



@article {3312,
	title = {Development and evaluation of an algorithm for computer analysis of maternal heart rate during labor},
	journal = {Computers in Biology and Medicine},
	volume = {49},
	year = {2014},
	note = {Export Date: 21 November 2014},
	month = {2014},
	pages = {30 - 35},
	abstract = {Background: Maternal heart rate (MHR) recordings are morphologically similar and sometimes coincident with fetal heart rate (FHR) recordings and may be useful for maternal-fetal monitoring if appropriately interpreted. However, similarly to FHR, visual interpretation of MHR features may be poorly reproducible. Methods: A computer algorithm for on-line MHR analysis was developed based on a previously existing version for FHR analysis. Inter-observer and computer-observer agreement and reliability were assessed in 40 one-hour recordings obtained from 20 women during the last 2. h of labor. Agreement and reliability were evaluated for the detection of basal MHR, long-term variability (LTV), accelerations and decelerations, using proportions of agreement (PA) and Kappa statistic (K), with 95\% confidence intervals (95\% CI). Changes in MHR characteristics between the first and the second hour of the tracings were also evaluated. Results: There was a statistically significant inter-observer and computer-observer agreement and reliability in estimation of basal MHR, accelerations, decelerations and LTV, with PA values ranging from 0.72 (95\% CI: 0.62-0.79) to 1.00 (95\% CI: 0.99-1.00), and K values ranging from 0.44 (95\% CI: 0.28-0.60) to 0.89 (95\% CI: 0.82-0.96). Moreover, basal MHR, number of accelerations and LTV were significantly higher in the last hour of labor, when compared to the initial hour. Discussion: The developed algorithm for on-line computer analysis of MHR recordings provided good to excellent computer-observer agreement and reliability. Moreover, it allowed an objective detection of MHR changes associated with labor progression, providing more information about the interpretation of maternal-fetal monitoring during labor. {\textcopyright} 2014 Elsevier Ltd.},
	keywords = {Agreement, Cardiotocography, computer analysis, Fetal heart rate, Maternal heart rate, reliability},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84897934596\&partnerID=40\&md5=95b314c6374a68fedb313594f59fdcce},
	author = {Pinto, P. and Bernardes, J. and Costa-Santos, C. and Amorim-Costa, C. and Silva, M. and Ayres-de-Campos, D.}
}
@article {3287,
	title = {External uterine contractions signal analysis in relation to labor progression and dystocia},
	journal = {IFMBE Proceedings},
	volume = {41},
	year = {2014},
	note = {Export Date: 21 November 2014},
	month = {2014},
	pages = {555 - 558},
	abstract = {Labor dystocia is a major cause of operative delivery, which is associated with increased risks for both mother and fetus. We assessed linear and non-linear dynamics of external uterine contraction signals, in relation to labor progression and dystocia. Linear time domain, spectral and entropy methods were used to analyze external uterine contraction recordings obtained during the last two hours of labor, in 28 cases with normal and 27 cases with operative deliveries (forceps, vacuum or caesarean). Progression of labor was associated with a statistically significant increase in most linear time domain and spectral indices, both in normal and operative deliveries, whereas most entropy indices increased in normal deliveries, but did not change in operative deliveries. On the other hand, when compared with normal births, operative deliveries were associated with significantly increased entropy indices before the last hour of labor and significantly decreased (a probably associated) sympatho-vagal balance in the last hour of labor. Linear and non-linear analysis of external uterine contraction recordings may provide useful physiopathological and clinical information on the progression of labor and the diagnosis of dystocia. {\textcopyright} Springer International Publishing Switzerland 2014.},
	keywords = {Cardiotocography, Dystocia, entropy, External uterine contractions, Spectral analysis},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84891293956\&partnerID=40\&md5=2d53a97f6000b704bf67435b61662c09},
	author = {Gon{\c c}alves, H. and Pinto, P. and Ayres-de-Campos, D. and Bernardes, J.}
}
@article {3288,
	title = {Fetal behavioral dynamics in cephalic versus breech presentations},
	journal = {Developmental Psychobiology},
	volume = {56},
	year = {2014},
	note = {Export Date: 21 November 2014},
	pages = {1595 - 1600},
	abstract = {Differences in fetal neurodevelopment can have important implications on future perceptual and learning capabilities. The aim of this study was to assess autonomic nervous system and complexity dynamics in fetal heart rate (FHR) tracings from 27 singleton fetuses in cephalic or breech presentations, matched for gestational age (37+3-40+4 weeks), weight, gender and outcome. Breeches exhibited significantly higher mean FHR and LF/(MF+HF) ratio, as well as lower entropy, denoting increased sympatho-vagal balance and decreased complexity, consistent with the occurrence of more active fetal behavioral states. These findings suggest that there are neurodevelopment differences between fetuses in cephalic and breech presentation.},
	keywords = {Breech presentation, Development, entropy, Fetal behavior, Heart rate, Spectral analysis},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84907881885\&partnerID=40\&md5=efdb9069ff9f41b3b0d0e85ee6b9abb1},
	author = {Gon{\c c}alves, H. and Ayres-de-Campos, D. and Bernardes, J.}
}
@article {3396,
	title = {Impact of the introduction of fetal central monitoring on hospital expenses with cardiotocographic paper},
	journal = {Journal of Obstetrics and Gynaecology},
	volume = {34},
	year = {2014},
	month = {2014},
	pages = {82-84},
	url = {<Go to ISI>://WOS:000328947300020},
	author = {Amorim-Costa, C. and Ayres-de-Campos, D. and Costa-Santos, C. and Bernardes, J.}
}
@article {3408,
	title = {Prolonged saltatory fetal heart rate pattern leading to newborn metabolic acidosis},
	journal = {Clinical and Experimental Obstetrics \& Gynecology},
	volume = {41},
	year = {2014},
	month = {2014},
	pages = {507-511},
	url = {<Go to ISI>://WOS:000343961800003},
	author = {Nunes, I. and Ayres-de-Campos, D. and Kwee, A. and Rosen, K. G.}
}
@article {2860,
	title = {Comparison of real beat-to-beat signals with commercially available 4 Hz sampling on the evaluation of foetal heart rate variability},
	journal = {Medical and Biological Engineering and Computing},
	volume = {51},
	year = {2013},
	note = {Export Date: 12 December 2013Source: Scopus},
	month = {2013///},
	pages = {665 - 676},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84877784836\&partnerID=40\&md5=cfdde94007fba73e03e51da6af74b995},
	author = {Gon{\c c}alves, H. and Costa, A. and Ayres-de-Campos, D. and Costa-Santos, C. and Rocha, A.P. and Bernardes, J.}
}
@article {2861,
	title = {Gender-specific heart rate dynamics in severe intrauterine growth-restricted fetuses},
	journal = {Early Human Development},
	volume = {89},
	year = {2013},
	note = {Export Date: 12 December 2013Source: Scopus},
	month = {2013///},
	pages = {431 - 437},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84876735249\&partnerID=40\&md5=fb66d2a3f8a56a6f99cfe8008a3def01},
	author = {Gon{\c c}alves, H. and Bernardes, J. and Ayres-de-Campos, D.}
}
@article {2870,
	title = {A model for educational simulation of the effect of oxytocin on uterine contractions},
	journal = {Medical Engineering and Physics},
	volume = {35},
	year = {2013},
	note = {Cited By (since 1996):1Export Date: 12 December 2013Source: Scopus},
	month = {2013///},
	pages = {524 - 531},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84876114966\&partnerID=40\&md5=ac7aee56840fe71fcaaa1171d75e927c},
	author = {Lobo, M.F. and Bastos, L.F. and van Meurs, W.L. and Ayres-de-Campos, D.}
}
@article {2887,
	title = {An overview of central fetal monitoring systems in labour},
	journal = {Journal of Perinatal Medicine},
	volume = {41},
	year = {2013},
	note = {Cited By (since 1996):1Export Date: 12 December 2013Source: Scopus},
	month = {2013///},
	pages = {93 - 99},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84881633207\&partnerID=40\&md5=f9c824ddb554c46a92331e20852ef509},
	author = {Nunes, I. and Ayres-de-Campos, D. and Figueiredo, C. and Bernardes, J.}
}
@article {2194,
	title = {A model for educational simulation of the evolution of uterine contractions during labor},
	journal = {Computer Methods and Programs in BiomedicineComput. Methods Programs Biomed.},
	volume = {107},
	year = {2012},
	note = {Export Date: 21 November 2012Source: ScopusCODEN: CMPBEdoi: 10.1016/j.cmpb.2011.09.016PubMed ID: 22047937Language of Original Document: EnglishCorrespondence Address: Bastos, L.F.; Campus da FEUP, Rua Dr. Roberto Frias, s/n, sala I305, 4200-465 Porto, Portugal; email: lbastos@fe.up.ptReferences: Curran, C.A., Intrapartum emergencies (2003) J. Obstet. Gynecol. Neonatal Nurs., 32 (6), pp. 802-813;Guise, J.-M., Anticipating and responding to obstetric emergencies (2007) Best Pract. Res. Clin. Obstet. Gynaecol., 21 (4), pp. 625-638; 
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Daniels, K., Lipman, S., Harney, K., Arafeh, J., Druzin, M., Use of simulation based team training for obstetric crises in resident education (2008) Simul. Healthc., 3 (3), pp. 154-160; 
Doyle, C., Angelotti, T., Diagnosis of an unsuspected maternal hemorrhage via fetal heart rate tracing (2004) J. Clin. Anesth., 16 (6), pp. 465-468; 
Odendaal, H.J., The frequency of uterine contractions in abruptio placentae (1976) S. Afr. Med. J., 50 (54), pp. 2129-2131; 
(2001) The Use of Electronic Fetal Monitoring: The Use and Interpretation of Cardiotocography in Intrapartum Fetal Surveillance, , RCOG,Royal-College-of-Obstetricians-and-Gynaecologists; 
Klavan, M., Laver, A.T., Boscola, M.A., (1977) Clinical Concepts of Fetal Heart Rate Monitoring, , Hewlett-Packard Waltham, Mass; 
Leveno, K.J., Cunningham, F.J., Gant, N.F., Alexander, J.M., Bloom, S.L., Casey, B.M., Dashe, J.S., Yost, N.P., (2003) Williams Manual of Obstetrics, , McGraw-Hill; 
Parer, J.T., (1997) Handbook of Fetal Heart Rate Monitoring, , W.B. Saunders Company; 
Bakker, P.C.A.M., van Geijn, H.P., Uterine activity: implications for the condition of the fetus (2008) J. Perinat. Med., 36 (1), pp. 30-37; 
Bakker, P.C.A.M., Van Rijswijk, S., van Geijn, H.P., Uterine activity monitoring during labor (2007) J. Perinat. Med., 35 (6), pp. 468-477; 
Dastur, A.E., Intrapartum fetal distress (2005) J. Obstet. Gynecol. India, 55 (2), pp. 115-117; 
Sadovsky, E., Rabinowitz, R., Freeman, A., Yarkoni, S., The relationship between fetal heart rate accelerations, fetal movements, and uterine contractions (1984) Am. J. Obstet. Gynecol., 149 (2), pp. 187-189; 
Arulkumaran, S., Chua, S., Ratnam, S.S., Symptoms and signs with scar rupture - value of uterine activity measurements (1992) Aust. N.Z. J. Obstet. Gynaecol., 32 (3), pp. 208-212; 
Beckley, S., Gee, H., Newton, J.R., Scar rupture in labour after previous lower uterine segment caesarean section: the role of uterine activity measurement (1991) Br. J. Obstet. Gynaecol., 98 (3), pp. 265-269; 
Burchell, H.J., Odendaal, H.J., de Wet, J.I., Badenhorst, P.N., Uterine contraction patterns in abruptio placentae (1985) S. Afr. Med. J., 67 (2), pp. 48-50; 
Phelan, J.P., Korst, L.M., Settles, D.K., Uterine activity patterns in uterine rupture: a case-control study (1998) Obstet. Gynecol., 92 (3), pp. 394-397; 
Rodriguez, M.H., Masaki, D.I., Phelan, J.P., Diaz, F.G., Uterine rupture: are intrauterine pressure catheters useful in the diagnosis? (1989) Am. J. Obstet. Gynecol., 161 (3), pp. 666-669; 
Andersen, H.F., Barclay, M.L., A computer-model of uterine contractions based on discrete contractile elements (1995) Obstet. Gynecol., 86 (1), pp. 108-111; 
Young, R.C., A computer model of uterine contractions based on action potential propagation and intercellular calcium waves (1997) Obstet. Gynecol., 89 (4), pp. 604-608; 
Vauge, C., Carbonne, B., Papiernik, E., Ferre, F., A mathematical model of uterine dynamics and its application to human parturition (2000) Acta Biotheor., 48 (2), pp. 95-105; 
Wray, S., Uterine contraction and physiological mechanisms of modulation (1993) Am. J. Physiol., 264 (1), pp. C1-C18; 
Wray, S., Kupittayanant, S., Shmygol, A., Smith, R.D., Burdyga, T., The physiological basis of uterine contractility: a short review (2001) Exp. Physiol., 86 (2), pp. 239-246; 
Bastos, L.F., Lobo, M.F., van-Meurs, W.L., Ayres-de-Campos, D., An intrauterine pressure generator for educational simulation of labor and delivery (2009) SESAM-ALASIC Winter Retreat; 
Harbert, G.M., Assessment of uterine contractility and activity (1992) Clin. Obstet. Gynecol., 35 (3), pp. 546-558; 
Matsuo, K., Scanlon, J.T., Atlas, R.O., Kopelman, J.N., Staircase sign: a newly described uterine contraction pattern seen in rupture of unscarred gravid uterus (2008) J. Obstet. Gynaecol. Res., 34 (1), pp. 100-104; 
Meniru, G.I., Brister, E., Nemunaitis-Keller, J., Gill, P., Krew, M., Hopkins, M.P., Spontaneous prolonged hypertonic uterine contractions (essential uterine hypertonus) and a possible infective etiology (2002) Arch. Gynecol. Obstet., 266 (4), pp. 238-240; 
Caspi, B., Lancet, M., Kessler, I., Sinusoidal pattern of uterine contractions in abruptio placentae (1980) Int. J. Gynaecol. Obstet., 17 (6), pp. 615-616; 
Eskes, T.K., Abruptio placentae. A "classic" dedicated to Elizabeth Ramsey (1997) Eur. J. Obstet. Gynecol. Reprod. Biol., 75 (1), pp. 63-70; 
Odendaal, H.J., Uterine contraction patterns in patients with severe abruptio placentae (1980) S. Afr. Med. J., 57 (22), pp. 908-910; 
Odendaal, H.J., Burchell, H., Raised uterine resting tone in patients with abruptio placentae (1985) Int. J. Gynaecol. Obstet., 23 (2), pp. 121-124; 
Sweeten, K.M., Graves, W.K., Athanassiou, A., Spontaneous rupture of the unscarred uterus (1995) Am. J. Obstet. Gynecol., 172 (6), pp. 1851-1855; 
Cobo, E., Quintero, C.A., Strada, G., Zambrana, M.A., Uterine behavior in abruptio placentae. I. Contraction patterns and their reactivity to oxytocin (1965) Am. J. Obstet. Gynecol., 93 (8), pp. 1151-1156; 
Eskes, T., Seelen, J., Stolte, L., Intrauterine pressure in placental abruption (1967) Ned. Tijdschr. Verloskd. Gynaecol., 67 (1), pp. 74-92; 
Beckmann, C.R., Byler, M., Jackson, K., Increasing baseline intrauterine pressure associated with impending spontaneous uterine rupture (1997) Int. J. Gynaecol. Obstet., 58 (2), pp. 239-240; 
Warrick, P.A., Hamilton, E.F., Precup, D., Kearney, R.E., Identification of the dynamic relationship between intrapartum uterine pressure and fetal heart rate for normal and hypoxic fetuses (2009) IEEE Trans. Biomed. Eng., 56 (6), pp. 1587-1597; 
Paul, M.J., Smeltzer, J.S., Relationship of measured external tocodynamometry with measured internal uterine activity (1991) Am. J. Perinatol., 8, pp. 417-420; 
Miles, A.M., Monga, M., Richeson, K.S., Correlation of external and internal monitoring of uterine activity in a cohort of term patients (2001) Am. J. Perinatol., 18, pp. 137-140
},
	month = {2012///},
	pages = {242 - 247},
	abstract = {Electronic fetal monitoring remains an important tool in labor ward settings, providing continuous information on fetal heart rate and maternal uterine contractions. A prompt detection of abnormalities in these signals is essential for the timely resolution of situations that may put both mother and fetus at risk. Uterine contraction signals provide information that is important to evaluate the onset and progress of labor, as well as the significance of certain fetal heart rate abnormalities. We present a model for educational simulation of the spontaneous evolution of uterine contractions during labor, which combines a previously published signal generator with literature-based pre-programmed scripts for educationally relevant scenarios. This model is an essential component of a high-fidelity simulator of intrapartum emergencies, aimed to improve the competency of healthcare providers. Real and simulated tracings were presented to three independent clinical experts who judged simulated signals to be indistinguishable or negligibly different from real tracings. {\textcopyright} 2011 Elsevier Ireland Ltd.},
	keywords = {article, clinical competence, computer memory, computer program, Computer simulation, Computer-Assisted Instruction, controlled study, Educational simulations, Essential component, Female, Fetal heart rate, Fetal monitoring, Health care, Health care providers, High-fidelity simulators, Humans, labor, Labor and delivery, medical education, Medical educational simulation, Models, Biological, Neonatal monitoring, Obstetric Labor Complications, Obstetrics, Pregnancy, Script-controlled simulation, signal detection, Signal generators, Simulated signals, User-Computer Interface, Uterine activities, Uterine activity, Uterine Contraction, Uterine Monitoring, uterus contraction},
	isbn = {01692607 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84861989435\&partnerID=40\&md5=6b5099845e4592661e2f426170d9f8b9},
	author = {Bastos, L.F. and van Meurs, W. and Ayres-de-Campos, D.}
}
@article {2208,
	title = {Poor reliability of visual analysis of fetal heart rate tracings: What should be done about it?},
	journal = {American Journal of Obstetrics and GynecologyAm. J. Obstet. Gynecol.},
	volume = {206},
	year = {2012},
	note = {Export Date: 21 November 2012Source: ScopusCODEN: AJOGAdoi: 10.1016/j.ajog.2012.02.027PubMed ID: 22425405Language of Original Document: EnglishCorrespondence Address: Bernardes, J.; Institute of Biomedical Engineering, University of Porto, S. Joao Hospital, Porto, Portugal; email: jbernardes59@gmail.comReferences: Blackwell, S.C., Grobman, W.A., Antoniewicz, L., Hutchinson, M., Gyamfi Bannerman, C., Interobserver and intraobserver reliability of the NICHD 3-Tier fetal heart rate interpretation system (2011) Am J Obstet Gynecol, 205, pp. 378e1-378e5;Bernardes, J., Ayres-De-Campos, D., The persistent challenge of foetal heart rate monitoring (2010) Curr Opin Obstet Gynecol, 22, pp. 104-109; 
Ayres-De-Campos, D., Bernardes, J., Twenty-five years after the FIGO guidelines for the use of fetal monitoring: Time for a simplified approach? (2010) Int J Gynaecol Obstet, 110, pp. 1-6. , FIGO Subcommittee; 
Pehrson, C., Sorensen, J.L., Amer-W{\r a}hlin, I., Evaluation and impact of cardiotocography training programmes: A systematic review (2011) BJOG, 118, pp. 926-935
},
	month = {2012///},
	pages = { - },
