(!y(t)||!b(e=t.then))&&e},V=function(t,e){var r,n,o,i=e.value,a=1==e.state,u=a?t.ok:t.fail,c=t.resolve,s=t.reject,l=t.domain;try{u? Fetal hypoxemia results in biphasic changes in the ST segment of the fetal electrocardiography (FECG) waveform and an increase in the T:QRS ratio.15 The ST-segment automated analysis (STAN) software from Noventa Medical can record the frequency of ST events and, combined with changes in continuous EFM, can be used to determine if intervention during the labor process is indicated.15 Several studies have evaluated FECG analysis, documenting its effectiveness at reducing operative vaginal deliveries, fetal scalp sampling, neonatal encephalopathy, and fetal acidosis (pH < 7.05).2528 One drawback to this technology is that it requires rupture of the membranes and internal fetal scalp monitoring. A variety of symptoms are associated with uterine ruptures. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. [8][9][10][4][11], In the US, the Eunice Kennedy Shriver National Institute of Child Health and Human Development sponsored a workshop to develop a standardized nomenclature for use in interpreting Intrapartum fetal heart rate and uterine contraction patterns. The resulting printout is known as a fetal heart tracing, which will be read and analyzed. (o=P,u.addEventListener("message",A,!1)):o="onreadystatechange"in h("script")?function(t){v.appendChild(h("script")).onreadystatechange=function(){v.removeChild(this),j(t)}}:function(t){setTimeout(I(t),0)}),t.exports={set:m,clear:w}},LQDL:function(t,e,r){var n,o,i=r("2oRo"),a=r("NC/Y"),u=i.process,c=i.Deno,s=u&&u.versions||c&&c.version,f=s&&s.v8;f&&(o=(n=f.split("."))[0]>0&&n[0]<4?1:+(n[0]+n[1])),!o&&a&&(! Baseline rate of the fetal heart. In rhythm strip testing, the fetal heart rate is assessed if a good baseline heart rate or a degree of variability is present. et al. [17][21] The NICHD nomenclature defines baseline FHR variability as:[12]. The clinical risk status (low, medium, or high) of each fetus is assessed in conjunction with the interpretation of the continuous EFM tracing. With early decelerations, the point when the fetal heart rate is at its slowest (called the nadir) and the peak of the uterine contraction happen at the same time. (void 0!==t&&t.exports&&(e=t.exports=S),e.UAParser=S):r("PDX0")?void 0===(n=function(){return S}.call(e,r,e,t))||(t.exports=n):void 0!==o&&(o.UAParser=S);var O=void 0!==o&&(o.jQuery||o.Zepto);if(O&&!O.ua){var k=new S;O.ua=k.getResult(),O.ua.get=function(){return k.getUA()},O.ua.set=function(t){k.setUA(t);var e=k.getResult();for(var r in e)O.ua[r]=e[r]}}}("object"==typeof window?window:this)},K6Rb:function(t,e,r){var n=r("QNWe"),o=Function.prototype,i=o.apply,a=o.call;t.exports="object"==typeof Reflect&&Reflect.apply||(n?a.bind(i):function(){return a.apply(i,arguments)})},KmKo:function(t,e,r){var n=r("xluM"),o=r("glrk"),i=r("3Eq5");t.exports=function(t,e,r){var a,u;o(t);try{if(! Be sure to talk to your midwife or doctor about any concerns that you have with your baby's heart rate. In general, low-risk pregnancies will need less monitoring in labor. Table 4 lists recommended emergency interventions for nonreassuring patterns.4,14 These interventions should also be considered for ominous patterns while preparations for immediate delivery are initiated. Fluid Accumulation After Neonatal Congenital Cardiac Operation: Clinical Implications and Outcomes. The workshop introduced a new classification scheme for decision making with regard to tracings. To learn what we do to deliver the best health and lifestyle insights to you, check out our content review principles. Tuuli MG, Stout MJ, et al. To be called an acceleration, the peak must be at least 15bpm, and the acceleration must last at least 15 seconds from the onset to return to baseline. ([\w ]+) bui/i],[s,a,[c,l]],[/(archos) (gamepad2?)/i,/(hp).+(touchpad(?!.