***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A prospect i ve study of 50 consecutive children who convulsed in the first 28 days of life is in progress . The surviving children are now aged from four to six years . The incidence of simple hypocalcaemic tetany in these children was low ( 14 per cent ) and its benign outcome has been confirmed . In considering neonatal seizures from other causes , the outcome at age four years is as follows : 26 per cent are dead ; 33 per cent show adverse sequelae ; 5 per cent are of question able status ; and 36 per cent appear to be normal . A wide range of h and icap is present among the sample . Seizures have recurred in 20 per cent of all children surviving the neonatal period OBJECTIVE Our purpose was to compare the predictive value of intrapartum fetal pulse oximetry with that of fetal blood analysis for an abnormal neonatal outcome in case of an abnormal fetal heart rate . STUDY DESIGN A prospect i ve multicenter observational study was conducted from June 1994 to November 1995 .  Fetal oxygen saturation  was continuously recorded with a Nellcor N-400 fetal pulse oximeter in case of an abnormal fetal heart rate during labor . Simultaneous readings of fetal oxygen saturation and fetal blood analysis  obtained before birth ( i.e. , either at full dilatation or before cesarean section when indicated ) were compared with the neonatal status . The criteria for an abnormal neonatal outcome were ( 1 ) an umbilical arterial blood pH < or = 7.15 and ( 2 ) a combined variable including 5-minute Apgar score < or = 7 , umbilical arterial pH < or = 7.15 , secondary respiratory distress , transfer in a neonatal care unit , or neonatal death . RESULTS At a 7.20 threshold for fetal scalp pH and 30 % for fetal oxygen saturation ( i.e. , the 10th percentile in the study population ) , the predictive value of  fetal pulse oximetry  was similar to that of fetal blood analysis  for an arterial umbilical pH < or = 7.15 and for an abnormal neonatal outcome ( positive predictive value 56 % vs 55 % , negative predictive value 81 % vs 82 % , sensitivity 29 % vs 35 % , and specificity 93 % vs 91 % , respectively ) . The receiver-operator characteristic curve showed similar performance of either technique for cutoff values < or = 7.20 for fetal blood pH and < or = 30 % for fetal oxygen saturation , whereas fetal pulse oximetry became superior at higher thresholds . CONCLUSION The predictive value of intrapartum fetal pulse oximetry can be favorably compared with that of fetal blood analysis . R and omized controlled management trials can now be performed to assess potential clinical benefits of this new tool A controlled prospect i ve study of the differential effects of intrapartum fetal  monitoring  on mothers and infants has been conducted at Denver General Hospital , Denver , Colorado . A total of 690 high-risk obstetric patients in labor were r and omly assigned to one of three monitoring groups -- auscultation , electronic fetal monitoring alone , or electronic monitoring with the option to scalp sample . There were no differences in immediate infant outcomes in any measured category ( Apgar scores , cord blood gases , neonatal death , neonatal morbidity , nursery course ) among the three groups . There were no differences in rates of infant or maternal infections . The cesarean section rate was markedly increased in the electronically monitored groups , especially in the electronically monitored alone ( 18 % ) as compared with the auscultated ( 6 % ) ( P less than 0.005 ) . In this controlled trial electronic monitoring did not improve neonatal outcomes and the mothers were at increased risk of cesarean section In a large r and omized , controlled study of fetal heart rate monitoring with either continuous electronic fetal heart monitoring or auscultation at specified intervals , only one pattern of deviation in the fetal heart rate correlated significantly with neonatal neurologic examinations at 0 to 48 hours and 72 hours to 1 week : late decelerations in stage 1 and in stage 2 . Other variables from labor and delivery , specifically , duration of labor after hospital admission , failure of labor to progress , number of fetal scalp pH values , and presence of meconium were important predictors of neonatal outcome in the regression analyses . The fetal heart rate deviations did contribute significantly to the percent variance accounted for in the regression analyses with neonatal outcomes of Apgar scores at 1 and 5 minutes and serial neonatal neurologic examinations A controlled prospect i ve study of the effects of fetal monitoring on mothers and infants was conducted at Denver General Hospital , Denver , Colorado . A total of 690 high-risk patients in labor were r and omly assigned to one of three groups ; auscultation alone , electronic fetal monitoring and electronic fetal monitoring with the option to obtain a scalp pH sample .  