Sinusoidal Fetal Heart Rate Pattern Research Articles

Amniotic band syndrome: a case report

A case of amniotic band syndrome (ABS) was reported here. No obvious fetal abnormality was revealed by systematic ultrasound at 22+4 weeks of gestation. At 30 weeks of gestation, the pregnant woman was found to have excessive amniotic fluid and possible fetal edema according to ultrasound images and admitted to the First Affiliated Hospital of Nanjing Medical University. After admission, she received diet control to lower blood glucose and amniotic fluid reduction. The dynamic amniotic fluid index was measured by ultrasound, and the electrical fetal heart rate was monitored daily. Since 32 weeks of gestation, progressive reduction in fetal movement with sinusoidal fetal heart rate pattern was observed. An emergent cesarean section was performed due to fetal distress at a gestational age of 32+3 weeks. During the operation, a porous amniotic membrane was found, from the umbilical cord insertion of the placenta to the ankle of the left lower limb of the fetus. Amniotic band constricting left ankle of newborn and the edema of the left foot was obvious, then ABS was diagnosed. This amniotic band affected the left foot of the fetus directly, while there was not enough evidence whether the flake amniotic membrane near the umbilical cord insertion of the placenta could affect the fetus. This premature infant died of neonatal asphyxia 24 hours after birth. Key words: Amniotic band syndrome; Ultrasonography, prenatal; Abnormalities, multiple

Notching in the Umbilical Artery Doppler Waveform in the Absence of Cord and Placental Structural Abnormalities: A Case of Massive Fetomaternal Hemorrhage

Massive fetomaternal hemorrhage can cause severe anemia and fetal death. Early diagnosis and blood transfusion can prevent life-threatening events. We describe a case of massive fetomaternal hemorrhage in a previously well primigravida who visited our hospital with a chief complaint of decreased fetal movements and presented with a sinusoidal fetal heart rate pattern in the cardiotocographic tracings. The umbilical artery Doppler waveform showed notching, and the peak systolic velocity of the fetal middle cerebral artery (MCA) was normal. Emergency cesarean section was performed; however, the neonate died despite providing life-support. Thus, we recommend consideration of impending fetal death in patients with non-reassuring fetal heart rate and notching in the umbilical artery Doppler waveform even in the absence of increased peak systolic velocity of the fetal MCA. J Clin Gynecol Obstet. 2016;5(1):50-52 doi: http://dx.doi.org/10.14740/jcgo386w

Saltatory and Sinusoidal Fetal Heart Rate (FHR) Patterns and significance of FHR ‘Overshoots’

Saltatory and Sinusoidal Fetal Heart Rate (FHR) Patterns and significance of FHR ‘Overshoots’

Severe fetomaternal hemorrhage confirmed and quantified by flow cytometry using anti fetal hemoglobin antibodies