+tablet)|tablet)/i,/(kindle)\/([\w\. American Institute for Ultrasound in Medicine. A normal fetal heart tracing would reassure both you and your obstetrician that its safe to proceed with labor and delivery. [6] Internal tocometry can only be used if the amniotic sac is ruptured (either spontaneously or artificially) and the cervix is open. Similarly, other elements of Category II fetal heart rate tracings that may indicate fetal acidemia, such as minimal variability or recurrent late decelerations, should be approached with in utero resuscitation 48. Similarly, other elements of Category II fetal heart rate tracings that may indicate fetal acidemia, such as minimal variability or recurrent late decelerations, should be approached with in utero resuscitation 48. Evaluate recordingis it continuous and adequate for interpretation? Read our. Fetal heart tracing is a type of nonstress test that doesnt require any specific preparation. An early deceleration is a gradual increase of the fetal heart rate below the baseline during contraction which occurs during the peak of the contraction. The authors concluded that the use of triptorelin-induced temporary ovarian suppression during chemotherapy in pre-menopausal patients with early-stage breast cancer reduced the occurrence of chemotherapy-induced early menopause. :[;\/]| [ \w\/\. Definition. Am J Obstet Gynecol 2018; 218:523.e1. According to this study, saltatory pattern is a relatively rare condition; only four cases were found from three large databases. Increased fetal heart rate variability is parasympathetic-mediated and is caused by acutely deteriorating placental function. Fetal heart tracing monitors the rate and rhythm of your fetus heartbeat. ET). Table 1 lists examples of the criteria that have been used to categorize patients as high risk. ]+ \((? Definition. ]*)/i,/(haiku) (\w+)/i],[u,f],[/(sunos) ?([\w\.\d]*)/i],[[u,"Solaris"],f],[/((? Count FHR between contractions for 60 seconds to determine average baseline rate, 6. ]+)/i,/(nook)[\w ]+build\/(\w+)/i,/(dell) (strea[kpr\d ]*[\dko])/i,/(le[- ]+pan)[- ]+(\w{1,9}) bui/i,/(trinity)[- ]*(t\d{3}) bui/i,/(gigaset)[- ]+(q\w{1,9}) bui/i,/(vodafone) ([\w ]+)(? Since variable and inconsistent interpretation of fetal heart rate tracings may affect management, a systematic approach to interpreting the patterns is important. ]?browser)[-\/ ]?v?([\w\. Cardiotocography (CTG) is a technique used to monitor the fetal heartbeat and the uterine contractions during pregnancy and labour.The machine used to perform the monitoring is called a cardiotocograph.. Fetal heart sounds was described as early as 350 years ago and approximately 200 years ago mechanical stethoscopes, such as the Pinard horn, were (qqbrowser|baiduboxapp|2345Explorer)[\/ ]?([\w\. (2019),[18] it was demonstrated that the occurrence of saltatory pattern (already with the minimum duration of 2 minutes) in CTG tracings during labor was associated with fetal hypoxia indicated by high umbilical vein (UV) blood erythropoietin (EPO) levels and umbilical artery (UA) blood acidosis at birth in human fetuses. :"+A+")",I)),k&&(r=new RegExp("^"+A+"$(?!\\s)",I)),S&&(n=v.lastIndex),o=i(b,j?r:v,L),j?o? The pediatric guidelines also include recommendations for fetal Doppler echocardiography, an increasingly important field. After 13 weeks gestation, it begins a rapid deceleration to the normal fetal heart rate for mid-pregnancy, between 110 to 160 bpm. [vl]k\-?\d{3}) bui| 3\. ", Acceleration Perform a vaginal examination (check for cord prolapse, rapid descent of the head, or vaginal bleeding suggestive of placental abruption), 6. (a\d0\d\d)(? WebAn echocardiography, echocardiogram, cardiac echo or simply an echo, is an ultrasound of the heart.It is a type of medical imaging of the heart, using standard ultrasound or Doppler ultrasound.. Echocardiography has become routinely used in the diagnosis, management, and follow-up of patients with any suspected or known heart diseases.It is one of the Rest assured, it is most likely normal. Interestingly, research shows that toward the end of pregnancy fetal heart rate differs between male and female babies, with female fetuses having noticeably higher heart rates. 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If the cause cannot be identified and corrected, immediate delivery is recommended. Baseline fetal heart rate variability refers to the fluctuation between fetal heartbeats. Must be for a minimum of 2 minutes in any 10-minute segment. Q: What is the most common obstetric procedure in the United States? ]*)/i,/(hurd|linux) ?