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
. 2022 Jul;101(7):758-770.
doi: 10.1111/aogs.14352. Epub 2022 May 3.

Associations between fetal heart rate variability and umbilical cord occlusions-induced neural injury: An experimental study in a fetal sheep model

Louise Ghesquière  1   2 , Romain Perbet  3 , Laure Lacan  1   4 , Yasmine Hamoud  1   2 , Morgane Stichelbout  3 , Dyuti Sharma  1   5 , Sylvie Nguyen  1   4 , Laurent Storme  1   6 , Véronique Houfflin-Debarge  1   2 , Julien De Jonckheere  1   7 , Charles Garabedian  1   2
Affiliations

Associations between fetal heart rate variability and umbilical cord occlusions-induced neural injury: An experimental study in a fetal sheep model

Louise Ghesquière et al. Acta Obstet Gynecol Scand. 2022 Jul.

Abstract

Introduction: This study evaluated the association between fetal heart rate variability (HRV) and the occurrence of hypoxic-ischemic encephalopathy in a fetal sheep model.

Material and methods: The experimental protocol created a hypoxic condition with repeated cord occlusions in three phases (A, B, C) to achieve acidosis to pH <7.00. Hemodynamic, gasometric and HRV parameters were analyzed during the protocol, and the fetal brain, brainstem and spinal cord were assessed histopathologically 48 h later. Associations between the various parameters and neural injury were compared between phases A, B and C using Spearman's rho test.

Results: Acute anoxic-ischemic brain lesions in all regions was present in 7/9 fetuses, and specific neural injury was observed in 3/9 fetuses. The number of brainstem lesions correlated significantly and inversely with the HRV fetal stress index (r = -0.784; p = 0.021) in phase C and with HRV long-term variability (r = -0.677; p = 0.045) and short-term variability (r = -0.837; p = 0.005) in phase B. The number of neurological lesions did not correlate significantly with other markers of HRV.

Conclusions: Neural injury caused by severe hypoxia was associated with HRV changes; in particular, brainstem damage was associated with changes in fetal-specific HRV markers.

Keywords: autonomic nervous system; fetal heart rate; heart rate variability; intrapartum hypoxic-ischemia; neural injury; umbilical cord compression.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
Evolution of fetal heart rate decelerations during umbilical cord occlusions in phase (A) phase (B) and phase (C). FHR: fetal heart rate. Umbilical cord occlusions (UCOs) were repeated every 5 minutes during the first phase (phase A), every 3 minutes during the second phase (phase B), and every 2 minutes during the third phase (phase C)
FIGURE 2
FIGURE 2
Total number of neural and brainstem lesions as a function of short‐term variability (STV) and long‐term variability (LTV) values per fetal sheep in phase B. One point: one fetal sheep. Vertical axis: number of lesions (total and brainstem). Horizontal axis: LTV and STV values
FIGURE 3
FIGURE 3
Total number of neural and brainstem lesions as a function of fetal stress index (FSI) and standard deviation of the normal‐to‐normal RR interval (SDNN) values per fetal sheep in phase C. One point: one fetal sheep. Vertical axis: number of lesions (total and brainstem). Horizontal axis: FSI and SDNN values
FIGURE 4
FIGURE 4
Individual tracing of fetal stress index (FSI) evolution against phases (phases A, B and C). Evolution of FSI during phases A, B and C of experimental protocol (horizontal ax). One line = one fetal sheep. Thick lines = fetuses with lesions in the brainstem
FIGURE 5
FIGURE 5
Individual tracing of short‐term variability (STV) evolution against phases (phases A, B and C). Evolution of STV during phase A, B and C of experimental protocol (horizontal axis). One line = one fetal sheep. Thick lines = fetuses with lesions in the brainstem
FIGURE 6
FIGURE 6
Individual tracing of short‐term variability evolution against phases (phases A, B and C). Evolution of standard deviation of the normal‐to‐normal RR interval (SDNN) during phase A, B and C of experimental protocol (horizontal axis). One line = one fetal sheep. Thick lines = fetuses with lesions in the brainstem
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Kurinczuk JJ, White‐Koning M, Badawi N. Epidemiology of neonatal encephalopathy and hypoxic‐ischaemic encephalopathy. Early Hum Dev. 2010;86:329‐338. - PubMed
    1. Chandraharan E Fetal scalp blood sampling during labour: is it a useful diagnostic test or a historical test that no longer has a place in modern clinical obstetrics? BJOG 2014;121:1056‐1060; discussion 1060‐1062. - PubMed
    1. Belfort MA, Saade GR, Thom E, et al. A randomized trial of intrapartum fetal ECG ST‐segment analysis. N Engl J Med. 2015;373:632‐641. - PMC - PubMed
    1. Graham EM, Adami RR, McKenney SL, Jennings JM, Burd I, Witter FR. Diagnostic accuracy of fetal heart rate monitoring in the identification of neonatal encephalopathy. Obstet Gynecol. 2014;124:507‐513. - PMC - PubMed
    1. INFANT Collaborative Group . Computerised interpretation of fetal heart rate during labour (INFANT): a randomised controlled trial. Lancet. 2017;389:1719‐1729. - PMC - PubMed