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Sample records for continuous fetal heart

  1. A Phonocardiographic-Based Fiber-Optic Sensor and Adaptive Filtering System for Noninvasive Continuous Fetal Heart Rate Monitoring

    Directory of Open Access Journals (Sweden)

    Radek Martinek

    2017-04-01

    Full Text Available This paper focuses on the design, realization, and verification of a novel phonocardiographic- based fiber-optic sensor and adaptive signal processing system for noninvasive continuous fetal heart rate (fHR monitoring. Our proposed system utilizes two Mach-Zehnder interferometeric sensors. Based on the analysis of real measurement data, we developed a simplified dynamic model for the generation and distribution of heart sounds throughout the human body. Building on this signal model, we then designed, implemented, and verified our adaptive signal processing system by implementing two stochastic gradient-based algorithms: the Least Mean Square Algorithm (LMS, and the Normalized Least Mean Square (NLMS Algorithm. With this system we were able to extract the fHR information from high quality fetal phonocardiograms (fPCGs, filtered from abdominal maternal phonocardiograms (mPCGs by performing fPCG signal peak detection. Common signal processing methods such as linear filtering, signal subtraction, and others could not be used for this purpose as fPCG and mPCG signals share overlapping frequency spectra. The performance of the adaptive system was evaluated by using both qualitative (gynecological studies and quantitative measures such as: Signal-to-Noise Ratio—SNR, Root Mean Square Error—RMSE, Sensitivity—S+, and Positive Predictive Value—PPV.

  2. Hypoxia and Fetal Heart Development

    OpenAIRE

    Patterson, A.J.; Zhang, L

    2010-01-01

    Fetal hearts show a remarkable ability to develop under hypoxic conditions. The metabolic flexibility of fetal hearts allows sustained development under low oxygen conditions. In fact, hypoxia is critical for proper myocardial formation. Particularly, hypoxia inducible factor 1 (HIF-1) and vascular endothelial growth factor play central roles in hypoxia-dependent signaling in fetal heart formation, impacting embryonic outflow track remodeling and coronary vessel growth. Although HIF is not th...

  3. Fetal Heart Rate Monitoring during Labor

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    f AQ FREQUENTLY ASKED QUESTIONS FAQ015 LABOR, DELIVERY, AND POSTPARTUM CARE Fetal Heart Rate Monitoring During Labor • What is fetal heart rate monitoring? • Why is fetal heart rate monitoring ...

  4. Fetal Echocardiography/Your Unborn Baby's Heart

    Science.gov (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More Fetal Echocardiography / Your Unborn Baby's Heart Updated:Oct 6,2016 ... Your Risk • Symptoms & Diagnosis Introduction Common Tests Fetal Echocardiography/Your Unborn Baby's Heart - Fetal Echocardiogram Test - Detection ...

  5. Intrapartum fetal heart rate profiles with and without fetal asphyxia.

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    Low, J A; Pancham, S R; Worthington, D N

    1977-04-01

    Fetal heart rate profiles for periods up to 12 hours prior to delivery have been reviewed in 515 patients with a fetus at risk. Mechanisms other than fetal asphyxia will cause fetal heart rate decelerations, and fetal asphyxia may in some instances develop in the absence of total or late decelerations. However, an increasing incidence of total decelerations and late decelerations and particularly a marked pattern of total decelerations and late decelerations are of value in the prediction of fetal asphyxia. Fetal heart rate deceleration patterns can predict the probability of fetal asphyxia at the time of initial intervention, while a progression of fetal heart rate deceleration patterns in the individual fetus can be of assistance in the subsequent scheduling of serial acid-base assessments during labor.

  6. Do high fetal catecholamine levels affect heart rate variability and ...

    African Journals Online (AJOL)

    Objectives. To deternrine the relationship between Umbilical arterial catecholamine levels and fetal heart rate variability and meconium passage. Study design. A prospective descriptive study was perfonned. Umbilical artery catecholamine levels were measured in 55 newborns and correlated with fetal heart rate before ...

  7. The Correlation Between Ultrasound-Measured Fetal Heart Rate ...

    African Journals Online (AJOL)

    ... for fetal heart rate (FHR) and the relationship between fetal heart rate and gestational age (GA) by 2–D ultrasound. Crown rump length measurement was used for estimating GA in the first trimester while femur length and biparietal diameter measurements were used for estimating GA in the second and third trimesters.

  8. Signal processing methodologies for an acoustic fetal heart rate monitor

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    Pretlow, Robert A., III; Stoughton, John W.

    1992-01-01

    Research and development is presented of real time signal processing methodologies for the detection of fetal heart tones within a noise-contaminated signal from a passive acoustic sensor. A linear predictor algorithm is utilized for detection of the heart tone event and additional processing derives heart rate. The linear predictor is adaptively 'trained' in a least mean square error sense on generic fetal heart tones recorded from patients. A real time monitor system is described which outputs to a strip chart recorder for plotting the time history of the fetal heart rate. The system is validated in the context of the fetal nonstress test. Comparisons are made with ultrasonic nonstress tests on a series of patients. Comparative data provides favorable indications of the feasibility of the acoustic monitor for clinical use.

  9. Diffusion MRI tractography of the developing human fetal heart.

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    Mekkaoui, Choukri; Porayette, Prashob; Jackowski, Marcel P; Kostis, William J; Dai, Guangping; Sanders, Stephen; Sosnovik, David E

    2013-01-01

    Human myocardium has a complex and anisotropic 3D fiber pattern. It remains unknown, however, when in fetal life this anisotropic pattern develops and whether the human heart is structurally fully mature at birth. We aimed here to use diffusion tensor MRI (DTI) tractography to characterize the evolution of fiber architecture in the developing human fetal heart. Human fetal hearts (n = 5) between 10-19 weeks of gestation were studied. The heart from a 6-day old neonate and an adult human heart served as controls. The degree of myocardial anisotropy was measured by calculating the fractional anisotropy (FA) index. In addition, fiber tracts were created by numerically integrating the primary eigenvector field in the heart into coherent streamlines. At 10-14 weeks the fetal hearts were highly isotropic and few tracts could be resolved. Between 14-19 weeks the anisotropy seen in the adult heart began to develop. Coherent fiber tracts were well resolved by 19 weeks. The 19-week myocardium, however, remained weakly anisotropic with a low FA and no discernable sheet structure. The human fetal heart remains highly isotropic until 14-19 weeks, at which time cardiomyocytes self-align into coherent tracts. This process lags 2-3 months behind the onset of cardiac contraction, which may be a prerequisite for cardiomyocyte maturation and alignment. No evidence of a connective tissue scaffold guiding this process could be identified by DTI. Maturation of the heart's sheet structure occurs late in gestation and evolves further after birth.

  10. Automated Fetal Heart Rate Analysis in Labor: Decelerations and Overshoots

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    Georgieva, A. E.; Payne, S. J.; Moulden, M.; Redman, C. W. G.

    2010-10-01

    Electronic fetal heart rate (FHR) recording is a standard way of monitoring fetal health in labor. Decelerations and accelerations usually indicate fetal distress and normality respectively. But one type of acceleration may differ, namely an overshoot that may atypically reflect fetal stress. Here we describe a new method for detecting decelerations, accelerations and overshoots as part of a novel system for computerized FHR analysis (OxSyS). There was poor agreement between clinicians when identifying these FHR features visually, which precluded setting a gold standard of interpretation. We therefore introduced `modified' Sensitivity (SE°) and `modified' Positive Predictive Value (PPV°) as appropriate performance measures with which the algorithm was optimized. The relation between overshoots and fetal compromise in labor was studied in 15 cases and 15 controls. Overshoots showed promise as an indicator of fetal compromise. Unlike ordinary accelerations, overshoots cannot be considered to be reassuring features of fetal health.

  11. Monitoring of fetal heart rate and uterine activity

    NARCIS (Netherlands)

    Graatsma, E.M.

    2010-01-01

    In this thesis a renewed monitoring technique for fetal heart rate (FHR) and uterine activity has been investigated. Through non-invasive measurements of electrical signals as recorded from the maternal abdomen, both the fetal-electrocardiogram (fECG) and uterine electrohysterogram (EHG) can be

  12. The Application of an Anatomical Database for Fetal Congenital Heart Disease.

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    Yang, Li; Pei, Qiu-Yan; Li, Yun-Tao; Yang, Zhen-Juan

    2015-10-05

    Fetal congenital heart anomalies are the most common congenital anomalies in live births. Fetal echocardiography (FECG) is the only prenatal diagnostic approach used to detect fetal congenital heart disease (CHD). FECG is not widely used, and the antenatal diagnosis rate of CHD varies considerably. Thus, mastering the anatomical characteristics of different kinds of CHD is critical for ultrasound physicians to improve FECG technology. The aim of this study is to investigate the applications of a fetal CHD anatomic database in FECG teaching and training program. We evaluated 60 transverse section databases including 27 types of fetal CHD built in the Prenatal Diagnosis Center in Peking University People's Hospital. Each original database contained 400-700 cross-sectional digital images with a resolution of 3744 pixels × 5616 pixels. We imported the database into Amira 5.3.1 (Australia Visage Imaging Company, Australia) three-dimensional (3D) software. The database functions use a series of 3D software visual operations. The features of the fetal CHD anatomical database were analyzed to determine its applications in FECG continuing education and training. The database was rebuilt using the 3D software. The original and rebuilt databases can be displayed dynamically, continuously, and synchronically and can be rotated at arbitrary angles. The sections from the dynamic displays and rotating angles are consistent with the sections in FECG. The database successfully reproduced the anatomic structures and spatial relationship features of different fetal CHDs. We established a fetal CHD anatomy training database and a standardized training database for FECG. Ultrasound physicians and students can learn the anatomical features of fetal CHD and FECG through either centralized training or distance education. The database of fetal CHD successfully reproduced the anatomic structures and spatial relationship of different kinds of fetal CHD. This database can be widely used in

  13. Establishment of a database of fetal congenital heart malformations and preliminary investigation of its clinical application.

