyNew South WalesAustralia
| | | | - Louise M. O'Brien
- Department of Neurology Sleep Disorders CenterUniversity of MichiganAnn ArborMichiganUSA
- Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborMichiganUSA
| | | | - Tomasina Stacey
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative CareKing's College LondonLondonUK
| | - Edwin A. Mitchell
- Department of Pediatrics: Child and Youth HealthUniversity of AucklandAucklandNew Zealand
| | - Lesley M. E. McCowan
- Department of Obstetrics and GynecologyUniversity of AucklandAucklandNew Zealand
| | - Billie F. Bradford
- Department of Obstetrics and GynecologyUniversity of AucklandAucklandNew Zealand
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18
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Andrén A, Akselsson A, Rådestad I, Ali SB, Lindgren H, Osman HM, Erlandsson K. Miscommunication influences how women act when fetal movements decrease an interview study with Swedish Somali migrant women. Midwifery 2023; 126:103796. [PMID: 37672854 DOI: 10.1016/j.midw.2023.103796] [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: 10/08/2022] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To explore how Swedish Somali migrant women perceive fetal movements, process information about fetal movements, and take actions if decreased fetal activity occurs. DESIGN A qualitative study based on individual semi-structured interviews. The interviews were analysed using content analysis. SETTING The study was conducted in Sweden. PARTICIPANTS Swedish Somali migrant women (n=15) pregnant in their third trimester or recently given birth. FINDINGS The analysis led to the main category: tailored information about fetal movements enhances the possibility to seek care if the movements decrease. The results are described in the generic categories: explanatory models determine action; and understand and interpret information. KEY CONCLUSIONS Miscommunication on fetal movements can be a hurdle for Swedish Somali migrant women that may have impact on stillbirth prevention and the quality of care. Improved communication and information tailored to individual needs is essential to achieve equality for women and their newborns. IMPLICATIONS FOR PRACTICE The midwife can be used as a hub for reassuring that adequate information about fetal movements reaches each individual woman in antenatal care. Individualised information on fetal movements based on the women's own understanding is suggested to increase the possibility that the pregnant woman will seek care if the movements decrease. Somali women's verbal communication can be used to spread accurate information in the Somali community on the importance of seeking care if fetal movements decrease.
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Affiliation(s)
| | | | | | - Salma Burhan Ali
- Region Uppsala, Enköping Hospital, Department of Gynecology, Sweden
| | - Helena Lindgren
- Sophiahemmet University, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Sweden
| | - Hodan Mohamoud Osman
- College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Somaliland
| | - Kerstin Erlandsson
- Department of Women's and Children's Health, Karolinska Institutet, Sweden; School of Health and Welfare, Dalarna University, Sweden
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19
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Nahian A, Mahomed K. Decreased fetal movements - An audit of predictors and an evaluation of management based on a locally developed flow chart. Eur J Obstet Gynecol Reprod Biol 2023; 290:67-73. [PMID: 37738889 DOI: 10.1016/j.ejogrb.2023.09.004] [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: 12/14/2022] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES Decreased fetal movements (DFM) is associated with adverse pregnancy outcomes. We aimed to look at the risk factors associated with DFM and outcomes of women who presented with and without DFM and outcomes before and after the implementation of a locally developed flow chart based on an evidence-based guideline. STUDY DESIGN This was a retrospective audit of 1165 women ≥ 28 weeks' gestation with a singleton pregnancy who presented with concerns regarding DFM. We compared labor and neonatal outcomes to 4706 in a control group who did not present with concerns regarding FM. We also compared the same pregnancy outcomes before and after the implementation of hospital guidelines on the management of DFM. Statistical analyses were performed primarily using Chi square analysis and relative risk. RESULTS AND CONCLUSIONS 1165 women presented 1645 times with DFM. Women presenting with DFM were younger, (82.8% vs 79.0%, p= <0.01 were 20 to 34-years old), tended to have a higher BMI (42.9% vs 34.4%, p=<0.001 with BMI ≥ 30) and were more likely to have mental health conditions (31.1% vs 24.2%, p=<0.01). There was no difference in the composite neonatal outcome including stillbirth, 5 min APGAR < 7 and Special Care Nursery (SCN) admission between DFM and control (22.9 vs 24.8% respectively, P = 0.18). There was no difference in perinatal outcomes pre- and post-implementation of the hospital guidelines on DFM management. Women presenting with DFM were more likely to have an induction (40.7% vs 29.9% p=<0.01) but not more likely to have a caesarean section (30.9% vs 28.8% respectively, p = 0.16). There were increasing rates of IOL with increasing number of presentations for DFM. Adoption of and adherence to locally developed guidelines was an opportunity to ensure all clinicians provide consistent advice on management and timing of birth for women presenting with DFM.
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Affiliation(s)
- Antara Nahian
- Department of Obstetrics, Ipswich Hospital. 1 Chelmsford Ave, Ipswich, Queensland 4305, Australia.
| | - Kassam Mahomed
- Department of Obstetrics and Gynaecology, Ipswich Hospital and University of Queensland, Chelmsford Avenue, Ipswich, QLD 4305, Australia.
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20
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Sabancı Baransel E, Uçar T. The effect of an attachment-based intervention program on attachment, expectation, and stress in pregnant women: A randomized controlled study. Jpn J Nurs Sci 2023; 20:e12549. [PMID: 37380333 DOI: 10.1111/jjns.12549] [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: 03/27/2023] [Revised: 05/20/2023] [Accepted: 06/04/2023] [Indexed: 06/30/2023]
Abstract
AIM This study aimed to determine the effect of an attachment-based intervention program (ABIP) on attachment, prenatal expectation and stress levels in pregnant women. METHODS This randomized controlled study was conducted in the pregnant outpatient clinics of a public hospital in Turkey. The study sample consisted of a total of 154 pregnant women (77 experimental, 77 control) at 28-38 weeks of gestation. The ABIP was applied to the pregnant women in the experimental group for 5-7 days. The ABIP included five interventions: (1) perceiving/counting fetal movements; (2) music therapy; (3) preparation for the baby; (4) writing notes/letters to the baby; and (5) watching images of the fetus/pregnancy. RESULTS After the ABIP, pregnant women in the experimental group had higher prenatal maternal attachment and prenatal positive expectation mean scores than those in the control group, and the difference between them was statistically significant in favor of those in the experimental group (P < .001). In addition, pregnant women in the experimental group had lower prenatal negative expectation and prenatal distress mean scores than those in the control group, and the difference between them was statistically significant in favor of those in the experimental group (P < .001). CONCLUSIONS The results of this study suggest that ABIP is a unique and pioneering program to increase maternal-antenatal attachment and prenatal positive expectations and reducing prenatal negative expectations and distress through diverse interventions. However, further research is required to assess the effectiveness of ABIP on maternal-fetal attachment, prenatal maternal expectations, and prenatal distress.
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Affiliation(s)
- Esra Sabancı Baransel
- Department of Midwifery, Faculty of Health Sciences, İnönü University, Malatya, Türkiye
| | - Tuba Uçar
- Department of Midwifery, Faculty of Health Sciences, İnönü University, Malatya, Türkiye
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21
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Miyagi Y, Hata T, Miyake T. Fetal brain activity and the free energy principle. J Perinat Med 2023; 51:925-931. [PMID: 37096665 DOI: 10.1515/jpm-2023-0092] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/12/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVES To study whether the free energy principle can explain fetal brain activity and the existence of fetal consciousness via a chaotic dimension derived using artificial intelligence. METHODS In this observational study, we used a four-dimensional ultrasound technique obtained to collect images of fetal faces from pregnancies at 27-37 weeks of gestation, between February and December 2021. We developed an artificial intelligence classifier that recognizes fetal facial expressions, which are thought to relate to fetal brain activity. We then applied the classifier to video files of facial images to generate each expression category's probabilities. We calculated the chaotic dimensions from the probability lists, and we created and investigated the free energy principle's mathematical model that was assumed to be linked to the chaotic dimension. We used a Mann-Whitney test, linear regression test, and one-way analysis of variance for statistical analysis. RESULTS The chaotic dimension revealed that the fetus had dense and sparse states of brain activity, which fluctuated at a statistically significant level. The chaotic dimension and free energy were larger in the sparse state than in the dense state. CONCLUSIONS The fluctuating free energy suggests consciousness seemed to exist in the fetus after 27 weeks.