Severe fetomaternal hemorrhage (FMH) is a rare but potentially life-threatening perinatal complication (1). The traditional method for diagnosis of this situation is the acid elution (Kleihaur–Betke) test. However, this technique is relatively insensitive and non-specific, and does not allow quantification of the hemorrhagic process. We report a case of severe FMH confirmed and quantified by means of flow cytometric analysis using specific staining for cells containing fetal hemoglobin (HbF) in maternal circulation. We believe that this method is more sensitive, more specific and allows accurate quantification of FMH. A 30-year-old nullipara at 36 + 2 gestational weeks was admitted to the delivery room for decreased fetal movements. On admission, a sinusoidal fetal heart rate pattern was recorded (Fig. 1), and an immediate cesarean section was performed. A 2400 g female infant was delivered with Apgar scores of five and seven at 1 and 5 min, respectively. The infant was extremely pale, limp and bradycardic. Initial hematocrit and hemoglobin levels were 12.3% and 4.4 g/dL, respectively, while a direct Coombs' test was negative. She was treated initially by infusion of normal saline followed by packed red blood cells (20 cc/kg), until marked clinical improvement, and her hematocrit reached 35%. The rest of her postnatal course was unremarkable. Fetal cardiotogoram showing a sinusoidal fetal heart rate pattern. In an attempt to confirm the suspected diagnosis of FMH, we performed flow cytometric analysis of fetal erythrocytes in maternal blood samples obtained soon after delivery. The cells were washed, fixed permiabilized and stained with monoclonal antibodies against HbF according to the manufacturer's instructions (Bioatlantic, Nantes, France). Cell analysis was performed with a FACstarplus flow cytometer (Beckton-Dickenson, Mountain View, CA, USA). A 488-nm argon laser beam at 250 mV served for excitation. The threshold was set on forward light scatter to exclude platelets. Green fluorescence was measured using logarithmic amplification through a 530 ± 30 nm band-pass-filter. As a positive control we used 3 neonatal cord blood samples and as negative controls blood samples from five other women after normal deliveries. The positivity threshold was adjusted with positive controls. Almost 11% of maternal erythrocytes contained high HbF level, i.e. were of fetal origin (Fig. 2). These results were confirmed by analyzing the hemoglobin types in the hemolysate of the maternal blood using high performance liquid chromatography (results not shown). Histogram of flow cytometric analysis of three samples stained for HbF. The flourescence intensity is demonstrated on a log scale along the X-axis, and the cell count along the Y-axis. A. The presented case showing a major peak of HbF negative cells (maternal cells) and a minor peak of cells containing high levels of HbF, i.e, fetal cells. B. A sample of umbilical cord blood. C. A sample of control maternal blood. Detection of fetal cells in maternal circulation represents an important support for the clinical diagnosis of FMH. Most laboratories perform FMH estimates on the basis of the slide-based microscopic counting method of acid elution (Kleihaur–Betke) test. This technique is laborious and suffers from lack of sensitivity, subjectivity and precision (2). These limitations prompted the use of flow cytometry which overcomes all these limitations by rapid and sensitive cell-by-cell analysis (3). In the past, flow cytometry approaches of fetal cells in maternal blood relied mainly on detection of the human D antigen. However, this approach was applicable only to clinical situations with D antigen incompatibility and could not be utilized in all cases of FMH. Using antibodies to HbF as described in the current case allows for broad application to various clinical situations (4, 5). Moreover, the quantitative nature of flow cytometric analysis permits the distinction of true fetal cells, which contain HbF as the major form of hemoglobin, from maternal circulating F-cells that have lower cellular HbF content. This is particularly applicable for individuals with hereditary persistence of HbF or various hemoglobinopathies. To our knowledge, this is the first reported case of severe FMH confirmed and quantified by flow cytometry using anti HbF antibodies. Clinicians may wish to apply this rapid and accurate method for diagnostic purposes postnataly and even antenatally when clinical suspicion arises.

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.)

Management of Nonobstetric Pain During Pregnancy and Lactation

Management of Nonobstetric Pain During Pregnancy and Lactation

Management of nonobstetric pain during pregnancy and lactation.

Management of nonobstetric pain during pregnancy and lactation.

Severe fetomaternal hemorrhage: a review.

