Format

Send to

Choose Destination
PLoS One. 2017 Apr 14;12(4):e0175823. doi: 10.1371/journal.pone.0175823. eCollection 2017.

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

Author information

1
Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
2
Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands.
3
Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, the Netherlands.
4
Department of Clinical Physics, Máxima Medical Centre, Veldhoven, the Netherlands.
5
Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden.

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.

PMID:
28410419
PMCID:
PMC5391944
DOI:
10.1371/journal.pone.0175823
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Public Library of Science Icon for PubMed Central
Loading ...
Support Center