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Affiliation(s)
- Yasunari Miyagi
- Department of Gynecology, Miyake Ofuku Clinic, Okayama, Japan
- Medical Data Labo, Okayama, Japan
| | - Toshiyuki Hata
- Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Kagawa, Japan
| | - Takahito Miyake
- Department of Gynecology, Miyake Ofuku Clinic, Okayama, Japan
- Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan
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22
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Pfannstiel L, Daoun C, Naccache JM, Bintein F, Adam J, Azria E. Metastatic gestational choriocarcinoma revealed by reduced fetal movements. Eur J Obstet Gynecol Reprod Biol 2023; 288:235-236. [PMID: 37599189 DOI: 10.1016/j.ejogrb.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/30/2023] [Indexed: 08/22/2023]
Affiliation(s)
| | - Cécile Daoun
- Maternity Unit, Paris Saint Joseph Hospital, FHU Prema, Paris, France
| | - Jean-Marc Naccache
- Department of Pneumology-Allergology-Thoracic Oncology, Paris Saint Joseph Hospital, Paris, France
| | - Flore Bintein
- Department of Pneumology-Allergology-Thoracic Oncology, Paris Saint Joseph Hospital, Paris, France
| | - Julien Adam
- Department of Pathology, Paris Saint Joseph Hospital, Paris, France
| | - Elie Azria
- Maternity Unit, Paris Saint Joseph Hospital, FHU Prema, Paris, France; Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.
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23
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Kumar S, Turner JM. Reply to Letter to Editor: Maternal awareness of decreased fetal movements to prevent stillbirth-no benefit. Am J Obstet Gynecol MFM 2023; 5:100892. [PMID: 36801263 DOI: 10.1016/j.ajogmf.2023.100892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/18/2023]
Affiliation(s)
- Sailesh Kumar
- Mater Research Institute, The University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia; Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia; Mater Centre for Maternal and Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Queensland, Australia; National Health and Medical Research Council Centre for Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia.
| | - Jessica M Turner
- Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
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24
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Wen YJ, Li DZ. Maternal awareness of decreased fetal movements to prevent stillbirth: no benefit. Am J Obstet Gynecol MFM 2023; 5:100891. [PMID: 36758679 DOI: 10.1016/j.ajogmf.2023.100891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/06/2022] [Indexed: 02/11/2023]
Affiliation(s)
- Yun-Jing Wen
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Jinsui Rd. 9, Guangzhou 510623, Guangdong, China
| | - Dong-Zhi Li
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Jinsui Rd. 9, Guangzhou 510623, Guangdong, China.
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25
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Hayes DJL, Dumville JC, Walsh T, Higgins LE, Fisher M, Akselsson A, Whitworth M, Heazell AEP. Effect of encouraging awareness of reduced fetal movement and subsequent clinical management on pregnancy outcome: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:100821. [PMID: 36481411 DOI: 10.1016/j.ajogmf.2022.100821] [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: 08/04/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Reduced fetal movement, defined as a decrease in the frequency or strength of fetal movements as perceived by the mother, is a common reason for presentation to maternity care. Observational studies have demonstrated an association between reduced fetal movement and stillbirth and fetal growth restriction related to placental insufficiency. However, individual intervention studies have described varying results. This systematic review and meta-analysis aimed to determine whether interventions aimed at encouraging awareness of reduced fetal movement and/or improving its subsequent clinical management reduce the frequency of stillbirth or other important secondary outcomes. DATA SOURCES Searches were conducted in MEDLINE, Embase, CINAHL, The Cochrane Library, Web of Science, and Google Scholar. Guidelines, trial registries, and gray literature were also searched. Databases were searched from inception to January 20, 2022. STUDY ELIGIBILITY CRITERIA Randomized controlled trials and controlled nonrandomized studies were eligible if they assessed interventions aimed at encouraging awareness of fetal movement or fetal movement counting and/or improving the subsequent clinical management of reduced fetal movement. Eligible populations were singleton pregnancies after 24 completed weeks of gestation. The primary review outcome was stillbirth; a number of secondary maternal and neonatal outcomes were specified in the review. METHODS Risk of bias was assessed using the Cochrane Risk of Bias 2 and Risk of Bias in Non-Randomized Studies I tools for randomized controlled trials and nonrandomized studies, respectively. Variation caused by heterogeneity was assessed using I2. Data from studies employing similar interventions were combined using random effects meta-analysis. RESULTS A total of 1609 citations were identified; 190 full-text articles were evaluated against the inclusion criteria, 18 studies (16 randomized controlled trials and 2 nonrandomized studies) were included. The evidence is uncertain about the effect of encouraging awareness of fetal movement on stillbirth when compared with standard care (2 studies, n=330,084) with a pooled adjusted odds ratio of 1.19 (95% confidence interval, 0.96-1.47). Interventions for encouraging awareness of fetal movement may be associated with a reduction in neonatal intensive care unit admissions and Apgar scores of <7 at 5 minutes of age and may not be associated with increases in cesarean deliveries or induction of labor. The evidence is uncertain about the effect of encouraging fetal movement counting on stillbirth when compared with standard care with a pooled odds ratio of 0.69 (95% confidence interval, 0.18-2.65) based on data from 3 randomized controlled trials (n=70,584). Counting fetal movements may increase maternal-fetal attachment and decrease anxiety when compared with standard care. When comparing combined interventions of fetal movement awareness and subsequent clinical management with standard care (1 study, n=393,857), the evidence is uncertain about the effect on stillbirth (adjusted odds ratio, 0.86; 95% confidence interval, 0.70-1.05). CONCLUSION The effect of interventions for encouraging awareness of reduced fetal movement alone or in combination with subsequent clinical management on stillbirth is uncertain. Encouraging awareness of fetal movement may be associated with reduced adverse neonatal outcomes without an increase in interventions in labor. The meta-analysis was hampered by variations in interventions, outcome reporting, and definitions. Individual studies are frequently underpowered to detect a reduction in severe, rare outcomes and no studies were included from high-burden settings. Studies from such settings are needed to determine whether interventions can reduce stillbirth.
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Affiliation(s)
- Dexter J L Hayes
- Tommy's Stillbirth Research Centre, School of Medical Sciences, Division of Developmental Biology and Medicine, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom (Mr Hayes and Drs Higgins, Whitworth, and Heazell).
| | - Jo C Dumville
- Division of Nursing, Midwifery, and Social Work, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Science Centre, Manchester, United Kingdom (Dr Dumville)
| | - Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom (Dr Walsh)
| | - Lucy E Higgins
- Tommy's Stillbirth Research Centre, School of Medical Sciences, Division of Developmental Biology and Medicine, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom (Mr Hayes and Drs Higgins, Whitworth, and Heazell)
| | - Margaret Fisher
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, United Kingdom (Dr Fisher)
| | - Anna Akselsson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden (Dr Akselsson)
| | - Melissa Whitworth
- Tommy's Stillbirth Research Centre, School of Medical Sciences, Division of Developmental Biology and Medicine, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom (Mr Hayes and Drs Higgins, Whitworth, and Heazell)
| | - Alexander E P Heazell
- Tommy's Stillbirth Research Centre, School of Medical Sciences, Division of Developmental Biology and Medicine, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom (Mr Hayes and Drs Higgins, Whitworth, and Heazell)
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26
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Turner JM, Cincotta R, Chua J, Gardener G, Petersen S, Thomas J, Lee-Tannock A, Kumar S. Decreased fetal movements-the utility of ultrasound to identify infants at risk and prevent stillbirth is poor. Am J Obstet Gynecol MFM 2023; 5:100782. [PMID: 36280144 DOI: 10.1016/j.ajogmf.2022.100782] [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: 06/14/2022] [Revised: 08/29/2022] [Accepted: 10/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite a paucity of evidence, it is widely accepted that a perceived reduction in fetal movements is associated with an increased risk of stillbirth and poor obstetrical outcome. Consequently, many international guidelines recommend urgent ultrasound assessment of fetal well-being in women presenting with decreased fetal movements. OBJECTIVE This study aimed to compare rates of abnormal ultrasound findings reflective of fetal compromise between women presenting with decreased fetal movements and gestation-matched controls in the third trimester. STUDY DESIGN This was a retrospective cohort study performed at the Mater Mothers' Hospital in Brisbane between 2017 and 2020. We undertook propensity score matching analysis comparing abnormal ultrasound parameters in women with singleton, nonanomalous pregnancies presenting with decreased fetal movements after 28 weeks' gestation. The primary outcome was a composite of any abnormal scan parameter: umbilical artery pulsatility index >95th centile, middle cerebral artery pulsatility index <5th centile, cerebroplacental ratio <10th centile, estimated fetal weight <10th centile for gestation, middle cerebral artery peak systolic velocity >1.5 multiples of the median, or deepest vertical pocket of amniotic fluid <2 or >8 cm. RESULTS After propensity score matching, the study cohort comprised 1466 cases and 2207 controls. The rate of the primary composite outcome was not significantly different between the 2 cohorts (20.2% vs 21.3%; P=.42). There were 30 new cases of small-for-gestational-age detected in the decreased fetal movements cohort, giving a number needed to scan of 48 in the decreased fetal movements group to detect 1 case of small-for-gestational-age. However, the frequency of the composite outcome was higher (13.0% vs 5.4%) at the final scan before birth in women with multiple decreased fetal movement presentations. Despite this, there was no significant difference in clinical outcomes between the 2 cohorts. CONCLUSION Ultrasound abnormalities are not increased in women with decreased fetal movements compared with controls.
