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CC BY-NC-ND 4.0 · Journal of Fetal Medicine 2020; 07(03): 199-203
DOI: 10.1007/s40556-020-00260-9
Original Article

Signal Ambiguity and Misinterpretation of Fetal Heart Rate: A Report of Two Cases and an Overview of Suspicious Patterns

Mohamad K. Ramadan
1   Department of Obstetrics and Gynecology, Rafic Hariri University Hospital, Jnah, Lebanon
2   Maternal-Fetal-Unit, Rafic Hariri University Hospital, Jnah, Lebanon
3   Department of Obstetrics and Gynecology, Makassed General Hospital, Beirut, Lebanon
4   Department of Obstetrics and Gynecology, Lebanese University, Beirut, Lebanon
,
Walaa Yamout
1   Department of Obstetrics and Gynecology, Rafic Hariri University Hospital, Jnah, Lebanon
5   Department of Obstetrics and Gynecology, Lebanese American University, Beirut, Lebanon
,
Mariam Kharroubi
1   Department of Obstetrics and Gynecology, Rafic Hariri University Hospital, Jnah, Lebanon
4   Department of Obstetrics and Gynecology, Lebanese University, Beirut, Lebanon
,
Abir Malas
3   Department of Obstetrics and Gynecology, Makassed General Hospital, Beirut, Lebanon
,
Janoub Khazaal
1   Department of Obstetrics and Gynecology, Rafic Hariri University Hospital, Jnah, Lebanon
2   Maternal-Fetal-Unit, Rafic Hariri University Hospital, Jnah, Lebanon
4   Department of Obstetrics and Gynecology, Lebanese University, Beirut, Lebanon
,
Georges Yared
1   Department of Obstetrics and Gynecology, Rafic Hariri University Hospital, Jnah, Lebanon
2   Maternal-Fetal-Unit, Rafic Hariri University Hospital, Jnah, Lebanon
4   Department of Obstetrics and Gynecology, Lebanese University, Beirut, Lebanon
5   Department of Obstetrics and Gynecology, Lebanese American University, Beirut, Lebanon
,
Dominique A. Badr 
4   Department of Obstetrics and Gynecology, Lebanese University, Beirut, Lebanon
6   Department of Obstetrics and Gynecology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
7   Brussels, Belgium
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Abstract

Electronic Fetal Heartrate Monitoring (EFHM) is the standard method for fetal well-being surveillance used during labor and delivery. There are, however, situations when tracings displayed by the EFHM are ambiguous and misleading. We present two cases where the Maternal Heart Rate (MHR) artefacts were mistaken for Fetal Heart Rate (FHR). In the first case, MHR masked the severity of fetal distress and caused a delayed and inappropriate management with subsequent poor neonatal outcome. In the second case, MHR was misinterpreted as FHR causing embarrassment of the birth attendants upon delivery of a dead macerated newborn. FHR should initially and continuously be verified as the actual origin of the signal displayed on the EFHM before any intervention is undertaken. Understanding the EFHM patterns produced by FHR or MHR and the utilization of modern EFHMs that apply concomitant recording and displaying of MHR and FHR can avert problems associated with signal ambiguity.

Keywords

Fetal Heart Monitoring - Fetal Heart Rate - Maternal Heart Rate - Neonatal outcome - Signal ambiguity


Publication History

Received: 23 January 2020

Accepted: 16 July 2020

Article published online:
05 May 2023

© 2020. Society of Fetal Medicine. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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