fetal heart rate

胎児心拍数 FHR

WordNet

1. be worthy of or have a certain rating; "This bond rates highly"
2. amount of a charge or payment relative to some basis; "a 10-minute phone call at that rate would cost $5" (同)charge per unit
3. a magnitude or frequency relative to a time unit; "they traveled at a rate of 55 miles per hour"; "the rate of change was faster than expected"
4. a quantity or amount or measure considered as a proportion of another quantity or amount or measure; "the literacy rate"; "the retention rate"; "the dropout rate"
5. assign a rank or rating to; "how would you rank these students?"; "The restaurant is rated highly in the food guide" (同)rank, range, order, grade, place
6. estimate the value of; "How would you rate his chances to become President?"; "Gold was rated highly among the Romans" (同)value
7. a plane figure with rounded sides curving inward at the top and intersecting at the bottom; conventionally used on playing cards and valentines; "he drew a heart and called it a valentine"
8. the courage to carry on; "he kept fighting on pure spunk"; "you havent got the heart for baseball" (同)mettle, nerve, spunk
9. an inclination or tendency of a certain kind; "he had a change of heart" (同)spirit
10. a playing card in the major suit that has one or more red hearts on it; "he led the queen of hearts"; "hearts were trumps"
11. the locus of feelings and intuitions; "in your heart you know it is true"; "her story would melt your bosom" (同)bosom
12. the hollow muscular organ located behind the sternum and between the lungs; its rhythmic contractions move the blood through the body; "he stood still, his heart thumping wildly" (同)pump, ticker
13. a firm rather dry variety meat (usually beef or veal); "a five-pound beef heart will serve six"
14. able to perceive sound
15. an opportunity to state your case and be heard; "they condemned him without a hearing"; "he saw that he had lost his audience" (同)audience
16. (law) a proceeding (usually by a court) where evidence is taken for the purpose of determining an issue of fact and reaching a decision based on that evidence
17. the ability to hear; the auditory faculty; "his hearing was impaired" (同)audition, auditory sense, sense of hearing, auditory modality
18. a session (of a committee or grand jury) in which witnesses are called and testimony is taken; "the investigative committee will hold hearings in Chicago"
19. give (hair) the appearance of being fuller by using a rat
20. a pad (usually made of hair) worn as part of a womans coiffure
21. any of various long-tailed rodents similar to but larger than a mouse
22. catch rats, especially with dogs
23. desert ones party or group of friends, for example, for ones personal advantage
24. employ scabs or strike breakers in
25. receive a communication from someone; "We heard nothing from our son for five years"
26. examine or hear (evidence or a case) by judicial process; "The jury had heard all the evidence"; "The case will be tried in California" (同)try
27. perceive (sound) via the auditory sense

PrepTutorEJDIC

1. 〈C〉『割合』,『率』 / 〈C〉《the~,a~》『速度』(speed),進度 / 〈C〉『値段』,『相場』;料金 / 〈U〉等級(class),(…)等 / 《複数形ぃ》《英》地方税 / (…の金額に)…‘の'『値段を決める』,見積もる《+『名』+『at』+『名』》 / …‘を'『評価する』,みなす / 《米話》…‘に'値する,‘の'価値がある / 『評価される』;みなされる
2. …‘を'どなりつける
3. 〈C〉『心臓』;胸 / 〈C〉(感情の中心をなす)『心』,気持ち / 〈U〉愛情,同情 / 〈U〉『勇気』,元気,熱意 / 《the ~》『中心』,内部,(物事の)本質,核心 / 〈C〉ハート形の物;(カードの)ハートの札
4. 〈U〉『聴力』,聴覚〈U〉〈C〉(…を)『聞くこと』,(…の)聞き取り《+『of』+『名』》・〈C〉聞いてもらう機会,聞いてやること・聴取・聴聞会〈C〉(法廷などでの)尋問,審問,;(刑罰の減免を求める)釈明,意見陳述 / 〈U〉聞こえる距離(範囲)
5. 『ネズミ』 / ひきょう者,裏切り者 / ネズミをつかまえる / 《話》(人を)裏切る,密告する《+『on』+『名』〈人〉》
6. 〈音〉‘が'『聞こえる』,‘を'聞く(進行形にできない) / 〈人の言うこと〉‘に'『耳を傾ける』,‘を'注意深く聞く(listen);(裁判官などが)…の申し立てを聞く / 〈うわさ・ニュースなど〉‘を'『耳にしている』,聞いている / 『耳が聞こえる』 / 《しばしば命令形で》耳を傾ける,注意を向ける / 『うわさ』(『消息』)『を聞く』

