Fetal Heart Rate Variability Research Articles

Interobserver Agreement and Reliability of Intrapartum Nonreassuring Cardiotocography and Prediction of Neonatal Acidemia

Abstract Objective: To evaluate the agreement and reliability of intrapartum nonreasurring cardiotocography (CTG) interpretation and prediction of neonatal acidemia by obstetricians working in different centers. Methods: A retrospective cohort study involving two tertiary hospitals (The First Affiliated Hospital of Sun Yat-sen University and Perking University Third Hospital) was conducted between 30th September 2018 and 1st April 2019. Six obstetricians from two hospitals with three levels of experience (junior, medium, and senior) reviewed 100 nonreassuring fetal heart rate (FHR) tracings from 1 hour before the onset of abnormalities until delivery. Each reviewer determined the FHR pattern, the baseline, variability, and presence of acceleration, deceleration, sinusoidal pattern, and predicted whether neonatal acidemia and abnormal umbilical arterial pH < 7.1 would occur. Inter-observer agreement was assessed using the proportions of agreement (Pa) and the proportion of specific agreement (Pa for each category). Reliability was evaluated with the kappa statistic (k-Light's kappa for n raters) and Gwet's AC1 statistic. Results: Good inter-observer agreement was found in evaluation of most variables (Pa > 0.5), with the exception of early deceleration (Pa = 0.39, 95% confidence interval (CI): 0.36,0.43). Reliability was also good among most variables (AC1 > 0.40), except for acceleration, early deceleration, and prediction of neonatal acidemia (AC1 = 0.17, 0.10, and 0.25, respectively). There were no statistically significant differences among the three groups, except in the identification of accelerations (Pa = 0.89, 95% CI: 0.83,0.95; Pa = 0.50, 95% CI: 0.41,0.60, and Pa = 0.35, 95% CI: 0.25,0.43 in junior, medium and senior groups, respectively) and the prediction of neonatal acidemia (Pa = 0.52, 0.52, and 0.62 in junior, medium and senior groups, respectively), where agreement was highest and lowest in the junior-level group, respectively. The accuracy and sensitivity of the prediction for umbilical artery pH < 7.1 were similar among the three groups, but the specificity was higher in the senior groups (93.68% vs. 92.53% vs. 98.85% in junior, medium and senior groups, P = 0.015). Conclusion: Although we found a good inter-observer agreement in the evaluation of the most basic CTG features and FHR category statistically, it was insufficient to meet the clinical requirements for “no objection” interpretation for FHR tracings. Further specialized training is needed for standardized interpretation of intrapartum FHR tracings.

Comparative Evaluation of Intrathecal Dexmedetomidine and Fentanyl as an Adjuvant for Combined Spinal-Epidural Analgesia for Labor.

Combined spinal-epidural technique is a widely accepted and popular modality for labor analgesia. Opioids are being used as adjuvants since long time. Dexmedetomidine is a new drug that is being used as an intrathecal adjuvant. The study aims to compare the safety and efficacy of fentanyl and dexmedetomidine as intrathecal adjuvants in labor analgesia. This was a continuous, prospective, randomized controlled trial with 120 parturients. After ethical approval and written consent, participants were divided randomly into two groups: Group A - bupivacaine 2.5 mg (0.5 mL diluted to 2 mL) + 20 μg of dexmedetomidine in 1 mL saline intrathecally (total volume: 3 mL) and Group B - bupivacaine 2.5 mg (0.5 mL diluted to 2 mL) + 15 μg of fentanyl in 1 mL saline intrathecally (total volume: 3 mL). Primary outcomes were satisfactory analgesia, mode of delivery, and neonatal outcome. Participants were monitored for the onset and duration of analgesia, degree of motor block, and maternal and fetal side effects. A total of 108 parturients reported sufficient analgesia (Group A: 57; Group B: 51), and 74 patients delivered vaginally (Group A: 41; Group B: 44). The rates of normal vaginal delivery were higher in Group B. Group A reported earlier onset of analgesia (61.26 ± 18.23 s) that lasted for longer duration (124.16 ± 26.23 min) than in Group B. There were no serious side effects in any of the groups. Fetal ultrasound revealed attenuation of fetal heart rate variability. The heart rate of newborns was also found to be low in Group A. Chances of vaginal delivery are higher with intrathecal fentanyl as an adjuvant. Intensity and duration of analgesia are better with intrathecal dexmedetomidine.

