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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 / Milner, 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, Marc J.N.C. / Kurjak M.D., Asim / Lee, Ben H. / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Romero, Roberto / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, Istvan / Vetter, Klaus / Winn, Hung N. / Young, Bruce K. / Zimmermann, Roland

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In This Section
Volume 36, Issue 5 (Sep 2008)


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

Uwe Schneider
  • 1University Hospital, Department of Obstetrics, Friedrich Schiller University of Jena, Germany
/ Birgit Frank
  • 2University Hospital, Biomagnetic Center, Department of Neurology, Friedrich Schiller University of Jena, Germany
/ Anja Fiedler
  • 3University Hospital, Department of Obstetrics, Friedrich Schiller University of Jena, Germany
/ Christiane Kaehler
  • 4Center for Ultrasound and Prenatal Diagnosis, Erfurt, Germany
/ Dirk Hoyer
  • 5University Hospital, Biomagnetic Center, Department of Neurology, Friedrich Schiller University of Jena, Germany
/ Mario Liehr
  • 6University Hospital, Biomagnetic Center, Department of Neurology, Friedrich Schiller University of Jena, Germany
/ Jens Haueisen
  • 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
/ Ekkehard Schleussner
  • 8University Hospital, Department of Obstetrics, Friedrich Schiller University of Jena, Germany
Published Online: 2008-06-12 | DOI: https://doi.org/10.1515/JPM.2008.059


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

About the article

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

Received: 2007-12-21

Revised: 2008-03-22

Accepted: 2008-04-15

Published Online: 2008-06-12

Published Online: 2008-06-12

Published in Print: 2008-09-01

Citation Information: Journal of Perinatal Medicine, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/JPM.2008.059.

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