	keywords = {accuracy, Cardiotocography, clinical decision making, clinical practice, computer analysis, fetus blood sampling, fetus electrocardiography, fetus heart rate, Heart Rate, Fetal, human, Humans, letter, medical education, metabolic acidosis, newborn disease, priority journal, reliability, visual acuity},
	isbn = {00029378 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84861573254\&partnerID=40\&md5=2d68d4ec0e762adf745a8b7b433023bf},
	author = {Bernardes, J. and Ayres-de-Campos, D.}
}
@article {2230,
	title = {Complexity and categorical analysis may improve the interpretation of agreement studies using continuous variables},
	journal = {Journal of Evaluation in Clinical PracticeJ. Eval. Clin. Pract.},
	volume = {17},
	year = {2011},
	note = {Cited By (since 1996): 2Export Date: 21 November 2012Source: ScopusCODEN: JECPFdoi: 10.1111/j.1365-2753.2011.01668.xPubMed ID: 21489051Language of Original Document: EnglishCorrespondence Address: Costa-Santos, C.; Department of Biostatistics and Medical Informatics, Faculty of Medicine, University of Porto, Al. Prof. Hern{\^a}ni Monteiro, 4200-319 Porto, Portugal; email: csantos@med.up.ptReferences: Costa Santos, C., Costa Pereira, A., Bernardes, J., Agreement studies in obstetrics and gynaecology: Inappropriateness, controversies and consequences (2005) BJOG: An International Journal of Obstetrics and Gynaecology, 112 (5), pp. 667-669. , DOI 10.1111/j.1471-0528.2004.00505.x;Khan, K.S., Chien, P.F., Evaluation of a clinical test. I: Assessment of reliability (2001) BJOG, 108, pp. 562-567; 
Luiz, R.R., Szklo, M., More than one statistical strategy to assess agreement of quantitative measurements may usefully be reported (2005) Journal of Clinical Epidemiology, 58 (3), pp. 215-216. , DOI 10.1016/j.jclinepi.2004.07.007; 
Costa-Santos, C., Bernardes, J., Ayres-De-Campos, D., Costa, A., Costa, C., The limits of agreement and the intraclass correlation coefficient may be inconsistent in the interpretation of agreement (2011) Journal of Clinical Epidemiology, 64 (3), pp. 264-269; 
Costa-Santos, C., Antunes, L., Souto, A., Bernardes, J., Assessment of disagreement: A new information-based approach (2010) Annals of Epidemiology, 20, pp. 555-561; 
Luiz, R.R., Costa, A.J.L., Kale, P.L., Werneck, G.L., Assessment of agreement of a quantitative variable: A new graphical approach (2003) Journal of Clinical Epidemiology, 56 (10), pp. 963-967. , DOI 10.1016/S0895-4356(03)00164-1; 
Plsek, P.E., Greenhalgh, T., The challenge of complexity in health care (2001) British Medical Journal, 323 (7313), pp. 625-628; 
Shiell, A., Hawe, P., Gold, L., Complex interventions or complex systems? Implications for health economic evaluation (2008) BMJ, 336 (7656), pp. 1281-1283; 
Wilson, T., Holt, T., Complexity science: Complexity and clinical care (2001) British Medical Journal, 323 (7314), pp. 685-688; 
Miles, A., Complexity in medicine and healthcare: People and systems, theory and practice (2009) Journal of Evaluation in Clinical Practice, 15 (3), pp. 409-410; 
Shannon, {\^I}., A mathematical theory of communication (1948) Bell System Technical Journal, 27, pp. 379-423. , 623- 656; 
Bernardes, J., Costa-Pereira, A., Ayres-De-Campos, D., Van Geijn, H.P., Pereira-Leite, L., Evaluation of interobserver agreement of cardiotocograms (1997) International Journal of Gynecology and Obstetrics, 57 (1), pp. 33-37. , DOI 10.1016/S0020-7292(97)02846-4, PII S0020729297028464; 
Ayres-De-Campos, D., Bernardes, J., Costa-Pereira, A., Pereira-Leite, L., Inconsistencies in classification by experts of cardiotocograms and subsequent clinical decision (1999) British Journal of Obstetrics and Gynaecology, 106, pp. 1307-1310; 
Rooth, G., Guidelines for the use of fetal monitoring (1987) International Journal of Gynaecology and Obstetrics, 25, pp. 159-167; 
Grant, J.M., The fetal heart rate is normal, isn{\textquoteright}t it? Observer agreement of categorical assessments (1991) Lancet, 337, pp. 215-218; 
M{\"u}ller, R., B{\"u}ttner, P., A critical discussion of intraclass correlation coefficients (1994) Statistics in Medicine, 13, pp. 2465-2476; 
Byrt, T., Bishop, J., Carlin, J.B., Bias, prevalence and kappa (1993) Journal of Clinical Epidemiology, 46 (5), pp. 423-429. , DOI 10.1016/0895-4356(93)90018-V; 
West, B.J., Homeostasis and Gauss statistics: Barriers to understanding natural variability (2010) Journal of Evaluation in Clinical Practice, 16, pp. 403-408; 
Goncalves, H., Rocha, A.P., Ayres-de-Campos, D., Bernardes, J., Linear and nonlinear fetal heart rate analysis of normal and acidemic fetuses in the minutes preceding delivery (2006) Medical and Biological Engineering and Computing, 44 (10), pp. 847-855. , DOI 10.1007/s11517-006-0105-6; 
Costa Santos, C., Vitanyi, P.M.B., Bernardes, J., Antunes, L., Clustering fetal heart rate tracings by compression (2006) Proceedings - IEEE Symposium on Computer-Based Medical Systems, 2006, pp. 685-690. , DOI 10.1109/CBMS.2006.68, 1647650, Proceedings - 19th IEEE International Symposium on Computer-Based Medical Systems, CBMS 2006
},
	month = {2011///},
	pages = {511 - 514},
	abstract = {Rationale Complex clinical scenarios involving a high degree of uncertainty frequently lead to a poor agreement over diagnosis and management. However, inconsistent results can be found with the most widely used measures of agreement for continuous variables - the limits of agreement and the intraclass correlation coefficient. Aims and objectives We aim to improve the interpretation of agreement studies using continues variables. Methods and results Evaluation of agreement may be improved by complexity analysis and by categorization of variables, followed by the use of the proportions of agreement. Conclusions The average never characterizes a complex phenomenon and the methods used to access agreement in continuous variables are based on the mean. For future agreement studies, involving complex continuous variables, we recommend a complexity and categorical analysis. {\textcopyright} 2011 Blackwell Publishing Ltd.},
	keywords = {article, Biomedical research, Cardiotocography, clinical decision making, clinical practice, complexity, Data Interpretation, Statistical, Decision Making, entropy, Female, fetus heart rate, Heart Rate, Fetal, human, Humans, observer variation, Pregnancy, Pregnancy Outcome, priority journal, Reproducibility of Results, statistical data interpretation, Uncertainty},
	isbn = {13561294 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-79956081274\&partnerID=40\&md5=bd7376dca48228f4c4b1b21389689596},
	author = {Costa-Santos, C. and Bernardes, J. and Antunes, L. and Ayres-de-Campos, D.}
}
@article {2225,
	title = {Knowledge of adverse neonatal outcome alters clinicians{\textquoteright} interpretation of the intrapartum cardiotocograph},
	journal = {BJOG: An International Journal of Obstetrics and GynaecologyBJOG Int. J. Obstet. Gynaecol.},
	volume = {118},
	year = {2011},
	note = {Cited By (since 1996): 2Export Date: 21 November 2012Source: ScopusCODEN: BIOGFdoi: 10.1111/j.1471-0528.2011.03003.xPubMed ID: 21609381Language of Original Document: EnglishCorrespondence Address: Ayres-de-Campos, D.; Departmento de Ginecologia e Obstetr{\'\i}cia, Faculdade de Medicina do Porto, 4200-309 Porto, Portugal; email: dcampos@med.up.ptReferences: (2006) Perinatal Mortality Surveillance 2004: England, Wales and Northern Ireland, , CEMACH - Centre for Maternal and Child Enquiries (previously Confidential Enquiries into Maternal and Child Health). London: CEMACH;(1997) CESDI - Confidential Enquiry into Stillbirths and Deaths in Infancy, , 4th Annual Report. London: CESDI; 
Wood, C., Renou, P., Oats, J., A controlled trial of fetal heart rate monitoring in a low-risk obstetric population (1981) American Journal of Obstetrics and Gynecology, 141 (5), pp. 527-534; 
MacDonald, D., Grant, A., Sheridan-Pereira, M., The Dublin randomized controlled trial of intrapartum fetal heart rate monitoring (1985) American Journal of Obstetrics and Gynecology, 152 (5), pp. 524-539; 
Shy, K.K., Luthy, D.A., Bennett, F.C., Whitfield, M., Larson, E.B., Van Belle, G., Hughes, J.P., Stenchever, M.A., Effects of electronic fetal-heart-rate monitoring, as compared with periodic auscultation, on the neurologic development of premature infants (1990) New England Journal of Medicine, 322 (9), pp. 588-593; 
Dillner, L., Babies{\textquoteright} deaths linked to suboptimal care (1995) Br Med J, 310, p. 757; 
Ayres-de-Campos, D., Bernardes, J., Costa-Pereira, A., Pereira-Leite, L., Inconsistencies in classification by experts of cardiotocograms and subsequent clinical decision (1999) Br J Obstet Gynaecol, 106, pp. 1307-1310; 
Palomaki, O., Luukkaala, T., Luoto, R., Tuimala, R., Intrapartum cardiotocography - The dilemma of interpretational variation (2006) Journal of Perinatal Medicine, 34 (4), pp. 298-302. , DOI 10.1515/JPM.2006.057, PII JPME344298; 
Westerhuis, M., Van Horen, E., Kwee, A., Van Der Tweel, I., Visser, G., Moons, K., Inter- and intra-observer agreement of intrapartum ST analysis of the fetal electrocardiogram in women monitored by STAN (2009) BJOG, 116, pp. 545-551; 
Caplan, R.A., Posner, K.L., Cheney, F.W., Effect of outcome on physician judgment of appropriateness of care (1991) J Am Med Assoc, 265, pp. 1957-1960; 
Rooth, G., Huch, A., Huch, R., Guidelines for the use of fetal monitoring (1987) Int J Gynecol Obstet, 25, pp. 159-167. , FIGO News; 
Amer-Wahlin, I., Hellsten, C., Noren, H., Hagberg, H., Herbst, A., Kjellmer, I., Lilja, H., Marsal, K., Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: A Swedish randomised controlled trial (2001) Lancet, 358 (9281), pp. 534-538. , DOI 10.1016/S0140-6736(01)05703-8; 
Westgate, J., Garibaldi, J.M., Greene, K.R., Umbilical cord blood gas analysis at delivery: A time for quality data (1994) British Journal of Obstetrics and Gynaecology, 101 (12), pp. 1054-1063; 
Figueras, F., Albela, S., Bonino, S., Palacio, M., Barrau, E., Hernandez, S., Casellas, C., Cararach, V., Visual analysis of antepartum fetal heart rate tracings: Inter- and intra-observer agreement and impact of knowledge of neonatal outcome (2005) Journal of Perinatal Medicine, 33 (3), pp. 241-245. , http://www.extenza-eps.com/extenza/loadPDF?objectIDValue=64432, DOI 10.1515/JPM.2005.044; 
Zain, H.A., Wright, J.W., Parrish, G.E., Diehl, S.J., Interpreting the fetal heart rate tracing: Effect of knowledge of neonatal outcome (1998) Journal of Reproductive Medicine for the Obstetrician and Gynecologist, 43 (4), pp. 367-370; 
Almstr{\"o}m, H., Axelsson, O., Ekman, G., Ingemarsson, I., Maesel, A., Arstr{\"o}m, K., Umbilical artery velocimetry may influence clinical interpretation of intrapartum cardiotocograms (1995) Acta Obstet Gynecol Scand, 74, pp. 526-529; 
Spencer, J.A.D., Clinical overview of cardiotocography (1993) British Journal of Obstetrics and Gynaecology, Supplement, 100 (9), pp. 4-7; 
Ayres-de-Campos, D., Bernardes, J., Early, variable and late decelerations: Can a consensus be reached in their identification? (1999) Int J Gynecol Obstet, 65, pp. 305-306; 
Capstick, J.B., Edwards, P.J., Trends in obstetric malpractice claims (1990) Lancet, 336 (8720), pp. 931-932. , DOI 10.1016/0140-6736(90)92291-O; 
Symonds, E.M., Litigation and the cardiotocogram (1993) British Journal of Obstetrics and Gynaecology, Supplement, 100 (9), pp. 8-9; 
Williams, B., Arulkumaran, S., Cardiotocography and medicolegal issues (2004) Best Practice and Research: Clinical Obstetrics and Gynaecology, 18 (3), pp. 457-466. , DOI 10.1016/j.bpobgyn.2004.02.005, PII S1521693404000318
},
	month = {2011///},
	pages = {978 - 983},
	abstract = {Objective: To evaluate the impact of knowledge of neonatal outcome on clinicians{\textquoteright} interpretation of the intrapartum cardiotocograph (CTG). Design: Prospective evaluation of pre-recorded cases. Setting: Five maternity hospitals. Population: From a database of intrapartum CTGs acquired with a scalp electrode in singleton near-term fetuses, 20 tracings were sequentially selected from cases with newborn umbilical artery pH < 7.05 and 20 from cases with pH > 7.20. Methods: Five experienced obstetricians practising in different maternity hospitals were asked to analyse the 40 tracings individually, according to the International Federation of Gynaecology and Obstetrics guidelines. In a first round, clinicians were given no information on neonatal outcome. In a second round, carried out 2 months later, clinicians were asked to analyse the same tracings, but the order was randomly altered and information on the newborn{\textquoteright}s arterial pH was provided. Clinicians were not informed of the purpose of the study or whether the tracings were the same. Main outcome measures: The incidence of individual fetal heart rate feature identification and tracing classification, before and after neonatal outcome was made available. Results: In the group with pH < 7.05, repetitive decelerations and reduced variability were more common in the second round (P < 0.001 and P = 0.001, respectively), as was a pathological classification (P = 0.002); variable decelerations were less common (P = 0.008). In the group with normal pH, less tracings in the second round had prolonged decelerations (P = 0.013) and no accelerations (P = 0.013), but more had pronounced decelerations (P = 0.031) and reduced variability (P = 0.007); there was a reduction in pathological classifications, but this difference failed to reach statistical significance (P = 0.051). Conclusions: A knowledge of adverse neonatal outcome leads to a more severe classification of the intrapartum CTG, which derives mainly from the evaluation of decelerations and variability. {\textcopyright} 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology {\textcopyright} 2011 RCOG.},
	keywords = {adverse outcome, Agreement, article, bradycardia, Cardiotocography, clinical competence, Female, Fetal, Fetal hypoxia, Fetal monitoring, fetus heart rate, fetus outcome, health practitioner, Heart rate, Heart Rate, Fetal, human, Humans, Hydrogen-Ion Concentration, incidence, Infant, Newborn, intrapartum care, Labor, Obstetric, medical practice, pH, practice guideline, Practice Guidelines as Topic, Pregnancy, Pregnancy Outcome, priority journal, Prospective Studies, Questionnaires, Reference Standards, Reproducibility of Results, Research Design, Risk Factors, Sweden, tachycardia, umbilical artery},
	isbn = {14700328 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-79959836242\&partnerID=40\&md5=6b43f72dfcfa8829dfc5395ed140ab7b},
	author = {Ayres-de-Campos, D. and Arteiro, D. and Costa-Santos, C. and Bernardes, J.}
}
@article {2238,
	title = {The limits of agreement and the intraclass correlation coefficient may be inconsistent in the interpretation of agreement},
	journal = {Journal of Clinical EpidemiologyJ. Clin. Epidemiol.},
	volume = {64},
	year = {2011},
	note = {Cited By (since 1996): 13Export Date: 21 November 2012Source: ScopusCODEN: JCEPEdoi: 10.1016/j.jclinepi.2009.11.010PubMed ID: 20189765Language of Original Document: EnglishCorrespondence Address: Costa-Santos, C.; Biostatistics and Medical Informatics Department, Faculty of Medicine, University of Porto, Al. Prof. Hern{\^a}ni Monteiro, 4200-319 Porto, Portugal; email: csantos@med.up.ptReferences: De Vet, H., Observer reliability and agreement (1999) Encyclopedia of Biostatistics, pp. 3123-3127;Ayres-De-Campos, D., Bernardes, J., Costa-Pereira, A., Pereira-Leite, L., Inconsistencies in expert{\textquoteright}s classification of cardiotocograms and subsequent clinical decision (1999) Br J Obstet Gynaecol, 106, pp. 1307-1310; 
Santos, C.C., Pereira, C.A., Bernardes, J., Agreement studies in obstetrics and gynaecology: Inappropriateness, controversies and consequences (2005) Br J Obstet Gynaecol, 112, pp. 667-669; 
Luiz, R.R., Szklo, M., More than one statistical strategy to assess agreement of quantitative measurements may usefully be reported (2003) J Clin Epidemiol, 56, pp. 963-967; 
Bland, J.M., Altman, D.G., Statistical methods for assessing two methods of clinical measurement (1986) Lancet, 1, pp. 307-310; 
Bartko, J.J., The intraclass correlation coefficient as a measure of reliability (1966) Psychol Rep, 19, pp. 3-11; 
Muller, R., Buttner, P., A critical discussion of intraclass correlation coefficients (1994) Stat Med, 13, pp. 2465-2476; 
Burdock, E., Fleiss, J.L., Hardesty, A.S., A new view of interobserver agreement (1963) Person Psychol, 16, pp. 373-384; 
Casey, B.M., McLntire, D.D., Leveno, K.J., The continuing value of the Apgar score for the assessment of newborn infants (2001) N Engl J Med, 344, pp. 467-471; 
Van De Riet, J.E., Vandenbussche, F.P., Le Cessie, S., Keirse, M.J., Newborn assessment and long-term adverse outcome: A systematic review (1999) Am J Obstet Gynecol, 180, pp. 1024-1029; 
Shrout, P.E., Fleiss, J.L., Intraclass correlations: Uses in assessing rater reliability (1979) Psychol Bull, 86, pp. 420-427; 
Fleiss, J.U., Davies, M., Measuring nominal scale agreement among many raters (1971) Psychol Bull, 76, pp. 378-382; 
Carpenter, J., Bithell, J., Bootstrap confidence intervals: When, which, what? A practical guide for medical statisticians (2000) Stat Med, 19, pp. 1141-1164; 
Landis, J.R., Koch, G.G., The measurement of observer agreement for categorical data (1977) Biometrics, 33, pp. 159-174
},
	month = {2011///},
	pages = {264 - 269},
	abstract = {Objective: To compare the interpretation of agreement in the prediction of neonatal outcome variables, using the limits of agreement (LA) and the intraclass correlation coefficient (ICC). Study Design and Setting: Three obstetricians were asked to predict neonatal outcomes independently based on the evaluation of intrapartum cardiotocographic tracings. Interobserver agreement was assessed with the LA and the ICC, and the results obtained were interpreted by six clinicians and six statisticians on a scale that established agreement as very poor, poor, fair, good, or very good. Results: Interpretation of the LA results was less consensual than the ICC results, with proportions of agreement of 0.36 (95\% confidence interval [CI]: 0.28-0.44) vs. 0.63 (95\% CI: 0.54-0.73), respectively. LA results suggested a fair to good agreement among obstetricians, whereas interpretation of ICC results suggested a poor to fair agreement. LA results were more plausible with reality, suggesting that obstetricians predicted neonatal outcomes better than randomly generated values, whereas it was not always the case with the ICC. Conclusions: LA and ICC can provide inconsistent results in agreement studies. Accordingly, in the absence of better strategies to assess agreement, both should be used for this purpose, but their results need to be interpreted with caution keeping their respective limitations in mind. {\textcopyright} 2011 Elsevier Inc. All rights reserved.},
