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

Abstract

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.

Heart rate variability categories of fluctuation amplitude and complexity: diagnostic markers of fetal development and its disturbances

“…Also, from a physiological point of view, the change from the predominant formation and growth of vagal and sympathetic complex structures before 32 WGA towards the increase of behavioral patterns of the mainly developed complex organism after 32 WGA indicates a phase transition. A corresponding transition range has been reported in the development of the HRV power spectra and complexity indices (Van Leeuwen et al, 2003;Hoyer et al, 2017). In a previous study using a former recruitment state of the Jena data base of 312 recordings from 60 women using multivariate linear mixed models over 4 maturation segments (<27, 27-31, 31+1-35, >35+1 WGA) we found qualitatively similar relationships of corresponding HRV indices (Schneider et al, 2018).…”

“…Influence of IUGR reference group 2: Fetal non-invasive ECG recordings obtained from maternal abdominal surface were performed in the Kharkiv perinatal center. The methodology has been previously described (Hoyer et al, 2017). Since the extraction of high-quality beat-to-beat variability using fetal ECG is still a challenge (see e.g.…”

Heart Rate Fragmentation as a Novel Biomarker of Adverse Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis

“…More generally, HRF metrics belong to the new class of dynamical probes (Cysarz et al, 2000 ; Goldberger, 2006 ; Costa et al, 2014 ; Porta et al, 2015 ; Makowiec et al, 2015 ; Hoyer et al, 2017 ; Zhang et al, 2017 ) that can report, in real-time, on salient aspects of integrative, multiscale, regulatory systems and of their breakdown with aging and disease. The use of these probes may enhance the clinical utility of traditional risk assessment tools (Tables 3 , 4 ) and of other emerging technologies, such as genomic profiling.…”

Diagnostic equivalency of mobile CTG devices and remote analysis to conventional on-site nonstress test

“…This has implications not only in acute care, but may also affect the quality of an entire future life burdened with the consequences of hypoxia. 11 The method routinely used for antenatal monitoring is cardiotocography (CTG), which allows for simultaneous detection of FHR (C -cardio) with an ultrasound transducer, and uterine contractions with a tocodynamometer (T -toco), and a graphic (G) presentation of their values as a function of time. 12 Contemporary CTG devices are also able to detect maternal heart rate (MHR) and fetal movements, or allow the mother to manually mark fetal movements.…”