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Affiliation(s)
- Jessica M Turner
- Mater Research Institute, University of Queensland, Brisbane, Australia (Drs Turner and Kumar); Faculty of Medicine, University of Queensland, Brisbane, Australia (Drs Turner and Kumar)
| | - Rob Cincotta
- Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, Brisbane, Australia (Drs Cincotta, Chua, Gardener, Petersen, Thomas, Tannock, and Kumar)
| | - Jacqueline Chua
- Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, Brisbane, Australia (Drs Cincotta, Chua, Gardener, Petersen, Thomas, Tannock, and Kumar)
| | - Glenn Gardener
- Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, Brisbane, Australia (Drs Cincotta, Chua, Gardener, Petersen, Thomas, Tannock, and Kumar)
| | - Scott Petersen
- Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, Brisbane, Australia (Drs Cincotta, Chua, Gardener, Petersen, Thomas, Tannock, and Kumar)
| | - Joseph Thomas
- Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, Brisbane, Australia (Drs Cincotta, Chua, Gardener, Petersen, Thomas, Tannock, and Kumar)
| | - Alison Lee-Tannock
- Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, Brisbane, Australia (Drs Cincotta, Chua, Gardener, Petersen, Thomas, Tannock, and Kumar)
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, Brisbane, Australia (Drs Turner and Kumar); Faculty of Medicine, University of Queensland, Brisbane, Australia (Drs Turner and Kumar); Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, Brisbane, Australia (Drs Cincotta, Chua, Gardener, Petersen, Thomas, Tannock, and Kumar); National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Brisbane, Australia (Dr Kumar).
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Vasung L, Xu J, Abaci-Turk E, Zhou C, Holland E, Barth WH, Barnewolt C, Connolly S, Estroff J, Golland P, Feldman HA, Adalsteinsson E, Grant PE. Cross-Sectional Observational Study of Typical in utero Fetal Movements Using Machine Learning. Dev Neurosci 2022; 45:105-114. [PMID: 36538911 PMCID: PMC10233700 DOI: 10.1159/000528757] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
Early variations of fetal movements are the hallmark of a healthy developing central nervous system. However, there are no automatic methods to quantify the complex 3D motion of the developing fetus in utero. The aim of this prospective study was to use machine learning (ML) on in utero MRI to perform quantitative kinematic analysis of fetal limb movement, assessing the impact of maternal, placental, and fetal factors. In this cross-sectional, observational study, we used 76 sets of fetal (24-40 gestational weeks [GW]) blood oxygenation level-dependent (BOLD) MRI scans of 52 women (18-45 years old) during typical pregnancies. Pregnant women were scanned for 5-10 min while breathing room air (21% O2) and for 5-10 min while breathing 100% FiO2 in supine and/or lateral position. BOLD acquisition time was 20 min in total with effective temporal resolution approximately 3 s. To quantify upper and lower limb kinematics, we used a 3D convolutional neural network previously trained to track fetal key points (wrists, elbows, shoulders, ankles, knees, hips) on similar BOLD time series. Tracking was visually assessed, errors were manually corrected, and the absolute movement time (AMT) for each joint was calculated. To identify variables that had a significant association with AMT, we constructed a mixed-model ANOVA with interaction terms. Fetuses showed significantly longer duration of limb movements during maternal hyperoxia. We also found a significant centrifugal increase of AMT across limbs and significantly longer AMT of upper extremities <31 GW and longer AMT of lower extremities >35 GW. In conclusion, using ML we successfully quantified complex 3D fetal limb motion in utero and across gestation, showing maternal factors (hyperoxia) and fetal factors (gestational age, joint) that impact movement. Quantification of fetal motion on MRI is a potential new biomarker of fetal health and neuromuscular development.
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Affiliation(s)
- Lana Vasung
- Department of Pediatrics, Boston Children's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Junshen Xu
- Department of Electrical Engineering and Computer Science, MIT, Cambridge, Massachusetts, USA
| | - Esra Abaci-Turk
- Department of Pediatrics, Boston Children's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Cindy Zhou
- Department of Pediatrics, Boston Children's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth Holland
- Department of Pediatrics, Boston Children's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - William H Barth
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Carol Barnewolt
- Department of Radiology, Boston Children's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Susan Connolly
- Department of Radiology, Boston Children's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Judy Estroff
- Department of Radiology, Boston Children's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Polina Golland
- Department of Electrical Engineering and Computer Science, MIT, Cambridge, Massachusetts, USA
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, Massachusetts, USA
- Institute for Medical Engineering and Science, MIT, Cambridge, Massachusetts, USA
| | - Henry A Feldman
- Department of Pediatrics, Boston Children's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Elfar Adalsteinsson
- Department of Electrical Engineering and Computer Science, MIT, Cambridge, Massachusetts, USA
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, Massachusetts, USA
- Institute for Medical Engineering and Science, MIT, Cambridge, Massachusetts, USA
| | - P Ellen Grant
- Department of Pediatrics, Boston Children's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Boston Children's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
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Tekeli Taşkömür A, Özen FZ, Erten Ö. Evaluation of the relationship between reduced fetal movement and obstetric-neonatal outcomes and placental pathologies. Minerva Obstet Gynecol 2022; 74:401-409. [PMID: 36239529 DOI: 10.23736/s2724-606x.22.04955-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Fetal movements are one of the simple methods that show the baby's well-being. Conditions associated with decreased fetal movements have not been determined, so it is important to analyze their different aspects. This study aimed to evaluate the relationship between reduced fetal movement and obstetric-neonatal outcomes, and placental pathologies. METHODS In this prospective controlled study, laboratory results (blood glucose, hemoglobin, thyroid-stimulating hormone [TSH]), a non-stress test (NST), biophysical profile results, obstetric and neonatal outcomes, and placental pathological results of 74 pregnant women at 35 or more gestational weeks (to exclude the effect of prematurity on obstetric and neonatal outcomes) attending the obstetrics clinic between December 26, 2017 and January 30, 2019 with complaints of reduced fetal movement, were compared with 74 healthy pregnant women. Since prematurity and post-maturity may adversely affect obstetric-neonatal and placental pathology results, term pregnancies between 370/7-406/7 weeks were evaluated separately. RESULTS In the group with reduced fetal movement, the biophysical profile was lower than the controls (P=0.013). Among placental pathologies, chorangiosis and hypercoiled cord were significantly higher in the group with reduced fetal movement than controls (P<0.05). Small for gestational age (SGA) and fetal growth restriction (FGR) in this group had these pathologies. Results of women at 370/7-406/7 weeks were similar except for the additional finding of chorioamnionitis. CONCLUSIONS Reduced fetal movement may be associated with the low biophysical profile. In cases where fetal movement decreases, placental chorangiosis and hypercoiled cord seem to be associated with fetal growth restriction.
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Affiliation(s)
- Aysun Tekeli Taşkömür
- Department of Gynecology and Obstetrics, Faculty of Medicine, Amasya University, Amasya, Turkey -
| | - Fatma Z Özen
- Department of Pathology, Faculty of Medicine, Amasya University, Amasya, Turkey
| | - Özlem Erten
- Department of Gynecology and Obstetrics, Faculty of Medicine, Kütahya Health Sciences University, Kütahya, Turkey
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Shokouhmand A, Tavassolian N. Fetal Movement Cancellation in Abdominal Electrocardiogram Recordings Using Signal-to-Signal Translation. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:2017-2020. [PMID: 36086419 DOI: 10.1109/embc48229.2022.9871826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This study addresses the cancellation of fetal movement in abdominal electrocardiogram (AECG) recordings through deep neural networks. For this purpose, a generative signal-to-signal translation model consisting of two coupled generators is employed to discover the relations between fetal movement-contaminated and clean AECG recordings. The model is trained on the fetal ECG synthetic database (FECGSYNDB) which provides AECG recordings from 10 pregnancies along with their ground-truth maternal and fetal ECG signals. The signals are initially segmented into 4-second segments and then fed into the network for denoising. It is demonstrated that the signal-to-signal translation method can reconstruct clean AECG signals with average mean-absolute-error (MAE), root-mean-square deviation (RMSD), and Pearson correlation coefficient (PCC) of 0.099, 0.124, and 99.12% respectively, between clean and denoised AECG signals. Furthermore, the robustness of the method to low signal-to-noise ratio (SNR) input values is shown by an RMSD range of (0.047, 0.352) for SNR values within the range of (-3, 3) dB. Clinical Relevance- The proposed framework allows for the denoising of abdominal ECG signals for non-invasive fetal heart rate monitoring. The approach is accurate due to the use of advanced neural network techniques.