	keywords = {Agreement, Apgar score, Cardiotocography, correlation coefficient, Female, Fetal Blood, human, Humans, Hydrogen-Ion Concentration, Infant, Newborn, intrapartum care, limit of agreement, newborn assessment, normal human, observer variation, Obstetrics, outcome variable, Pregnancy, Pregnancy Outcome, priority journal, reproducibility, Reproducibility of Results, review, statistical data interpretation, statistical parameters, Umbilical Arteries, Umbilical artery blood pH, umbilical cord blood},
	isbn = {08954356 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-78751646336\&partnerID=40\&md5=a64bd277d4122b8ce3affa5f3d5d68a5},
	author = {Costa-Santos, C. and Bernardes, J. and Ayres-de-Campos, D. and Costa, A. and Costa, C.}
}
@article {2229,
	title = {Observer reliability and agreement: Differences, difficulties, and controversies},
	journal = {Journal of Clinical EpidemiologyJ. Clin. Epidemiol.},
	volume = {64},
	year = {2011},
	note = {Export Date: 21 November 2012Source: ScopusCODEN: JCEPEdoi: 10.1016/j.jclinepi.2010.12.002Language of Original Document: EnglishCorrespondence Address: Costa Santos, C.; Department of Biostatistics and Medical Informatics, Faculty of Medicine, University of Porto, Porto, Portugal; email: csantos.cristina@gmail.comReferences: Costa-Santos, C., Bernardes, J., Ayres-De-Campos, D., Costa, A., Costa, C., The limits of agreement and the intraclass correlation coefficient may be inconsistent in the interpretation of agreement (2010) J Clin Epidemiol;Streiner, D.L., Norman, G.R., (1996) PDQ Epidemiology, , 2nd edition Mosby St. Louis; 
Costa Santos, C., Costa Pereira, A., Bernardes, J., Agreement studies in obstetrics and gynaecology: Inappropriateness, controversies and consequences (2005) BJOG: An International Journal of Obstetrics and Gynaecology, 112 (5), pp. 667-669. , DOI 10.1111/j.1471-0528.2004.00505.x; 
Bland, M., How Do i Analyse Observer Variation Studies?, , http://www-users.york.ac.uk/~mb55/meas/observer.pdf
},
	month = {2011///},
	pages = {702},
	keywords = {consensus, correlation coefficient, letter, methodology, organization, priority journal, reliability, research, scientific literature, validity},
	isbn = {08954356 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-79955028603\&partnerID=40\&md5=be278b8ed9336b6268066fca66d45280},
	author = {Costa Santos, C. and Bernardes, J. and Ayres-de-Campos, D.}
}
@article {2257,
	title = {Access to computerised analysis of intrapartum cardiotocographs improves clinicians{\textquoteright} prediction of newborn umbilical artery blood pH},
	journal = {BJOG: An International Journal of Obstetrics and GynaecologyBJOG Int. J. Obstet. Gynaecol.},
	volume = {117},
	year = {2010},
	note = {Cited By (since 1996): 3Export Date: 21 November 2012Source: ScopusCODEN: BIOGFdoi: 10.1111/j.1471-0528.2010.02645.xPubMed ID: 20618316Language of Original Document: EnglishCorrespondence Address: Costa, A.; Departamento de Ginecologia e Obstetr{\'\i}cia, Faculdade de Medicina da Universidade Do Porto, Alameda Hernani Monteiro, 4200-319 Porto, Portugal; email: cosantonia@gmail.comReferences: Ayres-De-Campos, D., Bernardes, J., Costa-Pereira, A., Pereira-Leite, L., Inconsistencies in classification by experts of cardiotocograms and subsequent clinical decision (1999) Br J Obstet Gynaecol, 106, pp. 1307-10;Donker, D.K., Van Geijn, H.P., Hasman, A., Interobserver variation in the assessment of fetal heart rate recordings (1993) Eur J Obstet Gynecol Reprod Biol, 52, pp. 21-8; 
Paneth, N., Bommarito, M., Stricker, J., Electronic fetal monitoring and later outcome (1993) Clin Invest Med, 16, pp. 159-65; 
Bernardes, J., Moura, C., Marques-De-S{\'a}, J.P., Pereira-Leite, L., The Porto system for automated cardiotocographic signal analysis (1991) J Perinat Med, 19, pp. 61-5; 
Ayres-De-Campos, D., Sousa, P., Costa, A., Bernardes, J., Omniview-SisPorto {\textregistered} 3.5 - A central fetal monitoring station with online alerts based on computerized cardiotocogram+ST event analysis (2008) J Perinat Med, 36, pp. 260-4; 
Costa, A., Ayres-De-Campos, D., Costa, F., Santos, C., Bernardes, J., Prediction of neonatal acidemia by computer analysis of fetal heart rate and ST event signals (2009) Am J Obstet Gynecol, 201, pp. 464e1-6. , Jun 17. [Epub ahead of print]; 
Westerhuis, M., Van Horen, E., Kwee, A., Van Dertweel, I., Visser, G., Moons, K., Inter- and intra-observer agreement of intrapartum ST analysis of the fetal electrocardiogram in women monitored by STAN (2009) BJOG, 116, pp. 545-51; 
Ayres-De-Campos, D., Bernardes, J., Marsalb, K., Nickelsen, C., Makarainend, L., Banfield, P., Can the reproducibility of fetal heart rate baseline estimation be improved? (2004) Eur J Obstet Gynecol Reprod Biol, 112, pp. 49-54; 
Huch, A., Huch, C., Rooth, G., Guidelines for blood sampling and measurement of pH and blood gas values in Obstetrics (1994) Eur J Obstet Gynecol Reprod Biol, 54, pp. 165-75; 
Umbilical artery blood acid-base analysis (1996) Int J Gynecol Obstet, 52, pp. 305-10. , ACOG technical bulletin; 
Westgate, J., Garibaldi, J.M., Greene, K.R., Umbilical cord blood gas analysis at delivery: A time for quality data (1994) Br J Obstet Gynaecol, 101, pp. 1054-63; 
Costa-Santos, C., Costa Pereira, A., Bernardes, J., Agreement studies in obstetrics and gynaecology: Inappropriateness, controversies and consequences (2005) BJOG, 112, pp. 667-9; 
Bland, J.M., Altman, D.G., Agreement between methods of measurement with multiple observations per individual (2007) J Biopharm Stat, 17, pp. 571-82; 
Chauhan, S.P., Klauser, C.K., Woodring, T.C., Sanderson, M., Magann, E.F., Morrison, J.C., Intrapartum nonreassuring fetal heart rate tracing and prediction of adverse outcomes: Interobserver variability (2008) Am J Obstet Gynecol, 199, pp. 623e1-e5; 
Nielsen, P.V., Stigsby, B., Nickelsen, C., Nim, J., The value of computer assessment compared with visual assessment (1988) Acta Obstet Gynecol Scand, 67, pp. 461-464
},
	month = {2010///},
	pages = {1288 - 1293},
	abstract = {Objective To evaluate the impact of access to computerised cardiotocograph (CTG) analysis on reproducibility and accuracy of clinicians{\textquoteright} predictions of umbilical artery blood pH (UAB pH) and 5-minute Apgar score. Design Prospective evaluation of pre-recorded cases. Setting A tertiary-care university hospital. Population From databases of intrapartum CTGs acquired in singleton term pregnancies, 204 tracings with low signal loss and short time interval to delivery were consecutively selected. Methods Tracings were randomly assigned to computer analysis by the Omniview-SisPorto 3.5                        {\textregistered} system (study group n = 104) or to no analysis (control group n = 100). Three experienced clinicians evaluated all tracing printouts independently and were asked to predict the newborns{\textquoteright} UAB pH and 5-minute Apgar scores from them. Main outcome measures Interobserver agreement (measured by the intraclass correlation coefficient [ICC]) and accuracy in prediction of neonatal outcomes with 95\% CI. Results Agreement on prediction of UAB pH was significantly higher in the study group (ICC = 0.70; 95\% CI 0.61-0.77) than in the control group (ICC = 0.43; 95\% CI 0.21-0.60), and a trend towards better agreement was also seen in estimation of 5-minute Apgar scores (ICC = 0.55; 95\% CI 0.38-0.68 versus ICC = 0.43; 95\% CI 0.25-0.57). Observers predicted UAB pH values correctly within a 0.10 margin in 70\% of cases in the study group (95\% CI 0.61-0.79) versus 46\% in the control group (95\% CI 0.35-0.56). They predicted 5-minute Apgar scores within a margin of one in 81\% of cases in the study group (95\% CI 0.73-0.88) and in 70\% of cases in the control group (95\% CI 0.61-0.79). Conclusions Prediction of UAB pH is more reproducible and accurate when clinicians have access to computerised analysis of CTGs. {\textcopyright} RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology.
},
	keywords = {access to information, Apgar score, arterial pH, article, Cardiotocography, clinical competence, computer analysis, computerised analysis, controlled study, delivery, Diagnosis, Computer-Assisted, diagnostic accuracy, Female, Fetal Blood, Fetal heart rate, Fetal monitoring, Gestational Age, human, Humans, Hydrogen-Ion Concentration, Infant, Newborn, male, neonatal acidaemia, Neonatology, newborn, observer variation, outcome assessment, prediction, Pregnancy, priority journal, Prospective Studies, prospective study, reproducibility, Umbilical Arteries, umbilical artery, university hospital},
	isbn = {14700328 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-77955794381\&partnerID=40\&md5=49e6cf80fa55cf7009fcb9ccec497ab2},
	author = {Costa, A. and Santos, C. and Ayres-de-Campos, D. and Costa, C. and Bernardes, J.}
}
@article {2283,
	title = {Comparison of a computer system evaluation of intrapartum cardiotocographic events and a consensus of clinicians.},
	journal = {Journal of perinatal medicineJ Perinat Med},
	volume = {38},
	year = {2010},
	note = {Cited By (since 1996): 2Export Date: 21 November 2012Source: Scopusdoi: 10.1515/JPM.2010.030PubMed ID: 20121542Language of Original Document: EnglishCorrespondence Address: Costa, M.A.email: cosantonia@gmail.com},
	month = {2010///},
	pages = {191 - 195},
	abstract = {AIMS: To compare between computer analysis of intrapartum cardiotocography (CTG) features by the Omniview-SisPorto 3.5 and a consensus of clinicians. METHODS: Agreement study using 50 consecutively acquired tracings (206 h of signals) with >60 min duration, <10\% signal loss and recorded in labor at term by internal fetal heart rate (FHR) monitoring. Tracings were divided into 10-min segments and independently analyzed by three experienced clinicians, in order to estimate the FHR baseline and identify periodic events. A consensus was reached using a three round Delphi procedure. Results were compared with the analysis provided by the Omniview-SisPorto 3.5 system. RESULTS: For baseline estimation, agreement between the computer and the consensus was high [intraclass correlation coefficient (ICC)=0.85; 95\% confidence interval (CI) 0.46-0.93], with a mean difference of 3.7 bpm (limits of agreement -4.4-11.9 bpm), and 99\% of differences under 15 bpm. A concordant identification was observed in 71\% of accelerations (95\% CI: 69\%-73\%), 68\% of decelerations (95\% CI: 66\%-70\%), and 87\% of uterine contractions (95\% CI: 85\%-89\%). CONCLUSIONS: A high agreement was observed between the Omniview-SisPorto 3.5 and a consensus of clinicians in evaluation of intrapartum CTG baseline, accelerations, decelerations and uterine contractions.},
	keywords = {algorithm, Algorithms, article, Cardiotocography, comparative study, computer assisted diagnosis, Diagnosis, Computer-Assisted, Female, Fetal Heart, Fetal monitoring, fetus heart, fetus monitoring, human, Humans, instrumentation, methodology, physician, Physicians, physiology, Pregnancy},
	isbn = {16193997 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-77953038696\&partnerID=40\&md5=bca187de4ffea0b2f2c4d2dcfb2140d9},
	author = {Costa, M.A. and Ayres-de-Campos, D. and Machado, A.P. and Santos, C.C. and Bernardes, J.}
}
@article {2259,
	title = {An intrauterine pressure generator for educational simulation of labour and delivery},
	journal = {Medical Engineering and PhysicsMed. Eng. Phys.},
	volume = {32},
	year = {2010},
	note = {Cited By (since 1996): 3Export Date: 21 November 2012Source: ScopusCODEN: MEPHEdoi: 10.1016/j.medengphy.2010.04.015PubMed ID: 20494606Language of Original Document: EnglishCorrespondence Address: Bastos, L.F.; Instituto de Engenharia Biom{\'e}dica, Divis{\~a}o de Sinal e Imagem, Rua Dr. Roberto Frias, s/n, I302, 4200-465 Porto, Portugal; email: lbastos@fe.up.ptReferences: Carlin, A., Alfirevic, Z., Intrapartum foetal emergencies (2006) Semin Foetal Neonatal Med, 11, pp. 150-157;Draycott, T., Sibanda, T., Owen, L., Akande, V., Winter, C., Reading, S., Does training in obstetric emergencies improve neonatal outcome? (2006) BJOG, 113, pp. 177-182; 
Daniels, K., Lipman, S., Harney, K., Arafeh, J., Druzin, M., Use of simulation based team training for obstetric crises in resident education (2008) Simul Healthc, 3, pp. 154-160; 
Gardner, R., Walzer, T.B., Simon, R., Raemer, D.B., Obstetric simulation as a risk control strategy: course design and evaluation (2008) Simul Healthc, 3, pp. 119-127; 
Pliego, J.F., Wehbe-Janek, H., Rajab, M.H., Browning, J.L., Fothergill, R.E., Ob/Gyn boot camp using high-fidelity human simulators: enhancing residents{\textquoteright} perceived competency, confidence in taking a leadership role, and stress hardiness (2008) Simul Healthc, 3, pp. 82-89; 
Crofts, J.F., Bartlett, C., Ellis, D., Hunt, L.P., Fox, R., Draycott, T.J., Training for shoulder dystocia: a trial of simulation using low-fidelity and high-fidelity mannequins (2006) Obstet Gynecol (New York, 1953), 108, pp. 1477-1485; 
Gardner, R., Raemer, D.B., Simulation in obstetrics and gynecology (2008) Obstet Gynecol Clin North Am, 35, pp. 97-127; 
(2001) The use of electronic foetal monitoring: the use and interpretation of cardiotocography in intrapartum foetal surveillance, , Royal-College-of-Obstetricians-and-Gynaecologists, RCOG, London; 
(2006) Intrapartum foetal surveillance: clinical guidelines, , Royal-Australian-and-New-Zealand-College-of-Obstetricians-and-Gynaecologists, RANZCOG, Melbourne; 
Bracero, L.A., Roshanfekr, D., Byrne, D.W., Analysis of antepartum foetal heart rate tracing by physician and computer (2000) J Matern Foetal Med, 9, pp. 181-185; 
Doyle, C., Angelotti, T., Diagnosis of an unsuspected maternal hemorrhage via foetal heart rate tracing (2004) J Clin Anesth, 16, pp. 465-468; 
Donn, S.M., Sinha, S.K., Chiswick, M.L., (2002) Birth asphyxia and the brain: basic science and clinical implications, , Blackwell Publishing; 
Laros, J.R.K., Presidential address: medical-legal issues in obstetrics and gynecology (2005) Am J Obstet Gynecol, 192, pp. 1883-1889; 
Cusick, W., Smulian, J.C., Vintzileos, A.M., Intrapartum use of foetal heart rate monitoring, contraction monitoring, and amnioinfusion (1995) Clin Perinatol, 22, pp. 875-906; 
Vanner, T., Gardosi, J., Intrapartum assessment of uterine activity (1996) Baillieres Clin Obstet Gynaecol, 10, pp. 243-257; 
Bakker, P.C.A.M., Van Rijswijk, S., Van Rijsiwijk, S., van Geijn, H.P., Uterine activity monitoring during labor (2007) J Perinat Med, 35, pp. 468-477; 
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van Meurs, W.L., Good, M.L., Lampotang, S., Functional anatomy of full-scale patient simulators (1997) J Clin Monit Comput, 13, pp. 317-324; 
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},
	month = {2010///},
	pages = {740 - 745},
	abstract = {Simulation provides a risk free and controllable environment for training of healthcare providers. The limited realism of available simulators and training programs impedes immersive training in obstetric emergencies. In developed countries, intrapartum monitoring in high-risk cases involves continuous evaluation of foetal heart rate and uterine contractions signals. We present an essential component of a high-fidelity simulator for normal and critical situations in labour and delivery, namely an intrauterine pressure generator. The signal model behind the generator consists of a truncated Gaussian curve with the programmable features: amplitude, frequency, duration, and resting tone. Through analysis of 44. h of physiological data, we demonstrate that the natural variability of these features and of the baseline pressure can be approximated by deterministic trends and stationary stochastic processes. Signal parameters can be controlled by simulation instructors, scripts, or other models to reflect different patients, pathologies, and evolving clinical situations. Twelve 40-min tracings reflecting three different patients in labour were presented to three clinical experts, who attributed similar realism scores to simulated and to real tracings. {\textcopyright} 2010 IPEM.},
	keywords = {article, Clinical situations, Computer simulation, delivery, Delivery, Obstetric, Developed countries, Educational simulations, Essential component, Female, Fetal monitoring, Gaussian curves, generator, Health care providers, Heart Rate, Fetal, Heart rates, High-fidelity simulators, Humans, Immersive, intrauterine pressure, labor, Labor, Obstetric, Labour and delivery, medical education, Medical educational simulation, muscle tone, Natural variability, normal distribution, Obstetrics, Physiological data, Pregnancy, Prenatal Diagnosis, Pressure, Pressure generators, priority journal, Random processes, Risk free, Signal generator, Signal generators, Signal models, Signal parameters, Signal Processing, Computer-Assisted, simulation, Stationary stochastic process, statistical model, statistical parameters, statistics, Stochastic Processes, Time Factors, Training program, Uterine activities, Uterine activity, Uterine Contraction, Uterine Monitoring, uterus contraction},
	isbn = {13504533 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-77955249563\&partnerID=40\&md5=42013058b547a71f970a3f7f1374caaf},
	author = {Bastos, L.F. and Lobo, M.F. and van Meurs, W.L. and Ayres-de-Campos, D.}
}
@article {2288,
	title = {A model for educational simulation of hemodynamic transitions at birth},
	journal = {Pediatric ResearchPediatr. Res.},
	volume = {67},
	year = {2010},
	note = {Cited By (since 1996): 2Export Date: 21 November 2012Source: ScopusCODEN: PEREBdoi: 10.1203/PDR.0b013e3181c2def3Language of Original Document: EnglishCorrespondence Address: Van Meurs, W. L.; INEB-Instituto de Engenharia Biom{\'e}dica, Divis{\~a}o de Sinal e Imagem, Campus FEUP, Rua Roberto Frias, s/n, 4200-465 Porto, Portugal; email: wvanmeurs@ineb.up.ptReferences: Van Meurs, W.L., Good, M.L., Lampotang, S., Functional anatomy of full-scale patient simulators (1997) J Clin Monit, 13, pp. 317-324;S{\'a} Couto, C.D., Van Meurs, W.L., Goodwin, J.A., Andriessen, P., A model for educational simulation of neonatal cardiovascular pathophysiology (2006) Simul Healthc, 1, pp. 4-9; 
Zijlmans, M., S{\'a}-Couto, C.D., Van Meurs, W.L., Goodwin, J.A., Andriessen, P., Corrected and improved model for educational simulation of neonatal cardiovascular pathophysiology (2009) Simul Healthc, 4, pp. 49-53; 
