Long-term Fetal Heart Rate Research Articles

Deep learning with information fusion and model interpretation for long-term prenatal fetal heart rate data

Long-term fetal heart rate (FHR) monitoring during the antepartum period, increasingly popularized by electronic FHR monitoring, represents a growing approach in FHR monitoring. This kind of continuous monitoring, in contrast to the short-term one, collects an extended period of fetal heart data. This offers a more comprehensive understanding of fetus’s conditions. However, the interpretation of long-term antenatal fetal heart monitoring is still in its early stages, lacking corresponding clinical standards. Furthermore, the substantial amount of data generated by continuous monitoring imposes a significant burden on clinical work when analyzed manually. To address above challenges, this study develops an automatic analysis system named LARA (Long-term Antepartum Risk Analysis system) for continuous FHR monitoring, combining deep learning and information fusion methods. LARA’s core is a well-established convolutional neural network (CNN) model. It processes long-term FHR data as input and generates a Risk Distribution Map (RDM) and Risk Index (RI) as the analysis results. We evaluate LARA on inner test dataset, the performance metrics are as follows: AUC 0.872, accuracy 0.816, specificity 0.811, sensitivity 0.806, precision 0.271, and F1 score 0.415. In our study, we observe that long-term FHR monitoring data with higher RI is more likely to result in adverse outcomes (p = 0.0021). In conclusion, this study introduces LARA, the first automated analysis system for long-term FHR monitoring, initiating the further explorations into its clinical value in the future.

An efficient compression technique for Foetal phonocardiogram signals in remote healthcare monitoring systems

Remote Healthcare Monitoring Systems (RHMs) that employ fetal phonocardiography (fPCG) signals are highly efficient technologies for monitoring continuous and long-term fetal heart rate. Wearable devices used in RHMs still face a challenge that decreases their efficacy in terms of energy consumption because these devices have limited storage and are powered by batteries. This paper proposes an effective fPCG compression algorithm to reduce RHM energy consumption. In the proposed algorithm, the Discrete Orthogonal Charlier Moment (DOCMs) is used to extract features of the signal. The householder orthonormalization method (HOM) is used with the Charlier Moment to overcome the propagation of numerical errors that occur when computing high-order Charlier polynomials. The proposed algorithm’s performance is evaluated in terms of CR, PRD, SNR, PSNR, and QS and provides the average values 18.33, 0.21, 48.85, 68.86, and 90.88, respectively. The results of the comparison demonstrate the proposed compression algorithm’s superiority over other algorithms. It also tested in terms of compression speed and computational efficiency. The results indicate that the proposed algorithm has a high Compression speed (218.672 bps) and high computational efficiency (21.33). Additionally, the results reveal that the proposed algorithm decreases the energy consumption of a wearable device due to the transmission time decreasing for data by 3.68 s.

Quantification of Feto-Maternal Heart Rate from Abdominal ECG Signal Using Empirical Mode Decomposition for Heart Rate Variability Analysis

In this paper, a robust method of feto-maternal heart rate extraction from the non-invasive composite abdominal Electrocardiogram (aECG) signal is presented. The proposed method is based on the Complete Ensemble Empirical Mode Decomposition with Adaptive Noise (CEEMDAN) method, in which a composite aECG signal is decomposed into its constituent frequency components called Intrinsic Mode Functions (IMFs) or simply “modes”, with better spectral separation. Decomposed IMFs are then selected manually according to probable maternal and fetal heart rate information and are processed further for quantification of maternal and fetal heart rate and variability analysis. The proposed method was applied to aECG recordings collected from three different sources: (i) the PhysioNet (adfecgdb) database; (ii) the PhysioNet (nifecgdb) database; and (iii) synthetic aECG signal generated from mathematical modeling in the LabVIEW software environment. An overall sensitivity of 98.83%, positive diagnostic value of 97.97%, accuracy of 96.93% and performance index of 96.75% were obtained in the case of Maternal Heart Rate (MHR) quantification, and an overall sensitivity of 98.13%, positive diagnostic value of 97.62%, accuracy of 95.91% and performance index of 95.69% were obtained in case of Fetal Heart Rate (FHR) quantification. The obtained results confirm that CEEMDAN is a very robust and accurate method for extraction of feto-maternal heart rate components from aECG signals. We also conclude that non-invasive aECG is an effective and reliable method for long-term FHR and MHR monitoring during pregnancy and labor. The requirement of manual intervention while selecting the probable maternal and fetal components from “n” number of decomposed modes limits the real-time application of the proposed methodology. This is due to the fact that the number of modes “n” produced by the CEEMDAN decomposition is unpredictable. However, the proposed methodology is well suited for applications where a small time-delay or offset in feto-maternal monitoring can be acceptable. In future, application-specific modification of the CEEMDAN algorithm can be implemented to eliminate manual intervention completely and will be suitable for long-term feto-maternal monitoring.

