Relative versus absolute rises in T/QRS ratio by ST analysis of fetal electrocardiograms in labour: A case-control pilot study

Alexandra D.J. Hulsenboom (Corresponding author), Kim M.J. Verdurmen, Rik Vullings, M. Beatrijs van der Hout-van der Jagt, Anneke Kwee, Judith O.E.H. van Laar, S. Guid Oei

Onderzoeksoutput: Bijdrage aan tijdschriftTijdschriftartikelAcademicpeer review

Uittreksel

INTRODUCTION: The additional value of ST analysis during labour is uncertain. In ST analysis, a T/QRS baseline value is calculated from the fetal electrocardiogram and successive T/QRS ratios are compared to this baseline. However, variation in the orientation of the electrical heart axis between fetuses may yield different T/QRS baseline values. In case of a higher T/QRS baseline value more ST events are encountered, although not always related to perinatal outcome. We hypothesised that we can partly correct for this effect by analysing T/QRS rises as a percentage from baseline (relative ST analysis). This study aimed to explore whether relative ST analysis has better diagnostic value for cord acidaemia compared to conventional ST analysis, where predefined fixed T/QRS ratios are used.

METHODS AND MATERIALS: A case-control study was performed in 20 term human fetuses during labour; 10 cases (umbilical cord artery pH <7.05 at birth, defining acidaemia) and 10 controls (pH >7.20) were included. The fetal electrocardiogram was recorded using a STAN monitor. We electronically extracted all T/QRS values, baseline and episodic ST events from the STAN monitor and calculated the relative T/QRS changes. The cut-off for relative ST events was determined in a receiver operator characteristic (ROC) curve at optimal specificity for cord acidaemia. Parameters of interest were area under the curve (AUC) of the ROC curve for relative ST events and test performance of both conventional and relative ST analysis.

RESULTS: Relative ST analysis showed an AUC of 0.99. The optimal cut-off value for relative T/QRS rise was determined at 0.70. Relative vs conventional (absolute) ST analysis showed a specificity of 100% vs 40% (p = 0.031); sensitivity 90% vs 90%; positive likelihood ratio infinity vs 1.5; negative likelihood ratio 0.10 vs 0.25, respectively.

CONCLUSION: Relative ST analysis seems to be a promising method to detect impending fetal acidaemia during labour. Further studies are required to determine the diagnostic accuracy.

TaalEngels
Pagina'se0214357
Aantal pagina's12
TijdschriftPLoS ONE
Volume14
Nummer van het tijdschrift3
DOI's
StatusGepubliceerd - 2019

Vingerafdruk

electrocardiography
Electrocardiography
normal values
Area Under Curve
Case-Control Studies
labor
Fetus
Personnel
Umbilical Arteries
Umbilical Cord
fetus
Parturition
umbilical cord
monitoring
disease diagnosis
case-control studies
arteries
heart
testing
methodology

Citeer dit

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title = "Relative versus absolute rises in T/QRS ratio by ST analysis of fetal electrocardiograms in labour: A case-control pilot study",
abstract = "INTRODUCTION: The additional value of ST analysis during labour is uncertain. In ST analysis, a T/QRS baseline value is calculated from the fetal electrocardiogram and successive T/QRS ratios are compared to this baseline. However, variation in the orientation of the electrical heart axis between fetuses may yield different T/QRS baseline values. In case of a higher T/QRS baseline value more ST events are encountered, although not always related to perinatal outcome. We hypothesised that we can partly correct for this effect by analysing T/QRS rises as a percentage from baseline (relative ST analysis). This study aimed to explore whether relative ST analysis has better diagnostic value for cord acidaemia compared to conventional ST analysis, where predefined fixed T/QRS ratios are used.METHODS AND MATERIALS: A case-control study was performed in 20 term human fetuses during labour; 10 cases (umbilical cord artery pH <7.05 at birth, defining acidaemia) and 10 controls (pH >7.20) were included. The fetal electrocardiogram was recorded using a STAN monitor. We electronically extracted all T/QRS values, baseline and episodic ST events from the STAN monitor and calculated the relative T/QRS changes. The cut-off for relative ST events was determined in a receiver operator characteristic (ROC) curve at optimal specificity for cord acidaemia. Parameters of interest were area under the curve (AUC) of the ROC curve for relative ST events and test performance of both conventional and relative ST analysis.RESULTS: Relative ST analysis showed an AUC of 0.99. The optimal cut-off value for relative T/QRS rise was determined at 0.70. Relative vs conventional (absolute) ST analysis showed a specificity of 100{\%} vs 40{\%} (p = 0.031); sensitivity 90{\%} vs 90{\%}; positive likelihood ratio infinity vs 1.5; negative likelihood ratio 0.10 vs 0.25, respectively.CONCLUSION: Relative ST analysis seems to be a promising method to detect impending fetal acidaemia during labour. Further studies are required to determine the diagnostic accuracy.",
author = "Hulsenboom, {Alexandra D.J.} and Verdurmen, {Kim M.J.} and Rik Vullings and {van der Hout-van der Jagt}, {M. Beatrijs} and Anneke Kwee and {van Laar}, {Judith O.E.H.} and Oei, {S. Guid}",
year = "2019",
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volume = "14",
pages = "e0214357",
journal = "PLoS ONE",
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Relative versus absolute rises in T/QRS ratio by ST analysis of fetal electrocardiograms in labour : A case-control pilot study. / Hulsenboom, Alexandra D.J. (Corresponding author); Verdurmen, Kim M.J.; Vullings, Rik; van der Hout-van der Jagt, M. Beatrijs; Kwee, Anneke; van Laar, Judith O.E.H.; Oei, S. Guid.