Goodwin, J.A., Van Meurs, W.L., S{\'a} Couto, C.D., Beneken, J.E., Graves, S.A., A model for educational simulation of infant cardiovascular physiology (2004) Anesth Analg, 99, pp. 1655-1664; 
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},
	month = {2010///},
	pages = {158 - 165},
	abstract = {Birth is characterized by swift and complex transitions in hemodynamic and respiratory variables. Unrecognized pathologies or incidents may quickly become fatal or cause permanent damage. This article introduces an essential component of an acute perinatal care simulator, namely a model for educational simulation of normal hemodynamic transitions seen during and shortly after birth. We explicitly formulate educational objectives and adapt a preexisting model for the simulation of neonatal cardiovascular physiology to include essential aspects of fetal hemodynamics. From the scientific literature, we obtain model parameters that characterize these aspects quantitatively. The fetal model is controlled by a time-and event-based script of changes occurring at birth, such as onset of breathing and cord clamping, and the transitory phase up to 24 h after birth. Comparison of simulation results with published target data confirms that realistic simulated hemodynamic vital signs are achieved. Copyright {\textcopyright} 2010 International Pediatric Research Foundation, Inc.},
	keywords = {article, artificial ventilation, biological model, birth, Blood flow, blood flow velocity, blood pressure, breathing, breathing mechanics, cardiovascular function, clamp, comparative study, Computer simulation, Constriction, education, evaluation, fetus, hemodynamics, human, Humans, Infant, Newborn, ligation, Models, Cardiovascular, newborn, Parturition, perinatal care, priority journal, Regional Blood Flow, reproducibility, Reproducibility of Results, Respiration, Artificial, Respiratory Mechanics, scientific literature, simulator, stimulation, time, Time Factors, umbilical cord, vascularization, vital sign},
	isbn = {00313998 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-77449090648\&partnerID=40\&md5=8b519ac5d166273410a6d24ec4d23578},
	author = {S{\'a}-Couto, C.D. and Andriessen, P. and van Meurs, W.L. and Ayres-de-Campos, D. and S{\'a}-Couto, P.M.}
}
@article {2246,
	title = {Simulation for teaching normal delivery and shoulder dystocia to midwives in training},
	journal = {Education for Health: Change in Learning and PracticeEduc. Health},
	volume = {23},
	year = {2010},
	note = {Cited By (since 1996): 1Export Date: 21 November 2012Source: ScopusCODEN: EDHEFLanguage of Original Document: EnglishCorrespondence Address: Reynolds, A.; Simulation Centre, Department of Obstetrics and Gynaecology, Faculty of Medicine, University of PortoPortugalReferences: Wilford, A., Doyle, T.J., Integrating simulation training into the nursing curriculum (2006) British Journal of Nursing, 15 (17), pp. 926-930;Lichtman, R., Walker, D., Supporting Innovations in Midwifery Education (2003) Journal of Midwifery \& Women{\textquoteright}s Health, 48 (6), pp. 389-390; 
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Robertson, B., An Obstetric Simulation Experience in an Undergraduate Nursing Curriculum (2006) Nurse Educator, 31 (2), pp. 74-78
},
	month = {2010///},
	abstract = {Introduction and objective: The cognitive impact of using simulation sessions in midwifery training has not been the subject of previous research. The aim of this study was to compare the effect on students{\textquoteright} knowledge of a simulation session versus an image-based lecture, for teaching routine management of normal delivery and resolution of shoulder dystocia to midwives in training. Methods: Sixty students were enrolled three weeks after a "labour and delivery" class, and randomly assigned to two groups. Ten were subsequently excluded as they were not able to attend the whole session and/or did not complete the tests. In the simulation group (n=26), students were divided into pairs and attended a 30-minute hands-on session in the simulation centre. In the lecture group (n=24), students participated in a 30-minute image-based interactive lecture. A ten-question multiple-choice test was taken before (pre-test) and after (post-test) both sessions, to evaluate students{\textquoteright} knowledge of labour and delivery and shoulder dystocia. Learner satisfaction was evaluated by adding a six question Likert scale questionnaire to the post-test. Independent t-test, paired samples t-test, and Mann-Whitney test were used for statistical analysis, setting significance at p<0.05. Results: The simulation group showed a significantly higher mean post-test score (6.38 vs. 5.16; p=0.003) and a significantly greater inter-test score progression (p<0.0001). Overall learner satisfaction was also higher in this group (p=0.0001). Conclusions: A significantly higher short-term reinforcement of knowledge and greater learner satisfaction was obtained using simulation sessions compared to image-based lectures when teaching routine management of normal delivery and resolution of shoulder dystocia to midwives in training. {\textcopyright} A Reynolds, D Ayres-de-Campos, A Pereira-Cavaleiro, L Ferreira-Bastos, 2010.},
	keywords = {Labour and delivery, Midwifery training, Patient simulators, Shoulder dystocia},
	isbn = {13576283 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-78649771419\&partnerID=40\&md5=7696155b2470aa2113e2199cf3d7c28d},
	author = {Reynolds, A. and Ayres-de-Campos, D. and Pereira-Cavaleiro, A. and Ferreira-Bastos, L.}
}
@article {2294,
	title = {Prediction of neonatal acidemia by computer analysis of fetal heart rate and ST event signals},
	journal = {American Journal of Obstetrics and GynecologyAm. J. Obstet. Gynecol.},
	volume = {201},
	year = {2009},
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Casey, B.M., McIntire, D.D., Leveno, K.J., The continuing value of the Apgar score for the assessment of the newborn infants (2001) N Engl J Med, 334, pp. 467-471; 
Moster, D., Lie, R.T., Irgens, L.M., Bjerkedal, T., Markestad, The association of Apgar score with subsequent death and cerebral palsy: a population-based study in term infants (2001) J Pediatr, 138, pp. 798-803
},
	month = {2009///},
	pages = {464.e1 - 464.e6},
	abstract = {Objective: The objective of the study was to evaluate the accuracy of computer analysis of fetal heart rate (FHR) and ST event signals in prediction of neonatal acidemia. Study Design: One hundred forty-eight FHR tracings were evaluated to identify red alerts provided by the system, based on automated analysis of FHR and ST event signals, and compared with the occurrence of umbilical artery acidemia (pH <=7.05). Results: The presence of red alerts obtained sensitivity of 1.00 (95\% confidence interval [CI], 0.56-1.00), specificity of 0.94 (95\% CI, 0.89-0.97), positive predictive value (PPV) of 0.47 (95\% CI, 0.22-0.72), negative predictive value (NPV) of 1 (95\% CI, 0.96-1.00), positive likelihood ratio (PLR) of 17.6 (95\% CI, 9.0-34.5), and negative likelihood ratio (NLR) of 0. When limiting analysis to red alerts that did not include ST data, sensitivity was 0.57 (95\% CI, 0.20-0.88), specificity was 0.97 (95\% CI, 0.92-0.99), PPV was 0.50 (95\% CI, 0.17-0.82), NPV was 0.98 (95\% CI, 0.93-0.99), PLR was 20.14 (95\% CI, 6.3-64.2), and NLR was 0.44 (95\% CI, 0.19-1.04). Conclusion: Computer analysis of FHR and ST event signals provide higher accuracy in predicting neonatal academia. {\textcopyright} 2009 Mosby, Inc. All rights reserved.},
	keywords = {acidemia, Acidosis, article, autoanalysis, Cardiotocography, computer analysis, computer assisted, computer prediction, Diagnosis, Computer-Assisted, diagnostic value, Electrocardiography, Female, Fetal heart rate, Fetal hypoxia, Fetal monitoring, fetus electrocardiography, fetus heart rate, Heart Rate, Fetal, human, Humans, Infant, Newborn, major clinical study, male, newborn, newborn acidosis, observational study, pH, Predictive Value of Tests, priority journal, Prospective Studies, prospective study, Reproducibility of Results, sensitivity and specificity, signal transduction, ST segment, umbilical artery},
	isbn = {00029378 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-70350572323\&partnerID=40\&md5=6ffddbacf1381ab65c9bd35f8db108dd},
	author = {Costa, A. and Ayres-de-Campos, D. and Costa, F. and Santos, C. and Bernardes, J.}
}
@article {2314,
	title = {Sex differences in linear and complex fetal heart rate dynamics of normal and acidemic fetuses in the minutes preceding delivery},
	journal = {Journal of Perinatal MedicineJ. Perinat. Med.},
	volume = {37},
	year = {2009},
	note = {Cited By (since 1996): 4Export Date: 21 November 2012Source: ScopusCODEN: JPEMAdoi: 10.1515/JPM.2009.024PubMed ID: 19021459Language of Original Document: EnglishCorrespondence Address: Bernardes, J.; Faculdade de Medicina, Universidade Do Porto, Ginecologia e Obstetr{\'\i}cia, Al. Hernani Monteiro, Porto, 4200, Portugal; email: jbernardes59@gmail.comReferences: Ayres-de-Campos, D., Bernardes, J., Costa-Pereira, A., Pereira-Leite, L., Inconsistencies in classification by experts of cardiotocograms and subsequent clinical decision (1999) Br J Obstet Gynaecol, 106, pp. 1307-1310;Ayres-de-Campos, D., Bernardes, J., Garrido, A., Marques-de-S{\`a}, J.P., Pereira-Leite, L., SisPorto 2.0 - a program for automated analysis of cardiotocograms (2000) J Matern Fetal Med, 9, pp. 311-318; 
Ayres-de-Campos, D., Costa-Santos, C., Bernardes, J., SisPorto Multicentre Validation Study Group. Prediction of neonatal state by computer analysis of fetal heart rate tracings: The antepartum arm of the SisPorto multicentre validation study (2005) Eur J Obstet Gynecol Reprod Biol, 118, pp. 52-60; 
Ayres-de-Campos, D., Sousa, P., Costa, A., Bernardes, J., Omniview-SisPorto 3.5 - a central fetal monitoring station with online alerts based on computerized cardio-tocogram+ST event analysis (2008) J Perinat Med, 36, pp. 260-264; 
Beckers, F., Verheyden, B., Aubert, A.E., Aging and non-linear heart rate control in a healthy population (2006) Am J Physiol Heart Circ Physiol, 290, pp. H2560-H2570; 
Bekedam, D.J., Engelsbel, S., Mol, B.W., Buitendijk, S.E., van der Pal-de Bruin, K.M., Male predominance in fetal distress during labor (2002) Am J Obstet Gynecol, 187, pp. 1605-1607; 
Bennet, L., Booth, L.C., Ahmed-Nasef, N., Dean, J.M., Davidson, J., Quaedackers, J.S., Male disadvantage? Fetal sex and cardiovascular responses to asphyxia in preterm fetal sheep (2007) Am J Physiol Regul Integr Comp Physiol, 293, pp. R1280-R1286; 
Bernardes, J., Moura, C., Marques-de-S{\'a}, J.P., Pereira-Leite, L., The Porto system for automated cardiotocographic signal analysis (1991) J Perinat Med, 19, pp. 61-65; 
Bernardes, J., Costa-Pereira, A., Ayres-de-Campos, D., van Geijn, H.P., Pereira-Leite, L., Evaluation of interobserver agreement of cardiotocograms (1997) Int J Gynecol Obstet, 57, pp. 33-37; 
Bernardes, J., Ayres-de-Campos, D., Costa-Pereira, A., Pereira-Leite, L., Garrido, A., Objective computerized fetal heart rate analysis (1998) Int J Gynaecol Obstet, 62, pp. 141-147; 
Bernardes, J., Gon{\c c}alves, H., Ayres-de-Campos, D., Rocha, A.P., Linear and complex heart rate dynamics vary with sex in relation to fetal behavioural states (2008) Early Hum Dev, 84, pp. 433-439; 
Boog, G., Analyse informatis{\'e}e du rythme cardiaque foetal au cours de la grosssesse et de l{\textquoteright}accouchement. (2004) Encyclop{\'e}die M{\'e}dico- Chirurgicale, 148, pp. 1-10; 
Browner, W.S., Newman, T.B., Cummings, S.R., Hulley, S.B., (2001) Estimating sample size and power: The nitty-gritty, pp. 65-84. , Hulley SB, Cummings SR, Browner WS, Grady D, Hearst N, Newman TB, editors. Philadelphia: Lippincot Williams \& Wilkins; 
Chaffin, D.G., Barnard, J.M., Phernetton, T., Reed, K.L., Decreased approximate entropy of heart rate variability in the hypoxic ovine fetus (1998) J Matern Fetal Invest, 8, pp. 23-26; 
Dawes, G.S., Moulden, M., Redman, C.W., Improvements in computerized fetal heart rate analysis antepartum (1996) J Perinat Med, 24, pp. 25-36; 
Dawes, N.W., Dawes, G.S., Moulden, M., Redman, C.W., Fetal heart rate patterns in term labor vary with sex, gestational age, epidural analgesia, and fetal weight (1999) Am J Obstet Gynecol, 180, pp. 181-187; 
DiPietro, J.A., Costigan, K.A., Shupe, A.K., Pressman, E.K., Johnson, T.R., Fetal neurobehavioral development: Associations with socioeconomic class and fetal sex (1998) Dev Psychobiol, 33, pp. 79-91; 
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Gon{\c c}alves, H., Rocha, A.P., Ayres-de-Campos, D., Bernardes, J., Internal versus external intrapartum foetal heart rate monitoring: The effect on linear and nonlinear parameters (2006) Physiol Meas, 27, pp. 307-319; 
Goncalves, H., Rocha, A.P., Ayres-de-Campos, D., Bernardes, J., Linear and nonlinear fetal heart rate analysis of normal and acidemic fetuses in the minutes preceding delivery (2006) Med Biol Eng Comput, 44, pp. 847-855; 
Goncalves, H., Bernardes, J., Rocha, A.P., Ayres-de-Campos, D., Linear and nonlinear analysis of heart rate patterns associated with fetal behavioral states in the antepartum period (2007) Early Hum Dev, 83, pp. 585-591; 
Groome, L.J., Mooney, D.M., Holland, S.B., Smith, L.A., Atterbury, J.L., Dykman, R.A., Behavioral state affects heart rate response to low-intensity sound in human fetuses (1999) Early Hum Dev, 54, pp. 39-54; 
Ingemarsson, I., Herbst, A., Thorngren-Jerneck, K., Long-term outcome after umbilical artery acidemia at term birth: Influence of gender and duration of fetal heart rate abnormalities (1997) Br J Obstet Gynaecol, 104, pp. 1123-1127; 
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King, T., Parer, J., The physiology of fetal heart rate patterns and perinatal asphyxia (2000) J Perinat Neonat Nurs, 14, pp. 19-39; 
Kuo, T.B., Yang, C.C., Sexual dimorphism in the complexity of cardiac pacemaker activity (2002) Am J Physiol Heart Circ Physiol, 283, pp. H1695-H1702; 
Li, X., Tang, D., Zhou, S., Zhou, G., Wang, C., Zhuang, Y., Redistribution of power spectrum of heart rate variability during acute umbilical artery embolism and hypoxemia in late-gestation fetal sheep (2004) J Obstet Gynecol Reprod Biol, 114, pp. 137-143; 
Magenes, G., Signorini, M.G., Arduini, D., Classification of cardiotocographic records by neural networks (2000) IJCNN 2000, Proceedings of the IEEE-INNS-ENNS International Joint Conference on Neural Networks, 3, pp. 637-641; 
Martinez, W.L., Martinez, A.R., (2002) Computational statistics handbook with MATLAB, , CRC Press;; 
Pincus, S., Approximate entropy as a measure of system complexity (1991) Proc Natl Acad Sci USA, 88, pp. 2297-2301; 
Pincus, S., Viscarello, R., Approximate Entropy: A regularity measure for fetal heart rate analysis (1992) Obstet Gynecol, 79, pp. 249-255; 
Richman, J.S., Moorman, J.R., Physiological time-series analysis using approximate entropy and sample entropy (2000) Am J Physiol Heart Circ Physiol, 278, pp. H2039-H2049; 
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Sheiner, E., Hadar, A., Hallak, M., Katz, M., Mazor, M., Shoham-Vardi, I., Clinical significance of fetal heart rate tracings during the second stage of labor (2001) Obstet Gynecol, 97, pp. 747-752; 
Signorini, M.G., Magenes, G., Cerrutti, S., Arduini, D., Linear and nonlinear parameters for the analysis of fetal heart rate signal from cardiotacographic recordings (2003) IEEE Transactions on Biomedical Engineering, 50, pp. 365-373; 
Siira, S.M., Ojala, T.H., Vahlberg, T.J., Jalonen, J.O., V{\"a}lim{\"a}ki, I.A., Ros{\'e}n, K.G., Marked fetal acidosis and specific changes in power spectrum analysis of fetal heart rate variability recorded during the last hour of labor (2005) Br J Obstet Gynaecol, 112, pp. 418-423; 
Suzuki, T., Okamura, K., Kimura, Y., Watanabe, T., Yaegashi, N., Murotsuki, J., Power spectral analysis of R-R interval variability before and during the sinusoidal heart rate pattern in fetal lambs (2000) Am J Obstet Gynecol, 182, pp. 1227-1232; 
},
	month = {2009///},
	pages = {168 - 176},
	abstract = {Aim: To assess linear and complex heart rate dynamics in relation to fetal gender in normal and acidemic fetuses during the minutes preceding delivery. Methods: Linear and non-linear fetal heart rate indices, namely mean FHR, long-term irregularity index, short-term variability, low and high frequency spectral indices, approximate and sample entropy, were assessed in 36 female and 30 male fetuses, adjusted for gestational age and weight, during the minutes preceding delivery. Analysis was performed in the initial and final minutes of each tracing in fetuses with umbilical artery blood pH at delivery >=7.20, 7.11-7.19 and <=7.10. Results: Progression of labor was associated with a significant decrease in non-linear indices and an increase in almost all linear indices, both in female and male fetuses, but changes were more marked in female fetuses. Non-acidemic females showed higher mean FHR in the final minutes of labor, compared with males. Acidemic females had higher linear indices when compared to similar male fetuses. Conclusions: During the minutes preceding delivery, female fetuses express higher linear indices than male fetuses, suggesting greater activation of the autonomic nervous system, while maintaining similar complexity indices, which suggests different reaction and adaptation capabilities to stress and distress. {\textcopyright} 2009 by Walter de Gruyter.},
	keywords = {acidemia, Acidemic fetuses, article, autonomic nervous system, Birth Weight, blood pH, Cross-Sectional Studies, delivery, Delivery, Obstetric, entropy, Entropy and spectral analysis, Female, Fetal Heart, fetus, fetus heart rate, Gestational Age, Heart Rate, Fetal, human, Humans, Hydrogen-Ion Concentration, Intrapartum, labor, Labor, Obstetric, male, Pregnancy, priority journal, Retrospective Studies, Sex Characteristics, sex difference, Umbilical Arteries, umbilical artery},
	isbn = {03005577 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-59449089216\&partnerID=40\&md5=7a093bd5c056231b3f8150912abca652},
	author = {Bernardes, J. and Gon{\c c}alves, H. and Ayres-de-Campos, D. and Rocha, A.P.}
}
@article {2304,
	title = {Skin adhesive versus subcuticular suture for perineal skin repair after episiotomy - A randomized controlled trial},
	journal = {Acta Obstetricia et Gynecologica ScandinavicaActa Obstet. Gynecol. Scand.},
	volume = {88},
	year = {2009},
