Use of automated fetal heart rate analysis to identify risk factors for umbilical cord acidosis at birth
| Autor: | Genia Babykina, Romain Demailly, Camille Ternynck, A. Houzé de l’Aulnoit, Samuel Boudet, D. Houze De L'aulnoit, Régis Beuscart, Michaël Genin |
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| Přispěvatelé: | Santé publique, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS) |
| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty [SDV]Life Sciences [q-bio] medicine.medical_treatment Health Informatics Umbilical cord Infant Newborn Diseases Umbilical Cord 03 medical and health sciences 0302 clinical medicine Pregnancy Risk Factors medicine Humans Heart rate variability Cardiotocography Caesarean section Acidosis Univariate analysis medicine.diagnostic_test Obstetrics business.industry Infant Newborn Fetal Bradycardia Heart Rate Fetal Hydrogen-Ion Concentration Confidence interval Computer Science Applications 030104 developmental biology medicine.anatomical_structure embryonic structures Female medicine.symptom business 030217 neurology & neurosurgery |
| Zdroj: | Computers in Biology and Medicine Computers in Biology and Medicine, Elsevier, 2019, 115, pp.103525-. ⟨10.1016/j.compbiomed.2019.103525⟩ |
| ISSN: | 0010-4825 |
| DOI: | 10.1016/j.compbiomed.2019.103525 |
| Popis: | Objective To identify clinical parameters and intrapartum fetal heart rate parameters associated with a risk of umbilical cord acidosis at birth, using an automated analysis method based on empirical mode decomposition. Methods Our single-center study included 381 cases (arterial cord blood pH at birth pHa ≤7.15) and 1860 controls (pHa ≥7.25) extracted from a database comprising 8,383 full datasets for over-18 mothers after vaginal or caesarean non-twin, non-breech deliveries at term (>37 weeks of amenorrhea). The analysis of a 120-min period of the FHR recording (before maternal pushing or the decision to perform a caesarean section during labor) led to the extraction of morphological, frequency-related, and long- and short-term heart rate variability variables. After univariate analyses, sparse partial least square selection and logistic regression were applied. Results Several clinical factors were predictive of fetal acidosis in a multivariate analysis: nulliparity (odds ratio (OR) 95% confidence interval (CI)]: 1.769 [1.362–2.300]), a male fetus (1.408 [1.097–1.811]), and the term of the pregnancy (1.333 [1.189–1.497]). The risk of acidosis increased with the time interval between the end of the FHR recording and the delivery (OR [95%CI] for a 1-min increment: 1.022 [1.012–1.031]). The risk factors related to the FHR signal were mainly the difference between the mean baseline and the mean FHR (OR [95%CI]: 1.292 [1.174–1.424]), the baseline range (1.027 [1.014–1.040]), fetal bradycardia (1.038 [1.003–1.075]) and the late deceleration area (1.002 [1.000–1.005]). The area under the curve for the multivariate model was 0.79 [0.76; 0.81]. Conclusion In addition to clinical predictors, the automated FHR analysis highlighted other significant predictors, such as the baseline range, the instability of the FHR signal and the late deceleration area. This study further extends the routine application of automated FHR analysis during labor and, ultimately, contributes to the development of predictive scores for fetal acidosis. |
| Databáze: | OpenAIRE |
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