INVESTIGATING THE PREDICTIVE VALUE OF FETAL ECG IN NST AND CST

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。高危妊娠的胎儿健康状况在妊娠23周后通过连续产前检查进行评估。通常采用的是非应激测试（NST），它评估胎儿心率（FHR）对胎儿运动的反应。最终的FHR追踪由临床医生对加速和搏动变异性的存在进行视觉评估。在不可靠的NST之后，可能会进行收缩压力测试（CST），在此期间监测FHR对收缩的反应，或生物物理概况（超声评估胎儿活动）。虽然NSTs和CSTs的特异性较高（约90%），但敏感性较低（45-55%）。最近的研究表明，对心率变异性进行计算机化分析可能会提高预测价值。当直接从胎儿心电图（FECG）测量时，而不是通过超声测定FHR，这种评估的准确性得到提高。此外，脑电图波形提供的信息更准确地预测胎儿在分娩时的健康状况不幸的是，FECG的采集是侵入性的（通过母体子宫颈将导线电极放置在胎儿头皮上），在产前检查时无法获得。我们提出了一项前瞻性观察性试点研究，将招募约200名24至43周的孕妇进行产前检查。在获得书面知情同意后，将放置腹部电极并将电数据收集到个人电脑中进行后续分析。将从医疗记录中提取人口统计和相关的孕产妇、分娩和新生儿医疗信息。将采用先进的数字信号处理技术对腹部电信号进行提取，并记录其特征。将分析这个连续进行产前检查的患者数据库及其产科结果，以确定FECG在预测新生儿结局方面的附加价值。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Fetal well-being in high-risk pregnancies is assessed with serial antenatal testing after 23 weeks gestation. Frequently employed is the non-stress test (NST), which evaluates the fetal heart rate (FHR) response to fetal movements. The resulting FHR tracing is evaluated visually by a clinician for the presence of accelerations and beat-to-beat variability. A non-reassuring NST may be followed by a contraction stress test (CST), during which FHR response to contractions is monitored, or a biophysical profile (an ultrasound assessment of fetal activity). While the specificity of NSTs and CSTs is relatively high (>90%), the sensitivity is fairly low (45-55%). Recent studies suggest computerized analysis of the heart rate variability may improve the predictive value. 1 The accuracy of this assessment is enhanced when measured directly from the fetal ECG (FECG), rather than by ultrasonic determination of FHR. Furthermore the FECG waveform contributes information that more accurately predicts fetal well-being intrapartum.2 Unfortunately, acquisition of the FECG is invasive (a wire electrode placed on the fetal scalp via the maternal cervix) and not available during antepartum testing. We propose a prospective observational pilot study that will enroll approximately 200 pregnant women between 24 and 43 weeks who present for antenatal testing. Following written, informed consent, abdominal electrodes will be placed and electrical data collected to a personal computer for subsequent analysis. Demographic and relevant maternal, delivery and neonatal medical information will be abstracted from medical records. Advanced digital signal processing techniques will be applied to the abdominal electrical signal to extract the FECG, features of which will be recorded. This database of patients presenting serially for antenatal testing, and their obstetric outcome, will be analyzed to determine the additive value of FECG in predicting neonatal outcome.