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    Gao, Jun-Xue; Pei, Qiu-Yan; Li, Yun-Tao; Yang, Zhen-Juan

    2015-06-01

    The aim of this study was to create a database of anatomical ultrathin cross-sectional images of fetal hearts with different congenital heart diseases (CHDs) and preliminarily to investigate its clinical application. Forty Chinese fetal heart samples from induced labor due to different CHDs were cut transversely at 60-μm thickness. All thoracic organs were removed from the thoracic cavity after formalin fixation, embedded in optimum cutting temperature compound, and then frozen at -25°C for 2 hours. Subsequently, macro shots of the frozen serial sections were obtained using a digital camera in order to build a database of anatomical ultrathin cross-sectional images. Images in the database clearly displayed the fetal heart structures. After importing the images into three-dimensional software, the following functions could be realized: (1) based on the original database of transverse sections, databases of sagittal and coronal sections could be constructed; and (2) the original and constructed databases could be displayed continuously and dynamically, and rotated in arbitrary angles. They could also be displayed synchronically. The aforementioned functions of the database allowed for the retrieval of images and three-dimensional anatomy characteristics of the different fetal CHDs, and virtualization of fetal echocardiography findings. A database of 40 different cross-sectional fetal CHDs was established. An extensive database library of fetal CHDs, from which sonographers and students can study the anatomical features of fetal CHDs and virtualize fetal echocardiography findings via either centralized training or distance education, can be established in the future by accumulating further cases. Copyright © 2015. Published by Elsevier B.V.

  14. 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.

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    Devoe, L; Boehm, F; Paul, R; Frigoletto, F; Penso, C; Goldenberg, R; Rayburn, W; Smith, C

    1994-02-01

    Our purpose was to correlate measures of Doppler-detected fetal movements with standard fetal heart rate parameters and perinatal outcomes. This prospective, multiinstitutional trial used the Hewlett-Packard M1350A monitor to record simultaneous fetal heart rate baseline, variability, accelerations, decelerations, and number of fetal movements, and duration and percent of total time. These data were compared at 10- and 30-minute intervals during nonstress tests and were correlated with fetal heart rate baseline parameters and maternally perceived fetal movements and with outcomes of infants delivered within 7 days of the last test. At six centers 1704 actocardiograms from 884 third-trimester patients were analyzed. Doppler-detected fetal movement counts, durations, and percent of total time correlated weakly with all baseline fetal heart rate parameters (all values < 0.20). All fetal movement parameters increased significantly in successive 10-minute blocks and in periods of increased or normal fetal heart rate variability compared with those with fetal heart rate variability. The sensitivity, specificity, and predictive values of the percent of total movement time were comparable to those of standard nonstress test parameters. The risk of poor perinatal outcomes after nonreactive nonstress tests was lower in cases with fetal movements than in those without. Doppler actocardiography may help to discriminate fetal states during antepartum testing. It may prevent inappropriate diagnosis of fetal compromise when the nonstress test is nonreactive or nonreassuring.

  15. CONTINUOUS MATERNAL HYPEROXYGENATION IN THE TREATMENT OF EARLY FETAL GROWTH-RETARDATION

    NARCIS (Netherlands)

    RIBBERT, LSM; VANLINGEN, RA; VISSER, GHA

    Continuous maternal hyperoxygenation treatment (2.5 l/min by means of a nasopharyngeal cannula) was given in four patients presenting with intrauterine growth-retarded (IUGR) fetuses and decelerative fetal heart rate (FHR) patterns at 27-28 weeks of gestation. The effect of maternal hyperoxia was

  16. Fetal magnetocardiography: time intervals and heart rate variability.

    Science.gov (United States)

    Van Leeuwen, P

    2004-11-30

    Biomagnetism in the perinatal domain has been dominated by fetal cardiology, and early work pointed out the potential of both fetal cardiac time intervals (CTI) and heart rate variability (HRV) for future clinical applications. Recent improvements in instrumentation have permitted numerous groups to investigate a substantial number of healthy fetuses in these two areas and to lay the groundwork for a delineation of normal ranges. With respect to fetal CTI it is now clear that in particular the duration of P wave, PR interval and QRS complex reflect fetal growth and development. Preliminary studies have shown that the age-adjusted CTI are shorter in growth-retarded fetuses and altered in cases of structural cardiac defects and in specific types of arrhythmia. Less work has been published on MCG-determined fetal HRV although parameters from both the time and frequency domains as well as complexity have been examined. Concomitant with the gradual change in heart rate during pregnancy, increases in time domain variables and complexity have been described for normal pregnancies. Furthermore, gestational age-related changes in specific spectral bands have been noted and increases in power have been documented at frequencies which are associated with fetal breathing movements. The fact that little has been reported to date on discriminatory power with respect to pathological states may be due to the lack of extended data acquisition in a clinical setting documenting acute states. Nonetheless, it may be expected that both fetal HRV and CTI will supplement standard fetal surveillance techniques in the near future.

  17. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour.

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    Alfirevic, Zarko; Devane, Declan; Gyte, Gillian Ml; Cuthbert, Anna

    2017-02-03

    Cardiotocography (CTG) records changes in the fetal heart rate and their temporal relationship to uterine contractions. The aim is to identify babies who may be short of oxygen (hypoxic) to guide additional assessments of fetal wellbeing, or determine if the baby needs to be delivered by caesarean section or instrumental vaginal birth. This is an update of a review previously published in 2013, 2006 and 2001. To evaluate the effectiveness and safety of continuous cardiotocography when used as a method to monitor fetal wellbeing during labour. We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 November 2016) and reference lists of retrieved studies. Randomised and quasi-randomised controlled trials involving a comparison of continuous cardiotocography (with and without fetal blood sampling) with no fetal monitoring, intermittent auscultation intermittent cardiotocography. Two review authors independently assessed study eligibility, quality and extracted data from included studies. Data were checked for accuracy. We included 13 trials involving over 37,000 women. No new studies were included in this update.One trial (4044 women) compared continuous CTG with intermittent CTG, all other trials compared continuous CTG with intermittent auscultation. No data were found comparing no fetal monitoring with continuous CTG. Overall, methodological quality was mixed. All included studies were at high risk of performance bias, unclear or high risk of detection bias, and unclear risk of reporting bias. Only two trials were assessed at high methodological quality.Compared with intermittent auscultation, continuous cardiotocography showed no significant improvement in overall perinatal death rate (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.59 to 1.23, N = 33,513, 11 trials, low quality evidence), but was associated with halving neonatal seizure rates (RR 0.50, 95% CI 0.31 to 0.80, N = 32,386, 9 trials, moderate quality evidence). There was no

  18. The influence of betamethasone on fetal heart rate variability, obtained by non-invasive fetal electrocardiogram recordings.

    Science.gov (United States)

    Verdurmen, Kim M J; Warmerdam, Guy J J; Lempersz, Carlijn; Hulsenboom, Alexandra D J; Renckens, Joris; Dieleman, Jeanne P; Vullings, Rik; van Laar, Judith O E H; Oei, S Guid

    2018-03-02

    Betamethasone is widely used to enhance fetal lung maturation in case of threatened preterm labour. Fetal heart rate variability is one of the most important parameters to assess in fetal monitoring, since it is a reliable indicator for fetal distress. To describe the effect of betamethasone on fetal heart rate variability, by applying spectral analysis on non-invasive fetal electrocardiogram recordings. Prospective cohort study. Patients that require betamethasone, with a gestational age from 24 weeks onwards. Fetal heart rate variability parameters on day 1, 2, and 3 after betamethasone administration are compared to a reference measurement. Following 68 inclusions, 12 patients remained with complete series of measurements and sufficient data quality. During day 1, an increase in absolute fetal heart rate variability values was seen. During day 2, a decrease in these values was seen. All trends indicate to return to pre-medication values on day 3. Normalised high- and low-frequency power show little changes during the study period. The changes in fetal heart rate variability following betamethasone administration show the same pattern when calculated by spectral analysis of the fetal electrocardiogram, as when calculated by cardiotocography. Since normalised spectral values show little changes, the influence of autonomic modulation seems minor. Copyright © 2018 Elsevier B.V. All rights reserved.

