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Bester M, Nichting TJ, Joshi R, Aissati L, Oei GS, Mischi M, van Laar JOEH, Vullings R. Changes in Maternal Heart Rate Variability and Photoplethysmography Morphology after Corticosteroid Administration: A Prospective, Observational Study. J Clin Med 2024; 13:2442. [PMID: 38673715 PMCID: PMC11051424 DOI: 10.3390/jcm13082442] [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: 03/23/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Owing to the association between dysfunctional maternal autonomic regulation and pregnancy complications, assessing non-invasive features reflecting autonomic activity-e.g., heart rate variability (HRV) and the morphology of the photoplethysmography (PPG) pulse wave-may aid in tracking maternal health. However, women with early pregnancy complications typically receive medication, such as corticosteroids, and the effect of corticosteroids on maternal HRV and PPG pulse wave morphology is not well-researched. Methods: We performed a prospective, observational study assessing the effect of betamethasone (a commonly used corticosteroid) on non-invasively assessed features of autonomic regulation. Sixty-one women with an indication for betamethasone were enrolled and wore a wrist-worn PPG device for at least four days, from which five-minute measurements were selected for analysis. A baseline measurement was selected either before betamethasone administration or sufficiently thereafter (i.e., three days after the last injection). Furthermore, measurements were selected 24, 48, and 72 h after betamethasone administration. HRV features in the time domain and frequency domain and describing heart rate (HR) complexity were calculated, along with PPG morphology features. These features were compared between the different days. Results: Maternal HR was significantly higher and HRV features linked to parasympathetic activity were significantly lower 24 h after betamethasone administration. Features linked to sympathetic activity remained stable. Furthermore, based on the PPG morphology features, betamethasone appears to have a vasoconstrictive effect. Conclusions: Our results suggest that administering betamethasone affects maternal autonomic regulation and cardiovasculature. Researchers assessing maternal HRV in complicated pregnancies should schedule measurements before or sufficiently after corticosteroid administration.
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Affiliation(s)
- Maretha Bester
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
- Patient Care and Monitoring, Philips Research, 5656 AE Eindhoven, The Netherlands
| | - Thomas J. Nichting
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
- Department of Obstetrics and Gynecology, Máxima Medical Centrum, 5504 DB Veldhoven, The Netherlands
| | - Rohan Joshi
- Patient Care and Monitoring, Philips Research, 5656 AE Eindhoven, The Netherlands
| | - Lamyae Aissati
- Faculty of Health, Medicine and Life Science, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Guid S. Oei
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
- Department of Obstetrics and Gynecology, Máxima Medical Centrum, 5504 DB Veldhoven, The Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | - Judith O. E. H. van Laar
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
- Department of Obstetrics and Gynecology, Máxima Medical Centrum, 5504 DB Veldhoven, The Netherlands
| | - Rik Vullings
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
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Weiss S, Cooper B, Leung C. Exposure to prenatal stressors and infant autonomic nervous system regulation of stress. Stress 2024; 27:2327328. [PMID: 38497496 PMCID: PMC11144651 DOI: 10.1080/10253890.2024.2327328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/02/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVES The purpose of this study was to determine the relationship between fetal exposure to maternal prenatal stressors and infant parasympathetic (PNS) and sympathetic (SNS) nervous function at 3 timepoints across the first year of life. BACKGROUND Autonomic nervous system impairments may mediate associations between gestational exposure to stressors and later infant health problems. Heart rate variability (HRV) provides a sensitive index of PNS and SNS function. However, no studies have assessed longitudinal associations between prenatal stressors and infant HRV measures of both PNS and SNS over the first year of life. METHODS During the third trimester of pregnancy, 233 women completed measures of life stressors and depression. At 1, 6 and 12 months of age, a stressor protocol was administered while infant electrocardiographic (ECG) data were collected from a baseline through a post-stressor period. HRV measures of PNS and SNS activity (HF, LF, LF/HF ratio) were generated from ECG data. We used multilevel regression to examine the aims, adjusting for maternal depression and neonatal morbidity. RESULTS There were no associations between prenatal stressors and any baseline or reactivity HRV metric over the infant's first year of life. However, exposure to more stressors was associated with lower post-stressor LF HRV at both 6 (β = -.44, p = .001) and 12 (β = -.37, p = .005) months of age. CONCLUSIONS Findings suggest potential alterations in development of the vagally mediated baroreflex function as a result of exposure to prenatal stressors, with implications for the infants' ability to generate a resilient recovery in response to stressors.
