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Erschienen in: Pediatric Cardiology 5/2015

01.06.2015 | Original Article

Feasibility of Noninvasive Fetal Electrocardiographic Monitoring in a Clinical Setting

verfasst von: Bhawna Arya, Rathinaswamy Govindan, Anita Krishnan, Adre Duplessis, Mary T. Donofrio

Erschienen in: Pediatric Cardiology | Ausgabe 5/2015

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Abstract

Cardiac rhythm is an essential component of fetal cardiac evaluation. The Monica AN24 is a fetal heart rate monitor that may provide a quick, inexpensive modality for obtaining a noninvasive fetal electrocardiogram (fECG) in a clinical setting. The fECG device has the ability to acquire fECG signals and allow calculation of fetal cardiac time intervals between 16- and 42-week gestational age (GA). We aimed to demonstrate the feasibility of fECG acquisition in a busy fetal cardiology clinic using the Monica fetal heart rate monitor. This is a prospective observational pilot study of fECG acquired from fetuses referred for fetal echocardiography. Recordings were performed for 5–15 min. Maternal signals were attenuated and fECG averaged. fECG and fetal cardiac time intervals (PR, QRS, RR, and QT) were evaluated by two cardiologists independently and inter-observer reliability was assessed using intraclass coefficient (ICC). Sixty fECGs were collected from 50 mothers (mean GA 28.1 ± 6.1). Adequate signal-averaged waveforms were obtained in 20 studies with 259 cardiac cycles. Waveforms could not be obtained between 26 and 30 weeks. Fetal cardiac time intervals were measured and were reproducible for PR (ICC = 0.89; CI 0.77–0.94), QRS (ICC = 0.79; CI 0.51–0.91), and RR (ICC = 0.77; CI 0.53–0.88). QT ICC was poor due to suboptimal T-wave tracings. Acquisition of fECG and measurement of fetal cardiac time intervals is feasible in a clinical setting between 19- and 42-week GA, though tracings are difficult to obtain, especially between 26 and 30 weeks. There was high reliability in fetal cardiac time intervals measurements, except for QT. The device may be useful for assessing atrioventricular/intraventricular conduction in fetuses from 20 to 26 and >30 weeks. Techniques to improve signal acquisition, namely T-wave amplification, are ongoing.
Literatur
1.
Zurück zum Zitat Amer-Wahlin I, Arulkumaran S, Hagberg H, Marsal K, Visser GH (2007) Fetal electrocardiogram: ST waveform analysis in intrapartum surveillance. BJOG 114(10):1191–1193CrossRefPubMedCentralPubMed Amer-Wahlin I, Arulkumaran S, Hagberg H, Marsal K, Visser GH (2007) Fetal electrocardiogram: ST waveform analysis in intrapartum surveillance. BJOG 114(10):1191–1193CrossRefPubMedCentralPubMed
2.
Zurück zum Zitat Bergveld P, Kolling AJ, Peuscher JH (1986) Real-time fetal ECG recording. IEEE Trans Biomed Eng 33(5):505–509CrossRefPubMed Bergveld P, Kolling AJ, Peuscher JH (1986) Real-time fetal ECG recording. IEEE Trans Biomed Eng 33(5):505–509CrossRefPubMed
3.
Zurück zum Zitat Clifford G, Sameni R, Ward J, Robinson J, Wolfberg AJ (2011) Clinically accurate fetal ECG parameters acquired from maternal abdominal sensors. Am J Obstet Gynecol 205(1):471–475CrossRef Clifford G, Sameni R, Ward J, Robinson J, Wolfberg AJ (2011) Clinically accurate fetal ECG parameters acquired from maternal abdominal sensors. Am J Obstet Gynecol 205(1):471–475CrossRef
4.
Zurück zum Zitat Gardiner HM, Belmar C, Pasquini L, Seale A, Thomas M, Dennes W et al (2007) Fetal ECG: a novel predictor of atrioventricular block in anti-Ro positive pregnancies. Heart 93(11):1454–1460CrossRefPubMedCentralPubMed Gardiner HM, Belmar C, Pasquini L, Seale A, Thomas M, Dennes W et al (2007) Fetal ECG: a novel predictor of atrioventricular block in anti-Ro positive pregnancies. Heart 93(11):1454–1460CrossRefPubMedCentralPubMed
