Pulsatile luteinizing hormone patterns in the follicular phase of the menstrual cycle, polycystic ovarian disease (PCOD) and non-PCOD secondary amenorrhea.

To characterize the oscillations of plasma LH in normally cycling and amenorrheic women, three groups of women were studied: I, normal women during the follicular phase of the cycle (n = 9); II, women with polycystic ovarian disease (PCOD; n = 11); and III, women with non-PCOD secondary amenorrhea (n = 12). Blood samples were obtained at 10-min intervals for 6 h on 2 separate days. A pulse was defined as an increase in LH at least 20% over the preceding lowest value (nadir). Since LHRH release immediately follows the nadir of the LH levels, the nadir interval (NI) was used for analysis. For analysis, the results from 1 day were selected at random from each subject, and from each day, the same number of NIs also were randomly selected. When two NIs from each patient were selected, the median NI was 75 min in group I, 45 min in group II, and 45 min in group III. When three or four NIs were chosen, the median NI was 60 min in group I, 50 min in group II, and 40 min in group III. The differences between the groups were statistically significant. When three NIs were selected, the mean of the corresponding LH amplitudes was 2.8 U/liter in group I, 6.0 U/liter in group II, and 1.5 U/liter in group III. The differences between these groups were statistically significant. Thus, the NI in PCOD patients was shorter than that during the follicular phase of the cycle, but this short NI is not unique for PCOD, since the NI in non-PCOD secondary amenorrhea patients was even smaller. The LH amplitude was higher in PCOD and lower in non-PCOD secondary amenorrhea compared to that during the follicular phase of the cycle. The decrease in NI in PCOD and/or non-PCOD secondary amenorrhea vs. the NI of the follicular phase could be explained by either a higher frequency of LHRH pulses from the hypothalamus or an increased sensitivity of the pituitary leading to a greater response of the pituitary to LHRH pulses.

Automated assignment of behavioural states in the human near term fetus.

Thirty-five 2-h recordings of fetal heart rate and fetal movements, made at 38-39 weeks of gestational age, have been analyzed in a partly automated procedure. Involved were 17 nulliparous and 19 multiparous women. To minimize subjectivity the classification of the heart rate was performed in a Delphi group opinion procedure consisting of three rounds. In the third round, three independent investigators classified 89.1% of the total tracing time as pattern A through D. The investigators could not classify 6.1% of the tracing time in any of the available categories. The percentages of coincidence of state parameters did not differ significantly between the fetuses of nulli- and multiparous women. Fifty percent of the fetuses showed true behavioural states, both in the nulli and the multiparous women. The percentage of time spent in state 1F was higher in the multiparous group (P less than 0.05). The other percentages of states did not differ significantly, neither did the duration of the enclosed epochs. The advantages and disadvantages of the automated assignment of fetal behavioural states are discussed.

Fetal hiccups; characteristics and relation to fetal heart rate.

In 35 two-hour recordings of fetal heart rate and fetal movements, 14 periods of fetal hiccups were present (1.2% of the recording time) with a median duration of 3.5 min (range 1 to 8 min). No specific relation to behavioural states or movement patterns could be identified. The hiccupping frequency varied from 10 to 21 per min. Within a hiccupping spell, the mean frequency decreased from 20 +/- 11 to 12 +/- 6.2 per min. A small but evident increase in baseline frequency was present during the hiccupping spells, independent from other movements performed by the fetus.

Fetal heart rhythms during behavioural state 1F.

Behavioural state 1F (quiet sleep) of the term fetus is defined on the basis of absence of eye and body movements, and the presence of a specific heart rate pattern (FHRP A), characterized by a stable heart rate with a small oscillation bandwidth. In the present paper the fetal heart rate pattern was studied in 39 enclosed periods with absence of fetal eye and body movements. In 37 periods the heart rate pattern met the criteria of FHRP A. Within FHRP A various distinct types of heart rhythm could be distinguished related to presence of breathing or regular mouthing and complete absence of movements. The bandwidth in the various heart rhythms differed significantly and was largest during breathing movements. During regular mouthing an oscillatory pattern was present with a frequency similar to the frequency of the clusters of mouthing movements. In 2 periods the heart rate deviated from the definition for FHRP A, i.e. a sinusoidal-like rhythm associated with sucking movements. These observations demonstrate the strong association between the fetal heart rate pattern and fetal movements during behavioural state 1F.

Fetal mouth movements during behavioural states 1F and 2F.

The aim of this study was to investigate the characteristics of mouth movements during behavioural states 1F (quiet sleep) and 2F (active sleep) in the near term human fetus. Thirty-six women participated. Fetal heart rate and fetal movements were recorded for 2 hours continuously. Videotapes with enclosed periods 1F and 2F were replayed to record fetal mouth movements in detail. During 1F, regular mouthing movements dominated (present in 74%), while jaw opening, yawn and grimace were only observed in 5 to 16% of the recordings. Tongue protrusion was not observed in 1F. In all 2F periods jaw opening was present (100%), while tongue protrusion, yawn and grimace were also frequently observed. Regular mouthing was observed in 2F in only two fetuses. For regular mouthing and sucking, onset-to-onset intervals of clusters, cluster duration, and number and frequency of movements within clusters were calculated. In all aspects the differences between these two types of movement were statistically significant. Within the clusters of regular mouthing a decline in the mouthing frequency was found. The data on fetal regular mouthing correspond with observations in the neonate.