In: PLoS ONE, Vol. 14, Nr. 3, 2019, blz. e0214357.

Onderzoeksoutput: Bijdrage aan tijdschriftTijdschriftartikelAcademicpeer review

TY - JOUR

T1 - Relative versus absolute rises in T/QRS ratio by ST analysis of fetal electrocardiograms in labour

T2 - PLoS ONE

AU - Hulsenboom,Alexandra D.J.

AU - Verdurmen,Kim M.J.

AU - Vullings,Rik

AU - van der Hout-van der Jagt,M. Beatrijs

AU - Kwee,Anneke

AU - van Laar,Judith O.E.H.

AU - Oei,S. Guid

PY - 2019

Y1 - 2019

N2 - INTRODUCTION: The additional value of ST analysis during labour is uncertain. In ST analysis, a T/QRS baseline value is calculated from the fetal electrocardiogram and successive T/QRS ratios are compared to this baseline. However, variation in the orientation of the electrical heart axis between fetuses may yield different T/QRS baseline values. In case of a higher T/QRS baseline value more ST events are encountered, although not always related to perinatal outcome. We hypothesised that we can partly correct for this effect by analysing T/QRS rises as a percentage from baseline (relative ST analysis). This study aimed to explore whether relative ST analysis has better diagnostic value for cord acidaemia compared to conventional ST analysis, where predefined fixed T/QRS ratios are used.METHODS AND MATERIALS: A case-control study was performed in 20 term human fetuses during labour; 10 cases (umbilical cord artery pH <7.05 at birth, defining acidaemia) and 10 controls (pH >7.20) were included. The fetal electrocardiogram was recorded using a STAN monitor. We electronically extracted all T/QRS values, baseline and episodic ST events from the STAN monitor and calculated the relative T/QRS changes. The cut-off for relative ST events was determined in a receiver operator characteristic (ROC) curve at optimal specificity for cord acidaemia. Parameters of interest were area under the curve (AUC) of the ROC curve for relative ST events and test performance of both conventional and relative ST analysis.RESULTS: Relative ST analysis showed an AUC of 0.99. The optimal cut-off value for relative T/QRS rise was determined at 0.70. Relative vs conventional (absolute) ST analysis showed a specificity of 100% vs 40% (p = 0.031); sensitivity 90% vs 90%; positive likelihood ratio infinity vs 1.5; negative likelihood ratio 0.10 vs 0.25, respectively.CONCLUSION: Relative ST analysis seems to be a promising method to detect impending fetal acidaemia during labour. Further studies are required to determine the diagnostic accuracy.

AB - INTRODUCTION: The additional value of ST analysis during labour is uncertain. In ST analysis, a T/QRS baseline value is calculated from the fetal electrocardiogram and successive T/QRS ratios are compared to this baseline. However, variation in the orientation of the electrical heart axis between fetuses may yield different T/QRS baseline values. In case of a higher T/QRS baseline value more ST events are encountered, although not always related to perinatal outcome. We hypothesised that we can partly correct for this effect by analysing T/QRS rises as a percentage from baseline (relative ST analysis). This study aimed to explore whether relative ST analysis has better diagnostic value for cord acidaemia compared to conventional ST analysis, where predefined fixed T/QRS ratios are used.METHODS AND MATERIALS: A case-control study was performed in 20 term human fetuses during labour; 10 cases (umbilical cord artery pH <7.05 at birth, defining acidaemia) and 10 controls (pH >7.20) were included. The fetal electrocardiogram was recorded using a STAN monitor. We electronically extracted all T/QRS values, baseline and episodic ST events from the STAN monitor and calculated the relative T/QRS changes. The cut-off for relative ST events was determined in a receiver operator characteristic (ROC) curve at optimal specificity for cord acidaemia. Parameters of interest were area under the curve (AUC) of the ROC curve for relative ST events and test performance of both conventional and relative ST analysis.RESULTS: Relative ST analysis showed an AUC of 0.99. The optimal cut-off value for relative T/QRS rise was determined at 0.70. Relative vs conventional (absolute) ST analysis showed a specificity of 100% vs 40% (p = 0.031); sensitivity 90% vs 90%; positive likelihood ratio infinity vs 1.5; negative likelihood ratio 0.10 vs 0.25, respectively.CONCLUSION: Relative ST analysis seems to be a promising method to detect impending fetal acidaemia during labour. Further studies are required to determine the diagnostic accuracy.

U2 - 10.1371/journal.pone.0214357

DO - 10.1371/journal.pone.0214357

M3 - Article

VL - 14

SP - e0214357

JO - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

IS - 3

ER -