The electrical heart axis and ST events in fetal monitoring : a post-hoc analysis following a multicentre randomised controlled trial

R. Vullings, K.M.J. Verdurmen, A.D.J. Hulsenboom, S. Scheffers, H. de Lau, A. Kwee, P.F.F. Wijn, I. Amer-Wahlin, J.O.E.H. van Laar, S.G. Oei

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OBJECTIVE: Reducing perinatal morbidity and mortality is one of the major challenges in modern health care. Analysing the ST segment of the fetal electrocardiogram was thought to be the breakthrough in fetal monitoring during labour. However, its implementation in clinical practice yields many false alarms and ST monitoring is highly dependent on cardiotocogram assessment, limiting its value for the prediction of fetal distress during labour. This study aims to evaluate the relation between physiological variations in the orientation of the fetal electrical heart axis and the occurrence of ST events. METHODS: A post-hoc analysis was performed following a multicentre randomised controlled trial, including 1097 patients from two participating centres. All women were monitored with ST analysis during labour. Cases of fetal metabolic acidosis, poor signal quality, missing blood gas analysis, and congenital heart disease were excluded. The orientation of the fetal electrical heart axis affects the height of the initial T/QRS baseline, and therefore the incidence of ST events. We grouped tracings with the same initial baseline T/QRS value. We depicted the number of ST events as a function of the initial baseline T/QRS value with a linear regression model. RESULTS: A significant increment of ST events was observed with increasing height of the initial T/QRS baseline, irrespective of the fetal condition; correlation coefficient 0.63, p<0.001. The most frequent T/QRS baseline is 0.12. CONCLUSION: The orientation of the fetal electrical heart axis and accordingly the height of the initial T/QRS baseline should be taken into account in fetal monitoring with ST analysis.
TaalEngels
Pagina's1-11
TijdschriftPLoS ONE
Volume12
Nummer van het tijdschrift4
DOI's
StatusGepubliceerd - 14 apr 2017

Vingerafdruk

Fetal monitoring
Fetal Monitoring
Fetal Heart
labor
Randomized Controlled Trials
heart
monitoring
Linear Models
Personnel
Cardiotocography
Blood gas analysis
Fetal Distress
Blood Gas Analysis
Perinatal Mortality
electrocardiography
blood gases
heart diseases
acidosis
distress
Acidosis

Citeer dit

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title = "The electrical heart axis and ST events in fetal monitoring : a post-hoc analysis following a multicentre randomised controlled trial",
abstract = "OBJECTIVE: Reducing perinatal morbidity and mortality is one of the major challenges in modern health care. Analysing the ST segment of the fetal electrocardiogram was thought to be the breakthrough in fetal monitoring during labour. However, its implementation in clinical practice yields many false alarms and ST monitoring is highly dependent on cardiotocogram assessment, limiting its value for the prediction of fetal distress during labour. This study aims to evaluate the relation between physiological variations in the orientation of the fetal electrical heart axis and the occurrence of ST events. METHODS: A post-hoc analysis was performed following a multicentre randomised controlled trial, including 1097 patients from two participating centres. All women were monitored with ST analysis during labour. Cases of fetal metabolic acidosis, poor signal quality, missing blood gas analysis, and congenital heart disease were excluded. The orientation of the fetal electrical heart axis affects the height of the initial T/QRS baseline, and therefore the incidence of ST events. We grouped tracings with the same initial baseline T/QRS value. We depicted the number of ST events as a function of the initial baseline T/QRS value with a linear regression model. RESULTS: A significant increment of ST events was observed with increasing height of the initial T/QRS baseline, irrespective of the fetal condition; correlation coefficient 0.63, p<0.001. The most frequent T/QRS baseline is 0.12. CONCLUSION: The orientation of the fetal electrical heart axis and accordingly the height of the initial T/QRS baseline should be taken into account in fetal monitoring with ST analysis.",
author = "R. Vullings and K.M.J. Verdurmen and A.D.J. Hulsenboom and S. Scheffers and {de Lau}, H. and A. Kwee and P.F.F. Wijn and I. Amer-Wahlin and {van Laar}, J.O.E.H. and S.G. Oei",
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The electrical heart axis and ST events in fetal monitoring : a post-hoc analysis following a multicentre randomised controlled trial. / Vullings, R.; Verdurmen, K.M.J.; Hulsenboom, A.D.J.; Scheffers, S.; de Lau, H.; Kwee, A.; Wijn, P.F.F.; Amer-Wahlin, I.; van Laar, J.O.E.H.; Oei, S.G.

