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de Vries IR, van Laar JOEH, van der Hout-van der Jagt MB, Vullings R. Unsupervised denoising of the non-invasive fetal electrocardiogram with sparse domain Kalman filtering and vectorcardiographic loop alignment. Physiol Meas 2024; 45:075006. [PMID: 38976988 DOI: 10.1088/1361-6579/ad605c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 07/08/2024] [Indexed: 07/10/2024]
Abstract
Objective.Even though the electrocardiogram (ECG) has potential to be used as a monitoring or diagnostic tool for fetuses, the use of non-invasive fetal ECG is complicated by relatively high amounts of noise and fetal movement during the measurement. Moreover, machine learning-based solutions to this problem struggle with the lack of clean reference data, which is difficult to obtain. To solve these problems, this work aims to incorporate fetal rotation correction with ECG denoising into a single unsupervised end-to-end trainable method.Approach.This method uses the vectorcardiogram (VCG), a three-dimensional representation of the ECG, as an input and extends the previously introduced Kalman-LISTA method with a Kalman filter for the estimation of fetal rotation, applying denoising to the rotation-corrected VCG.Main results.The resulting method was shown to outperform denoising auto-encoders by more than 3 dB while achieving a rotation tracking error of less than 33∘. Furthermore, the method was shown to be robust to a difference in signal to noise ratio between electrocardiographic leads and different rotational velocities.Significance.This work presents a novel method for the denoising of non-invasive abdominal fetal ECG, which may be trained unsupervised and simultaneously incorporates fetal rotation correction. This method might prove clinically valuable due the denoised fetal ECG, but also due to the method's objective measure for fetal rotation, which in turn might have potential for early detection of fetal complications.
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Affiliation(s)
- I R de Vries
- Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - J O E H van Laar
- Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - M B van der Hout-van der Jagt
- Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - R Vullings
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Nemo Healthcare BV, Veldhoven, The Netherlands
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Mercado L, Escalona-Vargas D, Siegel ER, Preissl H, Bolin EH, Eswaran H. Exploring the Influence of Fetal Sex on Heart Rate Dynamics Using Fetal Magnetocardiographic Recordings. Reprod Sci 2024; 31:823-831. [PMID: 37884730 DOI: 10.1007/s43032-023-01384-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023]
Abstract
Fetal sex has been associated with different development trajectories that cause structural and functional differences between the sexes throughout gestation. Fetal magnetocardiography (fMCG) recordings from 123 participants (64 females and 59 males; one recording/participant) from a database consisting of low-risk pregnant women were analyzed to explore and compare fetal development trajectories of both sexes. The gestational age of the recordings ranged from 28 to 38 weeks. Linear metrics in both the time and frequency domains were applied to study fetal heart rate variability (fHRV) measures that reveal the dynamics of short- and long-term variability. Rates of linear change with GA in these metrics were analyzed using general linear model regressions with assessments for significantly different variances and GA regression slopes between the sexes. The fetal sexes were well balanced for GA and sleep state. None of the fHRV measures analyzed exhibited significant variance heterogeneity between the sexes, and none of them exhibited a significant sex-by-GA interaction. The absence of a statistically significant sex-by-GA interaction on all parameters resulted in none of the regression slope estimates being significantly different between the sexes. With high-precision fMCG recordings, we were able to explore the variation in fHRV parameters as it relates to fetal sex. The fMCG-based fHRV parameters did not show any significant difference in rates of change with gestational age between sexes. This study provides a framework for understanding normal development of the fetal autonomic nervous system, especially in the context of fetal sex.
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Affiliation(s)
- Luis Mercado
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Diana Escalona-Vargas
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Eric R Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the Eberhard Karls University of Tübingen, fMEG Center, Tübingen, Germany
| | - Elijah H Bolin
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Hari Eswaran
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA.
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Polic A, Killen SA, Strasburger JF, Kannankeril PJ, Wakai RT, Patel SS. Low Baseline Fetal Heart Rate Leads to Diagnosis of Long QT Syndrome Type 1. JACC Case Rep 2024; 29:102183. [PMID: 38361570 PMCID: PMC10865115 DOI: 10.1016/j.jaccas.2023.102183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 02/17/2024]
Abstract
A low baseline fetal heart rate at 20 weeks' gestation was detected in a fetus without cardiac structural anomalies. Fetal echocardiography and magnetocardiography were used to diagnose congenital long QT syndrome. It was confirmed in the neonate, and the same pathogenic variant in KCNQ1 was subsequently identified in the mother.
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Affiliation(s)
- Aleksandra Polic
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stacy A.S. Killen
- Division of Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Janette F. Strasburger
- Division of Cardiology, Medical College of Wisconsin, Childrens Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Prince J. Kannankeril
- Division of Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ronald T. Wakai
- Department of Medical Physics, University of Wisconsin, Milwaukee, Wisconsin, USA
| | - Soha S. Patel
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Joglar JA, Kapa S, Saarel EV, Dubin AM, Gorenek B, Hameed AB, Lara de Melo S, Leal MA, Mondésert B, Pacheco LD, Robinson MR, Sarkozy A, Silversides CK, Spears D, Srinivas SK, Strasburger JF, Tedrow UB, Wright JM, Zelop CM, Zentner D. 2023 HRS expert consensus statement on the management of arrhythmias during pregnancy. Heart Rhythm 2023; 20:e175-e264. [PMID: 37211147 DOI: 10.1016/j.hrthm.2023.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
This international multidisciplinary expert consensus statement is intended to provide comprehensive guidance that can be referenced at the point of care to cardiac electrophysiologists, cardiologists, and other health care professionals, on the management of cardiac arrhythmias in pregnant patients and in fetuses. This document covers general concepts related to arrhythmias, including both brady- and tachyarrhythmias, in both the patient and the fetus during pregnancy. Recommendations are provided for optimal approaches to diagnosis and evaluation of arrhythmias; selection of invasive and noninvasive options for treatment of arrhythmias; and disease- and patient-specific considerations when risk stratifying, diagnosing, and treating arrhythmias in pregnant patients and fetuses. Gaps in knowledge and new directions for future research are also identified.
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Affiliation(s)
- José A Joglar
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Elizabeth V Saarel
- St. Luke's Health System, Boise, Idaho, and Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | | | | | - Luis D Pacheco
- The University of Texas Medical Branch at Galveston, Galveston, Texas
| | | | - Andrea Sarkozy
- University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium
| | | | - Danna Spears
- University Health Network, Toronto, Ontario, Canada
| | - Sindhu K Srinivas
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | - Carolyn M Zelop
- The Valley Health System, Ridgewood, New Jersey; New York University Grossman School of Medicine, New York, New York
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Munyaw Y, Urdal J, Ersdal H, Ngarina M, Moshiro R, Blacy L, Linde JE. Fetal to Neonatal Heart Rate Transition during Normal Vaginal Deliveries: A Prospective Observational Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040684. [PMID: 37189933 DOI: 10.3390/children10040684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/24/2023] [Accepted: 03/31/2023] [Indexed: 05/17/2023]
Abstract
Documentation of fetal to neonatal heart rate (HR) transition is limited. The aim of the current study was to describe HR changes from one hour before to one hour after normal vaginal deliveries. We conducted a prospective observational cohort study in Tanzania from 1 October 2020 to 30 August 2021, including normal vaginal deliveries with normal neonatal outcomes. HR was continuously recorded from one hour before to one hour after delivery, using the Moyo fetal HR meter, NeoBeat newborn HR meter, and the Liveborn Application for data storage. The median, 25th, and 75th HR percentiles were constructed. Overall, 305 deliveries were included. Median (interquartile range; IQR) gestational age was 39 (38-40) weeks and birthweight was 3200 (3000-3500) grams. HR decreased slightly during the last 60 min before delivery from 136 (123,145) to 132 (112,143) beats/minute. After delivery, HR increased within one minute to 168 (143,183) beats/min, before decreasing to around 136 (127,149) beats/min at 60 min after delivery. The drop in HR in the last hour of delivery reflects strong contractions and pushing. The rapid increase in initial neonatal HR reflects an effort to establish spontaneous breathing.
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Affiliation(s)
- Yuda Munyaw
- Faculty of Health Sciences, University of Stavanger, 4036 Stavanger, Norway
- Department of Obstetrics and Gynecology, Haydom Lutheran Hospital, Haydom P.O. Box 9000, Tanzania
| | - Jarle Urdal
- Department of Electrical Engineering and Computer Science, University of Stavanger, 4036 Stavanger, Norway
| | - Hege Ersdal
- Faculty of Health Sciences, University of Stavanger, 4036 Stavanger, Norway
- Department of Anesthesia, Stavanger University Hospital, 4011 Stavanger, Norway
| | - Matilda Ngarina
- Department of Obstetrics and Gynecology, Muhimbili National Hospital, Dar es Salaam P.O. Box 65000, Tanzania
| | - Robert Moshiro
- Department of Paediatrics, Muhimbili National Hospital, Dar es Salaam P.O. Box 65000, Tanzania
| | - Ladislaus Blacy
- Research Department, Haydom Lutheran Hospital, Haydom P.O. Box 9000, Tanzania
| | - Jorgen E Linde
- Department of Obstetrics and Gynecology, Stavanger University Hospital, 4011 Stavanger, Norway
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Meier K, Glavind J, Milidou I, Sørensen JCH, Sandager P. Burst Spinal Cord Stimulation in Pregnancy: First Clinical Experiences. Neuromodulation 2023; 26:224-232. [PMID: 35697598 DOI: 10.1016/j.neurom.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Spinal cord stimulation (SCS) is a treatment for chronic neuropathic pain. It is based on the delivery of electric impulses to the spinal cord, traditionally in a regular square-wave pattern ("tonic" stimulation) and, more recently, in a rhythmic train-of-five "BurstDR" pattern. The safety of active SCS therapy in pregnancy is not established, and recommendations are based on limited casuistic evidence. We present in this study clinical data on a case series of six women treated with burst SCS during pregnancy. In addition, we present the ultrasonographic flow measurements of fetal and uteroplacental blood flow in a pregnant patient. MATERIALS AND METHODS Patients were included if they had been implanted with a full SCS system at Aarhus University Hospital, Denmark, between 2006 and 2020 and received active burst SCS stimulation during a pregnancy. Telephone interviews were conducted, including details on SCS therapy, medication, pregnancy course and outcome, and health status of the offspring. In one patient, the uteroplacental and fetal blood flow was assessed in gestational week 29 by Doppler flow measurements performed during both ON and OFF phases of the SCS system. RESULTS Six patients were included with a total of 11 pregnancies. Three pregnancies ended in miscarriages, all in the same patient who had preexisting significant risk factors for miscarriage. Eight resulted in a live-born child with normal birth weight for gestational age; seven were born at term, and one was born late preterm, in gestational week 36. Ultrasonographic Doppler flow, measured in one patient, was normal and did not reveal any immediate changes between burst SCS ON and OFF. Seven children were reported healthy with normal neurodevelopment and one physically healthy but with developmental delays. CONCLUSIONS The data presented in this study add to the accumulating evidence of the safety of SCS in pregnancy.
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Affiliation(s)
- Kaare Meier
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark; Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark; Center for Experimental Neuroscience, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Julie Glavind
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ioanna Milidou
- Department of Pediatrics and Adolescent Medicine, Regional Hospital West Jutland, Herning, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Christian Hedemann Sørensen
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark; Center for Experimental Neuroscience, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Puk Sandager
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
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Crequit S, Tataru C, Coste E, Diane R, Lefebvre M, Haddad B, Lecarpentier E. Association of fetal heart rate short term variability pattern during term labor with neonatal morbidity and small for gestational age status. Eur J Obstet Gynecol Reprod Biol 2022; 278:77-89. [PMID: 36126423 DOI: 10.1016/j.ejogrb.2022.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 08/23/2022] [Accepted: 08/27/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the association of fetal heart rate short-term variability (STV) pattern during term labor with both neonatal composite morbidity (cord blood pH ≤ 7.10 and/or neonatal intensive care unit admission and/or Apgar score at 5 min <7) and small for gestational age (SGA) status. STUDY DESIGN Retrospective cohort in a single academic institution between January 2016 and December 2018. A total of 1896 women that delivered a singleton during labor in cephalic presentation after 37 weeks of gestation were included (948 women with SGA neonates and 948 women with appropriate weight for gestational age (AGA) neonates that were matched to women with SGA neonates based on maternal age, parity, induction of labor, gestational diabetes, gestational age at delivery and a history of one cesarean section using propensity score matching). STV was compared at labor onset (cervical dilation ≤ 4 cm), in the first stage of labor (cervical dilation = 6 cm) and in the second stage of labor (cervical dilation = 10 cm). A generalized linear mixed model was used to assess the association between SGA status, neonatal composite morbidity and STV. RESULTS After adjustment for maternal origin, term, gestational diabetes, labor length, SGA status was not associated with any change in STV during labor (mean adjusted STV: -0.20 ms, 95 %CI[-0.58-0.17], p = 0.284 at labor onset, 0.29 ms, 95 %CI[-0.1- 0.68], p = 0.155, in the first stage of labor and 0.36 ms, 95 %CI[-0.02-0.74], p = 0.065 in the second stage of labor). In case of neonatal composite morbidity mean adjusted STV was lower in the first stage of labor (mean adjusted STV: -1.29 ms, 95 %CI[-2.1 - -0.43], p = 0.003) and in the second stage of labor (mean adjusted STV: -1.15 ms, 95 %CI[-1.96 - -0.34], p = 0.005). The results were similar with the addition of delivery mode and meconium-stained amniotic fluid in the model or non-reassuring fetal heart rate and meconium-stained amniotic fluid. CONCLUSIONS This work suggests that STV decrease during term labor is associated with fetal well-being, independently of fetal weight. This suggests that further prospective studies should consider the evaluation of this parameter in the prediction of neonatal compromise.
