The fetal autonomic nervous system, the fetal heart rate and the beat-to-beat irregularity

Kleinhout, J.; Stolte, L.A.M.; Janssens, J.; Knoop, A.A.

doi:10.1016/0028-2243(77)90066-1

Cited by 6 publications

(2 citation statements)

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“…A number of different mechanisms may cause acidemia in a fetus and the present study was not designed to determine the exact cause of acidemia. Nevertheless, the different causes of acidemia may include autonomic system dysregulation such as vagal excitability (which often leads to fetal distress and neonatal asphyxia), any disruption of the adrenergic system versus cholinergic system balance, fetal movement, fetal age, and gestational complications that affect placenta/fetus blood and gas exchange (such as preeclampsia, thrombotic diseases, gestational diabetes, oligohydramnios, abnormal torsion and twining of the umbilical cord, abnormal placental position, or placental abruption), eventually resulting in hypoxemia, hypercapnia, and metabolic acidosis [ 38 , 50 – 55 ]. A recent study using an in vivo sheep model also found that increasing values of AC/DC suggested that activation of the fetal autonomic nervous system as the time evolution of AC/DC correlated well with the acid-base balance [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

A Comprehensive Evaluation of the Predictive Abilities of Fetal Electrocardiogram-Derived Parameters during Labor in Newborn Acidemia: Our Institutional Experience

Tian

Zhang

2018

BioMed Research International

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This study aimed to identify cardiotocography patterns that discriminate fetal acidemia newborns by comprehensively evaluating the parameters obtained from Holter monitoring during delivery. Between June 1, 2015, and August 1, 2016, a prospective observational study of 85 patients was conducted using fetal Holter monitoring at the Beijing Obstetrics and Gynecology Hospital, Capital Medical University, China. Umbilical cord blood was sampled immediately after delivery and fetal acidemia was defined as umbilical cord arterial blood pH < 7.20. Fetal electrocardiogram- (FECG-) derived parameters, including basal fetal heart rate (BFHR), short-term variation (STV), large acceleration (LA), deceleration capacity (DC), acceleration capacity (AC), proportion of episodes of high variation (PEHV), and proportion of episodes of low variation (PELV), were compared between 16 fetuses with acidemia and 47 without. The areas under the curve (AUC) of receiver operating characteristics (ROC) were calculated. Although all the computerized parameters showed predictive values for acidemia (all AUC > 0.50), STV (AUC = 0.84, P < 0.001), DC (AUC = 0.84, P < 0.001), AC (AUC = 0.80, P < 0.001), and PELV (AUC = 0.71, P = 0.012) were more strongly associated with fetal acidemia. Our institutional experience suggests that FECG-derived parameters from Holter monitoring are beneficial in reducing the incidence of neonatal acidemia.

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Section: Discussionmentioning

confidence: 99%

A Comprehensive Evaluation of the Predictive Abilities of Fetal Electrocardiogram-Derived Parameters during Labor in Newborn Acidemia: Our Institutional Experience

Tian

Zhang

2018

BioMed Research International

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“…Control of fetal heart rate (FHR) variation is poorly understood but some of its origins have been determined by pharmacological experiments. High frequency, beat‐to‐beat variation in fetal sheep was reduced significantly after parasympathetic blockade (atropine), whereas the effect of sympathetic blockade (propranolol) alone was predominantly a reduction in longer term variation (Klein‐hout et al 1977; Dalton et al 1983). However, combined blockade to remove all automatic influences on the fetal heart only reduced measured FHR variation by about two‐thirds (Dalton et al 1983).…”

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confidence: 98%

The effect of neuromuscular blockade on human fetal heart rate and its variation

Spencer

Ryan

Ronderos-Dumit

et al. 1994

BJOG

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Objective To determine the effect of neuromuscular blockade on fetal heart rate and its variation. Design Case control study. Setting Tertiary referral fetal medicine unit in a London teaching hospital. Subject Forty women with rhesus iso‐immunisation requiring an intravascular fetal blood transfusion between 28 and 34 weeks gestation. Intervention Intravascular injection of pancuronium to the fetus prior to fetal blood transfusion in 20 cases. Main outcome measures Comparison between the group receiving pancuronium and the control group with regard to differences in perceived fetal activity and computer derived numerical indices of fetal heart rate and fetal heart rate variation after fetal blood transfusion. Results After transfusion in the control group, there were fewer perceived fetal movements, a small reduction in fetal heart rate but no differences in number of fetal heart rate accelerations or measures of fetal heart rate variation. In the study group, pancuronium produced no change in fetal heart rate despite a virtual abolition of perceived fetal movements and fetal heart rate accelerations. Measures of fetal heart rate variation were reduced by 60%. Comparison of the pre‐ to post‐transfusion changes between the two groups showed significant differences for all fetal heart rate indices. Conclusion Fetal activity accounts for more than half the measured variation of the human fetal heart rate.

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Drugs and fetal heart rate patterns

Geijn¹

1985

Drug Therapy During Pregnancy

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The fetal autonomic nervous system, the fetal heart rate and the beat-to-beat irregularity

Cited by 6 publications

References 6 publications

A Comprehensive Evaluation of the Predictive Abilities of Fetal Electrocardiogram-Derived Parameters during Labor in Newborn Acidemia: Our Institutional Experience

A Comprehensive Evaluation of the Predictive Abilities of Fetal Electrocardiogram-Derived Parameters during Labor in Newborn Acidemia: Our Institutional Experience

The effect of neuromuscular blockade on human fetal heart rate and its variation

Drugs and fetal heart rate patterns

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