Spectral analysis of fetal heart rate variability for fetal surveillance: review of the literature

Laar, Judith O E H van; Porath, Martina; Peters, C.H.L.; Oei, S.G.

doi:10.1080/00016340801898950

Cited by 103 publications

(84 citation statements)

References 43 publications

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“…Thus our findings are in keeping with the redistribution in the power spectrum of heart rate variability during acute hypoxemia in late-gestation fetal sheep (24,26). This later frequency range is also similar to that used in the human fetus where frequencies ranging 0.03-0.31 Hz and 0.13-1.0 Hz have been used for LF and HF, respectively (50). The changes in the LF RRI -to-HF RRI ratio have been interpreted to reflect the balance between sympathetic and parasympathetic input on the heart, with an increased sympathetic activity favoring the LF component and consequently a higher ratio (31).…”

Section: Discussionsupporting

confidence: 68%

Mild chronic hypoxemia modifies expression of brain stem angiotensin peptide receptors and reflex responses in fetal sheep

Pulgar¹,

Hong²,

Jessup³

et al. 2009

American Journal of Physiology-Regulatory, Integrative and Comp

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The effects of chronic mild hypoxemia on the binding of angiotensin receptors in selected brain stem nuclei and reflex responses were studied in fetal sheep. Fetal and maternal catheters were placed at 120 days' gestation, and animals received intratracheal maternal administration of nitrogen (n ϭ 16) or compressed air in controls (n ϭ 19). Nitrogen infusion was adjusted to reduce fetal brachial artery PO2 by 25% during 5 days. Spontaneous baroreflex sensitivity and spectral analysis of the pulse interval were analyzed during the 5 days hypoxemia period using 90 min of daily recording. Brains of control and hypoxemic animals were collected, and brain stem angiotensin receptor binding was studied by in vitro autoradiography at 130 days of gestation. After 5 days of hypoxemia, some animals in each group were submitted to one complete umbilical cord occlusion during 5 min. [125 I]sarthran binding showed that chronic mild hypoxemia significantly increases angiotensin type 1 receptor, angiotensin type 2 receptor, and ANG-(1-7) angiotensin receptor binding sites in the nucleus tractus solitarius and dorsal motor nucleus of the vagus (P Ͻ 0.05). Hypoxemia induced lower baroreflex sensitivity and a higher low frequency-to-high frequency ratio in the fetus, consistent with a shift from vagal to sympathetic autonomic cardiac regulation. Cord occlusion to elicit a chemoreflex response induced a greater bradycardic response in hypoxemic fetuses (slope of the initial fall in heart rate; 11.3 Ϯ 1.9 vs. 6.4 Ϯ 1.2 beats ⅐ min Ϫ1 ⅐ s Ϫ1 , P Ͻ 0.05). In summary, chronic mild hypoxemia increased binding of angiotensin receptors in brain stem nuclei, decreased spontaneous baroreflex gain, and increased chemoreflex responses to asphyxia in the fetus. These results suggest hypoxemia-induced alterations in brain stem mechanisms for cardiovascular control.fetus; hypoxemia; baroreflex OXYGEN DEPRIVATION IMPOSES diverse challenges to fetal development, with changes in the autonomic cardiovascular control via baroreflex and chemoreflex pathways playing a major role as a survival strategy (16). In fetal sheep, acute episodes of hypoxemia induce a redistribution of cardiac output to maintain blood flow and oxygen delivery to the heart and brain (14). This response is initiated by stimulation of peripheral chemoreceptors and maintained by endocrine mechanisms involving secretion of hormones such as catecholamines, neuropeptide Y, arginine vasopressin, and cortisol (11). During acute severe hypoxia, i.e., complete occlusion of the umbilical cord, fetuses respond with a fall in heart rate (FHR) and an increase in blood pressure. This acute FHR during hypoxia represents a key fetal adaptation, believed to help reduce myocardial work and oxygen requirements (11). This initial bradycardia, which is mediated by chemoreflex vagal pathways (5, 17, 23), occurs before the increase in blood pressure and is an indication of the severity of the hypoxic insult (5). Recently, it was reported that the slope of the initial bradycardia increases during short ...

