Providing mothers with fetal heart monitors.

Enabling mothers in labour to monitor their baby's heart is improving maternal and neonatal outcomes in Liberia. Tatum Anderson reports.

The effect of music therapy on the cardiac activity parameters of a fetus in a cardiotocographic examination.

OBJECTIVE: The assessment of cardiac parameters of the fetus in cardiotocographic record of pregnant women listening to classical music. STUDY DESIGN: Sixty NST records with no musical stimulation and 30 NST records during a 15-min auditive stimulation with Wolfgang Amadeus Mozart's "Turkish March" as well as 30 NST records during Johann Strauss's "Tritsch-Tratsch Polka" were performed for the study. The average stage of the responders' pregnancy was the 36rd week, the lowest - the 27th week, the highest - 41st. RESULTS: Following the listening to W.A. Mozart's composition, a significant increase was observed in values concerning: the number of fetal movements (p < 0.0001), accelerations >10 (p = 0.0063), accelerations >15 (p = 0.0011), high variability (p = 0.0019) and short-term variability (p < 0.0001). Meanwhile, parameters concerning baseline cardiac activity (p = 0.0003) and low variability (p = 0.0021) significantly decreased. The number of uterine contractions decreased insignificantly (p = 0.3718). Following listening to J. Strauss's composition, the following parameters underwent increase: fetal movements (p = 0.0021) and short-term variability (p = 0.0025). The remaining parameters of the cardiotocographic record: accelerations, uterine contractions - underwent an improvement, but the changes were not significant. CONCLUSION: Music therapy is a noninvasive and uncostly method, significantly improving wellbeing-indicative fetal parameters.

Deficient maternal zinc intake-but not folate-is associated with lower fetal heart rate variability.

OBJECTIVE: Few studies of maternal prenatal diet and child development examine micronutrient status in relation to fetal assessment. METHODS: Twenty-four-hour dietary recall of zinc and folate and 20min of fetal heart rate were collected from 3rd trimester pregnant adolescents. RESULTS: Deficient zinc was associated with less fetal heart rate variability. Deficient folate had no associations with HRV. Neither deficient zinc nor deficient folate was related to fetal heart rate. CONCLUSIONS: These findings, from naturalistic observation, are consistent with emerging data on prenatal zinc supplementation using a randomized control design. PRACTICAL IMPLICATION: Taken together, the findings suggest that maternal prenatal zinc intake is an important and novel factor for understanding child ANS development.

Nutritional models of foetal programming and nutrigenomic and epigenomic dysregulations of fatty acid metabolism in the liver and heart.

Barker's concept of 'foetal programming' proposes that intrauterine growth restriction (IUGR) predicts complex metabolic diseases through relationships that may be further modified by the postnatal environment. Dietary restriction and deficit in methyl donors, folate, vitamin B12, and choline are used as experimental conditions of foetal programming as they lead to IUGR and decreased birth weight. Overfeeding and deficit in methyl donors increase central fat mass and lead to a dramatic increase of plasma free fatty acids (FFA) in offspring. Conversely, supplementing the mothers under protein restriction with folic acid reverses metabolic and epigenomic phenotypes of offspring. High-fat diet or methyl donor deficiency (MDD) during pregnancy and lactation produce liver steatosis and myocardium hypertrophy that result from increased import of FFA and impaired fatty acid ß-oxidation, respectively. The underlying molecular mechanisms show dysregulations related with similar decreased expression and activity of sirtuin 1 (SIRT1) and hyperacetylation of peroxisome proliferator-activated receptor-γ coactivator 1α (PGC-1α). High-fat diet and overfeeding impair AMPK-dependent phosphorylation of PGC-1α, while MDD decreases PGC-1α methylation through decreased expression of PRMT1 and cellular level of S-adenosyl methionine. The visceral manifestations of metabolic syndrome are under the influence of endoplasmic reticulum (ER) stress in overnourished animal models. These mechanisms should also deserve attention in the foetal programming effects of MDD since vitamin B12 influences ER stress through impaired SIRT1 deacetylation of HSF1. Taken together, similarities and synergies of high-fat diet and MDD suggest, therefore, considering their consecutive or contemporary influence in the mechanisms of complex metabolic diseases.

Testing foetal-maternal heart rate synchronization via model-based analyses.