  19. Metabolic gene profile in early human fetal heart development.

    Science.gov (United States)

    Iruretagoyena, J I; Davis, W; Bird, C; Olsen, J; Radue, R; Teo Broman, A; Kendziorski, C; Splinter BonDurant, S; Golos, T; Bird, I; Shah, D

    2014-07-01

    The primitive cardiac tube starts beating 6-8 weeks post fertilization in the developing embryo. In order to describe normal cardiac development during late first and early second trimester in human fetuses this study used microarray and pathways analysis and created a corresponding 'normal' database. Fourteen fetal hearts from human fetuses between 10 and 18 weeks of gestational age (GA) were prospectively collected at the time of elective termination of pregnancy. RNA from recovered tissues was used for transcriptome analysis with Affymetrix 1.0 ST microarray chip. From the amassed data we investigated differences in cardiac development within the 10-18 GA period dividing the sample by GA in three groups: 10-12 (H1), 13-15 (H2) and 16-18 (H3) weeks. A fold change of 2 or above adjusted for a false discovery rate of 5% was used as initial cutoff to determine differential gene expression for individual genes. Test for enrichment to identify functional groups was carried out using the Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG). Array analysis correctly identified the cardiac specific genes, and transcripts reported to be differentially expressed were confirmed by qRT-PCR. Single transcript and Ontology analysis showed first trimester heart expression of myosin-related genes to be up-regulated >5-fold compared with second trimester heart. In contrast the second trimester hearts showed further gestation-related increases in many genes involved in energy production and cardiac remodeling. In conclusion, fetal heart development during the first trimester was dominated by heart-specific genes coding for myocardial development and differentiation. During the second trimester, transcripts related to energy generation and cardiomyocyte communication for contractile coordination/proliferation were more dominant. Transcripts related to fatty acid metabolism can be seen as early as 10 weeks and clearly increase as the heart matures. Retinol

  20. Fetal Heart Rate Monitoring from Phonocardiograph Signal Using Repetition Frequency of Heart Sounds

    Directory of Open Access Journals (Sweden)

    Hong Tang

    2016-01-01

    Full Text Available As a passive, harmless, and low-cost diagnosis tool, fetal heart rate (FHR monitoring based on fetal phonocardiography (fPCG signal is alternative to ultrasonographic cardiotocography. Previous fPCG-based methods commonly relied on the time difference of detected heart sound bursts. However, the performance is unavoidable to degrade due to missed heart sounds in very low signal-to-noise ratio environments. This paper proposes a FHR monitoring method using repetition frequency of heart sounds. The proposed method can track time-varying heart rate without both heart sound burst identification and denoising. The average accuracy rate comparison to benchmark is 88.3% as the SNR ranges from −4.4 dB to −26.7 dB.

  1. Maternal bisphenol a exposure impacts the fetal heart transcriptome.

    Directory of Open Access Journals (Sweden)

    Kalyan C Chapalamadugu

    Full Text Available Conditions during fetal development influence health and disease in adulthood, especially during critical windows of organogenesis. Fetal exposure to the endocrine disrupting chemical, bisphenol A (BPA affects the development of multiple organ systems in rodents and monkeys. However, effects of BPA exposure on cardiac development have not been assessed. With evidence that maternal BPA is transplacentally delivered to the developing fetus, it becomes imperative to examine the physiological consequences of gestational exposure during primate development. Herein, we evaluate the effects of daily, oral BPA exposure of pregnant rhesus monkeys (Macaca mulatta on the fetal heart transcriptome. Pregnant monkeys were given daily oral doses (400 µg/kg body weight of BPA during early (50-100 ± 2 days post conception, dpc or late (100 ± 2 dpc--term, gestation. At the end of treatment, fetal heart tissues were collected and chamber specific transcriptome expression was assessed using genome-wide microarray. Quantitative real-time PCR was conducted on select genes and ventricular tissue glycogen content was quantified. Our results show that BPA exposure alters transcription of genes that are recognized for their role in cardiac pathophysiologies. Importantly, myosin heavy chain, cardiac isoform alpha (Myh6 was down-regulated in the left ventricle, and 'A Disintegrin and Metalloprotease 12', long isoform (Adam12-l was up-regulated in both ventricles, and the right atrium of the heart in BPA exposed fetuses. BPA induced alteration of these genes supports the hypothesis that exposure to BPA during fetal development may impact cardiovascular fitness. Our results intensify concerns about the role of BPA in the genesis of human metabolic and cardiovascular diseases.

  2. Fetal Heart Sounds Detection Using Wavelet Transform and Fractal Dimension.

    Science.gov (United States)

    Koutsiana, Elisavet; Hadjileontiadis, Leontios J; Chouvarda, Ioanna; Khandoker, Ahsan H

    2017-01-01

    Phonocardiography is a non-invasive technique for the detection of fetal heart sounds (fHSs). In this study, analysis of fetal phonocardiograph (fPCG) signals, in order to achieve fetal heartbeat segmentation, is proposed. The proposed approach (namely WT-FD) is a wavelet transform (WT)-based method that combines fractal dimension (FD) analysis in the WT domain for the extraction of fHSs from the underlying noise. Its adoption in this field stems from its successful use in the fields of lung and bowel sounds de-noising analysis. The efficiency of the WT-FD method in fHS extraction has been evaluated with 19 simulated fHS signals, created for the present study, with additive noise up to (3 dB), along with the simulated fPCGs database available at PhysioBank. Results have shown promising performance in the identification of the correct location and morphology of the fHSs, reaching an overall accuracy of 89% justifying the efficacy of the method. The WT-FD approach effectively extracts the fHS signals from the noisy background, paving the way for testing it in real fHSs and clearly contributing to better evaluation of the fetal heart functionality.

  3. Fetal Heart Sounds Detection Using Wavelet Transform and Fractal Dimension

    Directory of Open Access Journals (Sweden)

    Elisavet Koutsiana

    2017-09-01

    Full Text Available Phonocardiography is a non-invasive technique for the detection of fetal heart sounds (fHSs. In this study, analysis of fetal phonocardiograph (fPCG signals, in order to achieve fetal heartbeat segmentation, is proposed. The proposed approach (namely WT–FD is a wavelet transform (WT-based method that combines fractal dimension (FD analysis in the WT domain for the extraction of fHSs from the underlying noise. Its adoption in this field stems from its successful use in the fields of lung and bowel sounds de-noising analysis. The efficiency of the WT–FD method in fHS extraction has been evaluated with 19 simulated fHS signals, created for the present study, with additive noise up to (3 dB, along with the simulated fPCGs database available at PhysioBank. Results have shown promising performance in the identification of the correct location and morphology of the fHSs, reaching an overall accuracy of 89% justifying the efficacy of the method. The WT–FD approach effectively extracts the fHS signals from the noisy background, paving the way for testing it in real fHSs and clearly contributing to better evaluation of the fetal heart functionality.

  4. Consistent reconstruction of 4D fetal heart ultrasound images to cope with fetal motion.

    Science.gov (United States)

    Tanner, Christine; Flach, Barbara; Eggenberger, Céline; Mattausch, Oliver; Bajka, Michael; Goksel, Orcun

    2017-08-01

    4D ultrasound imaging of the fetal heart relies on reconstructions from B-mode images. In the presence of fetal motion, current approaches suffer from artifacts, which are unrecoverable for single sweeps. We propose to use many sweeps and exploit the resulting redundancy to automatically recover from motion by reconstructing a 4D image which is consistent in phase, space, and time. An interactive visualization framework to view animated ultrasound slices from 4D reconstructions on arbitrary planes was developed using a magnetically tracked mock probe. We first quantified the performance of 10 4D reconstruction formulations on simulated data. Reconstructions of 14 in vivo sequences by a baseline, the current state-of-the-art, and the proposed approach were then visually ranked with respect to temporal quality on orthogonal views. Rankings from 5 observers showed that the proposed 4D reconstruction approach significantly improves temporal image quality in comparison with the baseline. The 4D reconstructions of the baseline and the proposed methods were then inspected interactively for accessibility to clinically important views and rated for their clinical usefulness by an ultrasound specialist in obstetrics and gynecology. The reconstructions by the proposed method were rated as 'very useful' in 71% and were statistically significantly more useful than the baseline reconstructions. Multi-sweep fetal heart ultrasound acquisitions in combination with consistent 4D image reconstruction improves quality as well as clinical usefulness of the resulting 4D images in the presence of fetal motion.

  5. Influence of ECG sampling rate in fetal heart rate variability analysis.

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    De Jonckheere, J; Garabedian, C; Charlier, P; Champion, C; Servan-Schreiber, E; Storme, L; Debarge, V; Jeanne, M; Logier, R

    2017-07-01

    Fetal hypoxia results in a fetal blood acidosis (pHheart rate variability in hypoxic fetuses. So, fetal heart rate variability analysis could be of precious help for fetal hypoxia prediction. Commonly used fetal heart rate variability analysis methods have been shown to be sensitive to the ECG signal sampling rate. Indeed, a low sampling rate could induce variability in the heart beat detection which will alter the heart rate variability estimation. In this paper, we introduce an original fetal heart rate variability analysis method. We hypothesize that this method will be less sensitive to ECG sampling frequency changes than common heart rate variability analysis methods. We then compared the results of this new heart rate variability analysis method with two different sampling frequencies (250-1000 Hz).

  6. A brief history of fetal echocardiography and its impact on the management of congenital heart disease.

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    Maulik, Dev; Nanda, Navin C; Maulik, Devika; Vilchez, Gustavo

    2017-12-01

    Congenital heart disease (CHD), the most common congenital malformation, is associated with adverse outcome. Development of fetal echocardiography has made prenatal diagnosis of CHD a reality, and in the process revolutionized its management. This historical review briefly narrates this development over the decades focusing on the emergence of the primary modalities of fetal echocardiography comprised of the time-motion mode, two-dimensional B-mode, spectral Doppler, color Doppler, and three- and four-dimensional cardiac imaging. Collaboration between clinicians and engineers has been central to these advances. Also discussed are the accuracy and impact of fetal echocardiography on the management of CHD, and especially its role in the prenatal diagnosis of critical CHD in individualizing the management and improving the outcome. Despite these advances, most cases of CHD are not identified prenatally, emphasizing the continuing need for further technological and educational innovation and improvement. © 2017, Wiley Periodicals, Inc.

  7. A Comparative Study on Fetal Heart Rates Estimated from Fetal Phonography and Cardiotocography

    Science.gov (United States)

    Ibrahim, Emad A.; Al Awar, Shamsa; Balayah, Zuhur H.; Hadjileontiadis, Leontios J.; Khandoker, Ahsan H.

