Lisa Stroux1, Christopher W Redman2, Antoniya Georgieva2, Stephen J Payne1, Gari D Clifford3. 1. Institute of Biomedical Engineering, Department of Ethics approval to use this database was givenEngineering Science, University of Oxford, Oxford, UK. 2. Nuffield Department of Obstetrics & Gynecology, University of Oxford, Oxford, UK. 3. Departments of Biomedical Informatics and Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, USA.
Abstract
INTRODUCTION: One indicator for fetal risk of mortality is intrauterine growth restriction (IUGR). Whether markers reflecting the impact of growth restriction on the cardiovascular system, computed from a Doppler-derived heart rate signal, would be suitable for its detection antenatally was studied. MATERIAL AND METHODS: We used a cardiotocography archive of 1163 IUGR cases and 1163 healthy controls, matched for gestation and gender. We assessed the discriminative power of short-term variability and long-term variability of the fetal heart rate, computed over episodes of high and low variation aiming to separate growth-restricted fetuses from controls. Metrics characterizing the sleep state distribution within a trace were also considered for inclusion into an IUGR detection model. RESULTS: Significant differences in the risk markers comparing growth-restricted with healthy fetuses were found. When used in a logistic regression classifier, their performance for identifying IUGR was considerably superior before 34 weeks of gestation. Long-term variability in active sleep was superior to short-term variability [area under the receiver operator curve (AUC) of 72% compared with 71%]. Most predictive was the number of minutes in high variation per hour (AUC of 75%). A multivariate IUGR prediction model improved the AUC to 76%. CONCLUSION: We suggest that heart rate variability markers together with surrogate information on sleep states can contribute to the detection of early-onset IUGR.
INTRODUCTION: One indicator for fetal risk of mortality is intrauterine growth restriction (IUGR). Whether markers reflecting the impact of growth restriction on the cardiovascular system, computed from a Doppler-derived heart rate signal, would be suitable for its detection antenatally was studied. MATERIAL AND METHODS: We used a cardiotocography archive of 1163 IUGR cases and 1163 healthy controls, matched for gestation and gender. We assessed the discriminative power of short-term variability and long-term variability of the fetal heart rate, computed over episodes of high and low variation aiming to separate growth-restricted fetuses from controls. Metrics characterizing the sleep state distribution within a trace were also considered for inclusion into an IUGR detection model. RESULTS: Significant differences in the risk markers comparing growth-restricted with healthy fetuses were found. When used in a logistic regression classifier, their performance for identifying IUGR was considerably superior before 34 weeks of gestation. Long-term variability in active sleep was superior to short-term variability [area under the receiver operator curve (AUC) of 72% compared with 71%]. Most predictive was the number of minutes in high variation per hour (AUC of 75%). A multivariate IUGR prediction model improved the AUC to 76%. CONCLUSION: We suggest that heart rate variability markers together with surrogate information on sleep states can contribute to the detection of early-onset IUGR.
Authors: E M Graatsma; E J H Mulder; B Vasak; S M Lobmaier; S Pildner von Steinburg; K T M Schneider; G Schmidt; G H A Visser Journal: J Matern Fetal Neonatal Med Date: 2012-07-19
Authors: Victoria J King; Laura Bennet; Peter R Stone; Alys Clark; Alistair J Gunn; Simerdeep K Dhillon Journal: Front Physiol Date: 2022-08-19 Impact factor: 4.755