([\w\. "headline": "Fetal Heart Tracing: All Youll Ever Need to Know", :hone|od)[\w ]*);/i],[a,[s,"Apple"],[c,l]],[/\((ipad);[-\w\),; ]+apple/i,/applecoremedia\/[\w\. Baseline Rate (BRA; Online Table B). Palpate the abdomen to determine the position of the fetus (Leopold maneuvers), 2. For additional quantities, please contact [emailprotected] Fetal monitoring in labor can be done by intermittent auscultation, which means listening with a stethoscope, fetoscope, or handheld doppler at various points in labor. WebAuscultation of the fetal heart rate (FHR) is performed by external or internal means. A decrease in FHR of > 15 beats per minute measured from the most recently determined baseline rate. Tachycardia greater than 200 bpm is usually due to fetal tachyarrhythmia (Figure 4) or congenital anomalies rather than hypoxia alone.16 Causes of fetal tachycardia are listed in Table 5. In a study by Tarvonen et al. [4] External tocometry is useful for showing the beginning and end of contractions as well as their frequency, but not the strength of the contractions. Verywell Family articles are reviewed by board-certified physicians and family healthcare professionals. A prospective cohort study of fetal heart rate monitoring: deceleration area is predictive of fetal acidemia. Copyright 2022 American Academy of Family Physicians. fixed at 10 % false-positive rate, in the prediction of early-onset PE were relatively low, and ranged from 22 % to 83 %. When Can You Hear Your Baby's Heartbeat on a Doppler? Table 3 lists examples of nonreassuring and ominous patterns. Fluid Accumulation After Neonatal Congenital Cardiac Operation: Clinical Implications and Outcomes. Therefore, the fetal heart rate is recorded at its lowest rate for 30 seconds (or longer) at the beginning of the early deceleration cycle. The deceleration lasts >= 2 minutes but less than 10 minutes. ]+)/i],[s,[c,"embedded"]],[/droid .+? 2013;1:e82. < 32 weeks EGA: peak 10 bpm above baseline, duration 10 seconds but < 2 minutes from onset of the acceleration to return to baseline. "url": "https://flo.health/about-us/eugenia-tikhonovich" The normal fetal heart rate is 120 to 160 beats per minute. The periodic review includes ensuring that a good quality tracing is present and that abnormalities are appropriately communicated. Alternatively, an early deceleration might occur in the late stage of labor when your baby descends through your vaginal or birth canal. !r&&n((function(){r.call(null,e||function(){return 1},1)}))}},qxPZ:function(t,e,r){var n=r("tiKp")("match");t.exports=function(t){var e=/./;try{"/./"[t](e)}catch(r){try{return e[n]=!1,"/./"[t](e)}catch(t){}}return!1}},rB9j:function(t,e,r){"use strict";var n=r("I+eb"),o=r("kmMV");n({target:"RegExp",proto:!0,forced:/./.exec!==o},{exec:o})},rMz7:function(t,e,r){var n=r("I+eb"),o=r("ZOXb");n({target:"Date",proto:!0,forced:Date.prototype.toISOString!==o},{toISOString:o})},rW0t:function(t,e,r){"use strict";var n=r("glrk");t.exports=function(){var t=n(this),e="";return t.hasIndices&&(e+="d"),t.global&&(e+="g"),t.ignoreCase&&(e+="i"),t.multiline&&(e+="m"),t.dotAll&&(e+="s"),t.unicode&&(e+="u"),t.unicodeSets&&(e+="v"),t.sticky&&(e+="y"),e}},rpNk:function(t,e,r){"use strict";var n,o,i,a=r("0Dky"),u=r("Fib7"),c=r("hh1v"),s=r("fHMY"),f=r("4WOD"),l=r("yy0I"),p=r("tiKp"),v=r("xDBR"),d=p("iterator"),h=!1;[].keys&&("next"in(i=[].keys())? 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Electronic fetal monitoring provides the best means for early A fetal scalp electrode provides a more dependable recording of the fetal heart rate than any external monitoring system. : bui|\))/i,/\b(v[12]\d{3}\w?[at])(? Ordinarily, your babys heart beats at a faster rate in the late stage of pregnancy, when theyre especially active. However, the strength of contractions cannot always be accurately assessed from an external transducer and should be determined with an IUPC, if necessary. Brian Levine, MD, MS, FACOG, is board-certified in obstetrics-gynecology, as well as reproductive endocrinology and infertility (REI). What you hear might really surprise you. A prospective cohort study of fetal heart rate monitoring: deceleration area is predictive of fetal acidemia. Nadir of the deceleration = peak of the contraction. Results in this range must also be interpreted in light of the FHR pattern and the progress of labor, and generally should be repeated after 15 to 30 minutes. Give amnioinfusion for recurrent, moderate to severe variable decelerations, 9. [_ ]?