Fetal heart rate variability during pregnancy, obtained from non‐invasive electrocardiogram recordings

Laar, Joeh Judith van; Warmerdam, Gjj Guy; Verdurmen, Kmj Kim; Vullings, Rik; Peters, C.H.L.; Houterman, Saskia; Wijn, Pff Pieter; Andriessen, Peter; Pul, Carola van; Oei, S.G.

doi:10.1111/aogs.12286

Cited by 47 publications

(54 citation statements)

References 29 publications

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“…Using high-resolution fECG data, the new analysis technique could better discriminate between normal fetuses and fetuses who were small for gestational age than conventional short-term variation measures. Another study investigated the applicability of spectral analysis in abdominal fECG recording [23] . Forty women were studied longitudinally throughout pregnancy with an abdominal 8-channel ECG monitor (ECG prototype called NEMO) with a sampling rate of 1,000 Hz and a recording duration of 45 min at daytime.…”

Section: Discussionmentioning

confidence: 99%

Quality Predictors of Abdominal Fetal Electrocardiography Recording in Antenatal Ambulatory and Bedside Settings

Huhn¹,

Müller

Meyer

et al. 2016

Fetal Diagn Ther

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Background: Fetal electrocardiography using an abdominal monitor (Monica AN24™) could increase the diagnostic use of fetal heart rate (fHR) variability measurements. However, signal quality may depend on factors such as maternal physical activity, posture, and bedside versus ambulatory setting. Methods: Sixty-three healthy women wore the monitor at home and 42 women during a hospital stay. All women underwent a posture experiment, and all home and 13 hospital participants wore the monitor during daytime and nighttime. The success rate (SR) of fHR detection was analyzed in relation to maternal physical activity, posture, daytime versus nighttime, and other maternal and fetal predictors. Results: Ambulatorily, the SR was 86.8% for nighttime and 40.2% for daytime. The low daytime SR was largely due to effects of maternal physical activity and posture. The in-hospital SR was lower during nighttime (71.1%) and similar during daytime (43.3%). SR was related to gestational age, but not affected by pre-pregnancy and current body mass index or fetal growth restriction. Conclusions: The success of beat-to-beat fHR detection strongly depends on the home/hospital setting and predictors such as time of recording, activity levels, and maternal posture. Its clinical utility may be limited in periods of unsupervised recording with physical activity or posture shifts.

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Section: Discussionmentioning

confidence: 99%

Quality Predictors of Abdominal Fetal Electrocardiography Recording in Antenatal Ambulatory and Bedside Settings

Huhn¹,

Müller

Meyer

et al. 2016

Fetal Diagn Ther

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show abstract

“…Aside from these concerns related to implementation, little is known about the pathophysiological factors that influence the signal quality of the NI-FECG. A few contributions have partially analyzed the dependency of signal quality on some factors, such as gestational age and body-mass-index (Pieri et al 2001, Graatsma et al 2009, Reinhard et al 2012, Van Laar et al 2014, Van Leeuwen et al 2014). However, most of those studies considered a limited group of patients, or the conveyed information is incomplete to fully understand when the NI-FECG may have good quality.…”

Section: Fetal Ecg Recording Technique—state-of-the-art and Own Case-mentioning

confidence: 99%

Monitoring fetal maturation—objectives, techniques and indices of autonomic function

et al. 2017

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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.

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“…In case of average baseline T/QRS, ST events can be considered more reliable and could be considered as complementary diagnostic information. ST analysis based on relative elevations of the T/QRS ratio with respect to the baseline or standardised non-invasive fetal ECG recordings [30] might be feasible solutions, that warrant further research. In addition, the relation between signal quality and T/QRS reliability needs to be explored in future research, including analysis of the effects of signal quality of small variations in the ECG that are caused by e.g.…”

Section: Resultsmentioning

confidence: 99%

The electrical heart axis and ST events in fetal monitoring: A post-hoc analysis following a multicentre randomised controlled trial

et al. 2017

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ObjectiveReducing perinatal morbidity and mortality is one of the major challenges in modern health care. Analysing the ST segment of the fetal electrocardiogram was thought to be the breakthrough in fetal monitoring during labour. However, its implementation in clinical practice yields many false alarms and ST monitoring is highly dependent on cardiotocogram assessment, limiting its value for the prediction of fetal distress during labour. This study aims to evaluate the relation between physiological variations in the orientation of the fetal electrical heart axis and the occurrence of ST events.MethodsA post-hoc analysis was performed following a multicentre randomised controlled trial, including 1097 patients from two participating centres. All women were monitored with ST analysis during labour. Cases of fetal metabolic acidosis, poor signal quality, missing blood gas analysis, and congenital heart disease were excluded. The orientation of the fetal electrical heart axis affects the height of the initial T/QRS baseline, and therefore the incidence of ST events. We grouped tracings with the same initial baseline T/QRS value. We depicted the number of ST events as a function of the initial baseline T/QRS value with a linear regression model.ResultsA significant increment of ST events was observed with increasing height of the initial T/QRS baseline, irrespective of the fetal condition; correlation coefficient 0.63, p<0.001. The most frequent T/QRS baseline is 0.12.ConclusionThe orientation of the fetal electrical heart axis and accordingly the height of the initial T/QRS baseline should be taken into account in fetal monitoring with ST analysis.

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Fetal heart rate variability during pregnancy, obtained from non‐invasive electrocardiogram recordings

Cited by 47 publications

References 29 publications

Quality Predictors of Abdominal Fetal Electrocardiography Recording in Antenatal Ambulatory and Bedside Settings

Quality Predictors of Abdominal Fetal Electrocardiography Recording in Antenatal Ambulatory and Bedside Settings

Monitoring fetal maturation—objectives, techniques and indices of autonomic function

The electrical heart axis and ST events in fetal monitoring: A post-hoc analysis following a multicentre randomised controlled trial

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