Effects of maternal ritodrine hydrochloride administration on the heart rate of preterm fetal sheep with intraamniotic inflammation.

Ritodrine hydrochloride is used for pregnancy prolongation and intrauterine fetal resuscitation. However, its clinical significance in intraamniotic inflammation during preterm labor and intrauterine fetal distress is unclear. We investigated the effects of maternal ritodrine hydrochloride administration (MRA; 200 μg/min for 2 h, followed by 800 μg/min for 2 h after 24 h) on fetal physiological parameters. For this purpose, we used chronically instrumented pregnant sheep at 113–119 d (term = 145 d) of gestation without (Group 1, n = 5) and with (Group 2, n = 5) intraamniotic inflammation induced by lipopolysaccharide injection into the amniotic cavity. The changes in fetal heart rate (FHR) and short-term variability (STV) and long-term variability (LTV) in FHR, fetal blood pressure, and fetal arterial blood gas (FABG) values were measured before and at 1 and 2 h after initiating MRA. Before MRA, all parameters were similar between Groups 1 and 2; however, there was significantly higher STV in Group 2 than in Group 1 before MRA at 800 μg/min, significantly higher partial arterial pressure of carbon dioxide in FABG in Group 2 than in Group 1 before MRA at 200 μg/min, and significantly lower blood glucose (BG) in Group 2 than in Group 1 before MRA at 800 μg/min. One hour after MRA, the FHR, STV, and LTV were significantly higher at 800 μg/min than those at the baseline in Group 1, as determined by the Friedman test; however, no significant difference was observed in Group 2. Additionally, the FABG pH significantly decreased 1 h after MRA at 800 μg/min in Group 2, whereas FABG lactate and BG significantly increased 2 h after MRA at 800 μg/min in Groups 1 and 2. Thus, short-term MRA at 800 μg/min increased the FHR, STV, and LTV significantly; these values were further modified under intraamniotic inflammation.

Pregnant women with bipolar disorder who have a history of childhood maltreatment: Intergenerational effects of trauma on fetal neurodevelopment and birth outcomes.

Intergenerational transmission of trauma occurs when the effects of childhood maltreatment (CM) influence the next generation's development and health; prenatal programming via maternal mood symptoms is a potential pathway. CM is a risk factor for bipolar disorder which is present in 1.8% of pregnant women. Mood symptoms are likely to increase during pregnancy, particularly for those with a history of CM. We examined whether there was evidence for intergenerational transmission of trauma in utero in this population, and whether maternal mood was a transmission pathway. CM and maternal mood were self-reported by N=82 pregnant women in treatment for bipolar disorder. Fetal heart rate variability (FHRV) was measured at 24, 30, and 36 weeks' gestation. Gestational age at birth and birth weight were obtained from medical charts. A cluster analysis yielded two groups, Symptom+ (18.29%) and Euthymic (81.71%), who differed on severe mood symptoms (p < 0.001) but not on medication use. The Symptom+ group had more CM exposures (p < 0.001), a trend of lower FHRV (p=0.077), and greater birth complications (33.3% vs. 6.07% born preterm p < 0.01). Maternal prenatal mood mediated the association between maternal CM and birth weight in both sexes and at trend level for gestational age at birth in females. This is the first study to identify intergenerational effects of maternal CM prior to postnatal influences in a sample of pregnant women with bipolar disorder. These findings underscore the potential enduring impact of CM for women with severe psychiatric illness and their children.

Fetal respiratory movements improve reliability of heart rate variability and suggest a coupling between fetal respiratory arrhythmia and vagal activity.