Continuous objective recording of fetal heart rate and fetal movements could reliably identify fetal compromise, which could reduce stillbirth rates by facilitating timely management

Stillbirth currently affects approximately 1 in every 200 pregnancies in the United Kingdom. Fetuses may exhibit signs of compromise as part of a stress response before stillbirth, including reduced fetal movements (RFM) and fetal heart rate (FHR) alterations. At present, and despite widespread use, current fetal monitoring is not associated with a reduction in perinatal mortality rate (PMR) as signs of fetal compromise are not adequately detected. This may be attributed to inaccuracies resulting from manual interpretation of results or subjective assessment of fetal activity. In addition, signs of compromise often occur only hours or days before fetal death, so may be missed by current monitoring methods, which are performed intermittently. A significant consideration is that correct identification of these signs and consequent intervention can result in the delivery of a healthy baby, thus preventing stillbirth. A hypothesis is presented, proposing prompt detection of fetal compromise with the use of 24-hour continuous objective fetal monitoring. With focus placed on obtaining long-term FHR and fetal movement data, prior interest has been found in developing devices for this purpose. However, introduction into clinical practice has not been achieved. Investigation of the hypothesis will begin with the design of a device to record the mentioned parameters, followed by an appropriate validation process. Should development and testing be successful, an eventual comparison in PMR with the use of continuous fetal monitoring vs current monitoring would address the hypothesis. It is suggested that a timely yet reliable indication of fetal wellbeing obtained via long-term monitoring would allow prompt and appropriate obstetric intervention and consequently reduce PMR.

Passive Acoustic Signal Acquisition System for Non-Invasive Fetal Heart Sound Monitoring Applications.

A simple, low cost and non-invasive personal computer based system for the acquisition of passive acoustic signal is developed. The system hardware consists of a phonocardiographic sensor, a heart sound signal preprocessing circuit, and a personal computer, while the system software consists of a fetal heart sound acquisition program, a signal analysis program, and a data storage function block. The acquisition program is used to switch on or off of the hardware equipments for initializing the sampling rate, the number of acquisition channels and other relevant setups. The collected data in its original form is saved through storage function block for the purpose of further subsequent analysis. In this study, an attempt has been made to develop a phonocardiography based data acquisition system for non-invasive fetal monitoring applications with many advantages like long term home monitoring and high performance to cost ratio. The system was justified by recording the fetal heart sound from 21 subjects with different gestational period. The result shows that the overall accuracy of the system is 98.02%. The developed system can be efficiently used by a fetal heart sound monitoring system for long-term fetal heart rate monitoring in a fully passive manner.

The event synchronous canceller algorithm removes maternal ECG from abdominal signals without affecting the fetal ECG

Fetal monitoring using abdominally recorded signals (ADS) allows physicians to detect occurring changes in the well-being state of the fetus from the beginning of pregnancy. Mainly based on the fetal electrocardiogram (fECG), it provides the long-term fetal heart rate (fHR) and assessment of the fetal QRS morphology. But the fECG component in ADS is obscured by the maternal ECG (mECG), thus removal of the mECG from ADS improves fECG analysis. This study demonstrates the performance of the event-synchronous interference canceller (ESC) in mECG removal from ADS data, recorded during pregnancy and labor. Its advantage as a compensation method for extended ADS processing is discussed.

Development of a low cost fetal heart sound monitoring system for home care application

Variations in fetal heart rate (FHR) is a potential indicator of stress on unborn in the womb of mother. In hospitals, FHR surveillance is performed by ultrasound based Doppler equip-ments. However, recent studies show that frequent exposure to ultrasound radiations is not recommended for the fetal well-being. Because of this and many other reasons, these instruments are not recommended for prolonged home monitoring applications. This work is focused around development of a prototype system for fetal home monitoring application. Presented system can record the abnormal FHR and alert the pregnant women to report to a physician. Recorded data is then processed by a novel methodology for deriving results of diagnostic importance. The instrument has been tested on pregnant women in the clinical environment and has gone through an extensive clinical trial at local hospitals. The results show that the technique is suitable and effective for long-term FHR home monitoring application.

