The pre-ejection period of the fetal heart: Detection during labor with Doppler ultrasound

Organ, L.W.; Bernstein, A.; Rowe, I.; Smith, K.C.

doi:10.1016/0002-9378(73)90593-0

Cited by 27 publications

(11 citation statements)

References 6 publications

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“…Thus, enhancement of myocardial contractility and increase of afterload, respectively, were held responsible for the noted PEP changes. During steady state conditions Organ et al (1973a) found: PEP (mean ± SD) = 65 ± 8 msec.…”

Section: Pep In Fetal Researchmentioning

confidence: 99%

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Cardiac Pre-Ejection Period during Prenatal Life

Evers¹

1980

Gynecol Obstet Invest

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Perinatal clinicians are confronted with the problem that they are supposed to gather information about the condition of the unborn child almost exclusively by monitoring the rate of the fetal heart. Human heart rate recording, however, is no more or less informative in utero than in the newborn nursery. Determination of the pre-ejection period (PEP) of the fetal heart might provide information regarding the performance of the heart of the human fetus in utero and about its cardiovascular adjustments during fetal distress. On the verge of introduction of clinical human fetal PEP monitoring, this article presents a review of the results obtained from chronically instrumented fetal animals as well as some preliminary data from human perinatal research. Finally, possible future developments in human fetal PEP recording are anticipated and it is concluded that the most promising feature of the PEP for clinical use appears to be its predictive value as an early antepartum indicator of possible fetal distress during subsequent labor.

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Section: Pep In Fetal Researchmentioning

confidence: 99%

“…The demonstration of Murata et al (1971) that it was possible to determine the PEP of a fetus in utero stimulated Organ et al (1973a) in Toronto to study the behavior of this parameter in the acute sheep experiment. They found that the PEP was shortened during hypoxemia, and lengthened during umbilical cord occlusion.…”

Section: Pep In Fetal Researchmentioning

confidence: 99%

Cardiac Pre-Ejection Period during Prenatal Life

Evers¹

1980

Gynecol Obstet Invest

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“…in addition to this use of DUS for monitoring FHR, a body of work also exists describing the use of DUS and simultaneous ECG recordings to measure the timing of events within the cardiac cycle. (These are the pre-ejection period (PEP), isovolumic contraction time (ICVT) and the ventricular ejection time (VET) (WEISSLER et al, 1968;METZGER et al, 1970;ORGAN et al, 1973a;1973b;1980;MURATA and MARTIN, 1974;MURATA et al, 1978;HAWRYLYSHYN et al, 1980;SAMPSON, 1980). in terms of understanding the precise origin of the content of the DUS audio signals this work is actually of greater value than that concerned solely with the derivation of FHR.…”

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confidence: 96%

The information content of Doppler ultrasound signals from the fetal heart

Shakespeare

Crowe

Hayes‐Gill

et al. 2001

Med. Biol. Eng. Comput.

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Knowledge of the content of Doppler ultrasound signals from the fetal heart is essential if the performance of fetal heart rate (FHR) monitors based upon this technology is to be improved. For this reason instrumentation was constructed to enable the simultaneous collection of Doppler audio signals and the transabdominal fetal ECG (for signal registration), with a total of 22 recordings being made with an average length of around 20 minutes. These data demonstrate the transient nature of the Doppler audio data with wide variations in the signal content observable on a beat-to-beat basis. Short-time Fourier analysis enabled the content of the Doppler signals to be linked to six cardiac events, four valve and two wall motions, with higher frequency components being associated with the latter. This differing frequency content together with information regarding the direction of movement that can be discerned from Doppler signals provided a potential means of discriminating between these six events (which are unlikely to all contribute to the Doppler signal within the same cardiac cycle). Analysis of 100 records showed that wall contractions generate the most prominent signals, with atrial contraction recognisable in all records and ventricular wall contraction in 95% (although its amplitude is only around 30% of that of the atrial signal). Valve motion, with amplitudes between 15 and 25% that of the atrial wall signal, were visible in 75% of records. These results suggest means by which the six events that contribute to the Doppler signal may be distinguished, providing information that should enable an improvement in the current performance of Doppler ultrasound-based FHR monitors.

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“…Thus, we conclude that certain important findings from animal experiments may be transferable to the human fetus during birth [5,6,7,12,46,48]. The determination of absolute and relative PEP simultaneously with CTG apparentiy makes possible a more detailed assessment of the state.of the fetus during certain types of deceleration.…”

Section: Discussionmentioning

confidence: 90%

Characteristic changes of the pre-ejection period of the human fetal heart during umbilical cord complications

Bärtling¹,

Klöck²,

Bräcker³

et al. 1980

Journal of Perinatal Medicine

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l IntroductionA differential analysis of the cardiotocogram allows conclusions äs to the functional state of the fetus. However, the interpretations of changes in the heart rate depend to a large extent on the experience of the examiner because of the poorly defined deliminations of specific pattems of heart rate changes. New techniques enable the recording of the pre-ejection period (PEP) of the human fetal heart; i.e., the time between ventricular excitation and aortic pressure rise, continuously parallel with the CTG [3,12,16,24,27]. The PEP is a measure of the myocardial contractility. Thus, with adrenergic Stimulation the cardiac contractility increases and the PEP is shortened. On the other hand, an increase in peripheral resistance leads to a lengthening of the PEP äs does a decrease of ventricular filling. Recent experiments in fetal lambs [20,21,37,52,53] showed in acute and chronic experiments [20,29] that in acute hypoxia the PEP falls below the normal ränge, and that with compression the PEP is increased while the relation of the PEP to duration of systole (relative PEP = PEPr) is constant. Furthermore, with umbilical cord complications characteristic PEP changes are seen and chronic and acute hypoxia lead to changes in the baseline level of the PEP. This study de als with the question whether the results of animal experiments from PEP recording together with the CTG apply to the human fetus during birth and whether the characteristics of the PEP and heart rate allow conclusions äs to the pathophysiology of umbilical cord complications. Curriculum vitae THOMAS BÄRTLING was born in 1947 in Material and methodDuring the delivery of 115 fetuses the course of the absolute and relative PEP was recorded for at least 50-90 minutes simultaneously with the CTG. Of the 115 fetuses, 38 had anuchal umbilical cord noted at birth. The CTG and PEP recordings of these 38 fetuses are the subject of the study. During or shortly after PEP recording a blood sample was obtained from the fetal scalp for the analysis of pH, base excess and pC0 2 . Blood gas analysis from umbilical artery blood was performed immediately postpartum. In five fetuses with documented cord complication the transcutaneous oxygen tension was recorded from the presenting part according to the method of HUCH [28,29,30] and recorded together with the PEP and

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The pre-ejection period of the fetal heart: Detection during labor with Doppler ultrasound

Cited by 27 publications

References 6 publications

Cardiac Pre-Ejection Period during Prenatal Life

Cardiac Pre-Ejection Period during Prenatal Life

The information content of Doppler ultrasound signals from the fetal heart

Characteristic changes of the pre-ejection period of the human fetal heart during umbilical cord complications

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