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Affiliation(s)
- Sandra Weiss
- Department of Community Health Systems, University of California, San Francisco, San Francisco, California, USA
| | - Bruce Cooper
- Department of Community Health Systems, University of California, San Francisco, San Francisco, California, USA
| | - Cherry Leung
- Department of Community Health Systems, University of California, San Francisco, San Francisco, California, USA
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Braun T, Filleböck V, Metze B, Bührer C, Plagemann A, Henrich W. Dosage escalation of antenatal steroids in preterm twin pregnancies does not improve long-term outcome. J Perinat Med 2022; 50:25-33. [PMID: 34252994 DOI: 10.1515/jpm-2020-0575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 06/09/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To analyze long-term effects of antenatal betamethasone (≤16 mg, =24 mg and >24 mg) in preterm twins on infant and childhood morbidity. METHODS Retrospective cohort study among 198 preterm twins. Three follow up time points, including a total of 84 outcomes, were evaluated: first neonatal examination after birth and in the neonatal period up to 10 days after birth using data from the clinic charts; examination from the 21st to the 24th month of life and examination from the 60th to the 64th months, using data from copies of the children's examination booklets sent back by the parents. Dosage-dependent and sex-specific long-term effects of antenatal betamethasone treatment on neonatal, infant and early childhood development and morbidity up to 5.3 years of age were analyzed. RESULTS Dosage escalation of >24 mg was not associated with improved neonatal, infant or early child hood outcome, independent of twin pair structure. In contrast, higher doses >24 mg were significantly linked to increased rates of congenital infections (OR 5.867, 95% CI 1.895-18.167). Male sex as a factor was obvious for lower rates of apnea-bradycardia-syndrome in neonates, higher rates of no free steps after 15 months in infancy and highest rates of motor clumsiness in early childhood. CONCLUSIONS Betamethasone dosage escalation >24 mg in twins born between 23+5 and 33+6 weeks of gestation did not improve neonatal, infant or early childhood morbidity. In contrast, higher doses >24 mg total dose resulted in significantly higher rates of congenital infections and are not recommended. For males, 24 mg betamethasone appears to be the preferable dose.
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Affiliation(s)
- Thorsten Braun
- Department of Obstetrics, Clinic of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Division of Experimental Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Vivien Filleböck
- Department of Obstetrics, Clinic of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Boris Metze
- Clinic of Neonatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christoph Bührer
- Clinic of Neonatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Plagemann
- Division of Experimental Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Clinic of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Early recognition of neonatal sepsis using a bioinformatic vital sign monitoring tool. Pediatr Res 2022; 91:270-272. [PMID: 34716420 DOI: 10.1038/s41390-021-01829-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 12/31/2022]
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Cerritelli F, Frasch MG, Antonelli MC, Viglione C, Vecchi S, Chiera M, Manzotti A. A Review on the Vagus Nerve and Autonomic Nervous System During Fetal Development: Searching for Critical Windows. Front Neurosci 2021; 15:721605. [PMID: 34616274 PMCID: PMC8488382 DOI: 10.3389/fnins.2021.721605] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/19/2021] [Indexed: 12/17/2022] Open
Abstract
The autonomic nervous system (ANS) is one of the main biological systems that regulates the body's physiology. Autonomic nervous system regulatory capacity begins before birth as the sympathetic and parasympathetic activity contributes significantly to the fetus' development. In particular, several studies have shown how vagus nerve is involved in many vital processes during fetal, perinatal, and postnatal life: from the regulation of inflammation through the anti-inflammatory cholinergic pathway, which may affect the functioning of each organ, to the production of hormones involved in bioenergetic metabolism. In addition, the vagus nerve has been recognized as the primary afferent pathway capable of transmitting information to the brain from every organ of the body. Therefore, this hypothesis paper aims to review the development of ANS during fetal and perinatal life, focusing particularly on the vagus nerve, to identify possible "critical windows" that could impact its maturation. These "critical windows" could help clinicians know when to monitor fetuses to effectively assess the developmental status of both ANS and specifically the vagus nerve. In addition, this paper will focus on which factors-i.e., fetal characteristics and behaviors, maternal lifestyle and pathologies, placental health and dysfunction, labor, incubator conditions, and drug exposure-may have an impact on the development of the vagus during the above-mentioned "critical window" and how. This analysis could help clinicians and stakeholders define precise guidelines for improving the management of fetuses and newborns, particularly to reduce the potential adverse environmental impacts on ANS development that may lead to persistent long-term consequences. Since the development of ANS and the vagus influence have been shown to be reflected in cardiac variability, this paper will rely in particular on studies using fetal heart rate variability (fHRV) to monitor the continued growth and health of both animal and human fetuses. In fact, fHRV is a non-invasive marker whose changes have been associated with ANS development, vagal modulation, systemic and neurological inflammatory reactions, and even fetal distress during labor.
