The interaction of behavioural state, heart rate and resistance index in the human fetus.

The association and possible interactions of fetal behavioural state, fetal heart rate and vascular resistance was studied in 23 healthy pregnant women between 36 and 40 weeks' gestation. Doppler flow velocity waveforms were obtained from fetal cerebral (anterior cerebral, internal carotid and basilar), descending aorta and umbilical arteries during fetal behavioural state 1F and repeated during 2F. The Resistance Index (RI) was used as a measure of vascular resistance. Decreased vascular resistance was observed in all vessels except the umbilical artery during fetal behavioural state 2F compared to 1F (P less than 0.001). A significant interaction was observed between fetal heart rate and fetal behavioural state on the RI of the vessels studied, with a greater negative slope for RI plotted against fetal heart rate in fetal behavioural state 2F (-0.00139) compared to 1F (0.00005) (P less than 0.001). We conclude that the transition from fetal behavioural state 1F to 2F is associated with a significant reduction in cerebral and systemic vascular resistance, with no apparent change in placental resistance. Furthermore, fetal behavioural state and fetal heart rate interact, demonstrating a stronger association of fetal heart rate and RI in fetal behavioural state 2F in keeping with an increase in baroreflex sensitivity at this time.     

Preterm birth in lambs: sleep patterns and cardio-respiratory changes.

Cardio-respiratory physiology in sleep was examined in eight preterm lambs born at 133-135 (134 +/- 1, mean SEM) days of gestation after 3-5 days of pulsatile ACTH/TRH infusion, and contrasted with eight lambs born at term (147 +/- 1 days). Lambs were instrumented with electrodes for recording electrocorticogram, electro-oculogram and nuchal electromyogram to define behavioural states, as well as carotid arterial catheters for determination of arterial pressure, heart rate and arterial blood gases. Compared to full-term lambs, the preterm lambs exhibited extended active sleep times, elevated PaCO2 and faster heart rate in all behavioural states than full-term lambs; with increasing postnatal age, sleep times and heart rate declined. As similar differences are found in preterm human infants, the preterm lamb will be a useful model to study the underlying physiology of these cardio-respiratory alterations.     

Increase in regularity of fetal heart rate variability with age.

It is generally assumed that fetal heart rate variability increases with gestation, reflecting prenatal development of the autonomic nervous system. We examined standard measures quantifying fetal heart rate variability, as well as a complexity measure, approximate entropy, in 66 fetal magnetocardiograms recorded from 22 healthy pregnant women between the 16th and 42nd week of gestation. In particular, regularity in the fetal RR interval time series was assessed on the basis of symbolic dynamics. The results showed that, beside an overall increase in fetal heart rate variability and complexity during pregnancy, there was also an increase in specific sets of binary patterns with low approximate entropy, i.e., a high degree of regularity. These sets were characterized by short epochs of heart rate acceleration and deceleration, and comparison with surrogate data confirmed that their random occurrence is rare. The results most likely reflect the influence of increasingly differentiated fetal behavioral states and transitions between them in association with fetal development.     

Changes in antepartum heart rate patterns with progressive deterioration of the fetal condition

In this paper changes in antepartum fetal heart rate (FHR) patterns are described, that occur with progressive deterioration of the fetal condition. The data on the relationship between heart rate patterns and fetal blood gas and pH values are reviewed. A possible rank ordering is presented in which changes in FHR pattern, body movements and blood flow velocity wave form patterns occur with progressive deterioration of the fetal condition.It is concluded that in small-for-date fetuses changes in heart rate and movement patterns are rather late signs of impairment, coinciding with fetal hypoxaemia. In general, heart rate variation falls below the norm at the same time as decelerations occur; there are, however, large inter-fetal differences. In general, abnormal Doppler velocity wave form patterns precede the occurrence of heart rate decelerations. Their impact on the timing of delivery is, however, still uncertain. The advantages of a numerical analysis of FHR patterns include identification of fetuses with low FHR variation, precision of the actual fetal condition and (at early gestation) longitudinal follow-up of fetuses with abnormal heart rate patterns.     

