Castro Luísa, Loureiro Maria, Henriques Teresa S, Nunes Inês
Faculty of Medicine, Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal.
Health Information and Decision Sciences Department - MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.
Front Pediatr. 2021 Aug 2;9:661400. doi: 10.3389/fped.2021.661400. eCollection 2021.
It is fundamental to diagnose fetal acidemia as early as possible, allowing adequate obstetrical interventions to prevent brain damage or perinatal death. The visual analysis of cardiotocography traces has been complemented by computerized methods in order to overcome some of its limitations in the screening of fetal hypoxia/acidemia. Spectral analysis has been proposed by several studies exploring fetal heart rate recordings while referring to a great variety of frequency bands for integrating the power spectrum. In this paper, the main goal was to systematically review the spectral bands reported in intrapartum fetal heart rate studies and to evaluate their performance in detecting fetal acidemia/hypoxia. A total of 176 articles were reviewed, from MEDLINE, and 26 were included for the extraction of frequency bands and other relevant methodological information. An open-access fetal heart rate database was used, with recordings of the last half an hour of labor of 246 fetuses. Four different umbilical artery pH cutoffs were considered for fetuses' classification into acidemic or non-acidemic: 7.05, 7.10, 7.15, and 7.20. The area under the receiver operating characteristic curve (AUROC) was used to quantify the frequency bands' ability to distinguish acidemic fetuses. Bands referring to low frequencies, mainly associated with neural sympathetic activity, were the best at detecting acidemic fetuses, with the more severe definition (pH ≤ 7.05) attaining the highest values for the AUROC. This study shows that the power spectrum analysis of the fetal heart rate is a simple and powerful tool that may become an adjunctive method to CTG, helping healthcare professionals to accurately identify fetuses at risk of intrapartum hypoxia and to implement timely obstetrical interventions to reduce the incidence of related adverse perinatal outcomes.
尽早诊断胎儿酸血症至关重要，以便进行适当的产科干预，预防脑损伤或围产期死亡。为克服胎心监护图在筛查胎儿缺氧/酸血症方面的一些局限性，计算机化方法对其视觉分析起到了补充作用。多项研究提出了频谱分析，在参考多种频段以整合功率谱的同时探索胎儿心率记录。本文的主要目标是系统回顾产时胎儿心率研究中报告的频谱频段，并评估它们在检测胎儿酸血症/缺氧方面的表现。我们从MEDLINE数据库中检索了176篇文章，其中26篇被纳入，用于提取频段及其他相关方法学信息。我们使用了一个开放获取的胎儿心率数据库，其中记录了246例胎儿分娩最后半小时的情况。对于胎儿酸血症或非酸血症的分类，考虑了四个不同的脐动脉pH临界值：7.05、7.10、7.15和7.20。采用受试者操作特征曲线下面积（AUROC）来量化频段区分酸血症胎儿的能力。主要与神经交感神经活动相关的低频段在检测酸血症胎儿方面表现最佳，在更严格的定义（pH≤7.05）下，AUROC值最高。这项研究表明，胎儿心率的功率谱分析是一种简单而强大的工具，可能成为胎心监护的辅助方法，帮助医护人员准确识别有产时缺氧风险的胎儿，并及时实施产科干预，以降低相关围产期不良结局的发生率。