    2017-01-01

    The aim of this study is to investigate that fetal heart rates (fHR) extracted from fetal phonocardiography (fPCG) could convey similar information of fHR from cardiotocography (CTG). Four-channel fPCG sensors made of low cost (34 weeks of gestation). A novel multi-lag covariance matrix-based eigenvalue decomposition technique was used to separate maternal breathing, fetal heart sounds (fHS) and maternal heart sounds (mHS) from abdominal phonogram signals. Prior to the fHR estimation, the fPCG signals were denoised using a multi-resolution wavelet-based filter. The proposed source separation technique was first tested in separating sources from synthetically mixed signals and then on raw abdominal phonogram signals. fHR signals extracted from fPCG signals were validated using simultaneous recorded CTG-based fHR recordings.The experimental results have shown that the fHR derived from the acquired fPCG can be used to detect periods of acceleration and deceleration, which are critical indication of the fetus' well-being. Moreover, a comparative analysis demonstrated that fHRs from CTG and fPCG signals were in good agreement (Bland Altman plot has mean = −0.21 BPM and ±2 SD = ±3) with statistical significance (p < 0.001 and Spearman correlation coefficient ρ = 0.95). The study findings show that fHR estimated from fPCG could be a reliable substitute for fHR from the CTG, opening up the possibility of a low cost monitoring tool for fetal well-being. PMID:29089896

  8. A Comparative Study on Fetal Heart Rates Estimated from Fetal Phonography and Cardiotocography

    Directory of Open Access Journals (Sweden)

    Emad A. Ibrahim

    2017-10-01

    Full Text Available The aim of this study is to investigate that fetal heart rates (fHR extracted from fetal phonocardiography (fPCG could convey similar information of fHR from cardiotocography (CTG. Four-channel fPCG sensors made of low cost (<$1 ceramic piezo vibration sensor within 3D-printed casings were used to collect abdominal phonogram signals from 20 pregnant mothers (>34 weeks of gestation. A novel multi-lag covariance matrix-based eigenvalue decomposition technique was used to separate maternal breathing, fetal heart sounds (fHS and maternal heart sounds (mHS from abdominal phonogram signals. Prior to the fHR estimation, the fPCG signals were denoised using a multi-resolution wavelet-based filter. The proposed source separation technique was first tested in separating sources from synthetically mixed signals and then on raw abdominal phonogram signals. fHR signals extracted from fPCG signals were validated using simultaneous recorded CTG-based fHR recordings.The experimental results have shown that the fHR derived from the acquired fPCG can be used to detect periods of acceleration and deceleration, which are critical indication of the fetus' well-being. Moreover, a comparative analysis demonstrated that fHRs from CTG and fPCG signals were in good agreement (Bland Altman plot has mean = −0.21 BPM and ±2 SD = ±3 with statistical significance (p < 0.001 and Spearman correlation coefficient ρ = 0.95. The study findings show that fHR estimated from fPCG could be a reliable substitute for fHR from the CTG, opening up the possibility of a low cost monitoring tool for fetal well-being.

  9. PROFILE OF CONGENITAL HEART DISEASE AS DIAGNOSED BY FETAL ECHOCARDIOGRAPHY, A TERTIARY CARE EXPERIENCE

    OpenAIRE

    Venkata Arunavalli; Imamuddin; Udaykiran

    2015-01-01

    BACKGROUND : The incidence of congenital heart disease is 0.8 in 1000 live births. Fetal echo cardiography offers a chance to detect most hemodynamically significant congenital heart disease in early pregnancy, so that their management prenatally, at birth and postnatally can be planned better. OBJECTIVES : To analyze the profile of congenital heart disease as diagnosed by fetal echocardiography, in pregnant women r...

  10. Linear and nonlinear measures of fetal heart rate patterns evaluated on very short fetal magnetocardiograms

    International Nuclear Information System (INIS)

    Moraes, Eder Rezende; Murta, Luiz Otavio Jr; Baffa, Oswaldo; Wakai, Ronald T; Comani, Silvia

    2012-01-01

    We analyzed the effectiveness of linear short- and long-term variability time domain parameters, an index of sympatho-vagal balance (SDNN/RMSSD) and entropy in differentiating fetal heart rate patterns (fHRPs) on the fetal heart rate (fHR) series of 5, 3 and 2 min duration reconstructed from 46 fetal magnetocardiograms. Gestational age (GA) varied from 21 to 38 weeks. FHRPs were classified based on the fHR standard deviation. In sleep states, we observed that vagal influence increased with GA, and entropy significantly increased (decreased) with GA (SDNN/RMSSD), demonstrating that a prevalence of vagal activity with autonomous nervous system maturation may be associated with increased sleep state complexity. In active wakefulness, we observed a significant negative (positive) correlation of short-term (long-term) variability parameters with SDNN/RMSSD. ANOVA statistics demonstrated that long-term irregularity and standard deviation of normal-to-normal beat intervals (SDNN) best differentiated among fHRPs. Our results confirm that short- and long-term variability parameters are useful to differentiate between quiet and active states, and that entropy improves the characterization of sleep states. All measures differentiated fHRPs more effectively on very short HR series, as a result of the fMCG high temporal resolution and of the intrinsic timescales of the events that originate the different fHRPs. (paper)

  11. Algorithms for Computerized Fetal Heart Rate Diagnosis with Direct Reporting

    Directory of Open Access Journals (Sweden)

    Kazuo Maeda

    2015-06-01

    Full Text Available Aims: Since pattern classification of fetal heart rate (FHR was subjective and enlarged interobserver difference, objective FHR analysis was achieved with computerized FHR diagnosis. Methods: The computer algorithm was composed of an experts’ knowledge system, including FHR analysis and FHR score calculation, and also of an objective artificial neural network system with software. In addition, a FHR frequency spectrum was studied to detect ominous sinusoidal FHR and the loss of baseline variability related to fetal brain damage. The algorithms were installed in a central-computerized automatic FHR monitoring system, which gave the diagnosis rapidly and directly to the attending doctor. Results: Clinically perinatal mortality decreased significantly and no cerebral palsy developed after introduction of the centralized system. Conclusion: The automatic multichannel FHR monitoring system improved the monitoring, increased the objectivity of FHR diagnosis and promoted clinical results.

  12. Fetal heart rate patterns at 20 to 24 weeks gestation as recorded by fetal electrocardiography

    Science.gov (United States)

    Hofmeyr, F; Groenewald, CA; Nel, DG; Myers, MM; Fifer, WP; Signore, C; Hankins, GDV; Odendaal, HJ

    2014-01-01

    Introduction With advancing technology it has become possible to accurately record and assess fetal heart rate (FHR) patterns from gestations as early as 20 weeks. The aim of our study was to describe early patterns of FHR, as recorded by transabdominal fetal electrocardiogram according to the Dawes-Redman criteria. Accordingly, short-term variability, basal heart rate, accelerations and decelerations were quantified at 20-24 weeks gestation among women with uncomplicated pregnancies. Methods This study was conducted in a subset of participants enrolled in a large prospective pregnancy cohort study. Our final data set consisted of 281 recordings of women with good perinatal outcomes that had undergone fetal electrocardiographic assessment as part of the Safe Passage Study. Results The success rate of the recordings was 95.4%. The mean frequency of small and large accelerations was 0.5 and 0.1 per 10 minutes respectively and that of small and large decelerations 0.3 and 0.008 per 10 minutes respectively. The mean and basal heart rates were both equal to 148.0 bpm at a median gestation of 161 days. The mean short term variation was 6.2 (SD 1.4) milliseconds and mean minute range 35.1 (SD 7.1) milliseconds. Conclusion The 20 to 24 week fetus demonstrates FHR patterns with more accelerations and decelerations, as well as higher baseline variability than was anticipated. Information from this study provides an important foundation for further, more detailed, studies of early FHR patterns. PMID:23991757

  13. Human fetal cardiac progenitors: The role of stem cells and progenitors in the fetal and adult heart.

    Science.gov (United States)

    Bulatovic, Ivana; Månsson-Broberg, Agneta; Sylvén, Christer; Grinnemo, Karl-Henrik

    2016-02-01

    The human fetal heart is formed early during embryogenesis as a result of cell migrations, differentiation, and formative blood flow. It begins to beat around gestation day 22. Progenitor cells are derived from mesoderm (endocardium and myocardium), proepicardium (epicardium and coronary vessels), and neural crest (heart valves, outflow tract septation, and parasympathetic innervation). A variety of molecular disturbances in the factors regulating the specification and differentiation of these cells can cause congenital heart disease. This review explores the contribution of different cardiac progenitors to the embryonic heart development; the pathways and transcription factors guiding their expansion, migration, and functional differentiation; and the endogenous regenerative capacity of the adult heart including the plasticity of cardiomyocytes. Unfolding these mechanisms will become the basis for understanding the dynamics of specific congenital heart disease as well as a means to develop therapy for fetal as well as postnatal cardiac defects and heart failure. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Motion compensated cine CMR of the fetal heart using radial undersampling and compressed sensing

    OpenAIRE

    Roy, Christopher W.; Seed, Mike; Kingdom, John C.; Macgowan, Christopher K.

    2017-01-01

    Background To develop and evaluate a reconstruction framework for high resolution time-resolved CMR of the fetal heart in the presence of motion. Methods Data were acquired using a golden angle radial trajectory in seven fetal subjects and reconstructed as real-time images to detect fetal movement. Data acquired during through-plane motion were discarded whereas in-plane motion was corrected. A fetal cardiac gating signal was extracted to sort the corrected data by cardiac phase, allowing rec...

