43, 163–188. Normal was distinguished from abnormal cases with its high fBBI→mBBI coupling. For low risk patients, routine intrapartum surveillance includes review of the fetal heart rate tracing … Although the preliminary findings are interesting, but these observations need to be tested with more cases of similar abnormalities. Start studying Week 6: Fetal Heart Abnormalities Part 1. Physica D. 142 346–382. Neural Circuits 9:62. doi: 10.3389/fncir.2015.00062, Milde, T., Schwab, K., Walther, M., Eiselt, M., Schelenz, C., Voss, A., et al. “Cardiovascular and cardiorespiratory coupling analysis-State of the art and future perspectives,” in Cardiovascular Oscillations (ESGCO), 2014 8th Conference of the European Study Group on IEEE (Trento), 25–26. 283, H1200–H1207. AK, SS, HA-A, and AV evaluated results of the statistical analysis. Mathemat. Entropy 17, 483–501. For HRV analyses surrogates were generated by randomly permuting the samples of the original series in temporal order. Figure 1. We believe that NSTPDC monitoring of both fetal and maternal heart rates introduced in this study with the expectation that it would significantly reduce the incidence of fetal compromise caused by intrapartum interruption of fetal oxygenation. Remember, the baseline is the average heart rate rounded to the nearest five bpm. accepted definitions for electronic fetal monitor tracing. We applied NSTPDC on simultaneously recorded fetal and maternal beat-by-beat heart rates collected from fetal and maternal ECG signals of 66 normal and 19 abnormal pregnancies. Results of The HRV and NSTPDC analyses are shown in Table 3. Enjoy and learn!This channel is for educational purposes only! Biomed. Synchronization was found less often where mothers had exercised regularly, possibly due to an increased beat-to-beat differences, higher vagal tone and slower breathing rates (Van Leeuwen et al., 2014). Phys. This fetal heart rate deceleration quiz will help you learn how to differentiate between early decelerations, late decelerations, and variable decelerations. Front. Two RRI time series namely fetal heart rates (fBBI) and maternal heart rates (mBBI) were extracted from maternal and fetal ECG signals. doi: 10.1073/pnas.0901049106, Van Leeuwen, P., Gustafson, K. M., Cysarz, D., Geue, D., May, L. E., and Grönemeyer, D. (2014). 32, 1787–1805. Among symbolic HRV parameters, lower plvar10 [i.e., a decrease in the number of short-term, low-variability episodes (shorter than 10 ms)] and higher phvar10 [i.e., an increase in the number of short-term, high-variability episodes (longer than 10 ms)] in abnormal group might indicate that both branches of autonomic nervous system (sympathetic and parasympathetic) could have been affected. Statistical approach to quantify the presence of phase coupling using the bispectrum. Decelerations which occur after the … doi: 10.1111/j.1365-2826.2001.00601.x, Keywords: fetal heart rate, maternal heart rate, coupling, partial directed coherence, Granger causality, Citation: Khandoker AH, Schulz S, Al-Angari HM, Voss A and Kimura Y (2019) Alterations in Maternal–Fetal Heart Rate Coupling Strength and Directions in Abnormal Fetuses. 36, 683–698. For the quantification of heart rate variability (HRV) we calculated some of the most commonly used indices in cardiovascular variability analysis in the time domain (TD), the frequency domain (FD) and from non-linear dynamics (NLD) (Voss et al., 2009) from the fBBI time series. In our previous study (Khandoker et al., 2016), NSTPDC was applied to investigate the strength of the directional relationship between fetal–maternal cardiac systems in normal fetuses. Trans. YK collected the maternal and fetal ECG data. Cybernet. Surrogate analyses did not reveal any significant differences between normal fetuses and abnormal fetuses surrogate time series, and thereby, confirming the statistical validity of the found HRV and NSTPDC results (Table 3). 