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/02/05 03:01:37」(JST)

wiki en

[Wiki en表示]

Cardiotocography
Intervention
A cardiotocograph recording fetal heart rate and uterine contractions
ICD-9-CM	75.32
MeSH	D015148

In medicine (obstetrics), cardiotocography (CTG) is a technical means of recording (-graphy) the fetal heartbeat (cardio-) and the uterine contractions (-toco-) during pregnancy, typically in the third trimester. The machine used to perform the monitoring is called a cardiotocograph, more commonly known as an electronic fetal monitor (EFM).

The invasive fetal monitoring was invented by Doctors Alan Bradfield, Orvan Hess and Edward Hon. A refined (antepartal, non-invasive, beat-to-beat) version (cardiotocograph) was later developed for Hewlett Packard by Konrad Hammacher.

Method

Schematic explanation of cardiotocography: heart rate (A) is calculated from fetal heart motion determined by ultrasound, and uterine contractions are measured by a tocodynamometer (B). These numbers are represented on a time scale with the help of a running piece of paper, producing a graphical representation.

Auscultation: In this technique, the nurse or doctor listens to the baby's heart at set intervals during labor. This continuous CTG method is also called electronic fetal monitoring (EFM). They will either listen to the heart rate using a fetoscope (putting it on your abdomen), or they will listen by ultrasound (which will amplify the sound of the heartbeat, and be monitored and recorded after a contraction at set times). Whilst a continuous CTG gives a written record, it prevents women from moving during labour. This means that women may be unable to change positions freely or use a bath to help with comfort and control during labour. It also means that some resources tend to be focused on the needs to constantly interpret the CTG and not on the needs of a woman in labour.) With the introduction of ultrasound and external electronic fetal monitoring (discussed below), the doctor or nurse don’t often use a stethoscope to listen to the baby's heart.

External cardiotocography- for continuous or intermittent monitoring The fetal heart rate and the activity of the uterine muscle are detected by two transducers placed on the mother’'s abdomen (one above the fetal heart and the other at the fundus). Doppler ultrasound provides the information which is recorded on a paper strip known as a cardiotocograph (CTG).

Internal cardiotocography- uses an electronic transducer connected directly to the fetal scalp. A wire electrode is attached to the fetal scalp through the cervical opening and is connected to the monitor. This type of electrode is sometimes called a spiral or scalp electrode. Internal monitoring provides a more accurate and consistent transmission of the fetal heart rate than external monitoring because factors such as movement do not affect it. Internal monitoring may be used when external monitoring of the fetal heart rate is inadequate, or closer surveillance is needed.

	Fetal Heart Rate monitoring	Uterine Contraction monitoring
External	In this method, your health care provider straps an ultrasound transducer over your abdomen that will pick up the baby's heartbeat. The heartbeat will be recorded continuously on a paper strip. There may be another device strapped on top of your abdomen—a pressure gauge that measures the frequency of your contractions. The combination of these two measurements will provide detailed information as to how your baby is doing during labor.	The pressure-sensitive contraction transducer, called a tocodynamometer (toco) has a flat area that is fixated to the skin by a band around the belly. The pressure required to flatten a section of the wall correlates with the internal pressure, thereby providing an estimate of it.
Internal	This method can only be used if membranes (fore-waters) and your cervix have ruptured either spontaneously or artificially. An electrode is placed on the baby’s scalp to directly monitor the fetal heart rate. An electrode is called a fetal scalp electrode (FSE)	To gauge the strength of your contractions,a small catheter (Intrauterine pressure catheter or IUPC) is placed in your uterus. Combined with an internal fetal monitor, an IUPC may give a more precise reading of the baby's heart rate and your contractions.