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Affiliation(s)
- Simon Crequit
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Créteil, France; Sorbonne université médecine, 91-105 bd de l'hôpital, 75013, Paris
| | - Consuela Tataru
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Créteil, France; Sorbonne université médecine, 91-105 bd de l'hôpital, 75013, Paris
| | - Elise Coste
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Créteil, France
| | - Redel Diane
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Créteil, France
| | - Marion Lefebvre
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Créteil, France
| | - Bassam Haddad
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Créteil, France; Faculté de santé, Univ Paris Est Créteil, France; INSERM, IMRB U955 I-BIOT, Créteil 94010, France
| | - Edouard Lecarpentier
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Créteil, France; Faculté de santé, Univ Paris Est Créteil, France; INSERM, IMRB U955 I-BIOT, Créteil 94010, France.
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8
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Strasburger JF, Eckstein G, Butler M, Noffke P, Wacker-Gussmann A. Fetal Arrhythmia Diagnosis and Pharmacologic Management. J Clin Pharmacol 2022; 62 Suppl 1:S53-S66. [PMID: 36106782 PMCID: PMC9543141 DOI: 10.1002/jcph.2129] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022]
Abstract
One of the most successful achievements of fetal intervention is the pharmacologic management of fetal arrhythmias. This management usually takes place during the second or third trimester. While most arrhythmias in the fetus are benign, both tachy‐ and bradyarrhythmias can lead to fetal hydrops or cardiac dysfunction and require treatment under certain conditions. This review will highlight precise diagnosis by fetal echocardiography and magnetocardiography, the 2 primary means of diagnosing fetuses with arrhythmia. Additionally, transient or hidden arrhythmias such as bundle branch block, QT prolongation, and torsades de pointes, which can lead to cardiomyopathy and sudden unexplained death in the fetus, may also need pharmacologic treatment. The review will address the types of drug therapies; current knowledge of drug usage, efficacy, and precautions; and the transition to neonatal treatments when indicated. Finally, we will highlight new assessments, including the role of the nurse in the care of fetal arrhythmias. The prognosis for the human fetus with arrhythmias continues to improve as we expand our ability to provide intensive care unit–like monitoring, to better understand drug treatments, to optimize subsequent pregnancy monitoring, to effectively predict timing for delivery, and to follow up these conditions into the neonatal period and into childhood. Coordinated initiatives that facilitate clinical fetal research are needed to address gaps in knowledge and to facilitate fetal drug and device development.
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Affiliation(s)
- Janette F Strasburger
- Division of Cardiology, Departments of Pediatrics and Biomedical Engineering, Children's Wisconsin, Herma Heart Institute, and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Gretchen Eckstein
- Division of Cardiology, Departments of Pediatrics and Biomedical Engineering, Children's Wisconsin, Herma Heart Institute, and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mary Butler
- College of Nursing, University of Wisconsin-Oshkosh, Oshkosh, Wisconsin, USA
| | - Patrick Noffke
- Division of Cardiology, Departments of Pediatrics and Biomedical Engineering, Children's Wisconsin, Herma Heart Institute, and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Annette Wacker-Gussmann
- German Heart Center, Department of Congenital Heart Disease and Pediatric Cardiology Munich, Munchen, Bavaria, Germany
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Li SF, Zhao YY, Li GF, Wang N, Zhang S, Chen L, Wang Y. Computerized analysis of fetal heart rate pattern in the third trimester of low-risk pregnancy by long-range electronic fetal monitoring. J Matern Fetal Neonatal Med 2021; 35:5506-5512. [PMID: 33596763 DOI: 10.1080/14767058.2021.1887120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND With computerized analysis of fetal heart rate(FHR) data from long-range monitoring, we aimed to comprehensively clarify the characteristics of FHR with increasing gestational age in low-risk pregnant women during the third trimester of pregnancy. METHODS This was an observational study. 85 fetuses of low-risk pregnant women were included. The data covered 28 ∼ 40 weeks of gestation, and 125 cases of FHR monitoring from 85 fetuses were totally collected. The FHR baseline rate, variability, and acceleration were computationally calculated, analyzed and compared. RESULTS The average effective monitoring time for each case was 13.9 ± 4.3 h. FHR baseline gradually decreased as the gestational age progressed, and the maximum FHR baseline appeared at 28-29 weeks, which was 137.5 (133.0, 141.3) bpm, whereas the minimum FHR baseline appeared at 38-39 weeks, that was 132.8 (128.1, 138.4) bpm. FHR variability fluctuated in (4-12)bpm. It gradually increased from 28 to 33 weeks of gestation, reached the maximum of 7.6 (6.0-9.4) bpm, and then decreased until full-term pregnancy. The moderate variability proportion of FHR gradually increased from 28 weeks of gestation, peaked at 32-33 weeks as 65.8%, and then gradually decreased to 56.2% at 37 weeks, which was maintained at this level until 39 weeks. The variation tendency of minimal variability proportion was opposite to moderate variability proportion. When it reached 40 weeks, the minimal and moderate variability proportions were 50.0% and 49.0%, respectively. The FHR acceleration area showed no trend change during the third trimester, while fluctuated in (29.5-42.4) lattices/h. CONCLUSION This study revealed that the characteristics of FHR gradually changed with increasing gestational age, and the most obvious change was observed at 32-33 weeks, demonstrating that the specific gestational weeks may be an important period for the physiological bias of FHR tends to mature.
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Affiliation(s)
- Shu-Fang Li
- Department of Gynecology and Obstetrics, Peking University Third Hospital, Peking University, Beijing, China.,Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang-Yu Zhao
- Department of Gynecology and Obstetrics, Peking University Third Hospital, Peking University, Beijing, China
| | - Guang-Fei Li
- Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Nan Wang
- Department of Gynecology and Obstetrics, Peking University Third Hospital, Peking University, Beijing, China
| | - Song Zhang
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, China
| | - Lian Chen
- Department of Gynecology and Obstetrics, Peking University Third Hospital, Peking University, Beijing, China
| | - Yan Wang
- Department of Gynecology and Obstetrics, Peking University Third Hospital, Peking University, Beijing, China
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10
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Cahill LS, Stortz G, Chandran AR, Milligan N, Shinar S, Whitehead CL, Hobson SR, Millard S, Macgowan CK, Kingdom JC, Sled JG, Baschat AA. Determination of fetal heart rate short-term variation from umbilical artery Doppler waveforms. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:70-74. [PMID: 33030756 PMCID: PMC7779755 DOI: 10.1002/uog.23145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To evaluate the feasibility of using umbilical artery (UA) Doppler waveforms to measure fetal heart rate (FHR) short-term variation (STV) across gestation. METHODS This was a prospective longitudinal study, conducted at two study sites, of 195 pregnancies considered low risk. Pulsed-wave Doppler of the UAs was performed at 4-weekly intervals, between 14 and 40 weeks of gestation, using a standardized imaging protocol. Up to 12 consecutive UA Doppler waveforms were analyzed using offline processing software. FHR STV was calculated using average R-R intervals extracted from the waveforms and baseline corrected for FHR. RESULTS Baseline-corrected FHR STV increased significantly with gestational age (conditional R2 = 0.37; P < 0.0001) and was correlated inversely with FHR (conditional R2 = 0.54; P < 0.0001). The STV ranged (median (interquartile range)) from 3.5 (2.9-4.1) ms at 14-20 weeks' gestation to 6.3 (4.8-7.7) ms at 34-40 weeks' gestation. The change in heart rate STV did not differ between study sites or individual sonographers. CONCLUSIONS UA Doppler waveforms offer a robust and feasible method to derive STV of the FHR. It should be emphasized that the UA Doppler-derived STV is not interchangeable with measurements derived with computerized cardiotocography. Accordingly, further investigations are needed to validate associations with outcome, in order to determine the value of concurrent fetal cardiovascular and heart rate evaluations that are possible with the technique described here. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- Lindsay S. Cahill
- Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Chemistry, Memorial University of Newfoundland, St John’s, Newfoundland and Labrador, Canada
| | - Greg Stortz
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anjana Ravi Chandran
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Natasha Milligan
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shiri Shinar
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Clare L. Whitehead
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
- Pregnancy Research Centre, Department of Obstetrics and Gynaecology, Royal Women’s Hospital, Parkville, Australia
| | - Sebastian R. Hobson
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Sarah Millard
- Centre for Fetal Therapy, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Christopher K. Macgowan
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - John C. Kingdom
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - John G. Sled
- Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Ahmet A. Baschat
- Centre for Fetal Therapy, Johns Hopkins Medicine, Baltimore, Maryland, USA
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11
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Campbell KSJ, Collier AC, Irvine MA, Brain U, Rurak DW, Oberlander TF, Lim KI. Maternal Serotonin Reuptake Inhibitor Antidepressants Have Acute Effects on Fetal Heart Rate Variability in Late Gestation. Front Psychiatry 2021; 12:680177. [PMID: 34483982 PMCID: PMC8415315 DOI: 10.3389/fpsyt.2021.680177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/14/2021] [Indexed: 01/30/2023] Open
Abstract
Background: Prenatal exposure to serotonin reuptake inhibitor (SRI) antidepressants increases risk for adverse neurodevelopmental outcomes, yet little is known about whether effects are present before birth. In relation to maternal SRI pharmacokinetics, this study investigated chronic and acute effects of prenatal SRI exposure on third-trimester fetal heart rate variability (HRV), while evaluating confounding effects of maternal depressed mood. Methods: At 36-weeks' gestation, cardiotocograph measures of fetal HR and HRV were obtained from 148 pregnant women [four groups: SRI-Depressed (n = 31), SRI-Non-Depressed (n = 18), Depressed (unmedicated; n = 42), and Control (n = 57)] before, and ~5-h after, typical SRI dose. Maternal plasma drug concentrations were quantified at baseline (pre-dose) and four time-points post-dose. Mixed effects modeling investigated group differences between baseline/pre-dose and post-dose fetal HR outcomes. Post hoc analyses investigated sex differences and dose-dependent SRI effects. Results: Maternal SRI plasma concentrations were lowest during the baseline/pre-dose fetal assessment (trough) and increased to a peak at the post-dose assessment; concentration-time curves varied widely between individuals. No group differences in fetal HR or HRV were observed at baseline/pre-dose; however, following maternal SRI dose, short-term HRV decreased in both SRI-exposed fetal groups. In the SRI-Depressed group, these post-dose decreases were displayed by male fetuses, but not females. Further, episodes of high HRV decreased post-dose relative to baseline, but only among SRI-Non-Depressed group fetuses. Higher maternal SRI doses also predicted a greater number of fetal HR decelerations. Fetuses exposed to unmedicated maternal depressed mood did not differ from Controls. Conclusions: Prenatal SRI exposure had acute post-dose effects on fetal HRV in late gestation, which differed depending on maternal mood response to SRI pharmacotherapy. Importantly, fetal SRI effects were sex-specific among mothers with persistent depressive symptoms, as only male fetuses displayed acute HRV decreases. At trough (pre-dose), chronic fetal SRI effects were not identified; however, concurrent changes in maternal SRI plasma levels suggest that fetal drug exposure is inconsistent. Acute SRI-related changes in fetal HRV may reflect a pharmacologic mechanism, a transient impairment in autonomic functioning, or an early adaption to altered serotonergic signaling, which may differ between males and females. Replication is needed to determine significance with postnatal development.
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Affiliation(s)
- Kayleigh S J Campbell
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Abby C Collier
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Irvine
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Ursula Brain
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Dan W Rurak
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Tim F Oberlander
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kenneth I Lim
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
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12
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Ghi T, Di Pasquo E, Dall'Asta A, Commare A, Melandri E, Casciaro A, Fieni S, Frusca T. Intrapartum fetal heart rate between 150 and 160 bpm at or after 40 weeks and labor outcome. Acta Obstet Gynecol Scand 2020; 100:548-554. [PMID: 33051873 DOI: 10.1111/aogs.14024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/25/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A baseline fetal heart rate between 110 and 160 bpm is considered normal. However, among normal fetuses the average baseline heart rate has been shown to diminish progressively and the 90th centile of the fetal heart rate at 40 weeks of gestation has been consistently found at around 150 bpm. The aim of our study was to assess the labor and neonatal outcome of fetuses at 40 gestational weeks or beyond, whose intrapartum baseline fetal heart rate was between 150 and 160 bpm. MATERIAL AND METHODS Retrospective cohort study including singleton pregnancies with spontaneous onset of labor, gestational age between 40+0 and 42+0 weeks, category I CTG trace according to the FIGO guidelines 2015 with baseline fetal heart rate between 110 and 160 bpm during the first 60 minutes of active labor. Exclusion criteria were maternal hyperpyrexia at admission, fetal arrhythmias, maternal tachycardia (>110 bpm) and uterine tachysystole (>5 contractions/10 minutes). The following outcomes were compared between fetuses with a baseline ranging between 110 and 149 bpm and those with a baseline ranging between 150 and 160 bpm: incidence of meconium-stained amniotic fluid, intrapartum hyperpyrexia, mode of delivery, Apgar at 5 minutes <7, arterial pH <7.1 and Neonatal Intensive Care Unit admission, incidence of a composite adverse neonatal outcome. RESULTS In all, 1004 CTG traces were included in the analysis, 860 in Group 110-149 bpm and 144 in Group 150-160 bpm. Group 150-160 bpm had a significantly higher incidence of meconium-stained amniotic fluid (odds ratio [OR] 2.6; 95% CI 1.8-3.8), maternal intrapartum hyperpyrexia (OR 4.7; 95% CI 1.1-14.6), urgent/emergent cesarean section for suspected fetal distress (OR 13.4; 95% CI 3.3-54.3), Apgar <7 at 5th min (OR 9.13; 95% CI 1.5-55.1) and neonatal acidemia (OR 3.5; 95% CI 1.5-55.1). Logistic regression including adjustiing for potential confounders showed that fetal heart rate between 150 and 160 bpm is an independent predictor of meconium-stained amniotic fluid (adjusted odds ratio [aOR] 2.2; 95% CI 1.5-3.3), cesarean section during labor for fetal distress (aOR 10.7; 95% CI 2.9-44.6), neonatal acidemia (aOR 2.6; 95% CI 1.1-6.7) and adverse composite neonatal outcome (aOR 2.6; 95% CI 1.2-5.6). CONCLUSIONS In fetuses at 40 weeks or beyond, an intrapartum fetal heart rate baseline ranging between 150 and 160 bpm seems associated with a higher incidence of labor complications.
