Comparison of diurnal variations, gestational age and gender related differences in fetal heart rate (FHR) parameters between appropriate-for-gestational-age (AGA) and small-for-gestational-age (SGA) fetuses in the home environment

Abstract

ObjectiveTo assess the influence of gender, time of the day and gestational age on fetal heart rate (FHR) parameters between appropriate-for-gestational-age (AGA) and small-for-gestational age (SGA) fetuses using a portable fetal ECG monitor employed in the home setting.MethodsWe analysed and compared the antenatal FHR data collected in the home setting on 61 healthy pregnant women with singleton pregnancies from 24 weeks gestation. Of the 61 women, 31 had SGA fetuses (estimated fetal weight below the tenth gestational centile) and 30 were pregnant with AGA fetuses. FHR recordings were collected for up to 20 h. Two 90 min intervals were deliberately chosen retrospectively with respect to signal recording quality, one during day-time and one at night-time for comparison.ResultsOverall, success rate of the fetal abdominal ECG in the AGA fetuses was 75.7% compared to 48.6% in the SGA group. Based on randomly selected episodes of heart rate traces where recording quality exceeded 80% we were able to show a marginal difference between day and night-time recordings in AGA vs. SGA fetuses beyond 32 weeks of gestation. A selection bias in terms of covering different representation periods of fetal behavioural states cannot be excluded. In contrast to previous studies, we neither controlled maternal diet and activity nor measured maternal blood hormone and heart rate as all mothers were monitored in the home environment.ConclusionBased on clinically unremarkable, but statistically significant differences in the FHR parameters between the AGA and SGA group we suggest that further studies with large sample size are required to assess the clinical value of antenatal fetal ECG monitoring.

Is short-term-variation of fetal-heart-rate a better predictor of fetal acidaemia in labour? A feasibility study

“…In 50 participants, the device did not record the FHR data either from the beginning (n = 30) or during the last hour of delivery (n = 20). Our previous works [22][23][24] and that of other investigators [8,9] have demonstrated the feasibility and accuracy of computerised FHR https://doi.org/10.1371/journal.pone.0236982.g002…”

A systematic scoping review to identify the design and assess the performance of devices for antenatal continuous fetal monitoring

“…Ten of the 43 studies were from the UK [ 25 – 27 , 35 , 37 – 39 , 49 , 50 , 55 ], 22 from other European countries [ 24 , 28 – 33 , 36 , 40 , 42 – 44 , 48 , 51 – 54 , 56 , 57 , 61 , 64 , 65 ], five from Japan [ 41 , 59 , 60 , 62 , 63 ], one from India [ 45 ], one from Australia [ 66 ], three from the United States of America (USA) [ 46 , 47 , 58 ], and one study from both the Netherlands and USA [ 34 ]. The included studies were heterogeneous, they had a median sample size of 34.5 participants (range 1–657) and a median number of recordings of 63 (range 1–657).…”

“…Thirty-five out of the 43 studies were specifically concerned with a device to measure the FHR. Twenty-nine studies utilised only fECG devices, of which nine were unnamed [ 24 , 25 , 27 , 30 , 31 , 40 , 44 , 49 , 55 ] and the remaining 20 studies used either: Monica AN24 device [ 26 , 33 , 34 , 36 , 38 , 39 , 50 – 52 , 54 , 56 , 58 ]; Telefetalcare [ 28 , 29 , 53 ]; FECGV1 [ 35 ]; Cardiolab Babycard [ 43 ]; Nemo fetal monitor [ 48 , 57 ]; or Corometrics 112 abdominal ECG monitor [ 47 ]. Two studies used only fPCG devices, of which one was named the Fetaphon-2000 [ 42 ] and the other was unnamed [ 45 ].…”

“…The remaining four studies could not be included in the meta-analysis as they either did not provide an overall SQ [36,58] or they did not provide all of the required data (e.g. SD or IQR) [38,39]. Both Telefetalcare studies [29,53] reported identical values for the accuracy (91.3%) and sensitivity (92.9%) of the device at detecting fetal QRS complexes.…”

Fetal Heart Rate Variability Is Affected by Fetal Movements: A Systematic Review

“…Therefore, it is time to establish methodological standards concerning factors affecting FHRV analyses, to provide meaningful interpretation and comparison of results and consistency for future studies. Potential variables of importance include gestational age (Van Leeuwen et al, 2003 , 2013 ; Schneider et al, 2018 ), diurnal rhythm (Morokuma et al, 2001 ; Kapaya et al, 2018 ), fetal breathing movements (Timor-Tritsch et al, 1977 ), fetal gross movements (van Laar et al, 2014 ), fetal behavioral states (Goncalves et al, 2007 ), smoking (Kapaya et al, 2015 ; Spyridou et al, 2017 ), fetal gender (Bernardes et al, 2008 ; Tendais et al, 2015 ; Goncalves et al, 2017 ), ethnic differences (Marie et al, 2015 ; Tagliaferri et al, 2017 ), and maternal exercise (May et al, 2010 ). Fetal movements of the extremities and trunk, as well as fetal breathing movements, are intermittent and unpredictable; thus, it is especially important to know their influence on the results of FHRV analyses.…”