Fetal heart rate variability (FHRV) reflects autonomic cardiac regulation. The autonomic nervous system constantly adjusts the heart rate to maintain homeostasis. By providing insight into the fetal autonomic state, FHRV has the potential to become an investigational and clinical instrument. However, the method needs standardization and the influence of fetal movements, including fetal respiratory movements, is not well explored. Therefore, in a highly standardized setting, the aim was to evaluate the association between fetal movements and fetal heart rate variability (FHRV) including their impact on reliability. Fetal heart rate was obtained by noninvasive fetal electrocardiography (NI‐FECG) and fetal movements by simultaneous ultrasound scanning in 30 healthy singleton pregnant women on two occasions with a maximum interval of 7 days. The standard deviation of normal‐to‐normal RR‐intervals (SDNN), root mean square of successive RR‐interval differences (RMDDS), high‐frequency power (HF‐power), low‐frequency power (LF‐power), and LF/HF were measured. A multivariate mixed model was used and reliability was defined as acceptable by a coefficient of variance (CV) ≤15% and an intraclass correlation coefficient (ICC) ≥0.80. During time periods with fetal respiratory movements, the highest reliability was achieved. Intra‐ and inter‐observer reliability measurements were very high (CV: 0–9%; ICC ≧ 0.86). Within the same recording, SDNN and RMSSD achieved acceptable reliability (CV: 14–15%; ICC ≧ 0.80). However, day‐to‐day reliability displayed high CV’s. In time periods with fetal respiratory movements, as compared to periods with quiescence RMSSD and HF‐power were higher (Ratio: 1.33–2.03) and LF/HF power lower (Ratio: 0.54). In periods with fetal body movements SDNN, RMSSD and HF‐power were higher (Ratio: 1.27–1.65). In conclusion, time periods with fetal respiratory movements were associated with high reliability of FHRV analyses and the highest values of parameters supposed to represent vagal activity.

Towards better reliability in fetal heart rate variability using time domain and spectral domain analyses. A new method for assessing fetal neurological state?

ObjectivesFetal heart rate variability (FHRV) has shown potential in fetal surveillance. Therefore, we aimed to evaluate the reliability of time domain and spectral domain parameters based on non-invasive fetal electrocardiography (NI-FECG).MethodNI-FECG, with a sampling frequency of 1 kHz, was obtained in 75 healthy, singleton pregnant women between gestational age (GA) 20+0 to 41+0. The recording was divided into a) heart rate pattern (HRP) and b) periods fulfilling certain criteria of stationarity of RR-intervals, termed stationary heart rate pattern (SHRP). Within each recording, the first and the last time series from each HRP with less than 5% artifact correction were analyzed and compared. Standard deviation of normal-to-normal RR-intervals (SDNN), root mean square of successive differences (RMSSD), high frequency power (HF-power), low frequency power (LF-power), and LF-power/HF-power were performed. A multivariate mixed model was used and acceptable reliability was defined as intraclass correlation coefficient (ICC) ≥ 0.80 and a coefficient of variation (CV) ≤ 15%. Based on these results, the CV and ICC were computed if the average of two to six time series was used.ResultsFor GA 28+0 to 34+6, SDNN and RMSSD exhibited acceptable reliability (CV < 15%; ICC > 90%), whereas GA 35+0 to 41+0and 20+0 to 27+6 showed higher CVs. Spectral domain parameters also showed high CVs However, by using the mean value of two to six time series, acceptable reliability in SDNN, RMSSD and HF-power from GA 28+0 was achieved. Stationarity of RR-intervals showed high influence on reliability and SHRP was superior to HRP, whereas the length of the time series showed minor influence.ConclusionAcceptable reliability seems achievable in SDNN, RMSSD and HF-power from gestational week 28. However, stationarity of RR-intervals should be considered when selecting time series for analyses.

