The electrical axis of the fetal heart: A new criterion for fetal well-being or distress

Larks, Saul D.; Larks, Golda G.

doi:10.1016/0002-9378(65)90158-4

Cited by 16 publications

(9 citation statements)

References 4 publications

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“…The findings contrast with those previously described by Larks and Larks (1965) who suggested that a shift of cardiac axis to the right occurred with fetal distress. The right axis deviation described in their study of 11 cases of severe fetal depression at birth showed very pronounced changes, with cardiac axes between 210" and 240".…”

Section: Fetal and Neonatal Cardiac Axes And Apgar Scorescontrasting

confidence: 99%

“…An analysis was made of clinical condition at birth in relation to changes in cardiac axis during Larks (1965) and Larks and Larks (1965) has shown that fetal complexes recorded from maternal abdominal leads resemble Lead I1 of the neonatal ECG, and therefore the theoretical projection of the fetal ECG on the appropriate side of the Einthoven triangle can be used to estimate the fetal cardiac axis. Larks pointed out that, as the sine function is a double-valued function, it is not possible to specify completely the quadrant in which the angle falls.…”

Section: Fetal and Neonatal Cardiac Axes And Apgar Scoresmentioning

confidence: 99%

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Vectorcardiography and Acid‐base Balance in the Human Fetus

Symonds

1972

BJOG

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Summary An analysis of the configuration of the fetal electrocardiogram assessed by recording the ratio of the positive and negative deflections of the QRS complex has been performed in relation to the QRS complex of the neonatal electrocardiogram. Changes in R/S ratios in the fetal electrocardiogram late in labour were significantly related to changes in Lead II of the neonatal electrocardiogram. On the basis of the method described by Larks (1965) the mean cardiac axis of the fetus early in labour was +144.5° and late in labour +143.2°. The mean neonatal cardiac axis recorded within five hours after delivery was +134°. The fetal cardiac axis showed a significant shift to the left in relation to fetal acidosis and hyperkalaemia. Similar changes were seen in the neonatal electrocardiogram in relation to biochemical changes.

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Section: Fetal and Neonatal Cardiac Axes And Apgar Scorescontrasting

confidence: 99%

Section: Fetal and Neonatal Cardiac Axes And Apgar Scoresmentioning

confidence: 99%

Vectorcardiography and Acid‐base Balance in the Human Fetus

Symonds

1972

BJOG

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“…Recently, longitudinal studies followed pregnancies from 14 to 41 weeks of pregnancy and performed fetal ECG measurements during different stages of gestation [ 18 , 23 , 24 ]. In the 1960’s, Larks and colleagues described the orientation of the electrical fetal heart axis [ 25 , 26 , 28 , 29 ]. All mentioned studies performed fetal ECG recordings with different conduction and analysis techniques.…”

Section: Discussionmentioning

confidence: 99%

“…In a group around 20 weeks of gestation, the following mean values were found by Chia and Taylor respectively: P wave length 43.9 ms, PR interval 102.1/91.7 ms, QRS duration 47.2/40.7 ms, QT interval 224.0/242.3 ms and T wave duration 123.8 ms [ 23 , 24 ]. Larks found a normal range of the fetal heart axis between +100 and +160°, with a mean value of +134° in term fetuses during labour [ 29 ]. Due to the lack of correcting for the fetal position in utero, fetuses in breech position showed a negative electrical heart axis (−180 to 0°) [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Normal ranges for fetal electrocardiogram values for the healthy fetus of 18–24 weeks of gestation: a prospective cohort study

Verdurmen

Lempersz

Vullings

et al. 2016

BMC Pregnancy Childbirth

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BackgroundThe fetal anomaly ultrasound only detects 65 to 81 % of the patients with congenital heart disease, making it the most common structural fetal anomaly of which a significant part is missed during prenatal life. Therefore, we need a reliable non-invasive diagnostic method which improves the predictive value for congenital heart diseases early in pregnancy. Fetal electrocardiography could be this desired diagnostic method. There are multiple technical challenges to overcome in the conduction of the fetal electrocardiogram. In addition, interpretation is difficult due to the organisation of the fetal circulation in utero. We want to establish the normal ranges and values of the fetal electrocardiogram parameters in healthy fetuses of 18 to 24 weeks of gestation.Methods/DesignWomen with an uneventful singleton pregnancy between 18 and 24 weeks of gestation are asked to participate in this prospective cohort study. A certified and experienced sonographist performs the fetal anomaly scan. Subsequently, a fetal electrocardiogram recording is performed using dedicated signal processing methods. Measurements are performed at two institutes. We will include 300 participants to determine the normal values and 95 % confidence intervals of the fetal electrocardiogram parameters in a healthy fetus. We will evaluate the fetal heart rate, segment intervals, normalised amplitude and the fetal heart axis. Three months postpartum, we will evaluate if a newborn is healthy through a questionnaire.DiscussionFetal electrocardiography could be a promising tool in the screening program for congenital heart diseases. The electrocardiogram is a depiction of the intimate relationship between the cardiac nerve conduction pathways and the structural morphology of the fetal heart, and therefore particularly suitable for the detection of secondary effects due to a congenital heart disease (hypotrophy, hypertrophy and conduction interruption).

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“…Clearly in real time this was not going to be useful. In 1965 LARKS [6] introduced a new concept into fetal electrocardiography of estimating the axis of the fetal heart by measuring the sum of wave. Nevertheless, it is interesting to see that the negative and positive deflections of the QRS this study showed significant prolongation of complex in readings of the abdominal imaging the QT interval in the presence of a low cord of the fetal ECG.…”

Section: Introductionmentioning

confidence: 99%

Review article

1986

Journal of Perinatal Medicine

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The first recording of the fetal electrocardiogram was described 80 years ago. Since that time only the peak of the QRS complex has been used in fetal monitoring for the measurement of fetal heart rate. Attempts to quantify changes in the configuration and time constants have been attempted over the last 30 years but despite the data obtained from animal experiments suggesting configurational changes in relation to hypoxia, the problems of electrical noise and signal distortion have restricted the application of these observations in the detection of fetal hypoxia in the human. Recent technical developments have now enabled continuous real time monitoring of the PR interval, heart rate and ST segment, and their findings and the interrelationships between different variables suggest a new approach to precise monitoring of the fetal state.

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The electrical axis of the fetal heart: A new criterion for fetal well-being or distress

Cited by 16 publications

References 4 publications

Vectorcardiography and Acid‐base Balance in the Human Fetus

Vectorcardiography and Acid‐base Balance in the Human Fetus

Normal ranges for fetal electrocardiogram values for the healthy fetus of 18–24 weeks of gestation: a prospective cohort study

Review article

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