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Khalid S. Khan - One of the best experts on this subject based on the ideXlab platform.
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PP.23 Measurements of Amniotic Fluid: Association and Prediction of Small For Gestational Age and Compromise of Fetal Wellbeing: A Systematic Review and Meta-Analysis
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2013Co-Authors: Rk Morris, César H. Meller, Jennifer Tamblyn, Gm Malin, Richard D Riley, Kilby, Stephen C. Robson, Khalid S. KhanAbstract:Objective Evaluate the strength of association and predictive value of measurements of amniotic fluid volume (AFV) for small for gestational age and compromise of Fetal Wellbeing. Design Systematic literature review with random effects meta-analysis to compute summary odds ratios (OR) to assess prognostic association and assess predictive ability with sensitivity, specificity and likelihood ratios. Study characteristics, design, methodological and reporting quality were objectively assessed. Data Sources and Eligibility Systematic search (inception to October 2011) for studies comparing AFV measures and outcomes of Fetal size or Wellbeing. Results 43 studies reporting 244,493 fetuses included. Strong associations between oligohydramnios (heterogenic definition) and birth weight There was no significant association between polyhydramnios (heterogenic definitions) and poor Fetal growth [Birth weight th centile OR 0.37 (0.07–1.95)]. A strong association between polyhydramnios (maximum pool depth > 8 cm or amniotic fluid index ≥ 25 cm) and birth weight > 90 th centile [OR 11.41 (7.09–18.36) 1 study, 3960 fetuses] was found. Despite strong associations predictive ability was poor with significant heterogeneity despite sub-group analysis. Conclusion Oligohydramnios is associated with poor Fetal growth and mortality. Polyhydramnios is associated with BW > 90th centile. Despite strong associations, overall predictive ability was poor. MPD accuracy was slightly improved over AFI and is the recommended technique.
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The value of predicting restriction of Fetal growth and compromise of its Wellbeing: Systematic quantitative overviews (meta-analysis) of test accuracy literature
BMC pregnancy and childbirth, 2007Co-Authors: Rachel Katherine Morris, Stephen C. Robson, Khalid S. Khan, Aravinthan Coomarasamy, Jos KleijnenAbstract:Background Restriction of Fetal growth and compromise of Fetal Wellbeing remain significant causes of perinatal death and childhood disability. At present, there is a lack of scientific consensus about the best strategies for predicting these conditions before birth. Therefore, there is uncertainty about the best management of pregnant women who might have a growth restricted baby. This is likely to be due to a dearth of clear collated information from individual research studies drawn from different sources on this subject.
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the value of predicting restriction of Fetal growth and compromise of its Wellbeing systematic quantitative overviews meta analysis of test accuracy literature
BMC Pregnancy and Childbirth, 2007Co-Authors: Rk Morris, Stephen C. Robson, Khalid S. Khan, Aravinthan Coomarasamy, Jos KleijnenAbstract:Restriction of Fetal growth and compromise of Fetal Wellbeing remain significant causes of perinatal death and childhood disability. At present, there is a lack of scientific consensus about the best strategies for predicting these conditions before birth. Therefore, there is uncertainty about the best management of pregnant women who might have a growth restricted baby. This is likely to be due to a dearth of clear collated information from individual research studies drawn from different sources on this subject. A series of systematic reviews and meta-analyses will be undertaken to determine, among pregnant women, the accuracy of various tests to predict and/or diagnose Fetal growth restriction and compromise of Fetal Wellbeing. We will search Medline, Embase, Cochrane Library, MEDION, citation lists of review articles and eligible primary articles and will contact experts in the field. Independent reviewers will select studies, extract data and assess study quality according to established criteria. Language restrictions will not be applied. Data synthesis will involve meta-analysis (where appropriate), exploration of heterogeneity and publication bias. The project will collate and synthesise the available evidence regarding the value of the tests for predicting restriction of Fetal growth and compromise of Fetal Wellbeing. The systematic overviews will assess the quality of the available evidence, estimate the magnitude of potential benefits, identify those tests with good predictive value and help formulate practice recommendations.
