New computerized fetal heart rate analysis for surveillance of intrauterine growth restriction

Huhn, Evelyn A.; Lobmaier, Silvia M.; Fischer, T.; Schneider, Raphaël; Bauer, Axel; Schneider, K. T. M.; Schmidt, Georg

doi:10.1002/pd.2728

Cited by 56 publications

(76 citation statements)

References 17 publications

(24 reference statements)

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“…Our optimal parameter values were different from those reported by Huhn et al 11 This may be because of the intrinsic differences between antepartum and intrapartum FHR traces, or because of the small data set used by Huhn et al 11 Nevertheless, we found that the parameter combination reported by Huhn et al would also perform relatively well for labour traces (data not shown). 11 Huhn et al reported that AC PRSA yields better results than DC PRSA for diagnosing growth-retarded fetuses before labour;…”

Section: Strength and Limitationscontrasting

confidence: 53%

“…We analysed end-of-labour traces, which are fundamentally different from pre-labour (antepartum) traces such as the ones used by Huhn et al 11 Antepartum traces are more likely to be stable (constant mean and variance), and usually do not have decelerations, whereas end-of-labour traces are very likely to have FHR decelerations. Huhn et al showed that AC PRSA in antepartum FHR traces is reduced in growth-retarded fetuses.…”

Section: Discussionmentioning

confidence: 99%

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Phase‐rectified signal averaging for intrapartum electronic fetal heart rate monitoring is related to acidaemia at birth

Georgieva

Papageorghiou

Payne

et al. 2014

BJOG

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Objective Recent studies suggest that phase-rectified signal averaging (PRSA), measured in antepartum fetal heart rate (FHR) traces, may sensitively indicate fetal status; however, its value has not been assessed during labour. We determined whether PRSA relates to acidaemia in labour, and compare its performance to short-term variation (STV), a related computerised FHR feature. Design Historical cohort.Setting Large UK teaching hospital.Population All 7568 Oxford deliveries that met the study criteria from April 1993 to February 2008.Methods We analysed the last 30 minutes of the FHR and associated outcomes of infants. We used computerised analysis to calculate PRSA decelerative capacity (DC PRSA ), and its ability to predict umbilical arterial blood pH ≤ 7.05 using receiver operator characteristic (ROC) curves and event rate estimates (EveREst). We compared DC PRSA with STV calculated on the same traces.Main outcome measure Umbilical arterial blood pH ≤ 7.05.Results We found that PRSA could be measured in all cases. DC PRSA predicted acidaemia significantly better than STV: the area under the ROC curve was 0.665 (95% CI 0.632-0.699) for DC PRSA , and 0.606 (0.573-0.639) for STV (P = 0.007). EveREst plots showed that in the worst fifth centile of cases, the incidence of low pH was 17.75% for DC PRSA but 11.00% for STV (P < 0.001). DC PRSA was not highly correlated with STV.Conclusions DC PRSA of the FHR can be measured in labour, and appears to predict acidaemia more accurately than STV. Further prospective evaluation is warranted to assess whether this could be clinically useful. The weak correlation between DC PRSA and STV suggests that they could be combined in multivariate FHR analyses.

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Section: Strength and Limitationscontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Phase‐rectified signal averaging for intrapartum electronic fetal heart rate monitoring is related to acidaemia at birth

Georgieva

Papageorghiou

Payne

et al. 2014

BJOG

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“…A new signal-processing technique, phase-rectified signal averaging, was used to minimize noise by averaging signals. It provides separate quantification of acceleration-and deceleration-related heart rate modulations [18,21,22] . Only 3 of 30 (10.0%) fECG recordings of growth-restricted fetuses and 5 of 90 (5.6%) normal estimated fetuses had to be excluded due to poor signal quality in overnight recordings [18] .…”

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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“…Both methods might be more specific than conventional cardiotocography analysis in identifying in-utero early hypoxemic changes. Indeed, this new heart rate variability assessment has shown abnormalities in about 30 % of FGR, compared to only 5-8 % analysed with conventional computer analysis [72]. Moreover, heart rate variability analysis can be even improved by trans-abdominal fetal ECG recording [73].…”

Section: Future Directionsmentioning

confidence: 99%

Fetal Growth Restriction (FGR)—Fetal Evaluation and Antepartum Intervention

Ferrazzi

Stampalija

Makarenko

et al. 2013

Curr Obstet Gynecol Rep

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Fetal growth restriction (FGR) is a pathological condition that refers to a fetus that fails to reach his/her genetically predetermined growth potential. By epigenetic effects, substrate and energy deprivation in utero modify fetal metabolism with possible life-long impacts. Management of FGR still represents one of the main challenges for the obstetricians, both for the complexities of management of severe early FGR and for the diagnostic difficulties in late and term FGR. Late onset and term FGR define an intrauterine trajectory of growth that falls below its potential late in gestation, after 34 and 37 weeks of gestation, respectively. Ultrasound biometry examination is crucial for an accurate diagnosis of FGR. Pregnancies at risk of FGR should be considered for longitudinal ultrasound monitoring beyond the routine ultrasound screening at 20 weeks of gestation. Functional assessment of placental and fetal circulation by Doppler velocimetry and blood flow volume, together with computerized assessment of fetal heart rate variability, are key examinations in early and late FGR to assess severity of the disease and monitor fetal wellbeing. Appropriate timing of delivery in early FGR might change the outcome, and appropriate monitoring in late and term FGR might avoid unnecessary interventions.

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New computerized fetal heart rate analysis for surveillance of intrauterine growth restriction

Abstract: The results of AAC are in both groups comparable to STV. Longitudinal studies are needed to investigate the association of AAC with the clinical outcome of the newborn.

Cited by 56 publications

References 17 publications

Phase‐rectified signal averaging for intrapartum electronic fetal heart rate monitoring is related to acidaemia at birth

Phase‐rectified signal averaging for intrapartum electronic fetal heart rate monitoring is related to acidaemia at birth

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

Fetal Growth Restriction (FGR)—Fetal Evaluation and Antepartum Intervention

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