Complexity-loss in fetal heart rate dynamics during labor as a potential biomarker of acidemia

被引:23
作者
Costa, Madalena D. [1 ,2 ]
Schnettler, William T. [3 ]
Amorim-Costa, Celia [4 ,5 ]
Bernardes, Joao [4 ,5 ]
Costa, Antonia [4 ,5 ]
Goldberger, Ary L. [1 ,2 ]
Ayres-de-Campos, Diogo [4 ,5 ]
机构
[1] Harvard Univ, Beth Israel Deaconess Med Ctr, Sch Med, Div Interdisciplinary Med & Biotechnol, Boston, MA 02215 USA
[2] Harvard Univ, Wyss Inst Biol Inspired Engn, Boston, MA 02215 USA
[3] Harvard Univ, Beth Israel Deaconess Med Ctr, Div Maternal Fetal Med, Dept Obstet & Gynecol,Sch Med, Boston, MA 02215 USA
[4] Univ Porto, Sao Jao Hosp, Fac Med, Dept Obstet & Gynecol, P-4100 Oporto, Portugal
[5] Univ Porto, Inst Biomed Engn, P-4100 Oporto, Portugal
基金
美国国家卫生研究院;
关键词
Cardiotocography; Complexity analysis; Fetal monitoring; Heart rate; Multiscale entropy; POWER SPECTRUM ANALYSIS; RATE-VARIABILITY; CARDIOTOCOGRAPHY;
D O I
10.1016/j.earlhumdev.2013.10.002
中图分类号
R71 [妇产科学];
学科分类号
100211 [妇产科学];
摘要
Background: Continuous fetal heart rate (FHR) monitoring remains central to intrapartum care. However, advances in signal analysis are needed to increase its accuracy in diagnosis of fetal hypoxia. Aims: To determine whether FHR complexity, an index of multiscale variability, is lower among fetuses born with low (<= 7.05) versus higher pH values, and whether this measure can potentially be used to help discriminate the two groups. Study design: Evaluation of a pre-existing database of sequentially acquired intrapartum FHR signals. Subjects: FHR tracings, obtained from a continuous scalp electrocardiogram during labor, were analyzed using the multiscale entropy (MSE) method in 148 singletons divided in two groups according to umbilical artery pH at birth: 141 fetuses with pH > 7.05 and 7 with pH <= 7.05. A complexity index derived from MSE analysis was calculated for each recording. Results: The complexity of FHR signals for the last two hours before delivery was significantly (p < 0.004) higher for non-acidemic than for acidemic fetuses. The difference between the two groups remained significant (p < 0.003) when FHR data from the last 30 min before delivery were excluded. Conclusion: Complexity of FHR signals, as measured by the MSE method, was significantly lower for acidemic than non-acidemic fetuses. These results are consistent with previous studies showing that decreased nonlinear complexity is a dynamical signature of disrupted physiologic control systems. This analytic approach may have discriminative value in FHR analysis. (C) 2013 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:67 / 71
页数:5
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