Implementation of a revised classification for intrapartum fetal heart rate monitoring and association to birth outcome: A national cohort study.

Introduction: A revised intrapartum cardiotocography (CTG) classification was introduced in Sweden in 2017. The aims of the revision were to adapt to the international guideline published in 2015 and to adjust the classification of CTG patterns to current evidence regarding intrapartum fetal physiology. This study aimed to investigate adverse neonatal outcomes before and after implementation of the revised CTG classification.

Fetal scalp blood sampling during second stage of labor - analyzing lactate or pH? A secondary analysis of a randomized controlled trial.

Background: Cardiotocography (CTG) is a widely used method for assessing fetal wellbeing during labor. It is well-known that CTG has high sensitivity but low specificity. To avoid unnecessary operative interventions, adjunctive methods such as fetal blood sampling (FBS) are used.

Dextrose intravenous fluid therapy in labor reduces the length of the first stage of labor.

The aim of this systematic review with meta-analysis was to evaluate the effect on length of labor when patients receive IVF with or without dextrose. Searches were performed in electronic databases from inception of each database to May 2018. Trials comparing intrapartum IVF containing dextrose (i.

Fetal heart rate short term variation during labor in relation to scalp blood lactate concentration.

Introduction: Fetal heart rate short term variation (STV) decreases with severe chronic hypoxia in the antenatal period. However, only limited research has been done on STV during labor. We have tested a novel algorithm for a valid baseline estimation and calculated STV.

Validation of a computerized algorithm to quantify fetal heart rate deceleration area.

Introduction: Reliability in visual cardiotocography interpretation is unsatisfying, which has led to the development of computerized cardiotocography. Computerized analysis is well established for antenatal fetal surveillance but has yet not performed sufficiently during labor. We aimed to investigate the capacity of a new computerized algorithm compared with visual assessment in identifying intrapartum fetal heart rate baseline and decelerations.

Infant outcome at four years of age after intrapartum sampling of scalp blood lactate for fetal assessment. A cohort study.

Objective: To correlate the value of lactate in fetal scalp blood at delivery and the outcomes of the offspring at four years of age.

Methods: Cases where scalp blood lactate was taken within sixty minutes before delivery were identified from the randomized trial "Determination of pH or lactate in fetal scalp blood in management of intrapartum fetal distress". Data were grouped according to the generally accepted cutoffs for normality, pre-acidemia, acidemia and concentrations above mean +2 SD during the second stage.

Risk factors for intrapartum acidemia - a cohort study.

Purpose: Birth acidemia is associated with short- and long-term morbidity in the child. Optimal intrapartum surveillance and timely interventions may reduce the incidence of these outcomes. Knowledge about conditions which increase the risks might be beneficial for optimal care.

Absence of accelerations during labor is of little value in interpreting fetal heart rate patterns.

Introduction: The aim of this study was to investigate the correlation between increasing time since fetal heart rate (FHR) accelerations, positive (no acceleration) stimulation tests and fetal acidemia.

Material And Methods: Observational study of FHR recordings from 1070 laboring women with indication for fetal scalp blood sampling (FBS). FHR traces were scrutinized regarding acceleration at FBS and duration since most recent acceleration.

Reference values for Lactate Pro 2™ in fetal blood sampling during labor: a cross-sectional study.

Objective: Lactate Pro™ (LP1) is the only lactate meter evaluated for fetal scalp blood sampling (FBS) in intrapartum use. The reference values for this meter are: normal value <4.2 mmol/L, preacidemia 4.

Fetal heart rate monitoring of short term variation (STV): a methodological observational study.

Background: Cardiotocography (CTG) has high sensitivity, but less specificity in detection of fetal hypoxia. There is need for adjunctive methods easy to apply during labor. Low fetal heart rate short term variation (STV) is predictive for hypoxia during the antenatal period.

Neonatal outcome and delivery mode in labors with repetitive fetal scalp blood sampling.

Objective: To investigate if repeat (≥ 3) fetal scalp blood sampling (FBS) is associated with increased risk of caesarean delivery and worse neonatal outcome than occasional (1-2) FBS.

Study Design: Prospective cohort study of women undergoing intrapartum FBS at Karolinska University Hospital, Sweden. FBS with lactate analysis was performed if the attending doctor found the cardiotocography (CTG) tracing suspicious or abnormal.

Cardiotocography patterns and risk of intrapartum fetal acidemia.

Aim: To identify cardiotocography (CTG) patterns associated with increased risk of intrapartum fetal acidemia.

Methods: A prospective observational cohort study of 1070 women with fetal scalp blood sampling (FBS) during labor was conducted at Karolinska University Hospital, Stockholm, Sweden. Women with a nonreassuring CTG pattern underwent FBS, and lactate concentration was measured at the bedside.

Oxytocin augmentation during labor: how to implement medical guidelines into clinical practice.

Objective: To describe an extensive process to implement guidelines for oxytocin use during labor and to report its effects on compliance to clinical practice guidelines after 1 year.

Study Design: A multifaceted strategy was developed to involve all obstetric staff and identify possible local barriers to change in advance. The process lasted for more than 1 year.

Outcome of severe intrapartum acidemia diagnosed with fetal scalp blood sampling.

Aim: To analyze short-term neonatal outcome and the sampling to delivery interval in cases with severe intrapartum acidemia diagnosed with fetal scalp blood sampling (FBS).

Methods: This is a secondary analysis of data from a trial of 2992 women, who were, when indicated, randomized to either lactate or pH analyses by FBS. Median and 95(th) centile values for lactate analyses were 2.

Follow-up national survey (Sweden) of routines for intrapartum fetal surveillance.

We performed a follow-up national survey concerning intrapartum fetal surveillance in Sweden to investigate if routines had changed since a previous survey in 1999, due to new data that have emerged since and technical developments. All labor wards throughout Sweden, with sizes varying from around 350 to more than 9,000 deliveries per year, have at present a rather uniform policy for intrapartum fetal surveillance with electronic fetal monitoring (EFM). They all use admission tests, fetal scalp blood sampling and have written guidelines for EFM.