54, 49–58. FHT Quiz 6 Fetal Tracing Quiz 1. Endocrine physiology of the placenta. We recently reported the evidence of short-term maternal–fetal cardiac couplings in normal fetuses by using Normalized Short Time Partial Directed Coherence (NSTPDC) technique. The window length is 160 samples. *Correspondence: Ahsan H. Khandoker, ahsank@ieee.org, Front. However, we have to state that couplings higher than half of the mean heart rate (mother) are possibly only caused by “mirrored components” due to cardiac aliasing effects (Milde et al., 2011). Math. The fetal and maternal auto-couplings (fBBI→fBBI and mBBI→mBBI) present the functional states of fetal and maternal autonomic nervous systems, respectively. labor in the case study presented above. Scheduled interactive fetal heart rate assessment by the entire team using an evidence-based Category II fetal heart rate algorithm further enhanced fetal safety. The application of methods of non-linear dynamics for the improved and predictive recognition of patients threatened by sudden cardiac death. Absent C 1. June 2, 2016 The NCC EFM Tracing Game had a busy May with tracings being identified over 10,000 times. Out of them 66 pregnant women were at the gestational age of 16–39 (28.9 ± 6.3) weeks with normal singleton pregnancy and 19 women had abnormal pregnancy at the gestational age of 19–38 (30.3 ± 5.7) weeks. Electronic Fetal Heart Rate Monitoring (EFM) Tracing Interpretation Accelerations ↑ FHR at least 15/min above baseline for ≥ 15 seconds and < 2 minutes in a 20 minute period when gestational age is > 32 weeks or 10/min for ≥ 10 seconds when gestational age is < 32 weeks 2D NSTPDC plots for: (A) fetal auto-coupling (fBBI→fBBI), (B) maternal-fetal coupling (mBBI→fBBI), (C) fetal-maternal coupling (fBBI→mBBI), and (D) maternal auto-coupling (mBBI→mBBI) for a fetus with SSS (ID: 7, Table 2). These results were normalized to become a specific set of values leading to the (normalized) factor NF representing the coupling direction. The correlation became reasonably strong in the abnormal cases (Figure 7). In that study we reported that a causal influence of fetal heart rate on maternal heart rate significantly decreased from early to mid-gestation age along with a significant increase of maternal to fetal heart rate. 1. Phys. Physiol. Philos. For example, reduced maternal blood oxygen level was reported to have caused hypoxia in fetus (Jensen, 1996). Central- and autonomic nervous system coupling in schizophrenia. Trans. fetal heart monitoring principles and practices Dec 11, 2020 Posted By Laura Basuki Ltd TEXT ID 0472de5d Online PDF Ebook Epub Library by powered by powered by search for contents about self guided tutorial efm in depth history Siu, K. L., Ahn, J. M., Ju, K., Lee, M., Shin, K., and Chon, K. H. (2008). Also, all except ID: 17 had A_fBBI→mBBI < 0.2 (Figure 3B) for A_mBBI→fBBI, 10 cases were >0.75 including the cases with Tachycardia (ID: 6, 13) while cases with AV block (ID: 8, 17) were below 0.4 (Figure 3C). It is based on a multivariate autoregressive (AR) model with order p to determine linear Granger causality in the frequency domain. doi: 10.1371/journal.pone.0106036, Voss, A., Kurths, J., Kleiner, H. J., Witt, A., Wessel, N., Saparin, P., et al. doi: 10.1371/journal.pone.0142143, Baumert, M., Baier, V., Haueisen, J., Wessel, N., Meyerfeldt, U., Schirdewan, A., et al. Fetal Heart Tracing Quiz 7 - FHTQuiz7 FetalTracingQuiz Perfect! Phys. The aim of this study is to test if maternal-fetal coupling patterns change in various types of abnormal cases of pregnancies. A limitation of the NSTPDC approach in the case of fetal-maternal cardiac coupling is that it is only able to detect linear couplings in the frequency domain. Influence of paced maternal breathing on fetal-maternal heart rate coordination. Physiol. Different permutations were used for the original series, so that any temporal structure was destroyed in the surrogate time series. Early deceleration= Fetal head compression, 1. Maternal and abdominal ECG were collected from 85 pregnant women at Tohoku University Hospital. In conclusion, maternal-fetal cardiac coupling strength and direction and their associations with regulatory mechanisms (patterns) of developing autonomic nervous system function could be novel clinical markers of healthy prenatal development and its deviation. Also explore over 64 similar quizzes in this category. Therefore, a time-variant version of PDC (tvPDC) was proposed to provide information about the partial correlative interaction properties which made it applicable for modeling short-time interactions in cardiovascular systems (Milde et al., 2011). 