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Affiliation(s)
- Tullio Ghi
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Elvira Di Pasquo
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Andrea Dall'Asta
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Arianna Commare
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Elena Melandri
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Alessia Casciaro
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Stefania Fieni
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Tiziana Frusca
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
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13
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Hayes-Gill BR, Martin TRP, Liu C, Cohen WR. Relative accuracy of computerized intrapartum fetal heart rate pattern recognition by ultrasound and abdominal electrocardiogram detection. Acta Obstet Gynecol Scand 2019; 99:413-422. [PMID: 31792930 DOI: 10.1111/aogs.13760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Noninvasive fetal heart rate monitoring using transabdominal fetal electrocardiographic detection is now commercially available and has been demonstrated to be an effective alternative to traditional Doppler ultrasonographic techniques. Our objective in this study was to compare the results of computerized identification of fetal heart rate patterns generated by ultrasound-based and transabdominal fetal electrocardiogram-based techniques with simultaneously obtained fetal scalp electrode-derived heart rate information. MATERIAL AND METHODS We applied an objective computer-based analysis for recognition of fetal heart rate patterns (Monica Decision Support) to data obtained simultaneously from a direct fetal scalp electrode, Doppler ultrasound, and the abdominal-fetal electrocardiogram techniques. This allowed us to compare over 145 hours of fetal heart rate patterns generated by the external devices with those derived from the scalp electrode in 30 term singleton uncomplicated pregnancies during labor. The direct fetal scalp electrode is considered to be the most accurate and reliable technique used in current clinical practice, and was, therefore, used as the standard for comparison. The program quantified the baseline heart rate, long- and short-term variability. It indicated when an acceleration or deceleration was present and whether it was large or small. RESULTS Ultrasound was associated with significantly greater deviations from the fetal scalp electrode results than the abdominal fetal electrocardiogram technique in recognizing the correct baseline heart rate, its variability, and the presence of small and large accelerations and small decelerations. For large decelerations the two external methods were each not significantly different from the scalp electrode results. CONCLUSIONS Noninvasive fetal heart rate monitoring using maternal abdominal wall electrodes to detect fetal cardiac activity more reliably reproduced the computerized analysis of heart rate patterns derived from a direct fetal scalp electrode than did traditional ultrasound-based monitoring. Abdominal-fetal electrocardiogram should, therefore, be considered a primary option for externally monitored patients.
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Affiliation(s)
- Barrie R Hayes-Gill
- Faculty of Engineering, Department of Electrical and Electronic Engineering, University of Nottingham, Nottingham, UK
| | | | - Chong Liu
- Faculty of Engineering, Department of Electrical and Electronic Engineering, University of Nottingham, Nottingham, UK
| | - Wayne R Cohen
- Department of Obstetrics and Gynecology, University of Arizona College of Medicine, Tucson, AZ, USA
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14
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Wolf H, Bruin C, Dobbe JGG, Gordijn SJ, Ganzevoort W. Computerized fetal cardiotocography analysis in early preterm fetal growth restriction - a quantitative comparison of two applications. J Perinat Med 2019; 47:439-447. [PMID: 31005952 DOI: 10.1515/jpm-2018-0412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/08/2019] [Indexed: 11/15/2022]
Abstract
Background We developed an open-source software for the computerized analysis of antenatal fetal cardiotocography (CTG) without limitation of duration of the registration, enabling batch processing and adaptation to any digital storage system. Methods STVcalc was developed based on literature about the FetalCare system (Huntleigh Healthcare Ltd, Cardiff, UK). For comparison with FetalCare, we selected the CTGs of all women who delivered in 2011 a small-for-gestational-age (SGA) fetus between 24 and 31 weeks by cesarean section (CS) for fetal distress, or had fetal death, before labor onset. Results In 471 CTGs from 39 women, the agreement was 99% for a short-term variation (STV) cut-off of 2.6 ms below 29 weeks and 3.0 ms thereafter, and 95% for 3.5 and 4.0 ms, respectively. In 18 (4%) cases, the proportional difference in STV between FetalCare and STVcalc was more than 10%. Conclusion As only slight differences were observed between the proposed feature-rich application and the FetalCare system, it can be considered valuable for clinical practice and research purposes.
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Affiliation(s)
- Hans Wolf
- Department of Obstetrics, Amsterdam University Medical CenterAmsterdam, The Netherlands
| | - Claartje Bruin
- Department of Obstetrics, Amsterdam University Medical CenterAmsterdam, The Netherlands
| | - Johannes G G Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Sanne J Gordijn
- Department of Obstetrics, University Medical Center Groningen, Groningen, The Netherlands
| | - Wessel Ganzevoort
- Department of Obstetrics, Amsterdam University Medical CenterAmsterdam, The Netherlands
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15
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Shaw CJ, Allison BJ, Itani N, Botting KJ, Niu Y, Lees CC, Giussani DA. Altered autonomic control of heart rate variability in the chronically hypoxic fetus. J Physiol 2018; 596:6105-6119. [PMID: 29604064 PMCID: PMC6265555 DOI: 10.1113/jp275659] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/19/2018] [Indexed: 12/28/2022] Open
Abstract
KEY POINTS Fetal heart rate variability (FHRV) has long been recognised as a powerful predictor of fetal wellbeing, and a decrease in FHRV is associated with fetal compromise. However, the mechanisms by which FHRV is reduced in the chronically hypoxic fetus have yet to be established. The sympathetic and parasympathetic influences on heart rate mature at different rates throughout fetal life, and can be assessed by time domain and power spectral analysis of FHRV. In this study of chronically instrumented fetal sheep in late gestation, we analysed FHRV daily over a 16 day period towards term, and compared changes between fetuses of control and chronically hypoxic pregnancy. We show that FHRV in sheep is reduced by chronic hypoxia, predominantly due to dysregulation of the sympathetic control of the fetal heart rate. This presents a potential mechanism by which a reduction in indices of FHRV predicts fetuses at increased risk of neonatal morbidity and mortality in humans. Reduction in overall FHRV may therefore provide a biomarker that autonomic dysregulation of fetal heart rate control has taken place in a fetus where uteroplacental dysfunction is suspected. ABSTRACT Although fetal heart rate variability (FHRV) has long been recognised as a powerful predictor of fetal wellbeing, the mechanisms by which it is reduced in the chronically hypoxic fetus have yet to be established. In particular, the physiological mechanism underlying the reduction of short term variation (STV) in fetal compromise remains unclear. In this study, we present a longitudinal study of the development of autonomic control of FHRV, assessed by indirect indices, time domain and power spectral analysis, in normoxic and chronically hypoxic, chronically catheterised, singleton fetal sheep over the last third of gestation. We used isobaric chambers able to maintain pregnant sheep for prolonged periods in hypoxic conditions (stable fetal femoral arterial P O 2 10-12 mmHg), and a customised wireless data acquisition system to record beat-to-beat variation in the fetal heart rate. We determined in vivo longitudinal changes in overall FHRV and the sympathetic and parasympathetic contribution to FHRV in hypoxic (n = 6) and normoxic (n = 6) ovine fetuses with advancing gestational age. Normoxic fetuses show gestational age-related increases in overall indices of FHRV, and in the sympathetic nervous system contribution to FHRV (P < 0.001). Conversely, gestational age-related increases in overall FHRV were impaired by exposure to chronic hypoxia, and there was evidence of suppression of the sympathetic nervous system control of FHRV after 72 h of exposure to hypoxia (P < 0.001). This demonstrates that exposure to late gestation isolated chronic fetal hypoxia has the potential to alter the development of the autonomic nervous system control of FHRV in sheep. This presents a potential mechanism by which a reduction in indices of FHRV in human fetuses affected by uteroplacental dysfunction can predict fetuses at increased risk.
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Affiliation(s)
- C. J. Shaw
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
- Institute of Reproductive and Developmental BiologyImperial College LondonLondonUK
| | - B. J. Allison
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
| | - N. Itani
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
| | - K. J. Botting
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
- Cambridge Cardiovascular Research InitiativeAddenbrooke's HospitalCambridgeUK
| | - Y. Niu
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
- Cambridge Cardiovascular Research InitiativeAddenbrooke's HospitalCambridgeUK
| | - C. C. Lees
- Institute of Reproductive and Developmental BiologyImperial College LondonLondonUK
- Department of Obstetrics and GynaecologyUniversity Hospitals LeuvenLeuvenBelgium
| | - D. A. Giussani
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
- Cambridge Cardiovascular Research InitiativeAddenbrooke's HospitalCambridgeUK
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16
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Graupner O, Ortiz JU, Haller B, Wacker-Gussmann A, Oberhoffer R, Kuschel B, Weyrich J, Lees C, Lobmaier SM. Performance of computerized cardiotocography-based short-term variation in late-onset small-for-gestational-age fetuses and reference ranges for the late third trimester. Arch Gynecol Obstet 2018; 299:353-360. [PMID: 30446842 DOI: 10.1007/s00404-018-4966-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/08/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Fetal Doppler changes are well characterized in early-onset small-for-gestational-age (SGA) and fetal growth restriction (FGR) but less well characterized where the condition is late-onset. The aim of the study was to evaluate the role of computerized CTG (cCTG)-based short-term variation (STV) in late-onset SGA and FGR as an additional monitoring modality and to establish STV reference ranges in late third trimester healthy pregnancies. METHODS Of 86 late-onset SGA fetuses diagnosed after 32 weeks, 66 were diagnosed with FGR. 138 healthy pregnancies acted as controls. All underwent umbilical artery pulsatility index (PI), middle cerebral artery PI, cerebroplacental ratio and mean uterine artery PI. cCTG recordings were analyzed by Sonicaid FetalCare software for STV calculation as described by Dawes/Redman. RESULTS Median interval between inclusion and delivery was 13 (interquantile range = 4-30) days in the FGR group, 22 (12-37) days in the SGA group and 25 (10-40) days in the control group. STV was not different between controls (11.2 ms, 9.7-13.1), late-onset SGA (11.2 ms, 8.1-12.6) and FGR (10.5 ms, 8.5-12.4) fetuses. A greater proportion of late-onset SGA fetuses had STV < 5th percentile (7/86) compared to controls (4/138) (8.1% vs. 2.9%, p = 0.077). In the control group a significant positive correlation was seen between STV, and 1-min (ρ = 0.195, p = 0.026), 5-min (ρ = 0.247, p = 0.004) and 10-min (ρ = 0.211, p = 0.014) Apgar values. CONCLUSIONS We report no significant difference in STV median values between controls, SGA and FGR pregnancies. However, more SGA fetuses had a low STV compared to controls. Prospective longitudinal studies are needed to investigate if low STV is a useful surveillance method for late-onset FGR.
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Affiliation(s)
- Oliver Graupner
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Javier U Ortiz
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Haller
- Institute for Medical Statistics and Epidemiology (IMSE), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Annette Wacker-Gussmann
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Munich, Germany
| | - Renate Oberhoffer
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Bettina Kuschel
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Joy Weyrich
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christoph Lees
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Silvia M Lobmaier
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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17
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Bhide A, Acharya G. Sex differences in fetal heart rate and variability assessed by antenatal computerized cardiotocography. Acta Obstet Gynecol Scand 2018; 97:1486-1490. [PMID: 30091138 DOI: 10.1111/aogs.13437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/09/2018] [Accepted: 07/30/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of the current study is to explore the effect of fetal sex on the fetal heart rate and variability. MATERIAL AND METHODS This is a retrospective cross-sectional study. We analyzed fetal heart rate (FHR) traces of pregnant women that were recorded antenatally using a commercially available computerized cardiotocograph (cCTG; Oxford system). Fetal sex was ascertained after birth. Baseline FHR and short-term heart rate variation (STV) were compared between male and female fetuses. Expected mean values for baseline FHR and STV were computed and multiples of the mean (MOMean) of males and females were compared. RESULTS Information on 9259 cases is reported in this study. Baseline FHR of female fetuses was significantly higher (P < 0.001) and STV lower (P < 0.001) than that of male fetuses. This difference remained even after the effects of gestational age and diurnal variation were eliminated by computation of MOMean, but the absolute differences in the baseline FHR (0.9 beats/min [bpm]) and STV (0.246 ms) between male and female fetuses were small. A significant negative correlation was found between baseline FHR and STV (r = -0.518, P < 0.001). Similarly, a significant negative correlation was found between the MoMean of baseline FHR and MoMean STV (r = -0.481, P < 0.001). CONCLUSIONS Using the Oxford cCTG, male fetuses show a significantly lower baseline FHR and greater variability as compared with female fetuses. However, the absolute differences are small and may not be of major clinical significance.
