title: Acceleration and deceleration capacity of fetal heart rate in an in-vivo sheep model.
abstract: BACKGROUND
  Fetal heart rate (FHR) variability is an indirect index of fetal autonomic nervous system (ANS) integrity. FHR variability analysis in labor fails to detect early hypoxia and acidemia. Phase-rectified signal averaging (PRSA) is a new method of complex biological signals analysis that is more resistant to non-stationarities, signal loss and artifacts. It quantifies the average cardiac acceleration and deceleration (AC/DC) capacity.
  
  
  OBJECTIVE
  The aims of the study were: (1) to investigate AC/DC in ovine fetuses exposed to acute hypoxic-acidemic insult; (2) to explore the relation between AC/DC and acid-base balance; and (3) to evaluate the influence of FHR decelerations and specific PRSA parameters on AC/DC computation.
  
  
  METHODS
  Repetitive umbilical cord occlusions (UCOs) were applied in 9 pregnant near-term sheep to obtain three phases of MILD, MODERATE, and SEVERE hypoxic-acidemic insult. Acid-base balance was sampled and fetal ECGs continuously recorded. AC/DC were calculated: (1) for a spectrum of T values (T = 1÷50 beats; the parameter limits the range of oscillations detected by PRSA); (2) on entire series of fetal RR intervals or on "stable" series that excluded FHR decelerations caused by UCOs.
  
  
  RESULTS
  AC and DC progressively increased with UCOs phases (MILD vs. MODERATE and MODERATE vs. SEVERE, p<0.05 for DC [Formula: see text] = 2-5, and AC [Formula: see text] = 1-3). The time evolution of AC/DC correlated to acid-base balance (0.4<[Formula: see text]<0.9, p<0.05) with the highest [Formula: see text] for [Formula: see text]. PRSA was not independent from FHR decelerations caused by UCOs.
  
  
  CONCLUSIONS
  This is the first in-vivo evaluation of PRSA on FHR analysis. In the presence of acute hypoxic-acidemia we found increasing values of AC/DC suggesting an activation of ANS. This correlation was strongest on time scale dominated by parasympathetic modulations. We identified the best performing [Formula: see text] parameters ([Formula: see text]), and found that AC/DC computation is not independent from FHR decelerations. These findings establish the basis for future clinical studies.
authors.affiliation: Dept. of Computer Science, Università degli Studi di Milano, Milan, Italy.
authors.forename: Massimo W
authors.initials: MW
authors.lastname: Rivolta
authors.affiliation: Unit of Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
authors.forename: Tamara
authors.initials: T
authors.lastname: Stampalija
authors.affiliation: Dept. of Woman, Mother and Neonate, Buzzi Children's Hospital, Biomedical and Clinical Sciences School of Medicine University of Milan, Milan, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Casati
authors.affiliation: Dept. of Obstetrics and Gynecology, Western University, London, Ontario, Canada.
authors.forename: Bryan S
authors.initials: BS
authors.lastname: Richardson
authors.affiliation: Dept. of Obstetrics and Gynecology, LA BioMed at Harbor-UCLA Med. Ctr., Torrance, California, United States of America.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Ross
authors.affiliation: CHU Ste-Justine Research Center, Departments of Obstetrics-Gynaecology and Neurosciences, Université de Montréal, QC, Canada; Animal Reproduction Research Centre (CRRA), University of Montreal, St-Hyacinthe, QC, Canada.
authors.forename: Martin G
authors.initials: MG
authors.lastname: Frasch
authors.affiliation: Dept. of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich Germany and DZHK (German Centre for Cardiovascular Research).
authors.forename: Axel
authors.initials: A
authors.lastname: Bauer
authors.affiliation: Dept. of Woman, Mother and Neonate, Buzzi Children's Hospital, Biomedical and Clinical Sciences School of Medicine University of Milan, Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ferrazzi
authors.affiliation: Dept. of Computer Science, Università degli Studi di Milano, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Sassi
mesh_terms: D000054:Acceleration; D000136:Acid-Base Equilibrium; D000138:Acidosis / Q000503:physiopathology*; D000818:Animals; D001341:Autonomic Nervous System / Q000503:physiopathology*; D003654:Deceleration; D004195:Disease Models, Animal; D005260:Female; D005318:Fetal Heart / Q000502:physiology / Q000503:physiopathology*; D005311:Fetal Hypoxia / Q000503:physiopathology*; D006340:Heart Rate, Fetal / Q000502:physiology*; D011247:Pregnancy; D012756:Sheep