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Kasap B, Vali K, Qian W, Mo L, Chithiwala ZH, Curtin AC, Ghiasi S, Hedriana HL. Transcutaneous Discrimination of Fetal Heart Rate from Maternal Heart Rate: A Fetal Oximetry Proof-of-Concept. Reprod Sci 2024; 31:2331-2341. [PMID: 38728001 DOI: 10.1007/s43032-024-01582-z] [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: 07/14/2023] [Accepted: 04/29/2024] [Indexed: 07/31/2024]
Abstract
Intrapartum care uses electronic fetal heart rate monitoring (EFHRM) for over 50 years to indirectly assess fetal oxygenation. However, this approach has been associated with an increase in cesarean delivery rates and limited improvements in neonatal hypoxic outcome. To address these shortcomings, a novel transabdominal fetal pulse oximeter (TFO) is being developed to provide an objective measurement of fetal oxygenation. Previous studies have evaluated the performance of TFO on pregnant ewe. Building on the animal model, this study aims to determine whether TFO can successfully capture human fetal heart rate (FHR) signals during non-stress testing (NST) as a proof-of-concept. Eight ongoing pregnancies meeting specific inclusion criteria (18-40 years old, singleton, and at least 36 weeks' gestation) were enrolled with consent. Each study session was 15 to 20 min long. Reference maternal heart rate (MHR) and FHR were obtained using finger pulse oximetry and cardiotocography for subsequent comparison. The overall root-mean-square error was 9.7BPM for FHR and 4.4 for MHR, while the overall mean-absolute error was 7.6BPM for FHR and 1.8 for MHR. Bland-Altman analysis displayed a mean bias ± standard deviation between TFO and reference of -3.9 ± 8.9BPM, with limits of agreement ranging from -21.4 to 13.6 BPM. Both maternal and fetal heart rate measurements obtained from TFO exhibited a p-value < 0.001, showing significant correlation with the reference. This proof-of-concept study successfully demonstrates that TFO can accurately differentiate maternal and fetal heart signals in human subjects. This achievement marks the initial step towards enabling fetal oxygen saturation measurement in humans using TFO.
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Affiliation(s)
- Begum Kasap
- Department of Electrical and Computer Engineering, University of California Davis, Davis, CA, USA.
| | - Kourosh Vali
- Department of Electrical and Computer Engineering, University of California Davis, Davis, CA, USA
| | - Weitai Qian
- Department of Electrical and Computer Engineering, University of California Davis, Davis, CA, USA
| | - Lihong Mo
- Department of Obstetrics and Gynecology, University of California Davis Health, Sacramento, CA, USA
| | - Zahabiya H Chithiwala
- Department of Obstetrics and Gynecology, University of California Davis Health, Sacramento, CA, USA
| | - Anna C Curtin
- Department of Obstetrics and Gynecology, University of California Davis Health, Sacramento, CA, USA
| | - Soheil Ghiasi
- Department of Electrical and Computer Engineering, University of California Davis, Davis, CA, USA
| | - Herman L Hedriana
- Department of Obstetrics and Gynecology, University of California Davis Health, Sacramento, CA, USA
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Jia YJ, Ghi T, Pereira S, Gracia Perez-Bonfils A, Chandraharan E. Pathophysiological interpretation of fetal heart rate tracings in clinical practice. Am J Obstet Gynecol 2023; 228:622-644. [PMID: 37270259 DOI: 10.1016/j.ajog.2022.05.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 06/05/2023]
Abstract
The onset of regular, strong, and progressive uterine contractions may result in both mechanical (compression of the fetal head and/or umbilical cord) and hypoxic (repetitive and sustained compression of the umbilical cord or reduction in uteroplacental oxygenation) stresses to a human fetus. Most fetuses are able to mount effective compensatory responses to avoid hypoxic-ischemic encephalopathy and perinatal death secondary to the onset of anaerobic metabolism within the myocardium, culminating in myocardial lactic acidosis. In addition, the presence of fetal hemoglobin, which has a higher affinity for oxygen even at low partial pressures of oxygen than the adult hemoglobin, especially increased amounts of fetal hemoglobin (ie, 180-220 g/L in fetuses vs 110-140 g/L in adults), helps the fetus to withstand hypoxic stresses during labor. Different national and international guidelines are currently being used for intrapartum fetal heart rate interpretation. These traditional classification systems for fetal heart rate interpretation during labor are based on grouping certain features of fetal heart rate (ie, baseline fetal heart