Commentary: Computerised interpretation of fetal heart rate during labour (INFANT): a randomised controlled trial

Frasch, Martin G.; Boylan, Geraldine B.; Wu, Hau‐Tieng; Devane, Declan

doi:10.3389/fphys.2017.00721

Cited by 10 publications

(12 citation statements)

References 15 publications

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“…In particular, CTG is bound by a lower temporal precision in identifying beat-to-beat information (fetal heartbeat information derived with ultrasound or fetal scalp electrode by standard monitors at a uniform frequency of ~4Hz). True beat-to-beat data is needed for some of the derivative estimates of the FHR variability with a potential to improve the prediction of neonatal outcomes 53 . Its utility remains to be investigated in the future with the advance of transabdominal technologies and appropriate data collection.…”

Section: Trans-abdominal Fetal Electrocardiogram Monitoringmentioning

confidence: 99%

Computer‐based intrapartum fetal monitoring and beyond: A review of the 2nd Workshop on Signal Processing and Monitoring in Labor (October 2017, Oxford, UK)

Georgieva

Abry

Chudáček

et al. 2019

Acta Obstet Gynecol Scand

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The second Signal Processing and Monitoring in Labor workshop gathered researchers who utilize promising new research strategies and initiatives to tackle the challenges of intrapartum fetal monitoring. The workshop included a series of lectures and discussions focusing on: new algorithms and techniques for cardiotocogoraphy (CTG) and electrocardiogram acquisition and analyses; the results of a CTG evaluation challenge comparing state-of-the-art computerized methods and visual interpretation for the detection of arterial cord pH<7.05 at birth; the lack of consensus about the role of intrapartum acidemia in the etiology of fetal brain injury; the differences between methods for CTG analysis 'mimicking' expert clinicians and those derived from 'data-driven' analyses; a critical review of the results from two randomized controlled trials

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Section: Trans-abdominal Fetal Electrocardiogram Monitoringmentioning

confidence: 99%

Computer‐based intrapartum fetal monitoring and beyond: A review of the 2nd Workshop on Signal Processing and Monitoring in Labor (October 2017, Oxford, UK)

Georgieva

Abry

Chudáček

et al. 2019

Acta Obstet Gynecol Scand

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“…First, for HRV monitoring to deliver on this promise, non‐invasive acquisition of the fetal ECG from the maternal abdomen is needed at the sampling rate of 1000 Hz (Frasch et al . ). This forms the basis for a precise reconstruction of fetal heart rate time series from the R–R interval length fluctuations and to compute HRV measures such as RMSSD, SDNN or skewness deployed in the study by Yamaguchi et al .…”

mentioning

confidence: 97%

Saving the brain one heartbeat at a time

Frasch

2018

The Journal of Physiology

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In an article in this issue of The Journal of Physiology, Yamaguchi et al. (2018) set out to demonstrate the time course of changes in several widely used heart rate variability (HRV) measures during an exposure to a hypoxic-ischaemic (HI) insult using fetal sheep as a model.Although this study was conducted in a fetal model, the findings may well be useful as a surrogate for the neonate with HI encephalopathy that needs timely diagnosis for effective treatment. This information is difficult to obtain from neonatal models of HI injury due to anaesthetic confounding or from human studies where there are the confounding challenges of the treatment paradox and the lack of non-cooled controls. The team demonstrated a complex temporal profile of three linear time-domain (also referred to as statistical) HRV measures, standard deviation of the normalnormal interval (SDNN), square root of the mean squared differences of n successive RR intervals (root mean square of the successive differences; RMSSD) and skewness, during the evolving HI brain injury. SDNN and RMSSD represent the true beat-to-beat HRV measures widely deployed throughout HRV studies in all ages. In addition, and to account for the current practice of the ultrasound-based fetal heart rate monitoring, the long-term variation (LTV) and short-term variation (STV) metrics were also computed. These two metrics, unique to fetal monitoring, are not true beat-to-beat HRV measures, but, rather, even in the case of STV, derived from an average over roughly 12 fetal heart beats (3.75 s or 1/16th min epoch). Two groups were studied: mild HI, known to be associated with only selective subcortical neuronal injury, and severe HI, associated with a pattern of diffuse white matter injury and severe subcortical neuro-nal injury seen in preterm babies. A complete umbilical cord occlusion (UCO) lasting 15 min triggered the mild HI, while a severe HI was triggered by 25 min of complete UCO. For the entire first 6 h after the UCO insult, the RMSSD measure of HRV showed no suppression, but rather an increase in the severe HI group compared to both the mild HI group and the controls.

