INVESTIGATING THE PREDICTIVE VALUE OF FETAL ECG IN NST AND CST

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 在怀孕23周后，对高危妊娠的胎儿进行一系列产前检查，以评估胎儿的健康状况。经常使用的是无负荷试验(NST)，它评估胎儿心率(FHR)对胎儿运动的反应。由此产生的胎心率描记由临床医生对加速和节拍变异性的存在进行视觉评估。 在不能让人放心的NST之后，可能会进行收缩负荷试验(CST)，在此期间监测FHR对宫缩的反应，或进行生物物理检查(对胎儿活动的超声评估)。虽然NSTs和CSTs的特异度较高(90%)，但敏感度较低(45-55%)。 最近的研究表明，对心率变异性的计算机分析可能会提高预测价值。1如果直接从胎儿心电(FECG)测量，而不是通过超声测定FHR，这种评估的准确性会得到提高。此外，胎儿心电波形有助于更准确地预测胎儿在产中的健康状况。2不幸的是，胎儿心电的采集是有创性的(通过母体宫颈放置在胎儿头皮上的导线电极)，在产前测试中不可用。 我们提出了一项前瞻性观察性先导性研究，将招募大约200名怀孕24至43周的孕妇进行产前检测。在书面知情同意后，将放置腹部电极，并将电数据收集到个人计算机进行后续分析。人口统计和相关的产妇、分娩和新生儿医疗信息将从医疗记录中提取。 将先进的数字信号处理技术应用于腹部电信号，提取胎儿心电信号，并记录其特征。对连续进行产前检查的患者和他们的产科结局进行分析，以确定胎儿心电图在预测新生儿结局方面的相加价值。

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.