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Section: Discussionsupporting

confidence: 68%

Mild chronic hypoxemia modifies expression of brain stem angiotensin peptide receptors and reflex responses in fetal sheep

Pulgar¹,

Hong²,

Jessup³

et al. 2009

American Journal of Physiology-Regulatory, Integrative and Comp

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“…Spectral estimates in the low frequency range of the fetal heart rate appear to be clinically most relevant for fetal monitoring [5]. For clinically obtained fetal heart data, the power within this range can be calculated reliably after artifact correction, as long as the corrected data do not exceed 25% of the length of the segment to be analyzed.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, continuous need exists for additional information that can be used to assess the fetal condition more reliably. Spectral analysis of fetal heart rate variability might offer additional information that can be used for fetal monitoring [5]. To a certain extent, spectral analysis of fetal heart rate variability reflects fetal compromise during delivery, offers the potential to predict severe fetal acidose [6,7] and may be used to monitor the development of the autonomic nervous system in fetuses [8].…”

Section: Introductionmentioning

confidence: 99%

The effect of artifact correction on spectral estimates of heart rate variability

Peters

Vullings

Bergmans

et al. 2008

2008 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society

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Abstract-Spectral analysis of fetal heart rate variability might offer additional information that can be used for assessing the fetal condition more reliably. Clinical recordings of fetal heart rate are usually contaminated by artifacts. These artifacts can be detected and corrected or removed, but this can affect the spectral estimates obtained from the heart rate data. To determine what level of artifact correction is still acceptable for reliable calculation of spectral heart rate variability parameters, artifact correction is simulated on neonatal and fetal data that did originally not contain artifacts. 2000 data segments with various levels of artifact correction are analyzed spectrally, and calculated spectral estimates are compared to the values obtained from the original, artifact free data. In the very low (< 0.04 Hz) and low (0.04 -0.15 Hz) frequency range, powers can be calculated reliably when up to 25% of the data are missing due to artifact correction. Powers in the high frequency range (0.15 -0.4 Hz for adults, 0.4 -1.5 Hz for newborns) cannot be calculated reliably when data are missing due to artifact correction. This is a major limitation for application in clinical practice, which might be solved by calculating power in the high frequency range at a shorter time scale than power in the low frequency range. Short segments of heart rate data that are free of artifacts can then be used to calculate powers in the high frequency range reliably, while segments that contain artifacts are excluded.

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“…It is well-known that fetal hypoxia can produce alterations in autonomic balance. 42 During chronic hypoxia in late gestation, there are increases in the LF/ HF ratio, a measure of sympathetic-parasympathetic balance, and decreases in spontaneous baroreflex activity in the fetal sheep. 43 In the present study, increases in the LF/HF ratio of HRV, in baroreflex gain and in maximal and minimal heart rates were also observed in adult offspring of hypoxic pregnancy, all strongly indicative of programming of autonomic dysfunction.…”

Section: Hrv and Baroreflex Functionmentioning

confidence: 99%

Vitamin C Prevents Intrauterine Programming of in vivo Cardiovascular Dysfunction in the Rat

Kane

Herrera

Camm

et al. 2013

Circ J

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Background: Fetal hypoxia is common and in vitro evidence supports its role in the programming of adult cardiovascular dysfunction through the generation of oxidative stress. Whether fetal chronic hypoxia programmes alterations in cardiovascular control in vivo, and if these alterations can be prevented by antioxidant treatment, is unknown. This study investigated the effects of prenatal fetal hypoxia, with and without maternal supplementation with vitamin C, on basal and stimulated cardiovascular function in vivo in the adult offspring at 4 months of age in the rat. Methods and Results:From days 6 to 20 of pregnancy, Wistar rats were subjected to Normoxia, Hypoxia (13% O2), Hypoxia+Vitamin C (5 mg/ml in drinking water) or Normoxia+Vitamin C. At 4 months, male offspring were instrumented under urethane anaesthesia. Basal mean arterial blood pressure, heart rate and heart rate variability (HRV) were assessed, and stimulated baroreflex curves were generated with phenylephrine and sodium nitroprusside. Chronic fetal hypoxia increased the LF/HF HRV ratio and baroreflex gain, effects prevented by vitamin C administration during pregnancy. Conclusions:Chronic intrauterine hypoxia programmes cardiovascular dysfunction in vivo in adult rat offspring; effects ameliorated by maternal treatment with vitamin C. The data support a role for fetal chronic hypoxia programming cardiovascular dysfunction in the adult rat offspring in vivo through the generation of oxidative stress in utero. (Circ J 2013; 77: 2604 -2611

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Spectral analysis of fetal heart rate variability for fetal surveillance: review of the literature

Abstract: Spectral analysis could be a promising method for fetal surveillance. Larger prospective studies are needed to determine the exact diagnostic value of spectral analysis. For further research, standardisation of spectral analysis is recommended. Studies should focus on real time monitoring.

Cited by 103 publications

References 43 publications

Mild chronic hypoxemia modifies expression of brain stem angiotensin peptide receptors and reflex responses in fetal sheep

Mild chronic hypoxemia modifies expression of brain stem angiotensin peptide receptors and reflex responses in fetal sheep

The effect of artifact correction on spectral estimates of heart rate variability

Vitamin C Prevents Intrauterine Programming of in vivo Cardiovascular Dysfunction in the Rat

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