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Affiliation(s)
- Amar Bhide
- Institute of Clinical and Molecular Sciences, St George's, University of London, London, UK.,Women's Health & Perinatal Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Ganesh Acharya
- Women's Health & Perinatal Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway.,Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm, Sweden
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18
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Kouskouti C, Jonas H, Regner K, Ruisinger P, Knabl J, Kainer F. Validation of a new algorithm for the short-term variation of the fetal heart rate: an antepartum prospective study. J Perinat Med 2018; 46:599-604. [PMID: 28672744 DOI: 10.1515/jpm-2017-0035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 05/11/2017] [Indexed: 11/15/2022]
Abstract
AIMS Currently one of the most widespread systems for the computerized analysis of the fetal heart rate (FHR) is the Dawes-Redman system, where the short-term variation (STV) of the FHR is measured by dividing each minute into 16 segments (STV16). Technical progress has allowed for the development of a new algorithm, which measures the STV by dividing each minute into 240 segments (STV240), thus approximating the beat-to-beat variation. The STV240 still lacks reference values. Our aim was to develop clinically relevant reference values for the STV240 and compare them to the ones for the STV16. METHODS In a single centre, observational study, a total of 228 cardiotocograms were registered and subsequently analyzed with both algorithms (STV240 and STV16). RESULTS The 95% confidence interval (CI) was calculated for both algorithms. The values of the STV240 were significantly lower in comparison to the ones of the STV16. Not only the mean values but also the 95th percentile of the STV240 lay beneath the existent cut-off value for the STV16. CONCLUSIONS Every clinician using the new algorithm must be aware that the normal values for the STV240 lie beneath the, up until now, established cut-off values for the STV16.
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Affiliation(s)
- Christina Kouskouti
- Department of Obstetrics and Perinatal Medicine, Klinik Hallerwiese, St. Johannis-Mühlgasse 19, 90419 Nuremberg, Germany, Tel.: +49 162 7929487, +49 911 33402355, Fax: +49 911 33402301
| | - Hella Jonas
- Department of Obstetrics and Perinatal Medicine, Klinik Hallerwiese, St. Johannis-Mühlgasse 19, 90419 Nuremberg, Germany
| | - Kerstin Regner
- Department of Obstetrics and Perinatal Medicine, Klinik Hallerwiese, St. Johannis-Mühlgasse 19, 90419 Nuremberg, Germany
| | - Pia Ruisinger
- Department of Obstetrics and Perinatal Medicine, Klinik Hallerwiese, St. Johannis-Mühlgasse 19, 90419 Nuremberg, Germany
| | - Julia Knabl
- Department of Obstetrics and Perinatal Medicine, Klinik Hallerwiese, St. Johannis-Mühlgasse 19, 90419 Nuremberg, Germany
- Department of Gynecology and Obstetrics, Ludwig Maximilians University of Munich, Maistr. 11, 80337 Munich, Germany
| | - Franz Kainer
- Department of Obstetrics and Perinatal Medicine, Klinik Hallerwiese, St. Johannis-Mühlgasse 19, 90419 Nuremberg, Germany
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19
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Schneider U, Bode F, Schmidt A, Nowack S, Rudolph A, Doelcker EM, Schlattmann P, Götz T, Hoyer D. Developmental milestones of the autonomic nervous system revealed via longitudinal monitoring of fetal heart rate variability. PLoS One 2018; 13:e0200799. [PMID: 30016343 PMCID: PMC6049949 DOI: 10.1371/journal.pone.0200799] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 07/03/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Fetal heart rate variability (fHRV) of normal-to-normal (NN) beat intervals provides high-temporal resolution access to assess the functioning of the autonomic nervous system (ANS). AIM To determine critical periods of fetal autonomic maturation. The developmental pace is hypothesized to change with gestational age (GA). STUDY DESIGN Prospective longitudinal observational study. SUBJECTS 60 healthy singleton fetuses were followed up by fetal magnetocardiographic heart rate monitoring 4-11 times (median 6) during the second half of gestation. OUTCOME MEASURE FHRV parameters, accounting for differential aspects of the ANS, were studied applying linear mixed models over four predefined pregnancy segments of interest (SoI: <27; 27+0-31+0; 31+1-35+0; >35+1 weeks GA). Periods of fetal active sleep and quiescence were accounted for separately. RESULTS Skewness of the NN interval distribution VLF/LF band power ratio and complexity describe a saturation function throughout the period of interest. A decreasing LF/HF ratio and an increase in pNN5 indicate a concurrent shift in sympathovagal balance. Fluctuation amplitude and parameters of short-term variability (RMSSD, HF band) mark a second acceleration towards term. In contrast, fetal quiescence is characterized by sequential, but low-margin transformations; ascending overall variability followed by an increase of complexity and superseded by fluctuation amplitude. CONCLUSIONS An increase in sympathetic activation, connected with by a higher ability of parasympathetic modulation and baseline stabilization, is reached during the transition from the late 2nd into the early 3rd trimester. Pattern characteristics indicating fetal well-being saturate at 35 weeks GA. Pronounced fetal breathing efforts near-term mirror in fHRV as respiratory sinus arrhythmia.
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Affiliation(s)
- Uwe Schneider
- Department of Obstetrics, Division of Prenatal Diagnostics and Fetal Physiology, Jena University Hospital, Jena, Germany
- * E-mail:
| | - Franziska Bode
- Department of Obstetrics, Division of Prenatal Diagnostics and Fetal Physiology, Jena University Hospital, Jena, Germany
| | - Alexander Schmidt
- Hans Berger Clinic of Neurology, Biomagnetic Center, Jena University Hospital, Jena, Germany
| | - Samuel Nowack
- Hans Berger Clinic of Neurology, Biomagnetic Center, Jena University Hospital, Jena, Germany
| | - Anja Rudolph
- Department of Obstetrics, Division of Prenatal Diagnostics and Fetal Physiology, Jena University Hospital, Jena, Germany
| | - Eva-Maria Doelcker
- Hans Berger Clinic of Neurology, Biomagnetic Center, Jena University Hospital, Jena, Germany
- Institute of Biomedical Engineering and Informatics, Technical University, Ilmenau, Germany
| | - Peter Schlattmann
- Institute for Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Theresa Götz
- Hans Berger Clinic of Neurology, Biomagnetic Center, Jena University Hospital, Jena, Germany
- Institute for Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Dirk Hoyer
- Hans Berger Clinic of Neurology, Biomagnetic Center, Jena University Hospital, Jena, Germany
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Li G, Zhang S, Yang L, Li S, Wang Y, Zhao Y, Yang Y, Hao D, Li X, Zhang L, Xu M. Analysis of heart rate variation and foetal quiet sleep cycle correlation for normal and suspicious foetuses. BIOTECHNOL BIOTEC EQ 2018. [DOI: 10.1080/13102818.2018.1443401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Guangfei Li
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, PR China
| | - Song Zhang
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, PR China
| | - Lin Yang
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, PR China
| | - Shufang Li
- Obstetrics and Gynecology, Peking University Third Hospital, Beijing, PR China
| | - Yan Wang
- Obstetrics and Gynecology, Peking University Third Hospital, Beijing, PR China
| | - Yangyu Zhao
- Obstetrics and Gynecology, Peking University Third Hospital, Beijing, PR China
| | - Yimin Yang
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, PR China
| | - Dongmei Hao
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, PR China
| | - Xuwen Li
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, PR China
| | - Lei Zhang
- Beijing Yes Medical Devices Co., Ltd., Beijing, PR China
| | - Mingzhou Xu
- Beijing Aerospace Changfeng Co., Ltd., Beijing, PR China
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A Comprehensive Evaluation of the Predictive Abilities of Fetal Electrocardiogram-Derived Parameters during Labor in Newborn Acidemia: Our Institutional Experience. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3478925. [PMID: 29888259 PMCID: PMC5985095 DOI: 10.1155/2018/3478925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/20/2018] [Accepted: 04/17/2018] [Indexed: 11/17/2022]
Abstract
This study aimed to identify cardiotocography patterns that discriminate fetal acidemia newborns by comprehensively evaluating the parameters obtained from Holter monitoring during delivery. Between June 1, 2015, and August 1, 2016, a prospective observational study of 85 patients was conducted using fetal Holter monitoring at the Beijing Obstetrics and Gynecology Hospital, Capital Medical University, China. Umbilical cord blood was sampled immediately after delivery and fetal acidemia was defined as umbilical cord arterial blood pH < 7.20. Fetal electrocardiogram- (FECG-) derived parameters, including basal fetal heart rate (BFHR), short-term variation (STV), large acceleration (LA), deceleration capacity (DC), acceleration capacity (AC), proportion of episodes of high variation (PEHV), and proportion of episodes of low variation (PELV), were compared between 16 fetuses with acidemia and 47 without. The areas under the curve (AUC) of receiver operating characteristics (ROC) were calculated. Although all the computerized parameters showed predictive values for acidemia (all AUC > 0.50), STV (AUC = 0.84, P < 0.001), DC (AUC = 0.84, P < 0.001), AC (AUC = 0.80, P < 0.001), and PELV (AUC = 0.71, P = 0.012) were more strongly associated with fetal acidemia. Our institutional experience suggests that FECG-derived parameters from Holter monitoring are beneficial in reducing the incidence of neonatal acidemia.
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Abstract
This article reviews important features for improving the diagnosis of fetal arrhythmias by ultrasound in prenatal cardiac screening and echocardiography. Transient fetal arrhythmias are more common than persistent fetal arrhythmias. However, persistent severe bradycardia and sustained tachycardia may cause fetal hydrops, preterm delivery, and higher perinatal morbidity and mortality. Hence, the diagnosis of these arrhythmias during the routine obstetric ultrasound, before the progression to hydrops, is crucial and represents a challenge that involves a team of specialists and subspecialists on fetal ultrasonography. The images in this review highlight normal cardiac rhythms as well as pathologic cases consistent with premature atrial and ventricular contractions, heart block, supraventricular tachycardia (VT), atrial flutter, and VT. In this review, the details of a variety of arrhythmias in fetuses were provided by M-mode and Doppler ultrasound/echocardiography with high-quality imaging, enhancing diagnostic accuracy. Moreover, an update on the intrauterine management and treatment of many arrhythmias is provided, focusing on improving outcomes to enable planned delivery and perinatal management.
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Affiliation(s)
| | - Luciane Alves Rocha
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
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Avitan T, Sanders A, Brain U, Rurak D, Oberlander TF, Lim K. Variations from morning to afternoon of middle cerebral and umbilical artery blood flow, and fetal heart rate variability, and fetal characteristics in the normally developing fetus. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:235-240. [PMID: 29235099 DOI: 10.1002/jcu.22569] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/08/2017] [Accepted: 11/19/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine if there are changes in maternal uterine blood flow, fetal brain blood flow, fetal heart rate variability, and umbilical blood flow between morning (AM) and afternoon (PM) in healthy, uncomplicated pregnancies. STUDY DESIGN In this prospective study, 68 uncomplicated singleton pregnancies (mean 35 + 0.7 weeks gestation) underwent a standard observational protocol at both 08:00 (AM) and 13:30 (PM) of the same day. This protocol included Doppler measurements of uterine, umbilical, and fetal middle cerebral artery (MCA) volume flow parameters (flow, HR, peak systolic velocity [PSV], PI, and RI) followed by computerized cardiotocography. Standard descriptive statistics, χ2 and t tests were used where appropriate. P < .05 was considered significant. RESULTS A significant increase in MCA flow and MCA PSV was observed in the PM compared to the AM. This was accompanied by a fall in MCA resistance. Higher umbilical artery resistance indices were also observed in the PM compared to AM. In contrast, fetal heart rate characteristics, maternal uterine artery Doppler flow and resistance indices did not vary significantly between the AM and PM. CONCLUSION In normal pregnancies, variations in fetal cerebral and umbilical blood flow parameters were observed between AM and PM independent of other fetal movements or baseline fetal heart rate. In contrast, uterine flow parameters remained stable across the day. These findings may have implications for the use of serial Doppler parameters used to guide clinical management in high-risk pregnancies.
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Affiliation(s)
- Tehila Avitan
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia
| | - Ari Sanders
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia
| | - Ursula Brain
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Dan Rurak
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Tim F Oberlander
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia
| | - Ken Lim
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia
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Kapaya H, Jacques R, Anumba D. Comparison of diurnal variations, gestational age and gender related differences in fetal heart rate (FHR) parameters between appropriate-for-gestational-age (AGA) and small-for-gestational-age (SGA) fetuses in the home environment. PLoS One 2018. [PMID: 29522541 PMCID: PMC5844551 DOI: 10.1371/journal.pone.0193908] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective To assess the influence of gender, time of the day and gestational age on fetal heart rate (FHR) parameters between appropriate-for-gestational-age (AGA) and small-for-gestational age (SGA) fetuses using a portable fetal ECG monitor employed in the home setting. Methods We analysed and compared the antenatal FHR data collected in the home setting on 61 healthy pregnant women with singleton pregnancies from 24 weeks gestation. Of the 61 women, 31 had SGA fetuses (estimated fetal weight below the tenth gestational centile) and 30 were pregnant with AGA fetuses. FHR recordings were collected for up to 20 h. Two 90 min intervals were deliberately chosen retrospectively with respect to signal recording quality, one during day-time and one at night-time for comparison. Results Overall, success rate of the fetal abdominal ECG in the AGA fetuses was 75.7% compared to 48.6% in the SGA group. Based on randomly selected episodes of heart rate traces where recording quality exceeded 80% we were able to show a marginal difference between day and night-time recordings in AGA vs. SGA fetuses beyond 32 weeks of gestation. A selection bias in terms of covering different representation periods of fetal behavioural states cannot be excluded. In contrast to previous studies, we neither controlled maternal diet and activity nor measured maternal blood hormone and heart rate as all mothers were monitored in the home environment. Conclusion Based on clinically unremarkable, but statistically significant differences in the FHR parameters between the AGA and SGA group we suggest that further studies with large sample size are required to assess the clinical value of antenatal fetal ECG monitoring.