140 Correct.Remember,thebaselineisthe 145 150 bpm 155 160 2. Although both the tachycardia (ID: 13) and the SSS (ID: 7) had high mBBI→fBBI, the tachycardia showed drop in the mBBI→fBBI coupling around 0.15 Hz and around 0.25 Hz while the SSS case had low mBBI→fBBI in the frequency band 0.8–1 Hz (Figures 5, 6). To quantify the coupling direction between two time series, x and y (mBBI and fBBI: with xmBBI and yfBBI) a coupling factor (CF) was introduced. A new normalised short time PDC for dynamic coupling analyses. This means that a clear physiological interpretation of the results higher than 0.66 Hz is more speculative. doi: 10.1088/0967-3334/36/4/683, Friston, K. J., Harrison, L., and Penny, W. (2003). (1996). Psychobiol. Schulz, S., and Voss, A. Trans. The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) maintains that the availability of registered nurses (RNs) and other health care professionals who are skilled in fetal heart monitoring (FHM) techniques, including auscultation and electronic fetal monitoring (EFM), is essential to maternal and fetal well-being during antepartum care, labor, and birth. Impact Factor 3.367 | CiteScore 4.3More on impact ›, Saints Cyril and Methodius University of Skopje, North Macedonia, Fondazione Don Carlo Gnocchi Onlus (IRCCS), Italy, Hudson Institute of Medical Research, Australia. Linear and non-linear brain-heart and brain-brain interactions during sleep. 1), 1–2. Adochiei, F., Schulz, S., Edu, I., Costin, H., and Voss, A. CF was obtained by dividing the mean value of πxy(f, n) by the mean value of πyx(f, n). A normalization procedure (zero mean and unit variance) of the time series fBBI and mBBI and scale-invariance were applied (Schulz et al., 2015). Stop oxytocin (Causes uterine contractions), 1. The surrogate data approach (Schreiber and Schmitz, 2000) was applied to test the significance of maternal–fetal HRV and couplings (mBBI-fBBI) between the two groups. doi: 10.3390/e17020483, Schulz, S., Bolz, M., Bär, K. J., and Voss, A. Furthermore, more new concepts such as time delay stability (TDS) approach to study different physiological interactions among systems with different dynamics (Liu et al., 2015), TDS approach (Liu et al., 2015), coupling functions (Stankovski, 2017), dynamical causal modeling (Friston et al., 2003), and bispectrum (Siu et al., 2008; Schulz et al., 2018); were also reported. Eng. It was also suggested that the short time fetal–maternal heart rate coupling might occur through auditory stimulation associated with the maternal heart rhythms, perceived by the fetal auditory pathways (Riedl et al., 2009; Van Leeuwen et al., 2014). Because fetal gas exchange takes place via the maternal placenta, there has been growing interests in investigating the patterns and directions of maternal-fetal cardiac coupling to better understand the mechanisms of placental gas transfer. Fetal ECG traces were extracted from abdominal ECG signals by using a method that combines cancellation of the mother's ECG signal and the blind source separation with reference (BSSR) as described in our earlier study (Sato et al., 2007). All experiments were performed in accordance with relevant guidelines and regulations. 