Can fetal heart rate variability obtained from cardiotocography provide the same diagnostic value like from electrophysiological interbeat intervals

Published on Jan 1, 2021in Physiological Measurement2.309
· DOI :10.1088/1361-6579/ABC791
Dirk Hoyer21
Estimated H-index: 21
(FSU: University of Jena),
Alexander R. Schmidt27
Estimated H-index: 27
+ 7 AuthorsUwe Schneider4
Estimated H-index: 4
(FSU: University of Jena)
Sources
Abstract
OBJECTIVE Fetal heart rate variability (HRV) is widely used for monitoring fetal developmental disturbances. Only expensive fetal magnetocardiography (fMCG) allows the precise recording of the individual fetal heart beat intervals uncovering also highly frequent vagal modulation. In contrast, transabdominal fetal electrocardiography (fECG) suffers from noise overlaying the fetal cardiac signal. Cardiotocography (CTG) is the clinical method of choice, however, based on Doppler ultrasound, improper to resolve single beats concisely. The present work addresses the transferability of established electrophysiological HRV indices to CTG recordings during the fetal maturation period of 20-40 weeks of gestation (WGA). APPROACH We compared (a) HRV indices obtained from fMCG, CTG and fECG of short-term amplitude fluctuations (sAMPs) and long-term amplitude fluctuations (lAMPs) and complexity, and (b) their diagnostic value for identifying maturational age, fetal growth restriction (FGR) and small for gestational age (SGA). We used the functional brain age score (fABAS) and categories of long- and short-term regulation and complexity. MAIN RESULTS Integrating all substudies, we found: (a) indices related to long-term regulation, and with modified meaning and values of short-term regulation and sympathovagal balance (SVB) according to electrophysiological HRV standards can be obtained from CTG. (b) Models using HRV indices calculated from CTG allow the identification of maturational age and discriminate FGR from controls with almost similar precision as electrophysiological means. (c) A modified set of HRV parameters containing short- and long-term regulation and long-term/short-term ratio appeared to be most suitable to describe autonomic developmental state when CTG data is used. SIGNIFICANCE Whereas the predominantly vagally modulated beat-to-beat precise high frequencies of HRV are not assessable from CTG, we identified relevant related HRV indices and categories for CTG recordings with diagnostic potential. They require further evaluation and confirmation with respect to any issues of fetal developmental and perinatal problems in subsequent studies. This methodology significantly extends the measures of established CTG devices. Novelty and significance HRV indices provide predestinated diagnostic markers of autonomic control in fetuses. However, the established CTG does not provide the temporal precision of electrophysiological recordings. Beat-to-beat related, mainly vagally modulated behavior is not exactly represented in CTG. However, a set of CTG-specific HRV indices that are mainly comparable to established electrophysiological HRV parameters obtained by magnetocardiography or electrocardiography provided almost similar predictive value for fetal maturational age and were helpful in characterizing FGR. These results require validation in the monitoring of further fetal developmental disturbances. We recommend a corresponding extension of CTG methodology.
References30
Newest
#1Dirk HoyerH-Index: 21
Last. Uwe SchneiderH-Index: 36
view all 9 authors...
OBJECTIVE: In fetal diagnosis the myriad and diversity of heart rate variability (HRV) indices prevents a comparable routine evaluation of disturbances in fetal development and well-being. The work aims at the extraction of a small set of HRV key indices that could help to establish a universal, overarching tool to screen for any disturbance. APPROACH: HRV indices were organized in categories of short-term (prefix s) and long-term (prefix l) amplitude fluctuations (AMP), complexity (COMP), and p...
9 CitationsSource
#1Silvia M. Lobmaier (TUM: Technische Universität München)H-Index: 12
#2Javier U. Ortiz (TUM: Technische Universität München)H-Index: 9
Last. A Wacker-Gussmann (TUM: Technische Universität München)H-Index: 1
view all 10 authors...
Objectives Maternal gestational diabetes (GDM) is known to influence fetal physiology. Phase-rectified signal averaging (PRSA), an innovative signal processing technique, can be used to investigate signals obtained from fetal heart. The PRSA calculated variables “average acceleration capacity” (AAC) and “average deceleration capacity” (ADC) are established indices of autonomic nervous system (ANS) function. The aim of this study was to evaluate the influence of gestational diabetes on the fetal ...
6 CitationsSource
#1Alexander R. Schmidt (FSU: University of Jena)H-Index: 27
#2Ernst Günter Schukat-Talamazzini (FSU: University of Jena)H-Index: 12
Last. Dirk Hoyer (FSU: University of Jena)H-Index: 21
view all 12 authors...
Abstract Adverse prenatal environmental influences to the developing fetus are associated with mental and cardiovascular disease in later life. Universal developmental characteristics such as self-organization, pattern formation, and adaptation in the growing information processing system have not yet been sufficiently analyzed with respect to description of normal fetal development and identification of developmental disturbances. Fetal heart rate patterns are the only non-invasive order parame...