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Affiliation(s)
- Habiba Kapaya
- Department of Oncology and Metabolism, Academic Unit of Reproductive & Developmental Medicine, The University of Sheffield, Sheffield, United Kingdom
- * E-mail:
| | - Richard Jacques
- Medical Statistics Group, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Dilly Anumba
- Department of Oncology and Metabolism, Academic Unit of Reproductive & Developmental Medicine, The University of Sheffield, Sheffield, United Kingdom
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Gonçalves H, Amorim-Costa C, Ayres-de-Campos D, Bernardes J. Evolution of linear and nonlinear fetal heart rate indices throughout pregnancy in appropriate, small for gestational age and preterm fetuses: A cohort study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 153:191-199. [PMID: 29157452 DOI: 10.1016/j.cmpb.2017.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 09/19/2017] [Accepted: 10/12/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVES To assess the evolution of linear and nonlinear fetal heart rate (FHR) analysis throughout pregnancy in appropriate (AGA), small for gestational age (SGA) and preterm (PTB) fetuses. METHODS A prospective cohort study was carried out in 171 singleton pregnancies divided in three groups: AGA (n = 147), SGA (n = 13) fetuses and spontaneous PTB (n = 11). FHR was recorded with an external sensor from the 24th to the 40th week of gestation. Linear time- and frequency-domain and nonlinear FHR indices were computed on 10-min segments. Longitudinal analysis of indices throughout pregnancy was performed with generalized estimating equations, and receiver operating characteristic (ROC) curves were calculated for the prediction of SGA and PTB fetuses. RESULTS Increasing gestational age significantly affected most FHR indices, with a general increase in variability and entropy indices, and a decrease in mean FHR. The PTB group exhibited a significantly lower short-term variation, and no monotonic increase in the sympatho-vagal balance as observed in the AGA group. The SGA group exhibited higher long-term irregularity and lower short-term irregularity than the AGA group throughout gestation. In prediction of SGA and PTB, the largest areas under the ROC curves obtained were 0.76 and 0.78, respectively. CONCLUSIONS Linear and nonlinear FHR analysis provides useful information on the evolution of fetal autonomic nervous and complexity control systems throughout pregnancy, in relation with AGA, SGA and PTB fetuses, which may be helpful in clinical practice.
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Affiliation(s)
- Hernâni Gonçalves
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Portugal.
| | - Célia Amorim-Costa
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Portugal; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Portugal
| | - Diogo Ayres-de-Campos
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Portugal; Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal; INEB - Institute of Biomedical Engineering, I3S - Institute for Research and Innovation in Health, University of Porto, Portugal
| | - João Bernardes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Portugal; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Portugal; Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal; Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Portugal
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Gonçalves H, Amorim-Costa C, Ayres-de-Campos D, Bernardes J. Gender-specific evolution of fetal heart rate variability throughout gestation: A study of 8823 cases. Early Hum Dev 2017; 115:38-45. [PMID: 28889037 DOI: 10.1016/j.earlhumdev.2017.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/29/2017] [Accepted: 09/05/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fetal heart rate (FHR) variability throughout gestation reflects aspects of fetal development, and its analysis has been used for the assessment of fetal well-being. AIM The objective of this study was to provide a gender-specific analysis of the evolution of FHR variability indices throughout gestation, using linear time-domain, spectral and nonlinear FHR indices. STUDY DESIGN A large retrospective study was carried out using antepartum FHR recordings obtained from 4713 male and 4110 female fetuses, with normal pregnancy outcome, between 2004 and 2013, with gestational ages ranging between 25 and 40weeks. OUTCOME MEASURES FHR variability was analysed through linear time-domain methods, as well as using spectral analysis and entropy indices. Evolution of FHR indices throughout gestation was analysed through Spearman correlation coefficient. Comparison between male and female fetuses was performed using nonparametric bootstrap 95% confidence intervals for the median. RESULTS Mean FHR decreased significantly throughout gestation, whereas most variability indices increased. Sympatho-vagal balance measured by spectral analysis exhibited two local maxima at 29-30 and 34-35weeks and decreased afterwards. Entropy indices increased until around the 34th week, slightly decreasing after the 37th week. Female fetuses presented higher mean FHR and entropy from the 34th week afterwards, and lower short-term variability and sympatho-vagal balance in the same period. CONCLUSIONS Spectral and entropy analysis should be considered as a complement to conventional FHR variability analysis, aiming at a better characterization and follow-up of fetal development/maturation throughout gestation. Additionally, gestational age needs to be considered when defining reference ranges for FHR indices in systems of computerized analysis.
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Affiliation(s)
- Hernâni Gonçalves
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Portugal.
| | - Célia Amorim-Costa
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Portugal; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Portugal; INEB - Institute of Biomedical Engineering, I3S - Institute for Research and Innovation in Health, University of Porto, Portugal
| | - Diogo Ayres-de-Campos
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Portugal; INEB - Institute of Biomedical Engineering, I3S - Institute for Research and Innovation in Health, University of Porto, Portugal; Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal
| | - João Bernardes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Portugal; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Porto, Portugal; Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal; Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Portugal
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Kehl S, Dötsch J, Hecher K, Schlembach D, Schmitz D, Stepan H, Gembruch U. Intrauterine Growth Restriction. Guideline of the German Society of Gynecology and Obstetrics (S2k-Level, AWMF Registry No. 015/080, October 2016). Geburtshilfe Frauenheilkd 2017; 77:1157-1173. [PMID: 29375144 PMCID: PMC5784232 DOI: 10.1055/s-0043-118908] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 08/19/2017] [Accepted: 08/25/2017] [Indexed: 12/12/2022] Open
Abstract
AIMS The aim of this official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG) was to provide consensus-based recommendations obtained by evaluating the relevant literature for the diagnostic treatment and management of women with fetal growth restriction. METHODS This S2k guideline represents the structured consensus of a representative panel of experts with a range of different professional backgrounds commissioned by the Guideline Committee of the DGGG. RECOMMENDATIONS Recommendations for diagnostic treatment, management, counselling, prophylaxis and screening are presented.
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Affiliation(s)
- Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jörg Dötsch
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Köln, Köln, Germany
| | - Kurt Hecher
- Klinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Dagmar Schmitz
- Institut für Geschichte, Theorie und Ethik der Medizin, Uniklinik RWTH Aachen, Aachen, Germany
| | - Holger Stepan
- Abteilung für Geburtsmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Ulrich Gembruch
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn, Bonn, Germany
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Visser GHA, Bilardo CM, Derks JB, Ferrazzi E, Fratelli N, Frusca T, Ganzevoort W, Lees CC, Napolitano R, Todros T, Wolf H, Hecher K. Fetal monitoring indications for delivery and 2-year outcome in 310 infants with fetal growth restriction delivered before 32 weeks' gestation in the TRUFFLE study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:347-352. [PMID: 27854382 DOI: 10.1002/uog.17361] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 10/17/2016] [Accepted: 11/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE In the TRUFFLE (Trial of Randomized Umbilical and Fetal Flow in Europe) study on the outcome of early fetal growth restriction, women were allocated to one of three groups of indication for delivery according to the following monitoring strategies: (1) reduced fetal heart rate (FHR) short-term variation (STV) on cardiotocography (CTG); (2) early changes in fetal ductus venosus (DV) waveform (DV-p95); and (3) late changes in fetal DV waveform (DV-no-A). However, many infants per monitoring protocol were delivered because of safety-net criteria, for maternal or other fetal indications, or after 32 weeks of gestation when the protocol was no longer applied. The objective of the present posthoc subanalysis was to investigate the indications for delivery in relation to 2-year outcome in infants delivered before 32 weeks to further refine management proposals. METHODS We included all 310 cases of the TRUFFLE study with known outcome at 2 years' corrected age and seven fetal deaths, excluding seven cases with inevitable perinatal death. Data were analyzed according to the allocated fetal monitoring strategy in combination with the indication for delivery. RESULTS Overall, only 32% of liveborn infants were delivered according to the specified monitoring parameter for indication for delivery; 38% were delivered because of safety-net criteria, 15% for other fetal reasons and 15% for maternal reasons. In the CTG-STV group, 51% of infants were delivered because of reduced STV. In the DV-p95 group, 34% of infants were delivered because of abnormal DV and, in the DV-no-A group, only 10% of infants were delivered accordingly. The majority of infants in the DV groups were delivered for the safety-net criterion of spontaneous decelerations in FHR. Two-year intact survival was highest in the DV groups combined compared with the CTG-STV group (P = 0.05 for live births only, P = 0.21 including fetal death), with no difference between DV groups. A poorer outcome in the CTG-STV group was restricted to infants delivered because of FHR decelerations in the safety-net subgroup. Infants delivered because of maternal reasons had the highest birth weight and a non-significantly higher intact survival. CONCLUSIONS In this subanalysis of infants delivered before 32 weeks, the majority were delivered for reasons other than the allocated monitoring strategy indication. Since, in the DV group, CTG-STV criteria were used as a safety net but in the CTG-STV group, no DV safety-net criteria were applied, we speculate that the slightly poorer outcome in the CTG-STV group might be explained by the absence of DV data. The optimal timing of delivery of fetuses with early intrauterine growth restriction may therefore be best determined by monitoring them longitudinally, with both DV and CTG monitoring. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- G H A Visser
- Department of Perinatology, University Medical Center, Utrecht, The Netherlands
| | - C M Bilardo
- Department of Obstetrics and Gynaecology, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - J B Derks
- Department of Perinatology, University Medical Center, Utrecht, The Netherlands
| | - E Ferrazzi
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - N Fratelli
- Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - T Frusca
- Department of Obstetrics and Gynecology, University Hospital, Parma, Italy
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - C C Lees
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - R Napolitano
- Department of Gynecology and Obstetrics, University Federico II of Naples, Naples, Italy
| | - T Todros
- Department of Obstetrics and Gynecology, Sant' Anna Hospital, Turin, Italy
| | - H Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Amorim-Costa C, Gaio AR, Ayres-de-Campos D, Bernardes J. Longitudinal changes of cardiotocographic parameters throughout pregnancy: a prospective cohort study comparing small-for-gestational-age and normal fetuses from 24 to 40 weeks. J Perinat Med 2017; 45:493-501. [PMID: 27474837 DOI: 10.1515/jpm-2016-0065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/03/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare longitudinal trends of cardiotocographic (CTG) parameters between small-for-gestational-age (SGA) and normal fetuses, from 24 to 41 weeks of pregnancy. METHODS A prospective cohort study was carried out in singleton pregnancies without fetal malformations. At least one CTG was performed in each of the following intervals: 24-26 weeks+6 days, 27-29 weeks+6 days, 30-32 weeks+6 days, 33-35 weeks+6 days, 36-38 weeks+6 days and ≥39 weeks. Tracings were analyzed using the Omniview-SisPorto® 3.6 system. Cases with a normal pregnancy outcome, including a birthweight ≥10th percentile for gestational age, were compared with two groups of SGA fetuses: with birthweight <10th percentile (SGA<p10) and <3rd percentile (SGA<p3; a subgroup of the latter). Generalized linear mixed-effects models were used for analysis. RESULTS A total of 176 fetuses (31 SGA) and 1256 tracings (207 from SGA fetuses) were evaluated. All CTG parameters changed significantly throughout pregnancy in the three groups, with a decreasing baseline and probability of decelerations, and an increasing average long-term variability (LTV), average short-term variability (STV) and accelerations. Baseline showed a more pronounced decrease (steeper slope) in SGA fetuses, being higher in these cases at earlier gestational ages and lower later in pregnancy. Average LTV was significantly lower in SGA<p3 fetuses, but a parallel increase occurred in all groups. There was a considerable inter-fetal variability within each group. CONCLUSION A unique characterization of CTG trends throughout gestation in SGA fetuses was provided. A steeper descent of the baseline was reported for the first time. The findings raise the possibility of clinical application of computerized CTG analysis in screening and management of fetal growth restriction.
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Marzbanrad F, Khandoker AH, Kimura Y, Palaniswami M, Clifford GD. Assessment of Fetal Development Using Cardiac Valve Intervals. Front Physiol 2017; 8:313. [PMID: 28567021 PMCID: PMC5434138 DOI: 10.3389/fphys.2017.00313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 05/01/2017] [Indexed: 11/28/2022] Open
Abstract
An automated method to assess the fetal physiological development is introduced which uses the component intervals between fetal cardiac valve timings and the Q-wave of fetal electrocardiogram (fECG). These intervals were estimated automatically from one-dimensional Doppler Ultrasound and noninvasive fECG. We hypothesize that the fetal growth can be estimated by the cardiac valve intervals. This hypothesis was evaluated by modeling the fetal development using the cardiac intervals and validating against the gold standard gestational age identified by Crown-Rump Length (CRL). Among the intervals, electromechanical delay time, isovolumic contraction time, ventricular filling time and their interactions were selected in a stepwise regression process that used gestational age as the target in a cohort of 57 fetuses. Compared with the gold standard age, the newly proposed regression model resulted in a mean absolute error of 3.8 weeks for all recordings and 2.7 weeks after excluding the low quality recordings. Since Fetal Heart Rate Variability (FHRV) has been proposed in the literature for assessing the fetal development, we compared the performance of gestational age estimation by our new valve-interval based method, vs. FHRV, while assuming the CRL as the gold standard. The valve interval-based method outperformed both the model based on FHRV. Results of evaluation for 30 abnormal cases showed that the new method is less affected by arrhythmias such as tachycardia and bradycardia compared to FHRV, however certain types of heart anomalies cause large errors (more than 10 weeks) with respect to the CRL-based gold standard age. Therefore, discrepancies between the regression based estimation and CRL age estimation could indicate the abnormalities. The cardiac valve intervals have been known to reflect the autonomic function. Therefore the new method potentially provides a novel approach for assessing the development of fetal autonomic nervous system, which may be growth curve independent.
