Is fetal heart rate variability a good predictor of fetal outcome?

Samueloff, Arnon; Langer, Oded; Berkus, Michael D.; Field, Nancy T.; Xenakis, Elly; Ridgway, Louis E.

doi:10.3109/00016349409013391

Cited by 41 publications

(14 citation statements)

References 8 publications

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“…In 1968 pregnancies the presence of moderate variability had 499% negative predictive value for adverse outcome, defined as 5-minute Apgar score 57, and 485% negative predictive value for umbilical arterial blood pH 57.2 [12]. In a further publication from the same group, it was concluded that in 2200 consecutive deliveries, fetuses with a normal FHR trace, or mild variable decelerations, or decreased FHR variability, or mild bradycardia, or accelerations present, in the last 30-minute segment recorded before delivery, had an Apgar score 7 in 99.7%, and umbilical arterial cord pH 7.15 in 96.9% of cases [13].…”

Section: Resultsmentioning

confidence: 98%

Fetal acidemia and electronic fetal heart rate patterns: Is there evidence of an association?

Parer

King

Flanders

et al. 2006

The Journal of Maternal-Fetal & Neonatal Medicine

148

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The validity of the relationship between certain FHR patterns and fetal acidemia and/or vigor, is supported by observations from the literature. In addition four assumptions commonly used in clinical management are supported. These conclusions need to be confirmed by a prospective examination of a large number of consecutive, unselected FHR patterns, and their relationship to newborn acidemia. Pending the completion of such studies, these observations can be used to justify certain aspects of current clinical management, and may assist in standardizing the diversity of opinions regarding FHR pattern management.

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Section: Resultsmentioning

confidence: 98%

Fetal acidemia and electronic fetal heart rate patterns: Is there evidence of an association?

Parer

King

Flanders

et al. 2006

The Journal of Maternal-Fetal & Neonatal Medicine

148

View full text Add to dashboard Cite

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“…A reduction in fetal heart rate variability (FHRV), particularly when it is combined with other fetal heart rate (FHR) abnormalities, is reported to be an important indicator of fetal hypoxia and developing acidemia both in the term (58) and preterm fetus (29). Perhaps surprisingly, however, many clinical studies have suggested there is either a weak or no relationship between FHRV and Apgar scores or cord acid-base measures during labor (37, 43). Indeed, the initial response to acute experimental hypoxemia or repeated asphyxia in the term fetus is an increase in FHRV rather than a decrease (9,24,33,55); typically FHRV then becomes suppressed if the insult is continued or repeated (16,20,33,55).…”

mentioning

confidence: 98%

Fetal heart rate variability and brain stem injury after asphyxia in preterm fetal sheep

George¹,

Gunn²,

Westgate³

et al. 2004

American Journal of Physiology-Regulatory, Integrative and Comp

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This study was undertaken to determine the mechanisms mediating changes in fetal heart rate variability (FHRV) during and after exposure to asphyxia in the premature fetus. Preterm fetal sheep at 0.6 of gestation (91 +/- 1 days, term is 147 days) were exposed to either sham occlusion (n = 10) or to complete umbilical cord occlusion for either 20 (n = 7) or 30 min (n = 10). Cord occlusion led to a transient increase in FHRV with abrupt body movements that resolved after 5 min. In the 30 min group there was a marked increase in FHRV in the final 10 min of occlusion related to abnormal atrial activity. After reperfusion, FHRV in both study groups was initially suppressed and progressively increased to baseline levels over the first 4 h of recovery. In the 20 min group this improvement was associated with return of normal EEG activity and movements. In contrast, in the 30 min group the EEG was abnormal with epileptiform activity superimposed on a suppressed background, which was associated with abnormal fetal movements. As the epileptiform activity resolved, FHRV fell and became suppressed for the remainder of the study. Histological assessment after 72 h demonstrated severe brain stem injury in the 30 min group but not in the 20 min group. In conclusion, during early recovery from asphyxia, epileptiform activity and associated abnormal fetal movements related to evolving neural injury can cause a confounding transient increase in FHRV, which mimics the normal pattern of recovery. However, chronic suppression of FHRV was a strong predictor of severe brain stem injury.

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“…Since the fetus is mainly inaccessible to direct measurement during pregnancy, most studies are either based on fetal heart rate patterns obtained by cardiotocography [2] or experiments on chronically instrumented animals [3]. Compared to the former, alternative, more precise tools such as magnetocardiogram or abdominal electrocardiogram offer significant improvements for the beat-to-beat analysis of FHR variability.…”

Section: Introductionmentioning

confidence: 99%

Spectral Analysis of Fetal Heart Rate Variability in Fetuses with Supraventricular Extrasystoles

Troeger

Schaub²,

Bernasconi³

et al. 2003

Fetal Diagn Ther

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Objective: Fetal heart rate (FHR) variability is an important indicator of fetal well-being. In fetal tachyarrhythmias, however, visual analysis of FHR variability is limited. We therefore applied power spectral analysis of FHR to evaluate the fetal state. Methods: Fetal R-R intervals were detected by means of an external ECG in 3 fetuses with supraventricular extrasystoles after cardiac malformations had been excluded by fetal echocardiography. Using an autoregressive model, power spectral densities were calculated from 20 consecutive 256-beat segments for the following frequency bands: <0.03 Hz (very low frequency), 0.03–0.069 Hz (low frequency; LF), 0.07–0.129 Hz (mid-frequency) and 0.13–1.0 Hz (high frequency; HF). Results: The FHR variability in fetal supraventricular extrasystoles mainly resulted from the HF component (63.91 ± 6.97%). The sympatho-vagal balance (LF/HF) was decreased in the tracings with extrasystoles (0.13). Conclusion: The analysis of FHR variability in fetal supraventricular extrasystoles revealed an imbalance between sympathetic and parasympathetic regulation.

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Is fetal heart rate variability a good predictor of fetal outcome?

Abstract: FHR variability by itself cannot serve as the only indicator of fetal wellbeing. The presence of low variability should alert the physician; however, good FHR variability should not be interpreted as reassuring.

Cited by 41 publications

References 8 publications

Fetal acidemia and electronic fetal heart rate patterns: Is there evidence of an association?

Fetal acidemia and electronic fetal heart rate patterns: Is there evidence of an association?

Fetal heart rate variability and brain stem injury after asphyxia in preterm fetal sheep

Spectral Analysis of Fetal Heart Rate Variability in Fetuses with Supraventricular Extrasystoles

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