Sletten Julie, Kiserud Torvid, Kessler Jörg
Department of Clinical Science, University of Bergen, Bergen, Norway.
Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
Acta Obstet Gynecol Scand. 2016 Oct;95(10):1129-35. doi: 10.1111/aogs.12949.
The new Holter monitoring technology enables long-term electrocardiographic recording of the fetal heart rate without discomfort for the mother. The aim of the study was to assess the feasibility of a fetal Holter monitor. This technology was further used to study fetal heart rate outside the hospital setting during normal daily activities and to test the hypothesis that uterine activity during pregnancy influences fetal heart rate.
Prospective observational study including 12 healthy pregnant women at 20-40 weeks of gestation. Data were collected using the Monica AN24 system. Outcome measures were fetal heart rate, maternal heart rate, and uterine activity categorized according to the strength of the electrohysterographic signal.
The recordings had a median length of 18.8 h, and fetal heart rate and maternal heart rate were obtained with success rates of 73.1 and 99.9%, respectively. Uterine activity was found to affect fetal heart rate in all participants. Compared with the basal tone and mild levels of uterine activity, moderate and strong levels of uterine activity were associated with increases in fetal heart rate of 4.0 and 5.7 beats/min, respectively. At night, the corresponding increases were 4.9 and 7.6 beats/min. Linear correlations were found between maternal heart rate and fetal heart rate in 11 of the 12 cases, with a mean coefficient beta of 0.189. Both maternal heart rate and fetal heart rate exhibited a diurnal pattern, with lower heart rates being recorded at night.
Uterine activity during pregnancy is associated with a graded response in fetal heart rate and may represent a physiological challenge for the development and adaptation of the fetal cardiovascular system.
新型动态心电图监测技术能够长期记录胎儿心率，且不会给母亲带来不适。本研究的目的是评估胎儿动态心电图监测仪的可行性。该技术进一步用于研究正常日常活动期间医院外环境下的胎儿心率，并检验孕期子宫活动会影响胎儿心率这一假设。
前瞻性观察性研究，纳入12名妊娠20 - 40周的健康孕妇。使用莫妮卡AN24系统收集数据。观察指标为胎儿心率、母亲心率以及根据子宫肌电图信号强度分类的子宫活动情况。
记录的中位时长为18.8小时，胎儿心率和母亲心率的获取成功率分别为73.1%和99.9%。发现所有参与者的子宫活动均会影响胎儿心率。与子宫基础张力和轻度子宫活动水平相比，中度和强烈子宫活动水平分别使胎儿心率增加4.0次/分钟和5.7次/分钟。夜间，相应的增加幅度分别为4.9次/分钟和7.6次/分钟。12例中有11例发现母亲心率与胎儿心率之间存在线性相关性，平均β系数为0.189。母亲心率和胎儿心率均呈现昼夜节律模式，夜间心率较低。
孕期子宫活动与胎儿心率的分级反应相关，可能代表了胎儿心血管系统发育和适应过程中的一种生理挑战。
