title: Correlating multidimensional fetal heart rate variability analysis with acid-base balance at birth.
abstract: Fetal monitoring during labour currently fails to accurately detect acidemia. We developed a method to assess the multidimensional properties of fetal heart rate variability (fHRV) from trans-abdominal fetal electrocardiogram (fECG) during labour. We aimed to assess this novel bioinformatics approach for correlation between fHRV and neonatal pH or base excess (BE) at birth.We enrolled a prospective pilot cohort of uncomplicated singleton pregnancies at 38-42 weeks' gestation in Milan, Italy, and Liverpool, UK. Fetal monitoring was performed by standard cardiotocography. Simultaneously, with fECG (high sampling frequency) was recorded. To ensure clinician blinding, fECG information was not displayed. Data from the last 60 min preceding onset of second-stage labour were analyzed using clinically validated continuous individualized multiorgan variability analysis (CIMVA) software in 5 min overlapping windows. CIMVA allows simultaneous calculation of 101 fHRV measures across five fHRV signal analysis domains. We validated our mathematical prediction model internally with 80:20 cross-validation split, comparing results to cord pH and BE at birth.The cohort consisted of 60 women with neonatal pH values at birth ranging from 7.44 to 6.99 and BE from -0.3 to -18.7 mmol L(-1). Our model predicted pH from 30 fHRV measures (R(2) = 0.90, P < 0.001) and BE from 21 fHRV measures (R(2) = 0.77, P < 0.001).Novel bioinformatics approach (CIMVA) applied to fHRV derived from trans-abdominal fECG during labor correlated well with acid-base balance at birth. Further refinement and validation in larger cohorts are needed. These new measurements of fHRV might offer a new opportunity to predict fetal acid-base balance at birth.
authors.affiliation: Department of Obstetrics and Gynecology and Department of Neuroscience, CHU Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Martin G
authors.initials: MG
authors.lastname: Frasch
authors.forename: Yawen
authors.initials: Y
authors.lastname: Xu
authors.forename: Tamara
authors.initials: T
authors.lastname: Stampalija
authors.forename: Lucien D
authors.initials: LD
authors.lastname: Durosier
authors.forename: Christophe
authors.initials: C
authors.lastname: Herry
authors.forename: Xiaogang
authors.initials: X
authors.lastname: Wang
authors.forename: Daniela
authors.initials: D
authors.lastname: Casati
authors.forename: Andrew Je
authors.initials: AJ
authors.lastname: Seely
authors.forename: Zarko
authors.initials: Z
authors.lastname: Alfirevic
authors.forename: Xin
authors.initials: X
authors.lastname: Gao
authors.forename: Enrico
authors.initials: E
authors.lastname: Ferrazzi
mesh_terms: D000005:Abdomen; D004562:Electrocardiography; D005260:Female; D005323:Fetal Monitoring / Q000379:methods*; D006340:Heart Rate, Fetal; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D015233:Models, Statistical; D036801:Parturition; D011247:Pregnancy