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Affiliation(s)
- Francesco Cerritelli
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Martin G. Frasch
- Department of Obstetrics and Gynecology and Center on Human Development and Disability, University of Washington, Seattle, WA, United States
| | - Marta C. Antonelli
- Facultad de Medicina, Instituto de Biología Celular y Neurociencia “Prof. E. De Robertis”, Universidad de Buenos Aires, Buenos Aires, Argentina
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Chiara Viglione
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Stefano Vecchi
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Marco Chiera
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Andrea Manzotti
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
- Department of Pediatrics, Division of Neonatology, “V. Buzzi” Children's Hospital, Azienda Socio-Sanitaria Territoriale Fatebenefratelli Sacco, Milan, Italy
- Research Department, Istituto Osteopatia Milano, Milan, Italy
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Fratelli N, Prefumo F, Wolf H, Hecher K, Visser GHA, Giussani D, Derks JB, Shaw CJ, Frusca T, Ghi T, Ferrazzi E, Lees CC. Effects of Antenatal Betamethasone on Fetal Doppler Indices and Short Term Fetal Heart Rate Variation in Early Growth Restricted Fetuses. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:56-64. [PMID: 31476786 DOI: 10.1055/a-0972-1098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To investigate the effects of the antenatal administration of betamethasone on fetal Doppler and short term fetal heart rate variation (CTG-STV) in early growth restricted (FGR) fetuses. MATERIALS AND METHODS Post hoc analysis of data derived from the TRUFFLE study, a prospective, multicenter, randomized management trial of severe early onset FGR. Repeat Doppler and CTG-STV measurements between the last recording within 48 hours before the first dose of betamethasone (baseline value) and for 10 days after were evaluated. Multilevel analysis was performed to analyze the longitudinal course of the umbilico-cerebral ratio (UC ratio), the ductus venosus pulsatility index (DVPIV) and CTG-STV. RESULTS We included 115 fetuses. A significant increase from baseline in CTG-STV was found on day + 1 (p = 0.019) but no difference thereafter. The DVPIV was not significantly different from baseline in any of the 10 days following the first dose of betamethasone (p = 0.167). Multilevel analysis revealed that, over 10 days, the time elapsed from antenatal administration of betamethasone was significantly associated with a decrease in CTG-STV (p = 0.045) and an increase in the DVPIV (p = 0.001) and UC ratio (p < 0.001). CONCLUSION Although steroid administration in early FGR has a minimal effect on increasing CTG-STV one day afterwards, the effects on Doppler parameters were extremely slight with regression coefficients of small magnitude suggesting no clinical significance, and were most likely related to the deterioration with time in FGR. Hence, arterial and venous Doppler assessment of fetal health remains informative following antenatal steroid administration to accelerate fetal lung maturation.
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Affiliation(s)
- Nicola Fratelli
- Department of Obstetrics and Gynaecology, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynaecology, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Hans Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, Netherlands
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg-Eppendorf, Germany
| | - Gerard H A Visser
- Department of Perinatal Medicine, University of Utrecht, Netherlands
| | - Dino Giussani
- Department of Physiology Development & Neuroscience, University of Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Jan B Derks
- Department of Perinatal Medicine, University of Utrecht, Netherlands
| | - Caroline J Shaw
- Department of Surgery and Cancer, Imperial College London, United Kingdom of Great Britain and Northern Ireland
| | - Tiziana Frusca
- Department of Surgical Sciences, Obstetrics and Gynecology Unit, University of Parma, Italy
| | - Tullio Ghi
- Department of Surgical Sciences, Obstetrics and Gynecology Unit, University of Parma, Italy
| | - E Ferrazzi
- Children's Hospital Buzzi, University of Milan, Italy
| | - Christoph C Lees
- Department of Surgery and Cancer, Imperial College London, United Kingdom of Great Britain and Northern Ireland
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Bester M, Moors S, Joshi R, Nichting TJ, van der Hout-van der Jagt MB, Oei SG, Mischi M, Vullings R, van Laar JOEH. Changes in Maternal Heart Rate Variability in Response to the Administration of Routine Obstetric Medication in Hospitalized Patients: Study Protocol for a Cohort Study (MAMA-Heart Study). Clin Pract 2021; 11:13-25. [PMID: 33599215 PMCID: PMC7838947 DOI: 10.3390/clinpract11010004] [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] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 12/05/2022] Open
Abstract
Pregnancy is a period of continuous change in the maternal cardiovascular system, partly mediated by the autonomic nervous system. Insufficient autonomic adaptation to increasing gestation is associated with pregnancy complications, such as hypertensive disorders of pregnancy and preterm birth (both major causes of perinatal morbidity and mortality). Consequently, maternal heart rate variability (mHRV), which is a proxy measure for autonomic activity, is increasingly assessed in these cohorts to investigate the pathophysiology of their complications. A better pathophysiological understanding could facilitate the early detection of these complications, which remains challenging. However, such studies (typically performed in pregnancies leading to hospitalization) have generated conflicting findings. A probable reason for these conflicting findings is that these study cohorts were likely administered routine obstetric medications during the study period of which the effects on mHRV are largely unknown. Subsequently, we design a longitudinal, observational study to quantifying the effect of these medications-particularly corticosteroids, which are known to affect fetal HRV-on mHRV to improve the interpretation of past and future studies. We will enroll 61 women admitted to a tertiary obstetric unit with an indication to receive corticosteroids antenatally. Participants' mHRV will be continuously acquired throughout their hospitalization with wrist-worn photoplethysmography to facilitate a within-patient comparison of the effect of corticosteroids on mHRV.
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Affiliation(s)
- Maretha Bester
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands; (S.M.); (T.J.N.); (M.B.v.d.H.-v.d.J.); (S.G.O.); (M.M.); (R.V.); (J.O.E.H.v.L.)
- Department of Family Care Solutions, Philips Research, 5656 AE Eindhoven, The Netherlands;
| | - Suzanne Moors
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands; (S.M.); (T.J.N.); (M.B.v.d.H.-v.d.J.); (S.G.O.); (M.M.); (R.V.); (J.O.E.H.v.L.)
- Department of Obstetrics and Gynecology, Máxima MC, 5504 DB Veldhoven, The Netherlands
| | - Rohan Joshi
- Department of Family Care Solutions, Philips Research, 5656 AE Eindhoven, The Netherlands;
| | - Thomas J. Nichting
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands; (S.M.); (T.J.N.); (M.B.v.d.H.-v.d.J.); (S.G.O.); (M.M.); (R.V.); (J.O.E.H.v.L.)
