Evaluation of Abdominal Fetal Electrocardiography in Early Intrauterine Growth Restriction.

Clarissa L Velayo,Joyceline Noemi I Silao,Yoshitaka Kimura,Kypros Nicolaides,Kiyoe Funamoto

doi:10.3389/fphys.2017.00437

Abstract

Objectives: This descriptive study was performed to evaluate the capability of a non-invasive transabdominal electrocardiographic system to extract clear fetal electrocardiographic (FECG) measurements from intrauterine growth restricted (IUGR) fetuses and to assess whether abdominal FECG parameters can be developed as markers for evaluating the fetal cardiac status in IUGR.Methods: Transabdominal FECG was attempted in 20 controls and 15 IUGR singleton pregnancies at 20+0−33+6 weeks gestation. Standard ECG parameters were compared between the study groups and evaluated for their correlation. Accuracy for the prediction of IUGR by cut off values of the different FECG parameters was also determined.Results: Clear P-QRST complexes were recognized in all cases. In the IUGR fetuses, the QT and QTc intervals were significantly prolonged (p = 0.017 and p = 0.002, respectively). There was no correlation between ECG parameters and Doppler or other indices to predict IUGR. The generation of cut off values for detecting IUGR showed increasing sensitivities but decreasing specificities with the prolongation of ECG parameters.Conclusion: The study of fetal electrocardiophysiology is now feasible through a non-invasive transabdominal route. This study confirms the potential of FECG as a clinical screening tool to aid diagnosis and management of fetuses after key limitations are addressed. In the case of IUGR, both QT and QTc intervals were significantly prolonged and thus validate earlier study findings where both these parameters were found to be markers of diastolic dysfunction. This research is a useful prelude to a test of accuracy and Receiver Operating Characteristics (ROC) study.

Highlights

Intrauterine growth restriction (IUGR) affects 3–10% of all pregnancies and has been associated with the development of adult cardiovascular diseases.(Barker et al, 1989; Bahtiyar and Copel, 2008) Recent studies suggest that cardiovascular changes may be present during the prenatal period with evidence of cardiac remodeling in the form of increased transverse diameters and more globular cardiac ventricles (Crispi et al, 2010)
A total of 46 fetal ECG recordings were collected throughout the study period, 16 from the Philippines (RP) and 30 from the United Kingdom (UK)
All pregnancies (100%) were achieved through spontaneous conception in women with a mean gravidity score of 2.26 ± 1.52 and only 10 (28.6%) of these women reported a previous fetal loss. This evaluation revealed that there was a significant difference between the maternal weights of Control (C) and Maternal characteristics p-value

Summary

Introduction

Intrauterine growth restriction (IUGR) affects 3–10% of all pregnancies and has been associated with the development of adult cardiovascular diseases.(Barker et al, 1989; Bahtiyar and Copel, 2008) Recent studies suggest that cardiovascular changes may be present during the prenatal period with evidence of cardiac remodeling in the form of increased transverse diameters and more globular cardiac ventricles (Crispi et al, 2010). These corroborate with earlier descriptions of fetal hemodynamic adaptive changes in IUGR (Verburg et al, 2008) wherein the standard assessment of cardiac function utilizes various biochemical and ultrasound indices in relation to disease severity (Crispi et al, 2008). Other studies have found FECG useful in: (a) evaluating atrioventricular block (AVB) in Anti-RO positive pregnancies, (b) monitoring drug therapy, or (c) monitoring fetal anemia (Gardiner et al, 2007)

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