rate, baseline variability, accelerations, and decelerations) into different categories (eg, category I, II, and III tracings, "normal, suspicious, and pathologic" or "normal, intermediary, and abnormal"). These guidelines differ from each other because of the features included within different categories and because of their arbitrary time limits stipulated for each feature to warrant an obstetrical intervention. This approach fails to individualize care because the "ranges of normality" for stipulated parameters apply to the population of human fetuses and not to the individual fetus in question. Moreover, different fetuses have different reserves and compensatory responses and different intrauterine environments (presence of meconium staining of amniotic fluid, intrauterine inflammation, and the nature of uterine activity). Pathophysiological interpretation of fetal heart rate tracing is based on the application of the knowledge of fetal responses to intrapartum mechanical and/or hypoxic stress in clinical practice. Both experimental animal studies and observational human studies suggest that, just like adults undertaking a treadmill exercise, human fetuses show predictable compensatory responses to a progressively evolving intrapartum hypoxic stress. These responses include the onset of decelerations to reduce myocardial workload and preserve aerobic metabolism, loss of accelerations to abolish nonessential somatic body movements, and catecholamine-mediated increases in the baseline fetal heart rate and effective redistribution and centralization to protect the fetal central organs (ie, the heart, brain, and adrenal glands), which are essential for intrauterine survival. Moreover, it is essential to incorporate the clinical context (progress of labor, fetal size and reserves, presence of meconium staining of amniotic fluid and intrauterine inflammation, and fetal anemia) and understand the features suggestive of fetal compromise in nonhypoxic pathways (eg, chorioamnionitis and fetomaternal hemorrhage). It is important to appreciate that the timely recognition of the speed of onset of intrapartum hypoxia (ie, acute, subacute, and gradually evolving) and preexisting uteroplacental insufficiency (ie, chronic hypoxia) on fetal heart rate tracing is crucial to improve perinatal outcomes.
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Affiliation(s)
- Yan-Ju Jia
- Department of Obstetrics, Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin Central Hospital of Gynecology and Obstetrics, Nankai University Affiliated Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Tullio Ghi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Susana Pereira
- Kingston Hospital NHS Foundation Trust, Kingston upon Thames, England, United Kingdom
| | | | - Edwin Chandraharan
- Basildon University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, United Kingdom.
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Bernardes J. Computerized analysis of cardiotocograms in clinical practice and the SisPorto ® system thirty-two years after: technological, physiopathological and clinical studies. J Perinat Med 2023; 51:145-160. [PMID: 36064191 DOI: 10.1515/jpm-2022-0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 08/21/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The objective of this study is to present the why, what and how about computerized analysis of cardiotocograms (cCTG) and the SisPorto system for cCTG. CONTENT A narrative review about cCTG and the SisPorto system for cCTG is presented. The meta-analysis of randomized controlled trials (RCT) performed so far have evidenced that cCGT compared to traditional CTG analysis may save time spent in hospital for women, in the antepartum period, and is objective with at least equivalent results in maternal and perinatal outcomes, both in the ante and intrapartum periods. The SisPorto system for cCTG closely follows the FIGO guidelines for fetal monitoring. It may be used both in the ante and intrapartum periods, alone or connected to a central monitoring station, with simultaneous monitoring of fetal and maternal signals, not only in singletons but also in twins. It has been assessed in technical, physiopathological and clinical studies, namely in one large multicentric international RCT during labor and two meta-analysis. SUMMARY AND OUTLOOK There is evidence that cCTG may be useful in clinical practice with advantages compared to traditional CTG analysis, although without clear impact on the decrease of preventable maternal and perinatal mortality and morbidity. More studies are warranted, namely on technical improvements and assessment in larger studies in a wider range of clinical settings.