Maternal and neonatal infectious morbidity after vaginal or cesarean delivery was unchanged with internal fetal monitoring . Despite frequent antibiotic prophylaxis ( 95 % cesarean section v. 11 % vaginal ) , cesarean section was the most significant factor associated with increased maternal puerperal infectious morbidity ( 13.75 % cesarean section v. 3.9 % vaginal ) . Although hours of labor , hours of rupture of membranes , hours of internal catheter , number of exams and presence of meconium were not associated with increased maternal infection , prolonged hours of internal catheter usage greater than 8 hours and prolonged rupture of membranes greater than 12 hours were associated with increased antibiotic usage in the neonate OBJECTIVE To compare different methods of intrapartum foetal heart rate monitoring in high risk pregnancies in detecting foetal heart rate abnormalities , need for operative delivery for foetal distress , and neonatal mortality and short term neonatal morbidity . DESIGN A prospect i ve r and omised controlled trial . SETTING Women in labour at a referral maternity hospital . PATIENTS Women who were 37 weeks or more pregnant with singleton cephalic presentation and normal foetal heart rate prior to entry into the study . INTERVENTION Women were r and omly allocated using sealed opaque envelopes to either continuous electronic foetal heart rate monitoring or intermittent monitoring using h and held doppler foetal heart rate detector . OUTCOME MEASURES These include abnormal foetal heart rate patterns , need for operative delivery for foetal distress , neonatal mortality , Apgar scores , admission to NNU , neonatal seizures , and hypoxic encephalopathy . RESULTS R and omisation achieved good comparability between the two groups . Abnormal FHR patterns were more frequent in the electronic group ( 54 pc versus 32 pc ) . Caesarean section rate was not significantly different in the two groups ( 28 pc versus 24 pc ) although slightly higher compared to overall for the unit ( 18pc ) . Foetal outcome was also comparable between the two groups . CONCLUSIONS Asphyxia can be detected with a h and held doppler just as reliably as by the use of electronic monitors and their use should be further evaluated and promoted in obstetric units caring for high risk pregnancies in developing countries with scarce re sources Abstract Objective : To compare effectiveness of different methods of monitoring intrapartum fetal heart rate . Design : Prospect i ve r and omised controlled trial . Setting : Referral maternity hospital , Harare , Zimbabwe . Subjects : 1255 women who were 37 weeks or more pregnant with singleton cephalic presentation and normal fetal heart rate before entry into study . Interventions : Intermittent monitoring of fetal heart rate by electronic monitoring , Doppler ultrasound , use of Pinard stethoscope by a research midwife , or routine use of Pinard stethoscope by attending midwife . Main outcome measures - Abnormal fetal heart rate patterns , need for operative delivery for fetal distress , neonatal mortality , Apgar scores , admission to neonatal unit , neonatal seizures , and hypoxic ischaemic encephalopathy . Results : Abnormalities in fetal heart rate were detected in 54 % ( 172/318 ) of the electronic monitoring group , 32 % ( 100/312 ) of the ultrasonography group , 15 % ( 47/310 ) of the Pinard stethoscope group , and 9 % ( 28/315 ) of the routine monitoring group . Caesarean sections were performed for 28 % ( 89 ) , 24 % ( 76 ) , 10 % ( 32 ) , and 15 % ( 46 ) of the four groups respectively . Neonatal outcome was best in the ultrasonography group : hypoxic ischaemic encephalopathy occurred in two , one , seven , and 10 cases in the four groups respectively ; neonatal seizures occurred only in the last two groups ( six and nine cases respectively ) ; and deaths occurred in eight , two , five , and nine cases respectively . Conclusions : Abnormalities in fetal heart rate were more reliably detected by Doppler ultrasonography than with Pinard stethoscope , and its use result ed in good perinatal outcome . The use ofrelatively cheap ultrasound monitors should be further evaluated and promoted in obstetric units caring for high risk pregnancies in developing countries with scarce re sources OBJECTIVE Recent developments permit the use of pulse oximetry to evaluate fetal oxygenation in labor . We tested the hypothesis that the addition of fetal pulse oximetry in the evaluation of abnormal fetal heart rate patterns in labor improves the accuracy of fetal assessment and allows safe reduction of cesarean deliveries performed because of nonreassuring fetal status . STUDY DESIGN A r and omized , controlled trial was conducted