Fetal heart rate variability is a biomarker of rapid but not progressive exacerbation of inflammation in preterm fetal sheep

Perinatal infection/inflammation can trigger preterm birth and contribute to neurodevelopmental disability. There are currently no sensitive, specific methods to identify perinatal infection. We investigated the utility of time, frequency and non-linear measures of fetal heart rate (FHR) variability (FHRV) to identify either progressive or more rapid inflammation. Chronically instrumented preterm fetal sheep were randomly assigned to one of three different 5d continuous i.v. infusions: 1) control (saline infusions; n = 10), 2) progressive lipopolysaccharide (LPS; 200 ng/kg over 24 h, doubled every 24 h for 5d, n = 8), or 3) acute-on-chronic LPS (100 ng/kg over 24 h then 250 ng/kg/24 h for 4d plus 1 μg boluses at 48, 72, and 96 h, n = 9). Both LPS protocols triggered transient increases in multiple measures of FHRV at the onset of infusions. No FHRV or physiological changes occurred from 12 h after starting progressive LPS infusions. LPS boluses during the acute-on-chronic protocol triggered transient hypotension, tachycardia and an initial increase in multiple time and frequency domain measures of FHRV, with an asymmetric FHR pattern of predominant decelerations. Following resolution of hypotension after the second and third LPS boluses, all frequencies of FHRV became suppressed. These data suggest that FHRV may be a useful biomarker of rapid but not progressive preterm infection/inflammation.

RETRACTED: Impacts of smartphone 1 radiation on pregnancy: A systematic review

IntroductionThe COVID-19 pandemic has impacted all aspects of people's lives, with many tasks and services now being delivered online in the aim of reducing contact and preventing further transmission of the disease. This has resulted in the increase in the use of portable electronic devices (i.e., mobile phones, smartphones, laptops), which emit different frequencies of electromagnetic field (EMF) radiation. However, the evidence on the harmful impacts of EMF radiation exposure on the human body, particularly on the abdomen of the female body during pregnancy, is scarce. Further, the related studies in the literature have yet to be systematically reviewed. If unmanaged, the absorption of EMF radiation by the maternal abdomen during pregnancy is associated with serious birth and infant outcomes.PurposeThis study aimed to systematically review the published studies on the direct effects of EMF radiation emitted from mobile phones on pregnancy, birth, and infant outcomes.MethodsAfter a systematic search using the PRISMA guidelines, a total of 18 articles were retrieved from 5 databases. Studies which addressed the negative outcomes of EMF radiation exposure on mothers, adults, and children's health were included. The research articles were then sorted based on whether their findings were related to the impacts of EMF on physiological or pregnancy outcomes.ResultsThe findings of this review showed that EMF radiation exposure is associated with hormonal, thermal, and cardiovascular changes among adults. However, the reviewed studies did not consider the impacts of EMF radiation exposure on pregnancy outcomes specifically, which makes it difficult to draw conclusions from this review. Only four of the reviewed studies were conducted among pregnant women. These studies reported that EMF radiation exposure during pregnancy is associated with miscarriages and fluctuations in the fetal temperature and heart rate variability, as well as infant anthropometric measures.ConclusionsMore research should be conducted to identify the specific impacts of EMF radiation exposure on pregnancy, birth, and infant outcomes. Healthcare providers and researchers are recommended to collaborate to improve public health through public education and updated organizational policies to limit these environmental risks by encouraging the use of safe technologies.

Physiological control of fetal heart rate variability during labour: implications and controversies.

The interpretation of fetal heart rate (FHR) patterns is the only available method to continuously monitor fetal well-being during labour. One of the most important yet contentious aspects of the FHR pattern is changes in FHR variability (FHRV). Some clinical studies suggest that loss of FHRV during labour is a sign of fetal compromise so this is reflected in practice guidelines. Surprisingly, there is little systematic evidence to support this observation. In this review we methodically dissect the potential pathways controlling FHRV during labour-like hypoxaemia. Before labour, FHRV is controlled by the combined activity of the parasympathetic and sympathetic nervous systems, in part regulated by a complex interplay between fetal sleep state and behaviour. By contrast, preclinical studies using multiple autonomic blockades have now shown that sympathetic neural control of FHRV was potently suppressed between periods of labour-like hypoxaemia, and thus, that the parasympathetic system is the sole neural regulator of FHRV once FHR decelerations are present during labour. We further discuss the pattern of changes in FHRV during progressive fetal compromise and highlight potential biochemical, behavioural and clinical factors that may regulate parasympathetic-mediated FHRV during labour. Further studies are needed to investigate the regulators of parasympathetic activity to better understand the dynamic changes in FHRV and their true utility during labour.