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Affiliation(s)
- João Bernardes
- Head of the Department of Gynecology Obstetrics and Pediatrics, Faculdade de Medicina da Universidade do Porto, Portugal
- Senior Consultant of Centro Hospitalar Universitário de São João, Porto, Portugal
- Senior Researcher of Centro de Investigação em Tecnologias e Sistemas de Saúde (CINTESIS), Porto, Portugal
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Hurtado-Sánchez MF, Pérez-Melero D, Pinto-Ibáñez A, González-Mesa E, Mozas-Moreno J, Puertas-Prieto A. Characteristics of Heart Rate Tracings in Preterm Fetus. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:528. [PMID: 34070249 PMCID: PMC8225205 DOI: 10.3390/medicina57060528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/23/2021] [Indexed: 12/23/2022]
Abstract
Background and Objectives: Prematurity is currently a serious public health issue worldwide, because of its high associated morbidity and mortality. Optimizing the management of these pregnancies is of high priority to improve perinatal outcomes. One tool frequently used to determine the degree of fetal wellbeing is cardiotocography (CTG). A review of the available literature on fetal heart rate (FHR) monitoring in preterm fetuses shows that studies are scarce, and the evidence thus far is unclear. The lack of reference standards for CTG patterns in preterm fetuses can lead to misinterpretation of the changes observed in electronic fetal monitoring (EFM). The aims of this narrative review were to summarize the most relevant concepts in the field of CTG interpretation in preterm fetuses, and to provide a practical approach that can be useful in clinical practice. Materials and Methods: A MEDLINE search was carried out, and the published articles thus identified were reviewed. Results: Compared to term fetuses, preterm fetuses have a slightly higher baseline FHR. Heart rate is faster in more immature fetuses, and variability is lower and increases in more mature fetuses. Transitory, low-amplitude decelerations are more frequent during the second trimester. Transitory increases in FHR are less frequent and become more frequent and increase in amplitude as gestational age increases. Conclusions: The main characteristics of FHR tracings changes as gestation proceeds, and it is of fundamental importance to be aware of these changes in order to correctly interpret CTG patterns in preterm fetuses.
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Affiliation(s)
- Maria F. Hurtado-Sánchez
- Obstetrics and Gynecology Service, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.F.H.-S.); (A.P.-P.)
| | - David Pérez-Melero
- Anesthesiology, Resuscitation and Pain Therapy Service, Virgen de las Nieves University Hospital, 18014 Granada, Spain;
| | - Andrea Pinto-Ibáñez
- Obstetrics and Gynecology Service, Poniente Hospital, 04700 El Ejido (Almería), Spain;
| | - Ernesto González-Mesa
- Obstetrics and Gynecology Service, Regional University Hospital of Malaga, 29011 Malaga, Spain;
| | - Juan Mozas-Moreno
- Obstetrics and Gynecology Service, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.F.H.-S.); (A.P.-P.)
- Department of Obstetrics and Gynecology, University of Granada, 18016 Granada, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain
- Biohealth Research Institute (Instituto de Investigación Biosanitaria Ibs.GRANADA), 18014 Granada, Spain
| | - Alberto Puertas-Prieto
- Obstetrics and Gynecology Service, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.F.H.-S.); (A.P.-P.)
