RESEARCH ARTICLE
The electrical heart axis and ST events in fetal monitoring: A post-hoc analysis following a multicentre randomised controlled trial Rik Vullings1, Kim M. J. Verdurmen2*, Alexandra D. J. Hulsenboom2, Stephanie Scheffer2, Hinke de Lau2, Anneke Kwee3, Pieter F. F. Wijn4, Isis Amer-Wåhlin5, Judith O. E. H. van Laar2, S. Guid Oei1,2
a1111111111 a1111111111 a1111111111 a1111111111 a1111111111
1 Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands, 2 Department of Obstetrics and Gynaecology, Ma´xima Medical Centre, Veldhoven, the Netherlands, 3 Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, the Netherlands, 4 Department of Clinical Physics, Ma´xima Medical Centre, Veldhoven, the Netherlands, 5 Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden * [email protected]
Abstract OPEN ACCESS Citation: Vullings R, Verdurmen KMJ, Hulsenboom ADJ, Scheffer S, de Lau H, Kwee A, et al. (2017) The electrical heart axis and ST events in fetal monitoring: A post-hoc analysis following a multicentre randomised controlled trial. PLoS ONE 12(4): e0175823. https://doi.org/10.1371/journal. pone.0175823 Editor: Martin Gerbert Frasch, University of Washington, UNITED STATES Received: November 6, 2016
Objective Reducing perinatal morbidity and mortality is one of the major challenges in modern health care. Analysing the ST segment of the fetal electrocardiogram was thought to be the breakthrough in fetal monitoring during labour. However, its implementation in clinical practice yields many false alarms and ST monitoring is highly dependent on cardiotocogram assessment, limiting its value for the prediction of fetal distress during labour. This study aims to evaluate the relation between physiological variations in the orientation of the fetal electrical heart axis and the occurrence of ST events.
Accepted: March 27, 2017 Published: April 14, 2017
Methods
Copyright: © 2017 Vullings et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
A post-hoc analysis was performed following a multicentre randomised controlled trial, including 1097 patients from two participating centres. All women were monitored with ST analysis during labour. Cases of fetal metabolic acidosis, poor signal quality, missing blood gas analysis, and congenital heart disease were excluded. The orientation of the fetal electrical heart axis affects the height of the initial T/QRS baseline, and therefore the incidence of ST events. We grouped tracings with the same initial baseline T/QRS value. We depicted the number of ST events as a function of the initial baseline T/QRS value with a linear regression model.
Data Availability Statement: Since participants of the original study did not explicitly give consent that the gathered data would be made available in a public repository, the Ethics Committee of the Ma´xima Medical Centre and University Medical Centre Utrecht prohibit us from placing the data in a publicly available repository. Researchers who can demonstrate they are qualified to handle confidential data (e.g. medical doctors), will of course upon request have access to the data. Such requests can be send to either the corresponding
Results A significant increment of ST events was observed with increasing height of the initial T/ QRS baseline, irrespective of the fetal condition; correlation coefficient 0.63, p
The electrical heart axis and ST events in fetal monitoring: A post-hoc analysis following a multicentre randomised controlled trial Rik Vullings1, Kim M. J. Verdurmen2*, Alexandra D. J. Hulsenboom2, Stephanie Scheffer2, Hinke de Lau2, Anneke Kwee3, Pieter F. F. Wijn4, Isis Amer-Wåhlin5, Judith O. E. H. van Laar2, S. Guid Oei1,2
a1111111111 a1111111111 a1111111111 a1111111111 a1111111111
1 Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands, 2 Department of Obstetrics and Gynaecology, Ma´xima Medical Centre, Veldhoven, the Netherlands, 3 Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, the Netherlands, 4 Department of Clinical Physics, Ma´xima Medical Centre, Veldhoven, the Netherlands, 5 Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden * [email protected]
Abstract OPEN ACCESS Citation: Vullings R, Verdurmen KMJ, Hulsenboom ADJ, Scheffer S, de Lau H, Kwee A, et al. (2017) The electrical heart axis and ST events in fetal monitoring: A post-hoc analysis following a multicentre randomised controlled trial. PLoS ONE 12(4): e0175823. https://doi.org/10.1371/journal. pone.0175823 Editor: Martin Gerbert Frasch, University of Washington, UNITED STATES Received: November 6, 2016
Objective Reducing perinatal morbidity and mortality is one of the major challenges in modern health care. Analysing the ST segment of the fetal electrocardiogram was thought to be the breakthrough in fetal monitoring during labour. However, its implementation in clinical practice yields many false alarms and ST monitoring is highly dependent on cardiotocogram assessment, limiting its value for the prediction of fetal distress during labour. This study aims to evaluate the relation between physiological variations in the orientation of the fetal electrical heart axis and the occurrence of ST events.
Accepted: March 27, 2017 Published: April 14, 2017
Methods
Copyright: © 2017 Vullings et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
A post-hoc analysis was performed following a multicentre randomised controlled trial, including 1097 patients from two participating centres. All women were monitored with ST analysis during labour. Cases of fetal metabolic acidosis, poor signal quality, missing blood gas analysis, and congenital heart disease were excluded. The orientation of the fetal electrical heart axis affects the height of the initial T/QRS baseline, and therefore the incidence of ST events. We grouped tracings with the same initial baseline T/QRS value. We depicted the number of ST events as a function of the initial baseline T/QRS value with a linear regression model.
Data Availability Statement: Since participants of the original study did not explicitly give consent that the gathered data would be made available in a public repository, the Ethics Committee of the Ma´xima Medical Centre and University Medical Centre Utrecht prohibit us from placing the data in a publicly available repository. Researchers who can demonstrate they are qualified to handle confidential data (e.g. medical doctors), will of course upon request have access to the data. Such requests can be send to either the corresponding
Results A significant increment of ST events was observed with increasing height of the initial T/ QRS baseline, irrespective of the fetal condition; correlation coefficient 0.63, p
