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Geburtshilfe Frauenheilkd 2012; 72(3): 211-214
DOI: 10.1055/s-0031-1298329
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

Non-invasive Foetal ECG – a Comparable Alternative to the Doppler CTG?

Fetales nicht invasives EKG – eine gleichwertige Alternative zum CTG?
J. Reinhard
1   Johann Wolfgang Goethe University, Department of Gynaecology and Obstetrics, Frankfurt am Main
,
F. Louwen
1   Johann Wolfgang Goethe University, Department of Gynaecology and Obstetrics, Frankfurt am Main
› Author Affiliations
Further Information

Publication History

received 20 January 2012

accepted 2 08 January 2012

Publication Date:
05 April 2012 (online)

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Abstract

This review discusses the alternative of using the non-invasive foetal ECG compared with the conventionally used Doppler CTG. Non-invasive abdominal electrocardiograms (ECG) have been approved for clinical routine since 2008; subsequently they were also approved for antepartum and subpartum procedures. The first study results have been published. Non-invasive foetal ECG is especially indicated during early pregnancy, while the Doppler CTG is recommended for the vernix period. Beyond the vernix period no difference has been recorded in the success rate of either approach. The foetal ECG signal quality is independent of the BMI, whereas the success rate of the Doppler CTG is diminished with an increased BMI. During the first stage of labour, non-invasive foetal ECG demonstrates better signal quality; however during the second stage of labour no difference has been identified between the methods.

Zusammenfassung

In diesem Review soll die Alternative einer fetalen EKG-Überwachung mit der bisher üblichen CTG-Überwachung verglichen werden. Seit 2008 gibt es ein für die klinische Routine zugelassenes, nicht invasives abdominales Elektrokardiogramm-(EKG-)Gerät, das inzwischen antepartal und unter der Geburt zugelassen ist. Erste Studienergebnisse sind publiziert. Das nicht invasive EKG ist besonders in den frühen Schwangerschaftswochen indiziert, während in der Vernix-Periode das CTG überlegen ist. Nach der Vernix-Periode zeigt sich kein Unterschied in der Erfolgsrate. Die Signalqualität des fetalen EKGs ist vom BMI unabhängig, während das CTG bei einem erhöhten BMI eine schlechtere Signalqualität zeigt. In der Eröffnungsperiode zeigt das EKG eine bessere Signalqualität als das CTG, in der Austreibungsperiode weisen beide Verfahren keine Unterschiede hinsichtlich der Signalqualität auf.

Key words

obstetrics - fetal ECG - Doppler CTG

Schlüsselwörter

Geburtshilfe - fetales EKG - Doppler-CTG

Supporting Information

 