Measuring fetal heart rate and variability: Fetal cardiotocography versus electrocardiography.

Fetal heart rate variability is a key indicator of fetal neurodevelopment and well-being. Most studies have relied on Doppler-based fetal cardiotocography (fCTG) but recent technologies have made fetal electrocardiography (fECG) more widely available. We compared simultaneous recordings of fCTG and fECG in 131 fetuses twice during gestation (28 and 36weeks) using a commercially available device (Monica AN24). Within-individual correlations for fetal heart rate values, based on averaged data during 50-min recordings, neared 1.0. Continuous and episodic measures of variability were also correlated, particularly at 36weeks. Data collected during maternal polysomnography at 36weeks were used to evaluate reliability of variability measures collected during the 50-min recording. Both fCTG- and fECG-derived measures of variability exhibited correspondence with variability during maternal presleep wakefulness and most sleep states. Results did not appreciably differ by data source or method used to calculate variability. fECG monitoring presented challenges, particularly at 28weeks, when recordings with signal loss of ≤30% were available from only 27% of participants. Success rates improved to 84% at 36weeks. fCTG was successful in over 90% of participants at each gestational age. Considerations in the selection of fECG versus fCTG in developmental research are discussed.

Effect of different maternal positions on comfort of antenatal mothers and fetal parameters during nonstress test.

Providing comfort to an antenatal mother is one of the critical components of the nonstress test (NST). An experimental study was conducted on 450 antenatal mothers beyond 34 weeks, who were randomly allocated into three groups - supine, left lateral, and semi-fowler's position, to explore the association of selected maternal positions on NST results and to find the impact of these positions on the comfort level of antenatal mothers. The fetal parameters were assessed by observing and recording biophysiological measurements from the NST and the maternal comfort of different positions by the Verbal Numerical Rating Scale. The data analyzed reveal a significant association between maternal positions and fetal parameters at P < 0.05 level. Antenatal women who were in semi-fowler's position exhibited more comfort and fetal NST reactivity as noted by significant variation in the baseline fetal heart rate, beat-to-beat variability, acceleration, deceleration, and fetal movements.

Association between Intrapartum Cardiotocography and Umbilical Cord Blood pH in Term Pregnancies: A Cross-sectional Study in a Tertiary Care Centre, Kolkata, India

Introduction: Labour, a physiological process for majority of foetuses, often acts as a challenge to foetal reserves causing foetal hypoxia. Foetal monitoring with intrapartum cardiotocography is an important tool to enable timely intervention to reduce adverse neonatal outcomes like postnatal cerebral palsy. Aim: To determine an association between cardiotocography tracing and umbilical artery cord blood pH in term pregnancies in labour where the influence of drugs and the presence of other comorbid medical/obstetric adverse outcomes have been ruled out. Materials and Methods: This cross-sectional, hospital-based, observational study involved singleton uncomplicated term pregnancies with a normal baseline cardiotocography and spontaneous labour onset and progression admitted to the labour ward of R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India. Intrapartum continuous cardiotocography traces were recorded and those showing abnormal traces were documented and delivery expedited within two hours. Total of 90 such consecutive women were included in the study and umbilical arterial cord blood sample was taken for all these pregnancies immediate postpartum. Cardiotocography traces were then statistically compared with cord blood parameters and the findings were computed using Statistical Package for the Social Sciences (SPSS) software version 22.0. Results: Out of 90 participants the mean age was 24.21±3.43 years, most (43, 47.8%) of them were in between 21 to 25 years. Of the abnormal traces, 51 (56.7%) were NICE Category II (Suspicious) and 39 (43.3%) were NICE category III (pathological). Cord blood analysis revealed that 40% had a pH&lt;7, 44.4% had blood lactate levels above 6 mmol/L and another 47.7% had a base deficit ≥12 mmol/L. On crosstabulation and Chi-square analysis, these were all found to be statistically significant (p-value &lt;0.05). Abnormalities of Foetal Heart Rate (FHR) and baseline variability had higher Odds ratio of predicting umbilical artery acidemia with Odd’s ratio for baseline variability abnormality as high as 2.768. Conclusion: Although there has been a rising trend towards operative deliveries, the overall incidence of neonatal morbidity due to cerebral palsy is still on the rise. Cardiotocography can be a very important tool to identify neonatal acidosis in “at risk” foetuses and helps in timely intervention giving long term best outcomes.

