A New Computerized Analysis to Precisely Evaluate Heart Rate Variability During the Nonstress Test

Hisaaki Kobayashi; Atsushi Yoshida; Mitsunao Kobayashi; Takeo Hamada; Yasuaki Noguchi; Takashi Yamada

doi:10.1055/s-2003-38314

American Journal of Perinatology, Table of Contents

Am J Perinatol 2003; 20(2): 077-086
DOI: 10.1055/s-2003-38314

A New Computerized Analysis to Precisely Evaluate Heart Rate Variability During the Nonstress Test

Hisaaki Kobayashi¹ , Atsushi Yoshida² , Mitsunao Kobayashi³ , Takeo Hamada⁵ , Yasuaki Noguchi⁵ , Takashi Yamada⁴

¹Department of Clinical Medicine, Japan Self-Defense Force Hospital Maizuru, Maizuru, Kyoto
²Faculty of Medical Engineering, Suzuka University of Medical Science, Suzuka, Mie
³Department of Perinatal and Maternal Medicine, National Defense Medical College, Tokorozawa, Saitama
⁴Department of Mathematics and Statistics, National Defense Medical College, Tokorozawa, Saitama
⁵Department of Applied Physics, National Defense Academy, Yokosuka, Kanagawa, Japan

Abstract

ABSTRACT

The study was conducted to assess whether the power spectrum analysis of fetal heart rate (FHR) data obtained with a cardiotocograph provides more than visual judgment of nonstress test (NST) tracing to predict fetal well-being. A total of 71 FHR data were obtained from 44 healthy pregnant women with normally grown fetuses and 11 pregnant women with pregnancy-induced hypertension. Power spectrum analysis was performed for the 8192 points of the instantaneous heart rates derived from these FHR data. Abnormal perinatal outcome was defined when at least one of the followings were present at birth: Cesarean delivery for nonreassuring FHR pattern and umbilical artery cord PH ≤ 7.15, delivery at ≤ 32 weeks for fetal compromise, neonatal seizures within the first 72 hours of life, respiratory distress at 36 weeks or more, 5-minute Apgar score < 7 and stillbirth. The total power of the 8192 points without considering gestational weeks was 256.3 ± 65.6 normalized units (NU) ˙ Hz in the fetuses with good outcomes (n = 47), while that of the abnormal fetuses (n = 8) was 148.5 ± 54.6 NU ˙ Hz. There is a significant difference between the two values (p < 0.00001). When the abnormal value of the total power of the 8192 points was defined as < 200 NU ˙ Hz, the sensitivity on the prediction of fetal outcome using this method was 81.8%, significantly higher than that of the nonstress test tracing (p < 0.05). The power spectrum analysis of the large amount of FHR data obtained with a cardiotocograph permits a better assessment of the fetal well-being and may be suitable for the screening test because of no additional manpower to the current NST.

KEYWORDS

Spectrum analysis - fetal well-being - nonstress test

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References

REFERENCES

1 Malliani A, Lombardi F, Pagani M. Power spectrum analysis of heart rate variability: a tool to explore neural regulatory mechanisms. Br Heart J . 1994; 71 1-2
2 Sands K E, Appel M L, Lilly L S, Schoen F J, Mudge Jr H G, Cohen R J. Power spectrum analysis of heart rate variability in human cardiac transplant recipients. Circulation . 1989; 79 76-82
3 Malliani A, Pagani M, Lombardi F, Cerutti S. Cardiovascular neural regulation explored in the frequency domain. Circulation . 1991; 84 482-492
4 Yamasaki Y, Ueda N, Kishimoto M, Tani A, Ishida Y, Kawamori R, Kamada T. Assessment of early stage autonomic nerve dysfunction in diabetric subjects-application of power spectral analysis of heart rate variability. Diabetes Res . 1991; 17 73-80
5 Bernardi L, Ricordi L, Lazzari P, Solda P, Calciati A, Ferrari M R, Vandea I, Finardi G, Fratino P. Impaired circadian modulation of sympathovagal activity in diabetes. A possible explanation for altered temporal onset of cardiovascular disease. Circulation . 1992; 86 1443-1452
6 Salo T M, Viikari J S, Antila K J, Voipio-Pulkki L M, Jalonen J O, Valimaki I A. Antihypertensive treatment and heart rate variability in diabetic patients: role of cardiac autonomic neuropathy. J Autonom Nerv Syst . 1996; 60 61-70
7 Goldstein B, Kempski M H, DeKing D, Cox C, Delong D J, Kelly M M, Woolf P D. Autonomic control of heart rate after brain injury in children. Crit Care Med . 1996; 24 234-240
8 Noguchi Y, Mamune H, Sugimoto S, Yoshida A, Sasa H, Kobayashi H, Kobayashi M. Estimation of measurement characteristic of ultrasound fetal heart rate monitor. Jpn J Appl Phys . 1995; 34 2840-2843
9 Makhoul J. Linear prediction: A tutorial review. Proc IEEE . 1975; 63 561-580
10 Brown J S, Gee H, Olah K S, Docker M F, Taylor E W. A new technique for the identification of respiratory sinus arrhythmia in utero. J Biomed Eng . 1992; 14 263-267
11 Divon M Y, Yeh S, Zimmer E Z, Platt L D, Paldi E, Paul R H. Respiratory sinus arrhythmia in the human fetus. Am J Obstet Gynecol . 1985; 151 425-428
12 Akselrod S, Gordon D, Ubel F A, Shannon D C, Barger A C, Cohen R J. Power spectrum analysis of heart rate fluctuations: A quantitative probe of beat-to-beat cardiovascular control. Science . 1981; 213 220-222
13 Kay S M, Maple S L. Spectrum analysis-a modern perspective. Proc IEEE . 1981; 69 1380-1419
14 Akaike H. Statistical predictor identification. Am Int Stat Math . 1970; 22 203-217
15 American College of Obstetricians and Gynecologists. Antepartum fetal surveillance. Technical Bulletin no. 188, January 1994
16 Dunston-Boone G, Kuhlman K, Kaufmann M. Correlation of fetal heart rate decelerations following acoustic stimulation with perinatal outcome. Am J Perinatol . 1995; 12 342-346
17 Karin J, Hirsch M, Akselrod S. An estimate of fetal autonomic state by spectral analysis of fetal heart rate fluctuations. Pediatr Res . 1993; 34 134-138
18 Metsälä T H, Pirhonen J P, Jalonen J O, Erkkola R U, Välimäki I AT. Association of abnormal flow velocity waveforms in the uterine artery with frequency-specific fetal heart rate variability. Eary Hum Dev . 1993; 34 217-225
19 Carter M C. Signal processing and display-cardiotocographs. Br J Obstet Gynecol . 1993; 100 21-23
20 Devoe L, Boehm F, Paul R, Frigoletto F, Penso C, Goldenberg R, Rayburn W, Smith C. Clinical experience with the Hewlett-Packard M-1350A fetal monitor: correlation of Doppler-detected fetal body movements with fetal heart rate parameters and perinatal outcome. Am J Obstet Gynecol . 1994; 170 650-655