	note = {Cited By (since 1996): 3Export Date: 21 November 2012Source: ScopusCODEN: AOGSAdoi: 10.1080/00016340902883133Language of Original Document: EnglishCorrespondence Address: Mota, R.; Servi{\c c}o de Ginecologia e Obstetr{\'\i}cia, Hospital de S. Jo{\~a}o, 4200-319 Porto, Portugal; email: sisporto@med.up.ptChemicals/CAS: Tissue Adhesives; cyanoacrylic acid octyl ester, 6701-17-3; polyglactin, 26780-50-7, 34346-01-5Tradenames: Dermabond, EthiconManufacturers: EthiconReferences: Kettle, C., Hills, R.K., Jones, P., Darby, L., Gray, R., Johanson, R., Continuous versus interrupted perineal repair with standard or rapidly absorbed sutures after spontaneous vaginal birth: A randomized controlled trial (2002) Lancet, 359, pp. 2217-2223;Gordon, B., Mackrodt, C., Fern, E., Truesdale, A., Ayers, S., Grant, A., The Ipswich Childbirth Study: 1. A randomized evaluation of two stage postpartum perineal repair leaving the skin unsutured (1998) Br J Obstet Gynaecol, 105, pp. 435-440; 
Mackrodt, C., Gordon, B., Fern, E., Ayers, S., Truesdale, A., Grant, A., The Ipswich Childbirth Study: 2. A randomized comparison of polyglactin 910 with chromic catgut for postpartum perineal repair (1998) Br J Obstet Gynaecol, 105, pp. 441-445; 
Kettle, C., Johanson, R.B., Continuous versus interrupted sutures for perineal repair (2000) Cochrane DataBase Syst Rev, (2). , CD000947; 
Kettle, C., Hills, R.K., Ismail, K.M.K., Continuous versus interrupted sutures for repair of episiotomy or second degree tears (2007) Cochrane DataBase Syst Rev, (4). , CD000947; 
Gemynthe, A., Langhoff-Roos, J., Sahl, S., Knudsen, J., New VICRYL formulation: An improved method of perineal repair? (1996) Br J Midwifery, 4, pp. 230-234; 
Oboro, V.O., Tabowei, T.O., Loto, O.M., Bosah, J.O., A multicentre evaluation of the two-layered repair of postpartum perineal trauma (2003) J Obstet Gynaecol, 23, pp. 5-8; 
Kindberg, S., Stehouwer, M., Hvidman, L., Henriksen, T.B., Postpartum perineal repair performed by midwives: A randomised trial comparing two suture techniques leaving the skin unsutured (2008) Br J Obstet Gynaecol, 115, pp. 472-479; 
Gennari, R., Rotmensz, N., Ballardini, B., Scevola, S., Perego, E., Zanini, V., A prospective, randomized, controlled clinical trial of tissue adhesive (2-octylcyanoacrylate) versus standard wound closure in breast surgery (2004) Surgery, 136, pp. 593-599; 
Bernard, L., Doyle, J., Friedlander, S.F., Eichenfield, L.F., Gibbs, N.F., Cunningham, B.B., A prospective comparison of octylcya-noacrylate tissue adhesive (dermabond) and suture for the closure of excisional wounds in children and adolescents (2001) Arch Dermatol, 137, pp. 1177-1180; 
Matin, S.F., Prospective randomized trial of skin adhesive versus sutures for closure of 217 laparoscopic port-site incisions (2003) J Am Coll Surg, 196, pp. 845-853; 
Bhende, S., Rothenburger, S., Spangler, D.J., Dito, M., In vitro assessment of microbial barrier properties of Dermabond( topical skin adhesive (2002) Surg Infect, 3, pp. 251-257; 
Rogerson, L., Mason, G.C., Roberts, A.C., Preliminary experience with twenty perineal repairs using Indermil tissue adhesive (2000) Eur J Obstet Gynecol Reprod Biol, 88, pp. 139-142; 
Bowen, M.L., Selinger, M., Episiotomy closure comparing enbucrilate tissue adhesive with conventional sutures (2002) Int J Gynecol Obstet, 78, pp. 201-205; 
Adoni, A., Anteby, E., The use of Histoacryl for the episiotomy repair (1991) Br J Obstet Gynaecol, 98, pp. 476-478; 
Man, J., Quinn, J., Cyanoacrylate tissue adhesives (1997) Am J Cosm Surg, 14, pp. 413-416; 
Maw, J.L., Quinn, J.V., Wells, G.A., Ducic, Y., Odell, P.F., Lamothe, A., A prospective comparison of octylcyanoacrylate tissue adhesive and suture for the closure of head and neck incisions (1997) J Otolaryngol, 26, pp. 26-30
},
	month = {2009///},
	pages = {660 - 666},
	abstract = {Objective. Surgical repair of perineal lesions after delivery is frequently associated with pain and discomfort, interfering with the normal activities of the puerperium. The aim of this study was to compare perineal skin repair after episiotomy with adhesive glue versus a subcuticular suture, regarding the incidence of pain and wound complications. Study design. Randomized clinical trial. Setting. Tertiary care university hospital. Material and methods. One hundred women having mediolateral episiotomy at vaginal delivery were enrolled. They were randomized to receive skin adhesive (n = 53) or subcuticular suture (n = 47) for closure of perineal skin. The main outcome measure was self-evaluated pain in the 30 days following delivery. Secondary outcome measures were technical difficulties reported with the procedure, duration of surgical repair, wound complications observed at 42-68 hours post-partum and re-initiation of sexual activity by 30 days post-partum. Results. No significant differences were observed between the two groups in incidence of technical difficulties and failed procedures, pain during the procedure, wound complications at hospital discharge, self-evaluated measures of pain at 7 and 30 days or re-initiation of sexual activity by 30 days post-partum. The skin adhesive group had a significantly shorter mean duration of the procedure (four minutes less). Conclusion. Perineal skin closure using adhesive glue is faster than subcuticular suture, and associated with a similar incidence of complications and pain in the first 30 days.},
	keywords = {adult, article, clinical trial, comparative study, controlled clinical trial, controlled study, cyanoacrylic acid octyl ester, edema, episiotomy, Episiotomy closure, Female, granuloma, human, Humans, injury, major clinical study, obstetric care, pain, pain assessment, Perineal repair, perineum, perineum injury, polyglactin, priority journal, questionnaire, randomized controlled trial, sexual intercourse, Skin, Skin adhesive, suture, Suture Techniques, suturing method, Tissue adhesive, Tissue Adhesives, treatment outcome, vaginal delivery, wound closure, wound dehiscence, Wounds and Injuries},
	isbn = {00016349 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-66149113694\&partnerID=40\&md5=2a28b4b09b79b1c79c4cf903af92a16c},
	author = {Mota, R. and Costa, F. and Amaral, A. and Oliveira, F. and Santos, C.C. and Ayres-de-Campos, D.}
}
@article {2349,
	title = {Frequency domain and entropy analysis of fetal heart rate: Appealing tools for fetal surveillance and pharmacodynamic assessment of drugs},
	journal = {Cardiovascular and Hematological Disorders - Drug TargetsCardiovasc. Hematol. Disord. Drug Targets},
	volume = {8},
	year = {2008},
	note = {Cited By (since 1996): 1Export Date: 21 November 2012Source: Scopusdoi: 10.2174/187152908784533720Language of Original Document: EnglishCorrespondence Address: Gon{\c c}alves, H.; Departamento de Matem{\'a}tica Aplicada, Faculdade de Ci{\^e}ncias, Universidade do Porto, Rua do Campo Alegre 687, 4169-007 Porto, Portugal; email: hernani.goncalves@fc.up.ptChemicals/CAS: atropine, 51-55-8, 55-48-1; betamethasone, 378-44-9; lidocaine, 137-58-6, 24847-67-4, 56934-02-2, 73-78-9; magnesium sulfate, 7487-88-9; opiate, 53663-61-9, 8002-76-4, 8008-60-4; propranolol, 13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6; salbutamol, 18559-94-9References: Task-Force. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996) Eur. Heart J, 17, pp. 354-381;Beckers, F., Verheyden, B., Aubert, A.E., Aging and nonlinear heart rate control in a healthy population (2006) Am. J. Physiol. Heart Circ. Physiol, 29, pp. H2560-H2570; 
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American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists, Number 70, December 2005 (2005) Int. J. Gynecol. Obstet, 1, pp. 1453-1460. , ACOG; 
(2001) Royal College of Obstetricians and Gynaecologists. Evidence-Based Clinical Guideline Number 8. The Use of Electronic Fetal Monitoring, , RCOG, Royal College of Obstetricians and Gynaecologists: London; 
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Dawes, G.S., Moulden, M., Redman, C.W.G., System 8000 - Computerized antenatal FHR analysis (1991) J. Perinat. Med, 19 (1-2), pp. 47-51; 
Bernardes, J., Moura, C., Marques-de-S{\'a}, J.P., Pereira-Leite, L., The Porto system for automated cardiotocographic signal analysis (1991) J. Perinat. Med, 19, pp. 61-65; 
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Bernardes, J., Ayres-de-Campos, D., Costa-Pereira, A., Pereira-Leite, L., Garrido, A., Objective computerized fetal heart rate analysis (1998) Int. J. Gynecol. Obstet, 2, pp. 141-147; 
Bernardes, J., Costa-Pereira, A., The effect of different sampling intervals on the measurement of intrapartum fetal heart rate variability. Letter to the Editor (1997) Obstet. Gynecol, 9, pp. 318-319; 
Ayres-de-Campos, D., Bernardes, J., Costa-Pereira, A., Pereira-Leite, L., Inconsistencies in expert{\textquoteright}s classification of cardiotocograms and subsequent clinical decision (1999) Br. J. Obstet. Gynecol, 1, pp. 1307-1310; 
Ayres-de-Campos, D., Bernardes, J., Early, variable and late decelerations: Can a consensus be reached in their identification? (1999) Int. J. Gynecol. Obstet, 5 (3), pp. 305-306; 
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Bernardes, J.; Costa-Pereira, A. Efficacy and safety of intrapartum electronic fetal monitoring: An update. Obstet. Gynecol., 1996}, 87 3, 476-477Bernardes, J., Costa-Pereira, A., Admission cardiotocography (2003) Lancet, 3 (1), p. 1741; 
Alfirevic, Z., Devane, D., Gyte, G.M.L., Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (2006) Coch. Data. Sys. Rev, 3; 
Pincus, S., Viscarello, R., Approximate Entropy: A regularity measure for fetal heart rate analysis (1992) Obstet. Gynecol, 79 (2), pp. 249-255; 
Signorini, M.G., Magenes, G., Cerrutti, S., Arduini, D., Linear and nonlinear parameters for the analysis of fetal heart rate signal from cardiotacographic recordings (2003) IEEE Trans. Biomed. Eng, 5 (3), pp. 365-373; 
Gon{\c c}alves, H., Rocha, A.P., Ayres-de-Campos, D., Bernardes, J., Linear and nonlinear fetal heart rate analysis of normal and acidemic fetuses in the minutes preceding delivery (2006) Med. Biol. Eng. Comput, 44 (1), pp. 847-855; 
Gon{\c c}alves, H., Bernardes, J., Rocha, A.P., Ayres-de-Campos, D., Linear and nonlinear analysis of heart rate patterns associated with fetal behavioral states in the antepartum period (2007) Early Hum. Dev, 83, pp. 585-591; 
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Suzuki, T., Okamura, K., Kimura, Y., Watanabe, T., Yaegashi, N., Murotsuki, J., Uehara, S., Yajima, A., Power spectral analysis of R-R interval variability before and during the sinusoidal heart rate pattern in fetal lambs (2000) Am. J. Obstet. Gynecol, 182, pp. 1227-1232; 
Li, X., Tang, D., Zhou, S., Zhou, G., Wang, C., Zhuang, Y., Wu, G., Shen, L., Redistribution of power spectrum of heart rate variability during acute umbilical artery embolism and hypoxemia in late-gestation fetal sheep (2004) Eur. J. Obstet. Gynecol. Reprod. Biol, 114, pp. 137-143; 
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Bernardes, J., Costa-Pereira, A., A more objective fetal heart rate baseline estimation (1996) Br. J. Obstet. Gynaecol, 1 (3), pp. 714-715; 
Ayres-de-Campos, D., Bernardes, J., Marsal, K., Nickelsen, C., Makarainen, L., Banfield, P., Xavier, P., Campos, I., Can the reproducibility of fetal heart rate baseline estimation be improved? (2004) Eur. J. Obstet. Gynecol. Reprod. Biol, 112, pp. 49-54; 
Ayres-de-Campos, D., Santos, C., Bernardes, J., Prediction of neonatal state by computer analysis of fetal heart rate tracings: The antepartum arm of the SisPorto {\textregistered} multicentre validation study (2005) Eur. J. Obstet. Gynecol. Reprod. Biol, 118 (1), pp. 52-60; 
Pincus, S., Approximate entropy as a measure of system complexity (1991) Proc. Natl. Acad. Sci. USA, 88, pp. 2297-2301; 
Richman, J.S., Moorman, J.R., Physiological time-series analysis using approximate entropy and sample entropy (2000) Am. J. Physiol. Heart. Circ. Physiol, 278, pp. H2039-H2049; 
Fusheng, Y., Bo, H., Qingyu, T., (1998) Nonlinear biomedical signal processing - Volume II: Dynamical analysis and modelling, pp. 72-91. , Ed, Approximate entropy and its application in biosignal analysis; IEEE Press: New York; 
Pincus, S., Approximate entropy (ApEn) as a complexity measure (1995) Chaos, 5 (1), pp. 110-117; 
Hayes, M., (1996) Statistical digital signal processing and modelling, , Jonh Wiley and Sons, Inc.:New York; 
Boog, G., Analyse informatis{\'e}e du rythme cardiaque foetal au cours de la grossesse et de l{\textquoteright}accouchement (2004) Encyclop{\'e}die M{\'e}dico-Chirurgicale, 148, pp. 1-10. , 5.049-D-23; 
Gon{\c c}alves, H., Rocha, A.P., Ayres-de-Campos, D., Bernardes, J., Internal versus external intrapartum foetal heart rate monitoring: The effect on linear and nonlinear parameters (2006) Physiol. Meas, 27, pp. 307-319; 
Magenes, G., Signorini, M.G., Arduini, D., Cerutti, S., Fetal heart rate variability due to vibroacoustic stimulation: Linear and nonlinear contribution (2004) Methods Inf. Med, 43 (1), pp. 47-51; 
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Rotmensch, S., Lev, S., Kovo, M., Efrat, Z., Zahavi, Z., Lev, N., Celentano, C., Ben-Rafael, Z., Effect of betamethasone administration on fetal heart rate tracing: A blinded longitudinal study (2005) Fetal. Diagn. Ther, 2 (5), pp. 371-376; 
Lunshof, M.S., Boer, K., Wolf, H., Koppen, S., Velderman, J.K., Mulder, E.J.H., Short-term (0-48h) effects of maternal betamethasone administration on fetal heart rate and its variability (2005) Pediatr. Res, 57 (4), pp. 545-549; 
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DiRenzo, G.C., Montani, M., Fioriti, V., Clerici, G., Branconi, F., Pardini, A., Indraccolo, R., Cosmi, E.V., Fractal analysis: A new method for evaluating fetal heart rate variability (1996) J. Perinat. Med, 24 (3), pp. 261-269; 
Felgueiras, C., Marques-de-S{\'a}, J.P., Bernardes, J., Gama, S., Fractal characterisation of fetal heart rate sequences (1998) Biomed. Eng, 3 (2), pp. 197-201; 
},
	month = {2008///},
	pages = {91 - 98},
	abstract = {Recently, frequency domain and entropy analysis of fetal heart rate (FHR) have been assessed in several studies, providing new insights into physiologic regulatory mechanisms, constituting appealing tools for pharmacodynamic assessment, namely during fetal life. There is evidence that entropy and frequency domain analysis convey information on cortical and autonomic nervous system activities, respectively. Use of internal versus external FHR acquisition sensors and the signal sampling frequency may dramatically affect results. Most FHR frequency domain indices are significantly increased with rising fetal activity, namely during active wakefulness and active sleep, whereas the opposite occurs with nonlinear indices. This is in favour of increased activity of the autonomous nervous system and decreased activity of the central nervous system complexity control systems, during periods of fetal activity. Progression of labor is associated with a significant increase in FHR frequency domain indices, whereas entropy indices are significantly decreased. This denotes activation of the autonomic nervous system in the final minutes of labour, associated with decreased central nervous system activity. The emerging knowledge on FHR frequency domain and entropy analysis substantiates a continued interest of these methods in evaluation of the fetal pathophysiologic regulatory mechanisms, and opens new perspectives for clinical and pharmacodynamic assessment. {\textcopyright} 2008 Bentham Science Publishers Ltd.},
	keywords = {acidemia, adrenergic receptor stimulating agent, alpha adrenergic receptor blocking agent, anticonvulsive agent, article, atropine, autonomic nervous system function, beta adrenergic receptor blocking agent, betamethasone, Cardiotocography, central depressant agent, central nervous system function, cholinergic receptor blocking agent, chronotropism, Computerized analysis, drug effect, drug mechanism, electronic sensor, entropy, External and internal monitoring, Female, Fetal behavioral states, Fetal heart rate (FHR), Fetal monitoring, fetus, fetus heart rate, fetus monitoring, frequency analysis, Frequency domain and entropy analysis, gestation period, Heart rate variability, Heart Rate, Fetal, human, Humans, instrumentation, labor, lidocaine, local anesthetic agent, magnesium sulfate, mathematical computing, methodology, nonhuman, opiate, pharmacodynamics, physiology, Pregnancy, prenatal screening, propranolol, pulse rate, review, salbutamol, signal detection},
	isbn = {1871529X (ISSN)},
	author = {Gon{\c c}alves, H. and Rocha, A.P. and Ayres-de-Campos, D. and Bemardes, J.}
}
@article {2347,
	title = {Linear and complex heart rate dynamics vary with sex in relation to fetal behavioural states},
	journal = {Early Human DevelopmentEarly Hum. Dev.},
	volume = {84},
	year = {2008},
	note = {Cited By (since 1996): 16Export Date: 21 November 2012Source: ScopusCODEN: EHDEDdoi: 10.1016/j.earlhumdev.2007.12.001PubMed ID: 18248921Language of Original Document: EnglishCorrespondence Address: Bernardes, J.; Departamento de Ginecologia e Obstetr{\'\i}cia, Faculdade de Medicina, Universidade do Porto and INEB (Instituto Nacional de Engenharia Biom{\'e}dica), Porto, Portugal; email: jbernardes@mail.telepac.ptReferences: Ingemarsson, I., Herbst, A., Thorngren-Jerneck, K., Long term outcome after umbilical artery acidaemia at term birth: influence of gender and duration of fetal heart rate abnormalities (1997) Br J Obstet Gynaecol, 104 (10), pp. 1123-1127;Ingemarsson, I., Gender aspects of preterm birth (2003) BJOG, 110 (SUPPL. 20), pp. 34-38; 
DiPietro, J.A., Hodgson, D.M., Costigan, K.A., Hilton, S.C., Johnson, T.R., Development of fetal movement-fetal heart rate coupling from 20~weeks through term (1996) Early Hum Dev, 44 (2), pp. 139-151; 
DiPietro, J.A., Costigan, K.A., Shupe, A.K., Pressman, E.K., Johnson, T.R., Fetal neurobehavioral development: associations with socioeconomic class and fetal sex (1998) Dev Psychobiol, 33 (1), pp. 79-91; 
Ogueh, O., Steer, P., Gender does not affect fetal heart rate variation (1998) Br J Obstet Gynaecol, 105 (12), pp. 1312-1314; 
Dawes, N.W., Dawes, G.S., Moulden, M., Redman, C.W., Fetal heart rate patterns in term labor vary with sex, gestational age, epidural analgesia, and fetal weight (1999) Am J Obstet Gynecol, 180, pp. 181-187; 
Lange, S., Van Leeuwen, P., Geue, D., Hatzmann, W., Gronemeyer, D., Influence of gestational age, heart rate, gender and time of day on fetal heart rate variability (2005) Med Biol Eng Comput, 43 (4), pp. 481-486; 
Gon{\c c}alves, H., Bernardes, J., Rocha, A.P., Ayres-de-Campos, D., Linear and nonlinear analysis of heart rate patterns associated with fetal behavioral states in the antepartum period (2007) Early Hum Dev, 83 (9), pp. 585-591; 
