Computerized fetal heart rate analysis in the prediction of myocardial damage in pregnancies with placental insufficiency.
OBJECTIVE
To evaluate the reliability of fetal heart rate (FHR) parameters analyzed by computerized cardiotocography (cCTG) in predicting myocardial damage in pregnancies with placental insufficiency.


METHODS
We evaluated 38 patients with placental insufficiency detected before 34 weeks of gestation. All patients underwent 30 min of cCTG (Sonicaid Fetal Care, version 2.2) and Doppler of umbilical artery, middle cerebral artery, and ductus venosus. Umbilical vein blood samples were collected at birth to determine fetal cardiac Troponin T, and a ≥0.09ng/ml value was deemed a sign of myocardial damage.


RESULTS
The fetuses with myocardial damage (39%) showed significantly increased values of umbilical artery pulsatility index z-score (P=0.003), ductus venosus pulsatility index z-score (P=0.007), basal FHR (P=0.033) and periods of low episodes (P=0.038). The number of small accelerations and the short-term variation (STV) were significantly reduced in the group with myocardial damage (P=0.013 and P=0.003, respectively). Logistic regression analysis identified STV and gestational age at delivery as independent predictors for fetal myocardial damage, with area under ROC curve of 0.91.


CONCLUSIONS
Computerized cardiotocography parameters may be useful in the management of early onset placental insufficiency, and the association of STV with gestational age could play a role in detecting myocardial injury in pregnancies with placental insufficiency.
Department of Obstetrics and Gynecology, São Paulo University Medical School, University of Sao Paulo, São Paulo, Brazil.
Mariane de Fátima Y
Mde F
Maeda
Department of Obstetrics and Gynecology, São Paulo University Medical School, University of Sao Paulo, São Paulo, Brazil. Electronic address: roseli.nomura@hotmail.com.
Roseli M Y
RM
Nomura
Department of Obstetrics and Gynecology, São Paulo University Medical School, University of Sao Paulo, São Paulo, Brazil.
Juliana I
JI
Niigaki
Department of Obstetrics and Gynecology, São Paulo University Medical School, University of Sao Paulo, São Paulo, Brazil.
Rossana P V
RP
Francisco
Department of Obstetrics and Gynecology, São Paulo University Medical School, University of Sao Paulo, São Paulo, Brazil.
Marcelo
M
Zugaib
D019540:Area Under Curve; D015148:Cardiotocography; D005260:Female; D005312:Fetal Blood / Q000378:metabolism; D005865:Gestational Age; D006340:Heart Rate, Fetal; D006801:Humans; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D009206:Myocardium / Q000473:pathology*; D010927:Placental Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D012372:ROC Curve; D012815:Signal Processing, Computer-Assisted; D020107:Troponin T / Q000097:blood; D018608:Ultrasonography, Doppler; D014469:Umbilical Arteries / Q000000981:diagnostic imaging; D014471:Umbilical Veins / Q000000981:diagnostic imaging
D020107:Troponin T
Cardiotocography; Fetal hypoxia; Placental insufficiency; Troponin T; Ultrassonography, Doppler