System simulation for a novel fetal monitoring methodology

Monitoring the variations of fetal heart rate (FHR) is one of the most important approaches for fetal surveillance. In hospitals, ultrasound-based equipments such as Doppler fetal monitor and cardiotocograph (CTG) are used for FHR monitoring. However, recent studies show that frequent exposure to ultrasound radiations is not recommended for the fetal well-being. Because of this and many other reasons, these instruments are not recommended for prolonged monitoring applications. This work is focused around the development of a computer simulation for a novel fetal home monitoring application, which is also helpful in the management of complex pregnancies. Presented system can record the abnormal FHR and alert the pregnant women to report to a physician. Recorded data is then processed by a novel methodology for deriving results of diagnostic importance. The model has been tested by signals obtained from different pregnant women with varied gestation age. Simulation results show that the technique is suitable and effective for long-term FHR home monitoring application.

Short-Term (0–48 h) Effects of Maternal Betamethasone Administration on Fetal Heart Rate and Its Variability

The short-term (0-48 h) effects of maternal betamethasone administration on computerized fetal heart rate (FHR) parameters were studied in 36 pregnancies at increased risk for preterm delivery. FHR was recorded for 90 min immediately before the start of betamethasone treatment and again at 6-h intervals during the next 48 h. Multiple linear regression models were used to assess the possible effects on FHR parameters of gestational age, time of day, clinical indication for treatment, and use of tocolytic drugs. Within 12 h after the start of treatment, significant increases occurred in FHR accelerations, and short- and long-term FHR variability (36%, 28%, and 22%, respectively), whereas basal FHR showed a 5% decrease. FHR variability was decreased by 10% at 42-48 h. The observed changes were more pronounced in older (29-33 wk of gestation) compared with younger fetuses (25-28 wk of gestation). Decelerations occurred only in 4 out of 11 compromised fetuses during betamethasone therapy. We conclude that there are significant changes in FHR parameters during the first 48 h after betamethasone administration. These changes are transient in normal fetuses. However, the compromised fetus may be adversely affected by betamethasone.

A rule-based phonocardiographic method for long-term fetal heart rate monitoring.

A real-time method for fetal heart rate (FHR) monitoring based on signal processing of the fetal heart sounds is presented. The acoustic method, which utilizes an adaptive time pattern analysis to select and analyze those heartbeats that can be recorded without artefact, is guided by a number of rules involving an introduced confidence factor on the timing prediction. The algorithm was implemented in a low-power portable electronic instrument to enable long-term fetal surveillance. A large number of clinical tests have shown the very good performance of the phonocardiographic method in comparison with FHR curves simultaneously recorded with ultrasound cardiotocography. Indeed, approximately 90% of the time, the acoustic FHR curve remained inside a +/- 3 beats/min tolerance limit of the reference ultrasound method. The confidence was typically CF > 0.85. The acoustic method exceeded a +/- 5 beats/min limit relative to the ultrasound method approximately 5% of the time. Finally, no relevant FHR data was measured approximately 5% of the time.

Cardiovascular and metabolic responses to intermittent umbilical cord occlusion in the preterm ovine fetus.

To determine the cardiovascular and metabolic responses to umbilical cord occlusion in the preterm ovine fetus and the impact of repetitive intermittent insults over a 4-day period. Repetitive umbilical cord occlusions (experimental group, n = 7; control group, n = 7) were performed daily (112-115 days' gestation, term = 147 days). Mean arterial pressure (MAP), fetal heart rate (FHR), and FHR variation were monitored, and arterial blood was sampled at predetermined intervals. During umbilical cord occlusions, arterial oxygen pressure (PaO2) (approximately 17 mmHg) and glucose (approximately 0.3) millimoles per liter (mmol/L) fell and arterial carbon dioxide pressure (approximately 8 mmHg) rose (P < .01) to a similar extent on days 1 and 4. Umbilical cord occlusion produced a rise in lactate over the course of successive umbilical cord occlusions each day, the magnitude of which tended to be reduced by day 4 (0.3 +/- 0.1 versus 0.6 +/- 0.1 mmol/L). Control hour FHR and MAP were unaltered over the 4 days, but the delta (delta) FHR to delta PaO2 ratio during umbilical cord occlusions was less on day 4 than on day 1 (6.0 +/- 0.4 versus 10.9 +/- 1.5 beats per minute/mmHg; P < .01). During occlusion hours, high FHR variation episodes, as a measure of fetal activity, were reduced (14.6 +/- 1.5 versus 4.2 +/- 1.3 min/h; P < .01), whereas the reduction in short-term (7.4 +/- 0.7 to 5.8 +/- 0.6 milliseconds; P < .05) and long-term (34.9 +/- 2.7 to 30.0 +/- 0.6 milliseconds; P < .05) FHR variation reached significance only on day 4. The increase in lactate and reduced high-FHR variation episodes over successive umbilical cord occlusions may affect fetal growth and development. Furthermore, repeated umbilical cord occlusions over several days alter the preterm FHR response to subsequent stresses, suggesting an altered chemoreflex response.

