Fetal Heart Rate Decelerations Research Articles

The effect of prenatal exposure to music on fetal movements and fetal heart rate: a pilot study

Objective To assess and compare fetal cardiac parameters of fetuses listening to music before and during nonstress test, only during the test or never. Study design Thirty healthy mother-fetus dyads were randomized in a 1:1:1 ratio to one of three groups: group A in which fetuses were submitted to prelistening phase (33rd + 0 to 36th + 3 week) and listening sessions during 4 nonstress tests, group B in which fetuses were submitted to listening sessions during 4 nonstress tests, and group C receiving 4 nonstress tests without any listening. We assessed mean fetal heart rate, fetal heart rate accelerations, fetal heart rate decelerations, fetal movements and uterine contractility. Results Fetuses of the group A, who had already listened to a particular piece of music during previous sessions, had significantly increased their heart rate accelerations and movements during the music listening session of the last nonstress test. No significant changes were observed in the number of uterine contractions. Conclusions Our findings show that fetuses slightly respond to that music they know, but they do not significantly respond to unknown music.

Cerebral palsy, cesarean sections, and electronic fetal monitoring: All the light we cannot see

A half century ago electronic fetal monitoring was rushed into clinical use with the promise that the secrets of fetal heart rate decelerations had been discovered and that the newly discovered kno...

Pulse Pressure and Postepidural Complications in Women With Hypertensive Disorders of Pregnancy [33R

INTRODUCTION: Normotensive women with narrow pulse pressure have increased risk of postepidural complications and benefit from additional fluid volume. We hypothesized that narrow pulse pressure in hypertensive women was associated with increased postepidural intervention. METHODS: Single-center prospective cohort study of women with singleton pregnancies and diagnosis of gestational hypertension (gHTN) or preeclampsia admitted for delivery between December 2016 and January 2018. Mean pulse pressure in the 3 hours prior to test dose was calculated (narrow defined as <45 mm Hg). Primary outcome was a composite of postepidural resuscitative measures including fluid bolus, vasopressors, supplemental oxygen, or intentional maternal position changes. Secondary outcomes included hypotension, defined as a decrease in blood pressure (BP) of 20% from baseline, or fetal heart rate (FHR) decelerations compared to 1 hour prior to epidural bolus. RESULTS: 67 women with hypertensive disorders of pregnancy were included, with 15 (22.4%) having a narrow pulse pressure. Average systolic and diastolic BP prior to epidural for those with narrow vs. normal pulse pressure was 125 ± 11 vs. 137 ± 10 mm Hg (P<.001) and 86 ± 11 vs. 81 ± 8 mm Hg (P=.05), respectively. No observed difference in the need for postepidural resuscitation 13.3 vs. 38.5% (P=.12) or any component of the composite outcome. No observed increased risk of systolic (RR 0.74 [95%CI 0.25-2.25]) or diastolic hypotension (RR 0.89 [95%CI 0.53-1.51]) with narrow pulse pressure, nor were abnormal FHR patterns more frequent (P=.72). CONCLUSION: Narrow pulse pressure was not predictive of postepidural complications or resuscitation in women with gHTN or preeclampsia.

Correlation of prolonged fetal heart rate decelerations and perinatal outcome among patients undergoing emergency cesarean section: Implication to standardizing management and notification guidelines

Introduction: A prolonged fetal heart rate (FHR) decelerations reflects as a danger signal in relation to perinatal outcome.

Case 1: An Infant with Arm Swelling and Nodules

A male neonate is born via spontaneous vaginal delivery to a 28-year-old primiparous woman at 39 2/7 weeks of gestation after an uncomplicated pregnancy. Labor is complicated by prolonged fetal heart rate decelerations, but the mother declines a cesarean section and vacuum extraction is initially unsuccessful. At birth the neonate is apneic but maintains a heart rate greater than 100 beats/min throughout the resuscitation. He requires intubation for persistent apnea 4 minutes after birth. His Apgar scores are 2, 3, 5, and 5 at 1, 5, 10, and 20 minutes, respectively. His physical examination on admission to the NICU is significant for diffuse hypotonia, lethargy, and absence of primitive reflexes. His arterial blood gas measurement 1.5 hours after birth shows a pH of 7.32, Pco2 of 32 mm Hg, and base deficit of 9. A blood culture specimen is collected and he starts empiric treatment with ampicillin and gentamicin. The infant is transferred to a tertiary care NICU for therapeutic hypothermia and has moderate encephalopathy on admission. He has a fluctuant, boggy mass over his occipital skull and undergoes noncontrast head computed tomography, which shows a large subgaleal hemorrhage, skull fracture, and small ventricles concerning for cerebral edema. A significant drop in his hematocrit is noted, and he receives transfusions of packed red blood cells and fresh frozen plasma. He requires a dopamine infusion and stress-dose hydrocortisone to maintain age-appropriate blood pressures. Electroencephalography (EEG) shows electrographic and clinical seizure activity, which is …

Parasympathetic nervous system response to acidosis: Evaluation in an experimental fetal sheep model.