Quantifying the Interactions between Maternal and Fetal Heart Rates by Transfer Entropy

Evidence of the short term relationship between maternal and fetal heart rates has been found in previous studies. However there is still limited knowledge about underlying mechanisms and patterns of the coupling throughout gestation. In this study, Transfer Entropy (TE) was used to quantify directed interactions between maternal and fetal heart rates at various time delays and gestational ages. Experimental results using maternal and fetal electrocardiograms showed significant coupling for 63 out of 65 fetuses, by statistically validating against surrogate pairs. Analysis of TE showed a decrease in transfer of information from fetus to the mother with gestational age, alongside the maturation of the fetus. On the other hand, maternal to fetal TE was significantly greater in mid (26–31 weeks) and late (32–41 weeks) gestation compared to early (16–25 weeks) gestation (Mann Whitney Wilcoxon (MWW) p<0.05). TE further increased from mid to late, for the fetuses with RMSSD of fetal heart rate being larger than 4 msec in the late gestation. This difference was not observed for the fetuses with smaller RMSSD, which could be associated with the quiet sleep state. Delay in the information transfer from mother to fetus significantly decreased (p = 0.03) from mid to late gestation, implying a decrease in fetal response time. These changes occur concomitant with the maturation of the fetal sensory and autonomic nervous systems with advancing gestational age. The effect of maternal respiratory rate derived from maternal ECG was also investigated and no significant relationship was found between breathing rate and TE at any lag. In conclusion, the application of TE with delays revealed detailed information on the fetal-maternal heart rate coupling strength and latency throughout gestation, which could provide novel clinical markers of fetal development and well-being.     

Behavioural assessment of fetal health

The assessment of behavioural activity of the fetus is widely used to assess fetal health in clinical practice as part of the biophysical profile as well as the nonstress test. Considerable information regarding normal activity patterns of healthy human fetuses have been obtained from 24 to 40 weeks gestation. It is this information which has provided the scientific foundation for the development of fetal assessment protocols. Studies in chronically-catheterized fetal sheep have demonstrated that acute hypoxemia leads to an inhibition of fetal breathing movements although prolonged reductions in oxygen delivery to the fetus in the absence of acidemia are associated with adaptation by the fetus and subsequent return to normal incidence of behavioural activity. The behavioural responses of the fetus to specific stimuli including vibroacoustic stimulation have been examined in relation to gestational age as well as type of stimulus, it is proposed that fetal acoustic stimulation could possibly be used to assess fetal neurological function although prior to it being accepted as an universal method for assessing fetal health it is essential that a greater understanding of the mechanisms involved in fetal responses to sound and vibration be determined using appropriate experimental techniques.     

Fetal growth in the baboon during the second half of pregnancy

The normal growth profile of critical fetal organs through the last third of gestation has not been documented in detail in human fetuses or the fetus of any nonhuman primate species. Recent epidemiological studies in human pregnancy suggest that fetal growth plays a major role in the programming of life-long health by modifying cardiovascular, pancreatic, brain, and liver growth. The present study aimed to produce a detailed database of individual organ growth in the fetal baboon in late gestation. Fetal organ weights were obtained from 43 baboon fetuses between 121 and 177 days of gestation. Various organs (brain, heart, kidney, femur, intestines, and spinal cord) showed no sign of slowed growth in late gestation while growth of others (lung, liver, stomach, and bladder) accelerated in late gestation. The fetal adrenal and thymus showed a decrease in growth rate over the final 20 and 10 days of gestation respectively. These observations provide a database that will permit analysis of factors responsible for regulation of normal and altered fetal organ development in this important experimental species.     

Fetal heart rate variability in growth restricted fetuses.

Intrauterine growth restriction (IUGR) remains a major problem in perinatal medicine because of the variety of its underlying causes and the prediction of its outcome. Characteristics of heartbeat interval patterns are associated with neuro-vegetative and humoral regulatory processes. Fetal magnetocardiography allows non-invasive assessment of these processes with high precision throughout the second half of gestation. The aim of our study was the analysis of linear and non-linear parameters of fetal heart rate fluctuations to distinguish between IUGR fetuses and a cohort of normal subjects, both pre-selected from heart-rate traces representing a quiet state of activity in the third trimester of gestation.     