The etiology, clinical presentation, obstetrical antecedents, and outcome of pregnancies complicated by large fetomaternal hemorrhage (FMH) were reviewed by doing a MEDLINE search from 1966 to the present and manual search before 1966. One hundred thirty-four infants with FMH > 50 dl were reported in the literature. The primary variables: birth weight, gestational age, presence of sinusoidal fetal heart rate pattern, decrease or absent fetal body movements (FBM) estimated the amount of fetomaternal bleeding and the pretransfusion hemoglobin. Other variables included the condition of the infants at birth, erythroblasts, and reticulocyte blood counts at birth, as well as the year of publication. Thirty-five of the 134 cases were preterm. Twenty infants born to mothers reporting decreased or absent FBM survived. FBM was absent in 17 cases for a period ranging between 24 hours and 7 days. In this group, six infants survived, five were stillborn, and five died in the neonatal period. A sinusoidal heart rate (SHR) pattern was reported in 21 cases. A SHR pattern was associated with decreased FBM in 13 cases (39.3 percent). Fifteen cases with sinusoidal fetal heart rate pattern survived (71.4 percent). Both decreased or absent FBM and SHR patterns were reported more often in 1990 or later than before 1990 (P < .0017 and P < .008, respectively). The cause of FMH was not known in 82 percent of the cases. The most common presenting symptoms of FMH were anemia at birth (35.2 percent), decreased or absent FBM (26.8 percent), and unexpected stillbirths (12.5 percent). Seventeen intrauterine transfusions were performed in nine cases (eight survived). A negative correlation was found between pretransfusion hemoglobin and FMH (r = -0.35; P = .0019). No significant difference was found between the cases with FMH of > 200 ml or < 200 ml. Thus, decreased or absent FBM, SHR pattern, or hydrops fetalis are late signs of FMH. Other means of early detection are needed. The role of intrauterine transfusion (IUT) needs to be better defined. The inadequate outcome data indicate the need to follow infants born with large FMH into childhood to document the effect on the central nervous system.

Prenatal sonographic diagnosis of intracranial haemorrhage: Report of a case with a sinusoidal fetal heart rate tracing, and review of the literature

The sinusoidal fetal heart rate pattern has been described in association with severe fetal anaemia, with fetal hypoxaemia, and with the administration of parenteral narcotics. Here, we report a case of decreased fetal movement in which a sinusoidal tracing was recorded. The sonographic diagnosis of a massive fetal intracranial haemorrhage was made. A non-interventive approach was taken and the fetus died soon after in utero. We review 28 previous cases in which the prenatal sonographic diagnosis of fetal intracranial haemorrhage was made, including the underlying maternal and fetal factors and neonatal outcomes. We propose that the sinusoidal tracing in this case was due to the intracranial bleed and suggest that fetal intracranial haemorrhage be considered in the sonographic evaluation of the fetus with a sinusoidal pattern.

Pseudosinusoidal Fetal Heart Rate Pattern and Fetal Anaemia: Case Report and Review

The association of a pseudosinusoidal fetal heart rate pattern with fetal anaemia is reported. A system of classifying this cardiotocographic feature as minor, intermediate or major is discussed. The clinical correlates of each of these gradings and the differentiation from a true sinusoidal fetal heart rate pattern are presented.

Massive fetomaternal hemorrhage preceded by decreased fetal movement and a nonreactive fetal heart rate pattern

Background: Massive fetomaternal hemorrhage occurs in one in 1000 deliveries and has been associated with decreased fetal movements and a sinusoidal fetal heart rate (FHR) pattern. Cases: Three women presented with decreased fetal movements, nonreactive FHR patterns, and positive Kleihauer-Betke tests. All three were at a viable gestational age and were immediately delivered by cesarean. The three infants were severely anemic, with hemoglobin levels of 6.5, 5.3, and 5.1 g/dL, respectively. Conclusion: A patient who presents with decreased fetal movement associated with a nonreactive FHR pattern and a positive Kleihauer-Betke test of more than 140 mL should be considered for immediate delivery if the gestational age is consistent with neonatal viability.(Obstet Gynecol 1993; 82:711-4)

The Prevalence, Aetiology and Clinical Significance of Pseudo sinusoidal Fetal Heart Rate Patterns in Labour