Intrauterine infection effects on fetal heart rate variability : evaluation in an experimental sheep model

Intra uterine infection can lead to serious complications for the fetus and it’s detection is a major concern during labor. Currents methods for fetal surveillance during intrapartum are imperfect and new tools need to be developed. Analysis of fetal heart rate variability (HRV) seems to be an interesting option. The objective of this study was to evaluate acute intra uterine infection effects on fetal heart rate variability, using an experimental sheep model.

Bringing the laboratory into the home: A protocol for remote biobehavioral data collection in pregnant women with emotion dysregulation and their infants.

Pregnant women struggling with emotion dysregulation may be more likely to engage in a wide range of health risk behaviors. This protocol describes a study on intergenerational transmission of emotion dysregulation from the third trimester of pregnancy to 18 months postpartum. Biobehavioral markers of emotion dysregulation are typically measured in laboratory settings which was prohibited by many universities during the COVID-19 pandemic. We describe how markers of emotion dysregulation (e.g. maternal, fetal, and infant heart rate variability) are collected remotely. We detail how data collection can be augmented to reach diverse populations who may not otherwise participate in laboratory-based research.

Decreasing the Duration of Point of Decision to Getting Non-stress Test Done: A Quality Improvement Study.

IntroductionNon-stress test is an important non-invasive tool of antepartum surveillance. The hypoxia, acidemia in the fetus can easily be picked up by a non-stress test. It is important to get a non-stress test done on time to prevent the adverse neonatal outcome.AimThis quality improvement project aims to evaluate the waiting period for a non-stress test (NST) from the point of decision in the antenatal outpatient department and to increase the percentage of pregnant women getting NST done in less than 4 h from the point of decision from a baseline of 41% to 80% in 4 weeks.MethodThis observational study was conducted in the Department of Obstetrics & Gynecology at All India Institute of Medical Sciences Jodhpur for twelve weeks. This study has three phases—baseline assessment, implementation phase and continued implementation with the assessment phase. The tool used for the analysis of this problem was the Fishbone method.ResultsThe baseline assessment showed that only 41% of pregnant women got the non-stress test done in 4 h. We conducted a plan-do-study-act (PDSA) cycle 3 times, and the target was achieved in the second PDSA cycle.ConclusionThis quality improvement project has demonstrated that increasing awareness among all the team members who are dealing with pregnant women requiring NST can significantly increase the percentage of pregnant women getting NST done within 4 h from the point of decision. By detecting the fetal heart rate variation, we can prevent adverse fetal and neonatal outcomes.

35.1 Links Between Maternal Gestational Depression, Corticosteroids, and Fetal Heart Rate Variability: Predicting Early Markers of Infant Inhibition and Regulation

Maternal depression during gestation adversely affects fetal nervous system development and may lead to childhood behavioral problems. Mechanisms of adverse effects are less understood, although cortisol secretion is a potential mediator. Limited research has evaluated links between maternal depression, corticosteroids, and early markers of nervous system development, such as fetal heart rate variability (FHRV), cerebral inhibition, or temperament characteristics. Thus, the objectives were to: 1) evaluate associations between maternal depression, corticosteroids, and FHRV; and 2) test whether FHRV predicts markers of infant inhibition and regulatory capacity. Maternal depression and hair concentrations of cortisol and cortisone were measured during gestation. Heart rate was recorded in 23 fetuses by transabdominal Doppler. The SD of interbeat intervals over 20 minutes was computed to assess FHRV. Higher FHRV values reflect greater physiological regulation. Maternal depression, corticosteroid, and FHRV measurement occurred between 28 and 33 weeks gestation. Subsequent markers of infant nervous system development and temperament were assessed. Newborn development of cerebral inhibition was evaluated at 44 weeks gestation through an auditory sensory gating paradigm. Parents rated their infant’s temperamental regulatory capacity when infants were 3 months of age. Maternal depression was associated with lower FHRV, especially for male fetuses (β = –0.633; p = 0.045). Maternal depression was associated with lower cortisol to total corticosteroids ratios (β = –0.519; p = 0.033). Higher cortisol ratios were associated with increased FHRV (β = 0.485; p = 0.019). Higher FHRV was associated with decreased newborn sensory gating deficits (β = –0.992; p = 0.035), indicating better development of cerebral inhibition. Higher FHRV was also related to increased infant regulatory capacity (r = 0.454; p = 0.029). Maternal depression is associated via corticosteroids with decreased FHRV. Decreased FHRV predicted worse infant inhibition and infant regulatory capacity. Conclusions are limited due to the small sample size. Interventions addressing gestational depression may mitigate biologically mediated adverse effects on infants and thus need further study.

