Phase-rectified signal averaging for intrapartum electronic fetal heart rate monitoring is related to acidaemia at birth

<strong>Objective:</strong> Recent studies suggest that phase-rectified signal averaging (PRSA), measured in antepartum fetal heart rate (FHR) traces, may sensitively indicate fetal status; however, its value has not been assessed during labour. We determined whether PRSA relates to acid...

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Main Authors: Georgieva, A, Papageorghiou, A, Payne, S, Moulden, M, Redman, C
Format: Journal article
Language:English
Published: Wiley 2014
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author Georgieva, A
Papageorghiou, A
Payne, S
Moulden, M
Redman, C
author_facet Georgieva, A
Papageorghiou, A
Payne, S
Moulden, M
Redman, C
author_sort Georgieva, A
collection OXFORD
description <strong>Objective:</strong> Recent studies suggest that phase-rectified signal averaging (PRSA), measured in antepartum fetal heart rate (FHR) traces, may sensitively indicate fetal status; however, its value has not been assessed during labour. We determined whether PRSA relates to acidaemia in labour, and compare its performance to short-term variation (STV), a related computerised FHR feature. <strong>Design:</strong> Historical cohort. <strong>Setting:</strong> Large UK teaching hospital. <strong>Population:</strong> All 7568 Oxford deliveries that met the study criteria from April 1993 to February 2008. <strong>Methods:</strong> We analysed the last 30 minutes of the FHR and associated outcomes of infants. We used computerised analysis to calculate PRSA decelerative capacity (DC<sub>PRSA</sub>), and its ability to predict umbilical arterial blood pH ≤ 7.05 using receiver operator characteristic (ROC) curves and event rate estimates (EveREst). We compared DC<sub>PRSA</sub> with STV calculated on the same traces. <strong>Main outcome measure:</strong> Umbilical arterial blood pH ≤ 7.05. <strong>Results:</strong> We found that PRSA could be measured in all cases. DC<sub>PRSA</sub> predicted acidaemia significantly better than STV: the area under the ROC curve was 0.665 (95% CI 0.632-0.699) for DC<sub>PRSA</sub>, and 0.606 (0.573-0.639) for STV (P = 0.007). EveREst plots showed that in the worst fifth centile of cases, the incidence of low pH was 17.75% for DC<sub>PRSA</sub> but 11.00% for STV (P &lt; 0.001). DC<sub>PRSA</sub> was not highly correlated with STV. <strong>Conclusions:</strong> DC<sub>PRSA</sub> of the FHR can be measured in labour, and appears to predict acidaemia more accurately than STV. Further prospective evaluation is warranted to assess whether this could be clinically useful. The weak correlation between DC<sub>PRSA</sub> and STV suggests that they could be combined in multivariate FHR analyses.
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spelling oxford-uuid:a956060d-85d8-478b-825d-ad24fc93dc1e2022-03-27T03:07:49ZPhase-rectified signal averaging for intrapartum electronic fetal heart rate monitoring is related to acidaemia at birthJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:a956060d-85d8-478b-825d-ad24fc93dc1eEnglishSymplectic Elements at OxfordWiley2014Georgieva, APapageorghiou, APayne, SMoulden, MRedman, C<strong>Objective:</strong> Recent studies suggest that phase-rectified signal averaging (PRSA), measured in antepartum fetal heart rate (FHR) traces, may sensitively indicate fetal status; however, its value has not been assessed during labour. We determined whether PRSA relates to acidaemia in labour, and compare its performance to short-term variation (STV), a related computerised FHR feature. <strong>Design:</strong> Historical cohort. <strong>Setting:</strong> Large UK teaching hospital. <strong>Population:</strong> All 7568 Oxford deliveries that met the study criteria from April 1993 to February 2008. <strong>Methods:</strong> We analysed the last 30 minutes of the FHR and associated outcomes of infants. We used computerised analysis to calculate PRSA decelerative capacity (DC<sub>PRSA</sub>), and its ability to predict umbilical arterial blood pH ≤ 7.05 using receiver operator characteristic (ROC) curves and event rate estimates (EveREst). We compared DC<sub>PRSA</sub> with STV calculated on the same traces. <strong>Main outcome measure:</strong> Umbilical arterial blood pH ≤ 7.05. <strong>Results:</strong> We found that PRSA could be measured in all cases. DC<sub>PRSA</sub> predicted acidaemia significantly better than STV: the area under the ROC curve was 0.665 (95% CI 0.632-0.699) for DC<sub>PRSA</sub>, and 0.606 (0.573-0.639) for STV (P = 0.007). EveREst plots showed that in the worst fifth centile of cases, the incidence of low pH was 17.75% for DC<sub>PRSA</sub> but 11.00% for STV (P &lt; 0.001). DC<sub>PRSA</sub> was not highly correlated with STV. <strong>Conclusions:</strong> DC<sub>PRSA</sub> of the FHR can be measured in labour, and appears to predict acidaemia more accurately than STV. Further prospective evaluation is warranted to assess whether this could be clinically useful. The weak correlation between DC<sub>PRSA</sub> and STV suggests that they could be combined in multivariate FHR analyses.
spellingShingle Georgieva, A
Papageorghiou, A
Payne, S
Moulden, M
Redman, C
Phase-rectified signal averaging for intrapartum electronic fetal heart rate monitoring is related to acidaemia at birth
title Phase-rectified signal averaging for intrapartum electronic fetal heart rate monitoring is related to acidaemia at birth
title_full Phase-rectified signal averaging for intrapartum electronic fetal heart rate monitoring is related to acidaemia at birth
title_fullStr Phase-rectified signal averaging for intrapartum electronic fetal heart rate monitoring is related to acidaemia at birth
title_full_unstemmed Phase-rectified signal averaging for intrapartum electronic fetal heart rate monitoring is related to acidaemia at birth
title_short Phase-rectified signal averaging for intrapartum electronic fetal heart rate monitoring is related to acidaemia at birth
title_sort phase rectified signal averaging for intrapartum electronic fetal heart rate monitoring is related to acidaemia at birth
work_keys_str_mv AT georgievaa phaserectifiedsignalaveragingforintrapartumelectronicfetalheartratemonitoringisrelatedtoacidaemiaatbirth
AT papageorghioua phaserectifiedsignalaveragingforintrapartumelectronicfetalheartratemonitoringisrelatedtoacidaemiaatbirth
AT paynes phaserectifiedsignalaveragingforintrapartumelectronicfetalheartratemonitoringisrelatedtoacidaemiaatbirth
AT mouldenm phaserectifiedsignalaveragingforintrapartumelectronicfetalheartratemonitoringisrelatedtoacidaemiaatbirth
AT redmanc phaserectifiedsignalaveragingforintrapartumelectronicfetalheartratemonitoringisrelatedtoacidaemiaatbirth