  15. Myocardial bridges of the coronary arteries in the human fetal heart.

    Science.gov (United States)

    Cakmak, Yusuf Ozgür; Cavdar, Safiye; Yalin, Aymelek; Yener, Nuran; Ozdogmus, Omer

    2010-09-01

    During the last century, many investigators reported on myocardial bridges in the adult human heart. In the present study, 39 human fetal hearts (the mean gestastional age was 30 weeks) were studied for myocardial bridging, and the results were correlated with adult data. Among the 39 (27 male and 12 female) fetal hearts studied, 26 bridges were observed on 18 fetal hearts (46.2%). Ten of the bridges had one myocardial bridge, whereas double myocardial bridges were observed in eight fetal hearts. The most frequent myocardial bridges were observed on the left anterior descending artery (LAD), which had 13 bridges (50%). Eight (30.7%) myocardial bridges were on the diagonal artery, and on the posterior descending artery there were five (19.3%). Myocardial bridges were not observed on the circumflex artery. The data presented in this study may provide potentially useful information for the preoperative evaluation of the newborn and may have a clinical implication for sudden fetal death.

  16. The fetal heart rate collaborative practice project: situational awareness in electronic fetal monitoring-a Kaiser Permanente Perinatal Patient Safety Program Initiative.

    Science.gov (United States)

    MacEachin, S Rachel; Lopez, Connie M; Powell, Kimberly J; Corbett, Nancy L

    2009-01-01

    Electronic fetal monitoring has historically been interpreted with wide variation between and within disciplines on the obstetric healthcare team. This leads to inconsistent decision making in response to tracing interpretation. To implement a multidisciplinary electronic fetal monitoring training program, utilizing the best evidence available, enabling standardization of fetal heart rate interpretation to promote patient safety. Local multidisciplinary expertise along with an outside consultant collaborated over a series of meetings to create a multimedia instructional electronic fetal monitoring training program. After production was complete, a series of conferences attended by nurses, certified nurse midwives, and physician champions, from each hospital, attended to learn how to facilitate training at their own perinatal units. All healthcare personnel across the Kaiser Permanente perinatal program were trained in NICHD nomenclature, emergency response, interpretation guidelines, and how to create local collaborative practice agreements. Metrics for program effectiveness were measured through program evaluations from attendees, the Safety Attitudes Questionnaire. Program evaluations rendered very positive scores from both physicians and clinicians. Comparing baseline to 4 years later, the perception of safety from the staff has increased over 10% in 5 out of the 6 factors analyzed. Active participation from all disciplines in this training series has highlighted the importance of teamwork and communication. The Fetal Heart Rate Collaborative Practice Project continues to evolve utilizing other educational modalities, such as online EFM education and unit-based interdisciplinary tracing reviews.

  17. Telemetric monitoring of fetal blood pressure and heart rate in the freely moving pregnant sheep: a feasibility study.

    Science.gov (United States)

    Abi-Nader, Khalil N; Mehta, Vedanta; Shaw, S W Steven; Bellamy, Tom; Smith, Neil; Millross, Laura; Laverick, Beth; Filippi, Elisa; Boyd, Michael; Peebles, Donald M; David, Anna L

    2011-01-01

    Remote telemetric monitoring of fetal haemodynamics in pregnant sheep would allow unrestricted animal movement, minimize suffering and distress, and improve animal welfare, while enhancing the quality of data collected. This may also be useful in clinical practice following fetal surgery. Using an open fetal surgical technique at approximately two-thirds of gestation, we implanted the catheter of a D70-PCTP haemodynamic telemetric device (Data Sciences International, Tilburg, The Netherlands) into the carotid artery of the fetal sheep (n = 4). The attached transmitter was secured to the posterior aspect of the maternal anterior abdominal wall. Two receivers, with a range of 1 m each, were sited in an 11 m² sheep enclosure to maximize animal freedom while allowing continuous monitoring of the ewe. The receivers were connected by cable to a nearby computer. In the first two procedures, both fetuses died eight and 12 days after surgery, and the catheter tip was observed to be lying in the bicarotid trunk. In the next two procedures the catheter tip was threaded further upstream from the insertion point, in an attempt to reach the fetal aorta, and both fetuses survived until the scheduled postmortem examination at the end of pregnancy. After catheter implantation, fetal blood pressure (BP) and heart rate (HR) were successfully recorded continuously for seven days and then hourly per day for a further three weeks. The fetal BP and HR values were in the normal range for healthy sheep fetuses.

  18. Feature selection using genetic algorithms for fetal heart rate analysis

    International Nuclear Information System (INIS)

    Xu, Liang; Redman, Christopher W G; Georgieva, Antoniya; Payne, Stephen J

    2014-01-01

    The fetal heart rate (FHR) is monitored on a paper strip (cardiotocogram) during labour to assess fetal health. If necessary, clinicians can intervene and assist with a prompt delivery of the baby. Data-driven computerized FHR analysis could help clinicians in the decision-making process. However, selecting the best computerized FHR features that relate to labour outcome is a pressing research problem. The objective of this study is to apply genetic algorithms (GA) as a feature selection method to select the best feature subset from 64 FHR features and to integrate these best features to recognize unfavourable FHR patterns. The GA was trained on 404 cases and tested on 106 cases (both balanced datasets) using three classifiers, respectively. Regularization methods and backward selection were used to optimize the GA. Reasonable classification performance is shown on the testing set for the best feature subset (Cohen's kappa values of 0.45 to 0.49 using different classifiers). This is, to our knowledge, the first time that a feature selection method for FHR analysis has been developed on a database of this size. This study indicates that different FHR features, when integrated, can show good performance in predicting labour outcome. It also gives the importance of each feature, which will be a valuable reference point for further studies. (paper)

  19. Effect of maternal anxiety and music on fetal movements and fetal heart rate patterns.

    Science.gov (United States)

    Kafali, Hasan; Derbent, Aysel; Keskin, Esra; Simavli, Serap; Gözdemir, Elif

    2011-03-01

    Aimed to investigate (a) the effect of non-stress test (NST) and music on maternal anxiety (b) the effect of maternal anxiety and music on fetal heart rate (FHR) changes. The two hundred and one pregnant women coming for routine prenatal care were randomized to receive either music (n=96) or no music (n=105) during NST. Before and after the test, these women were asked to complete the Spielberg State-Trait Anxiety Inventory on two interviews; primary outcome was considered as a maternal state anxiety score before and after NST. Secondary outcome was the baseline FHR, the number of fetal movement, large accelerations, dubious NST, variable decelerations, and the minimum procedure time. Before NST, the mean state anxiety score of the music and control groups was found as 38.1 +/- 8.8 and 38.08 +/-8.2, respectively (p>0.05). On the other hand, after NST, the mean state anxiety score of the music and control groups was found as 35.5 +/- 8.2 and 40.2 +/- 9.2, respectively (pmusic during NST resulted in decrease in a state anxiety score of the study group but it was not statistically significant (38.1 +/- 8.8 versus 35.5 +/- 8.2, p>0.05). The baseline FHR of the music group was significantly higher than that of the control group (134.09 +/- 7.2 versus 130.3 +/- 5.7, pmusic group was significantly higher than that of the control group (8.9 +/- 4.7 versus 5.9 +/- 3.9, pmusic group was significantly higher than that of the control group (5.7 +/- 2.1 versus 4.5 +/- 2.04, pmusic group was significantly lower than that of control group (13.4 +/- 5.2 versus 15.6 +/- 6.1, p0.05). NST has anxiogenic effects on mothers and listening to music during the test has positive impact on both maternal and fetal parameters but it is an open question whether maternal anxiety during pregnancy may affect fetal accelerations to such an extent that it could influence clinical judgments.

  20. Correlating multidimensional fetal heart rate variability analysis with acid-base balance at birth.

    Science.gov (United States)

    Frasch, Martin G; Xu, Yawen; Stampalija, Tamara; Durosier, Lucien D; Herry, Christophe; Wang, Xiaogang; Casati, Daniela; Seely, Andrew Je; Alfirevic, Zarko; Gao, Xin; Ferrazzi, Enrico

    2014-12-01

    Fetal monitoring during labour currently fails to accurately detect acidemia. We developed a method to assess the multidimensional properties of fetal heart rate variability (fHRV) from trans-abdominal fetal electrocardiogram (fECG) during labour. We aimed to assess this novel bioinformatics approach for correlation between fHRV and neonatal pH or base excess (BE) at birth.We enrolled a prospective pilot cohort of uncomplicated singleton pregnancies at 38-42 weeks' gestation in Milan, Italy, and Liverpool, UK. Fetal monitoring was performed by standard cardiotocography. Simultaneously, with fECG (high sampling frequency) was recorded. To ensure clinician blinding, fECG information was not displayed. Data from the last 60 min preceding onset of second-stage labour were analyzed using clinically validated continuous individualized multiorgan variability analysis (CIMVA) software in 5 min overlapping windows. CIMVA allows simultaneous calculation of 101 fHRV measures across five fHRV signal analysis domains. We validated our mathematical prediction model internally with 80:20 cross-validation split, comparing results to cord pH and BE at birth.The cohort consisted of 60 women with neonatal pH values at birth ranging from 7.44 to 6.99 and BE from -0.3 to -18.7 mmol L(-1). Our model predicted pH from 30 fHRV measures (R(2) = 0.90, P base balance at birth. Further refinement and validation in larger cohorts are needed. These new measurements of fHRV might offer a new opportunity to predict fetal acid-base balance at birth.