VP33.07: Prelabour short‐term fetal heart rate variability by computerised cardiotocogram and maternal‐fetal Doppler indices as predictors of labour outcomes

VP33.07: Prelabour short‐term fetal heart rate variability by computerised cardiotocogram and maternal‐fetal Doppler indices as predictors of labour outcomes

Poincare plot

“Variability is the sign of life” is the principle being followed by all living beings on the earth. The study of variability came into existence in 1965 with Hon and Lee’s observation of the need for rapid delivery after a decrease in fetal heart rate variation. The field has grown phenomenally since then and has become an essential part of patient care. Heart rate variability is the most studied and explored for its physiological origin and subsequent clinical applications. It has been followed by blood pressure variability, blood flow variability, morphology index variability, and so on. These variabilities are expressed in the time domain, frequency domain, and nonlinear domain by different parameters and geometric shapes. Poincare representation is one of the nonlinear domain representations of variability. Elliptical, torpedo-like, or fan-shaped central conglomeration of points in Poincare plots are generally considered normal. The shape distorts considerably in different diseases. Not much effort has been made to classify these distortions since the time domain and frequency domain presentations have dominated most of the studies due to their numerical expression. Poincare presentation in arrhythmias is very interesting to the extent that a diagnosis can be made based on the Poincare plot. The point plots are now being extended to curve plots or line plots for better detection of arrhythmia and its understanding. Owing to large scatter in the time domain and frequency domain parameters of variability, extended Poincare plots are currently being explored as substitutes. Some of these features of Poincare plots and their clinical applications are briefly described in this article.

It Takes Two: An antenatal to postnatal RDoC framework for investigating the origins of maternal attachment and mother-infant social communication.

Transformation of the maternal-fetal relationship into the mother-infant relationship remains an enigmatic process. This progression is considered using an RDoC-informed approach centered on domains of Arousal/Regulation, Positive/Negative Valence, and Social Processes. 158 maternal-fetal dyads began participation during pregnancy, maternal-infant dyads were followed at 6-months postpartum. Women exhibited stability in feelings of attachment to the fetus and infant, and in positive/negative appraisal of pregnancy and motherhood. Elicited maternal physiological arousal to emotionally evocative videos generated fetal heart rate variability and motor activity responses. Parasympathetic (i.e., heart rate variability) suppression in the fetus was associated with more positive and regulated infant social communication in the Face-to-face Still Face protocol; suppression of maternal respiratory sinus arrhythmia was related to infant affect but in the opposite direction. Maternal ratings of infant temperament aligned with maternal antenatal affective valence. Attachment trajectories characterized by stability from antenatal to postnatal periods were most associated with maternal affective appraisal of pregnancy; shifts were influenced by infant characteristics and maternal sympathetic responsivity. Results illustrate how variation in arousal and regulatory systems of the pregnant woman and fetus operate within the context of maternal positive and negative valence systems to separately and jointly shape affiliation and temperament in early infancy.

Decreased fetal heart rate variability and maternal combined dose of sodium valproate and phenytoin.

A 32-year-old Japanese woman was admitted at 38 weeks' gestation with regular uterine contractions. She was diagnosed with frontal lobe epilepsy at the age of 17, and she had been treated with several anti-epileptic drugs (AEDs) since then but complied poorly due mainly to nausea and frequent seizure attacks.