Change in electrocardiogram T-wave amplitude during umbilical cord compression is predictive of fetal condition in sheep

Watanabe, Takanori; Okamura, Koji; Tanigawara, Shingo; Shintaku, Yuichi; Akagi, Kozo; Endo, Hidetaka; Yajima, Akira

doi:10.1016/0002-9378(92)91867-a

Cited by 17 publications

(13 citation statements)

References 15 publications

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“…Therefore, repetitive asphyxial episodes may lead to intrauterine death or striatal damage in survivors. (Pediatr Res 37: 707-713, 1995) Abbreviations ECoG, electrocorticogram CI, cortical impedance HR, heart rate MAP, mean arterial blood pressure GABA, y-amino butyric acid have shown increasing acidosis and electrocardiographic evidence of asphyxia during repeated umbilical cord occlusions (3). However, the relationship between cardiac function, cerebral function, and neuronal loss after recurrent episodes of fetal asphyxia is not clear.…”

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confidence: 99%

Repeated Episodes of Umbilical Cord Occlusion in Fetal Sheep Lead to Preferential Damage to the Striatum and Sensitize the Heart to Further Insults

et al. 1995

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The effect of repeated episodes of asphyxia on the fetal cardiovascular system and CNS was examined. The umbilical cord was occluded for 5 min, four times, at 30-min intervals in 11 chronically instrumented fetal sheep (118-126 d). Fetal electrocorticogram (ECoG), cortical impedance, ECG, heart rate, and blood pressure were continuously recorded for 3 d, after which neuronal loss was determined histologically. Each occlusion resulted in fetal hypoxemia and bradycardia accompanied by increased TIQRS ratio. Progressively severe hypotension and lactic acidosis developed during successive occlusions. The ECoG was depressed and cortical impedance increased with each occlusion. During the final occlusion, blood pressure fell to 3.5 -C 1 kPa and heart rate to 93 + 9 bpm, TIQRS ratio increased to 0.44 + 0.3, and lactate rose to 7.2 2 1.2 mMIL. Three animals died from cardiac fibrillation during recirculation after the third or fourth occlusion. After the asphyxial episodes, blood pressure and heart rate returned to normal, and the T wave was inverted for 310 + 155 min. Lactate returned to baseline within 24 h. The ECoG remained depressed for 90 + 35 min, and intermittent Prenatal asphyxia is thought to be a cause of intrauterine death or impaired postnatal neurologic development in survivors. However, specific cause and effect relationships have been difficult to establish in the human fetus because of inadequate means of monitoring fetal events. W e have previously shown that repeated episodes of cerebral ischemia in the fetal sheep alter the degree and distribution of brain injury compared with single insults (1). In particular, these repeated insults result in the loss of striatal neurons.Intermittent partial umbilical cord occlusion has been reported to cause cerebral white matter injury in fetal sheep (2). Others seizures developed at 3.3 -C 1.4 h after the last occlusion. Neuronal loss was primarily found in the striatum. The extent of neuronal loss correlated with the degree of hypotension, increase in T/QRS ratio, duration of postasphyxial ECoG depression, and number of seizures. These results indicate that transient asphyxial episodes compromise the ability of the heart to tolerate additional insults and further suggest that neuronal loss is a consequence of cardiovascular compromise secondary to asphyxia. Therefore, repetitive asphyxial episodes may lead to intrauterine death or striatal damage in survivors. (Pediatr Res 37: 707-713, 1995) Abbreviations ECoG, electrocorticogram CI, cortical impedance HR, heart rate MAP, mean arterial blood pressure GABA, y-amino butyric acid have shown increasing acidosis and electrocardiographic evidence of asphyxia during repeated umbilical cord occlusions (3). However, the relationship between cardiac function, cerebral function, and neuronal loss after recurrent episodes of fetal asphyxia is not clear. W e have previously shown that systemic asphyxia induced by umbilical cord occlusion in fetal sheep results in hippocampal injury, the severity of which is related to th...

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Repeated Episodes of Umbilical Cord Occlusion in Fetal Sheep Lead to Preferential Damage to the Striatum and Sensitize the Heart to Further Insults

et al. 1995

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“…The rationale is that fetal acidemia is associated with fetal ECG ST-segment elevation and increased T-wave amplitude. [2][3][4][5][6] The monitor for fetal ECG ST-segment analysis uses proprietary software to detect these ECG changes and then issues a visual alert ("ST event") when these changes occur.…”

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A Randomized Trial of Intrapartum Fetal ECG ST-Segment Analysis

Belfort

Saade

Thom

et al. 2015

Obstetrical &Amp; Gynecological Survey

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“…This ratio was proposed as a quantitative measure of the T wave amplitude to eliminate issues with signal gain and amplification from transabdominal electrodes. The T/QRS ratio is known to be affected by myocardial hypoxia and may serve as a marker for it [34–37].…”

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confidence: 99%

A systematic review on the utility of non-invasive electrophysiological assessment in evaluating for intra uterine growth restriction

Smith

Nair

Warty

et al. 2019

BMC Pregnancy Childbirth

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Background Non-invasive electrophysiological assessment (NIEA) is an evolving area in fetal surveillance and is attracting increasing research interest. There is however, limited data outlining its utility in evaluating intra uterine growth restriction (IUGR). The objective of this study was to carry out a systematic review to outline the utility of NIEA parameters in evaluating IUGR. Methods A systematic review of peer reviewed literature was performed, searching PUBMED, Ovid MEDLINE and EMBASE. The outcomes of interest included NIEA parameters [P wave duration, PR interval, QRS duration, QT interval, T/QRS ratio, short term variability (STV) and long term variability (LTV)] and a descriptive summary of relevant studies as well. Results Sixteen studies were identified as suitable for inclusion. The utility of NIEA parameters were investigated in tabular form. In particular, QRS and QT duration, T/QRS ratio, STV and PRSA analysis displayed utility and merit further consideration in evaluating for IUGR. Issues identified in the review were in relation to variances in definition of IUGR, small sample sizes and the lack of technological consistency across studies. Conclusion NIEA shows promise as an adjunct surveillance tool in fetal diagnostics for IUGR. Larger prospective studies should be directed towards establishing reliable parameters with a focus on uniformity of IUGR definition, technological consistency and the individualisation of NIEA parameters. Electronic supplementary material The online version of this article (10.1186/s12884-019-2357-9) contains supplementary material, which is available to authorized users.

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Change in electrocardiogram T-wave amplitude during umbilical cord compression is predictive of fetal condition in sheep

Cited by 17 publications

References 15 publications

Repeated Episodes of Umbilical Cord Occlusion in Fetal Sheep Lead to Preferential Damage to the Striatum and Sensitize the Heart to Further Insults

Repeated Episodes of Umbilical Cord Occlusion in Fetal Sheep Lead to Preferential Damage to the Striatum and Sensitize the Heart to Further Insults

A Randomized Trial of Intrapartum Fetal ECG ST-Segment Analysis

A systematic review on the utility of non-invasive electrophysiological assessment in evaluating for intra uterine growth restriction

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