  1. A systematic review of prenatal screening for congenital heart disease by fetal electrocardiography.

    Science.gov (United States)

    Verdurmen, Kim M J; Eijsvoogel, Noortje B; Lempersz, Carlijn; Vullings, Rik; Schroer, Christian; van Laar, Judith O E H; Oei, S Guid

    2016-11-01

    Congenital heart disease (CHD) is the most common severe congenital anomaly worldwide. Diagnosis early in pregnancy is important, but the detection rate by two-dimensional ultrasonography is only 65%-81%. To evaluate existing data on CHD and noninvasive abdominal fetal electrocardiography (ECG). A systematic review was performed through a search of the Cochrane Library, PubMed, and Embase for studies published up to April 2016 using the terms "congenital heart disease," "fetal electrocardiogram," and other similar keywords. Primary articles that described changes in fetal ECG among fetuses with CHD published in English were included. Outcomes of interest were changes in fetal ECG parameters observed for fetuses with congenital heart disease. Findings were reported descriptively. Only five studies described changes observed in the fetal electrocardiogram for fetuses with CHD, including heart rate, heart rate variability, and PR, QRS, and QT intervals. Fetal ECG reflects the intimate relationship between the cardiac nerve conduction system and the structural morphology of the heart. It seems particularly helpful in detecting the electrophysiological effects of cardiac anatomic defects (e.g. hypotrophy, hypertrophy, and conduction interruption). Fetal ECG might be a promising clinical tool to complement ultrasonography in the screening program for CHD. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  2. The role of abnormal fetal heart rate in scheduling chorionic villus sampling.

    Science.gov (United States)

    Yagel, S; Anteby, E; Ron, M; Hochner-Celnikier, D; Achiron, R

    1992-09-01

    To assess the value of fetal heart rate (FHR) measurements in predicting spontaneous fetal loss in pregnancies scheduled for chorionic villus sampling (CVS). A prospective descriptive study. Two hospital departments of obstetrics and gynaecology in Israel. 114 women between 9 and 11 weeks gestation scheduled for chorionic villus sampling (CVS). Fetal heart rate was measured by transvaginal Doppler ultrasound and compared with a monogram established from 75 fetuses. Whenever a normal FHR was recorded, CVS was performed immediately. 106 women had a normal FHR and underwent CVS; two of these pregnancies ended in miscarriage. In five pregnancies no fetal heart beats could be identified and fetal death was diagnosed. In three pregnancies an abnormal FHR was recorded and CVS was postponed; all three pregnancies ended in miscarriage within 2 weeks. Determination of FHR correlated with crown-rump length could be useful in predicting spontaneous miscarriage before performing any invasive procedure late in the first trimester.

  3. Fetal Intelligent Navigation Echocardiography (FINE): a novel method for rapid, simple, and automatic examination of the fetal heart.

    Science.gov (United States)

    Yeo, Lami; Romero, Roberto

    2013-09-01

    To describe a novel method (Fetal Intelligent Navigation Echocardiography (FINE)) for visualization of standard fetal echocardiography views from volume datasets obtained with spatiotemporal image correlation (STIC) and application of 'intelligent navigation' technology. We developed a method to: 1) demonstrate nine cardiac diagnostic planes; and 2) spontaneously navigate the anatomy surrounding each of the nine cardiac diagnostic planes (Virtual Intelligent Sonographer Assistance (VIS-Assistance®)). The method consists of marking seven anatomical structures of the fetal heart. The following echocardiography views are then automatically generated: 1) four chamber; 2) five chamber; 3) left ventricular outflow tract; 4) short-axis view of great vessels/right ventricular outflow tract; 5) three vessels and trachea; 6) abdomen/stomach; 7) ductal arch; 8) aortic arch; and 9) superior and inferior vena cava. The FINE method was tested in a separate set of 50 STIC volumes of normal hearts (18.6-37.2 weeks of gestation), and visualization rates for fetal echocardiography views using diagnostic planes and/or VIS-Assistance® were calculated. To examine the feasibility of identifying abnormal cardiac anatomy, we tested the method in four cases with proven congenital heart defects (coarctation of aorta, tetralogy of Fallot, transposition of great vessels and pulmonary atresia with intact ventricular septum). In normal cases, the FINE method was able to generate nine fetal echocardiography views using: 1) diagnostic planes in 78-100% of cases; 2) VIS-Assistance® in 98-100% of cases; and 3) a combination of diagnostic planes and/or VIS-Assistance® in 98-100% of cases. In all four abnormal cases, the FINE method demonstrated evidence of abnormal fetal cardiac anatomy. The FINE method can be used to visualize nine standard fetal echocardiography views in normal hearts by applying 'intelligent navigation' technology to STIC volume datasets. This method can simplify

  4. Investigation of the interaction of radiation and cardiotoxic anticancer agents using a fetal mouse heart organ culture system

    International Nuclear Information System (INIS)

    Kimler, B.F.; Rethorst, R.D.; Cox, G.G.

    1985-01-01

    The fetal mouse heart organ culture was utilized in an attempt to predict the cardiotoxic effects of combinations of radiation, Adriamycin (ADR), and Dihydroxyanthraquinone (DHAQ), antineoplastic agents which have been shown to produce clinical cardiomyopathy. Seventeen-day fetal hearts were removed and placed in a culture system of micro-titer plates. A single heart was placed in each well on a piece of aluminum mesh to keep the heart above the culture medium but bathed by capillary action. The plates were then placed in a 100% oxygen environment at 37 0 C. Treatments were performed on day 1 after culture: radiation doses (Cs-137) of 10, 20, or 40 Gy; drug treatment with 10, 30, or 100 μg/ml of ADR; 5, 20, or 50 μg/ml of DHAQ; and combinations and sequences of drug and radiation. Hearts were checked every day for functional activity as evidenced by a continuous heart beat. Untreated hearts beat rhythmically for up to 9 days; treated hearts stopped beating earlier. Using an endpoint of functional retention time, dose response curves were obtained for all individual agents and for combinations of agents. This system may help to predict the cardiotoxic effects that result from the use of these drugs and radiation. It may also aid in the development of new anthracycline chemotherapeutic agents that lack cardiotoxicity

  5. A genome resource to address mechanisms of developmental programming: determination of the fetal sheep heart transcriptome.

    Science.gov (United States)

    Cox, Laura A; Glenn, Jeremy P; Spradling, Kimberly D; Nijland, Mark J; Garcia, Roy; Nathanielsz, Peter W; Ford, Stephen P

    2012-06-15

    The pregnant sheep has provided seminal insights into reproduction related to animal and human development (ovarian function, fertility, implantation, fetal growth, parturition and lactation). Fetal sheep physiology has been extensively studied since 1950, contributing significantly to the basis for our understanding of many aspects of fetal development and behaviour that remain in use in clinical practice today. Understanding mechanisms requires the combination of systems approaches uniquely available in fetal sheep with the power of genomic studies. Absence of the full range of sheep genomic resources has limited the full realization of the power of this model, impeding progress in emerging areas of pregnancy biology such as developmental programming. We have examined the expressed fetal sheep heart transcriptome using high-throughput sequencing technologies. In so doing we identified 36,737 novel transcripts and describe genes, gene variants and pathways relevant to fundamental developmental mechanisms. Genes with the highest expression levels and with novel exons in the fetal heart transcriptome are known to play central roles in muscle development. We show that high-throughput sequencing methods can generate extensive transcriptome information in the absence of an assembled and annotated genome for that species. The gene sequence data obtained provide a unique genomic resource for sheep specific genetic technology development and, combined with the polymorphism data, augment annotation and assembly of the sheep genome. In addition, identification and pathway analysis of novel fetal sheep heart transcriptome splice variants is a first step towards revealing mechanisms of genetic variation and gene environment interactions during fetal heart development.

  6. An undeliverable fetus with an ominous fetal heart pattern: an obstetric dilemma.

    Science.gov (United States)

    Katz, M; Sokal, M M; Lilling, M

    1979-12-01

    An unusual fetal heart rate (FHR) pattern was detected in a patient with sickle cell crisis in early labor. Despite the potentially ominous significance of this pattern, immediate delivery by cesarean section had to be deferred because of maternal contraindications. Institution of treatment directed at possible etiologic factors failed to correct the heart rate abnormalities. An attempt at symptomatic treatment by administration of propranolol to the mother was successful and was associated with good fetal outcome.

  7. Self-gating MR imaging of the fetal heart: comparison with real cardiac triggering

    International Nuclear Information System (INIS)

    Yamamura, Jin; Frisch, Michael; Ecker, Hannes; Adam, Gerhard; Wedegaertner, Ulrike; Graessner, Joachim; Hecher, Kurt

    2011-01-01

    To investigate the self-gating technique for MR imaging of the fetal heart in a sheep model. MR images of 6 fetal sheep heart were obtained at 1.5T. For self-gating MRI of the fetal heart a cine SSFP in short axis, two and four chamber view was used. Self-gated images were compared with real cardiac triggered MR images (pulse-wave triggering). MRI of the fetal heart was performed using both techniques simultaneously. Image quality was assessed and the left ventricular volume and function were measured and compared. Compared with pulse-wave triggering, the self-gating technique produced slightly inferior images with artifacts. Especially the atrial septum could not be so clearly depicted. The contraction of the fetal heart was shown in cine sequences in both techniques. The average blood volumes could be measured with both techniques with no significant difference: at end-systole 3.1 ml (SD± 0.2), at end-diastole 4.9 ml (±0.2), with ejection fractions at 38.6%, respectively 39%. Both self-gating and pulse-wave triggered cardiac MRI of the fetal heart allowed the evaluation of anatomical structures and functional information. Images obtained by self-gating technique were slightly inferior than the pulse-wave triggered MRI. (orig.)