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Affiliation(s)
- Faezeh Marzbanrad
- Department of Electrical and Computer Systems Engineering, Monash UniversityClayton, VIC, Australia
| | - Ahsan H Khandoker
- Electrical and Electronic Engineering Department, University of MelbourneMelbourne, VIC, Australia.,Biomedical Engineering Department, Khalifa University of Science, Technology and ResearchAbu Dhabi, United Arab Emirates
| | | | - Marimuthu Palaniswami
- Electrical and Electronic Engineering Department, University of MelbourneMelbourne, VIC, Australia
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory UniversityAtlanta, GA, United States.,Department of Biomedical Engineering, Georgia Institute of TechnologyAtlanta, GA, United States
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Hoyer D, Żebrowski J, Cysarz D, Gonçalves H, Pytlik A, Amorim-Costa C, Bernardes J, Ayres-de-Campos D, Witte OW, Schleußner E, Stroux L, Redman C, Georgieva A, Payne S, Clifford G, Signorini MG, Magenes G, Andreotti F, Malberg H, Zaunseder S, Lakhno I, Schneider U. Monitoring fetal maturation-objectives, techniques and indices of autonomic function. Physiol Meas 2017; 38:R61-R88. [PMID: 28186000 PMCID: PMC5628752 DOI: 10.1088/1361-6579/aa5fca] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Monitoring the fetal behavior does not only have implications for acute care but also for identifying developmental disturbances that burden the entire later life. The concept, of 'fetal programming', also known as 'developmental origins of adult disease hypothesis', e.g. applies for cardiovascular, metabolic, hyperkinetic, cognitive disorders. Since the autonomic nervous system is involved in all of those systems, cardiac autonomic control may provide relevant functional diagnostic and prognostic information. The fetal heart rate patterns (HRP) are one of the few functional signals in the prenatal period that relate to autonomic control and, therefore, is predestinated for its evaluation. The development of sensitive markers of fetal maturation and its disturbances requires the consideration of physiological fundamentals, recording technology and HRP parameters of autonomic control. Based on the ESGCO2016 special session on monitoring the fetal maturation we herein report the most recent results on: (i) functional fetal autonomic brain age score (fABAS), Recurrence Quantitative Analysis and Binary Symbolic Dynamics of complex HRP resolve specific maturation periods, (ii) magnetocardiography (MCG) based fABAS was validated for cardiotocography (CTG), (iii) 30 min recordings are sufficient for obtaining episodes of high variability, important for intrauterine growth restriction (IUGR) detection in handheld Doppler, (iv) novel parameters from PRSA to identify Intra IUGR fetuses, (v) evaluation of fetal electrocardiographic (ECG) recordings, (vi) correlation between maternal and fetal HRV is disturbed in pre-eclampsia. The reported novel developments significantly extend the possibilities for the established CTG methodology. Novel HRP indices improve the accuracy of assessment due to their more appropriate consideration of complex autonomic processes across the recording technologies (CTG, handheld Doppler, MCG, ECG). The ultimate objective is their dissemination into routine practice and studies of fetal developmental disturbances with implications for programming of adult diseases.
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Affiliation(s)
- Dirk Hoyer
- Hans Berger Department of Neurology, Biomagnetic Center, Jena University Hospital, Jena 07747, Germany
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Amorim-Costa C, de Campos DA, Bernardes J. Cardiotocographic parameters in small-for-gestational-age fetuses: How do they vary from normal at different gestational ages? A study of 11687 fetuses from 25 to 40 weeks of pregnancy. J Obstet Gynaecol Res 2017; 43:476-485. [PMID: 28165176 DOI: 10.1111/jog.13235] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/16/2016] [Accepted: 10/07/2016] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to assess how cardiotocographic (CTG) parameters differ between small-for-gestational-age (SGA) and normal fetuses at different gestational ages. METHODS This was a retrospective cross-sectional study using the first antepartum tracing of singleton pregnancies with no malformations. Fetuses with birthweight ≥10th percentile for gestational age and other normal pregnancy outcome criteria (term birth, normal umbilical artery pH and Apgar scores, no intensive care unit admission) were compared with fetuses with birthweight <10th and <3rd percentiles for gestational age (SGA < p10 and SGA < p3, a subgroup of the latter). Each CTG parameter was compared, by gestational age, using both statistical tests and percentile curves derived from normal outcome cases. Tracings were analyzed with the OmniviewSisPorto® 3.7 system. RESULTS A total of 11 687 tracings (from the same number of fetuses) were analyzed: 9701 normal, 1986 SGA < p10, and 543 SGA < p3. SGA fetuses had lower long- and short-term variability, and number of accelerations, with more pronounced differences between around 28 and 35 weeks. In contrast, baseline was lower in SGA fetuses from 34 weeks onwards. All differences were more pronounced for SGA < p3 fetuses. Similar trends throughout gestation occurred in all groups: decrease in baseline, and increase in long- and short-term variability, and accelerations. CONCLUSIONS This study represents an important step for accurate CTG interpretation in SGA fetuses and, consequently, management of fetal growth restriction (FGR), as it contributes to differentiate between maturational CTG changes that occur physiologically throughout pregnancy, and possible signs of fetal compromise in FGR.
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Affiliation(s)
- Célia Amorim-Costa
- Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal.,Institute for Research and Innovation in Health (Instituto de Investigação e Inovação em Saúde - I3S) and Institute of Biomedical Engineering (Instituto de Engenharia Biomédica - INEB), University of Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Porto Medical School, University of Porto, Porto, Portugal
| | - Diogo Ayres de Campos
- Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal.,Institute for Research and Innovation in Health (Instituto de Investigação e Inovação em Saúde - I3S) and Institute of Biomedical Engineering (Instituto de Engenharia Biomédica - INEB), University of Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Porto Medical School, University of Porto, Porto, Portugal.,Department of Obstetrics and Gynecology, S. João Hospital, Porto, Portugal
| | - João Bernardes
- Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal.,Institute for Research and Innovation in Health (Instituto de Investigação e Inovação em Saúde - I3S) and Institute of Biomedical Engineering (Instituto de Engenharia Biomédica - INEB), University of Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Porto Medical School, University of Porto, Porto, Portugal.,Department of Obstetrics and Gynecology, S. João Hospital, Porto, Portugal.,Department of Obstetrics and Gynecology, Hospital Pedro Hispano, Matosinhos, Portugal
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Tagliaferri S, Esposito FG, Fagioli R, Di Cresce M, Sacchi L, Signorini MG, Campanile M, Martinelli P, Magenes G. Ethnic analogies and differences in fetal heart rate variability signal: A retrospective study. J Obstet Gynaecol Res 2016; 43:281-290. [PMID: 27987340 DOI: 10.1111/jog.13213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 09/09/2016] [Accepted: 09/23/2016] [Indexed: 11/27/2022]
Abstract
AIM We aimed to analyze computerized cardiotocographic (cCTG) parameters (including fetal heart rate baseline, short-term variability, Delta, long-term irregularity [LTI], interval index [II], low frequency [LF], movement frequency [MF], high frequency [HF], and approximate entropy [ApEn]) in physiological term pregnancies in order to correlate them with ethnic differences. The clinical meaning of numerical parameters may explain physiological or paraphysiological phenomena that occur in fetuses of different ethnic origins. METHODS A total of 696 pregnant women, including 384 from Europe, 246 from sub-Saharan Africa, 45 from South-East Asia, and 21 from South America, were monitored from the 37th to the 41st week of gestation. Statistical analysis was performed with the analysis of variance test, Pearson correlation test and receiver-operator curves (P < 0.05). RESULTS Our results showed statistically significant differences (P < 0.05) between white and black women for Delta, LTI, LF, MF, HF, and ApEn; between white and Asian women for Delta, LTI, MF, and the LF/(HF + MF) ratio; and between white and Latina women for Delta, LTI, and ApEn. In particular, Delta and LTI performed better in the white group than in the black, Asian, and Latina groups. Instead, LF, MF, HF, and ApEn performed better in the black than in the white group. CONCLUSION Our results confirmed the integrity and normal functionality of both central and autonomic nervous system components for all fetuses investigated. Therefore, CTG monitoring should include both linear and nonlinear components of fetal heart rate variability in order to avoid misinterpretations of the CTG trace among ethnic groups.
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Affiliation(s)
- Salvatore Tagliaferri
- Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples
| | - Francesca Giovanna Esposito
- Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples
| | - Rosa Fagioli
- Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples
| | - Marco Di Cresce
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia
| | - Lucia Sacchi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia
| | | | - Marta Campanile
- Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples
| | - Pasquale Martinelli
- Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples
| | - Giovanni Magenes
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia
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Giuliano N, Annunziata ML, Esposito FG, Tagliaferri S, Di Lieto A, Magenes G, Signorini MG, Campanile M, Arduini D. Computerised analysis of antepartum foetal heart parameters: New reference ranges. J OBSTET GYNAECOL 2016; 37:296-304. [PMID: 27923290 DOI: 10.1080/01443615.2016.1239069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We selected 4012 cCTG records (one trace for each patient) performed in healthy pregnancies from 30th to 42nd gestational week using foetal heart rate (FHR), short-term variability (STV), long-term irregularity (LTI), Delta, approximate entropy (ApEn), spectral components as low frequency (LF), median frequency (MF), high frequency (HF) and LF/(HF + MF) ratio were analysed. Reference nomograms were created and sensitivity and specificity for the prediction of foetal compromise were calculated which were 90% and 89%, respectively. Changes of cCTG parameters according to gestational week were evaluated: FHR (r = -.65) and LF (r = -.87) showed a statistically significant reduction (p < .05) with gestational age. STV (r = .59), LTI (r = .69), Delta (r = .67), and MF (r = .88) showed a statistically significant increase (p < .05) with gestational age. In contrast, for ApEn (r = -.098), HF (r = .14) and LF/(HF + MF) ratio (r = -.47) a non-statistically significant change was found (p > .05). The identification of reference ranges for cCTG indexes in according to gestational age could provide a more objective examination of cCTG trace.
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Affiliation(s)
- Natascia Giuliano
- a Department of Obstetrical-Gynaecological, Urological Science and Reproductive Medicine , Federico II University , Naples , Italy
| | - Maria Laura Annunziata
- a Department of Obstetrical-Gynaecological, Urological Science and Reproductive Medicine , Federico II University , Naples , Italy
| | - Francesca Giovanna Esposito
- a Department of Obstetrical-Gynaecological, Urological Science and Reproductive Medicine , Federico II University , Naples , Italy
| | - Salvatore Tagliaferri
- a Department of Obstetrical-Gynaecological, Urological Science and Reproductive Medicine , Federico II University , Naples , Italy
| | - Andrea Di Lieto
- a Department of Obstetrical-Gynaecological, Urological Science and Reproductive Medicine , Federico II University , Naples , Italy
| | - Giovanni Magenes
- b Department of Electrical, Computer and Biomedical Engineering , University of Pavia , Pavia , Italy
| | | | - Marta Campanile
- a Department of Obstetrical-Gynaecological, Urological Science and Reproductive Medicine , Federico II University , Naples , Italy
| | - Domenico Arduini
- d Department of Obstetrics and Gynaecology , Foetal Medicine Centre, University of Rome "Tor Vergata" , Rome , Italy
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Li G, Zhang S, Yang L, Li S, Wang Y, Hao D, Yang Y, Li X, Zhang L, Xu M. Computerized analysis of acceleration parameter for the non-stress test normal and potentially abnormal fetuses. Comput Assist Surg (Abingdon) 2016. [DOI: 10.1080/24699322.2016.1240293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Guangfei Li
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, PR China
| | - Song Zhang
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, PR China
| | - Lin Yang
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, PR China
| | - Shufang Li
- Obstetrics and Gynecology, Peking University Third Hospital, Beijing, PR China
| | - Yan Wang
- Obstetrics and Gynecology, Peking University Third Hospital, Beijing, PR China
| | - Dongmei Hao
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, PR China
| | - Yimin Yang
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, PR China
| | - Xuwen Li
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, PR China
| | - Lei Zhang
- Beijing Yes Medical Devices Co., Ltd, Beijing, PR China
| | - Mingzhou Xu
- Beijing Aerospace Changfeng Co., Ltd, Beijing, PR China
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36
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Wacker-Gussmann A, Wakai RT, Strasburger JF. Importance of Fetal Arrhythmias to the Neonatologist and Pediatrician. Neoreviews 2016; 17:e568-e578. [PMID: 28042286 PMCID: PMC5193162 DOI: 10.1542/neo.17-10-e568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Sudden, unexplained death during the perinatal period remains a major, longstanding challenge. Recent advances in diagnostic techniques and genetic testing has provided evidence that a significant fraction of these deaths may result from lethal cardiac arrhythmias. In this paper, we review current methods of diagnosing arrhythmia in the fetus and strategies for management of life-threatening arrhythmia throughout the perinatal period, including transitional care at the time of delivery.
