| 1. |
- Amer-Wåhlin, Isis, et al.
(författare)
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Brain-specific NSE and S-100 proteins in umbilical blood after normal delivery
- 2001
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Ingår i: Clinica Chimica Acta. - 0009-8981. ; 304:1-2, s. 57-63
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To determine normal blood levels of brain-specific proteins S-100 and neuron specific enolase (NSE) in healthy newborns and their mothers following uncomplicated birth. METHODS: Umbilical artery and vein blood and maternal venous blood was collected at 112 consecutive uncomplicated deliveries. Venous blood samples were taken from 18 of the neonates 3 days after birth. S-100 and NSE were analyzed quantitatively by double antibody immunoluminometric assay (Sangtec Medical AB, Sweden). RESULTS: Compared with adults, healthy neonates had higher levels of both S-100 and NSE. For S-100, median levels (range) were 1.10 microg/l (0.38-5.50 microg/l and 0.98 microg/l (0.43-2.70 microg/l) in umbilical artery and vein, respectively. For NSE, median levels (range) in umbilical artery blood and vein were 27 microg/l (10-140 microg/l) and 10.75 microg/l (8.80->/=200 microg/l) respectively. The maternal venous blood levels of both S-100 and NSE were significantly lower than in their infants. At 3 days of life, neonatal venous levels of the proteins were still high: S-100, 0.48-9.70 microg/l; NSE, 17->/=200 microg/l. In contrast to adults, haemolysis affected the S-100 levels in umbilical blood significantly. CONCLUSION: Concentrations of both S-100 and NSE in blood are greater in newborns after normal birth than in healthy adults. The higher levels in umbilical artery blood than in umbilical vein blood are consistent with a fetal origin of these proteins. High levels in venous blood at 3 days of life suggest that the high levels at birth are not related to the birth process but reflect a high activity of these proteins during fetal development.
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| 2. |
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| 3. |
- Amer-Wåhlin, Isis, et al.
(författare)
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Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: a Swedish randomised controlled trial
- 2001
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Ingår i: The Lancet. - 1474-547X. ; 358:9281, s. 534-538
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Previous studies indicate that analysis of the ST waveform of the fetal electrocardiogram provides information on the fetal response to hypoxia. We did a multicentre randomised controlled trial to test the hypothesis that intrapartum monitoring with cardiotocography combined with automatic ST-waveform analysis results in an improved perinatal outcome compared with cardiotocography alone. METHODS: At three Swedish labour wards, 4966 women with term fetuses in the cephalic presentation entered the trial during labour after a clinical decision had been made to apply a fetal scalp electrode for internal cardiotocography. They were randomly assigned monitoring with cardiotocography plus ST analysis (CTG+ST group) or cardiotocography only (CTG group). The main outcome measure was rate of umbilical-artery metabolic acidosis (pH <7.05 and base deficit >12 mmol/L). Secondary outcomes included operative delivery for fetal distress. Results were first analysed according to intention to treat, and secondly after exclusion of cases with severe malformations or with inadequate monitoring. FINDINGS: The CTG+ST group showed significantly lower rates of umbilical-artery metabolic acidosis than the cardiotocography group (15 of 2159 [0.7%] vs 31 of 2079 [2%], relative risk 0.47 [95% CI 0.25-0.86], p=0.02) and of operative delivery for fetal distress (193 of 2519 [8%] vs 227 of 2447 [9%], 0.83 [0.69-0.99], p=0.047) when all cases were included according to intention to treat. The differences were more pronounced after exclusion of 291 in the CTG+ST group and 283 in the CTG group with malformations or inadequate recording. INTERPRETATION: Intrapartum monitoring with cardiotocography combined with automatic ST-waveform analysis increases the ability of obstetricians to identify fetal hypoxia and to intervene more appropriately, resulting in an improved perinatal outcome.
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| 4. |
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| 5. |
- Amer-Wåhlin, Isis, et al.
(författare)
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Fetal cerebral energy metabolism and electrocardiogram during experimental umbilical cord occlusion and resuscitation.
