INVESTIGATING THE PREDICTIVE VALUE OF FETAL ECG IN NST AND CST

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子项目和研究者（PI）可能从另一个NIH来源获得主要资金，因此可以在其他CRISP条目中表示。所列机构为中心，不一定是研究者所在机构。高危妊娠的胎儿健康状况在妊娠23周后通过一系列产前检查进行评估。经常采用的是无应激试验（NST），其评估胎儿心率（FHR）对胎动的反应。由临床医生对所得到的FHR描记图进行视觉评估，以确定是否存在加速度和心跳间变异性。 一个不放心的NST之后可能是一个收缩应力测试（CST），在此期间，FHR对收缩的反应进行监测，或生物物理概况（胎儿活动的超声评估）。虽然NST和CST的特异性相对较高（>90%），但灵敏度相当低（45-55%）。 最近的研究表明，心率变异性的计算机分析可能会提高预测价值。1直接从胎儿心电图（FECG）测量，而不是通过超声测定FHR，可以提高该评估的准确性。此外，FECG波形提供了更准确地预测胎儿宫内健康的信息。2不幸的是，FECG的采集是侵入性的（通过母体子宫颈放置在胎儿头皮上的线电极），并且在产前测试期间不可用。 我们提出了一项前瞻性观察性试点研究，将招募约200名孕妇之间的24和43周谁出席产前检查。在签署书面知情同意书后，将放置腹部电极，并将电气数据收集到个人电脑中，用于后续分析。将从病历中提取人口统计学和相关的孕产妇、分娩和新生儿医疗信息。 将对腹部电信号应用先进的数字信号处理技术，以提取胎儿心电图，并记录其特征。将对连续进行产前检查的患者数据库及其产科结局进行分析，以确定FECG在预测新生儿结局方面的附加值。

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.