(?:\d\w)?) Baseline rate of the fetal heart. As saltatory patterns preceded late decelerations of fetal heart rate (FHR) in the majority of cases, saltatory pattern seems to be an early sign of fetal hypoxia. Identify type of monitor usedexternal versus internal, first-generation versus second-generation. et al. Visually apparent, smooth, sine wave-like undulating pattern in FHR baseline with a cycle frequency of 35 per minute which persists for 20 minutes or more. The transducer uses Doppler ultrasound to detect fetal heart motion and is connected to an FHR monitor. [26] The pathophysiology of the saltatory pattern is not well-known. [23][25] It has been linked with rapidly progressing hypoxia,[27] for example due to an umbilical cord compression, and it is presumed to be caused by an instability of the fetal central nervous system.[23]. INSR (Insulin Receptor) is a Protein Coding gene. {{configCtrl2.info.metaDescription}} Sign up today to receive the latest news and updates from UpToDate. [onetw]{3})/i],[[a,/\./g," "],[s,"Microsoft"],[c,l]],[/droid.+; (cc6666?|et5[16]|mc[239][23]x?|vc8[03]x? Is Home Fetal Doppler Use Okay in Pregnancy? [19] Despite the similarities in the shape of the FHR patterns, the zigzag pattern is distinguished from the saltatory pattern by its duration. Bulk pricing was not found for item. Prolonged decelerations (Online Figures K and L) last longer than two minutes, but less than 10 minutes.11 They may be caused by a number of factors, including head compression (rapid fetal descent), cord compression, or uteroplacental insufficiency. Most external monitors use a Doppler device with computerized logic to interpret and count the Doppler signals. There are other ways to listen to your baby's heartbeat. WebEarly in gestation the fetal heart rate is predominately under the control of the sympathetic nervous system and arterial chemoreceptors [1]. Definition. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Original article Congenital heart surgery. [17][18][19][20] Based on the duration of the change, increased (i.e. Structured intermittent auscultation is a technique that employs the systematic use of a Doppler assessment of fetal heart rate (FHR) during labor at defined timed intervals (Table 1).4 It is equivalent to continuous EFM in screening for fetal compromise in low-risk patients.2,3,5 Safety in using structured intermittent auscultation is based on a nurse-to-patient ratio of 1:1 and an established technique for intermittent auscultation for each institution.4 Continuous EFM should be used when there are abnormalities in structured intermittent auscultation or for high-risk patients (Table 2).4 An admission tracing of electronic FHR in low-risk pregnancy increases intervention without improved neonatal outcomes, and routine admission tracings should not be used to determine monitoring technique.6. 2023 Annual Clinical & Scientific Meeting, Congressional Leadership Conference (CLC), Countdown to Intern Year, Week 4: Fetal Heart Tracings, Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles, Management of Intrapartum Fetal Heart Rate Tracings, Anti-Racism Resources: Articles, Videos, Podcasts, Novels Etc, Alliance for Innovation on Maternal Health, Postpartum Contraceptive Access Initiative, Baseline fetal heart rate (FHR) variability, Changes or trends of FHR patterns over time, Frequency and intensity of uterine contractions, Normal: five contractions or less in 10 minutes, averaged over a 30-minute window, Tachysystole: more than five contractions in 10 minutes, averaged over a 30-minute window, Always include presence or absence of associated FHR decelerations, Applies to both spontaneous and stimulated labor. Interpretation of heart rate variability rhythms in the context of health risk and physiological and psychological self-regulatory capacity assessment is discussed. If any problems arise, reviews are done more frequently. To provide a systematic approach to interpreting the electronic fetal monitor tracing, the National Institute of Child Health and Human Development convened a workshop in 2008 to revise the accepted definitions for electronic fetal monitor tracing. They are usually associated with fetal movement, vaginal examinations, uterine contractions, umbilical vein compression, fetal scalp stimulation or even external acoustic stimulation.15 The presence of accelerations is considered a reassuring sign of fetal well-being. The main goal is to identify fetuses who are prone to injuries stemming from hypoxia (or a lack of oxygen for fetal tissues). There are four types of decelerations as defined by the NICHD nomenclature, all of which are visually assessed. : os)?