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Joshi SK, Dangal G. Non Stress Test as a Predictor of Maternal and Fetal Outcome in Patients Presenting with Reduced Fetal Movement at Term. J Nepal Health Res Counc 2022; 20:21-25. [PMID: 35945848 DOI: 10.33314/jnhrc.v20i01.3628] [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] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Establishing the predictive utility of Non stress test could be helpful to improve perinatal outcome especially in countries like Nepal, with heavy workload and limited resources. The aim of the study was to assess association between Non stress test abnormalities and fetal outcome in terms of Apgar score and newborn intensive care unit admission rate for patient with decreased fetal movement. METHODS The study included total 54 women with decreased fetal movement at term without any pregnancy complication not in labor admitted to paropakar maternity and women's hospital, Thapathali, Kathmandu from June 2020 to December 2020. Non stress test was done for 20 to 40 minutes and the readings were categorized in to three groups. The results were compared to see the relationship between normal, suspicious and abnormal Non stress test result in terms of mode of delivery, Apgar score, neonatal resuscitation and need for neonatal intensive care unit newborn intensive care unit admission. RESULTS Total 54 cases remained under inclusion criteria were included in this study. Mode of delivery on the basis of Non stress test result shows that 31.48% with abnormal Non stress test had a Lower segment Caesarian section, 1.8% had instrumental vaginal delivery and 14.8% had spontaneous vaginal delivery. While in reassuring Non stress test group 20.4% had spontaneous vaginal, 0% had Lower segment Caesarian section and 1.85% had instrumental vaginal delivery. There is statistically significant relationship between Non stress test result and Apgar score. In reactive Non stress test result only5.4% required neonatal resuscitation. However, in persistently non-reassuring or abnormal Non stress test result, 62.1% require neonatal resuscitation. Similarly, in reactive Non stress test result none of the neonate required newborn intensive care unit admission. However, in persistently non-reassuring or abnormal Non stress test result 46.1% neonates require newborn intensive care unit admission. There were 9 neonatal mortalities from abnormal Non stress test result. CONCLUSIONS We concluded that the Non stress test is a good predictor of maternal and fetal outcome detecting fetal hypoxia already present or likely to develop in patient presenting with reduced fetal movement in term pregnancies without complication.
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Affiliation(s)
- Sarita Kumari Joshi
- Department of Obstetrics and Gynecology, Paropakar Maternity Women's Hospital Kathmandu, Nepal
| | - Ganesh Dangal
- Department of Obstetrics and Gynecology, Kathmandu Model Hospital, Kathmandu, Nepal
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Pretti N, Paladini D, Panzeri S, Becchio C. Why 4D ultrasound has not (yet) revolutionized fetal-movement research. Ultrasound Obstet Gynecol 2022; 59:569-573. [PMID: 34435711 DOI: 10.1002/uog.24757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Affiliation(s)
- N Pretti
- Cognition, Motion and Neuroscience Unit, Center for Human Technologies, Istituto Italiano di Tecnologia, Genoa, Italy
- Department of Psychology, Università di Torino, Turin, Italy
| | - D Paladini
- Fetal Medicine and Surgery Unit, IRCCS G. Gaslini, Genoa, Italy
| | - S Panzeri
- Department of Neural Information Processing, Center for Molecular Neurobiology (ZMNH), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - C Becchio
- Cognition, Motion and Neuroscience Unit, Center for Human Technologies, Istituto Italiano di Tecnologia, Genoa, Italy
- Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Cohen G, Bogin R, Schreiber H, Shechter-Maor G, Cohen I, Biron-Shental T, Daykan Y. Are increased fetal movements during pregnancy a predictor of neonatal adverse outcomes? Am J Obstet Gynecol 2022; 227:349-351. [PMID: 35487329 DOI: 10.1016/j.ajog.2022.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/21/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Gal Cohen
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., Kfar Saba 44281, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Rona Bogin
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., Kfar Saba 44281, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Schreiber
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., Kfar Saba 44281, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Shechter-Maor
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., Kfar Saba 44281, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Cohen
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., Kfar Saba 44281, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., Kfar Saba 44281, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Daykan
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Cork University Maternity Hospital, University College Cork, Cork, Ireland
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Rahbek Zizzo A, Kirkegaard I, From Reese C, Hansen J, Uldbjerg N, Mølgaard H. Fetal respiratory movements improve reliability of heart rate variability and suggest a coupling between fetal respiratory arrhythmia and vagal activity. Physiol Rep 2022; 10:e15224. [PMID: 35307959 PMCID: PMC8935276 DOI: 10.14814/phy2.15224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 04/21/2023] Open
Abstract
Fetal heart rate variability (FHRV) reflects autonomic cardiac regulation. The autonomic nervous system constantly adjusts the heart rate to maintain homeostasis. By providing insight into the fetal autonomic state, FHRV has the potential to become an investigational and clinical instrument. However, the method needs standardization and the influence of fetal movements, including fetal respiratory movements, is not well explored. Therefore, in a highly standardized setting, the aim was to evaluate the association between fetal movements and fetal heart rate variability (FHRV) including their impact on reliability. Fetal heart rate was obtained by noninvasive fetal electrocardiography (NI-FECG) and fetal movements by simultaneous ultrasound scanning in 30 healthy singleton pregnant women on two occasions with a maximum interval of 7 days. The standard deviation of normal-to-normal RR-intervals (SDNN), root mean square of successive RR-interval differences (RMDDS), high-frequency power (HF-power), low-frequency power (LF-power), and LF/HF were measured. A multivariate mixed model was used and reliability was defined as acceptable by a coefficient of variance (CV) ≤15% and an intraclass correlation coefficient (ICC) ≥0.80. During time periods with fetal respiratory movements, the highest reliability was achieved. Intra- and inter-observer reliability measurements were very high (CV: 0-9%; ICC ≧ 0.86). Within the same recording, SDNN and RMSSD achieved acceptable reliability (CV: 14-15%; ICC ≧ 0.80). However, day-to-day reliability displayed high CV's. In time periods with fetal respiratory movements, as compared to periods with quiescence RMSSD and HF-power were higher (Ratio: 1.33-2.03) and LF/HF power lower (Ratio: 0.54). In periods with fetal body movements SDNN, RMSSD and HF-power were higher (Ratio: 1.27-1.65). In conclusion, time periods with fetal respiratory movements were associated with high reliability of FHRV analyses and the highest values of parameters supposed to represent vagal activity.
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Affiliation(s)
- Anne Rahbek Zizzo
- Department of Obstetrics and GynaecologyAarhus University HospitalAarhus NDenmark
| | - Ida Kirkegaard
- Department of Obstetrics and GynaecologyAarhus University HospitalAarhus NDenmark
| | - Camille From Reese
- Department of Obstetrics and GynaecologyAarhus University HospitalAarhus NDenmark
| | - John Hansen
- Department of Health Science and TechnologyAalborg UniversityAalborgDenmark
| | - Niels Uldbjerg
- Department of Obstetrics and GynaecologyAarhus University HospitalAarhus NDenmark
| | - Henning Mølgaard
- Department of CardiologyAarhus University HospitalAarhus NDenmark
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Ginther OJ. Physical activities and morphologic aspects of the equine fetus during Days 40 to 150. J Equine Vet Sci 2022; 112:103891. [PMID: 35143928 DOI: 10.1016/j.jevs.2022.103891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/16/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 11/17/2022]
Abstract
Intrauterine mobility of the fetal-amniotic unit is unique in equids among domestic species. Intrinsic activity begins as head nods on ∼ Day 40 (Day 0 = ovulation) and by Day 60 has progressed into intermittent subtle to vigorous head, neck, limb, and body movements. On Days 60-100, fetal mobility is maximal with traveling of the fetal-amniotic unit throughout an allantoic pool that encompasses the uterine horns and uterine body. The fetus may be entirely within one uterine horn with the horn entrance closed behind it, and then may work through the entrance into the uterine body. Mobility gradually decreases after Day 100 with a decrease in relative quantity of allantoic fluid but intrinsic activity continues. Changes in each of fetal intrauterine location, presentation, and recumbency can occur frequently (e.g., 5-min intervals). About 80% of fetal mobility is from the propulsive effects of intrinsic fetal activities, and the remainder is from currents and shifts in the allantoic pool. The fluid currents are attributable to transient uterine constrictions that vary from 10 mm in width to the length of a uterine horn and to extrinsic mare and adjacent visceral activity. The fetus is tethered by a long umbilical cord attached at the mid-uterus allowing travel throughout an allantoic sac that involves the entire uterus. The mobile fetus seemingly practices the neuromuscular coordination that it will need during independent life. The theriogenologist can educate and fascinate onlookers by ultrasound demonstrations of bursts of fetal activity and mobility. An online video is included.