6 CitationsSource
#1Hernâni Gonçalves (University of Porto)H-Index: 16
#2Célia Amorim-Costa (University of Porto)H-Index: 9
Last. João BernardesH-Index: 28
view all 4 authors...
Abstract Background and objectives To assess the evolution of linear and nonlinear fetal heart rate (FHR) analysis throughout pregnancy in appropriate (AGA), small for gestational age (SGA) and preterm (PTB) fetuses. Methods A prospective cohort study was carried out in 171 singleton pregnancies divided in three groups: AGA (n = 147), SGA (n = 13) fetuses and spontaneous PTB (n = 11). FHR was recorded with an external sensor from the 24th to the 40th week of gestation. Linear time- and frequency...
12 CitationsSource
#2A. Rita GaioH-Index: 1
Last. João BernardesH-Index: 28
view all 4 authors...
OBJECTIVE: To compare longitudinal trends of cardiotocographic (CTG) parameters between small-for-gestational-age (SGA) and normal fetuses, from 24 to 41 weeks of pregnancy. METHODS: A prospective cohort study was carried out in singleton pregnancies without fetal malformations. At least one CTG was performed in each of the following intervals: 24-26 weeks+6 days, 27-29 weeks+6 days, 30-32 weeks+6 days, 33-35 weeks+6 days, 36-38 weeks+6 days and ≥39 weeks. Tracings were analyzed using the Omnivi...
9 CitationsSource
#1Dirk HoyerH-Index: 21
#2Jan J. Żebrowski (Warsaw University of Technology)H-Index: 15
Last. Uwe SchneiderH-Index: 36
view all 22 authors...
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 prognost...
29 CitationsSource
#1G SeligerH-Index: 6
#2Ariane StenzelH-Index: 1
Last. Uwe SchneiderH-Index: 36
view all 7 authors...
Dawes and Redman (DR) based their definition of short-term variation (STV) on the successive differences of mean inter-beat intervals dividing 1 min of cardiotocography recordings in 16 epochs of 3.75 s each. In contrast, heart rate variability (HRV) is based on the inter-beat intervals of discrete R peaks, also referred to as normal-to-normal (NN) intervals. Despite the historical achievements of DR in providing a robust method with the equipment available at the time to encourage the widesprea...
11 CitationsSource
#1Hernâni Gonçalves (University of Porto)H-Index: 16
#2Joana Chaves (University of Porto)H-Index: 1
Last. João BernardesH-Index: 28
view all 5 authors...
BackgroundCardiotocographic (CTG) monitors may provide fetal heart rate (FHR) signals as beat-to-beat (BTB) or alternatively at a fixed sampling rate. The aim of this study was to assess the effect of different sampling modes on the evaluation provided by a commercially available system for computer analysis of CTGs. MethodsInternal FHR signals were acquired during the last hour of labor in 27 singleton term cephalic pregnancies, using the STAN S31? fetal monitor (Neoventa, Gothemburg, Sweden). ...
10 CitationsSource
#1Dirk HoyerH-Index: 21
#2Florian TetschkeH-Index: 7
Last. Uwe SchneiderH-Index: 36
view all 7 authors...
Fetal brain development involves the development of the neuro-vegetative (autonomic) control that is mediated by the autonomic nervous system (ANS). Disturbances of the fetal brain development have implications for diseases in later postnatal life. In that context, the fetal functional brain age can be altered. Universal principles of developmental biology applied to patterns of autonomic control may allow a functional age assessment. The work aims at the development of a fetal autonomic brain a...
42 CitationsSource
Since the 1980s, cardiotocography (CTG) has been the most diffused technique to monitor fetal well-being during pregnancy. CTG consists of the simultaneous recording of fetal heart rate (FHR) signal and uterine contractions and its interpretation is usually performed through visual inspection by trained obstetric personnel. To reduce inter- and intraobserver variabilities and to improve the efficacy of prenatal diagnosis, new quantitative parameters, extracted from the CTG digitized signals, hav...
44 CitationsSource
Cited By1
Newest
#1Janine Zöllkau (Schiller International University)
#2Laura Swiderski (Schiller International University)
Last. Uwe Schneider (Schiller International University)H-Index: 4
view all 7 authors...
(1) Background: Maternal metabolic control in gestational diabetes is suggested to influence fetal autonomic control and movement activity, which may have fetal outcome implications. We aimed to analyze the relationship between maternal metabolic control, fetal autonomic heart rate regulation, activity and birth weight. (2) Methods: Prospective noninterventional longitudinal cohort monitoring study accompanying 19 patients with specialist clinical care for gestational diabetes. Monthly fetal mag...
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