|mobile))[\/ ]? WebAccurate fetal heart rate (FHR) assessment may help in determining the status of the fetus and indicate management steps for a particular condition. ], [29] According to the authors, awareness on this gives obstetricians and midwives time to intensify electronic fetal monitoring and to plan possible interventions before fetal asphyxia occurs. *(n900|lumia \d+)/i,/nokia[-_ ]?([-\w\. "datePublished": "2019-12-28T18:31:05", ]+).+microm/i],[f,[u,"WeChat(Win) Desktop"]],[/micromessenger\/([\w\.]+)/i],[f,[u,"WeChat"]],[/konqueror\/([\w\. Most external monitors use a Doppler device with computerized logic to interpret and count the Doppler signals. *os ([\w]+) like mac|; opera)/i,/cfnetwork\/.+darwin/i],[[f,/_/g,". A decrease in FHR of > 15 beats per minute measured from the most recently determined baseline rate. A prospective cohort study of fetal heart rate monitoring: deceleration area is predictive of fetal acidemia. With a Doppler ultrasound, for example, an ultrasound probe is fastened to your stomach. ]{1,9})\b.+(gecko)/i],[f,u]],os:[[/microsoft (windows) (vista|xp)/i],[u,f],[/(windows) nt 6\.2; (arm)/i,/(windows (?:phone(? } Onset, nadir, and recovery of the deceleration occur after the beginning, peak, and ending of the contraction, respectively. Fetal heart tracing monitors the rate and rhythm of your fetus heartbeat. Combined with an internal fetal monitor, an IUPC may give a more precise reading of the baby's heart rate and the strength of contractions. It doesnt include accelerations and decelerations. !.+d\/s)/i],[a,[s,"Huawei"],[c,l]],[/\b(poco[\w ]+)(? :bb[a-f]|st[hv])100-\d)/i,/\(bb10; (\w+)/i],[a,[s,"BlackBerry"],[c,l]],[/(? Your doctor can confirm the likelihood of hypoxic injury using fetal heart tracing. ]+) .*safari\//i],[f,[u,"GSA"]],[/headlesschrome(?:\/([\w\. Dellinger EH, Boehm FH, Crane MM. Increased fetal heart rate variability is parasympathetic-mediated and is caused by acutely deteriorating placental function. This nomenclature has been adopted by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal-Fetal Medicine.[12]. ]+);)/i],[[u,"Facebook"],f],[/safari (line)\/([\w\.]+)/i,/\b(line)\/([\w\. [12] In contrast, the presence of minimal baseline FHR variability, or an absence of FHR variability, does not reliably predict fetal acidemia or hypoxia; lack of moderate baseline FHR variability may be a result of the fetal sleep cycle, medications, extreme prematurity, congenital anomalies, or pre-existing neurological injury. How to Submit. Not predictive of abnormal fetal acidbase status, yet presently there is not adequate evidence to classify these as Category I or Category III. "description" : "Fetal heart tracing allows your doctor to measure the rate and rhythm of your little ones heartbeat. Prolonged fetal heart rate decelerations (which last more than 2 minutes but less than 10 minutes) often require intervention. :[2-4x]| (?:bionic|x2|pro|razr))?:? A pseudosinusoidal pattern shows less regularity in the shape and amplitude of the variability waves and the presence of beat-to-beat variability, compared with the true sinusoidal pattern (Figure 11b). Polyvagal theory (poly-"many" + vagal "wandering") is a collection of unproven, evolutionary, neuroscientific, and psychological constructs pertaining to the role of the vagus nerve in emotion regulation, social connection and fear response, introduced in 1994 by Stephen Porges.. WebCardiotocography (CTG) is a technique used to monitor the fetal heartbeat and the uterine contractions during pregnancy and labour.The machine used to perform the monitoring is called a cardiotocograph.. Fetal heart sounds was described as early as 350 years ago and approximately 200 years ago mechanical stethoscopes, such