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Affiliation(s)
- O J Ginther
- Eutheria Foundation, Cross Plains, WI; Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI.
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Favre G, Mazzetti S, Gengler C, Bertelli C, Schneider J, Laubscher B, Capoccia R, Pakniyat F, Ben Jazia I, Eggel-Hort B, de Leval L, Pomar L, Greub G, Baud D, Giannoni E. Decreased Fetal Movements: A Sign of Placental SARS-CoV-2 Infection with Perinatal Brain Injury. Viruses 2021; 13:v13122517. [PMID: 34960786 PMCID: PMC8706116 DOI: 10.3390/v13122517] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 01/23/2023] Open
Abstract
Neonatal COVID-19 is rare and mainly results from postnatal transmission. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), however, can infect the placenta and compromise its function. We present two cases of decreased fetal movements and abnormal fetal heart rhythm 5 days after mild maternal COVID-19, requiring emergency caesarean section at 29 + 3 and 32 + 1 weeks of gestation, and leading to brain injury. Placental examination revealed extensive and multifocal chronic intervillositis, with intense cytoplasmic positivity for SARS-CoV-2 spike antibody and SARS-CoV-2 detection by RT-qPCR. Vertical transmission was confirmed in one case, and both neonates developed extensive cystic peri-ventricular leukomalacia.
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Affiliation(s)
- Guillaume Favre
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (G.F.); (L.P.)
| | - Sara Mazzetti
- Clinic of Pediatrics, Department Mother-Woman-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (S.M.); (B.L.)
| | - Carole Gengler
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (C.G.); (L.d.L.)
| | - Claire Bertelli
- Institute of Microbiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (C.B.); (G.G.)
| | - Juliane Schneider
- Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (J.S.); (E.G.)
| | - Bernard Laubscher
- Clinic of Pediatrics, Department Mother-Woman-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (S.M.); (B.L.)
- Department of Pediatrics, Réseau Hospitalier Neuchâtelois, 2000 Neuchâtel, Switzerland
| | - Romina Capoccia
- Department of Obstetrics and Gynecology, Réseau Hospitalier Neuchâtelois, 2000 Neuchatel, Switzerland; (R.C.); (F.P.); (I.B.J.)
| | - Fatemeh Pakniyat
- Department of Obstetrics and Gynecology, Réseau Hospitalier Neuchâtelois, 2000 Neuchatel, Switzerland; (R.C.); (F.P.); (I.B.J.)
| | - Inès Ben Jazia
- Department of Obstetrics and Gynecology, Réseau Hospitalier Neuchâtelois, 2000 Neuchatel, Switzerland; (R.C.); (F.P.); (I.B.J.)
| | - Béatrice Eggel-Hort
- Department of Obstetrics and Gynecology, Hôpital du Valais—Centre Hospitalier du Valais Romand—Site de Sion, 1951 Sion, Switzerland;
| | - Laurence de Leval
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (C.G.); (L.d.L.)
| | - Léo Pomar
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (G.F.); (L.P.)
- Midwifery Department, School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland, 1011 Lausanne, Switzerland
| | - Gilbert Greub
- Institute of Microbiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (C.B.); (G.G.)
- Infectious Diseases Service, Department of Internal Medicine, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (G.F.); (L.P.)
- Correspondence: ; Tel.: +41-79-556-13-51
| | - Eric Giannoni
- Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (J.S.); (E.G.)
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Hayes DJL, Devane D, Dumville JC, Smith V, Walsh T, Heazell AEP. Development of a core outcome set (COS) for studies relating to awareness and clinical management of reduced fetal movement: study protocol. Trials 2021; 22:894. [PMID: 34886899 PMCID: PMC8655489 DOI: 10.1186/s13063-021-05839-9] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Concerns regarding reduced fetal movements (RFM) are reported in 5-15% of pregnancies, and RFM are associated with adverse pregnancy outcomes including fetal growth restriction and stillbirth. Studies have aimed to improve pregnancy outcomes by evaluating interventions to raise awareness of RFM in pregnancy, such as kick counting, evaluating interventions for the clinical management of RFM, or both. However, there is not currently a core outcome set (COS) for studies of RFM. This study aims to create a COS for use in research studies that aim to raise awareness of RFM and/or evaluate interventions for the clinical management of RFM. METHODS A systematic review will be conducted, to identify outcomes used in randomised and non-randomised studies with control groups that aimed to raise awareness of RFM (for example by using mindfulness techniques, fetal movement counting, or other tools such as leaflets or mobile phone applications) and/or that evaluated the clinical management of RFM. An international Delphi consensus will then be used whereby stakeholders will rate the importance of the outcomes identified in the systematic review in (i) awareness and (ii) clinical management studies. The preliminary lists of outcomes will be discussed at a consensus meeting where one final COS for awareness and management, or two discrete COS (one for awareness and one for management), will be agreed upon. DISCUSSION A well-developed COS will provide researchers with the minimum set of outcomes that should be measured and reported in studies that aim to quantify the effects of interventions.
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Affiliation(s)
- Dexter J. L. Hayes
- Tommy’s Stillbirth Research Centre, School of Medical Sciences, Division of Developmental Biology and Medicine, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - Declan Devane
- HRB-Trials Methodology Research Network, School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Jo C. Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Science Centre, Manchester, UK
| | - Valerie Smith
- School of Nursing & Midwifery, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Tanya Walsh
- School of Dentistry, University of Manchester, Manchester, UK
| | - Alexander E. P. Heazell
- Tommy’s Stillbirth Research Centre, School of Medical Sciences, Division of Developmental Biology and Medicine, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
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Mesbah M, Khlif MS, Layeghy S, East CE, Dong S, Brodtmann A, Colditz PB, Boashash B. Automatic fetal movement recognition from multi-channel accelerometry data. Comput Methods Programs Biomed 2021; 210:106377. [PMID: 34517181 DOI: 10.1016/j.cmpb.2021.106377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/07/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Significant health care resources are allocated to monitoring high risk pregnancies to minimize growth compromise, reduce morbidity and prevent stillbirth. Fetal movement has been recognized as an important indicator of fetal health. Studies have shown that 25% of pregnancies with decreased fetal movement in the third trimester led to poor outcomes at birth. The studies have also shown that maternal perception of fetal movement is highly subjective and varies from person to person. A non-invasive system for fetal movement detection that can be used outside hospital would represent an advance in at-home monitoring of at-risk pregnancies. This is a challenging task that requires the use of advanced signal processing techniques to differentiate genuine fetal movements from contaminating artefacts. METHODS This manuscript proposes a novel algorithm for automatic fetal movement recognition using data collected from wearable tri-axial accelerometers strategically placed on the maternal abdomen. The novelty of the work resides in the efficient removal of artefacts and in distinctive feature extraction. The proposed algorithm used independent component analysis (ICA) for dimensionality reduction and artefact removal. A supplemental technique based on discrete wavelet transform (DWT) was also used to remove artefacts. RESULTS To identify fetal movements, 31 features were extracted from the acceleration data. Based on these features, several classifiers were used to distinguish fetal from non-fetal movements. Robustness of the classifiers was tested for various concentrations of artefacts in the classification data. The best performance was achieved by Bagging classifier algorithm, with random forest as its basis classifier, yielding an accuracy ranging from 87.6% to 95.8% depending on the artefact concentration level. CONCLUSIONS A high performance detection of fetal movements can be achieved using accelerometery-based systems suitable for long-term monitoring.