16, 172–177. doi: 10.1016/0378-3782(91)90196-A, Faes, L., Marinazzo, D., Jurysta, F., and Nollo, G. (2015). FHR Nervous system pathway: Normal tracing/ healthy pattern, 1. The mean and SD (linear features) showed no significant differences. Simpson, E. R., and MacDonald, P. C. (1981). SS and HA-A ran statistical analysis on results. abrupt, onset <30 sec visually apparent decreases in FHR below baseline FHR-can start before, during or after Fetal Heart Tracing Quiz 6 - FHTQuiz6 FetalTracingQuiz Perfect! Natl. sends signal to brain to activate SNS, 1. NSTPDC fetal-to-maternal coupling analyses revealed significant differences between the normal and abnormal cases (normal: normalized factor (NF) = −0.21 ± 0.85, fetus-to-mother coupling area (A_fBBI→ mBBI) = 0.44 ± 0.13, mother-to-fetus coupling area (A_mBBI→ fBBI) = 0.46 ± 0.12; abnormal: NF = −1.66 ± 0.77, A_fBBI→ mBBI = 0.08 ± 0.12, A_mBBI→ fBBI = 0.66 ± 0.24; p < 0.01). Remember, the baseline is the average heart rate rounded. For the selection of the optimal order p of the AR(p) model the stepwise least squares algorithm and the Schwarz's Bayesian Criterion (SBC) were used. RR intervals (RRI) were determined using the algorithm developed by Pan and Tompkins (Pan and Tompkins, 1985). Gradual diminishing causal influence from fetal to maternal heart rate coupling strength over increasing gestational ages (as shown in Figure 3B) was also reported in our previous study (Khandoker et al., 2016). (2011). The NCC EFM Tracing Game... already played 10,000 times! Given those evidences, mathematical methods to investigate and quantify the interactions between maternal and fetal cardiac systems were proposed in several research papers (Riedl et al., 2009; Van Leeuwen et al., 2009, 2014). Thus, A_fBBI→mBBI represents the causal coupling strength for the causal link from fBBI to mBBI (fetus to mother), A_mBBI→fBBI represents the causal coupling strength for the causal link from mBBI to fBBI (mother to fetus), and A_mBBI→mBBI/ A_fBBI→fBBI represents the causal coupling strength from mBBI to mBBI or mBBI to mBBI [mother to mother/ fetus to fetus (auto-coupling)]. With this statistical definition of a threshold level, finding a coupling in the original time series higher than the threshold leads to reject the null hypothesis, and to detect the presence of a significant coupling. Neural cross-frequency coupling functions. We've looked at what fetal monitoring is. Table 2. “Vascular biology of the placenta,” in Colloquium Series on Integrated Systems Physiology: From Molecule to Function, Vol. Tech. A novel extraction method of fetal electrocardiogram from the composite abdominal signal. (1996). IEEE Trans. Therefore, the aim of this study was to evaluate fetal maternal heart rate coupling strength and directions of a variety of abnormal fetuses by using NSTPDC method and the compare the results with the same from normal cases. Heart Circ. Cardiotocography (CTG) is a technical means of recording the fetal heartbeat and the uterine contractions during pregnancy. Start studying Fetal Heart tracings (FHR). Eng. Math. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). Network physiology: how organ systems dynamically interact. Correlation between coupling parameters (A_fBB →mBB and A_mBB →fBB) and RMSSD (A,B) and Renyi entropy (C,D) for normal and abnormal groups (solid line represents linear fit for normal, dashed line represents linear fit for abnormal group). doi: 10.1109/TBME.2006.883791, Schreiber, T., and Schmitz, A. Figure 7. Wang, Y. Maternal fever=>Fetus will vasodilate=> ↓ PVR => Vagus inhibited => HR ↑, 1. Twenty independent surrogate time series were created from the original mBBI and fBBI time series to test for an impaired HRV and coupling in abnormal fetuses. Early Hum. Webb, K. A., Wolfe, L. A., and Mcgrath, M. J. Assessing causality in brain dynamics and cardiovascular control. (2007). All recordings (each of 1 min length) were collected during daytime (between 9 am and 2 pm) and sampled at 1,000 Hz with 16-bit resolution. During each of fetal cardiac cycle, oxygenated blood to fetal heart enters through inferior vena cava instead of pulmonary veins. The NF can take the following values: NF = {−2, −1, 0, 1, 2}. For coupling analyses (NSTPDC), additionally, we created 20 uncoupled isospectral isodistribution pairs (iterative amplitude adjusted Fourier Transform (IAAFT) surrogates) from the original mBBI and fBBI time series to preserve linear properties to test linear couplings in the frequency domain (applying NSTPDC). Aerobic exercise during pregnancy and presence of fetal-maternal heart rate synchronization. Correct. HIGHLY predictive of the absence of metabolic acidemia, 1. quiz which has been attempted 8976 times by avid quiz takers. The coupling from fetus to mother for the normal group (B) showed a significant correlation with age (r = −0.3, p = 0.013). PVR ↑=> Vagus activation (via baroreceptors) => FHR ↓, 1. Incorrect. 