- Biohealth Research Institute (Instituto de Investigación Biosanitaria Ibs.GRANADA), 18014 Granada, Spain
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Sukumaran S, Pereira V, Mallur S, Chandraharan E. Cardiotocograph (CTG) changes and maternal and neonatal outcomes in chorioamnionitis and/or funisitis confirmed on histopathology. Eur J Obstet Gynecol Reprod Biol 2021; 260:183-188. [PMID: 33838555 DOI: 10.1016/j.ejogrb.2021.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the cardiotocographic changes and maternal and neonatal outcomes in cases of chorioamnionitis and or funisitis confirmed on histopathology. STUDY DESIGN A retrospective analysis of histopathology reports confirming chorioamnionitis and/or funisitis was carried out from 2014 to 2020 in a single centre. The preterm births (<37 weeks) were excluded. The maternal records were reviewed to determine the maternal and neonatal outcomes such as the mode of delivery, intrapartum and postpartum complications, umbilical cord arterial pH, and admission to the special care baby unit (SCBU). The CTG features were analysed on admission and during the intrapartum period. The study was approved by the Audit and Clinical Effectiveness department within the centre. RESULTS Out of the 57 cases of histologically confirmed chorioamnionitis and/or funisitis, 42 women (73.7 %) had intrapartum pyrexia and none of the mothers had an increased temperature at the point of fetal tachycardia (persistent increase in baseline fetal heart rate (FHR) by >10 % compared to the original baseline FHR). 43 (75.4 %) CTGs showed evidence of uterine tachysystole or hyperstimulation. 15 (26.3 %) cases had meconium stained amniotic fluid (MSAF). 54 (94.7 %) women had a caesarean section, and their babies were admitted to special care baby unit after delivery. 54 (94.7 %) babies had an umbilical artery of more than 7.1. 47 (87 %) of the women were readmitted with wound infection. All CTG traces showed a > 10 % increase in the baseline FHR and variable decelerations with overshoot were noted in cases where funisitis was confirmed in 25 cases (92.6 %). Loss of cycling was noted in 54 CTGs (94.7 %) and a sinusoidal pattern was identified in 27 (47.3 %). CONCLUSION Rising (>10 %) baseline during labour along with loss of cycling with or without features of tachysystole or hyperstimulation should be considered in labour as features of ongoing chorioamnionitis. Chorioamnionitis confirmed on histopathology is associated with an increase in caesarean section rate due to fetal heart rate changes, increased risk of wound infection in mothers, and increased admission of the babies to SCBU.
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Affiliation(s)
- Suganya Sukumaran
- Obstetrics & Gynaecology, South Warwickshire NHS Foundation Trust, Warwick, UK.
| | | | | | - Edwin Chandraharan
- Global Academy of Medical Education & Training, London & Consultant Intrapartum Care Advisor, Basildon University Hospital, Mid and South Essex NHS Foundation Trust, Essex, UK.
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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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7
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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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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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Galli L, Dall'Asta A, Whelehan V, Archer A, Chandraharan E. Intrapartum cardiotocography patterns observed in suspected clinical and subclinical chorioamnionitis in term fetuses. J Obstet Gynaecol Res 2019; 45:2343-2350. [PMID: 31621146 DOI: 10.1111/jog.14133] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/07/2019] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the cardiotocography (CTG) features observed in suspected intrapartum chorioamnionitis in term fetuses according to the recently suggested criteria for the pathophysiological interpretation of the fetal heart rate and their correlation with perinatal outcomes. METHODS Retrospective analysis of nonconsecutive CTG traces. 'CTG chorioamnionitis' was diagnosed either based on a persistent rise in the baseline for the given gestation or on a persistent increase in the baseline fetal heart rate during labor >10% without preceding CTG signs of hypoxia and in the absence of maternal pyrexia. Perinatal outcomes were compared among cases with no sign of chorioamnionitis, in those with only CTG features suspicious for chorioamnionitis and in those who developed clinical chorioamnionitis. RESULTS Two thousand one hundred and five CTG traces were analyzed. Of these, 356 fulfilled the criteria for "CTG chorioamnionitis". Higher rates of Apgar <7 at 1 and 5 min (21.6% vs 9.0% and 9.8% vs 2.0%, respectively, P < 0.01 for both) and lower umbilical artery pH (7.14 ± 0.11 vs 7.19 ± 0.11, P < 0.01) and an over fivefold higher rate of neonatal intensive care unit admission (16.6% vs 2.9%, P < 0.01) were noted in the 'CTG chorioamnionitis' group. Differences in the incidence of abnormal CTG patterns were noted between cases who eventually had clinical evidence of chorioamnionitis (89/356) and those showing CTG features suspicious for chorioamnionitis in the absence of clinical evidence of chorioamnionitis (267/356). CONCLUSION Intrapartum CTG features of suspected chorioamnionitis are associated with adverse perinatal outcomes.