- Department of Obstetrics and Gynecology, Máxima MC, 5504 DB Veldhoven, The Netherlands
| | - M. Beatrijs van der Hout-van der Jagt
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands; (S.M.); (T.J.N.); (M.B.v.d.H.-v.d.J.); (S.G.O.); (M.M.); (R.V.); (J.O.E.H.v.L.)
- Department of Obstetrics and Gynecology, Máxima MC, 5504 DB Veldhoven, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands
| | - S. Guid Oei
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands; (S.M.); (T.J.N.); (M.B.v.d.H.-v.d.J.); (S.G.O.); (M.M.); (R.V.); (J.O.E.H.v.L.)
- Department of Obstetrics and Gynecology, Máxima MC, 5504 DB Veldhoven, The Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands; (S.M.); (T.J.N.); (M.B.v.d.H.-v.d.J.); (S.G.O.); (M.M.); (R.V.); (J.O.E.H.v.L.)
| | - Rik Vullings
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands; (S.M.); (T.J.N.); (M.B.v.d.H.-v.d.J.); (S.G.O.); (M.M.); (R.V.); (J.O.E.H.v.L.)
| | - Judith O. E. H. van Laar
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands; (S.M.); (T.J.N.); (M.B.v.d.H.-v.d.J.); (S.G.O.); (M.M.); (R.V.); (J.O.E.H.v.L.)
- Department of Obstetrics and Gynecology, Máxima MC, 5504 DB Veldhoven, The Netherlands
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Wolf H, Gordijn SJ, Onland W, Vliegenthart RJS, Ganzevoort JW. Computerized fetal heart rate analysis in early preterm fetal growth restriction. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:51-60. [PMID: 31605504 DOI: 10.1002/uog.21887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/09/2019] [Accepted: 09/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess the value of computerized cardiotocography (cCTG) with calculation of fetal heart rate (FHR) short-term variability (STV) in early preterm fetal growth restriction (FGR) for prevention of fetal death and neonatal asphyxia, neonatal morbidity, and 2-year neurodevelopmental impairment. METHODS This was a retrospective cohort study of all women who were admitted to the Amsterdam University Medical Center-AMC between 2003 and 2015 due to FGR and/or pre-eclampsia, and who were delivered by prelabor Cesarean section, or had a fetal death, before 32 weeks' gestation. STV of all available cCTG registrations during the 5 days preceding fetal death or delivery was calculated retrospectively, and FHR decelerations were classified visually as absent, 1-2/h or recurrent (> 2/h). Adverse outcome endpoints were defined as fetal death, neonatal asphyxia at birth (including fetal death), neonatal death, major neonatal morbidity and 2-year neurodevelopmental outcome. A simulation analysis was performed to assess the incidence of adverse outcome using two thresholds for cCTG: (1) highly abnormal (STV < 2.6 ms before 29 weeks and < 3.0 ms thereafter, and/or recurrent FHR decelerations); and (2) moderately abnormal (STV < 3.5 ms before 29 weeks and < 4.0 ms thereafter, and/or recurrent FHR decelerations). Three management strategies were assessed using a strict schedule for the frequency of cCTG recordings: (1) cCTG without use of fetal arterial Doppler; (2) cCTG with additional fetal arterial Doppler after 29 weeks; and (3) cCTG with additional fetal arterial Doppler after 27 weeks. RESULTS Included were 367 pregnancies (3295 cCTG recordings), of which 20 resulted in fetal death and 347 were delivered by Cesarean section before the onset of labor. Cesarean delivery was indicated by fetal condition in 94% of cases and by maternal condition in 6%. Median gestational age at delivery was 30 (interquartile range (IQR), 28-31) weeks and median birth weight was 900 (IQR, 740-1090) g. Six cases of fetal death were not anticipated by standard practice using visual assessment of CTG. A last highly abnormal cCTG was associated with fetal death and with neonatal asphyxia (including fetal death; n = 99), but not with major neonatal morbidity and 2-year neurodevelopmental outcome. Moderately abnormal cCTG had no significant association with any endpoint. Simulation analysis showed that a strategy that combined cCTG results with umbilicocerebral ratio or umbilical absent or reversed end-diastolic flow could detect all fetal deaths. CONCLUSIONS Computerized CTG in combination with fetal arterial Doppler, with a strict protocol for the frequency of recordings, is likely to be more effective than visual CTG assessment for preventing fetal death in early preterm FGR. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- H Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - S J Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Onland
- Department of Neonatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R J S Vliegenthart
- Department of Neonatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J W Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
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Moors S, Staaks KJJ, Westerhuis MEMH, Dekker LRC, Verdurmen KMJ, Oei SG, van Laar JOEH. Heart rate variability in hypertensive pregnancy disorders: A systematic review. Pregnancy Hypertens 2020; 20:56-68. [PMID: 32179490 DOI: 10.1016/j.preghy.2020.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hypertensive pregnancy disorders (HPD) are associated with dysfunction of the autonomic nervous system. Cardiac autonomic functions can be assessed by heart rate variability (HRV) measurements. OBJECTIVE To study whether HRV detects differences in the function of the autonomic nervous system between pregnant women with HPD compared to normotensive pregnant women and between women with a history of a pregnancy complicated by HPD compared to women with a history of an uncomplicated pregnancy. METHODS A systematic search was performed in Medline, EMBASE, and CENTRAL to identify studies comparing HRV between pregnant women with HPD or women with a history of HPD to women with (a history of) normotensive pregnancies. RESULTS The search identified 523 articles of which 24 were included in this review, including 850 women with (a history of) HPD and 1205 normotensive controls. The included studies showed a large heterogenicity. A decrease in overall HRV was found in preeclampsia (PE), compared to normotensive pregnant controls. A trend is seen towards increased low frequency/high frequency-ratio in women with PE compared to normotensive pregnant controls. CONCLUSION Our systematic review supports the hypothesis a sympathetic overdrive is found in HPD which is associated with a parasympathetic withdrawal. However, the included studies in our review showed a large diversity in the methods applied and their results.