  8. Biphasic changes in fetal heart rate variability in preterm fetal sheep developing hypotension after acute on chronic lipopolysaccharide exposure.

    Science.gov (United States)

    Lear, Christopher A; Davidson, Joanne O; Booth, Lindsea C; Wassink, Guido; Galinsky, Robert; Drury, Paul P; Fraser, Mhoyra; Bennet, Laura; Gunn, Alistair J

    2014-08-15

    Perinatal exposure to infection is highly associated with adverse outcomes. Experimentally, acute, severe exposure to gram-negative bacterial lipopolysaccharide (LPS) is associated with increased fetal heart rate variability (FHRV). It is unknown whether FHRV is affected by subclinical infection with or without acute exacerbations. We therefore tested the hypothesis that FHRV would be associated with hypotension after acute on chronic exposure to LPS. Chronically instrumented fetal sheep at 0.7 gestation were exposed to a continuous low-dose LPS infusion (n = 12, 100 ng/kg over 24 h, followed by 250 ng·kg(-1)·24 h(-1) for a further 96 h) or the same volume of saline (n = 10). Boluses of either 1 μg LPS or saline were given at 48, 72, and 96 h. Low-dose infusion was not associated with hemodynamic or FHRV changes. The first LPS bolus was associated with tachycardia and suppression of nuchal electromyographic activity in all fetuses. Seven of twelve fetuses developed hypotension (a fall in mean arterial blood pressure ≥5 mmHg). FHRV was transiently increased only at the onset of hypotension, in association with increased cytokine induction and electroencephalogram suppression. FHRV then fell before the nadir of hypotension, with transient suppression of short-term FHRV. After the second LPS bolus, the hypotension group showed a biphasic pattern of a transient increase in FHRV followed by more prolonged suppression. These findings suggest that infection-related hypotension in the preterm fetus mediates the transient increase in FHRV and that repeated exposure to LPS leads to progressive loss of FHRV. Copyright © 2014 the American Physiological Society.

  9. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association.

    Science.gov (United States)

    Donofrio, Mary T; Moon-Grady, Anita J; Hornberger, Lisa K; Copel, Joshua A; Sklansky, Mark S; Abuhamad, Alfred; Cuneo, Bettina F; Huhta, James C; Jonas, Richard A; Krishnan, Anita; Lacey, Stephanie; Lee, Wesley; Michelfelder, Erik C; Rempel, Gwen R; Silverman, Norman H; Spray, Thomas L; Strasburger, Janette F; Tworetzky, Wayne; Rychik, Jack

    2014-05-27

    The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin-twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room

  10. Classification of Fetal Heart Rate Tracings Based on Wavelet-Transform & Self-Organizing Map Neural Networks

    National Research Council Canada - National Science Library

    Vasios, G

    2001-01-01

    .... We demonstrate that it is possible to distinguish between healthy subjects and acidemic fetuses by way of wavelet transform analysis of the fetal heart rate recordings and fetal pulse oximetry (FSpO2...

  11. Interpreting category II fetal heart rate tracings: does meconium matter?

    Science.gov (United States)

    Frey, Heather A; Tuuli, Methodius G; Shanks, Anthony L; Macones, George A; Cahill, Alison G

    2014-12-01

    Category II fetal heart rate (FHR) tracings are considered indeterminate; thus, improved risk stratification of category II FHR tracings is needed. We estimated whether the presence of meconium increased the risk of adverse neonatal outcomes. This study was conducted within a prospective cohort of 5000 women with singleton pregnancies who were admitted in labor at term. Pregnancies with category II FHR in the 60 minutes before delivery were included. FHR data were extracted by trained nurses who were blinded to clinical outcome. The exposure was the presence of meconium. The primary outcome was a composite neonatal morbidity defined as ≥1 of the following: neonatal death, neurologic morbidity, respiratory morbidity, hypotension that required treatment, and sepsis. Secondary outcomes were nursery admission, cord pH, 5-minute Apgar score, and components of the composite. Logistic regression was used to adjust for confounders. Of the 3257 women with category II FHR tracings, 693 women (21.3%) had meconium, and 2564 women (78.7%) did not. Meconium was associated with higher risk of the composite morbidity (adjusted odds ratio, 2.49; 95% confidence interval, 1.78-3.48) and increased risks of the secondary outcomes. The associations remained significant when infants with meconium aspiration syndrome were excluded. Thick meconium was associated significantly with the composite morbidity. The presence of meconium is associated with an increased risk of neonatal morbidity in women with category II FHR pattern. This clinical factor may assist clinicians in managing category II FHR patterns in labor. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Epicardial excitation pattern as observed in the isolated revived and perfused fetal human heart

    NARCIS (Netherlands)

    Durrer, D.; Büller, J.; Graaff, P.; Lo, G.I.; Meijler, F.L.

    1961-01-01

    The resuscitated fetal human heart can be used as an experimental tooI for the investigation of the excitatory process in the human heart. During perfusion the configuration of the epicardial electrocardiograms does not change appreciably. For accurate recording permitting a detailed analysis, the

  13. Fetal programming as a predictor of adult health or disease: the need to reevaluate fetal heart function.

    Science.gov (United States)

    Miranda, Joana O; Ramalho, Carla; Henriques-Coelho, Tiago; Areias, José Carlos

    2017-11-01

    Epidemiologic and experimental evidence suggests that adverse stimuli during critical periods in utero permanently alters organ structure and function and may have persistent consequences for the long-term health of the offspring. Fetal hypoxia, maternal malnutrition, or ventricular overloading are among the major adverse conditions that can compromise cardiovascular development in early life. With the heart as a central organ in fetal adaptive mechanisms, a deeper understanding of the fetal cardiovascular physiology and of the echocardiographic tools to assess both normal and stressed pregnancies would give precious information on fetal well-being and hopefully may help in early identification of special risk groups for cardiovascular diseases later in life. Assessment of cardiac function in the fetus represents an additional challenge when comparing to children and adults, requiring advanced training and a critical approach to properly acquire and interpret functional parameters. This review summarizes the basic fetal cardiovascular physiology and the main differences from the mature postnatal circulation, provides an overview of the particularities of echocardiographic evaluation in the fetus, and finally proposes an integrated view of in utero programming of cardiovascular diseases later in life, highlighting priorities for future clinical research.

  14. Aerobic exercise during pregnancy and presence of fetal-maternal heart rate synchronization.

    Directory of Open Access Journals (Sweden)

    Peter Van Leeuwen

    Full Text Available It has been shown that short-term direct interaction between maternal and fetal heart rates may take place and that this interaction is affected by the rate of maternal respiration. The aim of this study was to determine the effect of maternal aerobic exercise during pregnancy on the occurrence of fetal-maternal heart rate synchronization.In 40 pregnant women at the 36th week of gestation, 21 of whom exercised regularly, we acquired 18 min. RR interval time series obtained simultaneously in the mothers and their fetuses from magnetocardiographic recordings. The time series of the two groups were examined with respect to their heart rate variability, the maternal respiratory rate and the presence of synchronization epochs as determined on the basis of synchrograms. Surrogate data were used to assess whether the occurrence of synchronization was due to chance.In the original data, we found synchronization occurred less often in pregnancies in which the mothers had exercised regularly. These subjects also displayed higher combined fetal-maternal heart rate variability and lower maternal respiratory rates. Analysis of the surrogate data showed shorter epochs of synchronization and a lack of the phase coordination found between maternal and fetal beat timing in the original data.The results suggest that fetal-maternal heart rate coupling is present but generally weak. Maternal exercise has a damping effect on its occurrence, most likely due to an increase in beat-to-beat differences, higher vagal tone and slower breathing rates.

  15. [Effect of Music Intervention on Maternal Anxiety and Fetal Heart Rate Pattern During Non-Stress Test].

    Science.gov (United States)

    Oh, Myung Ok; Kim, Young Jeoum; Baek, Cho Hee; Kim, Ju Hee; Park, No Mi; Yu, Mi Jeong; Song, Han Sol

    2016-06-01

    The purpose of this cross-over experimental study was to examine effects of music intervention on maternal anxiety, fetal heart rate pattern and testing time during non-stress tests (NST) for antenatal fetal assessment. Sixty pregnant women within 28 to 40 gestational weeks were randomly assigned to either the experimental group (n=30) or control group (n=30). Music intervention was provided to pregnant women in the experimental group during NST. Degree of maternal anxiety and fetal heart rate pattern were our primary outcomes. State-trait anxiety inventory, blood pressure, pulse rate, and changes in peripheral skin temperature were assessed to determine the degree of maternal anxiety. Baseline fetal heart rate, frequency of acceleration in fetal heart rate, fetal movement test and testing time for reactive NST were assessed to measure the fetal heart rate pattern. The experimental group showed significantly lower scores in state anxiety than the control group. There were no significant differences in systolic blood pressure and pulse rate between the two groups. Baseline fetal heart rate was significantly lower in the experimental group than in the control group. Frequency of acceleration in fetal heart rate was significantly increased in the experimental group compared to the control group. There were no significant differences in fetal movement and testing time for reactive NST between the two groups. Present results suggest that music intervention could be an effective nursing intervention for alel viating anxiety during non-stress test.