Nijhuis, J.G., Prechtl, H.F., Martin Jr., C.B., Bots, R.S., Are there behavioural states in the human fetus? (1982) Early Hum Dev, 6 (2), pp. 177-195; 
Gon{\c c}alves, H., Rocha, A.P., Ayres-de-Campos, D., Bernardes, J., Internal versus external intrapartum foetal heart rate monitoring: the effect on linear and nonlinear parameters (2006) Physiol Meas, 27 (3), pp. 307-319; 
Goncalves, H., Rocha, A.P., Bernardes, J., Ayres-de-Campos, D., Linear and nonlinear fetal heart rate analysis of normal and acidemic fetuses in the minutes preceding delivery (2006) Med Biol Eng Comput, 44 (10), pp. 847-855; 
Ayres-de-Campos, D., Bernardes, J., Garrido, A., Marques-de-S{\'a}, Pereira-Leite, L., SisPorto 2.0 - a program for automated analysis of cardiotocograms (2000) J Matern Fetal Med, 9, pp. 311-318.; 
Magenes, G., Signorini, M.G., Arduini, D., Classification of cardiotocographic records by neural networks (2000) IJCNN 2000, Proceedings of the IEEE-INNS-ENNS International Joint Conference on Neural Networks, 3, pp. 637-641; 
Signorini, M.G., Magenes, G., Cerrutti, S., Arduini, D., Linear and nonlinear parameters for the analysis of fetal heart rate signal from cardiotacographic recordings (2003) IEEE Trans Biomed Eng, 50, pp. 365-373; 
Task force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology, Heart rate variability - standards of measurement, physiological interpretation and clinical use (1996) Circulation, 17, pp. 354-381; 
Boog, G., Analyse informatis{\'e}e du rythme cardiaque foetal au cours de la grosssesse et de l{\textquoteright}accouchement (2004) Encyclop{\'e}die M{\'e}dico-Chirurgicale, 148 (5-49 -D-23), pp. 1-10; 
Suzuki, T., Okamura, K., Kimura, Y., Watanabe, T., Yaegashi, N., Murotsuki, J., Power spectral analysis of R-R interval variability before and during the sinusoidal heart rate pattern in fetal lambs (2000) Am J Obstet Gynecol, 182, pp. 1227-1232; 
Pincus, S., Approximate entropy as a measure of system complexity (1991) Proc Natl Acad Sci U. S. A., 88, pp. 2297-2301; 
Richman, J.S., Moorman, J.R., Physiological time-series analysis using approximate entropy and sample entropy (2000) Am J Physiol Heart Circ Physiol, 278, pp. H2039-H2049; 
Fusheng, Y., Bo, H., Qingyu, T., Approximate entropy and its application in biosignal analysis (1998) Nonlinear biomedical signal processing - Volume II: Dynamical analysis and modelling, pp. 72-91. , Akay M. (Ed), IEEE Press; 
Pincus, S., Viscarello, R., Approximate entropy: a regularity measure for fetal heart rate analysis (1992) Obstet Gynecol, 79, pp. 249-255; 
Martinez, W.L., Martinez, A.R., (2002) Computational statistics handbook with MATLAB, , CRC Press; 
Dudewicz, E., Mishra, S., (1998) Modern Mathematical Statistics, , John Wiley and Sons, Inc; 
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Jensen-Urstad, K., Storck, N., Bouvier, F., Ericson, M., Lindblad, L.E., Jensen-Urstad, M., Heart rate variability in healthy subjects is related to age and gender (1997) Acta Physiol Scand, 160 (3), pp. 235-241; 
Beckers, F., Verheyden, B., Aubert, A.E., Aging and nonlinear heart rate control in a healthy population (2006) Am J Physiol Heart Circ Physiol, 290 (6), pp. H2560-H2570; 
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Bernardes, J., Costa-Pereira, A., Ayres-de-Campos, D., van Geijn, H.P., Pereira-Leite, L., Evaluation of interobserver agreement of cardiotocograms (1997) Int J Gynecol Obstet, Suppl, 57 (1), pp. 33-37; 
Ayres-de-Campos, D., Bernardes, J., Costa-Pereira, A., Pereira-Leite, L., Inconsistencies in expert{\textquoteright}s classification of cardiotocograms and subsequent clinical decision (1999) Br J Obstet Gynecol, 106, pp. 1307-1310; 
Bernardes, J., Moura, C., Marques-de-S{\'a}, J.P., Pereira-Leite, L., The Porto system for automated cardiotocographic signal analysis (1991) J Perinat Med, 19, pp. 61-65; 
Bernardes, J., Ayres-de-Campos, D., Costa-Pereira, A., Pereira-Leite, L., Garrido, A., Objective computerized fetal heart rate analysis (1998) Int J Gynaecol Obstet, 62 (2), pp. 141-147; 
Ayres-de-Campos, D., Costa-Santos, C., Bernardes, J., SisPorto Multicentre Validation Study Group. Prediction of neonatal state by computer analysis of fetal heart rate tracings: the antepartum arm of the SisPorto multicentre validation study (2005) Eur J Obstet Gynecol Reprod Biol, 118 (1), pp. 52-60; 
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},
	month = {2008///},
	pages = {433 - 439},
	abstract = {Background: A better understanding of gender influences on fetal heart rate can help to improve analysis of the latter and perhaps elucidate the increased risk of perinatal death that occurs in males. Aim: To assess differences in linear and complex heart rate dynamics according to fetal sex, in the antepartum period of normal term pregnancies, for patterns associated with fetal behavioural states. Study design and subjects: One hundred and eighty seven fetal heart rate segments of 10-minute duration, acquired with a system for computerized analysis of cardiotocograms and classified into fetal behavioural patterns A, B, C or D were analysed. They had been acquired from 24 female and 23 male term fetuses, with uneventful perinatal outcomes. Four different comparative studies between female and male fetuses were conducted, considering different adjustments for gestational age, weight and FHR pattern. Outcome measures: Indices of linear and nonlinear fetal heart rate variability, namely, long-term irregularity index, very low, low and high frequency spectral indices, approximate entropy and sample entropy. Results: Pattern B was the most frequent, both in female and male fetuses. Pattern A was more likely to be associated to female than male fetuses, whereas the opposite occurred with patterns C and D. Linear indices were significantly higher in male than in female fetuses, whereas the opposite occurred with nonlinear indices. Conclusions: Male fetuses exhibited significantly more linear and significantly less complex fetal heart rate activity than female fetuses, expressing signs of a more active autonomous nervous system and of less active complexity control systems. These aspects may need to be considered when interpreting FHR tracings. {\textcopyright} 2007 Elsevier Ireland Ltd. All rights reserved.},
	keywords = {article, Behavior, Cardiotocography, comparative study, Computerized analysis, Entropy and spectral analysis, Female, Fetal behavioural states and sex, Fetal heart rate, Fetal monitoring, Fetal Movement, fetus, fetus heart rate, Gestational Age, heart hemodynamics, Heart Rate, Fetal, human, Humans, male, normal human, Pregnancy, Pregnancy Outcome, Sex Characteristics, sex difference, SisPorto},
	isbn = {03783782 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-44749091847\&partnerID=40\&md5=0a0fcbbe86dcad0bee063b6cc7687573},
	author = {Bernardes, J. and Gon{\c c}alves, H. and Ayres-de-Campos, D. and Rocha, A.P.}
}
@article {2353,
	title = {Omniview-SisPorto{\textregistered} 3.5 - A central fetal monitoring station with online alerts based on computerized cardiotocogram+ST event analysis},
	journal = {Journal of Perinatal MedicineJ. Perinat. Med.},
	volume = {36},
	year = {2008},
	note = {Cited By (since 1996): 13Export Date: 21 November 2012Source: ScopusCODEN: JPEMAdoi: 10.1515/JPM.2008.030Language of Original Document: EnglishCorrespondence Address: Ayres-De-Campos, D.; Departmento Ginecologia e Obstetricia, Faculdade de Medicina, Universidade Do Porto, Alameda Hernani Monteiro, 4200-319 Porto, Portugal; email: sisporto@med.up.ptTradenames: Omniview-SisPorto 3.5 system, SpeculumManufacturers: SpeculumReferences: Amer-Wahlin, I., Arulkumaran, S., Hagberg, H., Marsal, K., Visser, G., Fetal electrocardiogram: ST waveform analysis in intrapartum surveillance (2007) Br J Obstet Gynaecol, 114, pp. 1191-1193;Ayres-de-Campos, D., Bernardes, J., Garrido, A., Marquesde-S{\'a}, J., Pereira-Leite, L., SisPorto 2.0: A program for automated analysis of cardiotocograms (2000) J Matern Fetal Med, 9, pp. 311-318; 
Ayres-de-Campos, D., Bernardes, J., Comparison of fetal heart rate baseline estimation by SisPorto 2.01 and a consensus of clinicians (2004) Eur J Obstet Gynecol Reprod Biol, 117, pp. 174-178; 
Ayres-de-Campos, D., Costa-Santos, C., Bernardes, J., SisPorto Multicentre Validation Study Group. Prediction of neonatal state by computer analysis of fetal heart rate tracings: The antepartum arm of the SisPorto multicentre validation study (2005) Eur J Obstet Gynecol Reprod Biol, 118, pp. 52-60; 
Ayres-de-Campos, D., Bernardes, J., Kwee, A., Westehuis, M., Visser, G.H.A., Computer quantification of short-term variability as an adjunct to fetal electrocardiographic monitoring (2007) Br J Obstet Gynaecol, 114, pp. 1446-1447; 
Bernardes, J., Moura, C., Marques de, S.J., Pereira Leite, L., The Porto system for automated cardiotocographic signal analysis (1991) J Perinat Med, 19, pp. 61-65; 
Electronic fetal heart rate monitoring: Research guidelines for interpretation (1997) Am J Obstet Gynecol, 177, pp. 1385-1390. , National Institute of Child Health and Human Development Research Planning Workshop; 
Neilson, J.P., Fetal electrocardiogram (ECG) for fetal monitoring during labor (2006) Cochrane Database of Systematic Reviews, (3); 
Paneth, N., Bommarito, M., Stricker, J., Electronic fetal monitoring and later outcome (1993) Clin Invest Med, 16, pp. 159-165; 
(2001) Evidence-based clinical guideline: The use of electronic fetal monitoring, , RCOG, Royal College of Obstetricians and Gynaecologists, London, RCOG Press; 
Rooth, G., Huch, A., Huch, R., Guidelines for the use of fetal monitoring (1987) Int J Gynecol Obstet, 25, pp. 159-167
},
	month = {2008///},
	pages = {260 - 264},
	abstract = {Visual analysis of cardiotocograms is poorly reproducible and is currently recognized as the main weakness of the STAN{\textregistered} methodology. The Omniview-SisPorto{\textregistered} 3.5 program is the most recent version of a central monitoring system that provides visual and sound alerts, based on computer analysis of cardiotocographic and ST event features. This paper describes the program{\textquoteright}s main characteristics and provides an overview of the system{\textquoteright}s online alerts. Omniview-SisPorto{\textregistered} 3.5 is the first central monitoring system to incorporate computerized analysis of cardiotocographic and ST event features, providing health professionals with online alerts for minor and major changes in monitored signals. The system is currently undergoing extensive clinical evaluation. {\textcopyright} 2008 by Walter de Gruyter.},
	keywords = {article, Cardiotocography, computer program, Computer-assisted, Electrocardiography, Female, Fetal, Fetal hypoxia, Fetal monitoring, fetus hypoxia, fetus monitoring, Heart rate, human, Humans, instrumentation, online system, Pregnancy, priority journal, Signal processing, ST segment},
	isbn = {03005577 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-44949183434\&partnerID=40\&md5=8a8b193ca1077d049f7333b4f6595962},
	author = {Ayres-de-Campos, D. and Sousa, P. and Costa, A. and Bernardes, J.}
}
@article {2375,
	title = {Linear and nonlinear analysis of heart rate patterns associated with fetal behavioral states in the antepartum period},
	journal = {Early Human DevelopmentEarly Hum. Dev.},
	volume = {83},
	year = {2007},
	note = {Cited By (since 1996): 17Export Date: 21 November 2012Source: ScopusCODEN: EHDEDdoi: 10.1016/j.earlhumdev.2006.12.006PubMed ID: 17261357Language of Original Document: EnglishCorrespondence Address: Gon{\c c}alves, H.; Universidade do Porto, Faculdade de Ci{\^e}ncias, Departamento de Matem{\'a}tica Aplicada, Porto, Portugal; email: hernani.goncalves@fc.up.ptReferences: Nijhuis, J.G., Prechtl, H.F., Martin, C.B.J., Bots, R.S., Are there behavioural states in the human fetus? (1982) Early Hum Dev, 6, pp. 177-195;Nijhuis, I., ten Hof, J., Development of fetal heart rate and behavior: indirect measures to assess the fetal nervous system (1999) Eur J Obstet Gynaecol Reprod Biol, 87, pp. 1-2; 
Vindla, S., James, D., Fetal behaviour as a test of fetal wellbeing (1995) Br J Obstet Gynaecol, 102, pp. 597-600; 
Swartjes, J.M., van Geijn, H.P., Mantel, R., van Woerden, E.E., Schoemaker, H.C., Coincidence of behavioural state parameters in the human fetus at three gestational ages (1990) Early Hum Dev, 23, pp. 75-83; 
Ayres-de-Campos, D., Santos, C., Bernardes, J., Prediction of neonatal state by computer analysis of fetal heart rate tracings: the antepartum arm of the SisPorto{\textregistered} multicentre validation study (2005) Eur J Obstet Gynaecol Reprod Biol, 118, pp. 52-60; 
Ayres-de-Campos, D., Bernardes, J., Garrido, A., de S{\'a}, J.M., Pereira-Leite, L., SisPorto 2.0: a program for automated analysis of cardiotocograms (2000) J Matern Fetal Med, 9, pp. 311-318; 
Rooth, G., Huch, A., Huch, R., FIGO news. Guidelines for the use of fetal monitoring (1987) Int J Gynaecol Obstet, 25, p. 159; 
Bernardes, J., Moura, C., de S{\'a}, J.P.M., Pereira-Leite, L., The Porto system for automated cardiotocographic signal analysis (1991) J Perinat Med, 19, pp. 61-65; 
Gon{\c c}alves, H., Rocha, A.P., Ayres-de-Campos, D., Bernardes, J., Internal versus external intrapartum foetal heart rate monitoring: the effect on linear and nonlinear parameters (2006) Physiol Meas, 27, pp. 307-319; 
Signorini, M.G., Magenes, G., Cerrutti, S., Arduini, D., Linear and nonlinear parameters for the analysis of fetal heart rate signal from cardiotacographic recordings (2003) IEEE Trans Biomed Eng, 50 (3), pp. 365-373; 
Pincus, S., Viscarello, R., Approximate Entropy: a regularity measure for fetal heart rate analysis (1992) Obstet Gynaecol, 79 (2), pp. 249-255; 
Richman, J.S., Moorman, J.R., Physiological time-series analysis using approximate entropy and sample entropy (2000) Am J Physiol Heart Circ Physiol, 278, pp. H2039-H2049; 
Pincus, S., Approximate entropy (ApEn) as a complexity measure (1995) Chaos, 5 (1), pp. 110-117; 
Grant, J.M., The fetal heart rate trace is normal, isn{\textquoteright}t it? Observer agreement of categorical assessments (1991) Lancet, 337, pp. 215-218; 
Martinez, W.L., Martinez, A.R., (2002) Computational statistics handbook with MATLAB, , CRC Press; 
van Woerden, E.E., Geijn, H.P., Caron, F.J., Swartjes, J.M., Mantel, R., Arts, N.F., Automated assignment of behavioural states in the human near term fetus (1989) Early Hum Dev, 19, pp. 137-146; 
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Bernardes, J., Costa-Pereira, A., de Campos, D.A., van Geijn, H.P., Pereira-Leite, L., Evaluation of interobserver agreement of cardiotocograms (1997) Int J Gynaecol Obstet, 57 (1), pp. 33-37; 
Bernardes, J., Costa-Pereira, A., van Geijn, H.P., Pereira-Leite, L., A more objective fetal heart rate baseline estimation (1996) Br J Obstet Gynaecol, 103, pp. 714-715; 
Mantel, R., van Geijn, H.P., Ververs, I.A., Copray, F.J., Automated analysis of near-term antepartum fetal heart rate in relation to fetal behavioral states: the Sonicaid System 8000 (1992) Am J Obstet Gynaecol, 167 (6), pp. 1912-1914; 
Court, D.J., Parer, J.T., Experimental studies of fetal asphyxia and fetal heart rate interpretation (1984) Research in perinatal medicine, pp. 113-169. , Nathanielsz P.W., and Parer J.T. (Eds), Perinatology Press, New York; 
Oppenheimer, L.W., Lewinsky, R.M., Power spectral analysis of fetal heart rate (1994) Bailliere{\textquoteright}s Clin Obstet Gynaecol, 8 (3), pp. 643-661; 
van Woerden, E.E., Geijn, H.P., Caron, F.J., Mantel, R., Spectral analysis of fetal heart rhythm in relation to fetal regular mouthing (1990) Int J Biomed Comput, 25 (4), pp. 253-260; 
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Suzuki, T., Okamura, K., Kimura, Y., Watanabe, T., Murotsuki, N.Y.J., Uehara, S., Power spectral analysis of R-R interval variability before and during the sinusoidal heart rate pattern in fetal lambs (2000) Am J Obstet Gynaecol, 182, pp. 1227-1232; 
Dawes, G.S., Moulden, M., Sheil, O., Redman, C.W.G., Approximate entropy, a statistic of regularity, applied to fetal heart rate data before and during labour (1992) Obstet Gynaecol, 80 (5), pp. 763-768; 
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di Renzo, G.C., Montani, M., Fioriti, V., Clerici, G., Branconi, F., Pardini, A., Fractal analysis: a new method for evaluating fetal heart rate variability (1996) J Perinat Med, 24 (3), pp. 261-269
},
	month = {2007///},
	pages = {585 - 591},
	abstract = {Background: Fetal behavioral states are important indicators of fetal physiology and pathology associated to typical fetal heart rate (FHR) patterns. Aim: To provide linear and nonlinear analysis of FHR patterns associated with fetal behavioral states regarding a better understanding of these states and patterns. Study design and subjects: Fifty FHR tracings from normal term pregnancies with a median duration of 40.3~min were acquired with the SisPorto{\textregistered} 2.01 system for computerized analysis of cardiotocograms. Each tracing was divided into consecutive 10-minute segments and each segment was classified by two experts as pattern A, B, C or D. Outcome measures: Linear and nonlinear indices were computed in each segment, namely mean FHR, long-term irregularity index (LTI), very low (VLF), low (LF) and high (HF) frequency spectral indices, approximate entropy (ApEn) and sample entropy (SampEn). Kappa statistic (κ) and proportions of agreement (Pa) were used for assessment of inter-observer agreement. Bootstrap percentile confidence intervals and nonparametric statistical tests were calculated for statistical inference. Results: Overall agreement between experts in pattern classification was good to excellent with values for κ and Pa of 0.74 (95\% CI: 0.64-0.94) and 0.94 (95\% CI: 0.92-0.96), respectively. Most linear domain indices increased significantly with rising fetal activity whereas the opposite occurred with nonlinear indices, except for SampEn(2, 0.1). LF/(MF + HF) ratio also significantly increased with fetal activity, denoting an increased sympatho-vagal balance. Conclusions: Results support the hypothesis that entropy and linear variability indices measure different FHR features. FHR patterns associated with active sleep (B) and active wakefulness (D) evidenced more signs of autonomous nervous system activity, with sympatho-vagal imbalance, and less signs related to complexity or irregularity control systems than patterns associated with calm sleep (A) and calm wakefulness (C). {\textcopyright} 2006 Elsevier Ireland Ltd. All rights reserved.},
