title: Mathematical Model of Cardiovascular and Metabolic Responses to Umbilical Cord Occlusions in Fetal Sheep.
abstract: Fetal acidemia during labor is associated with an increased risk of brain injury and lasting neurological deficits. This is in part due to the repetitive occlusions of the umbilical cord (UCO) induced by uterine contractions. Whereas fetal heart rate (FHR) monitoring is widely used clinically, it fails to detect fetal acidemia. Hence, new approaches are needed for early detection of fetal acidemia during labor. We built a mathematical model of the UCO effects on FHR, mean arterial blood pressure (MABP), oxygenation and metabolism. Mimicking fetal experiments, our in silico model reproduces salient features of experimentally observed fetal cardiovascular and metabolic behavior including FHR overshoot, gradual MABP decrease and mixed metabolic and respiratory acidemia during UCO. Combined with statistical analysis, our model provides valuable insight into the labor-like fetal distress and guidance for refining FHR monitoring algorithms to improve detection of fetal acidemia and cardiovascular decompensation.
authors.affiliation: Department of Mathematics and Statistics, York University, Toronto, ON, M3J 1P3, Canada.
authors.forename: Qiming
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Mathematics and Statistics, York University, Toronto, ON, M3J 1P3, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Gold
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, CHU Sainte-Justine Research Center, Montréal, QC, H3T 1C5, Canada.|Department of Neurosciences, Faculty of Medicine, CHU Sainte-Justine Research Center, Montréal, QC, H3T 1C5, Canada.|Centre de Recherche en Reproduction Animale (CRRA), Université de Montréal, 3200 rue Sicotte, Saint-Hyacinthe, QC, J2S 7C6, Canada.
authors.forename: Martin G
authors.initials: MG
authors.lastname: Frasch
authors.affiliation: Department of Mathematics and Statistics, York University, Toronto, ON, M3J 1P3, Canada. hhuang@yorku.ca.
authors.forename: Huaxiong
authors.initials: H
authors.lastname: Huang
authors.affiliation: UPMC, Laboratoire Jacques-Louis Lions, CNRS, UMR 7598, INRIA, EPI REO, Sorbonne University, 75252, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Thiriet
authors.affiliation: Department of Mathematics and Statistics, York University, Toronto, ON, M3J 1P3, Canada.
authors.forename: Xiaogang
authors.initials: X
authors.lastname: Wang
mesh_terms: D000138:Acidosis / Q000503:physiopathology; D000818:Animals; D001794:Blood Pressure; D003251:Constriction, Pathologic; D005260:Female; D005333:Fetus / Q000098:blood supply* / Q000378:metabolism / Q000503:physiopathology*; D006340:Heart Rate, Fetal; D055641:Mathematical Concepts; D023421:Models, Animal; D008955:Models, Cardiovascular; D011247:Pregnancy; D012756:Sheep / Q000502:physiology*; D014470:Umbilical Cord / Q000473:pathology / Q000503:physiopathology; D014590:Uterine Contraction / Q000502:physiology
keywords: Fetal acidemia; Fetal blood circulation; Hemodynamics; Labor; Mathematical modeling; Neural control; Sensitivity analysis