Declan Devane - One of the best experts on this subject based on the ideXlab platform.
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cardiotocography versus intermittent auscultation of Fetal heart on admission to labour ward for assessment of Fetal Wellbeing
Cochrane Database of Systematic Reviews, 2017Co-Authors: Declan Devane, Joan Lalor, Sean Daly, William Mcguire, Anna Cuthbert, Valerie SmithAbstract:Background The admission cardiotocograph (CTG) is a commonly used screening test consisting of a short (usually 20 minutes) recording of the Fetal heart rate (FHR) and uterine activity performed on the mother's admission to the labour ward. This is an update of a review published in 2012. Objectives To compare the effects of admission cardiotocography with intermittent auscultation of the FHR on maternal and infant outcomes for pregnant women without risk factors on their admission to the labour ward. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register to 30 November 2016 and we planned to review the reference list of retrieved papers. Selection criteria All randomised and quasi-randomised trials comparing admission CTG with intermittent auscultation of the FHR for pregnant women between 37 and 42 completed weeks of pregnancy and considered to be at low risk of intrapartum Fetal hypoxia and of developing complications during labour. Data collection and analysis Two authors independently assessed trial eligibility and quality, and extracted data. Data were checked for accuracy. Main results We included no new trials in this update. We included four trials involving more than 13,000 women which were conducted in the UK and Ireland and included women in labour. Three trials were funded by the hospitals where the trials took place and one trial was funded by the Scottish government. No declarations of interest were made in two trials; the remaining two trials did not mention declarations of interest. Overall, the studies were assessed as low risk of bias. Results reported in the 2012 review remain unchanged. Although not statistically significant using a strict P < 0.05 criterion, data were consistent with women allocated to admission CTG having, on average, a higher probability of an increase in incidence of caesarean section than women allocated to intermittent auscultation (risk ratio (RR) 1.20, 95% confidence interval (CI) 1.00 to 1.44, 4 trials, 11,338 women, I² = 0%, moderate quality evidence). There was no clear difference in the average treatment effect across included trials between women allocated to admission CTG and women allocated to intermittent auscultation in instrumental vaginal birth (RR 1.10, 95% CI 0.95 to 1.27, 4 trials, 11,338 women, I² = 38%, low quality evidence) and perinatal mortality rate (RR 1.01, 95% CI 0.30 to 3.47, 4 trials, 11,339 infants, I² = 0%, moderate quality evidence). Women allocated to admission CTG had, on average, higher rates of continuous electronic Fetal monitoring during labour (RR 1.30, 95% CI 1.14 to 1.48, 3 trials, 10,753 women, I² = 79%, low quality evidence) and Fetal blood sampling (RR 1.28, 95% CI 1.13 to 1.45, 3 trials, 10,757 women, I² = 0%) than women allocated to intermittent auscultation. There were no differences between groups in other secondary outcome measures including incidence and severity of hypoxic ischaemic encephalopathy (incidence only reported) (RR 1.19, 95% CI 0.37 to 3.90; 2367 infants; 1 trial; very low quality evidence) and incidence of seizures in the neonatal period (RR 0.72, 95% CI 0.32 to 1.61; 8056 infants; 1 trial; low quality evidence). There were no data reported for severe neurodevelopmental disability assessed at greater than, or equal to, 12 months of age. Authors' conclusions Contrary to continued use in some clinical areas, we found no evidence of benefit for the use of the admission CTG for low-risk women on admission in labour. Furthermore, the probability is that admission CTG increases the caesarean section rate by approximately 20%. The data lacked power to detect possible important differences in perinatal mortality. However, it is unlikely that any trial, or meta-analysis, will be adequately powered to detect such differences. The findings of this review support recommendations that the admission CTG not be used for women who are low risk on admission in labour. Women should be informed that admission CTG is likely associated with an increase in the incidence of caesarean section without evidence of benefit. Evidence quality ranged from moderate to very low, with downgrading decisions based on imprecision, inconsistency and a lack of blinding for participants and personnel. All four included trials were conducted in developed Western European countries. One additional study is ongoing. The usefulness of the findings of this review for developing countries will depend on FHR monitoring practices. However, an absence of benefit and likely harm associated with admission CTG will have relevance for countries where questions are being asked about the role of the admission CTG. Future studies evaluating the effects of the admission CTG should consider including women admitted with signs of labour and before a formal diagnosis of labour. This would include a cohort of women currently having admission CTGs and not included in current trials.