The investigation of foetal reaction to internal and external conditions and stimuli is an important tool in the characterization of the developing neural integration of the foetus. An interesting example of this is the study of the interrelationship between the foetal and the maternal heart rate. Recent studies have shown a certain likelihood of occasional heart rate synchronization between mother and foetus. In the case of respiratory-induced heart rate changes, the comparison with maternal surrogates suggests that the evidence for detected synchronization is largely statistical and does not result from physiological interaction. Rather, they simply reflect a stochastic, temporary stability of two independent oscillators with time-variant frequencies. We reanalysed three datasets from that study for a more local consideration. Epochs of assumed synchronization associated with short-term regulation of the foetal heart rate were selected and compared with synchronization resulting from white noise instead of the foetal signal. Using data-driven modelling analysis, it was possible to identify the consistent influence of the heartbeat duration of maternal beats preceding the foetal beats during epochs of synchronization. These maternal beats occurred approximately one maternal respiratory cycle prior to the affected foetal beat. A similar effect could not be found in the epochs without synchronization. Simulations based on the fitted models led to a higher likelihood of synchronization in the data segments with assumed foetal-maternal interaction than in the segment without such assumed interaction. We conclude that the data-driven model-based analysis can be a useful tool for the identification of synchronization.

Evaluación fetal intraparto: análisis crítico de la evidencia / Fetal intrapartum surveillance: critical appraisal of evidence

La evaluación de la condición fetal intraparto constituye uno de los principales desafíos de la obstetricia. En un intento por mejorar la discreta capacidad diagnóstica del registro electrónico intraparto de la frecuencia cardiaca fetal, se han ideado y desarrollado métodos complementarios de vigilancia fetal intraparto. El objetivo del presente artículo es realizar un análisis crítico de estos métodos complementarios de vigilancia fetal intraparto, respecto de su rendimiento diagnóstico y de su utilidad clínica, para concluir si se justifica la incorporación de alguno(s) de ellos como estándar de la práctica clínica habitual.

Is there evidence of fetal-maternal heart rate synchronization?

BACKGROUND: The prenatal condition offers a unique possibility of examining physiological interaction between individuals. Goal of this work was to look for evidence of coordination between fetal and maternal cardiac systems. METHODS: 177 magnetocardiograms were recorded in 62 pregnancies (16th-42nd week of gestation). Fetal and maternal RR interval time series were constructed and the phases, i.e. the timing of the R peaks of one time series in relation to each RR interval of the other were determined. The distributions of these phases were examined and synchrograms were constructed for real and surrogate pairs of fetal and maternal data sets. Synchronization epochs were determined for defined n:m coupling ratios. RESULTS: Differences between real and surrogate data could not be found with respect to number of synchronization epochs found (712 vs. 741), gestational age, subject, recording or n:m combination. There was however a preference for the occurrence of synchronization epochs in specific phases in real data not apparent in the surrogate for some n:m combinations. CONCLUSION: The results suggest that occasional coupling between fetal and maternal cardiac systems does occur.

[Collection of autologous blood during pregnancy and fetal safety. Computer analysis of fetal heart rate]. / Predonazione di sangue autologo in corso di gravidanza e sicurezza fetale. Analisi computerizzata dell'attività cardiaca fetale.

BACKGROUND: This study aims at objectively evaluating the impact on the fetus of a sudden maternal blood withdrawal, through a computer analysis of the various aspects of the cardiotocographic pattern before and after one autologous blood unit predonation from near term pregnant women. METHODS: For the collection of cardiotocographic data, a Sonicaid Team fetal monitor was used; it is a monitoring system which uses Doppler ultrasound impulses and autocorrelates the received Doppler signals with varied signals of frequency, connected to Sonicaid System 8000, a program for "objective" cardiotocographic analysis according to the so-called Dawes-Redman criteria. RESULTS: From the statistic comparison of Non Stress Tests preceeding and following predonation, some statistically significant differences have sometimes emerged on the level of specific parameters. CONCLUSIONS: In particular, the general variation of fetal heart frequency and fetal reactivity resulted higher after predonation, even though they were within absolute normality, justifying the suspicion that the stress of autologous predonation practice might produce some indefinite disturbance to fetal activity/rest rhythm.

Antepartum fetal surveillance. Nonstress test, contraction stress test, and biophysical profile.

The three most common methods used to evaluate fetal well being in utero are the nonstress test, contraction stress test, and the biophysical profile. This article reviews recent literature pertaining to these methods of antepartum fetal surveillance and compares and contrasts the different modalities.