- 2010
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Ingår i: Journal of Maternal-Fetal & Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 23:2, s. 158-166
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The purpose of this experimental study was to elucidate alterations in fetal energy metabolism in relation to ECG changes during extreme fetal asphyxia, postnatal resuscitation and the immediate post-resuscitatory phase. Study design. Five near-term fetal sheep were subjected to umbilical cord occlusion until cardiac arrest followed by delivery, resuscitation and postnatal pressure-controlled ventilation. Four sheep served as sham controls and were delivered immediately after ligation of the umbilical cord. Fetal ECG was analysed online for changes of the ST segment. Fetal metabolism was monitored by intracerebral and subcutaneous microdialysis catheters. Results. Fetal ECG reacted on cord occlusion with an increase in the T-wave height followed by changes in intracerebral levels of oxidative parameters. Cerebral lactate/pyruvate ratio and glutamate increased to median (range) of 240 (200-744) and 34.0 (22.6-60.5) mmol/l, respectively; both parameters returned to baseline after resuscitation. Cerebral glucose decreased to 0.1 (0.08-0.12) mmol/l after occlusion and increased above baseline upon resuscitation. In subcutaneous tissue as well as blood the increase in lactate occurred with a delay compared to cerebral levels. Conclusion. The fetal ECG changes related to asphyxia preceded the increase in excitotoxicity as determined by increase in cerebral glutamate during asphyxia. Cerebral lactate increase was superior to subcutaneous lactate increase.
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| 6. |
- Amer-Wåhlin, Isis
(författare)
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Fetal ECG waveform analysis for intrapartum monitoring
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Waveform analysis of the fetal electrocardiogram has been studied since the early seventies from both physiological, signal processing and clinical aspects. It has been found to contain more useful information than the mere detection of RR-intervals (fetal heart rate), e.g., the ST-segment giving evidence of the ability of fetal myocardium to respond to the stress of labor. In the Swedish RCT, STAN S21® was used to monitor 4966 labors either with cardiotocography (CTG) only or with CTG in combination with the ST waveform analysis of the fetal electrocardiogram. A computerized algorithm, the ST Log, was used to identify the qualitative changes in the ST waveform automatically. Metabolic acidosis in cord artery blood defined as pH < 7.05 and BDecf > 12 mmol/L, decreased with 54% in the CTG+ST group according to intention to treat analysis. The number of operative deliveries for fetal distress decreased by 19%. A blinded assessment of neonatal outcome revealed an improvement of Apgar score 1 and 5 min, need for intensive care and neonatal encephalopathy in the group monitored with CTG in combination with ST waveform analysis. Detailed evaluation of the CTG- and ST-traces of the fetuses with acidemia at birth and three controls for each from the randomized controlled trial gave a higher inter-observer agreement for ST analysis than for CTG alone. ST waveform analysis in combination with CTG increased the specificity in identifying fetal hypoxia without losing sensitivity and gave a more conform indication to intervene. Interim analysis during the trial revealed several protocol violations and therefore additional educational efforts were made. The experimental study on fetal lamb using microdialysis technique to monitor cerebral energy metabolites simultaneously with ECG recording confirmed earlier studies on the increase in T/QRS ratio with asphyxia. The increase preceded the liberation of excitotoxic transmitters and signs of cell membrane degradation. Thus, during clinical conditions, STAN monitoring should indicate fetal hypoxia before irreversible brain damage has occurred. ST analysis of the fetal ECG in combination with CTG, reduced the incidence of newborns with adverse outcome and concomitantly reduced operative interventions for fetal distress — it is ready for introduction into standard clinical practice
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| 7. |
- Amer-Wåhlin, Isis, et al.
(författare)
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Fetal electrocardiogram: ST waveform analysis in intrapartum surveillance
- 2007
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Ingår i: Bjog. - : Wiley. ; 114:10, s. 1191-1193
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Tidskriftsartikel (refereegranskat)abstract
- ST waveform analysis of fetal electrocardiogram (ECG) for intrapartum surveillance (STAN) is a newly introduced method for fetal surveillance. The purpose of this commentary is to assist in the proper use of fetal ECG in combination with cardiotocography (CTG) during labour. Guidelines and recommendations concerning CTG and ST waveform interpretation and classification are stated that were agreed on by the European experts on ST waveform analysis for intrapartum surveillance during a meeting in Utretcht, The Netherlands in January 2007.
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| 8. |
- Amer-Wåhlin, Isis, et al.