Heart rate variability and fetal heart rate decelerations are impacted by parasympathetic function and reflect acid-base status. Our team developed a new heart rate variability index, the fetal stress index (FSI), which has lower interindividual variability and higher sensitivity for detecting fluctuations in parasympathetic nervous system activity. The aim of this study was to explore the ability of the FSI to predict fetal acidosis in a fetal sheep model. Repeated 1-minute total umbilical cord occlusions (UCOs) were performed every 2.5minutes over 3hours to generate fetal acidosis mimicking that which occurs during labor and contractions. Fetal hemodynamic parameters, blood gas, the FSI and the magnitude (from the beginning to the nadir) of the fetal heart rate deceleration were recorded at regular intervals. The data were analyzed over three time intervals because of variation in the duration of the experiments: period A (first 12 UCOs), period B (middle 12 UCOs) and period C (last 12 UCOs). Nine experiments were performed. Acidosis was progressive with a significant difference between the pH, lactate levels and base deficit values for the three periods of occlusion (P<0.05). Both FSI and the magnitude of fetal heart rate decelerations gradually increased during the UCOs and both differed significantly between periods A and C (P=0.0008 for FSI and P=0.003 for deceleration). This experimental protocol allowed the development of progressive acidosis in a good model of the physiology of labor. Parasympathetic nervous system activity increased during acidosis and could be measured using our index, the FSI, and the magnitude of fetal heart rate decelerations.

Prevention of Cerebral Palsy with Novel Hypoxia Index Composed of Fetal Heart Rate Deceleration

Fetal brain damage develops after the loss of FHR variability followed by infantile cerebral palsy due to severe hypoxia in frequently repeated fetal heart rate (FHR) decelerations (transient bradycardia) or prolonged fetal bradycardia, where novel hypxia index is 25 or more, and it is prevented if the hpoxia index is 24 or less. The hypoxia index (HI) is the sum of FHR deceleration durations (min) divided by the lowest FHR (bpm), and multiplied by 100 (Figure 1). The HI is calculated by visual measurement, while it is also suitably calculated by computerized FHR monitoring. Cerebral palsy is prevented when HI is 24 or less with almost zero error probability in the delivery. The cases whose HI was 25 or more will develop cerebral palsy, thus, it can receive early cerebral palsy trearments in neonatal stage. As late deceleration disappeared when the parturient woman changed her posture to lateral one from supine, a parturient woman is recommended to have lateral posture, when they notice the appearance of FHR deceleration during the delivery to disappear deceleration to prevent the increase of HI value. As the HI is adopted not only late deceleration, but also all decelerations and continuous bradycardia, fetal diagnosis will change to objective numeric FHR analysis from the monitoring with vague subjective FHR pattern classification.

Automatic Cardiotocography Diagnostic System Based on Hilbert Transform and Adaptive Threshold Technique

The visual analysis of cardiotocographic examinations is a very subjective process. The accurate detection and segmentation of the fetal heart rate (FHR) features and their correlation with the uterine contractions in time allow a better diagnostic and the possibility of anticipation of many problems related to fetal distress. This paper presents a computerized diagnostic aid system based on digital signal processing techniques to detect and segment changes in the FHR and the uterine tone signals automatically. After a pre-processing phase, the FHR baseline detection is calculated. An auxiliary signal called detection line is proposed to support the detection and segmentation processes. Then, the Hilbert transform is used with an adaptive threshold for identifying fiducial points on the fetal and maternal signals. For an antepartum (before labor) database, the positive predictivity value (PPV) is 96.80% for the FHR decelerations, and 96.18% for the FHR accelerations. For an intrapartum (during labor) database, the PPV found was 91.31% for the uterine contractions, 94.01% for the FHR decelerations, and 100% for the FHR accelerations. For the whole set of exams, PPV and SE were both 100% for the identification of FHR DIP II and prolonged decelerations.

