Update Parameters to Diagnose Intrap; Artum Fetus in Fetal Monitoring Volume 3 - Issue 1

Kazuo Maeda*

• Department of Obstetrics and Gynecology, Japan

Received: January 29, 2018;   Published: February 01, 2019

*Corresponding author: Kazuo Maeda, Department of Obstetrics and Gynecology, Postal: 3-125 Nadamachi, Yonago, Tottorikenn, 683-0835 Japan

DOI: 10.32474/OAJBEB.2019.03.000152

Abstract PDF

Aim: It is very important to correctly diagnose intrapartum fetal heart rate (FHR), uterine contracion and other intrapartum phenomena recorded on chart paper of which velocity was 3 cm per min./

Methods: An cardiotocogram (CTG), wihch records FHR and uterine contractions in the delivery studied initially FHR pattern analysis including late deceleration, which resulted vague diagnosis, thus, the author created FHR score which predicted neonatal Apgar score and umbilical arterial pH with the regression equations of FHR score in 1960s. Novel hypoxia index prevented infantile cerebral palsy, and FHR frequency spectrum diagnosed pathologic sinusoidal FHR, which detects severe fetal anemia caused by fetal-maternal transfusion and viral infection. These 3 parameters will be enough to predict fetal demise, neonatal asphyxia and infantile cerebral palsy. Severe neonatal conditions which should be predicted to cure the baby by early deliveries reducing perinatal deaths. They will be applied to computerized fetal monitoring.

Keywords: Fetus; Fetal heart rate; Apgar score; UApH; Hypoxia index; FHR frequency spectrum

Although electronic fetal monitoring was initiated by using Cardiotocogram, a graphic recorder of FHR and uterine contaction, 60year sbefore, its sujective visual FHR pattern diagnosis was not improved due to subjective FHR pattern diagnosis, particularly, late deceleration was vague and controvercy. The author created mathematic FHR score, of which regression equation enabled to predict neonatal states and umbilical cord blood pH [1], thus, further studied FHR with mathematical analysis in the creation of novel hypoxia index.

The first change to mathematical FHR diagnosis was, therefore, FHR score and its regulation equations. Their diagnoses were the first computerization in 1970s. Nextly, the author mathematically analyzed vague late decelerations, and created hypoxia index, which was the sum of FHR deceleration durations (min) divided by the lowest FHR, then multiplied by 100, The hypoxiaindex differentiated two fetal states, namely, the first was no infantile cerebral palsy, where the hypoxia index was 24 or less, while cerebral palsy was predicted when hypoxia index was 25 or more, thus, cerebral palsy was prevented if hypoxia index was 24 or less, while cerebral palsy was predicted when hypoxia index was 25 or more, thus, a fetus whose hypoxa index is 25 or more can receive early cerebral palsy treatments even in neonatal stage. The parturient woman changes her posture to lateral one after the recognition of FHR deceleration, with the purpose to reduce hypoxia index, because late deceleration was removed by changing her posture to lateral one from supine, to reduce hypoxia index. As the roles of all FHR patterns including early, late and variable decelerations were replaced by the hypoxia index, namely, vague pattern diagnosis was correted by hypoxia index. The FHR study computerization will be improved by hypoxia index [2], Third improvement will be the frequency spectrum analysis of FHR baseline with the purpose to detect severe fetal anemia due to fetal to maternal transfusion, or B19 viral infection, through the diagnosis of pathologic sinusoidal pattern, which was unable to separate physiologic benign sinusoidal one with common CTG, but differentiated by the actocardiogram [3], which was however visual diagnosis of synchronized cyclic fetal movement with sinusoidal FHR. Diagnostic parameters of sinusoidal pattern were large La to Ta ratio at the same time large PPSD values [4].

Update correct diagnosis of fetal heart rate will be obtained by the combination of FHR score, hypoxia index and frequency spectrum analysis.

1. Maeda K, Noguchi Y, Nagasawa T (2012) Central computerized automatic fetal heart rate diagnosis with a rapid and direct alarm system. The Open Medical Devices Journal 4: 28-33.
2. Maeda K, Noguchi Y, Matsumoto F, Nagasawa T(2010) Quantitative fetal heart rate evaluation without pattern classification : FHR score and artificial neural network analysis 21(3-4):127-141.
3. In A Kurjak, FA Chervenak (2006) Text Book of Perinatal Medicine 2nd ed, Vol 2, 2006, UK, Informa, 1487-1495.
4. Maeda K (2018) Cerebral Palsy is prevented if hypoxia index is 24 or less in fetal monitoring. Obstetrics & Gynecology International Journal 9(4): 224-225.