(författare)
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Fetal heart-rate monitoring - Reply
- 2002
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Ingår i: The Lancet. - 1474-547X. ; 359:9302, s. 261-262
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 9. |
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| 10. |
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| 11. |
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| 12. |
- Amer-Wåhlin, Isis, et al.
(författare)
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Slutrapport för EVIDIGVO
- 2024
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Den här texten presenterar resultat från tre aktiviteter för kunskapsinsamling om implementering av digitala verktyg inom vård- och omsorg: en litteratursammanställning, en workshopserie i två delar och en enkätundersökning. Den primära målgruppen har varit verksamhetsutvecklare och projektledare i regioner och kommuner. Antalet svarande i enkätstudien var för lågt för att kunna dra några statistiska slutsatser, men resultatet kan, tillsammans med workshopserien, ändå användas för att identifiera områden där det verkar finnas utmaningar. Både litteratursammanställningen och enkätundersökningen pekar på ett behov av att utveckla strukturerade utvärderingsmodeller för implementering. Även under workshoppen diskuterades den bristande förmågan att ”samla in evidens under projektens gång”, och det fanns en önskan om att ett sådant arbetssätt skulle utvecklas. Enkäten och workshoppen pekar även på flera återkommande problem under implementeringsprojekts olika faser. I den inledande fasen efterfrågas bättre analyser och förankringsarbete. Analyser med användarfokus missas speciellt ofta, så som användarresa, hållbarhetsanalys och intressent- och behovsanalys. Även i andra ändan av processen, då system och arbetssätt ska avvecklas, finns utmaningar och förbättringsförslag, t.ex. saknas ofta beslut om utfasning av gamla lösningar, och ett förslag är att man redan när man skriver kontakt med en leverantör ska säkerställa att leverantören hjälper till med migrering vid utfasning. En annan genomgående problematik är osäkerhet, och ibland avsaknad, av roller, ansvar och kommunikation. Detta handlar om att man inte riktigt vet varför man ska göra saker, eller att verksamheten och personerna som ska göra förändringen inte är tillräckligt inblandade. Det kan också handla om att support och förvaltning inte är tillräckligt väl utvecklat, och om att man inte vet hur man kan samarbeta med leverantörer. Här identifieras även förändringsledning som ett viktigt verktyg för att underlätta en god implementering.
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| 13. |
- Amer-Wåhlin, Isis, et al.
(författare)
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ST analysis of fetal electrocardiography in labor
- 2011
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Ingår i: Seminars in Fetal & Neonatal Medicine. - : Elsevier BV. - 1878-0946 .- 1744-165X. ; 16:1, s. 29-35
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Tidskriftsartikel (refereegranskat)abstract
- Since its introduction more than 40 years ago, electronic fetal monitoring has become widely used for intrapartum surveillance to determine fetal wellbeing in labor. Although fetal hypoxia and acidosis are reflected in changes in fetal heart rate, there is no evidence that cardiotocography has been effective in reducing neonatal morbidity related to fetal distress occurring during labor. Indeed the specificity of this tool is poor and in many instances the incorporation of electronic fetal monitoring into intrapartum care has merely led to an increase in medical intervention rather than an improvement in neonatal outcome. Fetal electrocardiography (ECG) analysis provides an additional method for assessing the response of the fetus to hypoxia and in particular to the development of metabolic acidosis. ST changes in the fetal ECG can be quantified with computational analysis, reducing subjective interpretation that has been problematic with traditional electronic fetal monitoring. Formal algorithms indicating appropriate points for intervention in labor have been designed. The fetal ECG has been shown to be a useful adjunct to traditional electronic fetal monitoring in several randomized controlled trials with evidence of reduced rates of neonatal encephalopathy and reduced rates of obstetric intervention. (C) 2010 Elsevier Ltd. All rights reserved.
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| 14. |
- Amer-Wåhlin, Isis, et al.
(författare)
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ST-Analysis of the Fetal ECG
- 2013
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Ingår i: Antenatal and Intrapartum fetal surveillance. - : Universities Press. - 9788173718649 ; , s. 220-236
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 15. |
- Becker, Jeroen H, et al.
(författare)
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ST Analysis of the Fetal Electrocardiogram in Intrapartum Fetal Monitoring: A Meta-Analysis.
