title: Toward the improvement in fetal monitoring during labor with the inclusion of maternal heart rate analysis.
abstract: Fetal heart rate (FHR) monitoring is used routinely in labor, but conventional methods have a limited capacity to detect fetal hypoxia/acidosis. An exploratory study was performed on the simultaneous assessment of maternal heart rate (MHR) and FHR variability, to evaluate their evolution during labor and their capacity to detect newborn acidemia. MHR and FHR were simultaneously recorded in 51 singleton term pregnancies during the last two hours of labor and compared with newborn umbilical artery blood (UAB) pH. Linear/nonlinear indices were computed separately for MHR and FHR. Interaction between MHR and FHR was quantified through the same indices on FHR-MHR and through their correlation and cross-entropy. Univariate and bivariate statistical analysis included nonparametric confidence intervals and statistical tests, receiver operating characteristic curves and linear discriminant analysis. Progression of labor was associated with a significant increase in most MHR and FHR linear indices, whereas entropy indices decreased. FHR alone and in combination with MHR as FHR-MHR evidenced the highest auROC values for prediction of fetal acidemia, with 0.76 and 0.88 for the UAB pH thresholds 7.20 and 7.15, respectively. The inclusion of MHR on bivariate analysis achieved sensitivity and specificity values of nearly 100 and 89.1%, respectively. These results suggest that simultaneous analysis of MHR and FHR may improve the identification of fetal acidemia compared with FHR alone, namely during the last hour of labor.
authors.affiliation: Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Rua Dr Plácido Costa, s/n, 4200-319, Porto, Portugal. hernanigoncalves@med.up.pt.
authors.forename: Hernâni
authors.initials: H
authors.lastname: Gonçalves
authors.affiliation: Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Rua Dr Plácido Costa, s/n, 4200-319, Porto, Portugal.|Hospital Dr Nélio Mendonça, EPE, Funchal, Portugal.|Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal.
authors.forename: Paula
authors.initials: P
authors.lastname: Pinto
authors.affiliation: Hospital Dr Nélio Mendonça, EPE, Funchal, Portugal.
authors.forename: Manuela
authors.initials: M
authors.lastname: Silva
authors.affiliation: Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Rua Dr Plácido Costa, s/n, 4200-319, Porto, Portugal.|Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal.|Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal.|INEB - Institute of Biomedical Engineering; I3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal.
authors.forename: Diogo
authors.initials: D
authors.lastname: Ayres-de-Campos
authors.affiliation: Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Rua Dr Plácido Costa, s/n, 4200-319, Porto, Portugal.|Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal.|Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal.|Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Bernardes
mesh_terms: D000138:Acidosis / Q000175:diagnosis / Q000503:physiopathology; D000328:Adult; D016001:Confidence Intervals; D005260:Female; D005323:Fetal Monitoring / Q000379:methods*; D006339:Heart Rate / Q000502:physiology*; D006340:Heart Rate, Fetal / Q000502:physiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D007743:Labor, Obstetric; D011247:Pregnancy; D014469:Umbilical Arteries / Q000502:physiology
keywords: Acidosis; Cardiotocography; Fetal heart rate; Fetal monitoring; Maternal heart rate