A typical CTG reading is printed on paper and/or stored on a computer for later reference. A variety of systems for centralised viewing of CTG have been installed in a large number of maternity hospitals in industrialised countries, allowing simultaneous monitoring of multiple tracings in one or more locations. Display of maternal vital signs, ST signals and an electronic partogram are available in the majority of these systems. A few of them have incorporated computer analysis of cardiotocographic signals or combined cardiotocographic and ST data analysis.

Interpretation

A typical CTG output for a woman not in labour. A: Fetal heartbeat; B: Indicator showing movements felt by mother (caused by pressing a button); C: Fetal movement; D: Uterine contractions

In the US, the Eunice Kennedy Shriver National Institute of Child Health and Human Development sponsored a workshop to develop a standardized nomenclature for use in interpreting intrapartum fetal heart rate and uterine contraction patterns. This nomenclature has been adopted by the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN), the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal-Fetal Medicine.

The Royal College of Obstetricians and Gynaecologists and the Society of Obstetricians and Gynaecologists of Canada have also published consensus statements on standardized nomenclature for fetal heart rate patterns.

Interpretation of a CTG tracing requires both qualitative and quantitative description of:

• Uterine activity (contractions)
• Baseline fetal heart rate (FHR)
• Baseline FHR variability
• Presence of accelerations
• Periodic or episodic decelerations
• Changes or trends of FHR patterns over time.

Uterine activity

There are several factors used in assessing uterine activity.

• Frequency- the amount of time between the start of one contraction to the start of the next contraction.
• Duration- the amount of time from the start of a contraction to the end of the same contraction.
• Intensity- a measure of how strong a contraction is. With external monitoring, this necessitates the use of palpation to determine relative strength. With an IUPC, this is determined by assessing actual pressures as graphed on the paper.
• Resting Tone- a measure of how relaxed the uterus is between contractions. With external monitoring, this necessitates the use of palpation to determine relative strength. With an IUPC, this is determined by assessing actual pressures as graphed on the paper
• Interval- the amount of time between the end of one contraction to the beginning of the next contraction.

The NICHD nomenclature defines uterine activity by quantifying the number of contractions present in a 10-minute window, averaged over 30 minutes. Uterine activity may be defined as:

• Normal- less than or equal to 5 contractions in 10 minutes, averaged over a 30-minute window
• Tachysystole- more than 5 contractions in 10 minutes, averaged over a 30-minute window

Baseline fetal heart rate

The NICHD nomenclature defines baseline fetal heart rate as: The baseline FHR is determined by approximating the mean FHR rounded to increments of 5 beats per minute (bpm) during a 10-minute window, excluding accelerations and decelerations and periods of marked FHR variability (greater than 25 bpm). There must be at least 2 minutes of identifiable baseline segments (not necessarily contiguous) in any 10-minute window, or the baseline for that period is indeterminate. In such cases, it may be necessary to refer to the previous 10-minute window for determination of the baseline. Abnormal baseline is termed bradycardia when the baseline FHR is less than 110 bpm; it is termed tachycardia when the baseline FHR is greater than 160 bpm.

Baseline FHR variability

The NICHD nomenclature defines baseline FHR variability as: Baseline FHR variability is determined in a 10-minute window, excluding accelerations and decelerations. Baseline FHR variability is defined as fluctuations in the baseline FHR that are irregular in amplitude and frequency. The fluctuations are visually quantitated as the amplitude of the peak-to-trough in bpm. Using this definition, the baseline FHR variability is categorized by the quantitated amplitude as:

• Absent- undetectable
• Minimal- greater than undetectable, but less than or equal to 5 bpm
• Moderate- 6-25 bpm
• Marked- greater than 25 bpm

Accelerations

The NICHD nomenclature defines an acceleration as a visually apparent abrupt increase in FHR. An abrupt increase is defined as an increase from the onset of acceleration to the peak in less than or equal to 30 seconds. To be called an acceleration, the peak must be greater than or equal to 15 bpm, and the acceleration must last greater than or equal to 15 seconds from the onset to return to baseline. A prolonged acceleration is greater than or equal to 2 minutes but less than 10 minutes in duration. An acceleration lasting greater than or equal to 10 minutes is defined as a baseline change. Before 32 weeks of gestation, accelerations are defined as having a peak greater than or equal to 10 bpm and a duration of greater than or equal to 10 seconds.