Antepartum vibroacoustic stimulation in patients with low fetal heart rate variability.

OBJECTIVE: The purpose of this study was to examine the effect of vibroacoustic stimulation during low fetal heart rate (FHR) variability. METHODS: FHR was analyzed 30 min before and 30 min after computerized vibroacoustic stimulation using the Oxford Sonicaid system 8000. The study comprised 32 healthy pregnant women with low antepartum FHR variability. The significance of difference of the median values was examined using Wilcoxon's matched-pairs signed-ranks test. RESULTS: Vibroacoustic stimulation of the fetus during low FHR variability evoked a significant increase in the number of accelerations (> 10 bpm) and an increase in long- and short-term variation. CONCLUSION: Our findings indicate that vibroacoustic stimulation during low FHR variability produces an abrupt change from a quiet to an active fetal state.

Fetal heart rate response to vibroacoustic stimulation during low and high heart rate variability episodes in late pregnancy.

In 52 women in late pregnancy, the mean durations of transient fetal tachycardia after vibroacoustic stimulation during low fetal heart rate variability (4.8 minutes) and high fetal heart rate variability (6.3 minutes) were similar. The fetal heart rate continued with high variability in all cases, suggesting that the fetus did not return to its prestimulation state after vibroacoustic stimulation during quiescence. In 10 women, the duration of high variability after vibroacoustic stimulation during low fetal heart rate variability was significantly shorter (mean, 22 minutes) than the preceding (mean, 36 minutes) or subsequent (mean, 43 minutes) high-variability components of complete rest activity cycles. In another 10 women, the duration of high variability after vibroacoustic stimulation during high fetal heart rate variability was similar to preceding and subsequent high-variability episodes. In these 20 women, the next complete rest-activity cycle after vibroacoustic stimulation was not different in duration to the complete cycle recorded on the previous day.

[Effect of selenium on myocardial function and structure in mice within ischemic and hypoxic environment].

The experiment was designed to study the protective effect of selenium on myocardial function and ultrastructure changes of fetal mouse heart model under ischemic and hypoxic circumstances. The results showed that selenium can prolong the period of heart surviving and beating. Results via lanthanum probe technique indicated that selenium is able to maintain the functional integrity of the myocardial cell membrane as well as the mitochondria membrane. Ultrastructure changes under REM suggested that selenium may play a role in delaying the development of irreversible myocardial injury and to promote protein synthesis and the repairment of the injured cells.

Fetal vibratory acoustic stimulation in twin gestations with simultaneous fetal heart rate monitoring.

Sixteen vibratory acoustic stimulations were performed in seven normal twin gestations with continuous simultaneous recordings of each fetal heart rate response. All stimulations led to immediate synchronous fetal heart rate accelerations in both fetuses. This is in contrast to coinciding, yet nonsynchronous, spontaneous fetal heart rate accelerations that occur naturally. This observation suggests that different mechanisms are responsible for spontaneous and evoked fetal movements in twin gestations.

[Clinical evaluation of antepartum vibratory acoustic stimulation test].

A prospective comparative study between antepartum vibratory acoustic stimulation test (VAS-T) and nonstress test (NST) was done in 103 pregnant women. Of the 103 cases, 101 of VAS-Ts were positive and 2 negative, with no false negative result. 76 of NSTs were positive and 27 NSTs were negative, with 26 false negative result. The mean duration of VAS-T was 56 seconds. It showed that VAS-T as an effective antepartum monitoring test was safe and much less time consuming. As compared with NST, the false negative rate of VAS-T was reduced, thus the predictive value of negative VAS-T increased. A positive VAS-T predicts with high precision that the fetal well-being is satisfactory, while a negative VAS-T prognostic that the fetal outcome is poor.

Stimulation of human fetuses with sound and vibration.

It is clear that external vibroacoustic stimulation with the EAL produces remarkable changes in FHR and fetal movement patterns that are related to changes in fetal behavior. The clinical significance of these studies has been addressed in small series on human fetuses by many authors. There is an obvious lack of uniformity in the different protocols used to determine the predictive value of FAS in the assessment of fetal health. Current knowledge of the normal responses of healthy human fetuses to acoustic stimulation and the limitations of this type of testing should be taken into account to determine more accurately the negative and positive predictive values for fetal outcome. Currently available data are not sufficient to evaluate clinical efficiency of such stimuli to predict fetal compromise.