- 2012
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Ingår i: Obstetrics and Gynecology. - 1873-233X. ; 119:1, s. 145-154
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVE:: To compare the effects of ST-waveform analysis in combination with cardiotocography with conventional cardiotocography for intrapartum fetal monitoring. DATA SOURCES:: We searched MEDLINE, Embase, and PubMed for randomized controlled trials (RCTs) evaluating ST-waveform analysis for intrapartum fetal monitoring. METHODS OF STUDY SELECTION:: We identified RCTs that compared ST-waveform analysis and conventional cardiotocography for intrapartum fetal monitoring of singleton pregnancies in cephalic presentation beyond 34 weeks of gestation and evaluating at least one of the following: metabolic acidosis, umbilical cord pH less than 7.15, umbilical cord pH less than 7.10, umbilical cord pH less than 7.05, umbilical cord pH less than 7.00, Apgar scores less than 7 at 5 minutes, admittance to the neonatal intensive care unit, need for intubation, presence of hypoxic ischemic encephalopathy, perinatal death, operative delivery, and number of fetal blood samplings. TABULATION, INTEGRATION, AND RESULTS:: Five RCTs, which included 15,352 patients, met the selection criteria. Random-effects models were used to estimate the combined relative risks (RRs) of ST analysis compared with conventional cardiotocography. Compared with conventional cardiotocography, ST analysis showed a nonsignificant reduction in metabolic acidosis (RR 0.72, 95% confidence interval 0.43-1.19, number needed to treat [NNT] 357). ST analysis significantly reduced the incidence of additional fetal blood sampling (RR 0.59, 95% confidence interval 0.44-0.79, NNT 11), operative vaginal deliveries (RR 0.88, 95% confidence interval 0.80-0.97, NNT 64), and total operative deliveries (RR 0.94, 95% confidence interval 0.89-0.99, NNT 64). For other outcomes, no differences in effect were seen between ST analysis and conventional cardiotocography, or data were not suitable for meta-analysis. CONCLUSION:: The additional use of ST analysis for intrapartum monitoring reduced the incidence of operative vaginal deliveries and the need for fetal blood sampling but did not reduce the incidence of metabolic acidosis at birth.
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| 16. |
- Bengtsson, Jörgen, et al.
(författare)
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The influence of age on the distribution of morphine and morphine-3-glucuronide across the blood-brain barrier in sheep
- 2009
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Ingår i: British Journal of Pharmacology. - : Wiley. - 0007-1188 .- 1476-5381. ; 157:6, s. 1085-1096
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose The effect of age on the distribution of morphine and morphine-3-glucuronide (M3G) across the blood-brain barrier (BBB) was studied in a sheep model utilizing intracerebral microdialysis. The effect of neonatal asphyxia on brain drug distribution was also studied. Experimental approach Microdialysis probes were inserted into the cortex, striatum and blood of 11 lambs (127 gestation days) and six ewes. Morphine, 1 mg.kg(-1), was intravenously administered as a 10 min constant infusion. Microdialysis and blood samples were collected for up to 360 min and analysed using liquid chromatography-tandem mass spectrometry. The half-life, clearance, volume of distribution, unbound drug brain : blood distribution ratio (K(p,uu)) and unbound drug volume of distribution in brain (V(u,brain)) were estimated. Key results Morphine K(p,uu) was 1.19 and 1.89 for the sheep and premature lambs, respectively, indicating that active influx into the brain decreases with age. Induced asphyxia did not affect transport of morphine or M3G across the BBB. Morphine V(u,brain) measurements were higher in sheep than in premature lambs. The M3G K(p,uu) values were 0.27 and 0.17 in sheep and premature lambs, indicating a net efflux from the brain in both groups. Conclusions and implications The morphine K(p,uu) was above unity, indicating active transport into the brain; influx was significantly higher in premature lambs than in adult sheep. These results in sheep differ from those in humans, rats, mice and pigs where a net efflux of morphine from the brain is observed.
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| 17. |
- Bergström, Johan, et al.