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biophysical profile for Fetal assessment in high risk pregnancies
Cochrane Database of Systematic Reviews, 2008Co-Authors: Joan Lalor, Bukola Fawole, Zarko Alfirevic, Declan DevaneAbstract:Background A biophysical profile (BPP) includes ultrasound monitoring of Fetal movements, Fetal tone and Fetal breathing, ultrasound assessment of liquor volume with or without assessment of the Fetal heart rate. The BPP is performed in an effort to identify babies that may be at risk of poor pregnancy outcome, so that additional assessments of Wellbeing may be performed, or labour may be induced or a caesarean section performed to expedite birth. Objectives To assess the effects of the BPP when compared with conventional monitoring (CTG only or MBPP) on pregnancy outcome in high-risk pregnancies. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (October 2007), CENTRAL (The Cochrane Library 2006, Issue 4), MEDLINE (1966 to November 2006), EMBASE (1974 to November 2006) and CINAHL (1980 to November 2006). We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register (10 January 2012) and added the results to the awaiting classification section. Selection criteria Randomised and quasi-randomised controlled trials involving a comparison of Fetal BPP with other forms of antepartum Fetal assessment in women with high-risk pregnancies. Data collection and analysis Two authors independently assessed eligibility, quality and extracted data. Main results We included five trials, involving 2974 women. Most trials were not of high quality. Although the overall incidence of adverse outcomes was low, available evidence from randomised controlled trials does not support the use of BPP as a test of Fetal Wellbeing in high-risk pregnancies. We found no significant differences between the groups in perinatal deaths (relative risk (RR) 1.33, 95% confidence interval (CI) 0.60 to 2.98) or in Apgar score less than seven at five minutes (RR 1.27, 95% CI 0.85 to 1.92).Combined data from the two high-quality trials suggest an increased risk of caesarean section in the BPP group RR 1.60, 95% CI 1.05 to 2.44, n = 280, interaction test P = 0.03. However, the number of participating women was relatively small (n = 280). Therefore, additional evidence is required in order to be definitive regarding the efficacy of this test in high-risk pregnancies. Furthermore, the impact of the BPP on other interventions, length of hospitalisation, serious short-term and long-term neonatal morbidity and parental satisfaction requires further evaluation. Authors' conclusions At present, there is insufficient evidence from randomised trials to support the use of BPP as a test of Fetal Wellbeing in high-risk pregnancies. [Note: The three citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]
Nana Wiberg - One of the best experts on this subject based on the ideXlab platform.