Periodic or episodic decelerations

Periodic refers to decelerations that are associated with contractions; episodic refers to those not associated with contractions. There are four types of decelerations as defined by the NICHD nomenclature, all of which are visually assessed.

• Early Deceleration: Usually symmetrical, gradual decrease and return of FHR associated with a uterine contraction. A 'gradual' deceleration has onset to nadir of 30 seconds or more. The nadir of the deceleration occurs at the same time as the peak of the contraction. In most cases the onset, nadir, and recovery of the deceleration are coincident with the beginning, peak, and ending of the contraction, respectively
• Late Deceleration: Usually symmetrical gradual decrease and return of the FHR, associated with a uterine contraction. A 'gradual' deceleration has onset to nadir of 30 seconds or more. The deceleration is delayed in timing, with nadir occurring after the peak of the contraction. As with early decelerations, the onset, nadir, and recovery of the deceleration occurs after the beginning, peak, and ending of the contraction, respectively.
• Variable Deceleration: Abrupt decrease in FHR, defined as from onset of the deceleration to the beginning of the FHR nadir of less than 30 seconds. The decrease in FHR is calculated from the onset to the nadir of the deceleration. The decrease in FHR is greater than or equal to 15 beats per minute, lasting greater than or equal to 15 seconds, and less than 2 minutes in duration. When variable decelerations are associated with uterine contractions, their onset, depth, and duration commonly vary with successive uterine contractions.
• Prolonged Deceleration: Decrease in FHR from baseline greater than or equal to 15 bpm, lasting greater than or equal to 2 minutes, but less than 10 minutes. A deceleration greater than or equal to 10 minutes is a baseline change.

Additionally decelerations can be recurrent or intermittent based on their frequency (more or less than 50% of the time) within a 20 min window.

FHR pattern classification

The NICHD workgroup proposed terminology of a three-tiered system to replace the older undefined terms "reassuring" and "nonreassuring".

• Category I (Normal): Tracings with all these findings present are strongly predictive of normal fetal acid-base status at the time of observation and the fetus can be followed in a standard manner:
  • Baseline rate 110-160 bpm,
  • Moderate variability,
  • Absence of late, or variable decelerations,
  • Early decelerations and accelerations may or may not be present.

• Category II (Indeterminate): Tracing is not predictive of abnormal fetal acid-base status, but evaluation and continued surveillance and reevaluations are indicated.
  • Bradycardia with normal baseline variability
  • Tachycardia
  • Minimal or Marked baseline variability of FHR
  • Accelerations: Absence of induced accelerations after fetal stimulation
  • Periodic or Episodic decelerations: Longer than 2min but shorter than 10min; Recurrent late decelerations with moderate baseline variability
  • Variable decelerations with other characteristics such as slow return to baseline, overshoots of "shoulders" seen (humps on either side of deceleration)

• Category III (Abnormal): Tracing is predictive of abnormal fetal acid-base status at the time of observation; this requires prompt evaluation and management:
  • Absence of baseline variability with recurrent late or variable decelerations or bradycardia; or
  • Sinusoidal fetal heart rate.

Effect on management

A Cochrane Collaboration review has shown that use of cardiotocography reduces the rate of seizures in the newborn, but that the long term implications of this are unknown, and there is no clear benefit in the prevention of cerebral palsy, perinatal death and other complications of labour. In contrast, labour monitored by CTG is slightly more likely to result in instrumental delivery (forceps or vacuum extraction) or Cesarean section. The false-positive rate of cardiotocography for cerebral palsy is given as high as 99%, meaning that only 1-2 of one hundred babies with non-reassuring patterns will develop cerebral palsy. The introduction of additional methods of intrapartum assessment has given mixed results.

