A systematic review on the utility of non-invasive electrophysiological assessment in evaluating for intra uterine growth restriction

Vinayak Smith,Euan Morrison Wallace,Fabricio da Silva Costa,Joel Arun Sursas,Amrish Nair,Ritesh Warty

doi:10.1186/s12884-019-2357-9

Vinayak Smith, Euan Morrison Wallace + Show 4 more

Open Access

https://doi.org/10.1186/s12884-019-2357-9

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Abstract

BackgroundNon-invasive electrophysiological assessment (NIEA) is an evolving area in fetal surveillance and is attracting increasing research interest. There is however, limited data outlining its utility in evaluating intra uterine growth restriction (IUGR). The objective of this study was to carry out a systematic review to outline the utility of NIEA parameters in evaluating IUGR.MethodsA systematic review of peer reviewed literature was performed, searching PUBMED, Ovid MEDLINE and EMBASE. The outcomes of interest included NIEA parameters [P wave duration, PR interval, QRS duration, QT interval, T/QRS ratio, short term variability (STV) and long term variability (LTV)] and a descriptive summary of relevant studies as well.ResultsSixteen studies were identified as suitable for inclusion. The utility of NIEA parameters were investigated in tabular form. In particular, QRS and QT duration, T/QRS ratio, STV and PRSA analysis displayed utility and merit further consideration in evaluating for IUGR. Issues identified in the review were in relation to variances in definition of IUGR, small sample sizes and the lack of technological consistency across studies.ConclusionNIEA shows promise as an adjunct surveillance tool in fetal diagnostics for IUGR. Larger prospective studies should be directed towards establishing reliable parameters with a focus on uniformity of IUGR definition, technological consistency and the individualisation of NIEA parameters.

Highlights

Non-invasive electrophysiological assessment (NIEA) is an evolving area in fetal surveillance and is attracting increasing research interest
Utilisation of all NIEA parameters for comparison across groups We suggest that the following NIEA parameters be explored in future studies: P wave duration, PR interval, QRS duration, QT interval, T/QRS ratio, long term variability (LTV) and short term variability (STV)
We suggest the addition of cardiac circumference to thoracic circumference (CC/TC) ratio to explore the Fetal electrocardiogram (FECG) changes related to cardiac size in an attempt to correlate this with the postulated cardiovascular changes which occur in these fetuses [27]

Summary

Introduction

Non-invasive electrophysiological assessment (NIEA) is an evolving area in fetal surveillance and is attracting increasing research interest. There is limited data outlining its utility in evaluating intra uterine growth restriction (IUGR). The objective of this study was to carry out a systematic review to outline the utility of NIEA parameters in evaluating IUGR. 11% of all pregnancies in developed nations and up to 23.8% of pregnancies in developing nations are complicated by intra uterine growth restriction (IUGR) [1, 2]. There remains some level of difficulty in differentiating isolated fetal smallness from IUGR, at a late gestation, and in managing these findings as well [4, 12]. Recognising this diagnostic dilemma, seminal work has. There is still a lack of a gold standard which highlights an urgent need to characterise further tests [4]

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