5.
Zurück zum Zitat Govindan RB, Vairavan S, Sriram B, Wilson JD, Preissl H, Eswaran H (2011) Phase plane based identification of fetal heart rate patterns. Conf Proc IEEE Eng Med Biol Soc 2011:1455–1458PubMedCentralPubMed Govindan RB, Vairavan S, Sriram B, Wilson JD, Preissl H, Eswaran H (2011) Phase plane based identification of fetal heart rate patterns. Conf Proc IEEE Eng Med Biol Soc 2011:1455–1458PubMedCentralPubMed
6.
Zurück zum Zitat Graatsma EM, Jacod BC, van Egmond LA, Mulder EJ, Visser GH (2009) Fetal electrocardiography feasibility of long-term fetal heart rate recordings. BJOG11 6(2):334–337CrossRef Graatsma EM, Jacod BC, van Egmond LA, Mulder EJ, Visser GH (2009) Fetal electrocardiography feasibility of long-term fetal heart rate recordings. BJOG11 6(2):334–337CrossRef
7.
Zurück zum Zitat Gritzali F, Frangakis G, Papakonstantinou G (1989) Detection of the P and T-waves in an ECG. Comput Biomed Res 22(1):83–91CrossRefPubMed Gritzali F, Frangakis G, Papakonstantinou G (1989) Detection of the P and T-waves in an ECG. Comput Biomed Res 22(1):83–91CrossRefPubMed
8.
Zurück zum Zitat Hasan MA, Reaz MB, Ibrahimy MI, Hussain MS, Uddin J (2009) Detection and processing techniques of FECG signal for fetal monitoring. Biol Proced Online. 11:263–295CrossRefPubMedCentralPubMed Hasan MA, Reaz MB, Ibrahimy MI, Hussain MS, Uddin J (2009) Detection and processing techniques of FECG signal for fetal monitoring. Biol Proced Online. 11:263–295CrossRefPubMedCentralPubMed
9.
Zurück zum Zitat Hayashi R, Nakai K, Fukushima A, Itoh M, Sugiyama T (2009) Development and significance of a fetal electrocardiogram recorded by signal-averaged high-amplification electrocardiography. Int Heart J 50(2):161–171CrossRefPubMed Hayashi R, Nakai K, Fukushima A, Itoh M, Sugiyama T (2009) Development and significance of a fetal electrocardiogram recorded by signal-averaged high-amplification electrocardiography. Int Heart J 50(2):161–171CrossRefPubMed
10.
Zurück zum Zitat Horigome H, Takahashi MI, Asaka M, Shigemitsu S, Kandori A, Tsukada K (2000) Magnetocardiographic determination of the developmental changes in PQ, QRS and QT intervals in the foetus. Acta Paediatr 89(1):64–67CrossRefPubMed Horigome H, Takahashi MI, Asaka M, Shigemitsu S, Kandori A, Tsukada K (2000) Magnetocardiographic determination of the developmental changes in PQ, QRS and QT intervals in the foetus. Acta Paediatr 89(1):64–67CrossRefPubMed
11.
Zurück zum Zitat Leuthold A, Wakai RT, Martin CB (1999) Noninvasive in utero assessment of PR and QRS intervals from the fetal magnetocardiogram. Early Hum Dev 54(3):235–243CrossRefPubMed Leuthold A, Wakai RT, Martin CB (1999) Noninvasive in utero assessment of PR and QRS intervals from the fetal magnetocardiogram. Early Hum Dev 54(3):235–243CrossRefPubMed
12.
Zurück zum Zitat Luo S, Michler K, Johnston P, Macfarlane PW (2004) A comparison of commonly used QT correction formulae: the effect of heart rate on the QTc of normal ECGs. J Electrocardiol 37(Suppl):81–90CrossRefPubMed Luo S, Michler K, Johnston P, Macfarlane PW (2004) A comparison of commonly used QT correction formulae: the effect of heart rate on the QTc of normal ECGs. J Electrocardiol 37(Suppl):81–90CrossRefPubMed
13.