When introduced, this practice was expected to reduce the incidence of fetal demise in labor and make for a reduction in cerebral palsy (CP). Its use became almost universal for hospital births in the U.S. In recent years there has been some controversy as to the utility of the cardiotocograph in low-risk pregnancies, and the related belief that over-reliance on the test has led to increased misdiagnoses of fetal distress and hence increased (possibly unnecessary) cesarean deliveries.

See also

• Fetal stethoscope
• Nonstress test (NST)
• Biophysical profile (BPP)

References

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 分娩時胎児心拍数の評価 intrapartum fetal heart rate assessment
• 2. 分娩第Ⅰ期、Ⅱ期、およびⅢ期の胎児心拍数計測のマネージメント management of intrapartum category i ii and iii fetal heart rate tracings
• 3. 分娩前の胎児サーベイランスの概要 overview of antepartum fetal surveillance
• 4. ノンストレス検査および収縮ストレス検査 nonstress test and contraction stress test
• 5. 胎児不整脈の診断および治療に対する一般的アプローチの概要 overview of the general approach to diagnosis and treatment of fetal arrhythmias

English Journal

• Fetal gastroschisis: antepartum fetal heart rate analysis by computerized cardiotocography.

• Andrade WS1, Brizot ML1, Miyadahira S1, Osmundo Junior GS1, Francisco RP1, Zugaib M1.
• The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.J Matern Fetal Neonatal Med.2017 Mar;30(5):605-611. doi: 10.1080/14767058.2016.1181166. Epub 2016 May 16.
• OBJECTIVES: To describe the antenatal fetal heart rate (FHR) parameters analyzed by computerizedcardiotocography (cCTG) in fetuses with gastroschisis and compare the FHR parameters with ultrasound gastrointestinal markers.METHODS: A retrospective analysis of antepartum cCTG records were conducted in
• PMID 27180816

• Influence of physical exercise on baroreceptor sensitivity during pregnancy.

• Carpenter RE1, Emery SJ2, Uzun O3, Rassi D4, Lewis MJ1.
• The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.J Matern Fetal Neonatal Med.2017 Mar;30(5):514-519. doi: 10.1080/14767058.2016.1179275. Epub 2016 May 12.
• BACKGROUND: Baroreceptor sensitivity (BRS) refers to the magnitude of change in the heart rate in response to change in blood pressure (e.g. upon standing). The impact of regular antenatal exercise on maternal BRS is unclear.AIMS: To determine whether supervised weekly exercise influences BRS, and t
• PMID 27098455

• Untreated depression during pregnancy: Short- and long-term effects in offspring. A systematic review.

• Gentile S1.
• Neuroscience.Neuroscience.2017 Feb 7;342:154-166. doi: 10.1016/j.neuroscience.2015.09.001. Epub 2015 Sep 4.
• Aim of this systematic review is to assess short- and long-lasting effects of antenatal exposure to untreated maternal depressive symptoms. Pertinent articles were identified through combined searches of Science.gov, Cochrane library, and PubMed databases (through August 2015). Forty-three, selected
• PMID 26343292

Japanese Journal

• Ultrasonographic Evaluation of Equine Fetal Growth throughout Gestation in Normal Mares Using a Convex Transducer

• MURASE Harutaka,ENDO Yoshiro,TSUCHIYA Takeru,KOTOYORI Yasumitsu,SHIKICHI Mitsumori,ITO Katsumi,SATO Fumio,NAMBO Yasuo
• Journal of Veterinary Medical Science, 2014
• … It has not been common to perform regular ultrasound examination of the fetus in equine practice, due to the increasing volume of the uterus caused by fetal development. … The aim of this study was to measure Thoroughbred fetal growth indexes throughout gestation using a convex transducer, and to clarify the detectable period of some indexes for clinical use. …
• NAID 130003391307