Fetal heart rate patterns in postasphyxiated fetal lambs with brain damage

Objective: We previously showed that in asphyxiated fetal lambs the duration of hypotension correlated well with the severity of histologic damage to the brain, whereas the duration of bradycardia did not. This study compares fetal heart rate patterns with the degree of histologic damage to the brain. Study Design: Twelve chronically instrumented near-term fetal lambs were subjected to asphyxia by umbilical cord occlusion until fetal arterial pH was <6.9 and base excess was <–20 mEq/L. An additional 4 fetuses served as sham-asphyxia controls. Fetal heart rate (from electrocardiogram), arterial blood pressure, fetal breathing movements, and electrocorticogram were continuously monitored before, during, and for 72 hours after asphyxia. Fetal brain histologic features were categorized as mild (group 1, n = 5), moderate (group 2, n = 4), and severe (group 3, n = 3). Long-term fetal heart rate variability expressed as amplitude range was assessed visually every 5 minutes from 30 minutes before asphyxia until 2 hours of recovery and at 6, 12, 24, 48, and 72 hours of recovery. Results: Long-term fetal heart rate variability amplitude decreased from 32 ± 17 beats/min (mean ± SEM) preocclusion to 4 ± 13 beats/min at the end of occlusion ( P < .001) without significant differences among the 3 groups. During 10 to 45 minutes of recovery, the long-term variability of group 1 was significantly greater than that of groups 2 and 3. At 24 to 72 hours of recovery, the long-term variability of groups 1 and 2 was significantly higher than that of group 3, which was almost 0. The “checkmark” and sinusoidal fetal heart rate patterns were observed during the recovery period in groups 2 and 3. Conclusions: Decreased long-term fetal heart rate variability and the “checkmark” and sinusoidal fetal heart rate patterns were indicators of the severity of asphyxial histologic damage in the fetal brain. (Am J Obstet Gynecol 1998;179:1329-37.)

Ethnicity and fetal heart rate variation

Objective: To determine the effect of ethnicity on fetal heart rate (FHR) variation. Methods: A prospective study was conducted of 27 consecutive black women (of African or Caribbean ethnic origin) and 79 consecutive white women (of European ethnic origin) volunteers attending the antenatal clinic, with uncomplicated singleton pregnancies of at least 34 completed weeks' gestation. The participants had cardiotocography performed with an FHR monitor connected to a Sonicaid System 8002 computer. We studied the mean FHR, long-term FHR variation, short-term FHR variation, the number of accelerations, and the reactivity of the FHR. Results: The long-term FHR variation in centiles corrected for gestational age, the duration in minutes of episodes of high FHR variation, the long-term FHR variation in beats per minute during episode of high FHR variation, and the number of accelerations were significantly reduced in fetuses of black women compared with those in fetuses of white women ( P = .007, P = .005, P = .009, and P = .006, respectively, Mann-Whitney U test). The fetuses of black women had a significantly higher proportion of nonreactive traces ( P = .009, Fisher exact test). However, there was no significant difference in the short-term FHR variation between the two groups ( P = .101). Conclusion: There is an ethnic difference in FHR variation, with significantly reduced long-term variation in black fetuses.

Noninvasive monitoring of fetal heart rate during the last ten days of gestation in sows