Fetal behavioural states in epileptic pregnancies.

Possible negative effects of maternal antiepileptic medication on fetal motility and heart rate patterns were examined at 32 and 38 wk of gestation. Fetal eye and body movements were recorded using 2 real-time ultrasound units. Comparison between pregnancies with antiepileptic medication and control pregnancies did not show marked differences in patterns of motility and heart rate. Duration of sleep states, occurrence and duration of body movements in state 2F and statistical parameters of heart rate level and heart rate variability were very similar for both groups. This preliminary study, limited to mostly combined treatment with antiepileptic drugs, could not demonstrate any obvious effect on fetal neuromuscular development from maternal antiepileptic medication.

Behavioral states in the human fetus during labor.

Behavioral states in the near-term human fetus have been described during pregnancy. The aim of this study was to observe whether these same states are present during labor. Nine patients with uncomplicated singleton pregnancies participated. Fetal heart rate and uterine contractions were recorded. Fetal eye, mouth, rotation, and retroflexion of the head were observed by real-time ultrasound. Fetal movements were recorded with coded event-markers. Behavioral states were identified by the movement pattern. A total of 13 ultrasound observations, varying from 25 to 66 minutes, were obtained. Optimal viewing was present at least 60% and on the average 80% of the time. State 1F (quiet sleep), state 2F (active sleep), and state 3F (quite awake), as well as a total of 10 state changes, were identified during labor in spite of increasing contractions and/or ruptured membranes. These observations demonstrate existence of alternating behavioral states in the healthy term fetus during labor.

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.

Quantitative morphology. A study of the trophoblast.

It is difficult to predict the possible development of a malignant trophoblastic tumor after the evacuation of a hydatidiform mole. In order to help resolve this difficulty, a morphometric study has been carried out. The mean nuclear area of the trophoblast in a group of hydatidiform moles, followed by a trophoblastic malignancy, was found to be statistically significantly larger than that of the trophoblast in a group of hydatidiform moles which were not followed by malignant trophoblastic disease. However, the mean trophoblast/nontrophoblast ratio in villi demonstrated no statistically significant difference between those 2 groups of hydatidiform moles. Therefore it is not advisable to grade hydatidiform moles on the basis of trophoblastic proliferation alone. It is suggested that the trophoblastic lining of hydropic villi in the placental tissue of hydatidiform moles has malignant features already, but these are more pronounced in those hydatidiform moles which are subsequently followed by a choriocarcinoma.

Computerized assessment of fetal behavioral states.

Fetal heart rate and fetal movements provide information on the fetal condition. In the near term human fetus, four behavioural states have been described based upon heart rate patterns and presence or absence of eye and body movements. For our studies concerning fetal physiology as well as the influence of maternal antiepileptic medication and the effects of intrauterine growth retardation on the fetal condition, we developed a computerized system for acquisition and storage of fetal heart rate signals and observed fetal movements. Fetal heart rate is recorded using a commercially available monitor combined with a home-made computer interface. Fetal movements are observed using two real-time ultrasound units. The observers handle keyboards to mark occurrence and duration of various types of fetal movements, and pedals to mark the visibility of the observed part of the fetal body. Keyboards and pedals are scanned by the computer. Special techniques are used to store heart rate and movement signals in an efficient way. Three experts determine fetal heart rate patterns by application of a Delphi group opinion procedure. Fetal behavioral states are identified by the computer using the results of the Delphi procedure, and performing the so-called extended automatic window procedure. This procedure identifies periods of presence and periods of absence of fetal eye and body movements, and incorporates the loss of visibility of the ultrasound images during the recording session. Fetal heart rate variability indices and distributions of fetal movements can be computed in the context of the fetal behavioral state concept.

Computer analysis of antepartum fetal heart rate: 1. Baseline determination.

A consequent and reproducible determination of baseline is an essential prerequisite for objective interpretation of fetal heart rate. A fully automated off-line method of baseline determination has been developed and tested on 50 normal antepartum fetal heart rate recordings of two hours duration. The method is constructed around two functional units, a digital filter and a trim function, which interact in an iterative process. The results were evaluated in comparison with automated baseline determination according to Dawes and coworkers. A panel of 3 experts agreed that in 14 of the 50 recordings (28%), the new developed procedure resulted in a substantially better baseline fit. In the remaining 34 recordings (72%), baseline fit from both methods was judged as equivalent. The described procedure of baseline determination provides a solid base for automated detection of accelerations and decelerations in fetal heart rate recordings. It enables the study of the relation between the fetal heart rate pattern and fetal movements. Finally, it provides an objective tool for analysis of variables within the fetal heart rate with the highest predictive value with respect to fetal outcome.

Computer analysis of antepartum fetal heart rate: 2. Detection of accelerations and decelerations.

Based upon a previously described procedure for automated baseline determination in antepartum fetal heart rate recordings, a programme has been developed for recognition of accelerations and decelerations. Detection of these deviations from the baseline depends on criteria for amplitude and duration, with special account for signal loss. The described automated analysis provides an objective tool for description of antepartum fetal heart rate patterns. A first evaluation with respect to its capacity to discriminate between different fetal heart rate patterns in relation to fetal rest-activity patterns shows promising results.