title: Fetal Heart Rate Monitoring Using Maternal Abdominal Surface Electrodes in Third Trimester: Can We Obtain Additional Information Other than CTG Trace?
abstract: BACKGROUND
  Cardiotocography (CTG) is the most widely used procedure despite its low specificity for fetal acidosis and poor perinatal outcome. Fetal electrocardiography (fECG) with transabdominal electrodes is a new, non-invasive and promising method with greater potential for detecting impairment of fetal circulation. This study is the first that attempts to assess the usefulness of fECG in comparison to CTG during antepartum period.
  
  
  OBJECTIVE
  To determine if a single fECG examination along with CTG tracing and Doppler flow measurement in the fetal vessels has any additional clinical value in normal and intrauterine growth restricted (IUGR) fetuses.
  
  
  METHODS
  The study included 93 pregnancies with IUGR, 37 pregnancies with IUGR and brain sparing effect, and 324 healthy pregnant women. The T/QRS ratio, cerebro-placental ratio (CRP), and CTG tracings were analyzed. One-way analysis of variance and Spearman's rank correlation coefficient were applied. The relationship between results of the T/QRS ratio and CTG examination among the study groups was analyzed.
  
  
  RESULTS
  The highest average mean value of the T/QRS ratio was recorded in the IUGR group with a normal CPR and a pathologic CTG (0.235 ± 0.014). The highest average maximum values were observed in the groups of IUGR pregnancies with a reduced CPR with normal (0.309 ± 0.100), suspicious (0.330 ± 0.102) and pathologic (0.319 ± 0.056) CTGs. Analysis of variance revealed differences between study groups regarding maximum values and the difference between maximum and minimal values of T/QRS. Correlations between groups were insignificant.
  
  
  CONCLUSIONS
  Higher values of T/QRS ratio in IUGR pregnancies with normal and reduced CPR than in control group regardless of the result of CTG examination may indicate minimal worsening of intrauterine fetal well-being in growth retarded fetuses. No relationship between fECG examination and CTG tracings suggests that a single fECG does not provide any additional clinically significant information determining the condition of the fetus; however, further studies are required.
authors.affiliation: 2nd Department and Clinic of Gynaecology and Obstetrics, Wroclaw Medical University, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Fuchs
authors.affiliation: 2nd Department and Clinic of Gynaecology and Obstetrics, Wroclaw Medical University, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Grobelak
authors.affiliation: 2nd Department and Clinic of Gynaecology and Obstetrics, Wroclaw Medical University, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Pomorski
authors.affiliation: 2nd Department and Clinic of Gynaecology and Obstetrics, Wroclaw Medical University, Poland.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Zimmer
mesh_terms: D000005:Abdomen; D001783:Blood Flow Velocity; D015148:Cardiotocography; D016022:Case-Control Studies; D004562:Electrocardiography / Q000295:instrumentation / Q000379:methods*; D004566:Electrodes; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis* / Q000503:physiopathology; D005318:Fetal Heart / Q000503:physiopathology*; D006340:Heart Rate, Fetal; D006801:Humans; D021041:Placental Circulation; D011237:Predictive Value of Tests; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011296:Prenatal Diagnosis / Q000295:instrumentation / Q000379:methods*; D011379:Prognosis; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal
keywords: antepartum fetal monitoring; cardiotocography; fetal electrocardiography; fetal growth restriction; fetal heart rate