SUMMARY Objective To develop and evaluate a noninvasive technique for monitoring and analyzing porcine fetal heart rate (FHR) during late gestation. Animals 8 fetuses of 8 pluriparous sows in late gestation. Procedure With the sow positioned in lateral recumbency, the most caudal fetus was identified, using real time ultrasonography, and its heart rate was recorded for 60 minutes by use of Doppler cardiography. The same fetus was identified and monitored repeatedly during the last 10 days of gestation, excluding the 24 hours before delivery. Visual inspection and computerized analysis of the recordings were performed. Results 66 one-hour recordings were obtained from 8 fetuses, 1 in each of 8 sows. Mean signal loss was 37.5%. Episodes of low FHR and low FHR variation (FHR pattern A) alternated with episodes of high FHR and high FHR variation (FHR pattern B). This cyclic alternation between 2 distinct FHR patterns was observed in 46 of 66 (69.7%) recordings, and suggests the presence of different behavioral states in fetal pigs. Basal FHR decreased toward parturition in 7 fetuses, but increased in 1 fetus with abdominal ascites. Basal FHR and long-term FHR variation were negatively correlated (r[S) = −0.73; P &lt; 0.001). Conclusion Noninvasive monitoring of FHR is possible and feasible during late gestation in pigs. This method permits longitudinal studies under pathophysiologic conditions and the evaluation of the effects of endogenous and exogenous influences on porcine FHR. (Am J Vet Res 1997;58:1285–1290)

Fetal heart rate patterns in growth-restricted fetal sheep induced by chronic fetal placental embolization

OBJECTIVE: Our purpose was to test the hypothesis that chronic placental insufficiency and intrauterine growth restriction in fetal sheep causes a decrease in the number of fetal heart rate accelerations and fetal heart rate variability. STUDY DESIGN: Chronically catheterized fetal sheep were embolized ( n = 6) daily with 15 to 50 μm latex microspheres for 21 days between 0.74 and 0.88 of gestation into the abdominal aorta, until fetal arterial oxygen content was decreased by 40% to 50% of the preembolization value. Control animals ( n = 6) received saline solution only. Signals from chest electrodes were analyzed on-line with the Sonicaid System 8000 in 2-hour epochs every 6 hours starting at 8 am over the first 48 hours of hypoxemia and for 2 hours between 8 and 10 am every other day from day 3 to day 21 of hypoxemia. Umbilical artery Doppler-derived resistance index and fetal plasma catecholamine concentrations were also measured. RESULTS: Embolized fetuses had asymmetric intrauterine growth restriction and became chronically hypoxemic ( p < 0.001) with a progressive increase in the umbilical artery resistance index ( p < 0.001). During the first 48 hours of hypoxemia the number of accelerations and decelerations and both short- and long-term fetal heart rate variability increased initially, followed by a return to control levels by 20 hours after the onset of embolization. After 21 days of hypoxemia the number of accelerations was significantly reduced by 30% compared with controls ( p < 0.05). Both short- and long-term fetal heart rate variability in control fetuses gradually increased with advancing gestational age ( p < 0.001 and p < 0.01, respectively), whereas in embolized fetuses the fetal heart rate variability remained unchanged and was 20% lower than that of controls on day 21 (both p < 0.01). CONCLUSION: Intrauterine growth restriction and long-term hypoxemia in fetal sheep are associated with a decrease in short- and long-term fetal heart rate variability, possibly because of a delay in the normal maturational changes of the autonomic control of fetal heart rate. (Am J Obstet Gynecol 1997;176:282-90.)

Improvements in computerized fetal heart rate analysis antepartum.

The continued development of a computerised system for measuring the pattern of the antepartum fetal heart rate (FHR) is described. Previous work had established that measurement of FHR variation objectively detects chronic fetal hypoxaemia and the onset of metabolic acidaemia antepartum. The normal centiles were calculated for the amplitude of long-term FHR variation, in episodes of high and low variation, week by week from 24-42 weeks gestation. Reference to these (automatically by the computer) improved discrimination between normal and questionable records in 38% of records, with a small saving of time. Two types of sinusoidal rhythm were described (slow, 1 in 2-5 minutes, incidence 0.16% of subjects; and faster, 2-5 per minute, incidence 0.025%) with methods for their detection. Both may be of sufficient amplitude to induce an episode of high FHR variation. The different effects of maternal steroid (betamethasone or dexamethasone) administration of FHR variation were compared, and the clinical consequences considered. The frequency distribution of basal FHR in normal and abnormal records was measured, and the effects on basal FHR outside the normal range (120-160 bpm) on FHR variation described. Adjustment of the FHR baseline was undertaken when, exceptionally, large abrupt changes in heart rate occurred during a record. The duration and frequency of FHR record acquisition in clinical practice were reviewed, and new policies recommended. With adequate safeguards, measurement by a computer offers reliable objective information from which fetal health may be assessed, more objectively and accurately than by visual inspection.

Neural network prediction of nonstress test results: How often should we perform nonstress tests?

