Effect of uterine contractions on fetal heart rate in pregnancy: a prospective observational study
Effect of uterine contractions on fetal heart rate in pregnancy: a prospective observational study
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DOI：
10.1111/aogs.12949
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发表时间：
2016-10-01
影响因子：
4.3
通讯作者：
Kessler, Jorg
中科院分区：
文献类型：
--
作者：
Sletten, Julie;Kiserud, Torvid;Kessler, Jorg
导论.新的霍尔特监测技术可以长期心电图记录胎儿心率，而不会使母亲感到不适。本研究的目的是评估胎儿霍尔特监测的可行性。该技术进一步用于研究正常日常活动期间医院外的胎儿心率，并检验妊娠期间子宫活动影响胎儿心率的假设。材料和方法。前瞻性观察性研究，包括12例妊娠20-40周的健康孕妇。使用Monica AN 24系统收集数据。结局指标为胎儿心率、母体心率和根据子宫电图信号强度分类的子宫活动。结果记录的中位时间为18.8小时，获得胎儿心率和母体心率的成功率分别为73.1%和99.9%。在所有参与者中发现子宫活动影响胎儿心率。与基础张力和轻度子宫活动水平相比，中度和强烈子宫活动水平分别与胎心率增加4.0和5.7次/分相关。在夜间，相应的增加分别为4.9和7.6次/分。线性相关性之间的母亲心率和胎儿心率的12例中的11例，平均系数β为0.189。母体心率和胎儿心率均表现出昼夜模式，夜间心率较低。结论.妊娠期间的子宫活动与胎心率的分级反应相关，可能代表胎儿心血管系统发育和适应的生理挑战。
Introduction. The new Holter monitoring technology enables long-term electrocardiographic recording of the fetal heart rate without discomfort for the mother. The aim of the study was to assess the feasibility of a fetal Holter monitor. This technology was further used to study fetal heart rate outside the hospital setting during normal daily activities and to test the hypothesis that uterine activity during pregnancy influences fetal heart rate. Material and methods. Prospective observational study including 12 healthy pregnant women at 20-40 weeks of gestation. Data were collected using the Monica AN24 system. Outcome measures were fetal heart rate, maternal heart rate, and uterine activity categorized according to the strength of the electrohysterographic signal. Results. The recordings had a median length of 18.8 h, and fetal heart rate and maternal heart rate were obtained with success rates of 73.1 and 99.9%, respectively. Uterine activity was found to affect fetal heart rate in all participants. Compared with the basal tone and mild levels of uterine activity, moderate and strong levels of uterine activity were associated with increases in fetal heart rate of 4.0 and 5.7 beats/min, respectively. At night, the corresponding increases were 4.9 and 7.6 beats/min. Linear correlations were found between maternal heart rate and fetal heart rate in 11 of the 12 cases, with a mean coefficient beta of 0.189. Both maternal heart rate and fetal heart rate exhibited a diurnal pattern, with lower heart rates being recorded at night. Conclusions. Uterine activity during pregnancy is associated with a graded response in fetal heart rate and may represent a physiological challenge for the development and adaptation of the fetal cardiovascular system.