Fetal autonomic response to severe acidaemia during labour

Laar, Judith O E H van; Peters, C.H.L.; Vullings, Rik; Houterman, Saskia; Bergmans, J.W.M.; Oei, S.G.

doi:10.1111/j.1471-0528.2009.02456.x

Cited by 56 publications

(63 citation statements)

References 41 publications

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“…LF and HF HRV markers performed better than after their respective normalization by the total power in the 0.04-1.50 Hz band of the RR interval autospectrum. This contrasts with the findings by van Laar et al (14), who did not find significant hypoxia-induced changes in the LF and HF HRV markers but did find significant changes in their normalized counterparts. The different findings might be due to age of the subjects involved (term vs. preterm), which would indicate that domain-based HRV markers for hypoxia are age specific.…”

Section: Discussioncontrasting

confidence: 57%

“…Depressed temporal HR variability correlates to acidosis, (13) and frequency domain-based normalized LF and HF HRV markers were likewise correlated to acidosis (14). Temporal HRV was calculated as the SD of HRs of 5 min, and this is reflected in sharp transitions at the start and end of UCO (Supplementary Figure S3 online), when HR abruptly changes.…”

Section: Discussionmentioning

confidence: 99%

“…HR variability was calculated by determining the SD of HRs of ECG ind in the previous 5 min (30). Frequency domain markers for HR variability were calculated as defined by van Laar et al (14) Specifically, spectral power was calculated in the LF (0.04-0.15 Hz) and HF (0.40-1.50 Hz) bands of the RR interval autospectrum for RR intervals in the previous 64 s. Next to LF and HF band spectral power, normalized power was calculated by dividing the LF and HF band spectral power by the total spectral power in the 0.04-1.50 Hz band.…”

Section: Ecg-based Physiological Markersmentioning

confidence: 99%

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Comparison of ECG-based physiological markers for hypoxia in a preterm ovine model

et al. 2016

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Background: Current methods for assessing perinatal hypoxic conditions did not improve infant outcomes. Various waveform-based and interval-based ECG markers have been suggested, but not directly compared. We compare performance of ECG markers in a standardized ovine model for fetal hypoxia. Methods: Sixty-nine fetal sheep of 0.7 gestation had ECG recorded 4 h before, during, and 4 h after a 25-min period of umbilical cord occlusion (UCO), leading to severe hypoxia. Various ECG markers were calculated, among which were heart rate (HR), HR-corrected ventricular depolarization/ repolarization interval (QT c ), and ST-segment analysis (STAN) episodic and baseline rise markers, analogue to clinical STAN device alarms. Performance of interval-and waveform-based ECG markers was assessed by correlating predicted and actual hypoxic/normoxic state. results: Of the markers studied, HR and QT c demonstrated high sensitivity (≥86%), specificity (≥96%), and positive predictive value (PPV) (≥86%) and detected hypoxia in ≥90% of fetuses at 4 min after UCO. In contrast, STAN episodic and baseline rise markers displayed low sensitivity (≤20%) and could not detect severe fetal hypoxia in 65 and 28% of the animals, respectively. conclusion: Interval-based HR and QT c markers could assess the presence of severe hypoxia. Waveform-based STAN episodic and baseline rise markers were ineffective as markers for hypoxia. c ontinuous monitoring of the fetal heart rate (HR) is assumed to provide clinical information about the wellbeing of the fetus (1). Cardiotocography (CTG) allows noninvasive real-time assessment of fetal HR and its response to uterine contractions and is nowadays used in clinics worldwide. However, HR patterns in CTG are often not predictive for hypoxia (2). Introduction of CTG in clinics did not significantly reduce occurrences of neonatal death or cerebral palsy but did lead to an increase in caesarean sections (1). Consequently, analysis of the ECG ST waveform (STAN) was proposed as an additional analysis method. STAN assesses hypoxia-induced changes in the ST waveform of the ECG (3) and operates in conjunction with CTG. Implementation of STAN in clinical practice was initially associated with a beneficial reduction in hypoxia-induced outcomes (metabolic acidosis and moderate/ severe neonatal encephalopathy) compared to CTG alone (4). However, recent meta-analyses of clinical trials demonstrated no clear advantage of STAN with CTG over CTG alone with respect to primary outcomes (5,6).STAN markers are based on the shape of the ECG waveform. Other ECG markers for hypoxia detection have been suggested, namely, atrioventricular (AV) conduction delay (PR) (7,8), the relationship of AV delay and HR (PR/RR and PR-HR) (9,10) and ventricular activation and repolarization (QT) (11) and HR-corrected QT (QT c,Bazett and Qt c,Hodges ), as well as heart rate variability (HRV) in the temporal and frequency domain. These markers are all interval-based, i.e., they use time intervals between characteristic points in the ECG. A major di...