• 1) ヒト初期絨毛遺伝子の変化に着目した妊娠高血圧症候群発症の予知と予防(シンポジウム2:周産期「妊娠高血圧症候群の基礎と臨床-予防・治療の新戦略に向けて」,第65回日本産科婦人科学会・学術講演会)

• 小出 馨子
• 日本産科婦人科學會雜誌 65(11), 2574-2582, 2013-11-01
• … The detection rate of the combined marker panel (mRNA of ENG, FLT-1, PGF and parity) with a 10% false positive rate was 66%. … The detection rate of the combined marker panel (ENG, FLT1 and TGF-β1 mRNA level and parity) with a 5% false positive rate was 72.3%. …
• NAID 110009674981

• 1) ヒト初期絨毛遺伝子の変化に着目した妊娠高血圧症候群発症の予知と予防(シンポジウム2:周産期「妊娠高血圧症候群の基礎と臨床-予防・治療の新戦略に向けて」,第65回日本産科婦人科学会・学術講演会)

• 小出 馨子
• 日本産科婦人科學會雜誌 65(11), 2574-2582, 2013-11-01
• … The detection rate of the combined marker panel (mRNA of ENG, FLT-1, PGF and parity) with a 10% false positive rate was 66%. … The detection rate of the combined marker panel (ENG, FLT1 and TGF-β1 mRNA level and parity) with a 5% false positive rate was 72.3%. …
• NAID 110009661869

Related Links

• Fetal Heart Rate - Answers.com - Answers - The Most ...

Doctors monitor the heart rate of the growing fetus to make sure there are no abnormalities and that the child is healthy. ... Most fetal Doppler can be rented for around fifty dollars monthly. Although some can be rented cheaper for ...

• Normal Fetal Heart Rate - About Pregnancy and Childbirth - A ...

What is a normal fetal heart rate? Does your stage of pregnancy change the baby's heart rate? ... What is a normal fetal heart rate? This is a question that you probably have from the first time you

Related Pictures

---

★リンクテーブル★

リンク元	「胎児心拍数」「FHR」
拡張検索	「antepartum fetal heart rate monitoring」「baseline variability of fetal heart rate」
関連記事	「rate」「fetal」「hearing」「rat」「hear」

「胎児心拍数」

　　[★]

英

fetal heart rate, FHR

関

胎児心拍動

• 正常脈 normocardia 110-160 bpm
• 徐脈　 bradycardia <110 bpm
• 頻脈　 tachycardia >160 bpm

「FHR」

　　[★] 胎児心拍数 fetal heart rate

「antepartum fetal heart rate monitoring」

　　[★] 分娩前胎児心拍数モニタリング

「baseline variability of fetal heart rate」

　　[★] 胎児心拍数基線細変動

「rate」

　　[★]

• n.

• (全体に対する部分などの割合を示す)率　　　⇔　(率を率で除すような比 ratioとは区別するでしょう)

• vi.

• 格付けされる、等級に分けられる
• 影響力がある、重要な地位にある

• vt.

• ～を値踏みする、～の価格を査定する
• (～の重要性や価値を)評価する
• (性能などによって)～を格付けする(等級に分ける)
• (金融)(不動産の)課税額を決める
• ～に値する、～の価値がある

　 　 　 　 　 　 　 　

「fetal」

　　[★]

• adj.

• 胎生期の、胎性の、(人間)胎児の、胎児性の、(動物)胎仔の、胎仔型の

関

embryo、embryonal、embryonic、embryonic day、embryonic form、embryonic stage、fetal stage、feto、fetus、foetal、foetus

　

「hearing」

　　[★]

• n。

• 聴力、聴覚。聞くこと、聴取。聞こえる距離/範囲。聞いてやること、傾聴。聞いてもらうこと、発言の機会。(委員会などの)聴聞会、ヒアリング。(法)審問、尋問。

　 　 　 　 　 　

「rat」

　　[★]

• n.

• (げっ歯類)ラット、(マウスも含めての総称)ネズミ、ラットの

関

laboratory rat、mouse、Norway rat、Rattus、Rattus norvegicus

　 　 　 　 　 　 　

「hear」

　　[★]

• v.

• 聞く、聞こえる