Hoyer Dirk, Żebrowski Jan, Cysarz Dirk, Gonçalves Hernâni, Pytlik Adelina, Amorim-Costa Célia, Bernardes João, Ayres-de-Campos Diogo, Witte Otto W, Schleußner Ekkehard, Stroux Lisa, Redman Christopher, Georgieva Antoniya, Payne Stephen, Clifford Gari, Signorini Maria G, Magenes Giovanni, Andreotti Fernando, Malberg Hagen, Zaunseder Sebastian, Lakhno Igor, Schneider Uwe
Hans Berger Department of Neurology, Biomagnetic Center, Jena University Hospital, Jena 07747, Germany.
Physiol Meas. 2017 May;38(5):R61-R88. doi: 10.1088/1361-6579/aa5fca. Epub 2017 Feb 10.
Monitoring the fetal behavior does not only have implications for acute care but also for identifying developmental disturbances that burden the entire later life. The concept, of 'fetal programming', also known as 'developmental origins of adult disease hypothesis', e.g. applies for cardiovascular, metabolic, hyperkinetic, cognitive disorders. Since the autonomic nervous system is involved in all of those systems, cardiac autonomic control may provide relevant functional diagnostic and prognostic information. The fetal heart rate patterns (HRP) are one of the few functional signals in the prenatal period that relate to autonomic control and, therefore, is predestinated for its evaluation. The development of sensitive markers of fetal maturation and its disturbances requires the consideration of physiological fundamentals, recording technology and HRP parameters of autonomic control. Based on the ESGCO2016 special session on monitoring the fetal maturation we herein report the most recent results on: (i) functional fetal autonomic brain age score (fABAS), Recurrence Quantitative Analysis and Binary Symbolic Dynamics of complex HRP resolve specific maturation periods, (ii) magnetocardiography (MCG) based fABAS was validated for cardiotocography (CTG), (iii) 30 min recordings are sufficient for obtaining episodes of high variability, important for intrauterine growth restriction (IUGR) detection in handheld Doppler, (iv) novel parameters from PRSA to identify Intra IUGR fetuses, (v) evaluation of fetal electrocardiographic (ECG) recordings, (vi) correlation between maternal and fetal HRV is disturbed in pre-eclampsia. The reported novel developments significantly extend the possibilities for the established CTG methodology. Novel HRP indices improve the accuracy of assessment due to their more appropriate consideration of complex autonomic processes across the recording technologies (CTG, handheld Doppler, MCG, ECG). The ultimate objective is their dissemination into routine practice and studies of fetal developmental disturbances with implications for programming of adult diseases.
监测胎儿行为不仅对急性护理有意义，而且对于识别会影响整个成年后生活的发育障碍也具有重要意义。“胎儿编程”的概念，也被称为“成人疾病的发育起源假说”，适用于心血管、代谢、多动、认知障碍等。由于自主神经系统参与了所有这些系统，心脏自主控制可能提供相关的功能诊断和预后信息。胎儿心率模式（HRP）是孕期为数不多的与自主控制相关的功能信号之一，因此适合用于评估。胎儿成熟及其障碍的敏感标志物的开发需要考虑生理基础、记录技术和自主控制的HRP参数。基于2016年欧洲围产医学和妇产科超声学会（ESGCO）关于监测胎儿成熟的特别会议，我们在此报告以下最新结果：（i）功能性胎儿自主脑龄评分（fABAS）、复杂HRP的递归定量分析和二元符号动力学可确定特定的成熟期；（ii）基于磁心动图（MCG）的fABAS在胎心监护（CTG）中得到验证；（iii）30分钟的记录足以获得高变异性的片段，这对使用手持式多普勒仪检测宫内生长受限（IUGR）很重要；（iv）来自主成分回归分析（PRSA）的新参数可识别宫内IUGR胎儿；（v）对胎儿心电图（ECG）记录进行评估；（vi）子痫前期孕妇和胎儿心率变异性（HRV）之间的相关性受到干扰。所报告的新进展显著扩展了现有CTG方法的可能性。新的HRP指标由于更恰当地考虑了各种记录技术（CTG、手持式多普勒仪、MCG、ECG）中的复杂自主过程，提高了评估的准确性。最终目标是将它们推广到常规实践以及对胎儿发育障碍的研究中，这些研究对成人疾病的编程具有重要意义。