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Effectiveness of Fetal scalp stimulation test in assessing Fetal Wellbeing during labor, a retrospective cohort study
BMC pregnancy and childbirth, 2020Co-Authors: Farzaneh Shakouri, Linda Iorizzo, Hellen Mc Kinnon Edwards, Christina Anne Vinter, Karl Kristensen, Per-erik Isberg, Nana WibergAbstract:BACKGROUND: It is discussed whether Fetal scalp stimulation (FSS) test is a reliable complimentary tool to cardiotocography (CTG) to assess Fetal Wellbeing during labor. The test is based on the assumption that a well-oxygenated fetus, in contrast to the depressed fetus, will respond to a certain stimulus. The aim of this study was to investigate the effectiveness of the FSS-test.METHODS: A retrospective observational study carried out Copenhagen University Hospital, Herlev, Denmark. Laboring women with singleton pregnancies in cephalic presentation after gestation week 33 and indication for Fetal blood sampling (FBS) were eligible for inclusion. The FSS-test was classified as positive when an acceleration was absent at the time of FBS and negative when an acceleration was present. Lactate in scalp blood was measured by the point-of-care device LactatePro™ and pH in artery umbilical cord blood by the stationary blood gas analyzer ABL800. Lactate level 7.1 were cut-offs for normality.RESULTS: Three hundred eighty-five women were included. The cohort was divided by the FBS-to-delivery time: Group 1 (n = 128) ≤ 20 min, Group 2 (n = 117) 21-59 min and Group 3 (n = 140) ≥ 60 min. The proportion of FSS-positive tests differed significantly between the groups (p < 0.000). In Group 1 the sensitivity, specificity and likelihoods for scalp lactate ≥4.2 mmol/L were 81.5 (95% CI 67-90.1), 13.3 18.5 (95% CI 5.9-24.6), LHR+ 0.94 (95% CI 0.8-1.1) and LHR - 1.4 (95% CI 0.6-3.2) and for umbilical artery pH ≤ 7.10 the values were 82.6% (95% CI 61.2-95.1), 16% (95% CI 9.4-24.7), 1.0 (95% CI 0.8-1.2) and 1.1 (95% CI 0.4-3) respectively. Regardless of the FBS-to-delivery time the LHR+ for lactate ≥4.2 mmol/L increased to 1.38 (95% CI 1.2-1.6).CONCLUSION: The effectiveness of scalp stimulation test was poor for both ruling in and out Fetal hypoxia during labor. Absence of a provoked acceleration seems to be a normal phenomenon in the second stage of labor. (Less)
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effectiveness of Fetal scalp stimulation test in assessing Fetal Wellbeing during labor a retrospective cohort study
BMC Pregnancy and Childbirth, 2020Co-Authors: Farzaneh Shakouri, Linda Iorizzo, Hellen Mc Kinnon Edwards, Christina Anne Vinter, Karl Kristensen, Per-erik Isberg, Nana WibergAbstract:It is discussed whether Fetal scalp stimulation (FSS) test is a reliable complimentary tool to cardiotocography (CTG) to assess Fetal Wellbeing during labor. The test is based on the assumption that a well-oxygenated fetus, in contrast to the depressed fetus, will respond to a certain stimulus. The aim of this study was to investigate the effectiveness of the FSS-test. A retrospective observational study carried out Copenhagen University Hospital, Herlev, Denmark. Laboring women with singleton pregnancies in cephalic presentation after gestation week 33 and indication for Fetal blood sampling (FBS) were eligible for inclusion. The FSS-test was classified as positive when an acceleration was absent at the time of FBS and negative when an acceleration was present. Lactate in scalp blood was measured by the point-of-care device LactatePro™ and pH in artery umbilical cord blood by the stationary blood gas analyzer ABL800. Lactate level 7.1 were cut-offs for normality. Three hundred eighty-five women were included. The cohort was divided by the FBS-to-delivery time: Group 1 (n = 128) ≤ 20 min, Group 2 (n = 117) 21–59 min and Group 3 (n = 140) ≥ 60 min. The proportion of FSS-positive tests differed significantly between the groups (p < 0.000). In Group 1 the sensitivity, specificity and likelihoods for scalp lactate ≥4.2 mmol/L were 81.5 (95% CI 67–90.1), 13.3 18.5 (95% CI 5.9–24.6), LHR+ 0.94 (95% CI 0.8–1.1) and LHR – 1.4 (95% CI 0.6–3.2) and for umbilical artery pH ≤ 7.10 the values were 82.6% (95% CI 61.2–95.1), 16% (95% CI 9.4–24.7), 1.0 (95% CI 0.8–1.2) and 1.1 (95% CI 0.4–3) respectively. Regardless of the FBS-to-delivery time the LHR+ for lactate ≥4.2 mmol/L increased to 1.38 (95% CI 1.2–1.6). The effectiveness of scalp stimulation test was poor for both ruling in and out Fetal hypoxia during labor. Absence of a provoked acceleration seems to be a normal phenomenon in the second stage of labor.
