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Am J Perinatol 2003; 20(2): 077-086
DOI: 10.1055/s-2003-38314
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4693

A New Computerized Analysis to Precisely Evaluate Heart Rate Variability During the Nonstress Test

Hisaaki Kobayashi1 , Atsushi Yoshida2 , Mitsunao Kobayashi3 , Takeo Hamada5 , Yasuaki Noguchi5 , Takashi Yamada4
  • 1Department of Clinical Medicine, Japan Self-Defense Force Hospital Maizuru, Maizuru, Kyoto
  • 2Faculty of Medical Engineering, Suzuka University of Medical Science, Suzuka, Mie
  • 3Department of Perinatal and Maternal Medicine, National Defense Medical College, Tokorozawa, Saitama
  • 4Department of Mathematics and Statistics, National Defense Medical College, Tokorozawa, Saitama
  • 5Department of Applied Physics, National Defense Academy, Yokosuka, Kanagawa, Japan
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Publication History

Publication Date:
27 March 2003 (online)

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ABSTRACT

The study was conducted to assess whether the power spectrum analysis of fetal heart rate (FHR) data obtained with a cardiotocograph provides more than visual judgment of nonstress test (NST) tracing to predict fetal well-being. A total of 71 FHR data were obtained from 44 healthy pregnant women with normally grown fetuses and 11 pregnant women with pregnancy-induced hypertension. Power spectrum analysis was performed for the 8192 points of the instantaneous heart rates derived from these FHR data. Abnormal perinatal outcome was defined when at least one of the followings were present at birth: Cesarean delivery for nonreassuring FHR pattern and umbilical artery cord PH ≤ 7.15, delivery at ≤ 32 weeks for fetal compromise, neonatal seizures within the first 72 hours of life, respiratory distress at 36 weeks or more, 5-minute Apgar score < 7 and stillbirth. The total power of the 8192 points without considering gestational weeks was 256.3 ± 65.6 normalized units (NU) ˙ Hz in the fetuses with good outcomes (n = 47), while that of the abnormal fetuses (n = 8) was 148.5 ± 54.6 NU ˙ Hz. There is a significant difference between the two values (p < 0.00001). When the abnormal value of the total power of the 8192 points was defined as < 200 NU ˙ Hz, the sensitivity on the prediction of fetal outcome using this method was 81.8%, significantly higher than that of the nonstress test tracing (p < 0.05). The power spectrum analysis of the large amount of FHR data obtained with a cardiotocograph permits a better assessment of the fetal well-being and may be suitable for the screening test because of no additional manpower to the current NST.