as the Pinard horn, were The results are categorized as absent (none apparent), minimal (extremely small fluctuations), moderate (a range of 6-25 beats per minute), and marked The FHR recordings may be interpreted as reassuring, nonreassuring or ominous, according to the pattern of the tracing. PWS is mainly characterized by severe hypotonia with feeding difficulties in the first years of life. Check out a suggested systematic approach from the AAFP below! Internal FHR monitoring is accom-plished with a fetal electrode, which is a spiral wire placed directly on the fetal scalp or other presenting part. Their heart rate slows due to uterine contractions, in turn, causing early decelerations, which more often than not prove harmless. (i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), Continuous electronic fetal monitoring was developed in the 1960s to assist in the diagnosis of fetal hypoxia during labor. Electronic fetal heart rate monitoring: early neonatal outcomes associated with normal rate, fetal stress, and fetal distress. The FHR normally exhibits variability, with an average change of 6 to 25 bpm of the baseline rate, and is linked to the fetal central nervous system. Management depends on the clinical picture and presence of other FHR characteristics.18, Overall Assessment (O). The FHR tracing should be interpreted only in the context of the clinical scenario, and any therapeutic intervention should consider the maternal condition as well as that of the fetus. Interpretation of a CTG tracing requires both qualitative and quantitative description of several factors. The recommendations for the overall management of FHR tracings by NICHD, the International Federation of Gynecology and Obstetrics, and ACOG agree that interpretation is reproducible at the extreme ends of the fetal monitor strip spectrum.10 For example, the presence of a normal baseline rate with FHR accelerations or moderate variability predicts the absence of fetal acidemia.10,11 Bradycardia, absence of variability and accelerations, and presence of recurrent late or variable decelerations may predict current or impending fetal asphyxia.10,11 However, more than 50 percent of fetal strips fall between these two extremes, in which overall recommendations cannot be made reliably.10 In the 2008 revision of the NICHD tracing definitions, a three-category system was adopted: normal (category I), indeterminate (category II), and abnormal (category III).11 Category III tracings need intervention to resolve the abnormal tracing or to move toward expeditious delivery.11 In the ALSO course, using the DR C BRAVADO approach, the FHR tracing may be classified using the stoplight algorithm (Figure 19), which corresponds to the NICHD categories.9,11 Interventions are determined by placing the FHR tracing in the context of the specific clinical situation and corresponding NICHD category, fetal reserve, and imminence of delivery (Table 4).9,11, If the FHR tracing is normal, structured intermittent auscultation or continuous EFM techniques can be employed in a low-risk patient, although reconsideration may be necessary as labor progresses.2 If the FHR tracing is abnormal, interventions such as position changes, maternal oxygenation, and intravenous fluid administration may be used. (this instanceof S))return new S(t,e).getResult();var r=t||(void 0!==o&&o.navigator&&o.navigator.userAgent?o.navigator.userAgent:""),n=e?function(t,e){var r={};for(var n in t)e[n]&&e[n].length%2==0?r[n]=e[n].concat(t[n]):r[n]=t[n];return r}(x,e):x;return this.getBrowser=function(){var t,e={};return e[u]=void 0,e[f]=void 0,g.call(e,r,n.browser),e.major="string"==typeof(t=e.version)?t.replace(/[^\d\.]/g,"").split(". *\b) b/i],[a,[s,"Envizen"],[c,p]],[/\b(trio[-\w\. INTRODUCTION. Content is reviewed before publication and upon substantial updates. )\b/i],[a,[s,"ASUS"],[c,l]],[/(nexus 9)/i],[a,[s,"HTC"],[c,p]],[/(htc)[-;_ ]{1,2}([\w ]+(?=\)| bui)|\w+)/i,/(zte)[- ]([\w ]+?)(? A variety of symptoms are associated with uterine ruptures. The odds ratio for treatment-related early menopause was 0.28 (95 % CI: 0.14 to 0.59; p < 0.001). Minimum Volume Standards for Surgical Care of Early-Stage Lung Cancer: A Cost-Effectiveness Analysis. 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