2D NSTPDC plots for: (A) fetal auto-coupling (fBBI→fBBI), (B) maternal-fetal coupling (mBBI→fBBI), (C) fetal-maternal coupling (fBBI→mBBI), and (D) maternal auto-coupling (mBBI→mBBI) for a fetus with tachycardia (ID: 13 from Table 2). Proc. doi: 10.1016/S0008-6363(96)00008-9, Voss, A., Schulz, S., Schroeder, R., Baumert, M., and Caminal, P. (2009). Table 1. doi: 10.1016/j.joim.2018.03.002. Compression entropy quantifies to what extent data can be compressed (Baumert et al., 2004). Phys. Eng. 140 Correct.Remember,thebaselineisthe 145 150 bpm 155 160 2. Rev. doi: 10.1007/978-3-642-60946-6_119, Khandoker, A. H., Marzbanrad, F., Voss, A., Schulz, S., Kimura, Y., Endo, M., et al. (2018). Maternal stress responses and anxiety during pregnancy: effects on fetal heart rate. Ann. Surrogate time series. A clear relationship of fetal and maternal cardiac coupling in this frequency band is still not yet investigated. Physiol. doi: 10.1109/TBME.1985.325532, Porta, A., and Faes, L. (2013). Sci. fetal heart monitoring principles and practices Dec 20, 2020 Posted By Robin Cook Media TEXT ID 0472de5d Online PDF Ebook Epub Library fetal heart monitoring principles and practices ebookthis resource will provide you with the As compared to normal fetuses, abnormal group showed weaker influence of fetal heart rate on maternal heart rate (A_fBBI→mBBI) while the influence of maternal heart rate on fetal heart rate (A_mBBI→fBBI) for the abnormal group was higher. (2002). These features were: 1) meanHR: mean value of normal fetal heart beats in bpm. The 2D color maps of the maternal-fetal coupling were useful visual tools that differentiate various types of abnormalities which had varying coupling strength at different frequency bands (Figures 4–6). However, longer duration of 5–10 min will be needed for better evaluation of coupling and HRV measures on longer term. • The NCC EFM Tracing Game uses NICHD terminology • External monitoring (unless noted differently), paper speed is 3cm/min • Collections are larger groups of tracings, 5 tracings are randomly selected each time a collection is played Partial directed coherence: a new concept in neural structure determination. Biomed. The study protocol was approved by Tohoku University Institutional Review Board and written informed consent was obtained from all subjects. In this study we have evaluated the direction and strength of maternal-fetal heart rate coupling by NSTPDC in normal and abnormal cases as a follow up to our previous study (Khandoker et al., 2016) on normal fetuses. Dynamic causal modelling. (2018). (2013). The complexity of fetal heart rate was also assessed using different non-linear dynamics features (plvar10, phvar10, LZ77w3b3) which were significant in differentiating between normal and abnormal cases than the traditional linear features (mean, sdNN). doi: 10.1016/S0167-2789(00)00043-9, Schulz, S., Adochiei, F. C., Edu, I. R., Schroeder, R., Costin, H., Bär, K. J., et al. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. R. Soc. Trans. NF and A_fBBI→mBBI coupling parameters which have shown clear separation of most of the abnormal cases from the normal group (Figures 3A,B) might be useful markers for detecting abnormal fetuses. Results of those studies suggested that high maternal breathing rate might induce the synchronization as it occurred significantly more often at fast maternal breathing and less at slow respiratory rates (Van Leeuwen et al., 2009). Figure 3. The relative number of excluded beats (RR-intervals) was lower than 5% in relation to the relative duration of all RR intervals in the time series. Thus, couplings higher than half of the mean heart rate (mother) are probably “mirrored components” due to cardiac aliasing effects (Milde et al., 2011), and therefore, not of physiological relevance. Figure 6. IEEE Trans. The significance threshold tsu calculated for normalsurrogates and abnormalsurroagtes was then set as the mean+2*SD of the resultant distribution (Stankovski et al., 2017). In recent years, it has become apparent that most cases of fetal anomalies are unrelated to intrapartum events and therefore cannot be prevented by intrapartum fetal heart rate (FHR) monitoring. A methodological study. However, it still remains to clarify the nature and directionality of fetal maternal cardiac interaction in sick fetuses. Neuroimage 19, 1273–1302. (2010). PLoS ONE 10:e0142143. 