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Affiliation(s)
- Letizia Galli
- St George's University Hospitals NHS Foundation Trust, London, UK.,Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Unità Sanitaria Locale, Reggio Emilia, Italy.,Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Andrea Dall'Asta
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy.,Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | | | - Abigail Archer
- St George's University Hospitals NHS Foundation Trust, London, UK
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Zavala JH, Ecklund-Flores L, Myers MM, Fifer WP. Assessment of autonomic function in the late term fetus: The effects of sex and state. Dev Psychobiol 2019; 62:224-231. [PMID: 31127614 DOI: 10.1002/dev.21865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 04/06/2019] [Accepted: 04/12/2019] [Indexed: 11/09/2022]
Abstract
Researchers have reported associations between fetal sex and heart rate (FHR) and heart rate variability (FHRV) but rarely in the context of fetal behavioral sleep state. We examined differences in measures of fetal autonomic function by sex and sleep state. Fetal abdominal ECG monitoring technology was used to measure FHR and two measures of FHRV-standard deviation of FHR (SD) and beat-to-beat variability (RMSSD). FHR and movement patterns were also recorded with standard Doppler ultrasound monitor technology employed to code sleep states. Data were collected from 82 healthy fetuses ranging from 36 to 39 weeks gestation. A one-way MANOVA showed that FHR was significantly lower and SD was significantly higher for males than females. Independent samples t tests found that these sex differences were only in the active sleep state. There were no significant differences in RMSSD by sex. Repeated measures MANOVA for a subset that exhibited more than one state (N = 22) showed that SD was significantly different by state. RMSSD showed a marginally significant sleep state difference. In conclusion, fetal sex differences in HR and HRV may indicate more mature autonomic functioning in near-term males than females and fetal sleep state can influence abdominal fECG derived measures of FHR and FHRV.
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Affiliation(s)
- Julia H Zavala
- Department of Psychology, Mercy College, Dobbs Ferry, New York.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York
| | - Lisa Ecklund-Flores
- Department of Psychology, Mercy College, Dobbs Ferry, New York.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York
| | - Michael M Myers
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York.,Department of Psychiatry, Columbia University, New York, New York.,Department of Pediatrics, Columbia University, New York, New York
| | - William P Fifer
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, New York.,Department of Psychiatry, Columbia University, New York, New York.,Department of Pediatrics, Columbia University, New York, New York
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11
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Shuffrey LC, Myers MM, Odendaal HJ, Elliott AJ, du Plessis C, Groenewald C, Burd L, Angal J, Nugent JD, Isler JR, Fifer WP. Fetal heart rate, heart rate variability, and heart rate/movement coupling in the Safe Passage Study. J Perinatol 2019; 39:608-618. [PMID: 30833637 PMCID: PMC6483837 DOI: 10.1038/s41372-019-0342-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/19/2019] [Accepted: 01/30/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine normative values for heart rate patterns in healthy fetuses. METHODS This research is from the Safe Passage Study conducted by the Prenatal Alcohol and SIDS and Stillbirth (PASS) Network. A standardized protocol assessed fetal heart rate (FHR), heart rate variability (HRV), and movement from 1655 fetuses at three-time points during gestation (20-24 weeks, 28-32 weeks, 34-38 weeks gestation). RESULTS FHR decreased while HRV increased over gestation. At the latter two ages, males had significantly lower FHR than females while there were no sex differences in FHR at 20-24 weeks. When accounting for the fetal state during late gestation (34-28 weeks), we found that males had significantly lower FHR than females in the active fetal state only. CONCLUSION Results demonstrate significant state, gestational age, and sex-related changes in cardiac activity, somatic activity, and autonomic function as the fetus approaches birth.
