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Fetal autonomic response to severe acidaemia during labour

  1. JOEH van Laar1,
  2. CHL Peters2,
  3. R Vullings3,
  4. S Houterman4,
  5. JWM Bergmans3,
  6. SG Oei1,3

Article first published online: 17 DEC 2009

DOI: 10.1111/j.1471-0528.2009.02456.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 117, Issue 4, pages 429–437, March 2010

Additional Information

How to Cite

van Laar, J., Peters, C., Vullings, R., Houterman, S., Bergmans, J. and Oei, S. (2010), Fetal autonomic response to severe acidaemia during labour. BJOG: An International Journal of Obstetrics & Gynaecology, 117: 429–437. doi: 10.1111/j.1471-0528.2009.02456.x

Author Information

  1. 1

    Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven

  2. 2

    Department of Clinical Physics, Amphia Hospital, Breda

  3. 3

    Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven

  4. 4

    MMC Academy, Máxima Medical Centre, Veldhoven, the Netherlands

*Dr JOEH van Laar, Department of Obstetrics and Gynaecology, Máxima Medical Centre, PO Box 7777, 5500 MB Veldhoven, the Netherlands. Email joehvanlaar@hotmail.com

Publication History

  1. Issue published online: 8 FEB 2010
  2. Article first published online: 17 DEC 2009
  3. Accepted 28 October 2009. Published Online 17 December 2009.

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Keywords:

  • Fetal distress;
  • fetal heart rate variability;
  • frequency analysis;
  • spectral analysis

Please cite this paper as: van Laar J, Peters C, Vullings R, Houterman S, Bergmans J, Oei S. Fetal autonomic response to severe acidaemia during labour. BJOG 2010;117:429–437.

Objective  Spectral analysis of heart-rate variability is used to monitor autonomic nervous system fluctuations. The low-frequency component is associated with sympathetic and parasympathetic modulation and the high-frequency component is associated with parasympathetic modulation. The objective was to study whether changes in low-frequency or high-frequency power of heart-rate variability occur in case of fetal distress.

Design  Case–control study.

Setting  Obstetric unit of a tertiary-care teaching hospital.

Population  Twenty healthy human fetuses during labour at term of which ten had an umbilical artery pH < 7.05 (cases), and ten had an arterial pH > 7.20 (controls) after birth.

Methods  Spectral information about fetal beat-to-beat heart rate, calculated from direct fetal electrocardiogram registrations, was obtained by using a short-time Fourier transform.

Main outcome measures  Absolute power and normalised power in the low-frequency and high-frequency bands.

Results  No differences were found between fetuses with and without acidaemia in absolute low or high frequency power (P = 0.2 and P = 0.3, respectively). During the last 30 minutes of labour, acidaemic fetuses had significantly increased normalised low-frequency power (P = 0.01) and decreased normalised high-frequency power (P = 0.03) compared with non-acidaemic fetuses. These differences were not observed from 3 to 2 hours before birth (P = 0.7 and P = 0.9, respectively).

Conclusion  The autonomic nervous system of human fetuses at term responds adequately to severe stress during labour. Normalised low and high frequency power of heart-rate variability might be able to discriminate between normal and abnormal fetal condition.

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