Monitoring fetal maturation - Objectives, techniques and indices of autonomic function
Journal
Physiological Measurement
Journal Volume
38
Journal Issue
5
Pages
R61-R88
Date Issued
2017
Author(s)
Hoyer D.
Zebrowski J.
Cysarz D.
Goncalves H.
Pytlik A.
Amorim-Costa C.
Bernardes J.
Ayres-De-Campos D.
Witte O.W.
Schleu?ner E.
Stroux L.
Redman C.
Georgieva A.
Payne S.
Clifford G.
Signorini M.G.
Magenes G.
Andreotti F.
Malberg H.
Zaunseder S.
Lakhno I.
Schneider U.
Abstract
Monitoring the fetal behavior does not only have implications for acute care but also for identifying developmental disturbances that burden the entire later life. The concept, of 'fetal programming', also known as 'developmental origins of adult disease hypothesis', e.g. applies for cardiovascular, metabolic, hyperkinetic, cognitive disorders. Since the autonomic nervous system is involved in all of those systems, cardiac autonomic control may provide relevant functional diagnostic and prognostic information. The fetal heart rate patterns (HRP) are one of the few functional signals in the prenatal period that relate to autonomic control and, therefore, is predestinated for its evaluation. The development of sensitive markers of fetal maturation and its disturbances requires the consideration of physiological fundamentals, recording technology and HRP parameters of autonomic control. Based on the ESGCO2016 special session on monitoring the fetal maturation we herein report the most recent results on: (i) functional fetal autonomic brain age score (fABAS), Recurrence Quantitative Analysis and Binary Symbolic Dynamics of complex HRP resolve specific maturation periods, (ii) magnetocardiography (MCG) based fABAS was validated for cardiotocography (CTG), (iii) 30 min recordings are sufficient for obtaining episodes of high variability, important for intrauterine growth restriction (IUGR) detection in handheld Doppler, (iv) novel parameters from PRSA to identify Intra IUGR fetuses, (v) evaluation of fetal electrocardiographic (ECG) recordings, (vi) correlation between maternal and fetal HRV is disturbed in pre-eclampsia. The reported novel developments significantly extend the possibilities for the established CTG methodology. Novel HRP indices improve the accuracy of assessment due to their more appropriate consideration of complex autonomic processes across the recording technologies (CTG, handheld Doppler, MCG, ECG). The ultimate objective is their dissemination into routine practice and studies of fetal developmental disturbances with implications for programming of adult diseases. ? 2017 Institute of Physics and Engineering in Medicine.
Subjects
Biomedical signal processing
Electrocardiography
Fetal monitoring
Neonatal monitoring
Physiological models
Signal analysis
Autonomic nervous
Autonomic nervous system
Autonomics
Cardiotocography
Electrocardiographic
Fabas
Fetal development
Functional autonomic brain age score
Heart rate variability
Nonlinear signal analysis
Prenatal diagnosis
Heart
autonomic nervous system
electrocardiography
female
fetus development
fetus heart rate
fetus monitoring
human
pathophysiology
physiology
preeclampsia
pregnancy
procedures
Autonomic Nervous System
Female
Fetal Development
Fetal Monitoring
Heart Rate, Fetal
Humans
Pre-Eclampsia
Pregnancy
SDGs
Type
review