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Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Ecg-based Physiological Markersmentioning

confidence: 99%

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Comparison of ECG-based physiological markers for hypoxia in a preterm ovine model

et al. 2016

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“…Previous studies have suggested that fetal heart-rate variability (HRV) is affected by metabolic acidosis during labor [19,20] . HRV is mediated by parasympathetic and sympathetic activities, which involve two arms of the autonomic nervous system (ANS).…”

Section: Introductionmentioning

confidence: 99%

Fetal Heart-Rate Variability: Validation of a New Continuous, Noninvasive Computerized Analysis

Garabédian

Butruille²,

Servan-Schreiber³

et al. 2016

Gynecol Obstet Invest

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Objective: We developed a computerized heart-rate variability index related to the fetal parasympathetic activity: the Fetal Stress Index (FSI). The objective was to determine whether the FSI is related to the visual analysis of the fetal heart rate (FHR). Methods: Thirty tracings recorded at a labor ward were classified according to the NICHD categories: (I) normal FHR tracing, (II) intermediate risk of acidosis, and (III) high risk. FSI was calculated as minimum, maximum, and mean, and was evaluated before the onset of the FHR pattern, during the 10 min following, and between 10 and 20 min after that. Results: The FSI for categories II and III was similar to that of category I before the onset of the FHR pattern. FSI min was lower just after the onset of the abnormal FHR in category III, compared with that of category I (33 vs. 43, p < 0.001). Between 10 and 20 min after the onset of the abnormal FHR, we observed a significant reduction in FSI min in categories II and III (44 vs. 39 vs. 29.7, p < 0.0001). Conclusion: Although further studies are necessary for the sake of clinical validation, FSI could constitute an interesting method for the evaluation of fetal well-being.

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“…With computerized analysis of tracings now available, we can rigorously test hypotheses about EFM patterns, such as the optimal defi nition of reduced variability. Furthermore, it is also possible to separate the different frequency components of heart rate variability corresponding to the clinical concepts of short-and long-term variability [22,38,50,64,69] . Considerable debate remains regarding the best method to measure the various components of variability and what components or ratio of components are the most discriminating of metabolic acidemia in general [22,50,52,64,68] .…”

Section: Three Basic Steps In Clinical Monitoringmentioning

confidence: 99%

New perspectives in electronic fetal surveillance

Hamilton¹,

Warrick²

2012

Journal of Perinatal Medicine

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Despite its recognized limitations, fetal heart rate monitoring is a mainstay of intrapartum care. Although the basic technology in standard electronic fetal monitors has changed little in recent decades, clinical behavior in response to heart rate monitoring has changed considerably. In addition to clearly defi ned nomenclature and clinical guidelines, there is an increased awareness that environmental and human factors can impair clinical judgment, resulting in delayed intervention and, consequently, birth-related injury. This review examines three essential steps that affect clinical outcome: (1) signal acquisition, (2) associations with physiological outcome, and (3) clinical intervention. Only the third step is directly responsible for changing clinical outcome. However, timely initiation of interventions is dependent upon the second step, which is dependent upon the fi rst step. Thus, defi ciencies at each step tend to accumulate and contribute to the worsening of overall clinical outcome. This review article summarizes advances occurring at each step. The synergy and convergence of innovations in engineering, mathematics, and behavioral science shows considerable promise in intrapartum fetal surveillance.

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Fetal autonomic response to severe acidaemia during labour

Abstract: The autonomic nervous system of human fetuses at term responds adequately to severe stress during labour. Normalised low and high frequency power of heart-rate variability might be able to discriminate between normal and abnormal fetal condition.

Cited by 56 publications

References 41 publications

Comparison of ECG-based physiological markers for hypoxia in a preterm ovine model

Comparison of ECG-based physiological markers for hypoxia in a preterm ovine model

Fetal Heart-Rate Variability: Validation of a New Continuous, Noninvasive Computerized Analysis

New perspectives in electronic fetal surveillance

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