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Affiliation(s)
- Mostefa Mesbah
- Department of Electrical and Computer Engineering, Sultan Qaboos University, Muscat, Oman.
| | - Mohamed S Khlif
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
| | - Siamak Layeghy
- School of ITEE, The University of Queensland, Brisbane, Australia
| | - Christine E East
- Department of Obstetrics and Gynaecology, The University of Melbourne & Department of Perinatal Medicine, Royal Women's Hospital, Melbourne, Australia; School of Nursing and Midwifery, Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - Shiying Dong
- University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia; Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Paul B Colditz
- University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Boualem Boashash
- University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia
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Radestad I, Pettersson K, Lindgren H, Skokic V, Akselsson A. Country of birth, educational level and other predictors of seeking care due to decreased fetal movements: an observational study in Sweden using data from a cluster-randomised controlled trial. BMJ Open 2021; 11:e050621. [PMID: 34172554 PMCID: PMC8237734 DOI: 10.1136/bmjopen-2021-050621] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To identify predictors of seeking care for decreased fetal movements and assess whether care-seeking behaviour is influenced by Mindfetalness. DESIGN Observational study with data from a cluster-randomised controlled trial. SETTING 67 maternity clinics and 6 obstetrical clinics in Sweden. PARTICIPANTS All pregnant women with a singleton pregnancy who contacted the obstetrical clinic due to decreased fetal movements from 32 weeks' gestation of 39 865 women. METHODS Data were collected from a cluster-randomised controlled trial where maternity clinics were randomised to Mindfetalness or routine care. Mindfetalness is a self-assessment method for women to use daily to become familiar with the unborn baby's fetal movement pattern. OUTCOME MEASURES Predictors for contacting healthcare due to decreased fetal movements. RESULTS Overall, 5.2% (n=2059) of women contacted healthcare due to decreased fetal movements, among which 1287 women (62.5%) were registered at a maternity clinic randomised to Mindfetalness and 772 women (37.5%) were randomised to routine care. Predictors for contacting healthcare due to decreased fetal movements were age, country of birth, educational level, parity, prolonged pregnancy and previous psychiatric care (p<0.001). The main differences were seen among women born in Africa as compared with Swedish-born women (2% vs 6%, relative risk (RR) 0.34, 95% CI 0.25 to 0.44) and among women with low educational level compared with women with university-level education (2% vs 5.4%, RR 0.36, 95% CI 0.19 to 0.62). Introducing Mindfetalness in maternity care increased the number of women seeking care due to decreased fetal movements overall. CONCLUSION Women with country of birth outside Sweden and low educational level sought care for decreased fetal movements to a lesser extent compared with women born in Sweden and those with university degrees. Future research could explore whether pregnancy outcomes can be improved by motivating women in these groups to contact healthcare if they feel a decreased strength or frequency of fetal movements. TRIAL REGISTRATION NUMBER NCT02865759.
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Affiliation(s)
- Ingela Radestad
- Reproductive Health, Sophiahemmet University, Stockholm, Sweden
| | - Karin Pettersson
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Helena Lindgren
- Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Viktor Skokic
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Anna Akselsson
- Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
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Marques-Fernandez L, Sharma S, Mannu U, Chong HP. Impact of Covid-19 on attendances for a 1st episode of reduced fetal movements: A retrospective observational study. PLoS One 2021; 16:e0253796. [PMID: 34170973 PMCID: PMC8232461 DOI: 10.1371/journal.pone.0253796] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/15/2021] [Accepted: 06/11/2021] [Indexed: 12/04/2022] Open
Abstract
Background Prior studies have demonstrated an increased stillbirth rate. It was suggested that the COVID-19 pandemic may have impacted on attendances for reduced fetal movements. Thus, we sought to ascertain the impact of the pandemic on attendances for reduced fetal movements (RFM) in our unit, ultrasound provision for reduced fetal movements, and the stillbirth rate. Methods This was a single site retrospective cohort study involving all women complaining of a 1st episode of reduced fetal movements between 01/03/2020-30/04/2020 (COVID) to 01/03/2019-30/04/2019 (Pre-COVID). Data were retrieved from computerised hospital records and statistical analyses were performed using GraphPad Prism and SPSS. Results 22% (179/810) of women presented with a 1st episode of reduced fetal movements Pre-COVID compared to 18% (145/803) during COVID (p = 0.047). Primiparous women were significantly over-represented in this population with a 1.4-fold increase in attendances during COVID (67% vs 48%, p = 0.0005). Neither the total stillbirth rate nor the stillbirth rate amongst women who presented with reduced fetal movements changed during COVID. Ultrasound provision was not impacted by COVID with 95% of the scans performed according to local guidelines, compared to Pre-COVID (74%, p = 0.0001). Conclusions There is a significant decrease in 1st attendances for reduced fetal movements during COVID-19 pandemic. Primiparous women were 1.4 times more likely to attend with RFM. Women should be reassured that COVID-19 has not resulted in a decreased provision of care for RFM, and has not impacted on the stillbirth rate.
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Affiliation(s)
- Laia Marques-Fernandez
- Department of Obstetrics and Gynaecology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom
- * E-mail:
| | - Swati Sharma
- Department of Obstetrics and Gynaecology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom
| | - Una Mannu
- Department of Obstetrics and Gynaecology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom
| | - Hsu Phern Chong
- Department of Obstetrics and Gynaecology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom
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Inubashiri E, Fujita S, Shimakura S, Kurasawa M, Yamamoto T, Watanabe Y, Deguchi K, Akutagawa N, Kuroki K, Maeda N. A new approach for quantitative assessment of fetal general movements in the early second trimester of pregnancy using four-dimensional ultrasound. J Med Ultrason (2001) 2021; 48:335-344. [PMID: 33907961 DOI: 10.1007/s10396-021-01095-1] [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: 12/17/2020] [Accepted: 04/01/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Complex fetal behavior involving multiple parts of the body, called general movement (GM), has been considered an essential predictor of neurological functional development because it directly reflects the integrity of the brain and central and peripheral nervous systems. We have developed a novel method for quantitative analysis of fetal behavior using four-dimensional ultrasound (4DUS) and conducted a pilot study for quantitative assessment of fetal GM in the early second trimester. METHODS All subjects underwent 4DUS to depict the whole fetal body, and maximum velocity (MAXV), median velocity (MV), average velocity (AV), and mode velocity (MOV) were calculated by utilizing optical flow analysis. Receiver operating characteristic (ROC) curve analysis was performed to analyze the optimal speed parameters for detecting GM in the fetus. The Mann-Whitney U test was used to validate MAXV, AV, and MV ability to detect fetal GM. RESULTS The presence of fetal GMs and the absence of fetal GMs were 226 and 107, respectively, based on optical flow analysis. Mann-Whitney U test revealed a significant difference in the presence or absence of fetal GM in MAXV, MV, AV, and MOV. ROC analysis showed that the area under the curve (AUC) of MAXV was 0.959; the threshold was 0.421, the sensitivity was 86%, and the specificity was 93%. In contrast, the AUC/threshold for AV and MV was 0.700/0.110 (sensitivity 71% and specificity 76%) and 0.521/0.119 (sensitivity 21% and specificity 90%), respectively. Spearman's rank correlation analysis also showed a weak negative correlation between GM and MAXV (r = - 0.235, P < 0.01) and AV (r = - 0.28, P < 0.01). CONCLUSION In this study, we conducted a quantitative analysis of fetal behavior based on optical flow using 4DUS and demonstrated that it was highly accurate for detecting GMs and for evaluating developmental changes in GMs. The implementation of quantitative analysis of fetal GMs in the early second trimester has been very preliminary, and there is much debate on how it will be clinically applied to perinatal assessment.
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Affiliation(s)
- Eisuke Inubashiri
- Sapporo Toho Hospital, Kita 17, Higashi 15, Higashi-ku, Sapporo, Hokkaido, 065-0017, Japan.