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Affiliation(s)
- Annette Wacker-Gussmann
- Institute of Preventive Pediatrics, Faculty of Sport and Health Sciences, and German Heart Center, Department of Pediatric Cardiology and Congenital Heart Defects, Munich, Germany
| | - Ronald T Wakai
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - Janette F Strasburger
- Department of Pediatrics, Division of Cardiology, Children's Hospital of Wisconsin- Milwaukee and Fox Valley, 9000 W Wisconsin Avenue, Milwaukee, Wisconsin 53226, USA
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37
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Seliger G, Stenzel A, Kowalski EM, Hoyer D, Nowack S, Seeger S, Schneider U. Evaluation of standardized, computerized Dawes/Redman heart-rate analysis based on different recording methods and in relation to fetal beat-to-beat heart rate variability. J Perinat Med 2016; 44:785-792. [PMID: 26584353 DOI: 10.1515/jpm-2015-0169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 10/23/2015] [Indexed: 11/15/2022]
Abstract
Dawes and Redman (DR) based their definition of short-term variation (STV) on the successive differences of mean inter-beat intervals dividing 1 min of cardiotocography recordings in 16 epochs of 3.75 s each. In contrast, heart rate variability (HRV) is based on the inter-beat intervals of discrete R peaks, also referred to as normal-to-normal (NN) intervals. Despite the historical achievements of DR in providing a robust method with the equipment available at the time to encourage the widespread use and creation of large databases, one must ask whether the STV (DR) parameter is reproducible using a different method of recording, and how much temporal information is actually lost by applying the averaging algorithm sketched above. We simultaneously performed both standard Oxford cardiotocography and transabdominal fetal electrocardiography recordings in 26 patients with low-risk singletons. In addition, we revisited our database of 418 standard fetal magnetocardiographic recordings, applying the DR algorithm to the fetal NN data and compared them to standard HRV parameters. The correlation between STV (DR) from cardiotocography and fetal electrocardiography was stronger that of either with short term fHRV from NN intervals. The methodological trade-off to gain STV as a robust parameter from heart rate traces of limited temporal resolution is accompanied by a loss of temporal information that, at the moment, only fetal magnetocardiography and, to a lesser extent, fetal electrocardiography may provide.
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Amorim-Costa C, Costa-Santos C, Ayres-de-Campos D, Bernardes J. Longitudinal evaluation of computerized cardiotocographic parameters throughout pregnancy in normal fetuses: a prospective cohort study. Acta Obstet Gynecol Scand 2016; 95:1143-52. [PMID: 27238561 DOI: 10.1111/aogs.12932] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/26/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The longitudinal cardiotocographic (CTG) changes throughout pregnancy in normal fetuses have never been fully described. We aimed at characterizing the evolution of CTG parameters in healthy fetuses, from 24 to 41 weeks of gestation. MATERIAL AND METHODS A prospective cohort study was conducted in singleton fetuses without structural abnormalities on second-trimester ultrasound. At least one CTG was performed in each of the following intervals: 24-26 weeks(+6d) , 27-29 weeks(+6d) , 30-32 weeks(+6d) , 33-35 weeks(+6d) , 36-38 weeks(+6d) and ≥39 weeks; tracings were analyzed by the OMNIVIEW-SISPORTO 3.6 system. Cases of preterm delivery, fetal death, birthweight under the 10th percentile, low five-minute Apgar, umbilical artery acidemia or neonatal intensive care unit admission were subsequently excluded. RESULTS A total of 1049 eligible tracings were obtained from 145 fetuses. There was a significant increase over time in average long-term variability (LTV), average short-term variability (STV), number of accelerations and uterine contractions. Conversely, fetal heart rate (FHR) baseline and number of decelerations decreased. A high inter-fetal variability was observed, but there was considerable intra-fetal consistency. Fetuses showing a marked decrease in FHR baseline and those with a marked increase in average LTV had a significantly lower birthweight. Cesarean section rate was significantly higher in cases with a decrease in average STV throughout gestation. CONCLUSIONS This prospective longitudinal study shows an evolution in computerized CTG parameters during pregnancy, indicating the need to adapt interpretation criteria based on gestational age. The high inter-fetal variability and considerable intra-fetal consistency suggests the possible value of using each fetus as its own reference in serial assessments.
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Affiliation(s)
- Célia Amorim-Costa
- Department of Obstetrics and Gynecology, Porto Medical School, University of Porto, Porto, Portugal. .,Institute for Research and Innovation in Health (I3S) and Institute of Biomedical Engineering (INEB), University of Porto, Porto, Portugal. .,Center for Research in Health Technologies and Information Systems (CINTESIS), Porto Medical School, University of Porto, Porto, Portugal.
| | - Cristina Costa-Santos
- Center for Research in Health Technologies and Information Systems (CINTESIS), Porto Medical School, University of Porto, Porto, Portugal.,Department of Health Information and Decision Sciences, Porto Medical School, University of Porto, Porto, Portugal
| | - Diogo Ayres-de-Campos
- Department of Obstetrics and Gynecology, Porto Medical School, University of Porto, Porto, Portugal.,Institute for Research and Innovation in Health (I3S) and Institute of Biomedical Engineering (INEB), University of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Porto Medical School, University of Porto, Porto, Portugal.,Department of Obstetrics and Gynecology, S. João Hospital, Porto, Portugal
| | - João Bernardes
- Department of Obstetrics and Gynecology, Porto Medical School, University of Porto, Porto, Portugal.,Institute for Research and Innovation in Health (I3S) and Institute of Biomedical Engineering (INEB), University of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Porto Medical School, University of Porto, Porto, Portugal.,Department of Obstetrics and Gynecology, S. João Hospital, Porto, Portugal.,Department of Obstetrics and Gynecology, Hospital Pedro Hispano, Matosinhos, Portugal
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Andrade WS, Brizot MDL, Miyadahira S, Osmundo Junior GDS, Francisco RP, Zugaib M. Fetal gastroschisis: antepartum fetal heart rate analysis by computerized cardiotocography. J Matern Fetal Neonatal Med 2016; 30:605-611. [DOI: 10.1080/14767058.2016.1181166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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40
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Li G, Zhang S, Yang L, Li S, Wang Y, Hao D, Yang Y, Li X, Zhang L, Xu M. Influence of gestational age and time of day in baseline and heart rate variation of fetuses. Technol Health Care 2016; 24 Suppl 2:S471-6. [PMID: 27163306 DOI: 10.3233/thc-161170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Fetal electrocardiography (FECG) places electrodes on the maternal abdomen to convert the fetal electrocardiosignals into fetal heart rate (FHR), improving the accuracy and comfort of pregnant woman. At the same time, FECG simplifies the procedure of long term monitoring in the perinatal period. OBJECTIVE Investigating the influence of gestational age and time of day on FHR features to distinguish between non-stress test (NST) normal fetuses and NST suspicious fetuses. METHODS A novel method of FHR baseline estimation was presented; then baseline value and fetal heart rate variation (FHRV) were analyzed in the time domain using FHR signals recorded from 52 fetuses. RESULTS Baseline values in 1:00, 2:00, 4:00, 5:00 and heart rate variation (HRV) distribution showed a significant difference (p< 0.05) between NST normal fetuses and NST suspicious fetuses. CONCLUSIONS The results suggest that NST normal and suspicious fetuses had same outcome and different FHR features. Accurately distinguishing normal fetuses and suspicious fetuses is important for lowering the false positive rate and reducing unnecessary clinical intervention.
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Affiliation(s)
- Guangfei Li
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, China
| | - Song Zhang
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, China
| | - Lin Yang
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, China
| | - Shufang Li
- Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Yan Wang
- Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Dongmei Hao
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, China
| | - Yimin Yang
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, China
| | - Xuwen Li
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, China
| | - Lei Zhang
- Beijing Yes Medical Devices Co., Ltd., Beijing, China
| | - Mingzhou Xu
- Beijing Aerospace ChangFeng Co., Ltd., Beijing, China
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Amorim-Costa C, Cruz J, Ayres-de-Campos D, Bernardes J. Gender-specific reference charts for cardiotocographic parameters throughout normal pregnancy: a retrospective cross-sectional study of 9701 fetuses. Eur J Obstet Gynecol Reprod Biol 2016; 199:102-7. [DOI: 10.1016/j.ejogrb.2016.01.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/29/2016] [Indexed: 11/15/2022]
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Kapaya H, Jacques R, Rahaim N, Anumba D. "Does short-term variation in fetal heart rate predict fetal acidaemia?" A systematic review and meta-analysis. J Matern Fetal Neonatal Med 2016; 29:4070-7. [PMID: 26902464 DOI: 10.3109/14767058.2016.1156670] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the association of short-term variation (STV) of the fetal heart rate in predicting fetal acidaemia at birth. METHODS The search strategy employed searching of electronic databases (MEDLINE, Web of Science, Scopus, and Google Scholar) and reference lists of relevant studies. Data were extracted from studies, adhering strictly to the following criteria: singleton pregnancy at ≥24 weeks' gestation, computerized CTG (index test) and calculation of STV before delivery. The outcome measure was arterial pH assessed in cord blood obtained at birth. RESULTS Meta-analysis showed moderate accuracy of STV in predicting fetal acidaemia with a sensitivity of 0.57 (95% CI: 0.45-0.68), specificity of 0.81 (95% CI: 0.69-0.89), positive likelihood ratio of 3.14 (95% CI: 2.13-4.63) and negative likelihood ratio of 0.58, (95% CI: 0.46-0.72). However, in intra-uterine growth restricted fetuses, a small improvement in detecting acidaemia was observed; with a sensitivity of 0.63 (95% CI: 0.49-0.75) and negative likelihood ratio of 0.50 (95% CI: 0.31-0.80). CONCLUSION STV appears to be a moderate predictor for fetal acidaemia. However, its usefulness as a stand-alone test in predicting acidaemia in clinical setting remains to be determined.
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Affiliation(s)
- Habiba Kapaya
- a Department of Human Metabolism , Academic Unit of Reproductive & Developmental Medicine , Sheffield , UK
| | - Richard Jacques
- b School of Health and Related Research (ScHARR), University of Sheffield , Sheffield , UK
| | - Nadia Rahaim
- a Department of Human Metabolism , Academic Unit of Reproductive & Developmental Medicine , Sheffield , UK
| | - Dilly Anumba
- a Department of Human Metabolism , Academic Unit of Reproductive & Developmental Medicine , Sheffield , UK
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Wretler S, Holzmann M, Graner S, Lindqvist P, Falck S, Nordström L. Fetal heart rate monitoring of short term variation (STV): a methodological observational study. BMC Pregnancy Childbirth 2016; 16:55. [PMID: 26984160 PMCID: PMC4794822 DOI: 10.1186/s12884-016-0845-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 03/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiotocography (CTG) has high sensitivity, but less specificity in detection of fetal hypoxia. There is need for adjunctive methods easy to apply during labor. Low fetal heart rate short term variation (STV) is predictive for hypoxia during the antenatal period. The objectives of our study were to methodologically evaluate monitoring of STV during labor and to compare two different monitors (Sonicaid™ and EDAN™) for antenatal use. METHODS A prospective observational study at the obstetric department, Karolinska University hospital, Stockholm (between September 2011 and April 2015). In 100 women of ≥ 36 weeks gestation, STV values were calculated during active labor. In a subset of 20 women we compared STV values between internal and external signal acquisition. Additionally we compared antenatal monitoring with two different monitors in another 20 women. RESULTS Median STV in 100 fetuses monitored with scalp electrode during labor (EDAN™) was 7.1 msec (range 1.3-25.9) with no difference between early (3-6 cm) and late (7-10 cm) labor (7.1 vs 6.8 msec; p = 0.80). STV calculated from scalp electrode signals were positively correlated with delta-STV (STV internal -external) (R = 0.70; p < 0.01). No significant differences were found between Sonicaid™ and EDAN™ in antenatal external monitoring of STV (median difference 0.9 msec, Spearman Rank Correlation Sonicaid vs delta-STV; R = 0.35; p = 0.14). CONCLUSIONS Median intrapartum STV was 7.1 msec. Significant differences were found between internal and external signal acquisition, a finding that suggests further intrapartum studies to be analysed separately depending upon type of signal acquisition. Antenatal external monitoring with Sonicaid™ and EDAN™ indicates that the devices perform equally well in the identification of acidemic fetuses. Further studies are needed to assess the clinical value of intrapartum STV.
