title: Monitoring fetal maturation-objectives, techniques and indices of autonomic function.
abstract: Monitoring the fetal behavior does not only have implications for acute care but also for identifying developmental disturbances that burden the entire later life. The concept, of 'fetal programming', also known as 'developmental origins of adult disease hypothesis', e.g. applies for cardiovascular, metabolic, hyperkinetic, cognitive disorders. Since the autonomic nervous system is involved in all of those systems, cardiac autonomic control may provide relevant functional diagnostic and prognostic information. The fetal heart rate patterns (HRP) are one of the few functional signals in the prenatal period that relate to autonomic control and, therefore, is predestinated for its evaluation. The development of sensitive markers of fetal maturation and its disturbances requires the consideration of physiological fundamentals, recording technology and HRP parameters of autonomic control. Based on the ESGCO2016 special session on monitoring the fetal maturation we herein report the most recent results on: (i) functional fetal autonomic brain age score (fABAS), Recurrence Quantitative Analysis and Binary Symbolic Dynamics of complex HRP resolve specific maturation periods, (ii) magnetocardiography (MCG) based fABAS was validated for cardiotocography (CTG), (iii) 30 min recordings are sufficient for obtaining episodes of high variability, important for intrauterine growth restriction (IUGR) detection in handheld Doppler, (iv) novel parameters from PRSA to identify Intra IUGR fetuses, (v) evaluation of fetal electrocardiographic (ECG) recordings, (vi) correlation between maternal and fetal HRV is disturbed in pre-eclampsia. The reported novel developments significantly extend the possibilities for the established CTG methodology. Novel HRP indices improve the accuracy of assessment due to their more appropriate consideration of complex autonomic processes across the recording technologies (CTG, handheld Doppler, MCG, ECG). The ultimate objective is their dissemination into routine practice and studies of fetal developmental disturbances with implications for programming of adult diseases.
authors.affiliation: Hans Berger Department of Neurology, Biomagnetic Center, Jena University Hospital, Jena 07747, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Hoyer
authors.forename: Jan
authors.initials: J
authors.lastname: Żebrowski
authors.forename: Dirk
authors.initials: D
authors.lastname: Cysarz
authors.forename: Hernâni
authors.initials: H
authors.lastname: Gonçalves
authors.forename: Adelina
authors.initials: A
authors.lastname: Pytlik
authors.forename: Célia
authors.initials: C
authors.lastname: Amorim-Costa
authors.forename: João
authors.initials: J
authors.lastname: Bernardes
authors.forename: Diogo
authors.initials: D
authors.lastname: Ayres-de-Campos
authors.forename: Otto W
authors.initials: OW
authors.lastname: Witte
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Schleußner
authors.forename: Lisa
authors.initials: L
authors.lastname: Stroux
authors.forename: Christopher
authors.initials: C
authors.lastname: Redman
authors.forename: Antoniya
authors.initials: A
authors.lastname: Georgieva
authors.forename: Stephen
authors.initials: S
authors.lastname: Payne
authors.forename: Gari
authors.initials: G
authors.lastname: Clifford
authors.forename: Maria G
authors.initials: MG
authors.lastname: Signorini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Magenes
authors.forename: Fernando
authors.initials: F
authors.lastname: Andreotti
authors.forename: Hagen
authors.initials: H
authors.lastname: Malberg
authors.forename: Sebastian
authors.initials: S
authors.lastname: Zaunseder
authors.forename: Igor
authors.initials: I
authors.lastname: Lakhno
authors.forename: Uwe
authors.initials: U
authors.lastname: Schneider
mesh_terms: D001341:Autonomic Nervous System / Q000502:physiology*; D004562:Electrocardiography; D005260:Female; D047109:Fetal Development / Q000502:physiology*; D005323:Fetal Monitoring / Q000379:methods*; D006340:Heart Rate, Fetal; D006801:Humans; D011225:Pre-Eclampsia / Q000503:physiopathology; D011247:Pregnancy