| | - Sachiko Fujita
- Department of Obstetrics and Gynecology, Takamatsu Municipal Hospital, 847-1 Busshozanchoko, Takamatsu, Kagawa, Japan
| | - Shiho Shimakura
- Sapporo Toho Hospital, Kita 17, Higashi 15, Higashi-ku, Sapporo, Hokkaido, 065-0017, Japan
| | - Megumi Kurasawa
- Sapporo Toho Hospital, Kita 17, Higashi 15, Higashi-ku, Sapporo, Hokkaido, 065-0017, Japan
| | - Towa Yamamoto
- Sapporo Toho Hospital, Kita 17, Higashi 15, Higashi-ku, Sapporo, Hokkaido, 065-0017, Japan
| | - Yukio Watanabe
- Sapporo Toho Hospital, Kita 17, Higashi 15, Higashi-ku, Sapporo, Hokkaido, 065-0017, Japan
| | - Keizou Deguchi
- Sapporo Toho Hospital, Kita 17, Higashi 15, Higashi-ku, Sapporo, Hokkaido, 065-0017, Japan
| | - Noriyuki Akutagawa
- Sapporo Toho Hospital, Kita 17, Higashi 15, Higashi-ku, Sapporo, Hokkaido, 065-0017, Japan
| | - Katsumaru Kuroki
- Sapporo Toho Hospital, Kita 17, Higashi 15, Higashi-ku, Sapporo, Hokkaido, 065-0017, Japan
| | - Nobuhiko Maeda
- Sapporo Toho Hospital, Kita 17, Higashi 15, Higashi-ku, Sapporo, Hokkaido, 065-0017, Japan
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Abstract
IMPORTANCE Stillbirth is a devastating pregnancy outcome with far-reaching economic and psychosocial consequences, but despite significant investment, a screening tool for identifying those fetuses at risk for stillbirth remains elusive. Maternal reporting of decreased fetal movements (DFM) has been found to be associated with stillbirth and other adverse perinatal outcomes. OBJECTIVE To examine pregnancy outcomes of women presenting with DFM in the third trimester at a tertiary Australian center with a clear clinical management algorithm. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data on all births meeting the inclusion criteria from 2009 through 2019 at Mater Mothers' Hospital in Brisbane, Australia. This is a tertiary center and Australia's largest maternity hospital. All singleton births without a known congenital anomaly after 28 weeks' gestation were included. Among 203 071 potential participants identified from the hospital database, 101 597 individuals met the eligibility criteria. Data analysis was performed from May through September 2020. EXPOSURE Presentation to hospital with DFM after 28 weeks gestation. MAIN OUTCOMES AND MEASURES The primary outcome of this study was the incidence of stillbirth. Multivariate analysis was undertaken to determine the association between DFM and stillbirth, obstetric intervention, and other adverse outcomes, including being born small for gestational age (SGA) and a composite adverse perinatal outcome (at least 1 of the following: neonatal intensive care unit admission, severe acidosis [ie, umbilical artery pH <7.0 or base excess -12.0 mmol/L or less], 5-minute Apgar score <4, or stillbirth or neonatal death). The hypothesis being tested was formulated prior to data collection. RESULTS Among 101 597 women with pregnancies that met the inclusion criteria, 8821 (8.7%) presented at least once with DFM and 92 776 women (91.3%) did not present with DFM (ie, the control population). Women presenting with DFM, compared with those presenting without DFM, were younger (mean [SD] age, 30.4 [5.4] years vs 31.5 [5.2] years; P < .001), more likely to be nulliparous (4845 women [54.9%] vs 42 210 women [45.5%]; P < .001) and have a previous stillbirth (189 women [2.1%] vs 1156 women [1.2%]; P < .001), and less likely to have a previous cesarean delivery (1199 women [13.6%] vs 17 444 women [18.8%]; P < .001). During the study period, the stillbirth rate was 2.0 per 1000 births after 28 weeks' gestation. Presenting with DFM was not associated with higher odds of stillbirth (9 women [0.1%] vs 185 women [0.2%]; adjusted odds ratio [aOR], 0.54; 95% CI, 0.23-1.26, P = .16). However, presenting with DFM was associated with higher odds of a fetus being born SGA (aOR, 1.14; 95% CI, 1.03-1.27; P = .01) and the composite adverse perinatal outcome (aOR, 1.14; 95% CI, 1.02-1.27; P = .02). Presenting with DFM was also associated with higher odds of planned early term birth (aOR, 1.26; 95% CI, 1.15-1.38; P < .001), induction of labor (aOR, 1.63; 95% CI, 1.53-1.74; P < .001), and emergency cesarean delivery (aOR, 1.18; 95% CI, 1.09-1.28; P < .001). CONCLUSIONS AND RELEVANCE The presence of DFM is a marker associated with increased risk for a fetus. This study's findings of a nonsignificantly lower rate of stillbirth among women with DFM may be reflective of increased community awareness of timely presentation to their obstetric care clinician when concerned about fetal movements and the benefits of tertiary level care guided by a clear clinical management protocol. However, DFM was associated with increased odds of an infant being born SGA, obstetric intervention, early term birth, and a composite of adverse perinatal outcomes.
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Affiliation(s)
- Jessica M. Turner
- Mater Research, University of Queensland, South Brisbane, Queensland, Australia
- Faculty of Medicine, University of Medicine, South Brisbane, Queensland, Australia
| | - Vicki Flenady
- Mater Research, University of Queensland, South Brisbane, Queensland, Australia
- Faculty of Medicine, University of Medicine, South Brisbane, Queensland, Australia
- National Heath and Medical Research Council Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - David Ellwood
- National Heath and Medical Research Council Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Michael Coory
- National Heath and Medical Research Council Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Mater Research, University of Queensland, South Brisbane, Queensland, Australia
- Faculty of Medicine, University of Medicine, South Brisbane, Queensland, Australia
- National Heath and Medical Research Council Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
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Tan LK. Revisiting Decreased Fetal Movements After 28 Weeks Gestation-An Important Obstetric Symptom and Surrogate Associated With Placental Insufficiency. JAMA Netw Open 2021; 4:e215365. [PMID: 33830231 DOI: 10.1001/jamanetworkopen.2021.5365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lay-Kok Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
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Esin S, Okuyan E, Gunakan E, Zengin HY, Hayran M, Tohma YA. A novel technique for prediction of preterm birth: fetal nasal flow Doppler. J Perinat Med 2021; 49:319-325. [PMID: 33180051 DOI: 10.1515/jpm-2020-0276] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/18/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Absence of fetal breathing movements (FBM) has been found to be a good predictor of preterm delivery in symptomatic patients. However, analysis of FBM patterns and Doppler measurement of them for preterm birth prediction have not been performed before. In this study, we aimed to investigate and analyze FBM patterns in symptomatic preterm labor patients by fetal ultrasonography and nasal Doppler. METHODS This was a multicenter, prospective cohort study. Singleton pregnant patients between 24 and 37 gestational weeks diagnosed with preterm labor were included in the study. Patients were evaluated in three groups: no FBM (Group 1), regular FBM (Group 2), irregular FBM (Group3). RESULTS Seventy-three patients were available for the final analysis after exclusion. Preterm delivery rate in 24 h in groups were 91.7, 32.7 and 100%, respectively. The absence of FBM (Group 1) was statistically significant for preterm delivery in for both 24 (91.7 vs. 42.6%, p=0.002) and 48 h (91.7 vs. 49.2%, p=0.006) when compared with fetal breathing positive Group 2 and 3. In fetal nasal Doppler analyses in Group 2, the inspiration/expiration number rate was significantly lower in the patients who delivered in 24 h (0.98±0.2 vs. 1.25±0.57, p=0.015). By using fetal nasal Doppler, combination of absence of FBM or irregular FBM or regular FBM with inspiration number/expiration number (I/E) <1.25 detects 94.6% of patients who will eventually deliver in the first 24 h after admission. CONCLUSIONS Examining FBM patterns and using nasal Doppler may help the clinician to differentiate those who will deliver preterm and may be an invaluable tool for managing preterm labor patients.
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Affiliation(s)
- Sertac Esin
- Department of Perinatology, Baskent University School of Medicine, Ankara, Turkey
| | | | - Emre Gunakan
- Department of Perinatology, Baskent University School of Medicine, Ankara, Turkey
| | - Hatice Yagmur Zengin
- Department of Biostatistics, Baskent University School of Medicine, Ankara, Turkey
| | - Mutlu Hayran
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Yusuf Aytac Tohma
- Department of Obstetrics and Gynecology, Baskent University School of Medicine, Ankara, Turkey
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Goda MÁ, Telek T, Kovács F. Novel Phonography-Based Measurement for Fetal Breathing Movement in the Third Trimester. Sensors (Basel) 2020; 21:s21010211. [PMID: 33396263 PMCID: PMC7794941 DOI: 10.3390/s21010211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 10/14/2020] [Revised: 12/25/2020] [Accepted: 12/27/2020] [Indexed: 12/17/2022]
Abstract
The detailed assessment of fetal breathing movement (FBM) monitoring can be a pre-indicator of many critical cases in the third trimester of pregnancy. Standard 3D ultrasound monitoring is time-consuming for FBM detection. Therefore, this type of measurement is not common. The main goal of this research is to provide a comprehensive image about FBMs, which can also have potential for application in telemedicine. Fifty pregnancies were examined by phonography, and nearly 9000 FBMs were identified. In the case of male and female fetuses, 4740 and 3100 FBM episodes were detected, respectively. The measurements proved that FBMs are well detectable in the 20-30 Hz frequency band. For these episodes, an average duration of 1.008 ± 0.13 s (p < 0.03) was measured in the third trimester. The recorded material lasted for 16 h altogether. Based on these measurements, an accurate assessment of FBMs could be performed. The epochs can be divided into smaller-episode groups separated by shorter breaks. During the pregnancy, the rate of these breaks continuously decreases, and episode groups become more contiguous. However, there are significant differences between male and female fetuses. The proportion of the episodes which were classified into minimally 10-member episode groups was 19.7% for males and only 12.1% for females, even at the end of the third trimester. In terms of FBM detection, phonography offers a novel opportunity for long-term monitoring. Combined with cardiac diagnostic methods, it can be used for fetal activity assessment in the third trimester and make measurement appreciably easier than before.