Fetal and maternal responses to yoga in the third trimester

Objective: The primary purpose of this study was to examine maternal and fetal responses to a typical, moderate-intensity yoga session in healthy pregnant women during the third trimester using continuous monitoring.Methods: This prospective observational study in low-risk, pregnant women used the Monica AN24 Abdominal ECG wireless maternal-fetal monitor to measure fetal heart rate, maternal heart rate, and uterine activity during a prenatal yoga session. Sessions included 4 time periods: (1) 20-minute rest, (2) 50 minutes standard prenatal yoga, (3) 10-minute meditation, (4) 20-minute recovery. Data were continuously recorded throughout the entire session, stored at 0.25-second intervals, and then averaged over 5-minute intervals. To evaluate changes over time, overall means for the four time periods (rest, yoga, meditation, recovery) were compared using one-way ANOVA with repeated measures. Post-hoc pairwise comparisons (Tukey’s) were used to probe significant differences between the four time points. Statistical significance was reached at p < .05.Results: Twenty participants were enrolled; 19 completed the yoga session. Mean gestational age was 35 weeks and 6 days (range of 32–0/7 to 38–6/7) with an average participant age of 32 ± 2.7 years. Maternal heart rates significantly increased during the yoga period (102 ± 11 bpm) compared to rest (90 ± 10), meditation (85 ± 12), and recovery (88 ± 10) (p < .01). The maximum maternal heart rate reached during the yoga session was 125 ± 13 bpm. While fetal heart rates fluctuated slightly over the course of the yoga session, there were no significant fetal heart rate decelerations to suggest deleterious fetal effects. There were no statistically significant differences among resting (138 ± 14 bpm), yoga (137 ± 11 bpm), meditation (139 ± 7 bpm), or recovery (135 ± 22 bpm) fetal heart rates (p = .814). Uterine activity was significantly greater during the yoga period compared with the other time points (p < .001).Conclusion: Yoga can be recommended for low-risk women during pregnancy as no adverse fetal or maternal heart rate changes were observed during a typical prenatal yoga session.

Automated fetal heart rate analysis for baseline determination and acceleration/deceleration detection: A comparison of 11 methods versus expert consensus

The fetal heart rate (FHR) serves as a guide to fetal well-being during the first stage of delivery. The visual morphological analysis of the FHR during labor is subject to inter- and intra-observer variability – particularly when the FHR is abnormal. It has been suggested that automatic analysis of the FHR can reduce this variability. To compare 11 morphological FHR analyses (baseline computation, and detection of FHR decelerations and accelerations) produced by automatic analysis methods (AAMs) with an expert consensus. Eleven AAMs were reprogrammed (using the description published in the literature) and applied to 90 FHR recordings collected during the early phase of labor. Furthermore, the recordings were divided into three tertiles, according to the difficulty of analysis. The results of the morphological FHR analyses produced by the AAMs were compared with a consensus morphological analysis performed by four experts. In addition to standard discriminant criteria, a new morphological analysis discriminant index (MADI) was introduced; it provides an overall evaluation that collates all the individual criteria. The AAM developed by Lu and Wei's gave better results than the other AAMs for baseline computation. Regarding this method's detection of FHR decelerations and accelerations, the F-measure [95% confidence interval] was respectively 0.73 [0.67; 0.76] and 0.70 [0.64; 0.76]. The MADI indicated that Lu and Wei's AAM agreed best with the expert consensus (discordance: 7.3% [6.10; 8.60]). Our study demonstrated the superiority of Lu and Wei's method for baseline computation and deceleration/acceleration detection, although there was still a significant degree of discordance versus expert consensus. The MADI appears to be a good overall index for evaluating AAMs with regard to the quality of baseline computation and acceleration/deceleration detection. The application of precise criteria and the methodology and software tools developed here should facilitate the evaluation of new AAMs and their comparison with other methods.

Pregnancy in patient with X-linked hypophosphatemic rickets – management and outcome

Introduction: X-linked hypophosphatemia (XLH) is a genetically determined disorder inherited as a dominant trait associated with mutation within the PHEX gene. Phenotypic presentation of XLH ranges from isolated hypophosphatemia to severe lower-extremity bowing. Case Report: Preterm hypotrophic infant was born to a mother with a history of XLH, arterial hypertension, and aortic valve insufficiency. The course of pregnancy was complicated by severe symmetric intrauterine growth restriction (IUGR), abnormal umbilical artery flow, and fetal heart rate decelerations during the non-stress test. Discussion: Occurrence of IUGR was most probably due to severe maternal disorders, as no data suggesting association between XLH in mother and symmetric IUGR is available. XLH, treatment side effects, and secondary hyperparathyroidism may manifest by variety of medical conditions including nephrocalcinosis, hypertension or heart disease. Proper management of pregnancy in this group of patients requires appropriate preconception counseling and multidisciplinary approach during pregnancy and after delivery.