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Affiliation(s)
- Stina Wretler
- />Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Malin Holzmann
- />Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Sophie Graner
- />Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden
- />Department of Medicine, Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Pelle Lindqvist
- />Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Susanne Falck
- />Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Lennart Nordström
- />Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden
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44
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Tetschke F, Schneider U, Schleussner E, Witte OW, Hoyer D. Assessment of fetal maturation age by heart rate variability measures using random forest methodology. Comput Biol Med 2016; 70:157-162. [PMID: 26848727 DOI: 10.1016/j.compbiomed.2016.01.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/14/2016] [Accepted: 01/16/2016] [Indexed: 11/17/2022]
Abstract
Fetal maturation age assessment based on heart rate variability (HRV) is a predestinated tool in prenatal diagnosis. To date, almost linear maturation characteristic curves are used in univariate and multivariate models. Models using complex multivariate maturation characteristic curves are pending. To address this problem, we use Random Forest (RF) to assess fetal maturation age and compare RF with linear, multivariate age regression. We include previously developed HRV indices such as traditional time and frequency domain indices and complexity indices of multiple scales. We found that fetal maturation was best assessed by complexity indices of short scales and skewness in state-dependent datasets (quiet sleep, active sleep) as well as in state-independent recordings. Additionally, increasing fluctuation amplitude contributed to the model in the active sleep state. None of the traditional linear HRV parameters contributed to the RF models. Compared to linear, multivariate regression, the mean prediction of gestational age (GA) is more accurate with RF than in linear, multivariate regression (quiet state: R(2)=0,617 vs. R(2)=0,461, active state: R(2)=0,521 vs. R(2)=0,436, state independent: R(2)=0,583 vs. R(2)=0,548). We conclude that classification and regression tree models such as RF methodology are appropriate for the evaluation of fetal maturation age. The decisive role of adjustments between different time scales of complexity may essentially extend previous analysis concepts mainly based on rhythms and univariate complexity indices. Those system characteristics may have implication for better understanding and accessibility of the maturating complex autonomic control and its disturbance.
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Affiliation(s)
- F Tetschke
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany.
| | - U Schneider
- Department of Obstetrics, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - E Schleussner
- Department of Obstetrics, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - O W Witte
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - D Hoyer
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
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Marie C, Sinoquet C, Barasinski C, Lémery D, Vendittelli F. Does maternal race influence the short-term variation of the fetal heart rate? An historical cohort study. Eur J Obstet Gynecol Reprod Biol 2015; 193:102-7. [PMID: 26277781 DOI: 10.1016/j.ejogrb.2015.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/21/2015] [Accepted: 07/23/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The main aim of this article was to analyze short-term variation (STV) of the fetal heart rate according to maternal race. The secondary aim was to study the baseline fetal heart rate according to this factor. STUDY DESIGN This single-center historical cohort study covered the period from November 2008 through December 2011 (n=182). The inclusion criteria were: black women from sub-Saharan Africa or white European women, with a singleton pregnancy ≥34 weeks and fetal heart rate recorded by computerized analysis (Oxford Sonicaid System 8002) at a prenatal visit. The exclusion criteria were: medication likely to modify fetal heart rate, abnormal fetal heart rate tracing, and being in labor. A multiple linear regression analysis was used to study the association between maternal race and STV. RESULTS STV was lower by 2.6ms in fetuses of black women (n=55) compared to those of white women (n=127) (8.9±2.1ms vs. 11.4±3.4ms) (p<0.001). The basal fetal heart rate was higher (p=0.001), and the recording criteria were met less often for the black women (p=0.04). After adjustment for maternal age, body mass index at the beginning of pregnancy, maternal cigarette smoking, parity, gestational diabetes, gestational age at the time of the fetal heart rate recording, and the time between the last meal and the recording, mean STV was lower by 3.1±0.6ms in fetuses of black compared with white women (p<0.001). CONCLUSION STV is lower in fetuses of black women compared to those of white women in a low-risk population. A study of black and white women with high-risk pregnancies is necessary to assess the impact of medical practices on perinatal outcome after STV analysis.
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Affiliation(s)
- Cécile Marie
- Centre Hospitalier Universitaire de Clermont-Ferrand, 58 Rue Montalembert 63000, Clermont-Ferrand Cedex 1 63003, France; Clermont Université, Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), 28 place Henri-Dunant BP 38, 63001 Clermont-Ferrand, France.
| | - Céline Sinoquet
- Centre Hospitalier Universitaire de Clermont-Ferrand, 58 Rue Montalembert 63000, Clermont-Ferrand Cedex 1 63003, France
| | - Chloé Barasinski
- Centre Hospitalier Universitaire de Clermont-Ferrand, 58 Rue Montalembert 63000, Clermont-Ferrand Cedex 1 63003, France; Clermont Université, Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), 28 place Henri-Dunant BP 38, 63001 Clermont-Ferrand, France
| | - Didier Lémery
- Centre Hospitalier Universitaire de Clermont-Ferrand, 58 Rue Montalembert 63000, Clermont-Ferrand Cedex 1 63003, France; Clermont Université, Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), 28 place Henri-Dunant BP 38, 63001 Clermont-Ferrand, France; AUDIPOG (Association des Utilisateurs de Dossiers informatisés en Pédiatrie, Obstétrique et Gynécologie), RTH Laennec Medical University, 7 rue Guillaume Paradin, 69372 Lyon Cedex 08, France
| | - Françoise Vendittelli
- Centre Hospitalier Universitaire de Clermont-Ferrand, 58 Rue Montalembert 63000, Clermont-Ferrand Cedex 1 63003, France; Clermont Université, Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), 28 place Henri-Dunant BP 38, 63001 Clermont-Ferrand, France; AUDIPOG (Association des Utilisateurs de Dossiers informatisés en Pédiatrie, Obstétrique et Gynécologie), RTH Laennec Medical University, 7 rue Guillaume Paradin, 69372 Lyon Cedex 08, France
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46
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Cuneo BF, Strasburger JF. We only find what we look for: fetal heart rate and the diagnosis of long-QT syndrome. Circ Arrhythm Electrophysiol 2015; 8:760-2. [PMID: 26286300 PMCID: PMC4552049 DOI: 10.1161/circep.115.003196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Long QT syndrome (LQTS), an inherited channelopathy, is a common cause of arrhythmic death in infants, children and young adults. Although many LQTS genes have been identified, most (~75%) of LQTS mutations are found in KCNQ1, KCNH2 or SCN5A. In most cases, treatment for LQTS is successful and modifies the risk of life-threatening arrhythmias; thus, making the correct diagnosis is important. The diagnosis of LQTS is made by the measurement of a prolonged QT interval on the standard ECG; family history or characteristic arrhythmia features are used to strengthen the diagnosis and genetic testing confirms the diagnosis.
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Affiliation(s)
- Bettina F Cuneo
- From the Children's Hospital Colorado Heart Institute, Department of Pediatrics, The University of Colorado School of Medicine, Aurora (B.F.C.); and Division of Cardiology, Department of Pediatrics, Children's Hospital of Wisconsin, The Medical College of Wisconsin, Milwaukee (J.F.S.).
| | - Janette F Strasburger
- From the Children's Hospital Colorado Heart Institute, Department of Pediatrics, The University of Colorado School of Medicine, Aurora (B.F.C.); and Division of Cardiology, Department of Pediatrics, Children's Hospital of Wisconsin, The Medical College of Wisconsin, Milwaukee (J.F.S.)
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Lauletta ALF, Nomura RMY, Miyadahira S, Francisco RPV, Zugaib M. Transient accelerations of fetal heart rate analyzed by computerized cardiotocography in the third trimester of pregnancy. Rev Assoc Med Bras (1992) 2015; 60:270-5. [PMID: 25004274 DOI: 10.1590/1806-9282.60.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/30/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the patterns of transient FHR accelerations (10 bpm and 15 bpm) in the third trimester of pregnancy, comparing the occurrence of this event before and after the 32nd gestational week. METHODS This is a prospective study comparing the results of the computerized cardiotocography of 46 low-risk women with singleton pregnancies, maternal age between 18 and 40 years, gestational age between 28 and 40 weeks, absence of maternal morbidity and adequate fetal growth according to ultrasound. Computed Cardiotocography (8002 Sonicaid System and Fetal Care System) was performed for 30 minutes to analyze the variables of FHR. RESULTS Twenty-three pregnant women underwent cardiotocography before 32 weeks (mean = 29.9 weeks, SD = 1.4 weeks) and were compared with 23 pregnant women who were examined after 32 weeks (mean = 36.3 weeks, SD = 2.5 weeks). Regarding the characteristics of FHR, fetuses evaluated between 32 1/7 weeks and 40 weeks showed a significantly greater number of accelerations above 15 bpm (median = 5, variation 0-18) than the group of pregnant women from 28 to 32 weeks (median = 4, variation 0 to 10; P = 0.048). There was a significant positive correlation between the number of accelerations above 15 bpm and the gestational age at examination (rho = 0.33; P = 0.026). CONCLUSION Computerized cardiotocography showed an association regarding the number of transient accelerations greater than 15 bpm in the assessment of both periods before and after 32 weeks of gestational age, suggesting the influence of the maturation of the fetal autonomic nervous system with pregnancy progression.
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Affiliation(s)
| | - Roseli Mieko Yamamoto Nomura
- Division of Obstetrics, Department of Obstetrics and Gynecology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Seizo Miyadahira
- Division of Obstetrics, Department of Obstetrics and Gynecology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - Marcelo Zugaib
- Division of Obstetrics, Department of Obstetrics and Gynecology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Chen CY, Yu C, Chang CC, Lin CW. Comparison of a novel computerized analysis program and visual interpretation of cardiotocography. PLoS One 2014; 9:e112296. [PMID: 25437442 PMCID: PMC4249819 DOI: 10.1371/journal.pone.0112296] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 10/13/2014] [Indexed: 11/20/2022] Open
Abstract
Objective To compare a novel computerized analysis program with visual cardiotocography (CTG) interpretation results. Methods Sixty-two intrapartum CTG tracings with 20- to 30-minute sections were independently interpreted using a novel computerized analysis program, as well as the visual interpretations of eight obstetricians, to evaluate the baseline fetal heart rate (FHR), baseline FHR variability, number of accelerations, number/type of decelerations, uterine contraction (UC) frequency, and the National Institute of Child Health and Human Development (NICHD) 3-Tier FHR classification system. Results There was no significant difference in interobserver variation after adding the components of computerized analysis to results from the obstetricians' visual interpretations, with excellent agreement for the baseline FHR (ICC 0.91), the number of accelerations (ICC 0.85), UC frequency (ICC 0.97), and NICHD category I (kappa statistic 0.91); good agreement for baseline variability (kappa statistic 0.68), the numbers of early decelerations (ICC 0.78) and late decelerations (ICC 0.67), category II (kappa statistic 0.78), and overall categories (kappa statistic 0.80); and moderate agreement for the number of variable decelerations (ICC 0.60), and category III (kappa statistic 0.50). Conclusions This computerized analysis program is not inferior to visual interpretation, may improve interobserver variations, and could play a vital role in prenatal telemedicine.
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Affiliation(s)
- Chen-Yu Chen
- Institute of Biomedical Engineering and College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
- Mackay Medical College, Taipei, Taiwan
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Chun Yu
- Institute of Biomedical Engineering and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Chen Chang
- Institute of Biomedical Engineering and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chii-Wann Lin
- Institute of Biomedical Engineering and College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
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49
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Hoyer D, Kowalski EM, Schmidt A, Tetschke F, Nowack S, Rudolph A, Wallwitz U, Kynass I, Bode F, Tegtmeyer J, Kumm K, Moraru L, Götz T, Haueisen J, Witte OW, Schleußner E, Schneider U. Fetal autonomic brain age scores, segmented heart rate variability analysis, and traditional short term variability. Front Hum Neurosci 2014; 8:948. [PMID: 25505399 PMCID: PMC4243554 DOI: 10.3389/fnhum.2014.00948] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 11/07/2014] [Indexed: 11/13/2022] Open
Abstract
Disturbances of fetal autonomic brain development can be evaluated from fetal heart rate patterns (HRP) reflecting the activity of the autonomic nervous system. Although HRP analysis from cardiotocographic (CTG) recordings is established for fetal surveillance, temporal resolution is low. Fetal magnetocardiography (MCG), however, provides stable continuous recordings at a higher temporal resolution combined with a more precise heart rate variability (HRV) analysis. A direct comparison of CTG and MCG based HRV analysis is pending. The aims of the present study are: (i) to compare the fetal maturation age predicting value of the MCG based fetal Autonomic Brain Age Score (fABAS) approach with that of CTG based Dawes-Redman methodology; and (ii) to elaborate fABAS methodology by segmentation according to fetal behavioral states and HRP. We investigated MCG recordings from 418 normal fetuses, aged between 21 and 40 weeks of gestation. In linear regression models we obtained an age predicting value of CTG compatible short term variability (STV) of R (2) = 0.200 (coefficient of determination) in contrast to MCG/fABAS related multivariate models with R (2) = 0.648 in 30 min recordings, R (2) = 0.610 in active sleep segments of 10 min, and R (2) = 0.626 in quiet sleep segments of 10 min. Additionally segmented analysis under particular exclusion of accelerations (AC) and decelerations (DC) in quiet sleep resulted in a novel multivariate model with R (2) = 0.706. According to our results, fMCG based fABAS may provide a promising tool for the estimation of fetal autonomic brain age. Beside other traditional and novel HRV indices as possible indicators of developmental disturbances, the establishment of a fABAS score normogram may represent a specific reference. The present results are intended to contribute to further exploration and validation using independent data sets and multicenter research structures.
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Affiliation(s)
- Dirk Hoyer
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Eva-Maria Kowalski
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology Ilmenau, Germany
| | - Alexander Schmidt
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Florian Tetschke
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Samuel Nowack
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Anja Rudolph
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Ulrike Wallwitz
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Isabelle Kynass
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Franziska Bode
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Janine Tegtmeyer
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Kathrin Kumm
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Liviu Moraru
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Theresa Götz
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Jens Haueisen
- Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology Ilmenau, Germany
| | - Otto W Witte
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Ekkehard Schleußner
- Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Uwe Schneider
- Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
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50
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Carvalho JS. Primary bradycardia: keys and pitfalls in diagnosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:125-130. [PMID: 25088508 DOI: 10.1002/uog.13451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- J S Carvalho
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK; Fetal Medicine Unit, St George's Hospital, St George's University of London, London, SW17 0QT, UK.
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