Objective 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. Approach 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 key to fetal autonomic assessment. 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. Main Results 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. Significance 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.
Postpartum hemorrhage due to uterine atony continues to be one of the major causes of maternal morbidity and mortality. Several uterine compression suture techniques have been described and are increasingly being used worldwide as a conservative approach. However, little is known about the long-term effects on the uterine cavity, as well as fertility and pregnancy outcomes. We reviewed the reported complications and uterine findings after the use of compression sutures, both in examinations to evaluate the cavity (hysteroscopy, hysterosalpingography or sonohysterography) and at cesarean section, in order to assess the possible usefulness of routine postoperative cavity evaluation. Overall, the use of uterine compression sutures is effective and safe; however, some severe and potentially life-threatening complications have been reported and could possibly have been prevented if uterine cavity evaluation had been performed. Routine follow-up, both by hysteroscopy and an imaging technique, seems worthwhile.
Background Continuous fetal heart rate (FHR) monitoring remains central to intrapartum care. However, advances in signal analysis are needed to increase its accuracy in diagnosis of fetal hypoxia. Aims Todetermine whether FHR complexity, an index of multiscale variability, islower among fetuses born with low (≤7.05) versus higher pH values, and whether this measure can potentially be used to help discriminate the two groups. Study design Evaluation of a pre-existing database of sequentially acquired intrapartum FHR signals. Subjects FHR tracings, obtained from a continuous scalp electrocardiogram during labor, were analyzed using the multiscale entropy (MSE) method in 148 singletons divided in two groups according to umbilical artery pH at birth: 141 fetuses with pH> 7.05 and 7 with pH≤7.05. A complexity index derived from MSE analysis was calculated for each recording. Results The complexity of FHR signals for the last two hours before delivery was significantly (p< 0.004) higher for non-acidemic than for acidemic fetuses. The difference between the two groups remained significant (p<0.003) when FHR data from the last 30min before delivery were excluded. Conclusion Complexity of FHR signals, as measured by the MSE method, was significantly lower for acidemic than non-acidemic fetuses. These results are consistent with previous studies showing that decreased nonlinear complexity is a dynamical signature of disrupted physiologic control systems. This analytic approach may have discriminative value in FHR analysis.
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