Nonlinear characterization and complexity analysis of cardiotocographic examinations using entropy measures

The nonlinear analysis of biological time series provides new possibilities to improve computer aided diagnostic systems, traditionally based on linear techniques. The cardiotocography (CTG) examination records simultaneously the fetal heart rate (FHR) and the maternal uterine contractions. This paper shows, at first, that both signals present nonlinear components based on the surrogate data analysis technique and exploratory data analysis with the return (lag) plot. After that, a nonlinear complexity analysis is proposed considering two databases, intrapartum (CTG-I) and antepartum (CTG-A) with previously identified normal and suspicious/pathological groups. Approximate Entropy (ApEn) and Sample Entropy (SampEn), which are signal complexity measures, are calculated. The results show that low entropy values are found when the whole examination is considered, $$\hbox {ApEn}=0.3244\pm 0.1078$$ and $$\hbox {SampEn}=0.2351\pm 0.0758$$ ($$\hbox {average}\pm \hbox {standard}$$ deviation). Besides, no significant difference was found between the normal ($$\hbox {ApEn}=0.3366\pm 0.1250$$ and $$\hbox {SampEn}=0.2532\pm 0.0818$$) and suspicious/pathological ($$\hbox {ApEn}=0.3420\pm 0.1220$$ and $$\hbox {SampEn}=0.2457\pm 0.0850$$) groups for the CTG-A database. For a better analysis, this work proposes a windowed entropy calculation considering 5-min window. The windowed entropies presented higher average values ($$\hbox {ApEn}=0.6505\pm 0.2301$$ and $$\hbox {SampEn}=0.5290\pm 0.1188$$) for the CTG-A and ($$\hbox {ApEn}=0.5611\pm 0.1970$$ and $$\hbox {SampEn}=0.4909\pm 0.1782$$) for the CTG-I. The changes during specific long-term events show that entropy can be considered as a first-level indicator for strong FHR decelerations ($$\hbox {ApEn}=0.1487\pm 0.0341$$ and $$\hbox {SampEn}=0.1289\pm 0.0301$$), FHR accelerations ($$\hbox {ApEn}=0.1830\pm 0.1078$$ and $$\hbox {SampEn}=0.1501\pm 0.0703$$) and also for pathological behavior such as sinusoidal FHR ($$\hbox {ApEn}=0.1808\pm 0.0445$$ and $$\hbox {SampEn}=0.1621\pm 0.0381$$).

Modifying Maternal Sleep Position in Late Pregnancy Through Positional Therapy: A Feasibility Study.

To test whether a customized positional therapy device, PrenaBelt, would reduce time spent sleeping supine and evaluate any change in maternal or fetal parameters, in a group of healthy pregnant women in the third trimester of pregnancy. Participants underwent an in-home, overnight sleep study during late pregnancy (32-38 weeks). Participants were observed over 2 nights: 1 night when the PrenaBelt was not worn (nonintervention or control) and 1 night when it was (intervention). The intervention night was randomly allocated, and the study nights were consecutive. On the control night, participants were filmed using a night-capable (infrared) video camera, maternal sleep was measured by the Watch-PAT200, and the fetus was continuously monitored using the Monica AN24. On the intervention night, video, maternal, and fetal monitoring were repeated with the addition of the mother wearing the PrenaBelt. A total of 25 healthy pregnant women were studied. Four had missing data for the Watch-PAT or Monica, and eight had missing or disrupted video data. Video-determined time in bed was not significantly different during intervention and control nights (P = .196, r = -.23). Median time spent supine during the intervention night was reduced from 48.3 minutes, to 28.5 minutes during the control night (P = .064, r = -.33). The difference in the proportion of time spent supine was significant (P = .039). There was no significant difference in objectively estimated sleep time (P = .651, r = -.07). Improvement was observed in both maternal and fetal parameters during the intervention night with an increase in median minimum maternal oxygen saturations (control = 91.6%, intervention = 92.4%, P = .006, r = -.42), fewer maternal oxygen desaturations (control = 7.1, intervention = 5.9, P = .095, r = -.26), and fewer fetal heart rate decelerations (control = 14.0, intervention = 10.4, P = .045, r = -.31) compared to the control night. Results provide preliminary evidence that an intervention to reduce supine sleep in late pregnancy may provide maternal and fetal health benefits, with minimal effect on maternal perception of sleep quality and objectively estimated sleep time. Further research to explore relationships between objectively determined maternal sleep position, maternal respiratory indices, and fetal well-being is warranted.