OBJECTIVE: Our purpose was to predict outcomes and optimal intervals for nonstress tests of term gravid women with neural networks. STUDY DESIGN: We studied 100 normal term patients whose 30-minute nonstress tests, performed on 5 consecutive days, were computer analyzed for the following elements: fetal heart rate baseline, variability, signal loss, accelerations (>15 beats/min), and decelerations. The training set used 65 patients; the testing, 35 patients. Nonstress test data (days 1 to 4) were inputs; day 5 data were training patterns. Networks for each nonstress tet element used Brainmaker Macintosh 1.0 (California Scientific Software, Nevada City, Calif.) trained to 0.12 tolerance. Actual fetal heart rate elements and their daily differences were compared with predictions by the networks and multiple regressions. RESULTS: There was little difference between networks using daily or alternate-day inputs for predicting test performance on day 5; networks using test intervals >2 days could not be trained to tolerance. Long-term fetal heart rate variation was the nonstress test element best predicted. Daily differences networks provided better prediction of all day 5 data than did actual daily values networks or multiple regression formulas. CONCLUSIONS: Baseline long-term fetal heart rate variability seems to be the most predictable fetal heart rate element over time and should merit more consideration in overall fetal testing. Fetal heart rate elements are not easily predicted by any method for intervals longer than 2 days. Using longer test intervals might run a greater risk for unanticipated changes in nonstress test outcomes, even when fetal condition is normal.

The feasibility of long-term fetal heart rate monitoring in the home environment using maternal abdominal electrodes

It is well established that fetal and maternal electrocardiograms (ECGs) can be obtained from the maternal abdomen using standard surface electrodes, although this cannot be guaranteed. The unobtrusive and non-invasive nature of such monitoring lends itself naturally to the long-term ambulatory collection of this data on cardiac activity. By employing suitable algorithms it would then be possible to extract records of both fetal and maternal heart rate. This article presents results of the collection of raw electrophysiological signals, containing both fetal and maternal ECGs from a single volunteer from the 20th week of gestation until term. The significance of the data is that they were recorded by the mother herself in her own environment. Previously written software was then used to extract fetal and maternal heart rate data. These results demonstrate the feasibility of using this method for the long-term recording of fetal and maternal heart rate in the mother's normal surroundings.

Effect of Magnesium on Fetal Heart Rate Variability Using Computer Analysis

We studied 16 women, at 32 weeks' or more gestation who required magnesium sulfate (MgSO4) therapy for preterm labor or preeclampsia. A 60-minute Doppler fetal heart rate (FHR) tracing, analyzed by the Oxford Sonicaid System 8000, was obtained for 1 hour before and 2 hours after each patient received intravenous MgSO4 therapy. Maternal serum Mg2+ levels were obtained at the second monitoring session. Matched paired measures of FHR parameters were compared with the Student's t test. After MgSO4 administration, we noted significant falls in long-term variability, short-term variability, and total acceleration (more than 10 beats/min) counts. Reduced short-term and overall variability occurred in all cases with maternal serum Mg2+ levels more than 4.6 mg/dL. Therapeutic maternal serum Mg2+ levels are linked with decreases in long-term and short-term FHR variability and acceleration counts. These findings should be considered when evaluating resting FHR baseline of patients thus treated.

Antenatal bleeding and fetal heart rate.

Objective of the paper was to determine the fetal heart rate (FHR) changes that occur in preterm fetuses whose mothers have suffered antepartum bleeding, versus uncomplicated controls. Over a 12-year span, 91 patients with significant antenatal bleeding (bleeding requiring inhospital observation) were examined and compared to 75 controls with uncomplicated normal pregnancies. None of the women were in labor and all were evaluated at 25-37 weeks' gestation. Excluded were: patients with any other complication (i.e., premature rupture of membranes, intrauterine growth retardation, diabetes, hypertension, collagen vascular disease, postuterine surgery, substance abuse and twins). Analysis of the FHR tracings included baseline heart rate, long-term FHR variability, and number and amplitude of FHR accelerations in 20-min segments. There was no difference in baseline heart rate in the preterm fetuses of pregnancies complicated by antepartum bleeding versus controls. However, the parameters associated with FHR reactivity (number of accelerations in 20 min, and amplitude of accelerations) were higher to a statistically significant degree in fetuses of pregnancies complicated by antenatal bleeding than in controls. Fetuses of mothers suffering antenatal bleeding exhibited significant higher rates of reactive FHR patterns at earlier gestational ages than did controls. In conclusion, there is a significant increase in FHR reactivity in pregnancies in which significant antenatal bleeding occurs, suggesting a probable acceleration in fetal central nervous system maturation in these fetuses.