Vanspranghels Roxane, De Jonckheere Julien, Drumez Elodie, Lauriot Dit Prevost Arthur, Sharma Dyuti, Ghesquiere Louise, Storme Laurent, Houfflin-Debarge Véronique, Garabedian Charles
University of Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France.
University of Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, CIC-IT 1403, F-59000 Lille, France.
Eur J Obstet Gynecol Reprod Biol. 2020 Mar;246:151-155. doi: 10.1016/j.ejogrb.2020.01.018. Epub 2020 Jan 23.
The autonomic nervous system has a major role in fetal adaptation to hypoxia. Its activity might be assessed using heart rate variability and heart rate deceleration analyses.
To evaluate the ability of different heart rate variability and morphological deceleration analyses to predict fetal acidosis during labor in an experimental fetal sheep model.
Repeated 1-minute total umbilical cord occlusions were performed at mild (1minute every 5 min), moderate (1 min every 3 min), and severe (1 min every 2 min) umbilical cord occlusion periodicities until arterial pH reached 7.10. Hemodynamic,blood gas analysis, morphological analysis of decelerations (magnitude, slope, and area ofdecelerations), and heart rate variability parameters were recorded throughout the experiment.Heart rate variability analysis included temporal analysis (root mean square of successivedifferences between adjacent RR intervals, standard deviation of normal to normal RR intervals, short term variability), spectral analysis (low frequencies, high frequencies,normalized high frequencies), and a new index developed by our team, the Fetal Stress Index.We defined and compared three pH groups: >7.20, 7.10-7.20, and <7.10.
Eleven experiments were performed. Repetitive umbilical cord occlusions resulted in progressive fetal acidosis. Fetal Stress Index was correlated with pH and lactate (p < 0.05) and increased with acidosis. There were no significant correlations between pH, lactate, and other indices (spectral analysis, temporal analysis, or morphological analysis of decelerations).
This protocol allowed us to identify the progressive onset of fetal acidosis in an experimental model close to labor. Fetal Stress Index is a heart rate variability method that varies with acidosis and indicates an increase in parasympathetic nervous system activity in response to fetal acidosis.
自主神经系统在胎儿适应缺氧过程中起主要作用。其活动可通过心率变异性和心率减速分析来评估。
在实验性胎羊模型中，评估不同的心率变异性和形态学减速分析预测分娩期间胎儿酸中毒的能力。
在轻度（每5分钟1分钟）、中度（每3分钟1分钟）和重度（每2分钟1分钟）脐带阻塞周期下重复进行1分钟的完全脐带阻塞，直至动脉pH值达到7.10。在整个实验过程中记录血流动力学、血气分析、减速的形态学分析（减速的幅度、斜率和面积）以及心率变异性参数。心率变异性分析包括时域分析（相邻RR间期差值的均方根、正常RR间期的标准差、短期变异性）、频域分析（低频、高频、归一化高频）以及我们团队开发的一个新指标——胎儿应激指数。我们定义并比较了三个pH组：>7.20、7.10 - 7.20和<7.10。
进行了11项实验。重复脐带阻塞导致胎儿酸中毒逐渐加重。胎儿应激指数与pH值和乳酸水平相关（p < 0.05），并随着酸中毒加重而升高。pH值、乳酸水平与其他指标（频谱分析、时域分析或减速的形态学分析）之间无显著相关性。
该方案使我们能够在接近分娩的实验模型中识别胎儿酸中毒的逐渐发生。胎儿应激指数是一种心率变异性方法，随酸中毒而变化，表明胎儿酸中毒时副交感神经系统活动增加。