(författare)
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The Social Process of Escalation: A Promising Focus for Crisis Management Research
- 2012
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 12:161
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Tidskriftsartikel (refereegranskat)abstract
- Background This study identifies a promising, new focus for the crisis management research in the health care domain. After reviewing the literature on health care crisis management, there seems to be a knowledge-gap regarding organisational change and adaption, especially when health care situations goes from normal, to non-normal, to pathological and further into a state of emergency or crisis. Discussion Based on studies of escalating situations in obstetric care it is suggested that two theoretical perspectives (contingency theory and the idea of failure as a result of incomplete interaction) tend to simplify the issue of escalation rather than attend to its complexities (including the various power relations among the stakeholders involved). However studying the process of escalation as inherently complex and social allows us to see the definition of a situation as normal or non-normal as an exercise of power in itself, rather than representing a putatively correct response to a particular emergency. Implications The concept of escalation, when treated this way, can help us further the analysis of clinical and institutional acts and competence. It can also turn our attention to some important elements in a class of social phenomenon, crises and emergencies, that so far have not received the attention they deserve. Focusing on organisational choreography, that interplay of potential factors such as power, professional identity, organisational accountability, and experience, is not only a promising focus for future naturalistic research but also for developing more pragmatic strategies that can enhance organisational coordination and response in complex events.
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| 18. |
- Dekker, Sidney, et al.
(författare)
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Complicated, complex and compliant: Best practice in obstetrics
- 2013
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Ingår i: Cognition, Technology & Work. - : Springer Science and Business Media LLC. - 1435-5566 .- 1435-5558. ; 15:2, s. 189-195
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Tidskriftsartikel (refereegranskat)abstract
- Abstract in Undetermined In this study the distinction between complicated and complex is used to shed some light on compliance with best-practice guidelines. Data was gathered related to obstetric practice in labor wards and operating theatres at two Scandinavian hospitals, one of them being a university hospital, and in a training facility. The complexity of obstetrical intervention is analyzed in this paper, as is the potential of compliance-based routines in obstetrics. Complex situations are different from complicated ones and patient safety management efforts should recognize and enhance the sort of diversity that helps the emergence of resilience in complex situations.
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| 19. |
- Edvinsson, Åsa, 1982-
(författare)
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Biological Aspects of Peripartum Depression
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Peripartum depression affects around 12% of women in pregnancy and postpartum, and about 2–3% of European pregnant women use antidepressants, mostly selective serotonin reuptake inhibitors (SSRIs). An increased risk of poor pregnancy outcomes has been described in women with antenatal depression and SSRI treatment during pregnancy. The biological mechanisms behind these complications are not fully understood and here we investigated several biological correlates of peripartum depression, and discriminated between the effects of antidepressant treatment and depression itself.In Paper I, attentional biases in pregnant and postpartum women were studied by using the Emotional Stroop Task, measuring reaction times to different stimuli. The major finding was shorter reaction times in postpartum depressed women, for emotionally valenced stimuli, which can be interpreted as emotional numbing.In Paper II, peripheral inflammatory markers were assessed by proximity extension assay technology in depressed, SSRI-treated and healthy pregnant women. Lower levels of 23 markers were found in women with antenatal depression, independent of treatment, compared with healthy controls. These findings suggest a dysregulated switch to the anti-inflammatory M2 milieu characterizing a normal third trimester.In Paper III, normal changes in inflammatory markers across pregnancy and postpartum were assessed in healthy pregnant and postpartum women. The majority (41) of the 50 markers that differed between groups were lower postpartum. These results clearly reflect the change in the immune system in pregnancy to postpartum transition.In Paper IV, placental gene and protein expression were investigated and nominally significant findings were noted for serotonin receptor 1A (HTR1A) and neuropeptide Y2 receptor (NPY2R), where women with untreated depression displayed higher gene expression than healthy controls. Protein expression analyses revealed higher levels of HTR1A in placentas from SSRI-treated women, compared with healthy controls and women with untreated depression. This suggests possible involvement of HTR1A in the effect of antenatal depression on the placenta.Overall, peripartum depression is associated with altered cognitive-emotional processing, lower levels of several mostly anti-inflammatory markers, and altered placental gene and protein expression. However, we found no major differences between untreated and treated depression.