Fetal Heart Rate Deceleration Patterns will be Replaced by Numeric Deceleration Data

Fetal Heart Rate Deceleration Patterns will be Replaced by Numeric Deceleration Data

Automatic Identification and Classification of Fetal Heart-Rate Decelerations from Cardiotocographic Recordings.

Cardiotocography (CTG) consists in the simultaneous recording of two distinct traces, the fetal heart rate (FHR; bpm) and the maternal uterine contractions (UCs; mmHg). CTG analysis consists in the evaluation of specific features of traces, among which fetal decelerations (DECs) are considered the "center-stage" since possibly related to fetal distress. DECs are classified based on their duration and occurrence in relation to UCs as prolonged, early, late and variable; each class associates to a specific status of the fetus health. Typically, CTG traces are visually interpreted; however, computerized CTG analysis may overcome subjectivity in CTG interpretation. Thus, this study proposes a new automatic algorithm for computerized identification and classification of DECs. The algorithm was tested on the 552 CTG recordings constituting the "CTU-CHB intra-partum CTG database" of Physionet. Of these, 470 (85.15%) were found suitable for automatic DECs identification and classification. Overall, 5888 DECs were identified, of which 3255 (55.28%) were classified while the other 2633 (44.72%) remained unclassified due to very strict preliminary classification criteria (now required for avoiding misclassifications). Among the classified DECs, 468 (14.38%) were classified as prolonged, 1498 (46.02%) as early, 32 (0.98%) as late, 1257 (38.62%) as variable. Thus, among the classified DECs, the most common are the early and the variable ones (overall 84.64%), the occurrence of which ranged from 0 to 14 DECs per recording. These findings are in agreement with what reported in literature. In conclusion, the proposed algorithm for automatic DECs identification and classification represents a useful tool for computerized CTG analysis.

Validation of a computerized algorithm to quantify fetal heart rate deceleration area

Reliability in visual cardiotocography interpretation is unsatisfying, which has led to the development of computerized cardiotocography. Computerized analysis is well established for antenatal fetal surveillance but has yet not performed sufficiently during labor. We aimed to investigate the capacity of a new computerized algorithm compared with visual assessment in identifying intrapartum fetal heart rate baseline and decelerations. In all, 312 intrapartum cardiotocography tracings with variable decelerations were analyzed by the computerized algorithm and visually examined by two observers, blinded to each other and the computer analysis. The width, depth and area of each deceleration was measured. Four cases (>100 variable decelerations) were subjected to in-depth detailed analysis. The outcome measures were bias in seconds (width), beats per minute (depth), and beats (area) between computer and observers using Bland-Altman analysis. Interobserver reliability was determined by calculating intraclass correlation and Spearman rank analysis. The analysis (312 cases) showed excellent intraclass correlation (0.89-0.95) and very strong Spearman correlation (0.82-0.91). The detailed analysis of >100 decelerations in four cases revealed low bias between the computer and the two observers; width 1.4 and 1.4 seconds, depth 5.1 and 0.7 beats per minute, and area 0.1 and -1.7 beats. This was comparable to the bias between the two observers: 0.3 seconds (width), 4.4 beats per minute (depth) and 1.7 beats (area). The intraclass correlation was excellent (0.90-.98). A novel computerized algorithm for intrapartum cardiotocography analysis is as accurate as gold standard visual assessment, with high correlation and low bias.