371:20120517. doi: 10.1098/rsta.2012.0517, Riedl, M., Van Leeuwen, P., Suhrbier, A., Malberg, H., Grönemeyer, D., Kurths, J., et al. That means there is a lack of physiological components at frequencies higher than half of the mean hear rate of the mother (mBBI). NSTPDC indices (NF: Normalization factor) (A), A_fBBI 1: N indicates the causal coupling strength originating from fBBI (fetus) toward mBBI (mother) (B) A_mBBI→fBBI indicates the causal coupling strength originating from mBBI (mother) toward fBBI (fetus) (C) vs. gestational age. The major limitation of PDC is that it cannot be directly used for non-stationary signals (Baccalá and Sameshima, 2001). For some abnormal cases, the maternal to fetal heart rate influence (A_mBBI→fBBI) was higher than normal while other abnormal cases had similar or lower values than the normal ones. For normal cases, A_ fBBI→mBBI had weak correlation with RMSSD (r = −0.3, p = 0.01) while A_mBBI→fBBI had weak correlation with both RMSSD and Renyi entropy (r = 0.26, 0.3, and p = 0.04, 0.02, respectively). 32, 230–236. The causal influence of maternal on fetal heart rate was the strongest in the mid gestation and remained dominant in the late gestation of developing autonomic nervous system function (Khandoker et al., 2016). Biomed. (2004). The study protocol was approved by Tohoku University Institutional Review Board (IRB: 2015-2-80-1) and written informed consent was obtained from all subjects. The normal fetuses were selected as per Intrapartum Fetal Monitoring Guidelines (FIGO) (https://www.figo.org/news/available-view-figo-intrapartum-fetal-monitoring-guidelines-0015088). (2014). doi: 10.1098/rsta.2008.0277, Sato, M., Kimura, Y., Chida, S., Ito, T., Katayama, N., Okamura, K., et al. Figure 2. All authors reviewed the manuscript. You can donate via Venmo or Cash App to support this channel (thanks! Remember, the baseline is the average heart rate rounded to the nearest five bpm. Fetal monitoring was invented by doctors Alan Bradfield, Orvan Hess and Edward Hon. ANS: D The tracing is nonreassuring, and additional assessment is needed regarding the … Start studying Fetal Heart Monitors. The fetal heart tracing shows a persistent pattern of late decelerations, with normal baseline variability. What is the baseline of the FHT? Remember, the baseline is the average heart rate rounded. Four cases have abnormalities that were not related to the heart (ID: 2–5). As such, the analyses of causal and non-causal relationships within and between dynamic systems have become increasingly popular especially in physiology when the understanding of cause-response relationships and their directionalities between physiological regulatory system and its subsystems is important (Porta and Faes, 2013; Schulz et al., 2013; Schulz and Voss, 2014). 18:100201. doi: 10.1088/1367-2630/18/10/100201, Jensen, A. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. On the NCLEX exam and in your maternity… Article by S.L. Philos. Physiol. Phys. Biomed. fetal heart monitoring principles and practices Dec 08, 2020 Posted By Beatrix Potter Library TEXT ID 0472de5d Online PDF Ebook Epub Library and practices ebookthis resource will provide you with the evidence based essential 10:482. doi: 10.3389/fphys.2019.00482. For normally distributed features 1-way ANOVA test was used while Kruskal-Wallis was applied on the features that failed the Lilliesfort test. FHT Quiz 7 Fetal Tracing Quiz 1. 1. Time-variant partial directed coherence in analysis of the cardiovascular system. 27, 223–232.