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Affiliation(s)
- S Moors
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - K J J Staaks
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - M E M H Westerhuis
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - L R C Dekker
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - K M J Verdurmen
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - S G Oei
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, 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 Center, Veldhoven, The Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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10
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Noben L, Verdurmen KMJ, Warmerdam GJJ, Vullings R, Oei SG, van Laar JOEH. The fetal electrocardiogram to detect the effects of betamethasone on fetal heart rate variability. Early Hum Dev 2019; 130:57-64. [PMID: 30677639 DOI: 10.1016/j.earlhumdev.2019.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Betamethasone is widely used to enhance fetal lung maturation in case of threatened preterm birth. Antenatal corticosteroids are known to reduce fetal heart rate variability (fHRV) in the days following administration. Since decreased fHRV is a marker for fetal distress, this transient decrease of fHRV can cause unnecessary medical intervention. AIM To describe the effect of betamethasone on fHRV, by applying spectral analysis on non-invasive fetal electrocardiogram (fECG) recordings. STUDY DESIGN Secondary analysis of a prospective cohort study. SUBJECTS Women with a singleton pregnancy, at risk for preterm delivery and receiving betamethasone, admitted to the obstetric high care unit in the period from March 2013 until July 2016. OUTCOME MEASURES The primary outcome measure was fHRV in both time- and frequency-domain. Secondary outcome measures included basal fetal heart rate (fHR) and fHR variance. FHRV parameters were then calculated separately for the quiet and active state. RESULTS Following 68 inclusions, 22 patients remained with complete series of measurements and sufficient data quality. FHRV parameters and fHR showed a decrease on day 2 compared to day 1, significant for short-term variability and high-frequency power. Similar results were found when analyzing for separate behavioral states. The number of segments in quiet state increased during days 1 and 2. Normalized values showed no difference for all behavioral states. CONCLUSION FHRV decreases on day 2 after betamethasone administration, while periods of fetal quiescence increase. No changes were found in the normalized values, indicating that the influence of autonomic modulation is minor. Clinical trial registration number NL43294.015.13.
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Affiliation(s)
- L Noben
- Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands.
| | - K M J Verdurmen
- Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands
| | - G J J Warmerdam
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands
| | - R Vullings
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands
| | - S G Oei
- Department of Obstetrics and Gynecology, Maxima Medical Center, 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, Maxima Medical Center, Veldhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands
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11
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The influence of betamethasone on fetal heart rate variability, obtained by non-invasive fetal electrocardiogram recordings. Early Hum Dev 2018; 119:8-14. [PMID: 29505915 DOI: 10.1016/j.earlhumdev.2018.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Betamethasone is widely used to enhance fetal lung maturation in case of threatened preterm labour. Fetal heart rate variability is one of the most important parameters to assess in fetal monitoring, since it is a reliable indicator for fetal distress. AIM To describe the effect of betamethasone on fetal heart rate variability, by applying spectral analysis on non-invasive fetal electrocardiogram recordings. STUDY DESIGN Prospective cohort study. SUBJECTS Patients that require betamethasone, with a gestational age from 24 weeks onwards. OUTCOME MEASURES Fetal heart rate variability parameters on day 1, 2, and 3 after betamethasone administration are compared to a reference measurement. RESULTS Following 68 inclusions, 12 patients remained with complete series of measurements and sufficient data quality. During day 1, an increase in absolute fetal heart rate variability values was seen. During day 2, a decrease in these values was seen. All trends indicate to return to pre-medication values on day 3. Normalised high- and low-frequency power show little changes during the study period. CONCLUSIONS The changes in fetal heart rate variability following betamethasone administration show the same pattern when calculated by spectral analysis of the fetal electrocardiogram, as when calculated by cardiotocography. Since normalised spectral values show little changes, the influence of autonomic modulation seems minor.
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12
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Warmerdam GJJ, Vullings R, Van Laar JOEH, Van der Hout-Van der Jagt MB, Bergmans JWM, Schmitt L, Oei SG. Detection rate of fetal distress using contraction-dependent fetal heart rate variability analysis. Physiol Meas 2018; 39:025008. [PMID: 29350194 DOI: 10.1088/1361-6579/aaa925] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Monitoring of the fetal condition during labor is currently performed by cardiotocograpy (CTG). Despite the use of CTG in clinical practice, CTG interpretation suffers from a high inter- and intra-observer variability and a low specificity. In addition to CTG, analysis of fetal heart rate variability (HRV) has been shown to provide information on fetal distress. However, fetal HRV can be strongly influenced by uterine contractions, particularly during the second stage of labor. Therefore, the aim of this study is to examine if distinguishing contractions from rest periods can improve the detection rate of HRV features for fetal distress during the second stage of labor. APPROACH We used a dataset of 100 recordings, containing 20 cases of fetuses with adverse outcome. The most informative HRV features were selected by a genetic algorithm and classification performance was evaluated using support vector machines. MAIN RESULTS Classification performance of fetal heart rate segments closest to birth improved from a geometric mean of 70% to 79%. If the classifier was used to indicate fetal distress over time, the geometric mean at 15 minutes before birth improved from 60% to 72%. SIGNIFICANCE Our results show that combining contraction-dependent HRV features with HRV features calculated over the entire fetal heart rate signal improves the detection rate of fetal distress.