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“…In fact, the role of fHR monitoring (electronic fetal monitoring, EFM, to be precise), despite being used in over 90% of hospitals during delivery, remains controversial (Schifrin, 2020 ). There is no clarity on its usefulness in decreasing perinatal mortality or cerebral palsy when measured by a CTG which has been explained by the incorrect focus of EFM on prediction of acidemia, a poor correlate to fetal injury, instead of predicting fetal cardiovascular decompensation per se as well as the limitations of CTG technologies in capturing the short-term time scale fluctuations of HRV reflecting vagal modulations (Alfirevic et al, 2017 ; Frasch et al, 2017 ; Frasch, 2018 ; Gold and Frasch, 2021 ). Consequently, EFM fails to identify fetuses at risk of brain injury; this is because there is no clear correlation between fetal brain injury and acidemia (Westerhuis et al, 2007 ; Cahill et al, 2017 ).…”

Section: The Environmental Factors Affecting the Ans Developmentmentioning

confidence: 99%

A Review on the Vagus Nerve and Autonomic Nervous System During Fetal Development: Searching for Critical Windows

Cerritelli¹,

Frasch²,

Antonelli³

et al. 2021

Front. Neurosci.

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The autonomic nervous system (ANS) is one of the main biological systems that regulates the body's physiology. Autonomic nervous system regulatory capacity begins before birth as the sympathetic and parasympathetic activity contributes significantly to the fetus' development. In particular, several studies have shown how vagus nerve is involved in many vital processes during fetal, perinatal, and postnatal life: from the regulation of inflammation through the anti-inflammatory cholinergic pathway, which may affect the functioning of each organ, to the production of hormones involved in bioenergetic metabolism. In addition, the vagus nerve has been recognized as the primary afferent pathway capable of transmitting information to the brain from every organ of the body. Therefore, this hypothesis paper aims to review the development of ANS during fetal and perinatal life, focusing particularly on the vagus nerve, to identify possible “critical windows” that could impact its maturation. These “critical windows” could help clinicians know when to monitor fetuses to effectively assess the developmental status of both ANS and specifically the vagus nerve. In addition, this paper will focus on which factors—i.e., fetal characteristics and behaviors, maternal lifestyle and pathologies, placental health and dysfunction, labor, incubator conditions, and drug exposure—may have an impact on the development of the vagus during the above-mentioned “critical window” and how. This analysis could help clinicians and stakeholders define precise guidelines for improving the management of fetuses and newborns, particularly to reduce the potential adverse environmental impacts on ANS development that may lead to persistent long-term consequences. Since the development of ANS and the vagus influence have been shown to be reflected in cardiac variability, this paper will rely in particular on studies using fetal heart rate variability (fHRV) to monitor the continued growth and health of both animal and human fetuses. In fact, fHRV is a non-invasive marker whose changes have been associated with ANS development, vagal modulation, systemic and neurological inflammatory reactions, and even fetal distress during labor.

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Commentary: Computerised interpretation of fetal heart rate during labour (INFANT): a randomised controlled trial

Cited by 10 publications

References 15 publications

Computer‐based intrapartum fetal monitoring and beyond: A review of the 2nd Workshop on Signal Processing and Monitoring in Labor (October 2017, Oxford, UK)

Computer‐based intrapartum fetal monitoring and beyond: A review of the 2nd Workshop on Signal Processing and Monitoring in Labor (October 2017, Oxford, UK)

Saving the brain one heartbeat at a time

A Review on the Vagus Nerve and Autonomic Nervous System During Fetal Development: Searching for Critical Windows

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