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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, Joachim W.

Editorial Board Member: / Bancalari, Eduardo / Greenough, Anne / Genc, Mehmet R. / Chervenak, Frank A. / Chappelle, Joseph / Bergmann, Renate L. / Bernardes, J.F. / Bevilacqua, G. / Blickstein, Isaac / Cabero Roura, Luis / Carbonell-Estrany, Xavier / Carrera, Jose M. / D`Addario, Vincenzo / D'Alton, MD, Mary E. / Dimitrou, G. / Grunebaum, Amos / Hentschel, Roland / Köpcke, W. / Kawabata, Ichiro / Keirse, M.J.M.C. / Kurjak M.D., Asim / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, MD, PhD, HonD, Istvan / Vetter, Klaus / Winn, MD, Hung N. / Young, Bruce K. / Zimmermann, Roland

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Human fetal heart rate variability-characteristics of autonomic regulation in the third trimester of gestation

Uwe Schneider1 / Birgit Frank2 / Anja Fiedler3 / Christiane Kaehler4 / Dirk Hoyer5 / Mario Liehr6 / Jens Haueisen7 / Ekkehard Schleussner8

1University Hospital, Department of Obstetrics, Friedrich Schiller University of Jena, Germany

2University Hospital, Biomagnetic Center, Department of Neurology, Friedrich Schiller University of Jena, Germany

3University Hospital, Department of Obstetrics, Friedrich Schiller University of Jena, Germany

4Center for Ultrasound and Prenatal Diagnosis, Erfurt, Germany

5University Hospital, Biomagnetic Center, Department of Neurology, Friedrich Schiller University of Jena, Germany

6University Hospital, Biomagnetic Center, Department of Neurology, Friedrich Schiller University of Jena, Germany

7University Hospital, Biomagnetic Center, Department of Neurology, Friedrich Schiller University of Jena, Germany and Institute of Biomedical Engineering and Informatics, Technical University of Ilmenau, Germany

8University Hospital, Department of Obstetrics, Friedrich Schiller University of Jena, Germany

Corresponding author: Dr. Uwe Schneider, MD, Registrar Department of Obstetrics, University Hospital Friedrich Schiller University of Jena Bachstrasse 18 D-07743 Jena Germany Tel.: +49-0171 2270 414 Fax: +49-3641-933986

Citation Information: Journal of Perinatal Medicine. Volume 36, Issue 5, Pages 433–441, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: 10.1515/JPM.2008.059, June 2008

Publication History

Received:
2007-12-21
Revised:
2008-03-22
Accepted:
2008-04-15
Published Online:
2008-06-12

Abstract

Aim: To describe developmental aspects of the sympatho-vagal heart rate regulation in the human fetus by applying numerics to visual descriptions of fetal heart rate patterns throughout the third trimester of pregnancy. The focus is to determine potential benefits of this alternative means of assessing the maturation of the fetal autonomic nervous system by analysis of fetal heart rate variability (fHRV).

Subjects and methods: The magnetocardiograms of 103 normal fetuses between 24+1 and 41+6 weeks of gestation were studied. Fetal heart beat intervals were determined with a temporal precision of 1 ms. The levels of fetal activity were estimated according to characteristic heart rate patterns (I–III) prior to 32, between 32–35 and beyond 35 (groups 1–3) completed weeks. Mean heart rate (mHR), standard deviation of normal-to-normal beat intervals (SDNN) and root mean square of successive differences of normal beats (RMSSD) served as fHRV indices, mean permutation entropy (PE_Mean) as complexity measure. SDNN/RMSSD was introduced as a potential marker for sympatho-vagal balance.

Results: Low activity fHRP (I) were characterized by significantly lower level fHRV indices and higher PE_Mean when compared to fHRP II. We found that SDNN/RMSSD decreases with gestation in fHRP I, which suggests increasing vagal influence. In fHRP III (assigned to active awake fetuses only after 32 weeks), highest level SDNN and mHR are associated with a dramatically reduced complexity. fHRV indices cluster characteristically with the activity levels.

Conclusions: We conclude that a combined analysis of fHRV, based on SDNN/RMSSD and PE_Mean, and fHRP is advantageous in the assessment of maturation of the fetal autonomic nervous system.

Keywords: Autonomic nervous system; fetal magnetocardiography; fetal state; heart rate variability; sympatho-vagal balance

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