KEYWORDS

Spectrum analysis - fetal well-being - nonstress test

REFERENCES

  • 1 Malliani A, Lombardi F, Pagani M. Power spectrum analysis of heart rate variability: a tool to explore neural regulatory mechanisms.  Br Heart J . 1994;  71 1-2
    PubMedGoogle Scholar
  • 2 Sands K E, Appel M L, Lilly L S, Schoen F J, Mudge Jr H G, Cohen R J. Power spectrum analysis of heart rate variability in human cardiac transplant recipients.  Circulation . 1989;  79 76-82
    PubMedGoogle Scholar
  • 3 Malliani A, Pagani M, Lombardi F, Cerutti S. Cardiovascular neural regulation explored in the frequency domain.  Circulation . 1991;  84 482-492
    CrossrefPubMedGoogle Scholar
  • 4 Yamasaki Y, Ueda N, Kishimoto M, Tani A, Ishida Y, Kawamori R, Kamada T. Assessment of early stage autonomic nerve dysfunction in diabetric subjects-application of power spectral analysis of heart rate variability.  Diabetes Res . 1991;  17 73-80
    PubMedGoogle Scholar
  • 5 Bernardi L, Ricordi L, Lazzari P, Solda P, Calciati A, Ferrari M R, Vandea I, Finardi G, Fratino P. Impaired circadian modulation of sympathovagal activity in diabetes. A possible explanation for altered temporal onset of cardiovascular disease.  Circulation . 1992;  86 1443-1452
    PubMedGoogle Scholar
  • 6 Salo T M, Viikari J S, Antila K J, Voipio-Pulkki L M, Jalonen J O, Valimaki I A. Antihypertensive treatment and heart rate variability in diabetic patients: role of cardiac autonomic neuropathy.  J Autonom Nerv Syst . 1996;  60 61-70
    CrossrefPubMedGoogle Scholar
  • 7 Goldstein B, Kempski M H, DeKing D, Cox C, Delong D J, Kelly M M, Woolf P D. Autonomic control of heart rate after brain injury in children.  Crit Care Med . 1996;  24 234-240
    CrossrefPubMedGoogle Scholar
  • 8 Noguchi Y, Mamune H, Sugimoto S, Yoshida A, Sasa H, Kobayashi H, Kobayashi M. Estimation of measurement characteristic of ultrasound fetal heart rate monitor.  Jpn J Appl Phys . 1995;  34 2840-2843
    CrossrefPubMedGoogle Scholar
  • 9 Makhoul J. Linear prediction: A tutorial review.  Proc IEEE . 1975;  63 561-580
    PubMedGoogle Scholar
  • 10 Brown J S, Gee H, Olah K S, Docker M F, Taylor E W. A new technique for the identification of respiratory sinus arrhythmia in utero.  J Biomed Eng . 1992;  14 263-267
    PubMedGoogle Scholar
  • 11 Divon M Y, Yeh S, Zimmer E Z, Platt L D, Paldi E, Paul R H. Respiratory sinus arrhythmia in the human fetus.  Am J Obstet Gynecol . 1985;  151 425-428
    PubMedGoogle Scholar
  • 12 Akselrod S, Gordon D, Ubel F A, Shannon D C, Barger A C, Cohen R J. Power spectrum analysis of heart rate fluctuations: A quantitative probe of beat-to-beat cardiovascular control.  Science . 1981;  213 220-222
    CrossrefPubMedGoogle Scholar
  • 13 Kay S M, Maple S L. Spectrum analysis-a modern perspective.  Proc IEEE . 1981;  69 1380-1419
    PubMedGoogle Scholar
  • 14 Akaike H. Statistical predictor identification.  Am Int Stat Math . 1970;  22 203-217
    PubMedGoogle Scholar
  • 15 American College of Obstetricians and Gynecologists. Antepartum fetal surveillance. Technical Bulletin no. 188, January 1994
  • 16 Dunston-Boone G, Kuhlman K, Kaufmann M. Correlation of fetal heart rate decelerations following acoustic stimulation with perinatal outcome.  Am J Perinatol . 1995;  12 342-346
    PubMedGoogle Scholar
  • 17 Karin J, Hirsch M, Akselrod S. An estimate of fetal autonomic state by spectral analysis of fetal heart rate fluctuations.  Pediatr Res . 1993;  34 134-138
    PubMedGoogle Scholar
  • 18 Metsälä T H, Pirhonen J P, Jalonen J O, Erkkola R U, Välimäki I AT. Association of abnormal flow velocity waveforms in the uterine artery with frequency-specific fetal heart rate variability.  Eary Hum Dev . 1993;  34 217-225
    PubMedGoogle Scholar
  • 19 Carter M C. Signal processing and display-cardiotocographs.  Br J Obstet Gynecol . 1993;  100 21-23
    PubMedGoogle Scholar
  • 20 Devoe L, Boehm F, Paul R, Frigoletto F, Penso C, Goldenberg R, Rayburn W, Smith C. Clinical experience with the Hewlett-Packard M-1350A fetal monitor: correlation of Doppler-detected fetal body movements with fetal heart rate parameters and perinatal outcome.  Am J Obstet Gynecol . 1994;  170 650-655
    PubMedGoogle Scholar
      >