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Affiliation(s)
- G J J Warmerdam
- Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
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13
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Cohen E, Wong FY, Wallace EM, Mockler JC, Odoi A, Hollis S, Horne RSC, Yiallourou SR. Fetal-growth-restricted preterm infants display compromised autonomic cardiovascular control on the first postnatal day but not during infancy. Pediatr Res 2017; 82:474-482. [PMID: 28388597 DOI: 10.1038/pr.2017.105] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/03/2017] [Indexed: 12/26/2022]
Abstract
BackgroundFetal growth restriction (FGR) is associated with increased perinatal mortality and long-term cardiovascular and neurodevelopmental sequelae. We hypothesized that FGR impacts on the development of autonomic heart rate and blood pressure control, contributing to unfavorable short- and long-term outcomes following FGR.MethodsWe studied 25 preterm FGR and 22 preterm and 19 term appropriate for gestational age (AGA) infants. Preterm neonates were studied on postnatal day 1, and all infants were studied at 1 and 6 months post-term age. To investigate autonomic cardiovascular control, we examined heart rate variability (HRV) and baroreflex sensitivity using spectral power and transfer-function analyses.ResultsPreterm FGR neonates exhibited higher heart rates and reduced HRV compared with preterm AGA controls on postnatal day 1. No significant differences were found between the three groups at 1 or 6 months post-term age.ConclusionPreterm FGR neonates display compromised HRV on postnatal day 1, which may suggest increased vulnerability to circulatory instability. This may predispose these neonates to systemic and cerebral hypoperfusion and increase the risk of long-term neurodevelopmental sequelae. Differences were no longer found at 1 and 6 months post-term age, suggesting that the maturation of autonomic cardiovascular control may be preserved following FGR.
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Affiliation(s)
- Emily Cohen
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics Monash University, Melbourne, Victoria, Australia
| | - Flora Y Wong
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics Monash University, Melbourne, Victoria, Australia
| | - Euan M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Joanne C Mockler
- Department of Obstetrics and Gynaecology, Monash University and Monash Women's, Monash Health, Melbourne, Victoria, Australia
| | - Alexsandria Odoi
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics Monash University, Melbourne, Victoria, Australia
| | - Samantha Hollis
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics Monash University, Melbourne, Victoria, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics Monash University, Melbourne, Victoria, Australia
| | - Stephanie R Yiallourou
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics Monash University, Melbourne, Victoria, Australia
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14
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Ghi T, Dall'Asta A, Saccone G, Bellussi F, Frusca T, Martinelli P, Pilu G, Rizzo N. Reduced short-term variation following antenatal administration of betamethasone: Is reduced fetal size a predisposing factor? Eur J Obstet Gynecol Reprod Biol 2017; 216:74-78. [PMID: 28735176 DOI: 10.1016/j.ejogrb.2017.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/05/2017] [Accepted: 07/07/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the association between fetal size and the incidence of reduced short-term variability (STV) following bethametasone administration for fetal lung maturity. STUDY DESIGN This was a retrospective, multicenter, cohort study conducted in two Tertiary University Units. Only uncomplicated singleton pregnancies admitted for threatened preterm labor between 26 and 34 weeks and submitted to betamethasone for fetal lung maturity were included. Delivery occurring within 72h from betamethasone administration represented criteria for exclusion. Computerized cardiotocography was carried out on a daily basis. Cases were identified by persistently reduced STV, defined as <5th percentile for gestational age and lasting for at least 72h after the first dose of betamethasone. The primary outcome was estimated fetal weight (EFW) at ultrasound in fetuses with normal and in those with persistently reduced STV. Pregnancy outcomes were also evaluated. RESULTS Persistently reduced STV occurred in 33/405 of the included patients (8.1%). Compared to women with normal STV, those with persistently reduced STV had significantly lower EFW (1472±435 vs 1812±532g, p 0.04), lower birthweight (2353±635 vs 2857±796g, p<0.01) and earlier gestational age at delivery (35.1±4.2 vs 37.3±2.4weeks, p<0.01), whereas all the other variables including gestational age on admission were comparable. CONCLUSIONS Reduced STV following maternal betamethasone administration among appropriately grown fetuses seems to correlate with lower fetal size. Furthermore, fetuses with such abnormal response to steroids seem to carry a higher risk of perinatal complications, including lower birthweight and earlier gestational age at delivery.
