title: Do fetal electrocardiogram PR-RR changes reflect progressive asphyxia after repeated umbilical cord occlusion in fetal sheep?
abstract: The aim of this study was to determine whether there is a relationship between changes in PR-RR correlation of the fetal ECG and progressive changes in fetal acid-base status and blood pressure (BP) during repeated umbilical occlusion. Chronically instrumented fetal sheep at 126.8+/-0.6 d (mean+/-SEM) were randomized to receive 1 min of total umbilical cord occlusion either every 5 min for 4 h (1:5 group; n=8), or every 2.5 min until BP fell <2.7 kPa (20 mm Hg) on two successive occlusions (1:2.5 group; n=8). The PR-RR correlation was determined in 5- or 2.5-min intervals. Umbilical cord occlusion caused variable decelerations with initial sustained hypertension. In the 1:5 group BP remained elevated throughout, and there was little change in acid-base status (pH=7.34+/-0.07, base deficit=1.3+/-3.9 after 4 h). In contrast, after the third occlusion the 1:2.5 group showed progressive hypotension during occlusions, and severe progressive metabolic acidemia (pH 6.92+/-0.1, base deficit 17.0+/-4.7 mmol/L after the last occlusion). In both groups, the PR-RR relationship switched from positive to negative with the onset of occlusions, then reverted to positive after a variable interval. In the 1:2.5 group later reversion of the PR-RR to positive was associated with earlier and more prolonged hypotension during the middle and end of the occlusion series (p < 0.001). We conclude that the initial switch to a negative PR-RR relationship during repetitive umbilical occlusion was due to a reflex-mediated response unrelated to fetal acidosis or hypotension. Both stable well compensated fetuses and severely hypoxic, hypotensive fetuses subsequently showed a positive PR-RR correlation.
authors.affiliation: Research Centre for Developmental Medicine and Biology, School of Medicine, University of Auckland, New Zealand.
authors.forename: J A
authors.initials: JA
authors.lastname: Westgate
authors.forename: A J
authors.initials: AJ
authors.lastname: Gunn
authors.forename: L
authors.initials: L
authors.lastname: Bennet
authors.forename: M I
authors.initials: MI
authors.lastname: Gunning
authors.forename: H H
authors.initials: HH
authors.lastname: de Haan
authors.forename: P D
authors.initials: PD
authors.lastname: Gluckman
mesh_terms: D000818:Animals; D001237:Asphyxia / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D005333:Fetus / Q000098:blood supply* / Q000503:physiopathology*; D011247:Pregnancy; D012756:Sheep; D014470:Umbilical Cord / Q000473:pathology*