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Affiliation(s)
- Márton Áron Goda
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Práter utca 50/a, 1083 Budapest, Hungary;
- Correspondence:
| | - Tamás Telek
- St. Margaret Hospital, Bécsi út 132, 1032 Budapest, Hungary;
| | - Ferenc Kovács
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Práter utca 50/a, 1083 Budapest, Hungary;
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Tamber KK, Hayes DJL, Carey SJ, Wijekoon JHB, Heazell AEP. A systematic scoping review to identify the design and assess the performance of devices for antenatal continuous fetal monitoring. PLoS One 2020; 15:e0242983. [PMID: 33259507 PMCID: PMC7707469 DOI: 10.1371/journal.pone.0242983] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/12/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Antepartum fetal monitoring aims to assess fetal development and wellbeing throughout pregnancy. Current methods utilised in clinical practice are intermittent and only provide a 'snapshot' of fetal wellbeing, thus key signs of fetal demise could be missed. Continuous fetal monitoring (CFM) offers the potential to alleviate these issues by providing an objective and longitudinal overview of fetal status. Various CFM devices exist within literature; this review planned to provide a systematic overview of these devices, and specifically aimed to map the devices' design, performance and factors which affect this, whilst determining any gaps in development. METHODS A systematic search was conducted using MEDLINE, EMBASE, CINAHL, EMCARE, BNI, Cochrane Library, Web of Science and Pubmed databases. Following the deletion of duplicates, the articles' titles and abstracts were screened and suitable papers underwent a full-text assessment prior to inclusion in the review by two independent assessors. RESULTS The literature searches generated 4,885 hits from which 43 studies were included in the review. Twenty-four different devices were identified utilising four suitable CFM technologies: fetal electrocardiography, fetal phonocardiography, accelerometry and fetal vectorcardiography. The devices adopted various designs and signal processing methods. There was no common means of device performance assessment between different devices, which limited comparison. The device performance of fetal electrocardiography was reduced between 28 to 36 weeks' gestation and during high levels of maternal movement, and increased during night-time rest. Other factors, including maternal body mass index, fetal position, recording location, uterine activity, amniotic fluid index, number of fetuses and smoking status, as well as factors which affected alternative technologies had equivocal effects and require further investigation. CONCLUSIONS A variety of CFM devices have been developed, however no specific approach or design appears to be advantageous due to high levels of inter-device and intra-device variability.
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Affiliation(s)
- Kajal K. Tamber
- Faculty of Biology, Division of Developmental Biology and Medicine, Maternal and Fetal Health Research Centre, School of Medical Sciences, Medicine and Health, University of Manchester, St. Mary’s Hospital, Manchester, United Kingdom
| | - Dexter J. L. Hayes
- Faculty of Biology, Division of Developmental Biology and Medicine, Maternal and Fetal Health Research Centre, School of Medical Sciences, Medicine and Health, University of Manchester, St. Mary’s Hospital, Manchester, United Kingdom
| | - Stephen J. Carey
- School of Electrical and Electronic Engineering, University of Manchester, Manchester, United Kingdom
| | - Jayawan H. B. Wijekoon
- School of Electrical and Electronic Engineering, University of Manchester, Manchester, United Kingdom
| | - Alexander E. P. Heazell
- Faculty of Biology, Division of Developmental Biology and Medicine, Maternal and Fetal Health Research Centre, School of Medical Sciences, Medicine and Health, University of Manchester, St. Mary’s Hospital, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, St. Mary’s Hospital, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Abstract
Close observation and rapid escalation of care is essential for obstetric patients with COVID-19. The pandemic forced widespread conversion of in-person to virtual care delivery and telehealth was primed to enable outpatient surveillance of infected patients. We describe the experience and lessons learned while designing and implementing a virtual telemonitoring COVID-19 clinic for obstetric patients. All patients with suspected for confirmed COVID-19 were referred and enrolled. Telehealth visits were conducted every 24 to 72 hours based on the severity of symptoms and care was escalated to in person when necessary. The outcome of the majority (96.1%) of telehealth visits was to continue outpatient management. With regard to escalation of care, 25 patients (26.6%) presented for in person evaluation and five patients (5.3%) required inpatient admission. A virtual telemonitoring clinic for obstetric patients with mild COVID-19 offers an effective surveillance strategy as it allows for close monitoring, direct connection to in person evaluation, minimization of patient and provider exposure, and scalability.
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Affiliation(s)
- Nicole M Krenitsky
- Department of Obstetrics and Gynecology, NewYork-Presbyterian Hospital / Columbia University Irving Medical Center, New York, NY, United States
| | - Jessica Spiegelman
- Department of Obstetrics and Gynecology, NewYork-Presbyterian Hospital / Columbia University Irving Medical Center, New York, NY, United States
| | - Desmond Sutton
- Department of Obstetrics and Gynecology, NewYork-Presbyterian Hospital / Columbia University Irving Medical Center, New York, NY, United States
| | - Sbaa Syeda
- Department of Obstetrics and Gynecology, NewYork-Presbyterian Hospital / Columbia University Irving Medical Center, New York, NY, United States
| | - Leslie Moroz
- Department of Obstetrics and Gynecology, NewYork-Presbyterian Hospital / Columbia University Irving Medical Center, New York, NY, United States.
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Yang C, Tavassolian N. A Fetal Movement Simulation System for Wearable Vibrational Sensors. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:4454-4457. [PMID: 33018983 DOI: 10.1109/embc44109.2020.9175790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
This paper introduces a low-cost phantom system that simulates fetal movements (FMVs) for the first time. This vibration system can be used for testing wearable inertial sensors which detect FMVs from the abdominal wall. The system consists of a phantom abdomen, a linear stage with a stepper motor, a tactile transducer, and control circuits. The linear stage is used to generate mechanical vibrations which are transferred to the latex abdomen. A tactile transducer is implemented to add environmental noise to the system. The system is characterized and tested using a wireless sensor. The sensor recordings are analyzed using time-frequency analysis and the results are compared to real FMVs reported in the literature. Experiments are conducted to characterize the vibration range, frequency response, and noise generation of the system. It is shown that the system is effective in simulating the vibration of fetal movements, covering the full frequency and magnitude ranges of real FMV vibrations. The noise generation test shows that the system can effectively create scenarios with different signal-to-noise ratios for FMV detection. The system can facilitate the development of fetal movement monitoring systems and algorithms.
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Kovacs F, Goda MA, Hosszu G, Telek T. A Proposed Phonography-Based Measurement of Fetal Breathing Movement Using Segmented Structures with Frequency Splitting. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:4483-4486. [PMID: 33018990 DOI: 10.1109/embc44109.2020.9175477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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
This paper proposes a detection method of fetal breathing movement (FBM) as an important data of fetal well-being. To analyze the chaotic nature of the individual episodes, the frequency band has been split into single test frequencies in order to find its starting point (SP) as a signal free (quiet) zone. Computing some features of the signal the sound will be distinguishable from the disturbing signals as hiccups, body's rotation and limb movements or even additional noises of maternal heart beats. The SPs of the episodes are characterized by an approximation process in order to select the real ones.Clinical relevance- The method is an irradiation free measurement, carried out on the maternal abdomen. Furthermore, connected with the fetal phonocardiographic (fPCG) monitoring the method offers a non-invasive way for FBM detection applicable also at home. More than 50 pregnancies were examined with the proposed method for at least for 20-min with synchronous measurements by the proposed phonographic device and a 3D ultrasound machine in the third trimester.
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Rådestad I, Doveson S, Lindgren H, Georgsson S, Akselsson A. Midwives' experiences of using the Mindfetalness method when talking with pregnant women about fetal movements. Women Birth 2020; 34:e498-e504. [PMID: 33309478 DOI: 10.1016/j.wombi.2020.10.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Information given to pregnant women about fetal movements is important in maternity care and decreased fetal movements is associated with fetal growth restriction and stillbirth. The fetal movement pattern is different for every fetus and women perceive different types of movements. Mindfetalness is a self-assessment method for a woman to use to become familiar with her unborn baby's fetal movement pattern. AIM We aimed to explore midwives' perceptions about informing pregnant women about fetal movements and their experiences of working with Mindfetalness in their daily work. METHODS A web-questionnaire was distributed to midwives who participated in a randomized controlled trial evaluating Mindfetalness, a method for the observation of fetal movements. In total, 67 maternity clinics in Stockholm, Sweden, were randomized to Mindfetalness or routine care. Of the 144 midwives working in maternity clinics randomized to Mindfetalness, 80% answered the questionnaire. FINDINGS The midwives thought that the leaflet about Mindfetalness was supportive in their work when informing women about fetal movements and the majority wanted to continue to distribute the leaflet when the trial ended. The midwives also expressed that the study increased their own knowledge about fetal movements. Women embraced the information about Mindfetalness positively and appreciated the written material. The midwives thought that talking about fetal movements in maternity care is an important but challenging task. CONCLUSION Mindfetalness is a useful tool to use in maternity clinics when informing pregnant women about fetal movements. The written information was appreciated by both pregnant women and midwives.
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Affiliation(s)
| | - Sandra Doveson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden.
| | - Helena Lindgren
- Department of Women and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Susanne Georgsson
- The Swedish Red Cross University College, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Anna Akselsson
- Sophiahemmet University, Stockholm, Sweden; Department of Women and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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