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Affiliation(s)
- Tullio Ghi
- Obstetrics and Gynecology Unit, University of Parma, Parma, Italy.
| | - Andrea Dall'Asta
- Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Federica Bellussi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Tiziana Frusca
- Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Pasquale Martinelli
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gianluigi Pilu
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Nicola Rizzo
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
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15
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Wolf H, Arabin B, Lees CC, Oepkes D, Prefumo F, Thilaganathan B, Todros T, Visser GHA, Bilardo CM, Derks JB, Diemert A, Duvekot JJ, Ferrazzi E, Frusca T, Hecher K, Marlow N, Martinelli P, Ostermayer E, Papageorghiou AT, Scheepers HCJ, Schlembach D, Schneider KTM, Valcamonico A, van Wassenaer-Leemhuis A, Ganzevoort W. Longitudinal study of computerized cardiotocography in early fetal growth restriction. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:71-78. [PMID: 27484356 DOI: 10.1002/uog.17215] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/03/2016] [Accepted: 07/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To explore whether, in early fetal growth restriction (FGR), the longitudinal pattern of fetal heart rate (FHR) short-term variation (STV) can be used to identify imminent fetal distress and whether abnormalities of FHR recordings are associated with 2-year infant outcome. METHODS The original TRUFFLE study assessed whether, in early FGR, delivery based on ductus venosus (DV) Doppler pulsatility index (PI), in combination with safety-net criteria of very low STV on cardiotocography (CTG) and/or recurrent FHR decelerations, could improve 2-year infant survival without neurological impairment in comparison with delivery based on CTG monitoring only. This was a secondary analysis of women who delivered before 32 weeks and had consecutive STV data recorded > 3 days before delivery and known infant outcome at 2 years of age. Women who received corticosteroids within 3 days of delivery were excluded. Individual regression line algorithms of all STV values, except the last one before delivery, were calculated. Life tables and Cox regression analysis were used to calculate the daily risk for low STV or very low STV and/or FHR decelerations (below DV group safety-net criteria) and to assess which parameters were associated with this risk. Furthermore, it was assessed whether STV pattern, last STV value or recurrent FHR decelerations were associated with 2-year infant outcome. RESULTS One hundred and forty-nine women from the original TRUFFLE study met the inclusion criteria. Using the individual STV regression lines, prediction of a last STV below the cut-off used by the CTG monitoring group had sensitivity of 42% and specificity of 91%. For each day after study inclusion, the median risk for low STV (CTG group cut-off) was 4% (interquartile range (IQR), 2-7%) and for very low STV and/or recurrent FHR decelerations (below DV group safety-net criteria) was 5% (IQR, 4-7%). Measures of STV pattern, fetal Doppler (arterial or venous), birth-weight multiples of the median and gestational age did not usefully improve daily risk prediction. There was no association of STV regression coefficients, a low last STV and/or recurrent FHR decelerations with short- or long-term infant outcomes. CONCLUSION The TRUFFLE study showed that a strategy of DV monitoring with safety-net criteria of very low STV and/or recurrent FHR decelerations for delivery indication could increase 2-year infant survival without neurological impairment. This post-hoc analysis demonstrates that, in early FGR, the daily risk of abnormal CTG, as defined by the DV group safety-net criteria, is 5%, and that prediction is not possible. This supports the rationale for CTG monitoring more often than daily in these high-risk fetuses. Low STV and/or recurrent FHR decelerations were not associated with adverse infant outcome and it appears safe to delay intervention until such abnormalities occur, as long as DV-PI is within normal range. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- H Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - B Arabin
- Center for Mother and Child of the Phillips University, Marburg, Germany
| | - C C Lees
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - D Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - F Prefumo
- Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - B Thilaganathan
- Fetal Medicine Unit, St George's, University of London and St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - T Todros
- Department of Obstetrics and Gynaecology, University of Turin, Turin, Italy
| | - G H A Visser
- Department of Perinatal Medicine, 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 Perinatal Medicine, University Medical Center, Utrecht, The Netherlands
| | - A Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg, Eppendorf, Germany
| | - J J Duvekot
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - E Ferrazzi
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - T Frusca
- Department of Obstetrics and Gynecology, Maggiore Hospital, University of Parma, Parma, Italy
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg, Eppendorf, Germany
| | - N Marlow
- Department of Neonatology, Institute for Women's Health, University College Hospitals London, London, UK
| | - P Martinelli
- Department of Neuroscience, Dentistry and Reproductive Sciences, University of Naples Federico II, Naples, Italy
| | - E Ostermayer
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's, University of London and St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - H C J Scheepers
- Department of Obstetrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - D Schlembach
- Department of Obstetrics, Vivantes Clinic Neukölln, Berlin, Germany
| | - K T M Schneider
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany
| | - A Valcamonico
- Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - A van Wassenaer-Leemhuis
- Department of Neonatology, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
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16
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Knaven O, Ganzevoort W, de Boer M, Wolf H. Fetal heart rate variation after corticosteroids for fetal maturation. Eur J Obstet Gynecol Reprod Biol 2017; 216:38-45. [PMID: 28715659 DOI: 10.1016/j.ejogrb.2017.06.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 06/24/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Several studies report a decrease of fetal heart rate (FHR) short-term variation (STV) after corticosteroids for improvement of fetal maturity and advice not to deliver a fetus for low STV within 2-3days after corticosteroids. However, literature is not unanimous in this respect. This study intends to asses STV longitudinally after corticosteroid administration. MATERIAL AND METHODS A retrospective cohort study in a tertiary perinatal centre from 2009 to 2015 included all women who had been treated with corticosteroids at gestational age of 26-34 weeks, had a computerized cardiotocography (cCTG) before and after medication and did not deliver within 48h. FHR and STV were stratified over 12-h periods and compared before and after corticosteroids. Women with imminent preterm labour (including PPROM) and women with placental problems (fetal growth restriction (FGR) or preeclampsia) (PE) were analysed separately. The effect of co-medication and gestational age was assessed. RESULTS The study included 406 women, 211 with imminent preterm labour, 195 with FGR-PE. After corticosteroids STV increased 1-2ms (median 1.4; IQR 0.1-3.1) during the first 36h after start of corticosteroids. Thereafter a small decrease of less than 1ms (median -0,6; IQR -1.6 to 0.3) compared to before CC was seen. CONCLUSIONS The most conspicuous effect of corticosteroids is a short term increase of STV and decrease of FHR. A slight decrease after 48-71h is possible, but abnormally low values should be considered as a sign of fetal distress. The clinical guidance, given by some, not to intervene because of a low STV after corticosteroids appears invalid.
