Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan;57(1):70-74.
doi: 10.1002/uog.23145. Epub 2020 Dec 3.

Determination of fetal heart rate short-term variation from umbilical artery Doppler waveforms

L S Cahill  1   2 , G Stortz  3 , A Ravi Chandran  4 , N Milligan  5 , S Shinar  4 , C L Whitehead  4   6 , S R Hobson  4 , S Millard  7 , C K Macgowan  3   8 , J C Kingdom  4   9 , J G Sled  1   3   8   9 , A A Baschat  7
Affiliations

Determination of fetal heart rate short-term variation from umbilical artery Doppler waveforms

L S Cahill et al. Ultrasound Obstet Gynecol. 2021 Jan.

Abstract

Objective: To evaluate the feasibility of using umbilical artery (UA) Doppler waveforms to measure fetal heart rate (FHR) short-term variation (STV) across gestation.

Methods: This was a prospective longitudinal study, conducted at two study sites, of 195 pregnancies considered low risk. Pulsed-wave Doppler of the UAs was performed at 4-weekly intervals, between 14 and 40 weeks of gestation, using a standardized imaging protocol. Up to 12 consecutive UA Doppler waveforms were analyzed using offline processing software. FHR STV was calculated using average R-R intervals extracted from the waveforms and baseline corrected for FHR.

Results: Baseline-corrected FHR STV increased significantly with gestational age (conditional R2 = 0.37; P < 0.0001) and was correlated inversely with FHR (conditional R2 = 0.54; P < 0.0001). The STV ranged (median (interquartile range)) from 3.5 (2.9-4.1) ms at 14-20 weeks' gestation to 6.3 (4.8-7.7) ms at 34-40 weeks' gestation. The change in heart rate STV did not differ between study sites or individual sonographers.

Conclusions: UA Doppler waveforms offer a robust and feasible method to derive STV of the FHR. It should be emphasized that the UA Doppler-derived STV is not interchangeable with measurements derived with computerized cardiotocography. Accordingly, further investigations are needed to validate associations with outcome, in order to determine the value of concurrent fetal cardiovascular and heart rate evaluations that are possible with the technique described here. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Keywords: Doppler ultrasound; cardiotocography; fetal growth restriction; fetal heart rate; fetal monitoring; gestational age; late onset; longitudinal; short-term variation; umbilical artery.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: none

Figures

Figure 1.
Figure 1.
Representative umbilical artery Doppler waveform with maximum velocity envelope traced (red) and start of R-wave (blue). The fetal heart rate interval (ms) is annotated above each waveform.
Figure 2.
Figure 2.
Baseline corrected heart rate variation over gestation (p < 0.0001). A best fit line based on the fixed factors of the mixed-effects model and a 95% confidence ribbon is shown.
Figure 3.
Figure 3.
Baseline corrected heart rate variation is inversely correlated with fetal heart rate (p < 0.0001). A best fit line based on the fixed factors of the mixed-effects model and a 95% confidence ribbon is shown.
See this image and copyright information in PMC

References

    1. Grivell RM, Alfirevic Z, Gyte GML, Devane D. Antenatal cardiotocography for fetal assessment. Cochrane Database Syst Rev 2015; 12: CD007863. - PubMed
    1. Pardey J, Moulden M, Redman CWG. A computerized system for the numerical analysis of nonstress tests. Am J Obstet Gynecol 2002; 186: 1095–1103. - PubMed
    1. Wolf H, Arabin B, Lees CC, Oepkes D, Prefumo F, Thilaganathan B, Todros T, Visser GHA, Bilardo CM, Derks JB, Diemert A, Duvekot JJ, Ferrazzi E, Frusca T, Hecher K, Marlow N, Martinelli P, Ostermayer E, Papageorghiou AT, Scheepers HCJ, Schlembach D, Schneider KTM, Valcamonico A, van Wassenaer-Leemhuis A, Ganzevoort W, TRUFFLE group. Longitudinal study of computerized cardiotocography in early fetal growth restriction. Ultrasound Obstet Gynecol 2017; 50: 71–78. - PubMed
    1. Pels A, Mensing van Charante NA, Vollgraff Heidweiller-Schreurs CA, Limpens J, Wolf H, de Boer MA, Ganzevoort W. The prognostic accuracy of short term variation of fetal heart rate in early-onset fetal growth restriction: a systematic review. Eur J Obstet Gynecol Reprod Biol 2019; 234: 179–184. - PubMed
    1. McCowan LM, Figueras F, Anderson NH. Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy. Am J Obstet Gynecol 2018; 218: S855–S868. - PubMed

Publication types