Cardiotocography in cows: A method for monitoring calves during delivery

Fetal ECG-electrodes and an intrauterine catheter were inserted into 15 Holstein-Friesian cows during their first stage of labor to make a cardiotocogram. Simultaneously, fetal heart rate and intrauterine pressure were recorded until completion of fetal expulsion. Immediatly post partum the viability of the calf was assessed by clinical evaluation and measurements of blood pH, base excess (BE) and pCO(2). Fetal heart rate patterns and their changes were evaluated according to standards used in human medicine. Basal fetal heart rate (90 to 120) in 10 calves gradually increased towards the end of parturition, with a marked loss of variability. Decelerations, coinciding with periods of increased intrauterine pressure, occurred in all cows. When decelerations occurred beyond the end of a contraction the calf was born in a poor condition. Accelerations were only recorded in two cows. Many of the fetal heart rate changes observed were similar to those which in human cardiotocography are considered to be signs of fetal distress. Further investigation is needed to establish the predictive value of fetal heart rate patterns in cows, which would be a welcome addition to improved fetal diagnostics during parturition.     

Spectral analysis of fetal heart rhythm in relation to fetal regular mouthing

Fetal heart rate variation during fetal regular mouthing in behavioural state 1F was investigated applying spectral analysis. Periods with and without fetal regular mouthing movements were compared. The power spectrum of the periods with regular mouthing movements showed a peak at the frequency of the clusters of mouthing movements which was absent in the power spectrum of the corresponding periods without movements. The oscillations in the fetal heart rate associated with this peak in the power spectrum were detectable both in the heart rate tracings obtained from the abdominal electrocardiogram and those recorded by means of wide range Doppler ultrasound.     

DEVELOPMENT OF A BIMODAL HEART RATE PATTERN IN UNDISTURBED FETAL HARBOR SEALS

Fetal and maternal heart rates were studied in unrestrained, pregnant harbor seals during the last third of gestation. Heart rates were recorded while the mothers were resting on land or performing trained simulated dives of up to 2.25 min. Data from resting mothers showed the development of a bimodal or two-speed fetal heart rate pattern during late gestation. The mean faster and slower fetal heart rates at term were 125 ± 3.7 and 79 ± 3.1 (mean + SEM) respectively. The amount of fetal bradycardia observed increased steadily towards term, and fetal heart rate changes were not correlated with changes in maternal heart rate or maternal respiration. The bimodal fetal heart rate was also seen during the simulated dives, and no decrease in either the faster or slower heart rate was found. Heart rates from resting, unrestrained harbor seal pups were also studied. The pups displayed a bimodal heart rate similar to the fetuses' with the slower rate occurring during breath-holds. The bradycardia in the pups was equivalent to the slower fetal heart rate. These findings suggest that the regulatory mechanism that determines the apneic bradycardia in young harbor seals during non-stressful conditions develops in the last quarter of gestation.     

Relationship between accelerations and decelerations in heart rate and skeletal muscle activity in fetal sheep

Accelerations in fetal heart rate have been shown to be closely related to fetal body movements and are indicative of well-being in the human fetus. We have examined the association of accelerations and decelerations in heart rate with skeletal muscle activity in 8 fetal sheep between 125 and 145 days' gestation. Accelerations/decelerations were defined as transient increases/decreases in fetal heart rate of greater than or equal to 10 beats/min. lasting for 5 s or longer. For accelerations (n = 1180), the mean duration was 18.8 +/- 1.5 s (SEM) and the mean amplitude was 25.3 +/- 1.2 beats/min; for decelerations (n = 237), the mean duration was 17.4 +/- 1.6 s and the mean amplitude was 18.7 +/- 1.0 beats/min. Electromyograms were recorded from the nuchal muscles and antagonistic muscle groups of the fetal forelimb and hindlimb. Electromyogram activity occurred during 88.4 +/- 2.8% of accelerations and 60.6 +/- 7.7% of decelerations. There was a 36.6% reduction in the number of accelerations following fetal paralysis with gallamine, but no change in their amplitude or duration. It is concluded that accelerations in heart rate are highly associated with skeletal muscle activity in fetal sheep. The majority of these occur as a result of central neuronal output rather than as a consequence of fetal movement.     