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Affiliation(s)
- Olga Knaven
- Department of Obstetrics and Gynecology, Academic Medical Centre, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Centre, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Marjon de Boer
- Department of Obstetrics and Gynecology, VU Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Hans Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, PO Box 22660, 1100DD, Amsterdam, The Netherlands.
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17
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Verdurmen KMJ, Hulsenboom ADJ, van Laar JOEH, Oei SG. Effect of tocolytic drugs on fetal heart rate variability: a systematic review. J Matern Fetal Neonatal Med 2016; 30:2387-2394. [PMID: 27756155 DOI: 10.1080/14767058.2016.1249844] [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: 10/20/2022]
Abstract
INTRODUCTION Tocolytics may cause changes in fetal heart rate (HR) pattern, while fetal heart rate variability (HRV) is an important marker of fetal well-being. We aim to systematically review the literature on how tocolytic drugs affect fetal HRV. MATERIALS AND METHODS We searched CENTRAL, PubMed and EMBASE up to June 2016. Studies published in English, using computerized or visual analysis to describe the effect of tocolytics on HRV in human fetuses were included. Studies describing tocolytics during labor, external cephalic version, pre-eclampsia and infection were excluded. Eventually, we included six studies, describing 169 pregnant women. RESULTS Nifedipine, atosiban and indomethacin administration show no clinically important effect on fetal HRV. Following administration of magnesium sulfate decreased variability and cases of bradycardia are described. Fenoterol administration results in a slight increase in fetal HR with no changes in variability. After ritodrine administration increased fetal HR and decreased variability is seen. The effect of co-administration of corticosteroids should be taken into account. CONCLUSION In order to prevent iatrogenic preterm labor, the effects of tocolytic drugs on fetal HRV should be taken into account when monitoring these fetuses.
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Affiliation(s)
- Kim M J Verdurmen
- a Department of Obstetrics and Gynecology , Máxima Medical Center , Veldhoven , the Netherlands and
| | - Alexandra D J Hulsenboom
- a Department of Obstetrics and Gynecology , Máxima Medical Center , Veldhoven , the Netherlands and
| | - Judith O E H van Laar
- a Department of Obstetrics and Gynecology , Máxima Medical Center , Veldhoven , the Netherlands and
| | - S Guid Oei
- a Department of Obstetrics and Gynecology , Máxima Medical Center , Veldhoven , the Netherlands and.,b Faculty of Electrical Engineering , Eindhoven University of Technology , Eindhoven , the Netherlands
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18
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Alonge S, Mauri M, Faustini M, Luvoni GC. Feto-maternal heart rate ratio in pregnant bitches: effect of gestational age and maternal size. Reprod Domest Anim 2016; 51:688-92. [PMID: 27440379 DOI: 10.1111/rda.12731] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/08/2016] [Indexed: 12/01/2022]
Abstract
Few information is available on parameters that can be used to objectively assess the foetal health during canine pregnancy. To identify a reliable parameter for the evaluation of foetal well-being, the effect of pre-gestational maternal bodyweight and gestational age on foetal heart rate (FHR) and on feto-maternal heart rate ratio (FHR/MHR) was investigated. Seventeen client-owned pregnant bitches of different pre-gestational maternal bodyweight were examined by serial echo colour Doppler. Only data from 11 uncomplicated pregnancies were included in the statistical analysis. The relationship between FHR, and FHR/MHR, and independent variables was analysed by polynomial regression (p ≤ .05). The FHR and the FHR/MHR significantly fitted a multiple quadratic regression for all independent variables. They both increased from 35 to 20 days before parturition and then a decreasing pattern followed. Higher values of both parameters were observed in bitches of lowest and highest bodyweight. Patterns of FHR and FHR/MHR were similar, but the ratio better describes the effect of the independent variables on the data. Thus, the highest significance of FHR/MHR compared to FHR alone encourages the application of this ratio to evaluate foetal well-being. The equation derived by the regression analysis of FHR/MHR could be applied in clinical practice to obtain its expected values in healthy pregnancies.
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Affiliation(s)
- S Alonge
- Department of Health, Animal Science and Food Safety, Università degli Studi di Milano, Milano, Italy
| | - M Mauri
- Department of Health, Animal Science and Food Safety, Università degli Studi di Milano, Milano, Italy
| | - M Faustini
- Department of Veterinary Science and Public Health, Università degli Studi di Milano, Milano, Italy
| | - G C Luvoni
- Department of Health, Animal Science and Food Safety, Università degli Studi di Milano, Milano, Italy.
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