Rk Morris - One of the best experts on this subject based on the ideXlab platform.
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PP.23 Measurements of Amniotic Fluid: Association and Prediction of Small For Gestational Age and Compromise of Fetal Wellbeing: A Systematic Review and Meta-Analysis
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2013Co-Authors: Rk Morris, César H. Meller, Jennifer Tamblyn, Gm Malin, Richard D Riley, Kilby, Stephen C. Robson, Khalid S. KhanAbstract:Objective Evaluate the strength of association and predictive value of measurements of amniotic fluid volume (AFV) for small for gestational age and compromise of Fetal Wellbeing. Design Systematic literature review with random effects meta-analysis to compute summary odds ratios (OR) to assess prognostic association and assess predictive ability with sensitivity, specificity and likelihood ratios. Study characteristics, design, methodological and reporting quality were objectively assessed. Data Sources and Eligibility Systematic search (inception to October 2011) for studies comparing AFV measures and outcomes of Fetal size or Wellbeing. Results 43 studies reporting 244,493 fetuses included. Strong associations between oligohydramnios (heterogenic definition) and birth weight There was no significant association between polyhydramnios (heterogenic definitions) and poor Fetal growth [Birth weight th centile OR 0.37 (0.07–1.95)]. A strong association between polyhydramnios (maximum pool depth > 8 cm or amniotic fluid index ≥ 25 cm) and birth weight > 90 th centile [OR 11.41 (7.09–18.36) 1 study, 3960 fetuses] was found. Despite strong associations predictive ability was poor with significant heterogeneity despite sub-group analysis. Conclusion Oligohydramnios is associated with poor Fetal growth and mortality. Polyhydramnios is associated with BW > 90th centile. Despite strong associations, overall predictive ability was poor. MPD accuracy was slightly improved over AFI and is the recommended technique.
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the value of predicting restriction of Fetal growth and compromise of its Wellbeing systematic quantitative overviews meta analysis of test accuracy literature
BMC Pregnancy and Childbirth, 2007Co-Authors: Rk Morris, Stephen C. Robson, Khalid S. Khan, Aravinthan Coomarasamy, Jos KleijnenAbstract:Restriction of Fetal growth and compromise of Fetal Wellbeing remain significant causes of perinatal death and childhood disability. At present, there is a lack of scientific consensus about the best strategies for predicting these conditions before birth. Therefore, there is uncertainty about the best management of pregnant women who might have a growth restricted baby. This is likely to be due to a dearth of clear collated information from individual research studies drawn from different sources on this subject. A series of systematic reviews and meta-analyses will be undertaken to determine, among pregnant women, the accuracy of various tests to predict and/or diagnose Fetal growth restriction and compromise of Fetal Wellbeing. We will search Medline, Embase, Cochrane Library, MEDION, citation lists of review articles and eligible primary articles and will contact experts in the field. Independent reviewers will select studies, extract data and assess study quality according to established criteria. Language restrictions will not be applied. Data synthesis will involve meta-analysis (where appropriate), exploration of heterogeneity and publication bias. The project will collate and synthesise the available evidence regarding the value of the tests for predicting restriction of Fetal growth and compromise of Fetal Wellbeing. The systematic overviews will assess the quality of the available evidence, estimate the magnitude of potential benefits, identify those tests with good predictive value and help formulate practice recommendations.
Stephen C. Robson - One of the best experts on this subject based on the ideXlab platform.