Fetal and Maternal Responses to Yoga in the Third Trimester [30F

INTRODUCTION: The goal is to examine the practical and real-time maternal and fetal responses to a moderate intensity yoga session in the third trimester of pregnancy. Unlike previous studies, our study examines a typical 1-hour, moderate intensity prenatal yoga session. METHODS: This is a prospective observational study in low-risk, pregnant participants. Exclusion criteria included hypertension, IUGR, preterm labor, or contraindications to exercise. Wireless fetal monitors were used to monitor fetal beat-to-beat variability, accelerations, and decelerations as well as maternal heart rate and uterine activity. For analysis, fetal and maternal heart rates were continuously recorded over the entire yoga session, and pre- and post NST tracings were analyzed for loss of fetal heart rate variability and decelerations. RESULTS: Twenty participants were enrolled; 19 completed the session. Mean gestational age was 35 weeks and 6 days with an average participant age of 32 years. While fetal heart rates fluctuated over the course of the yoga session, there were no significant fetal heart rate decelerations or changes in beat-to-beat variability to suggest deleterious fetal effects. The fetal heart rate averaged 135.3 bpm (SD±12.2) regardless of activity level . Maternal heart rate also fluctuated from a mean resting heart rate of 88.7 bpm (SD±9.7), increasing to an average heart rate of 104.8 bpm (SD±18.6) during the session, reaching a maximum of 154.9 bpm (SD±12.8), and subsequently decreasing to 88.7 bpm (SD±11.2) during meditation,. CONCLUSION: Yoga can be recommended for low-risk women during pregnancy as no adverse fetal heart rate effects were observed during a realistic, continuous yoga session.

Fetal Heart Rate Decelerations Evaluated by Hypoxia Index

Fetal Heart Rate Decelerations Evaluated by Hypoxia Index

Slow Fetal Heart Rate before Miscarriage in the Early First Trimester Predicts Fetal Aneuploidy in Women with Recurrent Pregnancy Loss.

Establishing whether miscarriages result from fetal aneuploidy or other factors is important for treating recurrent pregnancy loss. We examined the relationship between fetal heart rate (FHR) before miscarriage in the early first trimester and fetal karyotype, analyzing 223 pregnant women with recurrent pregnancy loss. Among the pregnancies, 110 resulted in live births regarded as normal karyotype (the Norm-group). The other 113 pregnancies ended in miscarriage, and we categorized them into groups based on fetal karyotype, determined by chorionic villus sampling: the Misc-NK (normal karyotype) group, n=35 euploid cases; the Misc-CA1 (chromosomal abnormality) group, n=18 cases of aneuploidy with trisomies 13/18/21, Turner's syndrome, or Klinefelter's syndrome; and the Misc-CA2 subgroup, n=60 cases of other aneuploidies excluding those in the Misc-CA1 group. We compared the groups' regression line slopes and intercepts for FHR by an analysis of covariance. The FHRs of the Norm, Misc-NK and Misc-CA1 groups increased from 36 to 49 days after fertilization, but did not significantly differ across these groups. The Misc-CA2 group's FHR did not increase and significantly differed from the other three groups (p<0.01). These results suggest that the absence of an increase in FHR in early pregnancy may indicate the presence of chromosomal abnormalities causing miscarriage.

Effect of Structured Bed Exercise on Uterine Contractions, Fetal Heart Rate Patterns, and Maternal Psychophysical Symptoms of Hospitalized High-Risk Pregnant Women: A Randomized Control Trial

PurposeThis study examined the effect on uterine contraction frequency (UCF), blood pressure (BP), heart rate (HR), fetal heart rate (FHR) patterns and psychophysical symptoms (physical discomfort, anxiety, and depression) of structured bed exercise (SBE) in hospitalized high-risk pregnant women prescribed bed rest. MethodsForty-five hospitalized high risk pregnant women at >24 weeks of pregnancy prescribed bed rest were randomly assigned to the experimental or control group. From January to May 2014, data were collected using electronic fetal monitoring and patient monitoring of UCF, BP, HR and FHR patterns, and psychophysical symptoms were measured using the antenatal physical discomfort scale, state-trait anxiety scale, and Edinburgh postnatal depression scale. ResultsUCF, BP, HR, and FHR patterns (rate, variability, acceleration, and deceleration) did not differ significantly between the experimental and control groups. The experimental group showed a significant increase in baseline FHR after SBE within the normal range, and after SBE, it reduced to the FHR before SBE. The variability, acceleration and deceleration of FHR before and after SBE did not differ significantly between two groups. Moreover, there was no statistically significant difference before and after SBE in the experimental group. Also, the experimental group showed statistically significant decreases in physical discomfort score. However, there were no significant differences in depression and anxiety score between two groups. ConclusionsSBE in hospitalized high-risk pregnant women under bed rest did not increase the risk to the fetus, and relieved physical discomfort and anxiety. Therefore, SBE should be considered as a nursing intervention in hospitalized high-risk pregnant women.