Zurück zum Zitat Oostendorp TF, van Oosterom A, Jongsma HW (1989) The effect of changes in the conductive medium on the fetal ECG throughout gestation. Clin Phys Physiol Meas 10(Suppl B):11–20CrossRefPubMed Oostendorp TF, van Oosterom A, Jongsma HW (1989) The effect of changes in the conductive medium on the fetal ECG throughout gestation. Clin Phys Physiol Meas 10(Suppl B):11–20CrossRefPubMed
14.
Zurück zum Zitat Quinn A, Weir A, Shahani U, Bain R, Maas P, Donaldson G (1994) Antenatal fetal magnetocardiography: A new method for fetal surveillance? Br J Obstet Gynaecol 101(10):866–870CrossRefPubMed Quinn A, Weir A, Shahani U, Bain R, Maas P, Donaldson G (1994) Antenatal fetal magnetocardiography: A new method for fetal surveillance? Br J Obstet Gynaecol 101(10):866–870CrossRefPubMed
15.
Zurück zum Zitat Reinhard J, Hayes-Gill BR, Yi Q, Hatzmann H, Schiermeier S (2010) Comparison of non-invasive fetal electrocardiogram to Doppler cardiotocogram during the 1st stage of labor. J Perinat Med 38(2):179–185CrossRefPubMed Reinhard J, Hayes-Gill BR, Yi Q, Hatzmann H, Schiermeier S (2010) Comparison of non-invasive fetal electrocardiogram to Doppler cardiotocogram during the 1st stage of labor. J Perinat Med 38(2):179–185CrossRefPubMed
16.
Zurück zum Zitat Rychik J, Ayres N, Cuneo B, Gotteiner N, Hornberger L, Spevak PJ et al (2004) American Society of Echocardiography guidelines and standards for performance of the fetal echocardiogram. J Am Soc Echocardiogr 17(7):803–810CrossRefPubMed Rychik J, Ayres N, Cuneo B, Gotteiner N, Hornberger L, Spevak PJ et al (2004) American Society of Echocardiography guidelines and standards for performance of the fetal echocardiogram. J Am Soc Echocardiogr 17(7):803–810CrossRefPubMed
17.
Zurück zum Zitat Stinstra J, Golbach E, van Leeuwen P, Lange S, Menendez T, Moshage W et al (2002) Multicentre study of fetal cardiac time intervals using magnetocardiography. BJOG 109(11):1235–1243CrossRefPubMed Stinstra J, Golbach E, van Leeuwen P, Lange S, Menendez T, Moshage W et al (2002) Multicentre study of fetal cardiac time intervals using magnetocardiography. BJOG 109(11):1235–1243CrossRefPubMed
19.
Zurück zum Zitat Symonds EMSD, Chang A (2001) Historical development. In: Symonds EMSD, Chang A (eds) Fetal electrocardiography. Imperial College Press, London, pp 1–29CrossRef Symonds EMSD, Chang A (2001) Historical development. In: Symonds EMSD, Chang A (eds) Fetal electrocardiography. Imperial College Press, London, pp 1–29CrossRef
20.
Zurück zum Zitat Taylor MJ, Smith MJ, Thomas M, Green AR, Cheng F, Oseku-Afful S et al (2003) Non-invasive fetal electrocardiography in singleton and multiple pregnancies. BJOG 110(7):668–678CrossRefPubMed Taylor MJ, Smith MJ, Thomas M, Green AR, Cheng F, Oseku-Afful S et al (2003) Non-invasive fetal electrocardiography in singleton and multiple pregnancies. BJOG 110(7):668–678CrossRefPubMed
21.
Zurück zum Zitat Velayo C, Sato N, Ito T, Chisaka H, Yaegashi N, Okamura K et al (2011) Understanding congenital heart defects through abdominal fetal electrocardiography: case reports and clinical implications. J Obstet Gynaecol Res. 37(5):428–435CrossRefPubMed Velayo C, Sato N, Ito T, Chisaka H, Yaegashi N, Okamura K et al (2011) Understanding congenital heart defects through abdominal fetal electrocardiography: case reports and clinical implications. J Obstet Gynaecol Res. 37(5):428–435CrossRefPubMed
Metadaten
Titel
Feasibility of Noninvasive Fetal Electrocardiographic Monitoring in a Clinical Setting
verfasst von
Bhawna Arya
Rathinaswamy Govindan
Anita Krishnan
Adre Duplessis
Mary T. Donofrio
Publikationsdatum
01.06.2015
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 5/2015
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-015-1118-4

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