	keywords = {adult, article, behavior change, Cardiotocography, Computerized analysis, controlled study, entropy, Female, Fetal behavioral states, Fetal heart rate, Fetal monitoring, fetus, fetus heart rate, fetus monitoring, Heart Rate, Fetal, human, Humans, Image Interpretation, Computer-Assisted, Linear Models, Nonlinear Dynamics, Pregnancy, SisPorto, Spectral analysis, vagus nerve stimulation},
	isbn = {03783782 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-34249751815\&partnerID=40\&md5=3a787d5accf317ad2b020e59ddb6a465},
	author = {Gon{\c c}alves, H. and Bernardes, J. and Paula Rocha, A. and Ayres-de-Campos, D.}
}
@conference {2388,
	title = {Characterization of fetal heart rate irregularity using approximate entropy and wavelet filtering},
	booktitle = {Computers in CardiologyComput Cardiol},
	series = {2006 Computers in Cardiology, CIC},
	volume = {33},
	year = {2006},
	note = {Conference code: 73228Cited By (since 1996): 3Export Date: 21 November 2012Source: ScopusArt. No.: 4512006CODEN: COCADLanguage of Original Document: EnglishCorrespondence Address: Marques De S{\'a}, J. P.; Faculdade de Engenharia, DEEC, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; email: jmsa@fe.up.ptReferences: Pincus, S., Approximate entropy as a measure of system complexity (1991) Proc. Natl. Acad. Sci. U.S.A, 88, pp. 2297-2301;Pincus, S., Randomness and degrees of irregularity (1996) Proc. Natl. Acad. Sci. U.S.A, 93, pp. 2083-2088; 
Pincus, S.M., Viscarello, R.R., Approximate entropy: A regularity measure for fetal heart rate (1992) Obstet. Gynecol, 2, pp. 249-255; 
Fleisher, L.A., Dipietro, J.A., Johnson, T.R., Pincus, S., Complementary and non-coincident increases in heart rate variability and irregularity during fetal development (1997) Clin. Sci, 4, pp. 345-349; 
van Leeuwen, P., Lange, S., Betterman, H., Gronemeyer, D., Hatzmann, W., Fetal heart rate variability and complexity in the course of pregnancy (1999) Early Human Develop, 54, pp. 259-269; 
Pincus, S., Assessing Serial Irregularity and its Implications for Health (2001) Ann N Y Acad Sci, 954, pp. 245-267; 
Cysarz, D., Betterman, H., van Leeuwen, P., Entropies of short binary sequences in heart period dynamics (2000) Am J Physiol Heart Circ Physiol, 6, pp. 2163-2172; 
Signorini, M.G., Magenes, G., Cerutti, S., Arduini, D., Linear and Nonlinear Parameters for the Analysis of Fetal Heart Rate Signal from Cardiotocographic Recordings (2003) IEEE Tr. BME, 50, pp. 365-373; 
Ayres-de-Campos, D., Bernardes, J., Garrido, A., Marques-de-S{\'a}, J., Pereira-Leite, L., SisPorto 2.0 - A Program for Automated Analysis of Cardiotocograms (2000) J Matern Fetal Med, 9, pp. 311-318; 
S{\'a} Couto, P.M., van Meurs, W.L., Bernardes, J.F., Marques de, S.J., Goodwin, J.A., Combined Model-Driven and Rule-Based Approach for Educational Simulation of Fetal Heart Rate (2002) Proc. 16th Biennial Int. Conf. Europ. Assoc. for Speech, Signal and Image Processing, pp. 400-402. , EURASIP, Brno, Czech Rep, pp; 
Marques de S{\'a}, J.P., Characterization of fetal heart rate using approximate entropy (2005) Proc. IEEE Comp. in Cardiology 2005, 32, pp. 671-673
},
	month = {2006///},
	pages = {933 - 936},
	address = {Valencia},
	abstract = {Approximate Entropy (ApEn) has been used by several researchers as a means to characterize the irregularity of fetal heart rate (FHR), a major contributor to fetal risk assessment. The present work starts by analyzing the influence of accelerative and decelerative (AD) components of the FHR signal in the computation of ApEn. Having shown that the AD components may completely distort the ApEn evaluation we proceed to present two methods of eliminating the influence of the AD components: wavelet filtering; AD detection using specific algorithms based on well-established physiological criteria. We obtained good results with the first method when applied to simulated signals; however it proved unreliable in the practical application of discriminating normal from pathological fetal FHR. With the second method we were able to achieve this discrimination with high statistical significance.},
	keywords = {Approximate entropy, Cardiology, Fetal heart rate, Neonatal monitoring, Occupational risks, Physiological models, risk assessment, Risk management, Safety engineering, Simulated signals, Statistical significance, Wavelet filtering},
	isbn = {02766574 (ISSN); 1424425328 (ISBN); 9781424425327 (ISBN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-50149100681\&partnerID=40\&md5=51e2dd8109d66e30498d7c2f8689c820},
	author = {Magalh{\~a}es, F. and Marques De S{\'a}, J.P. and Bernardes, J. and Ayres-de-Campos, D.}
}
@article {2419,
	title = {Internal versus external intrapartum foetal heart rate monitoring: The effect on linear and nonlinear parameters},
	journal = {Physiological MeasurementPhysiol. Meas.},
	volume = {27},
	year = {2006},
	note = {Cited By (since 1996): 15Export Date: 21 November 2012Source: ScopusCODEN: PMEAEdoi: 10.1088/0967-3334/27/3/008PubMed ID: 16462016Language of Original Document: EnglishCorrespondence Address: Gon{\c c}alves, H.; Departamento de Matem{\'a}tica Aplicada, Faculdade de Ci{\^e}ncias, Universidade Do Porto, Porto, Portugal; email: hernani.goncalves@fc.up.ptReferences: Ayres-De-Campos, D., Bernardes, J., Garrido, A., Marques-De-S{\'a}, J., Pereira-Leite, L., SisPorto 2.0: A program for automated analysis of cardiotocograms (2000) J. Matern. Fetal Med., 9 (5), pp. 311-318;Ayres-De-Campos, D., Bernardes, J., Reynolds, A., Saraiva, J.P., Santos, C., Pereira-Leite, L., Computer evaluation of internal versus external FHR monitoring in the minutes preceding delivery (2000) Int. J. Gynecol. Obstet., 70, pp. 60-B61; 
Ayres-De-Campos, D., Santos, C., Bernardes, J., Prediction of neonatal state by computer analysis of fetal heart rate tracings: The antepartum arm of the SisPorto {\textregistered}multicentre validation study (2005) Eur. J. Obstet. Gynecol. Reprod. Biol., 118 (1), pp. 52-60; 
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Bernardes, J., Ayres-De-Campos, D., Costa-Pereira, A., Pereira-Leite, L., Garrido, A., Objective computerized fetal heart rate analysis (1998) Int. J. Gynecol. Obstet., 62 (2), pp. 141-147; 
Bernardes, J., Costa-Pereira, A., The effect of different sampling intervals on the measurement of intrapartum fetal heart rate variability (1997) Obstet. Gynecol., 90 (2), pp. 318-319; 
Bernardes, J., Garrido, A., Computerized fetal heart rate analysis in labour based on 2-s sampling. Can it proceed with confidence? (1995) Eur. J. Obstet. Gynecol. Reprod. Biol., 63 (1), pp. 105-107; 
Bernardes, J., Moura, C., Marques-De-S{\'a}, J.P., Pereira-Leite, L., The Porto system for automated cardiotocographic signal analysis (1991) J. Perinat. Med., 19, pp. 61-65; 
Bernardes, J., Moura, C., Marques-De-S{\'a}, J.P., Van Geijn, H.P., Pereira-Leite, L., The Porto system (1994) A Critical Appraisal of Fetal Surveillance, pp. 315-324; 
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Chang, A., Sahota, D.S., Reed, N.N., James, D.K., Mohajer, M.P., Computerised fetal heart rate analysis in labour-effect of sampling rate (1995) Eur. J. Obstet. Gynecol. Reprod. Biol., 59 (2), pp. 125-129; 
Court, D.J., Parer, J.T., Experimental studies of fetal asphyxia and fetal heart rate interpretation (1984) Research in Perinatal Medicine, pp. 113-169; 
Dawes, G., Computerized fetal heart rate analysis (1994) A Critical Appraisal of Fetal Surveillance, pp. 311-314; 
Dawes, G.S., Moulden, M., Sheil, O., Redman, C.W.G., Approximate entropy, a statistic of regularity, applied to fetal heart rate data before and during labour (1992) Obstet. Gynecol., 80, pp. 763-768; 
Dawes, G.S., Moulden, M., Redman, C.W., Criteria for the design of fetal heart rate analysis systems (1990) Int. J. Biomed. Comput., 25 (4), pp. 287-294; 
Di Renzo, G.C., Montani, M., Fioriti, V., Clerici, G., Branconi, F., Pardini, A., Indraccolo, R., Cosmi, E.V., Fractal analysis: A new method for evaluating fetal heart rate variability (1996) J. Perinat. Med., 24, pp. 261-269; 
Echeverria, J.C., Hayes-Gill, B.R., Crowe, J.A., Woolfson, M.S., Croaker, G.D., Detrended fluctuation analysis: A suitable method for studying fetal heart rate variability? (2004) Physiol. Meas., 25 (3), pp. 763-774; 
Felgueiras, C., Marques-De-S{\'a}, J.P., Bernardes, J., Gama, S., Fractal characterisation of fetal heart rate sequences (1998) Biomed. Eng., 36, pp. 197-201; 
Felgueiras, C.S., Marques-De-S{\'a}, J.P., Bernardes, J., Gama, S., On the reconstruction of fetal heart rate sequences (1996) Actas Do 4{\textdegree} Congresso Portugu{\^e}s de Engenharia Biom{\'e}dica-BioEng{\textquoteright}96, pp. 61-vii65; 
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Pincus, S., Approximate entropy as a measure of system complexity (1991) Proc. Natl. Acad. Sci. USA, 88, pp. 2297-2301; 
Pincus, S., Approximate entropy (ApEn) as a complexity measure (1995) Chaos, 5 (1), pp. 110-117; 
Pincus, S., Viscarello, R., Approximate entropy: A regularity measure for fetal heart rate analysis (1992) Obstet. Gynecol., 79, pp. 249-255; 
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},
	month = {2006///},
	pages = {307 - 319},
	abstract = {The effect of foetal heart rate (FHR) acquisition mode on linear and nonlinear parameters is still largely unknown. In 33 normal labouring women, FHR signals were acquired simultaneously by an external ultrasound sensor applied to the maternal abdomen and an internal scalp electrode, in the minutes preceding delivery. For each case, the initial and final 5, 10 and 20 min segments were analysed, considering FHR signals at a frequency of 4 Hz (the frequency at which they are transmitted by the majority of commercialized foetal monitors). Several time and frequency domain linear and nonlinear FHR indices were computed in these segments, namely mean FHR, very low frequency (VLF), low frequency (LF), high frequency (HF), approximate entropy (ApEn) and sample entropy (SampEn). Parametric confidence intervals, statistical tests and correlation coefficients were calculated in order to evaluate the effect of internal versus external FHR monitoring modes on the considered indices. The whole evaluation was repeated using FHR signals at a frequency of 2 Hz. Most time domain linear indices were similar with external and internal monitoring in the initial and final segments of the tracings. However, linear frequency domain indices were poorly correlated in the final segments and had significantly different mean values in the initial segments. Nonlinear indices were significantly different in both initial and final segments. The correlation between 4 and 2 Hz sampled parameters was high for both linear and nonlinear indices (most correlation coefficient values ranging between 0.95 and 1) but nonlinear index values were significantly higher at 2 Hz. In conclusion, the mode used to acquire FHR signals and the sampling rate employed can significantly affect most FHR indices. {\textcopyright} 2006 IOP Publishing Ltd.},
	keywords = {abdomen, Algorithms, article, Cardiotocography, commercial phenomena, Confidence interval, controlled study, correlation coefficient, delivery, Diagnosis, Computer-Assisted, Electrocardiography, electrode, entropy, External and internal monitoring, Female, fetus electrocardiography, fetus monitoring, Foetal heart rate (FHR), Frequency domain analysis, Heart, Heart rate, human, intermethod comparison, intrapartum care, Linear and nonlinear analysis, Linear Models, mathematical computing, Nonlinear Dynamics, normal human, priority journal, Reproducibility of Results, sensitivity and specificity, sensor, Signal Processing, Computer-Assisted, Statistical significance, ultrasound, Variability},
	isbn = {09673334 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-32144438860\&partnerID=40\&md5=dd6dbb9f364b7f974c7048c4cf08d53f},
	author = {Gon{\c c}alves, H. and Rocha, A.P. and Ayres-de-Campos, D. and Bernardes, J.}
}
@article {2400,
	title = {Linear and nonlinear fetal heart rate analysis of normal and acidemic fetuses in the minutes preceding delivery},
	journal = {Medical and Biological Engineering and ComputingMed. Biol. Eng. Comput.},
	volume = {44},
	year = {2006},
	note = {Cited By (since 1996): 20Export Date: 21 November 2012Source: ScopusCODEN: MBECDdoi: 10.1007/s11517-006-0105-6PubMed ID: 16988896Language of Original Document: EnglishCorrespondence Address: Gon{\c c}alves, H.; Departamento de Matem{\'a}tica Aplicada, Faculdade de Ci{\^e}ncias, Universidade do Porto, Rua do Campo Alegre - 687, 4169-007 Porto, Portugal; email: hernani.goncalves@fc.up.ptChemicals/CAS: AcidsReferences: ACOG technical bulletin. Fetal heart rate patterns: Monitoring, interpretation, and management (1995) Int J Gynecol Obstet, 51, pp. 65-74. , ACOG;Ayres-de-Campos, D., Bernardes, J., Costa-Pereira, A., Pereira-Leite, L., Inconsistencies in expert{\textquoteright}s classification of cardiotocograms and subsequent clinical decision (1999) Br J Obstet Gynecol, 106, pp. 1307-1310; 
Ayres-de-Campos, D., Bernardes, J., Garrido, A., de S{\'a}, J.M., Pereira-Leite, L., Sisporto 2.0: A program for automated analysis of cardiotocograms (2000) J Mat Fet Med, 9, pp. 311-318; 
Bernardes, J., de Campos, D.A., Costa-Pereira, A., Pereira-Leite, L., Garrido, A., Objective computerized fetal heart rate analysis (1998) Int J Gynecol Obstet, 62, pp. 141-147; 
Bernardes, J., Costa-Pereira, A., de Campos, D.A., van Geijn, H.P., Pereira-Leite, L., Evaluation of interobserver agreement of cardiotocograms (1997) Int J Gynecol Obstet, 57 (1), pp. 33-37; 
Bernardes, J., Moura, C., de S{\'a}, J.P.M., Pereira-Leite, L., The porto system for automated cardiotocographic signal analysis (1991) J Perinat Med, 19, pp. 61-65; 
Boog, G., Analyse informatisTe du rythme cardiaque foetal au cours de la grossesse et de l{\textquoteright}accouchement (2004) EncyclopTdie MTdico-Chirurgicale, 148, pp. 1-10. , (5-049-D-23); 
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Felgueiras, C., de S{\'a}, J.P.M., Bernardes, J., Gama, S., Fractal characterisation of fetal heart rate sequences (1998) Biomed Eng, 36 (2), pp. 197-201; 
Fusheng, Y., Bo, H., Qingyu, T., Approximate entropy and its application in biosignal analysis (1998) Nonlinear Biomedical Signal Processing. Dynamical Analysis and Modelling, 2, pp. 72-91. , In: Akay M (ed) IEEE Press, New York; 
Gon{\c c}alves, H., Rocha, A.P., de Campos, D.A., Bernardes, J., Internal versus external intrapartum foetal heart rate monitoring: The effect on linear and nonlinear parameters (2006) Physiol Meas, 27, pp. 307-319; 
Gough, N.A., Fractal analysis of foetal heart rate variability (1993) Physiol Meas, 14 (3), pp. 309-315; 
Hayes, M., (1996) Statistical Digital Signal Processing and Modelling, , Wiley, New York; 
Hewlett-Packard, (1993) Hewlett-Packard Series 50 Service Manual, , M1351A and 1353A. Germany; 
King, T., Parer, J., The physiology of fetal heart rate patterns and perinatal asphyxia (2000) J Perinat Neonat Nurs, 14 (3), pp. 19-39; 
Li, X., Tang, D., Zhou, S., Zhou, G., Wang, C., Zhuang, Y., Wu, G., Shen, L., Redistribution of power spectrum of heart rate variability during acute umbilical artery embolism and hypoxemia in late-gestation fetal sheep (2004) Eur J Obstet Gynecol Reprod Biol, 114, pp. 137-143; 
Magenes, G., Signorini, M.G., Arduini, D., Classification of cardiotocographic records by neural networks (2000) Proceedings of the IEEE-INNS-ENNS International Joint Conference on Neural Networks,, 3, pp. 637-641. , In: IJCNN 2000; 
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Pincus, S., Approximate entropy (apen) as a complexity measure (1995) Chaos, 5 (1), pp. 110-117; 
Pincus, S., Viscarello, R., Approximate entropy: A regularity measure for fetal heart rate analysis (1992) Obstet Gynecol, 79 (2), pp. 249-255; 
di Renzo, G.C., Montani, M., Fioriti, V., Clerici, G., Branconi, F., Pardini, A., Indraccolo, R., Cosmi, E.V., Fractal analysis: A new method for evaluating fetal heart rate variability (1996) J Perinat Med, 24 (3), pp. 261-269; 
Richman, J.S., Moorman, J.R., Physiological time-series analysis using approximate entropy and sample entropy (2000) Am J Physiol Heart Circ Physiol, 278, pp. H2039-H2049; 
Ripley, B.D., (1996) Pattern Recognition and Neural Networks, , Cambridge University Press, London; 
Rooth, G., Huch, A., Huch, R., FIGO news. Guidelines for the use of fetal monitoring (1987) Int J Gynecol Obstet, 25, p. 159; 
(2001) Evidence-Based Clinical Guideline Number 8. The Use of Electronic Fetal Monitoring, , Royal College of Obstetricians and Gynaecologists Royal College of Obstetricians and Gynaecologists, London; 
Salamalekis, E., Thomopoulos, P., Giannaris, D., Salloum, I., Vasios, G., Prentza, A., Koutsouris, D., Computerised intrapartum diagnosis of fetal hypoxia based on fetal heart rate monitoring and fetal pulse oximetry recordings utilising wavelet analysis and neural networks (2002) BJOG, 109 (10), pp. 1137-1142; 
Signorini, M.G., Cerutti, S., Nonlinear properties of cardiovascular time series (1999) Methodology and Clinical Applications of Blood Pressure and Heart Rate Analysis, pp. 73-89. , In: Di Rienzo M, Mancia G, Parati G, Pedotti A, Zanchetti A (eds) IOS Press, Amsterdam; 
Signorini, M.G., Magenes, G., Cerrutti, S., Arduini, D., Linear and nonlinear parameters for the analysis of fetal heart rate signal from cardiotacographic recordings (2003) IEEE Trans Biomed Eng, 50 (3), pp. 365-373; 
Siira, S.M., Ojala, T.H., Vahlberg, T.J., Jalonen, J.O., Valimaki, I.A., Rosen, K.G., Ekholm, E.M., Marked fetal acidosis and specific changes in power spectrum analysis of fetal heart rate variability recorded during the last hour of labour (2005) Br J Obstet Gynaecol, 112, pp. 418-423; 
Suzuki, T., Okamura, K., Kimura, Y., Watanabe, T., Murotsuki, N.Y.J., Uehara, S., Yajima, A., Power spectral analysis of R-R interval variability before and during the sinusoidal heart rate pattern in fetal lambs (2000) Am J Obstet Gynecol, 182, pp. 1227-1232; 
Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task force of the european society of cardiology and the north american society of pacing and electrophysiology (1996) Eur Heart J, 17, pp. 354-381. , Task-Force; 
Teich, M.C., Lowen, S.B., Jost, B.M., Vibe-Rheymer, K., Heneghan, C., Heart rate variability: Measures and models (1998) Nonlinear Biomedical Signal Processing. Dynamic Analysis and Modeling, 2, pp. 159-213. , In: Akay M (ed) IEEE Press, New York; 
Yum, M.K., Kim, K., Kim, J.H., Park, E.Y., A consistent abnormality in the average local smoothness of fetal heart rate in growth-restricted fetuses affected by severe pre-eclampsia (2004) Hypertens Res, 27 (12), pp. 911-918
},
	month = {2006///},
	pages = {847 - 855},