Objective To investigate the prevalence of sinusoidal and pseudo-sinusoidal fetal heart rate (FHR) patterns in labour and the relation between the characteristics of the FHR pattern and fetal outcome. Design A prospective observational study over a 6-month period in which all women who had continuous FHR monitoring in labour had their intrapartum cardiotocographs (CTGs) scrutinized for the presence of sinusoidal or pseudo-sinusoidal FHR patterns. Setting John Radcliffe Hospital, Oxford. Subjects 1520 women who had fetal monitoring during labour for various reasons. Main outcome measures Both internal (electrocardiographic) and external (ultrasound) recordings of the FHR were analysed. Abnormal FHR patterns were related to obstetric characteristics and fetal outcome in terms of Apgar scores, umbilical artery pH and admission to the special care unit. Results No true sinusoidal FHR patterns were observed, but pseudo-sinusoidal FHR patterns were found in 230 of the 1520 CTGs examined (15%). Of these, 219 were classified as minor (amplitude 5-15 beats/min) and 11 as intermediate (amplitude 16-24 beats/min). Major pseudo-sinusoidal FHR patterns (amplitude greater than 24 beats/min) were not observed. Minor pseudo-sinusoidal FHR patterns had a mean duration of 21 (SD 13) min and typically occurred once or twice early in labour. Using logistic regression analysis a significant, independent relation was demonstrated between the presence of minor pseudo-sinusoidal FHR patterns and the use of pethidine (RR 1.84, 95% CI 1.3 to 2.59, P less than 0.0001) and epidural analgesia (RR 1.85, 95% CI 1.24 to 2.76, P less than 0.001). Intermediate pseudo-sinusoidal FHR patterns were found in association with both in utero fetal sucking and transient episodes of fetal hypoxia such as that caused by periodic umbilical cord compression. Conclusion Pseudo-sinusoidal FHR patterns in labour will usually be associated with a normal fetal outcome but a careful fetal assessment is mandatory.

The prevalence, aetiology and clinical significance of pseudo‐sinusoidal fetal heart rate patterns in labour

To investigate the prevalence of sinusoidal and pseudo-sinusoidal fetal heart rate (FHR) patterns in labour and the relation between the characteristics of the FHR pattern and fetal outcome. A prospective observational study over a 6-month period in which all women who had continuous FHR monitoring in labour had their intrapartum cardiotocographs (CTGs) scrutinized for the presence of sinusoidal or pseudo-sinusoidal FHR patterns. John Radcliffe Hospital, Oxford. 1520 women who had fetal monitoring during labour for various reasons. Both internal (electrocardiographic) and external (ultrasound) recordings of the FHR were analysed. Abnormal FHR patterns were related to obstetric characteristics and fetal outcome in terms of Apgar scores, umbilical artery pH and admission to the special care unit. No true sinusoidal FHR patterns were observed, but pseudo-sinusoidal FHR patterns were found in 230 of the 1520 CTGs examined (15%). Of these, 219 were classified as minor (amplitude 5-15 beats/min) and 11 as intermediate (amplitude 16-24 beats/min). Major pseudo-sinusoidal FHR patterns (amplitude greater than 24 beats/min) were not observed. Minor pseudo-sinusoidal FHR patterns had a mean duration of 21 (SD 13) min and typically occurred once or twice early in labour. Using logistic regression analysis a significant, independent relation was demonstrated between the presence of minor pseudo-sinusoidal FHR patterns and the use of pethidine (RR 1.84, 95% CI 1.3 to 2.59, P less than 0.0001) and epidural analgesia (RR 1.85, 95% CI 1.24 to 2.76, P less than 0.001). Intermediate pseudo-sinusoidal FHR patterns were found in association with both in utero fetal sucking and transient episodes of fetal hypoxia such as that caused by periodic umbilical cord compression. Pseudo-sinusoidal FHR patterns in labour will usually be associated with a normal fetal outcome but a careful fetal assessment is mandatory.

Ruptured vasa praevia indicated by a sinusoidal fetal heart rate pattern: a case report

A sinusoidal heart rate pattern is usually considered to signify fetal distress. A case is reported in which the diagnosis vasa praevia was considered 20 h after a short period of vaginal bleeding, after the occurrence of a sinusoidal heart-rate pattern.

