title: Modalities of fetal evaluation to detect fetal compromise prior to the development of significant neurological damage.
abstract: OBJECTIVE
  The aim of this study was to clarify the developmental mechanism underlying fetal heart rate (FHR) long-term variability (LTV) and acceleration with respect to fetal brain damage.
  
  
  METHODS
  The fetal state was deduced from the developmental mechanism of FHR variability analyzed by actocardiogram, animal experiments, and simulations.
  
  
  RESULTS
  LTV develops due to minor fetal movements in the fetal midbrain, moderate LTV by fetal periodic movements and triangular accelerations by large fetal movement bursts. Stimulation of the fetal midbrain by sound and light produces fetal movements that lead to FHR acceleration. Severe hypoxia can result in the loss of LTV and neuronal necrosis that may damage the fetal brain. Therefore, a cesarean section is recommended prior to the loss of LTV, rather than after its loss. The vagal center of the fetal medulla oblongata is excited by hypoxia and produces FHR bradycardia. The heart rate of hypoxic rabbits was found to be closely correlated with the PaO₂, thus the impact of hypoxia could be estimated by the hypoxia index, which is calculated from the reciprocal of nadir FHR and bradycardia duration.
  
  
  CONCLUSIONS
  Analyzing the development of FHR signs could help to diagnose fetal state. An early cesarean section is recommended before the loss of LTV as indicated by the hypoxia index, which will contribute to prevent fetal brain damage and neurological sequels.
authors.affiliation: Department of Obstetrics and Gynecology, Tottori University Medical School, Yonago, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Maeda
mesh_terms: D000818:Animals; D001927:Brain Diseases / Q000196:embryology / Q000209:etiology / Q000517:prevention & control; D002585:Cesarean Section; D005260:Female; D047109:Fetal Development; D005316:Fetal Distress / Q000175:diagnosis* / Q000196:embryology / Q000503:physiopathology; D005323:Fetal Monitoring / Q000379:methods; D006340:Heart Rate, Fetal; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000196:embryology / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods*
keywords: development of FHR changes; feial bradycardia; fetal brain damage; fetal movement; hypoxia; loss of FHR variability