Age-related changes of glycogen metabolism in human fetal heart

The changes in the activities of three important glycogen metabolising enzymes, viz. glycogen synthetase, glycogen phosphorylase and alpha-D-glucosidase, along with glycogen content have been measured in adult human heart and human fetal heart collected at 13-36 weeks of gestation. At an early period, particularly 13-16 weeks of gestational age, the activity of glycogen synthetase and glycogen content were found to be maximum. However the activity of glycogen phosphorylase remained constant throughout the gestation and that of alpha-D-glucosidase showed a peak at 25-28 weeks of gestation, thereby indicating that fetal heart tissue has the capacity to utilise glycogen for energy.     

The behavioural state in human perinatal life

Behavioural states are easy to recognise in healthy neonates with a gestational age of 36 weeks or more. In younger neonates stable behavioural states, as seen at full-term, are not present, but activity cycles exist. In utero stable behavioural states can also be recognised from 36 to 38 weeks onwards. The existence of awake states in utero remains controversial. A close relationship exists between neural mechanisms regulating the behavioural state cycling and those modulating breathing. Our understanding of these is still very limited. The absence of behavioural states or of activity cycles is a very sensitive but non-specific sign of nervous system dysfunction in human perinatal life.     

A model of the structural and functional development of the normal human fetal left ventricle based on a global growth law

The purpose of this research is to study the growth of the normal human left ventricle (LV) during the fetal period from 14 to 40 weeks of gestation. A new constitutive law for the active myocardium describing the mechanical properties of the active muscle during the whole cardiac cycle has been proposed. The LV model is a thick-walled, incompressible, hyperelastic cylinder, with families of helicoidal fibers running on cylindrical surfaces [1]. Based on the works of Lin and Taber [2] done on the embryonic chick heart, we use for the human fetal heart a growth law in which the growth rate depends on the wall stresses. The parameters of the growth law are adapted to agree with sizes and volumes inferred from two dimensional ultrasound measurements performed on 18 human fetuses.Then calculations are performed to extrapolate the cardiac performance during normal growth of the fetal LV. The results presented support the idea that a growth law in which the growth rate depends linearly on the mean wall stresses averaged through the space and during whole cardiac cycle, is adapted to the normal human fetal LV development.     

A Model of the Structural and Functional Development of the Normal Human Fetal Left Ventricle Based on a Global Growth Law

The purpose of this research is to study the growth of the normal human left ventricle (LV) during the fetal period from 14 to 40 weeks of gestation. A new constitutive law for the active myocardium describing the mechanical properties of the active muscle during the whole cardiac cycle has been proposed. The LV model is a thick-walled, incompressible, hyperelastic cylinder, with families of helicoidal fibers running on cylindrical surfaces [1] . Based on the works of Lin and Taber [2] done on the embryonic chick heart, we use for the human fetal heart a growth law in which the growth rate depends on the wall stresses. The parameters of the growth law are adapted to agree with sizes and volumes inferred from two dimensional ultrasound measurements performed on 18 human fetuses. Then calculations are performed to extrapolate the cardiac performance during normal growth of the fetal LV. The results presented support the idea that a growth law in which the growth rate depends linearly on the mean wall stresses averaged through the space and during whole cardiac cycle, is adapted to the normal human fetal LV development.     

Masking of fetal supraventricular tachycardia by electronic monitoring artefact.

In a fetus of 42 weeks'' gestation electronic monitoring demonstrated a heart rate of 120 beats/min that lacked the normal variability. Auscultation with a fetoscope revealed the true rate to be 240 beats/min. When used in the external Doppler mode the fetal monitor had a 250-ms refractory period after the recognition of a fetal cardiac event. This precluded recognition of the next beat and produced the artefactual halving of the heart rate. With the increasing reliance upon electronic fetal monitoring, those practising obstetrics should be aware of the possibility of artefacts and ensure that they can recognize truly representative information about the fetus.