Objective and Quantitative Evaluation of Fetal Movement with Ultrasonic Doppler Actocardiogram

Actocardiogram is the simultaneous recording of fetal movement (FM) and fetal heart rate (FHR) with the use of a single transducer by weak ultrasound. Fetal behavioral states, fetal hiccups, nonpathologic sinusoidal FHR pattern induced by cyclic FM were reported in the use of this technique. Computer processing of FM signals enabled automatic recognition of fetal behavior. Fetal hypoxic state preceding fetal distress was diagnosed by the actocardiogram. Cross-correlation coefficient of FHR and delayed FM was high, showing a new possibility of detailed grading of mild fetal hypoxia.

Computer-assisted analysis of normal second trimester fetal heart rate patterns

A software package for computer-assisted analysis of antenatal fetal heart rate (FHR) patterns has been commercially available from 1989. Reference ranges for the third trimester of pregnancy have been established. In order to obtain reference values for the second trimester, one hour FHR recordings were made between 20 and 29 weeks gestation in 77 women with uncomplicated pregnancies. There was a significant increase of (medium term) FHR variation and of the number of accelerations from 20 to 29 weeks (r = 0.48, p less than 0.01 and r = 0.34, p less than 0.01 respectively). The lower limit of normal FHR variation (mean--2 SD's) increased from 18 msec at 20 weeks to 28 msec at 28 weeks. Furthermore, a 30 minute recording appeared to be sufficient to obtain a reliable impression of FHR variation. Short term FHR variation, a measure of FHR variation that facilitates the identification of sinusoidal FHR patterns, also increased significantly between 20 and 29 weeks (r = 0.61, p less than 0.01). Delerations (greater than 20 beats/min and greater than or equal to 30 seconds) were present in 54% of the recordings and are a more or less common phenomenon at this age. It is concluded that during the second trimester FHR variation differs considerably from that in the third trimester. This should be taken into account in the interpretation of second trimester FHR records.

Massive Fetomaternal Hemorrhage: Case Report

Massive fetomaternal hemorrhage (FMH) is rare. Early diagnosis is important because FMH has a poor prognosis in the antepartum or early postpartum period. A case of massive FMH in which 400 ml blood was lost is presented here. Fetal anemia was suspected from the sinusoidal fetal heart rate pattern. The hemorrhage in the maternal circulation was diagnosed before delivery by using the Kleihauer-Betke test. An emergency cesarean section was performed. The cord hemoglobin level was 3.7 g/dl. The baby's severe anemia was treated with a neonatal blood transfusion. In this case, the baby had a good clinical course. Early diagnosis and treatment of massive FMH are necessary for a good prognosis.

Sinusoidal fetal heart rate pattern during cardiopulmonary bypass

A gravida 3, para 2 woman underwent an emergency mitral valve replacement at 24 weeks' gestation. A sinusoidal fetal heart pattern was recorded throughout cardiopulmonary bypass. This pattern persisted despite a pump flow maintained at 31 ml/m2 min and an intravenous infusion of phenylephrine to maintain the mean systemic arterial pressure at 50 mm Hg.

Sinusoidal fetal heart rate pattern associated with the twin to twin transfusion syndrome

Sinusoidal fetal heart rate pattern (FHR) is regarded by most authors as signifying a compromised fetus. In most cases, this is secondary to fetal anemia of different causes, usually Rh isoimmunization, more rarely to fetomaternal transfusion, bleeding vasa previa, placental chorioangioma, or traumatic amniocentesis. A case is described which to our knowledge is the first reported of a sinusoidal FHR pattern occurring in the relatively anemic donor twin in a case of the twin to twin transfusion syndrome. The importance of separate antepartum biophysical evaluation of each member of a twin pregnancy is emphasized.

Epidural Butorphanol-Bupivacaine for Analgesia During Labor and Delivery

Hunt, C. O.; Naulty, J. S.; Malinow, A. M.; Datta, S.; Ostheimer, G. W. Author Information