In: PLoS ONE, Vol. 12, Nr. 4, 14.04.2017, blz. 1-11.

Onderzoeksoutput: Bijdrage aan tijdschriftTijdschriftartikelAcademicpeer review

TY - JOUR

T1 - The electrical heart axis and ST events in fetal monitoring : a post-hoc analysis following a multicentre randomised controlled trial

AU - Vullings,R.

AU - Verdurmen,K.M.J.

AU - Hulsenboom,A.D.J.

AU - Scheffers,S.

AU - de Lau,H.

AU - Kwee,A.

AU - Wijn,P.F.F.

AU - Amer-Wahlin,I.

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

AU - Oei,S.G.

PY - 2017/4/14

Y1 - 2017/4/14

N2 - OBJECTIVE: Reducing perinatal morbidity and mortality is one of the major challenges in modern health care. Analysing the ST segment of the fetal electrocardiogram was thought to be the breakthrough in fetal monitoring during labour. However, its implementation in clinical practice yields many false alarms and ST monitoring is highly dependent on cardiotocogram assessment, limiting its value for the prediction of fetal distress during labour. This study aims to evaluate the relation between physiological variations in the orientation of the fetal electrical heart axis and the occurrence of ST events. METHODS: A post-hoc analysis was performed following a multicentre randomised controlled trial, including 1097 patients from two participating centres. All women were monitored with ST analysis during labour. Cases of fetal metabolic acidosis, poor signal quality, missing blood gas analysis, and congenital heart disease were excluded. The orientation of the fetal electrical heart axis affects the height of the initial T/QRS baseline, and therefore the incidence of ST events. We grouped tracings with the same initial baseline T/QRS value. We depicted the number of ST events as a function of the initial baseline T/QRS value with a linear regression model. RESULTS: A significant increment of ST events was observed with increasing height of the initial T/QRS baseline, irrespective of the fetal condition; correlation coefficient 0.63, p<0.001. The most frequent T/QRS baseline is 0.12. CONCLUSION: The orientation of the fetal electrical heart axis and accordingly the height of the initial T/QRS baseline should be taken into account in fetal monitoring with ST analysis.

AB - OBJECTIVE: Reducing perinatal morbidity and mortality is one of the major challenges in modern health care. Analysing the ST segment of the fetal electrocardiogram was thought to be the breakthrough in fetal monitoring during labour. However, its implementation in clinical practice yields many false alarms and ST monitoring is highly dependent on cardiotocogram assessment, limiting its value for the prediction of fetal distress during labour. This study aims to evaluate the relation between physiological variations in the orientation of the fetal electrical heart axis and the occurrence of ST events. METHODS: A post-hoc analysis was performed following a multicentre randomised controlled trial, including 1097 patients from two participating centres. All women were monitored with ST analysis during labour. Cases of fetal metabolic acidosis, poor signal quality, missing blood gas analysis, and congenital heart disease were excluded. The orientation of the fetal electrical heart axis affects the height of the initial T/QRS baseline, and therefore the incidence of ST events. We grouped tracings with the same initial baseline T/QRS value. We depicted the number of ST events as a function of the initial baseline T/QRS value with a linear regression model. RESULTS: A significant increment of ST events was observed with increasing height of the initial T/QRS baseline, irrespective of the fetal condition; correlation coefficient 0.63, p<0.001. The most frequent T/QRS baseline is 0.12. CONCLUSION: The orientation of the fetal electrical heart axis and accordingly the height of the initial T/QRS baseline should be taken into account in fetal monitoring with ST analysis.

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DO - 10.1371/journal.pone.0175823

M3 - Article

VL - 12

SP - 1

EP - 11

JO - PLoS ONE

T2 - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

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ER -