Fetal autonomic response to severe acidaemia during labour

Abstract

Objective: Spectral analysis of heart-rate variability is used to monitor autonomic nervous system fluctuations. The low-frequency component is associated with sympathetic and parasympathetic modulation and the high-frequency component is associated with parasympathetic modulation. The objective was to study whether changes in low-frequency or high-frequency power of heart-rate variability occur in case of fetal distress.

Design: Case-control study.

Setting: Obstetric unit of a tertiary-care teaching hospital.

Population: Twenty healthy human fetuses during labour at term of which ten had an umbilical artery pH < 7.05 (cases), and ten had an arterial pH > 7.20 (controls) after birth.

Methods: Spectral information about fetal beat-to-beat heart rate, calculated from direct fetal electrocardiogram registrations, was obtained by using a short-time Fourier transform.

Main outcome measures: Absolute power and normalised power in the low-frequency and high-frequency bands.

Results: No differences were found between fetuses with and without acidaemia in absolute low or high frequency power (P = 0.2 and P = 0.3, respectively). During the last 30 minutes of labour, acidaemic fetuses had significantly increased normalised low-frequency power (P = 0.01) and decreased normalised high-frequency power (P = 0.03) compared with non-acidaemic fetuses. These differences were not observed from 3 to 2 hours before birth (P = 0.7 and P = 0.9, respectively).

Conclusion: The autonomic nervous system of human fetuses at term responds adequately to severe stress during labour. Normalised low and high frequency power of heart-rate variability might be able to discriminate between normal and abnormal fetal condition.