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Affiliation(s)
- Lauren C. Shuffrey
- Department of Psychiatry, Columbia University Medical
Center, New York, NY 10032,Division of Developmental Neuroscience, New York State
Psychiatric Institute, New York, NY 10032
| | - Michael M. Myers
- Department of Psychiatry, Columbia University Medical
Center, New York, NY 10032,Division of Developmental Neuroscience, New York State
Psychiatric Institute, New York, NY 10032,Department of Pediatrics, Columbia University Medical
Center, New York, NY 10032
| | - Hein J. Odendaal
- Department of Obstetrics and Gynaecology, Faculty of
Medicine and Health Science, Stellenbosch University, Cape Town, Western Cape, South
Africa 7530
| | - Amy J. Elliott
- Center for Pediatric & Community Research, Avera
Research Institute, Sioux Falls, SD 57108,Department of Pediatrics, University of South Dakota School
of Medicine, Sioux Falls, SD 57105
| | - Carlie du Plessis
- Department of Obstetrics and Gynaecology, Faculty of
Medicine and Health Science, Stellenbosch University, Cape Town, Western Cape, South
Africa 7530
| | - Coen Groenewald
- Department of Obstetrics and Gynaecology, Faculty of
Medicine and Health Science, Stellenbosch University, Cape Town, Western Cape, South
Africa 7530
| | - Larry Burd
- Department of Pediatrics, University of North Dakota
Medical School, Grand Forks, ND 58202
| | - Jyoti Angal
- Center for Pediatric & Community Research, Avera
Research Institute, Sioux Falls, SD 57108,Department of Pediatrics, University of South Dakota School
of Medicine, Sioux Falls, SD 57105
| | - J. David Nugent
- Division of Developmental Neuroscience, New York State
Psychiatric Institute, New York, NY 10032
| | - Joseph R. Isler
- Division of Developmental Neuroscience, New York State
Psychiatric Institute, New York, NY 10032
| | - William P. Fifer
- Department of Psychiatry, Columbia University Medical
Center, New York, NY 10032,Division of Developmental Neuroscience, New York State
Psychiatric Institute, New York, NY 10032,Department of Pediatrics, Columbia University Medical
Center, New York, NY 10032
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12
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Correlation of short-term variation and Doppler parameters with adverse perinatal outcome in low-risk fetuses at term. Arch Gynecol Obstet 2018; 299:411-420. [PMID: 30511191 DOI: 10.1007/s00404-018-4978-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the association of short-term variation (STV) and Doppler parameters with adverse perinatal outcome in low-risk fetuses at term. METHODS This was a retrospective study of 1008 appropriate-for-gestational age (AGA) term fetuses. Doppler measurements [umbilical artery (UA), middle cerebral artery (MCA), and cerebroplacental ratio (CPR)] and computerized CTG (cCTG) with STV analysis were performed prior to active labor (≤ 4 cm cervical dilatation) within 72 h of delivery. The association between Doppler indices and STV values with adverse perinatal outcome was analyzed using univariate regression analysis. RESULTS No significant association between Doppler parameters and the need for secondary cesarean delivery (CD) or operative vaginal delivery (OVD) was shown. Regarding fetuses delivered by CD due to fetal distress, regression analyzes revealed significantly higher UA PI MoM. However, the differences in MCA PI MoM and CPR MoM were not statistically significant. Fetuses with the need for emergency CD showed significantly higher UA PI MoM, lower MCA PI MoM and lower CPR MoM. Neonates with a 5-min Apgar score < 7 had significantly lower MCA PI MoM and neonatal acidosis (UA pH ≤ 7.10) showed a significant association with UA PI MoM. None of the assessed outcome parameters were significantly associated to STV. CONCLUSION Doppler indices assessed close to delivery in low-risk fetuses at term show a moderate association with adverse outcome parameters, whereas STV does not appear to predict poor perinatal outcome in this group of fetuses.
