Fetal heart rate variability: An ocean of meanings beyond ups and downs

Heart Rate Variability Code: Does It Exist and Can We Hack It?

“…A novel bioinformatics approach to fetal HRV (fHRV) derived from maternal abdominal ECG during labor predicted well acid-base status at birth [16]. Conversely, HRV measures engineered to capture longer-term time scales of interbeat fluctuations recover the predictive information for early detection of fetal cardiovascular decompensation even when a 4 Hz sampling rate is used [20,21].…”

“…HRV exhibits features of time structure, phase space structure, specificity with respect to (organ) target, and pathophysiological syndromes, as well as universality with respect to species independence (Figure 1). Together, these features form a spatiotemporal [15][16][17][18][19][20][21], phase space structure ( [7,8,[22][23][24][25][26], specificity with respect to (organ) target [27][28][29], and pathophysiological syndromes [25,30,31], as well as species independence, i.e., universality with respect to species [32][33][34]. Together, these properties present the necessary features of an HRV code reflecting brain-body communication in the fluctuations of beat-to-beat intervals.…”

Increased variability of fetal heart rate: from evidence to implementation

“…Dear Dr. Papageorghiou, We appreciate Dr Frasch's interest in our work. 1,2 He raises some important issues that should be considered when measuring and analysing fetal heart rate variability (FHRV) by complementary signal-analytical domains, as well as novel machine learning and deep learning methods. 1 However, our focus was on the clinical reality of fetal heart rate (FHR) interpretation.…”

“…Dr Frasch fundamentally argues that FHRV should not be described or interpreted as 'decreased' or 'increased', as this 'goes against the evidence of what variability represents-a complex dynamic multi-dimensional pattern, such that a single-order description in terms of "ups" and "downs" discards most of its predictive information.' 1 Unfortunately, Dr Frasch fails to clarify what predictive features in this meta-level FHRV the frontline clinician should draw from to support their decisions, for example, whether to perform intrauterine resuscitation methods or caesarean delivery.…”

“…Data sharing is not applicable to this article as no new data were created or analysed in this manuscript. Mikko J. Tarvonen 1 Sture Andersson 2 Alistair J. Gunn 3 Christopher A. Lear…”