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| 20. |
- Fornander, Liselott, 1981-
(författare)
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How we talk : aspects of communication and team cognition of trauma resuscitation teams
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A trauma team consists of professionals assembling in an ad hoc manner to resuscitate a patient with life-threatening injuries. In such a team, how the team manages to use non-technical skills, such as communication is important to achieve task management and decision making. Communication is practised in simulations, and the simulation environment has also been used in research to understand teamwork processes. This thesis is based on video observations of trauma teams working in real life (IRL) and in situ simulations of trauma resuscitations. The aim was to assess the creation of team cognition IRL and in simulation, to analyse verbal communication in the teams and the effects of real-time communication on team structure. In Study I, a grounded theory analysis was undertaken to understand how verbal and non-verbal interactions create team cognition. The analysis resulted in a theory pointing to “split vision” as a team’s ability to alter process modes between team positioning and sensitivity to the patient that was dependent on patient and situational values absorbed from team members’ implicit actions. In Study II, the verbal response modes taxonomy was applied to analyse both the grammatical and pragmatic meaning of verbal interactions that were compared between team roles. In the six most communicative team roles in the context of IRL trauma teamwork, pure mode communication dominated the way of delivering messages. In Study III, the structures of four IRL and four simulated trauma teams were analysed using a social network analysis of real-time communication. Overall, the teams were highly centralised, with the examining physician functioning as an information hub. In Study IV, communication from the same teams was categorised according to information and task management, as well as different coordination behaviours. We compared the IRL and simulation domains based on the proportions of utterances of each category/code, and found that “Give information after request” and closed-loop communication were more prevalent in simulation. Observing real-time communications using different methodologies gave a perspective on the conditions and possibilities for adaptation in terms of work prescriptions and team training, such as room for more communication and possible congestions of nodes in terms of occupancy and tacit communications and working modes thus far unnoticed by us and unreported. Such understanding complements established knowledge about coordination behaviours and interactive team cognition and should be taken into consideration in the practise and training of trauma teams.
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| 21. |
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| 22. |
- Hansson, Stefan, et al.
(författare)
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Increased fetal blood pressure response to maternal norepinephrine after pharmacological inhibition f norepinephrine uptake in pregnant sheep.
- 2007
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Ingår i: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 96:5, s. 650-654
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Norepinephrine (NE) is elevated in pregnancies complicated by preeclampsia (PE). Specific uptake of NE by the NE transporter (NET) plays a central role as regulator of NE levels. Expression of NET is reduced in placentas from PE pregnancies. To study adverse fetal effects of reduced NET expression on the placental buffering capacity, the NET was pharmacologically blocked by a specific uptake inhibitor reboxetine. Study Design: We evaluated the effect of NE uptake inhibition on maternal and fetal arterial blood pressure responses to increasing maternal doses of NE in 10 chronically prepared fetal sheep. Arterial blood pressure was monitored continuously during increasing doses of iv NE. Results: NET inhibition increased both fetal and maternal mean arterial blood pressure (p < 0.001, respectively). Conclusion: Reuptake by NET appears to be a mechanism protecting the fetus from NE. A reduced uptake capacity in preeclamptic pregnancies due to reduced NE uptake may lead to increased fetal arterial blood pressure.
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| 23. |
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| 24. |
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| 25. |
- Lavesson, Tony, et al.
(författare)
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Continuous monitoring of fetal scalp temperature in labor : a new technology validated in a fetal lamb model
- 2010
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 89:6, s. 807-812
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate a new technical equipment for continuous recording of human fetal scalp temperature in labor.DESIGN: Experimental animal study.METHODS: Two temperature sensors were placed subcutaneously and intracranially on the forehead of 10 fetal lambs and connected to a temperature monitoring system. The system records temperatures simultaneously on-line and stores data to be analyzed off-line. Throughout the experiment, the fetus was oxygenated via the umbilical cord circulation. Asphyxia was induced by intermittent cord compression, as assessed by pH in jugular vein blood. The intracranial (ICT) and subcutaneous (SCT) temperatures were compared with simple and polynomial regression analyses.MAIN OUTCOME MEASURES: Absolute and delta ICT and SCT changes.RESULTS: ICT and SCT were both successfully recorded in all 10 cases. With increasing acidosis, the temperatures decreased. The correlation coefficient between ICT and SCT had a range of 0.76-0.97 (median 0.88) by simple linear regression and 0.80-0.99 (median 0.89) by second grade polynomial regression. After an initial system stabilization period of 10 minutes, the delta temperature values (ICT minus SCT) were less than 1.5 degrees C throughout the experiment in all but one case.CONCLUSIONS: The fetal forehead SCT mirrored the ICT closely, with the ICT being higher.
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