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13
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Bernardes J. Foetal circadian rhythms, interpretation of foetal heart rate recordings and clues about foetal preparedness for stressful situations. Acta Physiol (Oxf) 2018; 224:e13174. [PMID: 30133146 DOI: 10.1111/apha.13174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/16/2018] [Indexed: 11/26/2022]
Affiliation(s)
- João Bernardes
- Departamento de Ginecologia Obstetrícia e Pediatria; Faculdade de Medicina da Universidade do Porto; Porto Portugal
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14
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Sletten J, Cornelissen G, Assmus J, Kiserud T, Albrechtsen S, Kessler J. Maternal exercise, season and sex modify the daily fetal heart rate rhythm. Acta Physiol (Oxf) 2018; 224:e13093. [PMID: 29754451 DOI: 10.1111/apha.13093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/18/2018] [Accepted: 05/03/2018] [Indexed: 12/01/2022]
Abstract
AIM The knowledge on biological rhythms is rapidly expanding. We aimed to define the longitudinal development of the daily (24-hour) fetal heart rate rhythm in an unrestricted, out-of-hospital setting and to examine the effects of maternal physical activity, season and fetal sex. METHODS We recruited 48 women with low-risk singleton pregnancies. Using a portable monitor for continuous fetal electrocardiography, fetal heart rate recordings were obtained around gestational weeks 24, 28, 32 and 36. Daily rhythms in fetal heart rate and fetal heart rate variation were detected by cosinor analysis; developmental trends were calculated by population-mean cosinor and multilevel analysis. RESULTS For the fetal heart rate and fetal heart rate variation, a significant daily rhythm was present in 122/123 (99.2%) and 116/121 (95.9%) of the individual recordings respectively. The rhythms were best described by combining cosine waves with periods of 24 and 8 hours. With increasing gestational age, the magnitude of the fetal heart rate rhythm increased, and the peak of the fetal heart rate variation rhythm shifted from a mean of 14:25 (24 weeks) to 20:52 (36 weeks). With advancing gestation, the rhythm-adjusted mean value of the fetal heart rate decreased linearly in females (P < .001) and nonlinearly in males (quadratic function, P = .001). At 32 and 36 weeks, interindividual rhythm diversity was found in male fetuses during higher maternal physical activity and during the summer season. CONCLUSION The dynamic development of the daily fetal heart rate rhythm during the second half of pregnancy is modified by fetal sex, maternal physical activity and season.
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Affiliation(s)
- J Sletten
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - G Cornelissen
- Department of Integrative Biology and Physiology, Halberg Chronobiology Center, University of Minnesota, Minneapolis, MN, USA
| | - J Assmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - T Kiserud
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - S Albrechtsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - J Kessler
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
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15
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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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16
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Schmidt A, Schukat-Talamazzini EG, Zöllkau J, Pytlik A, Leibl S, Kumm K, Bode F, Kynass I, Witte OW, Schleussner E, Schneider U, Hoyer D. Universal characteristics of evolution and development are inherent in fetal autonomic brain maturation. Auton Neurosci 2018. [DOI: 10.1016/j.autneu.2018.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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17
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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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18
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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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Pereira S, Chandraharan E. Recognition of chronic hypoxia and pre-existing foetal injury on the cardiotocograph (CTG): Urgent need to think beyond the guidelines. Porto Biomed J 2017; 2:124-129. [PMID: 32258602 DOI: 10.1016/j.pbj.2017.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/11/2017] [Indexed: 02/06/2023] Open
Abstract
Chronic utero-placental insufficiency may result in progressive hypoxia culminating in fetal decompensation and acidosis and this is termed 'chronic' or 'long-standing' hypoxia. It is essential to recognise the features of chronic hypoxia on the CTG trace so as to institute timely and appropriate action. The current guidelines may not capture a fetus who starts labour already compromised or limited in its ability to compensate for hypoxic or mechanical stresses during labour. The aim of this short review is to explore the CTG features that allow the clinician to recognise a fetus who may present with an antenatal insult such as chronic hypoxia, anaemia, infection, fetal arrhythmias and preexisting non-hypoxic brain injury.
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Affiliation(s)
- Susana Pereira
- Kingston Hospital NHS Foundation Trust, Galsworthy Road, Kingston upon Thames, Surrey, UK
| | - Edwin Chandraharan
- St. George's University Hospitals NHS Foundation Trust & St George's University of London, Blackshaw Road, London, UK
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