	abstract = {Linear and nonlinear fetal heart rate (FHR) indices, namely mean FHR, interval index (II), very low, low and high frequencies, approximate (ApEn) and sample entropy (SampEn), were computed, immediately before delivery, in the initial and final FHR tracing segments, from 48 normal, 10 mildly acidemic and 10 moderate-to-severely acidemic fetuses. Progression of labor was associated with a significant increase in linear frequency domain indices whereas nonlinear indices were significantly decreased. Moderate-to-severe fetal acidemia was associated with a significant decrease in nonlinear indices. The best discrimination between moderate-to-severe acidemic fetuses and the remaining cases was obtained combining II and ApEn(2,0.15), with a specificity of 71\% and a sensitivity of 80\%. These findings support the hypothesis of increased autonomic nervous system activity in the final minutes of labor and of decreased central nervous system activity, both in the final minutes of labor and in moderate-to-severe acidemic fetuses. {\textcopyright} International Federation for Medical and Biological Engineering 2006.},
	keywords = {acidemia, Acidosis, Acids, article, autonomic nervous system, Biological materials, Cardiology, Central nervous system, clinical article, controlled study, delivery, Delivery, Obstetric, Discriminant Analysis, disease severity, entropy, Fetal Diseases, Fetal heart rate, Fetal heart rate (FHR), Fetal monitoring, fetus, fetus heart rate, Frequency domain analysis, Heart Rate, Fetal, human, Humans, hypothesis, labor, Linear and nonlinear indices, linear system, Neurology, newborn, nonlinear system, Prenatal Care, Second stage of labor, sensitivity and specificity, Severity of Illness Index},
	isbn = {01400118 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-33749566759\&partnerID=40\&md5=88f9959edd8363f90b13742d0ce5221b},
	author = {Gon{\c c}alves, H. and Rocha, A.P. and Ayres-de-Campos, D. and Bernardes, J.}
}
@article {2507,
	title = {Development of foetal and neonatal simulators at the University of Porto},
	journal = {Medical Education, SupplementMed. Educ. Suppl.},
	volume = {37},
	year = {2003},
	note = {Cited By (since 1996): 6Export Date: 21 November 2012Source: ScopusCODEN: MESECPubMed ID: 14641636Language of Original Document: EnglishCorrespondence Address: Van Meurs, W.L.; INEB - Inst. de Engenharia Biomedica, Lab. de Sinal e Imagem Biomedica, Edificio I-Poente, Rua Roberto Prias, s/n, 4200-465 Porto, Portugal; email: wvanmeurs@ineb.up.ptChemicals/CAS: oxygen, 7782-44-7References: Kohn, L.T., Corrigan, J.M., Donaldson, M.S., (2000) To Err Is Human, Building a Safer Health Care System, , Washington, DC: National Academic Press;Denson, J.S., Abrahamson, S., A computer-controlled patient simulator (1969) JAMA, 208, pp. 504-508; 
Gaba, D.M., DeAnda, A., A comprehensive anesthesia simulation environment. Re-creating the operating room for research and training (1988) Anesthesiology, 69, pp. 387-394; 
Good, M.L., Gravenstein, J.S., Anesthesia simulators and training devices (1989) Int Anesthesiol Clin, 27, pp. 161-168; 
Gaba, D., Howard, S., Fish, K., Smith, B., Sowb, Y., Simulation-based training in anesthesia crisis resource management (ACRM): A decade of experience (2001) Simulation Gaming, 32, pp. 175-193; 
Gordon, J.A., {\textquoteright}Practicing{\textquoteright} medicine without risk: Students{\textquoteright} and educators{\textquoteright} responses to high-fidelity patient simulation (2001) Acad Med, 76, pp. 469-472; 
Ma, O., Simulation saves lives (2001) Newsletter of the American Society of Anesthesiologists, , Park Ridge: American Society of Anesthesiologists; October; 
Van Meurs, W.L., Good, M.L., Lampotang, S., Functional anatomy of full-scale patient simulators (1997) J Clin Monit, 13, pp. 317-324; 
Van Meurs, W.L., Nikkelen, E., Good, M.L., Pharmacokinetic-pharmacodynamic model for educational simulations (1998) IEEE Trans Biomed Eng, 45, pp. 582-590; 
{\"O}hrn, M.A.K., Van Oostrom, J.H., Van Meurs, W.L., A comparison of traditional textbook and interactive computer learning of neuromuscular block (1997) Anesth Analg, 84, pp. 657-661; 
Euliano, T.Y., Caton, D., Van Meurs, W.L., Good, M.L., Modeling obstetric cardiovascular physiology on a full-scale patient simulator (1997) J Clin Monit, 13, pp. 293-297; 
S{\'a} Couto, P.M., Van Meurs, W.L., Bernardes, J.F., Marques De S{\'a}, J.P., Goodwin, J.A., Mathematical model for educational simulation of the oxygen delivery to the fetus (2002) Cont Eng Prac, 10, pp. 59-66; 
S{\'a} Couto, P.M., Van Meurs, W.L., Bernardes, J.F., Marques De S{\'a}, J.P., Goodwin, J.A., Combined model-driven and rule-based approach for educational simulation of fetal heart rate (2002) BIOSIGNAL 2002. Proceedings of the 16th Biennial International Conference of the European Association for Speech, Signal and Image Processing (EURASIP), 26-28 June 2002, Brno, Czech Republic, pp. 400-402. , Jan J, Kozumpl{\'\i}k J, Provazn{\'\i}k I, eds. Brno: Vutium Press; 
Itskovitz, J., LaGamma, E.F., Rudolph, A.M., Heart rate and blood pressure responses to umbilical cord compression in fetal lambs with special references to the mechanism of variable deceleration (1983) Am J Obstet Gynecol, 147, pp. 451-457; 
Lee, S.T., Hon, E.H., Fetal hemodynamic response to umbilical cord compression (1963) J Obstet Gynecol, 22, pp. 553-562; 
Goodlin, R.C., Lowe, E.W., A functional umbilical cord occlusion heart rate pattern - The significance of overshoot (1974) Obstet Gynecol, 43, pp. 22-30; 
Scheffs, J., Vasicka, A., Li, C., Solomon, N., Siler, W., Uterine blood flow during labor (1971) Obstet Gynecol, 38, pp. 15-24; 
Brotanek, V., Hendricks, C.H., Yoshida, T., Importance of changes in uterine blood flow in initiation of labor (1969) Am J Obstet Gynecol, 105, pp. 535-546; 
Butler, L.A., Longo, L.D., Power, G.G., Placental blood flows and oxygen transfer during uterine contractions: A mathematical model (1976) J Theor Biol, 61, pp. 81-95; 
Felgueiras, C., Marques De S{\'a}, J.P., Bernardes, J., Gama, S., Classification of foetal heart rate sequences based on fractal features (1998) Med Biol Eng Comput, 36, pp. 197-201; 
S{\'a} Couto, C.D., Van Meurs, W.L., Goodwin, J.A., Graphical and mathematical representation of congenital heart disease (2002) Proceedings of the SESAM Annual Meeting, 10-11 May 2002; Centro de Entrenamiento en Situaciones Cr{\'\i}ticas, Santander, Spain, p. 18; 
Beneken, J.E.W., (1965) A Mathematical Approach to Cardiovascular Function: The Uncontrolled Human System, , PhD dissertation. Utrecht, The Netherlands: Rijksuniversiteit Utrecht; 
Huikeshoven, F., Coleman, T.G., Jongsma, H.W., Mathematical model of the fetal cardiovascular system: The uncontrolled case (1980) Am J Physiol, 239, pp. R317-25; 
Klaus, M.H., Fanaroff, A.A., (2001) Care of the High-Risk Neonate, 5th Edn., , Philadelphia: WB Saunders
},
	month = {2003///},
	pages = {29 - 33},
	abstract = {Background: Human error can be expected to play a significant role in adverse outcomes in perinatal acute care. In acute care of the adult, simulator based training is recommended and used to improve patient safety. Aims: Our general goal is to develop model-driven foetal and neonatal educational simulators and curricula. The specific objectives of this paper are to introduce the reader to the perinatal acute care context and simulator design considerations, as well as to give initial results and describe ongoing developments. A brief description of adult simulators and simulation engines is followed by a more detailed description of a foetal distress simulator (FDS) and of models for a neonatal simulator developed at the University of Porto. Ongoing developments involve the modelling of foetal baroreflexes, the effect of uterine contractions, and an adapted method for estimating foetal heart rate variability parameters. Results: We present FDS simulation results reflecting the changes in oxygen supply to the foetus and the foetal heart rate in response to a reduction in uterine blood flow. We also present a structural diagram of a model for the educational simulation of congenital heart disease and preliminary simulation results reflecting a patent ductus arteriosus. Conclusion: We expect that, after initial clinical and educational validation, the presented models and simulators will play a role in simulator-based educational programmes contributing to increased perinatal safety.},
	keywords = {article, audiovisual equipment, blackstarPatient simulation, clinical competence, Clinical competence/blackstarstandards/economics, competence, Curriculum, Education, Medical, Undergraduate, Education, medical, undergraduate/blackstarmethods, Equipment Safety, fetus distress, human, Humans, Manikins, medical education, model, oxygen, Patient Simulation, perinatal care, Perinatal care/ blackstarstandards/methods, Portugal, safety, simulator, training},
	isbn = {13523929 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-0242550943\&partnerID=40\&md5=4ad77934dd61ea164105b57b431c82a1},
	author = {van Meurs, W.L. and S{\'a} Couto, P.M. and S{\'a} Couto, C.D. and Bernardes, J.F. and Ayres-de-Campos, D.}
}
@article {2564,
	title = {Fetal heart rate baselines in twins: Interobserver agreement in antepartum estimation},
	journal = {Journal of Reproductive Medicine for the Obstetrician and GynecologistJ. Reprod. Med. Obstet. Gynecol.},
	volume = {45},
	year = {2000},
	note = {Cited By (since 1996): 2Export Date: 21 November 2012Source: ScopusCODEN: JRPMAPubMed ID: 10710739Language of Original Document: EnglishCorrespondence Address: Bernardes, J.; Depto. de Ginecologia e Obstetricia, Faculdade de Medicina do Porto, Al. Prof. Hernani Monteiro, 4200 Porto, Portugal; email: Jbernardes@mail.telepac.ptReferences: Sherman, S.J., Kovacs, B.W., Medearis, A.L., Nonstress test assessment of twins (1992) J Reprod Med, 37, pp. 804-808;Grant, J.M., The fetal heart rate is normal, isn{\textquoteright}t it?: Observer agreement of categorical assessments (1991) Lancet, 337, pp. 215-218; 
Cibils, L.A., On intrapartum fetal monitoring (1996) Am J Obstet Gynecol, 174, pp. 1382-1389; 
Bernardes, J., Costa-Pereira, A., Ayres-De-Campos, D., Evaluation of interobserver agreement of cardiotocograms (1997) Int J Gynecol Obstet, 57, pp. 33-37; 
Bernardes, J., Costa-Pereira, A., Van Geijn, H.P., A more objective fetal heart rate baseline estimation (1996) Br J Obstet Gynaecol, 103, pp. 714-715; 
Bernardes, J., Ayres-De-Campos, D., Costa-Pereira, A., Objective computerized fetal heart rate analysis (1998) Int J Gynecol Obstet, 62, pp. 141-147; 
Bland, J.M., Altman, D.G., Statistical methods for assessing two methods of clinical measurement (1986) Lancet, 11, pp. 307-310; 
Armitage, P., Berry, G., (1994) Statistical Methods in Medical Research, pp. 273-276. , Oxford, Blackwell Science Ltd; 
Khan, K.S., Chien, P.F.W., Honest, M.R., Evaluating measurement variability of clinical investigations: The case of ultrasonic estimation of urinary bladder volume (1997) Br J Obstet Gynaecol, 104, pp. 1036-1043; 
Devoe, L.D., Carlton, E., Prescott, P., Neural network prediction of nonstress test results: How often should we perform nonstress tests? (1995) Am J Obstet Gynecol, 173, pp. 1128-1131; 
Bernardes, J., Ayres De Campos, D., Costa-Pereira, A., Baseline estimation in typical fetal heart rate patterns using different computerized methods (1997) Acta Obstet Gynecol Scand (Suppl), 76, p. 56; 
},
	month = {2000///},
	pages = {105 - 108},
	abstract = {OBJECTIVE: To assess interobserver agreement in antepartum estimation of fetal heart rate (FHR) baselines in twins. STUDY DESIGN: Two residents and one specialist in obstetrics and gynecology, all with special interest in FHR monitoring, independently estimated baselines in 162 consecutive antepartum FHR tracings recorded in 24 twins. Tracings were obtained with a dual-channel fetal monitor for the simultaneous recording of both twins{\textquoteright} heart rates. Baselines were estimated, as single values corresponding to the mean of the lowest stable FHR segment, in the absence of fetal movements and uterine contractions, within physiologic limits (110-150 beats per minute [bpm]). If these criteria were not met, the possibility of persistent bradycardia or tachycardia was considered, and if this was confirmed in a tracing with at least 40 minutes, a baseline < 110 or > 150 bpm was chosen. Interobserver agreement was assessed by the proportions of agreement (PA), kappa statistic (K) and intraclass correlation coefficient (ICCC), with 95\% confidence intervals (CIs). RESULTS: Interobserver agreement was excellent, with a PA of 0.90 (95\% CI: 0.89-0.91), K of 0.88 (95\% CI: 0.84-0.92) and ICCC of 0.91 (95\% CI: 0.88-0.94). CONCLUSION: Interobserver agreement in antepartum estimation of fetal heart rate baselines in twins was excellent with the baseline concept used in this study.},
	keywords = {adult, article, clinical article, Electrocardiography, Female, Fetal heart rate, Fetal monitoring, fetus, fetus heart rate, fetus monitoring, Heart rate variability, Heart Rate, Fetal, human, Humans, Internship and Residency, observer variation, Obstetrics, Pregnancy, Prenatal Care, priority journal, Professional Competence, Twins},
	isbn = {00247758 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-0034002107\&partnerID=40\&md5=82b6075749b0531b00b1195b539b4bb3},
	author = {Bernardes, J. and Costa-Pereira, A. and Calejo, L. and Ayres-de-Campos, D. and Patr{\'\i}cio, B. and Pereira-Leite, L.}
}
@article {2583,
	title = {Objective computerized fetal heart rate analysis},
	journal = {International Journal of Gynecology and ObstetricsInt. J. Gynecol. Obstet.},
	volume = {62},
	year = {1998},
	note = {Cited By (since 1996): 23Export Date: 21 November 2012Source: ScopusCODEN: IJGOAdoi: 10.1016/S0020-7292(98)00079-4PubMed ID: 9749885Language of Original Document: EnglishCorrespondence Address: Bernardes, J.; Departmento Ginecologia Obstetricia, Faculdade Medicina-Hospital S. Joao, Porto, Portugal; email: sisporto@mail.telepac.ptReferences: Bernardes, J., Costa-Pereira, A., Ayres-De-Campos, D., Van Geijn, H.P., Pereira-Leite, L., Evaluation of interobserver agreement of cardiotocograms (1997) Int J Gynecol Obstet, 57 (1), pp. 33-37;Bernardes, J., Costa-Pereira, A., Van Geijn, H.P., Pereira-Leite, L., A more objective fetal heart rate baseline estimation (1996) Br J Obstet Gynaecol, 103, pp. 714-715; 
Grant, A., Principles for clinical evaluation of methods of perinatal monitoring (1984) J Perinat Med, 12, pp. 227-231; 
Bernardes, J., Moura, C., Marques-De-S{\'a}, J.P., Pereira-Leite, L., Van Geijn, H.P., The Porto System (1994) A Critical Appraisal of Fetal Surveillance, pp. 315-324. , In: van Geijn HP, Copray FJA, editors. Amsterdam: Elsevier Science; 
Rooth, G., Huch, A., Huch, R., Guidelines for the use of fetal monitoring. FIGO news (1987) Int J Gynaecol Obstet, 25, pp. 159-167; 
Mohide, P., Grant, A., Evaluating diagnosis and screening during pregnancy and childbirth (1989) Effective Care in Pregnancy and Childbirth, pp. 66-80. , In: Chalmers I, Enkin M, Keirse M JNC, editors. Oxford University Press; 
Garcia-Romero, H., Garcia-Barrios, C., Ramos-Gutierrez, F.R., Effects of uncertain results on sensitivity and specificity of diagnostic tests (1996) Lancet, 348, pp. 1745-1746; 
Grant, J.M., The fetal heart rate is normal, isn{\textquoteright}t it?. Observer agreement of categorical assessments (1991) Lancet, 337, pp. 215-218; 
Guzman, E., Vintzileos, A., Martins, M., Benito, C., Houlihan, C., The efficacy of individual computer heart rate indices in detecting acidemia at birth in growth-restricted fetuses (1996) Obstet Gynecol, 87, pp. 969-974; 
Nielsen, P.V., Stigsby, B., Nickelsen, C., Nim, J., Computer assessment of the intrapartum cardiotocogram. II. The value of compared with visual assessment (1988) Acta Obstet Gynecol Scand, 67, pp. 461-464; 
Chung, T.K.H., Mohajer, M.P., Yang, Z.J., Chang, A.M.Z., Sahota, D.S., The prediction of fetal acidosis at birth by computerized analysis of intrapartum cardiotocography (1995) Br J Obstet Gynaecol, 102, pp. 454-460; 
Stigsby, B., Nielson, P.V., Nickelsen, C., Nim, J., Computer assessment of the intrapartum cardiotocogram. I. Methods of data reduction and diagnostic procedure (1988) Acta Obstet Gynecol Scand, 67, pp. 455-460
},
	month = {1998///},
	pages = {141 - 147},
	abstract = {Objective: To assess the validity of a computerized methodology for cardiotocogram analysis based on a recently described reproducible visual estimation of the baseline. Methods: Forty-two antepartum and 43 intrapartum cardiotocograms (CTGs) acquired by a personal computer were selected. Antepartum tracings were performed in the 48 h that preceded an elective cesarean section, and intrapartum tracings were performed until delivery. FHR baselines were estimated by an expert, according to an objective and reproducible methodology. Using these baselines, automated detection of accelerations and decelerations and estimation of variability was performed by the personal computer. A quantitative adaptation of the FIGO guidelines for fetal monitoring was used to classify tracings. Perinatal outcome was classified according to the Apgar score and umbilical arterial pH. Validity was then assessed by the proportions of agreement (PA), kappa statistic (κ), sensitivity and specificity, with 95\% confidence intervals (95\% CI). Cases showing a disagreement between CTG and perinatal classification were reviewed and an adjustment in baseline definition was tested. Results: The initial overall PA and κ between CTG and perinatal classification were, respectively, 0.79 (95\% CI: 0.69-0.87) and 0.62 (95\% CI: 0.41-0.83). The overall PA and κ, after baseline adjustment were, respectively, 0.89 (95\% CI: 0.81-0.95) and 0.78 (95\% CI: 0.58-0.98). Sensitivities and specificities ranged between 79\% (95\% CI: 60-92\%) and 100\% (95\% CI: 95-100\%). Conclusions: Good clinical prediction may be possible with an objective methodology for cardiotocogram analysis based on a recently described reproducible baseline estimation.},
	keywords = {Apgar score, arterial pH, article, Cardiotocography, cesarean section, computer analysis, Computerized analysis, Female, Fetal heart rate, fetus, fetus heart rate, fetus monitoring, Heart Rate, Fetal, human, Humans, Image Processing, Computer-Assisted, practice guideline, Predictive Value of Tests, Pregnancy, priority journal, umbilical artery, validity},
	isbn = {00207292 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-0031873609\&partnerID=40\&md5=2b885fbc95cba06c5f31f417216ebba2},
	author = {Bernardes, J. and Ayres-de-Campos, D. and Costa-Pereira, A. and Pereira-Leite, L. and Garrido, A.}
}
