Abstract
Cardiotocography (CTG) is widely used in pregnant women for fetal monitoring and has provided extensive knowledge on the pathophysiology of fetal hypoxia. Computer analyses of CTG tracings were developed to reduce intraobserver and interobserver disagreement inherent to visual analyses, but commonly rely on the use of simple linear time-domain indices, providing a limited understanding of fetal heart rate (FHR) variability. Additional information can be obtained from linear analysis of FHR in the frequency-domain and from nonlinear methods such as measures of entropy. Such indices are able to characterize fetal behavioral states, different gestational ages, and to identify situations of fetal acidemia. However, the technical specifications of fetal monitoring equipment and fetal presentation should be considered in order to ensure an adequate application of these indices. In addition to these, the inclusion of fetal gender may improve the identification of fetal acidemia and intrauterine growth-restriction. In conclusion, linear and nonlinear analysis of FHR variability is likely to improve the performance of existing computer systems for CTG analysis, justifying more extensive clinical trials with these methods.
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References
ACOG, American College of Obstetricians and Gynecologists. (2005). ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists. Obstetrics & Gynecology, 106, 1453–1460.
Almeida, R., Gonçalves, H., Bernardes, J., & Rocha, A. P. (2014). Fetal QRS detection and heart rate estimation: A wavelet-based approach. Physiological Measurement, 35, 1723–1735.
Amorim-Costa, C., Gonçalves, H., Bernardes, J., & Ayres-de-Campos, D. (2012). Spectral and entropy analysis of fetal heart rate throughout gestation: A prospective cohort study. International Journal of Gynecology & Obstetrics, 119(Suppl3), S735.
Ayres-de-Campos, D., Bernardes, J., & Costa-Pereira, A. (1999). Inconsistencies in classification by experts of cardiotocograms and subsequent clinical decision. BJOG: An International Journal of Obstetrics & Gynaecology, 106, 1307–1310.
Ayres-de-Campos, D., Sousa, P., Costa, A., & Bernardes, J. (2008). Omniview-SisPorto 3.5—A central fetal monitoring station with online alerts based on computerized cardiotocogram + ST event analysis. Journal of Perinatal Medicine, 36, 260–264.
Bernardes, J., Gonçalves, H., Ayres-de-Campos, D., & Rocha, A. P. (2008). Linear and complex heart rate dynamics vary with sex in relation to fetal behavioural states. Early Human Development, 84, 433–439.
Bernardes, J., Gonçalves, H., Ayres-de-Campos, D., & Rocha, A. P. (2009). Sex differences in linear and complex fetal heart rate dynamics of normal and acidemic fetuses in the minutes preceding delivery. Journal of Perinatal Medicine, 37, 168–176.
Chung, D. Y., Sim, Y. B., Park, K. T., Yi, S. H., Shin, J. C., & Kim, S. P. (2001). Spectral analysis of fetal heart rate variability as a predictor of intrapartum fetal distress. International Journal of Gynecology & Obstetrics, 73, 109–116.
Clifford, G. D., Silva, I., Behar, J., & Moody, G. B. (2014). Noninvasive fetal ECG analysis. Physiological Measurement, 35, 1521–1536.
Costa, M., Goldberger, A. L., & Peng, C. K. (2002). Multiscale entropy analysis of complex physiologic time series. Physical Review Letters, 89, 068102.
Costa, M., Goldberger, A. L., & Peng, C. K. (2005). Multiscale entropy analysis of biological signals. Physical Review E, 71, 021906.
FIGO, International Federation of Gynecology and Obstetrics. (1995). Intrapartum surveillance: Recommendations on current practice and overview of new developments. FIGO study group on the assessment of new technology international federation of gynecology and obstetrics. International Journal of Gynecology & Obstetrics, 49, 213–221.
Fong, B. F., Savelsbergh, G. J. P., Leijsen, M. R., & de Vries, J. I. P. (2009). The influence of prenatal breech presentation on neonatal leg posture. Early Human Development, 85, 201–206.
Gonçalves, H., Ayres-de-Campos, D., & Bernardes, J. (2014). Fetal behavioral dynamics in cephalic versus breech presentations. Developmental Psychobiology, 56, 1595–1600.
Gonçalves, H., Bernardes, J., & Ayres-de-Campos, D. (2013). Gender-specific heart rate dynamics in severe intrauterine growth-restricted fetuses. Early Human Development, 89, 431–437.
Gonçalves, H., Bernardes, J., Rocha, A. P., & Ayres-de-Campos, D. (2007). Linear and nonlinear analysis of heart rate patterns associated to fetal behavioral states in the antepartum period. Early Human Development, 83, 585–591.
Gonçalves, H., Costa, A., Ayres-de-Campos, D., Costa-Santos, C., Rocha, A. P., & Bernardes, J. (2013). Comparison of real beat-to-beat signals with commercially available 4 Hz sampling on the evaluation of fetal heart rate variability. Medical & Biological Engineering & Computing, 51, 665–676.
Gonçalves, H., Rocha, A. P., Ayres-de-Campos, D., & Bernardes, J. (2006a). Internal versus external intrapartum fetal heart rate monitoring: Effect on linear and nonlinear parameters. Physiological Measurement, 27, 307–319.
Gonçalves, H., Rocha, A. P., Ayres-de-Campos, D., & Bernardes, J. (2006b). Linear and nonlinear fetal heart rate analysis of normal and acidemic fetuses in the minutes preceding delivery. Medical & Biological Engineering & Computing, 44, 847–855.
Henriques, T., Gonçalves, H., Antunes, L., Matias, M., Bernardes, J., & Costa-Santos, C. (2013). Entropy and compression: Two measures of complexity. Journal of Evaluation in Clinical Practice, 19, 1101–1106.