concurrently in 9 centers . The patients had term pregnancies and were in active labor when abnormal fetal heart rate patterns developed . The patients were r and omized to electronic fetal heart rate monitoring alone  ( control group ) or to the combination of electronic fetal monitoring and continuous fetal pulse oximetry  ( study group ) . The primary outcome was a reduction in cesarean deliveries for nonreassuring fetal status as a measure of improved accuracy of assessment of fetal oxygenation . RESULTS A total of 1010 patients were r and omized , 502 to the control group and 508 to the study group . There was a reduction of > 50 % in the number of cesarean deliveries performed because of nonreassuring fetal status in the study group ( study , 4 . 5 % ; vs. control , 10.2 % ; P = .007 ) . However , there was no net difference in overall cesarean delivery rates ( study , n = 147 [ 29 % ] ; vs. control , 130 [ 26 % ] ; P = .49 ) because of an increase in cesarean deliveries performed because of dystocia in the study group . In a blinded partogram analysis 89 % of the study patients and 91 % of the control patients who had a cesarean delivery because of dystocia met defined criteria for actual dystocia . There was no difference between the 2 groups in adverse maternal or neonatal outcomes . In terms of the operative intervention for nonreassuring fetal status , there was an improvement in both the sensitivity and the specificity for the study group compared with the control group for the end points of metabolic acidosis and need for resuscitation . CONCLUSION The study confirmed its primary hypothesis of a safe reduction in cesarean deliveries performed because of nonreassuring fetal status . However , the addition of fetal pulse oximetry did not result in an overall reduction in cesarean deliveries . The increase in cesarean deliveries because of dystocia in the study group did appear to result from a well-documented arrest of labor . Fetal pulse oximetry improved the obstetrician 's ability to more appropriately intervene by cesarean or operative vaginal delivery for fetuses who were actually depressed and acidotic . The unexpected increase in operative delivery for dystocia in the study group is of concern and remains to be explained Objective : The present study was design ed to assess the utility of Doppler velocimetry in the setting of non-reassuring cardiotocography tracings . Methods : Two hundred fifty six women with term singleton pregnancies were enrolled in a controlled trial . Patients received either routine cardiotocograpic ( CTG ) monitoring , or CTG with the addition of Doppler velocimetry in cases of non-reassuring CTG tracings . The results were analyzed according to protocol . Results : In the CTG+Doppler group , there was a trend toward lower risk of neonatal metabolic acidosis than in the CTG group , although the incidence was rare . The CTG+Doppler group had significantly lower rates of cesarean section for fetal distress , and improved neonatal outcomes . Conclusions : We conclude that intrapartum fetal Doppler velocimetry , when combined with CTG , increases the clinicians ’ ability to accurately identify fetal hypoxia , and decreases the rate of Cesarean section In a r and omized controlled trial involving 12,964 women , a policy of continuous electronic intrapartum fetal heart monitoring was compared with an alternative policy of intermittent auscultation , both policies including an option to measure fetal scalp blood pH. Women allocated to electronic fetal heart monitoring had shorter labors and received less analgesia . The caesarean delivery rates were 2.4 % for electronic fetal heart monitoring and 2.2 % for intermittent auscultation but this small difference arose from the identification of nearly twice as many fetuses with low scalp pH ( less than 7.20 ) in the electronic fetal heart monitoring group . The forceps delivery rate was 8.2 % in the electronic fetal heart monitoring group compared with 6.3 % in the intermittent auscultation group , and this excess was explained by more instrumental deliveries prompted by fetal heart rate abnormalities . There were 14 stillbirths and neonatal deaths in each group , with a similar distribution of causes . There 
    Output:
    
CTG during labour is associated with reduced rates of neonatal seizures , but no clear differences in cerebral palsy , infant mortality or other st and ard measures of neonatal wellbeing .
However , continuous CTG was associated with an increase in caesarean sections and instrumental vaginal births .
Research should also address the possible contribution of the supine position to adverse outcomes for babies , and assess whether the use of mobility and positions can further reduce the low incidence of neonatal seizures and improve psychological outcomes for women