  • References

  • 1 Shewa A, Hacker TW, Nuovo J. Interpretation of the electronic fetal heart rate during labour. Am Family Phys 1999; 59: 2507-2512
    PubMedGoogle Scholar
  • 2 Neilson DR, Freeman RK, Mangan S. Signal ambiguity resulting in unexpected outcome with external fetal heart rate monitoring. AJOG 2008; 6: 717-724
    PubMedGoogle Scholar
  • 3 Amer-Wahlin I, Hellsten C, Norén H et al. Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: a Swedish randomised controlled trial. Lancet 2001; 358: 534-538
    CrossrefPubMedGoogle Scholar
  • 4 Strachan BK, van Wijngaarden WJ, Sahota D et al. Cardiotocography only versus cardiotocography plus PR-interval analysis in intrapartum surveillance: a randomised, multicentre trial. Lancet 2000; 355: 456-459
    CrossrefPubMedGoogle Scholar
  • 5 Strachan KB, Sahota DS, van Wijngaarden WJ et al. Computerised analysis of the fetal heart rate and relation to academia at delivery. Br J Obstet Gynaecol 2001; 108: 848-852
    PubMedGoogle Scholar
  • 6 Schiermeier S, Hatzmann H, Reinhard J. Die Wertigkeit der computergestützten CTG-Analyse in den letzten 70 Minuten vor der Entbindung. Z Geburtsh Neonatol 2008; 212: 189-193
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Schiermeier S, Westhof G, Daumer M et al. Die Kurzzeitvariation der fetalen Herzfrequenz und der FIGO-CTG-Score. Erste Erfahrungen in der Kombination dieser Überwachungsparameter. Geburtsh Frauenheilk 2006; 66: 752-755
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Schiermeier S, Pildner von Steinburg S, Thieme A et al. Sensitivity and specificity of intrapartum computerised FIGO criteria for cardiotocography (CTG) and fetal scalp pH during labour: multi-centre, observational study. BJOG 2008; 115: 1557-1563
    CrossrefPubMedGoogle Scholar
  • 9 Schiermeier S, Westhof G, Leven A et al. Intra- and interobserver variability of intrapartum cardiotocography: a multicenter study comparing the FIGO classification with computer analysis software. Gynecol Obstet Invest 2011; 72: 169-173
    CrossrefPubMedGoogle Scholar
  • 10 Parer JT, King T. Fetal heart rate monitoring: is it salvageable?. Am J Obstet Gynecol 2000; 182: 982-987
    CrossrefPubMedGoogle Scholar
  • 11 Hatzmann W, Schiermeier S, Reinhard J. Die nicht-invasive Ableitung des fetalen EKGs – Eine neue Möglichkeit der Überwachung der fetalen Herzfrequenz mit dem Monica AN24 TM. Frauenarzt 2010; 51: 120-123
    PubMedGoogle Scholar
  • 12 Reinhard J, Hayes-Gill BR, Yi Q et al. Signalqualität der nicht-invasiven fetalen Echokardiographie (EKG) unter der Geburt. Geburtsh Frauenheilk 2009; 69: 703-706
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Reinhard J, Hayes-Gill BR, Yi Q et al. The equivalence of non-invasive foetal electrocardiogram (fEKG) to Doppler cardiotocogram (CTG) ultrasound during the 1st stage of labour. J Perinat Med 2010; 38: 179-185
    CrossrefPubMedGoogle Scholar
  • 14 Reinhard J, Hatzmann H, Schiermeier S. Fetales Elektrokardiogramm (EKG) als Alternative der Doppler-Kardiotokografie (CTG) zur antepartualen Überwachung des Feten – erste Ergebnisse. Z Geburtsh Neonatol 2008; 212: 226-229
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Reinhard J, Hayes-Gill BR, Yi Q et al. Long term non-invasive fetal electrocardiogram (fEKG) and Doppler cardiotocogram (CTG) ultrasound during 1st and 2nd stage of labor. J Perinat Med 2009; 37 (Suppl. 01) 638
    PubMedGoogle Scholar
  • 16 Reinhard J, Hayes-Gill BR, Schiermeier S et al. Intrapartum fetal and maternal heart rate ambiguity – a comparison of Doppler ultrasound CTG and the abdominal fetal electrocardiogram with maternal electrocardiogram. Gyn Obs Invest (review)
    PubMedGoogle Scholar
  • 17 http://www.healthcare.philips.com/us_en/support/fetal_monitor_notice.wpd last access: 4.9.2009
    PubMed
  • 18 Poston L, Harthoom LF, Van der Beek EM. Obesity in pregnancy: implications for the mother and lifelong health of the child. A consensus statement. Pediatr Res 2011; 69: 175-180
    CrossrefPubMedGoogle Scholar
  • 19 Reinhard J, Hayes-Gill BR, Schiermeier S et al. Uterine activity monitoring during labour – a multi-centre, blinded two-way trial of external tocodynamometry against electrohysterography. Z Geburtsh Neonatol 2011; 215: 199-204
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Vinken MP, Rabotti C, Mischi M et al. Accuracy of frequency-related parameters of the electrohysterogram for predicting preterm delivery: a review of the literature. Obstet Gynecol Surv 2009; 64: 529-541
    CrossrefPubMedGoogle Scholar