Hoyer, D., Tetschke, F., Jaekel, S., Nowack, S., Witte, O. W., Schleuβner, E., & Schneider, U. (2013). Fetal functional brain age assessed from universal developmental indices obtained from neuro-vegetative activity patterns. PLoS One, 8, e74431.
Kean, L. H., Suwanrath, C., Gargari, S. S., Sahota, D. S., & James, D. K. (1999). A comparison of fetal behaviour in breech and cephalic presentations at term. British Journal of Obstetrics & Gynaecology, 106, 1209–1213.
Lange, S., Van Leeuwen, P., Geue, D., Hatzmann, W., & Grönemeyer, D. (2005). Influence of gestational age, heart rate, gender and time of day on fetal heart rate variability. Medical & Biological Engineering & Computing, 43, 481–486.
Martínez, J. P., Almeida, R., Olmos, S., Rocha, A. P., & Laguna, P. (2004). Wavelet-based ECG delineator: Evaluation on standard databases. IEEE Transactions on Biomedical Engineering, 51, 570–581.
Nijhuis, I., & ten Hof, J. (1999). Development of fetal heart rate and behavior: Indirect measures to assess the fetal nervous system. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 87, 1–2.
Nunes, I., Ayres-de-Campos, D., Figueiredo, C., & Bernardes, J. (2013). An overview of central fetal monitoring systems in labour. Journal of Perinatal Medicine, 41, 93–99.
Oppenheimer, L. W., & Lewinsky, R. M. (1994). Power spectral analysis of fetal heart rate. Baillière’s Clinical Obstetrics and Gynaecology, 8, 643–661.
Park, Y. S., Ryu, K. Y., Shim, S. S., Hoh, J. K., & Park, M. I. (2012). Comparison of fetal heart rate patterns using nonlinear dynamics in breech versus cephalic presentation at term. Early Human Development, 89, 101–106.
Pincus, S., & Viscarello, R. (1992). Approximate entropy: A regularity measure for fetal heart rate analysis. Obstetrics & Gynecology, 79, 249–255.
Pinto, P., Bernardes, J., Costa-Santos, C., Amorim-Costa, C., Silva, M., & Ayres-de-Campos, D. (2014). Development and evaluation of an algorithm for computer analysis of maternal heart rate during labour. Computers in Biology and Medicine, 49, 30–35.
RCOG, Royal College of Obstetricians and Gynaecologists. (2001). Evidence-based clinical guideline number 8. The use of electronic fetal monitoring. London: Royal College of Obstetricians and Gynaecologists.
Richman, J. S., & Moorman, J. R. (2000). Physiological time-series analysis using approximate entropy and sample entropy. American Journal of Physiology – Heart and Circulatory Physiology, 278, H2039–H2049.
Rooth, G., Huch, A., & Huch, R. (1987). FIGO news. Guidelines for the use of fetal monitoring. International Journal of Gynecology & Obstetrics, 25, 159–167.
Salamalekis, E., Thomopoulos, P., Giannaris, D., Salloum, I., Vasios, G., Prentza, A., & Koutsouris, D. (2002). Computerised intrapartum diagnosis of fetal hypoxia based on fetal heart rate monitoring and fetal pulse oximetry recordings utilising wavelet analysis and neural networks. BJOG: An International Journal of Obstetrics & Gynaecology, 109, 1137–1142.
Signorini, M. G., Magenes, G., Cerrutti, S., & Arduini, D. (2003). Linear and nonlinear parameters for the analysis of fetal heart rate signal from cardiotacographic recordings. IEEE Transactions on Biomedical Engineering, 50, 365–374.
Silva, I., Behar, J., Sameni, R., Zhu, T., Oster, J., Clifford, G. D., & Moody, G. B. (2013). Noninvasive fetal ECG: The PhysioNet/computing in cardiology challenge 2013. Computing in Cardiology, 40, 149–152.
Sørensen, H. T., Steffensen, F. H., Olsen, J., Sabroe, S., Gillman, M. W., Fischer, P., & Rothman, K. J. (1999). Long-term follow-up of cognitive outcome after breech presentation at birth. Epidemiology, 10, 554–556.
Swartjes, J. M., van Geijn, H. P., Mantel, R., van Woerden, E. E., & Schoemaker, H. C. (1990). Coincidence of behavioural state parameters in the human fetus at three gestational ages. Early Human Development, 23, 75–83.
Task Force, Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. (1996). Task Force Heart rate variability: Standards of measurement, physiological interpretation and clinical use. Circulation, 93, 1043–1065.
Tendais, I., Figueiredo, B., Gonçalves, H., Bernardes, J., Ayres-de-Campos, D., & Montenegro, N. (2014). Sex differences in the fetal heart rate variability indices of twins. Journal of Perinatal Medicine, 43, 221–225.
Van der Meulen, J. A., Davies, G. A., & Kisilevsky, B. S. (2008). Fetal sensory-elicited body movements differ in breech compared to cephalic position. Developmental Psychobiology, 50, 530–534.
Van Leeuwen, P., Lange, S., Betterman, H., Grönemeyer, D., & Hatzmann, W. (1999). Fetal heart variability and complexity in the course of pregnancy. Early Human Development, 54, 259–269.
Vindla, S., & James, D. (1995). Fetal behaviour as a test of fetal well-being. British Journal of Obstetrics and Gynaecology, 102, 597–600.
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Gonçalves, H., Ayres-de-Campos, D., Bernardes, J. (2016). Linear and Nonlinear Analysis of Fetal Heart Rate Variability. In: Reissland, N., Kisilevsky, B. (eds) Fetal Development. Springer, Cham. https://doi.org/10.1007/978-3-319-22023-9_7
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DOI: https://doi.org/10.1007/978-3-319-22023-9_7
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