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PP.23 Measurements of Amniotic Fluid: Association and Prediction of Small For Gestational Age and Compromise of Fetal Wellbeing: A Systematic Review and Meta-Analysis
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2013Co-Authors: Rk Morris, César H. Meller, Jennifer Tamblyn, Gm Malin, Richard D Riley, Kilby, Stephen C. Robson, Khalid S. KhanAbstract:Objective Evaluate the strength of association and predictive value of measurements of amniotic fluid volume (AFV) for small for gestational age and compromise of Fetal Wellbeing. Design Systematic literature review with random effects meta-analysis to compute summary odds ratios (OR) to assess prognostic association and assess predictive ability with sensitivity, specificity and likelihood ratios. Study characteristics, design, methodological and reporting quality were objectively assessed. Data Sources and Eligibility Systematic search (inception to October 2011) for studies comparing AFV measures and outcomes of Fetal size or Wellbeing. Results 43 studies reporting 244,493 fetuses included. Strong associations between oligohydramnios (heterogenic definition) and birth weight There was no significant association between polyhydramnios (heterogenic definitions) and poor Fetal growth [Birth weight th centile OR 0.37 (0.07–1.95)]. A strong association between polyhydramnios (maximum pool depth > 8 cm or amniotic fluid index ≥ 25 cm) and birth weight > 90 th centile [OR 11.41 (7.09–18.36) 1 study, 3960 fetuses] was found. Despite strong associations predictive ability was poor with significant heterogeneity despite sub-group analysis. Conclusion Oligohydramnios is associated with poor Fetal growth and mortality. Polyhydramnios is associated with BW > 90th centile. Despite strong associations, overall predictive ability was poor. MPD accuracy was slightly improved over AFI and is the recommended technique.
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The value of predicting restriction of Fetal growth and compromise of its Wellbeing: Systematic quantitative overviews (meta-analysis) of test accuracy literature
BMC pregnancy and childbirth, 2007Co-Authors: Rachel Katherine Morris, Stephen C. Robson, Khalid S. Khan, Aravinthan Coomarasamy, Jos KleijnenAbstract:Background Restriction of Fetal growth and compromise of Fetal Wellbeing remain significant causes of perinatal death and childhood disability. At present, there is a lack of scientific consensus about the best strategies for predicting these conditions before birth. Therefore, there is uncertainty about the best management of pregnant women who might have a growth restricted baby. This is likely to be due to a dearth of clear collated information from individual research studies drawn from different sources on this subject.
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the value of predicting restriction of Fetal growth and compromise of its Wellbeing systematic quantitative overviews meta analysis of test accuracy literature
BMC Pregnancy and Childbirth, 2007Co-Authors: Rk Morris, Stephen C. Robson, Khalid S. Khan, Aravinthan Coomarasamy, Jos KleijnenAbstract:Restriction of Fetal growth and compromise of Fetal Wellbeing remain significant causes of perinatal death and childhood disability. At present, there is a lack of scientific consensus about the best strategies for predicting these conditions before birth. Therefore, there is uncertainty about the best management of pregnant women who might have a growth restricted baby. This is likely to be due to a dearth of clear collated information from individual research studies drawn from different sources on this subject. A series of systematic reviews and meta-analyses will be undertaken to determine, among pregnant women, the accuracy of various tests to predict and/or diagnose Fetal growth restriction and compromise of Fetal Wellbeing. We will search Medline, Embase, Cochrane Library, MEDION, citation lists of review articles and eligible primary articles and will contact experts in the field. Independent reviewers will select studies, extract data and assess study quality according to established criteria. Language restrictions will not be applied. Data synthesis will involve meta-analysis (where appropriate), exploration of heterogeneity and publication bias. The project will collate and synthesise the available evidence regarding the value of the tests for predicting restriction of Fetal growth and compromise of Fetal Wellbeing. The systematic overviews will assess the quality of the available evidence, estimate the magnitude of potential benefits, identify those tests with good predictive value and help formulate practice recommendations.