  16. PPAR ligands improve impaired metabolic pathways in fetal hearts of diabetic rats.

    Science.gov (United States)

    Kurtz, Melisa; Capobianco, Evangelina; Martinez, Nora; Roberti, Sabrina Lorena; Arany, Edith; Jawerbaum, Alicia

    2014-10-01

    In maternal diabetes, the fetal heart can be structurally and functionally affected. Maternal diets enriched in certain unsaturated fatty acids can activate the nuclear receptors peroxisome proliferator-activated receptors (PPARs) and regulate metabolic and anti-inflammatory pathways during development. Our aim was to investigate whether PPARα expression, lipid metabolism, lipoperoxidation, and nitric oxide (NO) production are altered in the fetal hearts of diabetic rats, and to analyze the putative effects of in vivo PPAR activation on these parameters. We found decreased PPARα expression in the hearts of male but not female fetuses of diabetic rats when compared with controls. Fetal treatments with the PPARα ligand leukotriene B4 upregulated the expression of PPARα and target genes involved in fatty acid oxidation in the fetal hearts. Increased concentrations of triglycerides, cholesterol, and phospholipids were found in the hearts of fetuses of diabetic rats. Maternal treatments with diets supplemented with 6% olive oil or 6% safflower oil, enriched in unsaturated fatty acids that can activate PPARs, led to few changes in lipid concentrations, but up-regulated PPARα expression in fetal hearts. NO production, which was increased in the hearts of male and female fetuses in the diabetic group, and lipoperoxidation, which was increased in the hearts of male fetuses in the diabetic group, was reduced by the maternal treatments supplemented with safflower oil. In conclusion, impaired PPARα expression, altered lipid metabolism, and increased oxidative and nitridergic pathways were evidenced in hearts of fetuses of diabetic rats and were regulated in a gender-dependent manner by treatments enriched with PPAR ligands. © 2014 Society for Endocrinology.

  17. Correlating multidimensional fetal heart rate variability analysis with acid-base balance at birth

    International Nuclear Information System (INIS)

    Frasch, Martin G; Durosier, Lucien D; Xu, Yawen; Wang, Xiaogang; Gao, Xin; Stampalija, Tamara; Herry, Christophe; Seely, Andrew JE; Casati, Daniela; Ferrazzi, Enrico; Alfirevic, Zarko

    2014-01-01

    Fetal monitoring during labour currently fails to accurately detect acidemia. We developed a method to assess the multidimensional properties of fetal heart rate variability (fHRV) from trans-abdominal fetal electrocardiogram (fECG) during labour. We aimed to assess this novel bioinformatics approach for correlation between fHRV and neonatal pH or base excess (BE) at birth. We enrolled a prospective pilot cohort of uncomplicated singleton pregnancies at 38–42 weeks’ gestation in Milan, Italy, and Liverpool, UK. Fetal monitoring was performed by standard cardiotocography. Simultaneously, with fECG (high sampling frequency) was recorded. To ensure clinician blinding, fECG information was not displayed. Data from the last 60 min preceding onset of second-stage labour were analyzed using clinically validated continuous individualized multiorgan variability analysis (CIMVA) software in 5 min overlapping windows. CIMVA allows simultaneous calculation of 101 fHRV measures across five fHRV signal analysis domains. We validated our mathematical prediction model internally with 80:20 cross-validation split, comparing results to cord pH and BE at birth. The cohort consisted of 60 women with neonatal pH values at birth ranging from 7.44 to 6.99 and BE from −0.3 to −18.7 mmol L −1 . Our model predicted pH from 30 fHRV measures (R 2 = 0.90, P < 0.001) and BE from 21 fHRV measures (R 2 = 0.77, P < 0.001). Novel bioinformatics approach (CIMVA) applied to fHRV derived from trans-abdominal fECG during labor correlated well with acid-base balance at birth. Further refinement and validation in larger cohorts are needed. These new measurements of fHRV might offer a new opportunity to predict fetal acid-base balance at birth. (fast track communication)

  18. Detection of congenital heart disease by fetal echocardiography

    International Nuclear Information System (INIS)

    Fayyaz, A.; Majeed, S.M.I.

    2013-01-01

    Objective: The objective of the study was to determine the sensitivity, specificity, accuracy and predictive value of fetal echocardiography in our set up using postnatal echocardiography as gold standard. Study Design: Validation study. Place and Duration of study: This is an ongoing study in the Radiology department of CMH Rawalpindi and Armed Forces Institute of Cardiology (AFIC) Rawalpindi and the data collected from January 2007 to Jan 2012 is presented. Patients and Methods: Two hundred eighty seven patients reported for fetal echocardiography. Two hundred twenty nine patients were subsequently included in the study. These included patients of all ages who reported to the Radiology department of CMH Rawalpindi for fetal echocardiography. Fetal echo was done on Toshiba Aplio with 3.5 MHz probe having Doppler facility. Post natal evaluation was done by a pediatric cardiologist. Results: There were 207 (90.4%) true negative cases, 15 (6.6%) true positive, 2 (0.9%) false positive and 6 (2.2%) false negative cases. The sensitivity, specificity, positive and negative predictive values were 75%, 99%, 88%, 97% respectively. Conclusion: Fetal echocardiography has high specificity, negative predictive values and accuracy and cases diagnosed as normal can reassure the parents about the normal cardiac status of the fetus. (author)

  19. Motion compensated cine CMR of the fetal heart using radial undersampling and compressed sensing.

    Science.gov (United States)

    Roy, Christopher W; Seed, Mike; Kingdom, John C; Macgowan, Christopher K

    2017-03-20

    To develop and evaluate a reconstruction framework for high resolution time-resolved CMR of the fetal heart in the presence of motion. Data were acquired using a golden angle radial trajectory in seven fetal subjects and reconstructed as real-time images to detect fetal movement. Data acquired during through-plane motion were discarded whereas in-plane motion was corrected. A fetal cardiac gating signal was extracted to sort the corrected data by cardiac phase, allowing reconstruction of cine images. The quality of motion corrected images and the effect of data undersampling were quantified using separate expressions for spatial blur and image error. Motion corrected reordered cine reconstructions (127 slices) showed improved image quality relative to both uncorrected cines and corresponding real-time images across a range of root-mean-squared (RMS) displacements (0.3-3.7 mm) and fetal heart rates (119-176 bpm). The relative spatial blur between cines with and without motion correction increased with in-plane RMS displacement leading to an effective decrease in the effective spatial resolution for images without motion correction. Image error between undersampled and reference images was less than 10% for reconstructions using 750 or more spokes, yielding a minimum acceptable scan time of approximately 4 s/slice during quiescent through plane motion. By rejecting data corrupted by through-plane motion, and correcting data corrupted by in-plane translation, the proposed reconstruction framework accounts for common sources of motion artifact (gross fetal movement, maternal respiration, fetal cardiac contraction) to produce high quality images of the fetal heart.

  20. Prenatally engineered autologous amniotic fluid stem cell-based heart valves in the fetal circulation.

    Science.gov (United States)

    Weber, Benedikt; Emmert, Maximilian Y; Behr, Luc; Schoenauer, Roman; Brokopp, Chad; Drögemüller, Cord; Modregger, Peter; Stampanoni, Marco; Vats, Divya; Rudin, Markus; Bürzle, Wilfried; Farine, Marc; Mazza, Edoardo; Frauenfelder, Thomas; Zannettino, Andrew C; Zünd, Gregor; Kretschmar, Oliver; Falk, Volkmar; Hoerstrup, Simon P

    2012-06-01

    Prenatal heart valve interventions aiming at the early and systematic correction of congenital cardiac malformations represent a promising treatment option in maternal-fetal care. However, definite fetal valve replacements require growing implants adaptive to fetal and postnatal development. The presented study investigates the fetal implantation of prenatally engineered living autologous cell-based heart valves. Autologous amniotic fluid cells (AFCs) were isolated from pregnant sheep between 122 and 128 days of gestation via transuterine sonographic sampling. Stented trileaflet heart valves were fabricated from biodegradable PGA-P4HB composite matrices (n = 9) and seeded with AFCs in vitro. Within the same intervention, tissue engineered heart valves (TEHVs) and unseeded controls were implanted orthotopically into the pulmonary position using an in-utero closed-heart hybrid approach. The transapical valve deployments were successful in all animals with acute survival of 77.8% of fetuses. TEHV in-vivo functionality was assessed using echocardiography as well as angiography. Fetuses were harvested up to 1 week after implantation representing a birth-relevant gestational age. TEHVs showed in vivo functionality with intact valvular integrity and absence of thrombus formation. The presented approach may serve as an experimental basis for future human prenatal cardiac interventions using fully biodegradable autologous cell-based living materials. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. Evolving changes in fetal heart rate variability and brain injury after hypoxia-ischaemia in preterm fetal sheep.

    Science.gov (United States)

    Yamaguchi, Kyohei; Lear, Christopher A; Beacom, Michael J; Ikeda, Tomoaki; Gunn, Alistair J; Bennet, Laura

    2018-01-08

    Fetal heart rate variability is a critical index of fetal wellbeing. Suppression of heart rate variability may provide prognostic information on the risk of hypoxic-ischaemic brain injury after birth. In the present study, we report the evolution of fetal heart rate variability after both mild and severe hypoxia-ischaemia. Both mild and severe hypoxia-ischaemia were associated with an initial, brief suppression of multiple measures of heart rate variability. This was followed by normal or increased levels of heart rate variability during the latent phase of injury. Severe hypoxia-ischaemia was subsequently associated with the prolonged suppression of measures of heart rate variability during the secondary phase of injury, which is the period of time when brain injury is no longer treatable. These findings suggest that a biphasic pattern of heart rate variability may be an early marker of brain injury when treatment or intervention is probably most effective. Hypoxia-ischaemia (HI) is a major contributor to preterm brain injury, although there are currently no reliable biomarkers for identifying infants who are at risk. We tested the hypothesis that fetal heart rate (FHR) and FHR variability (FHRV) would identify evolving brain injury after HI. Fetal sheep at 0.7 of gestation were subjected to either 15 (n = 10) or 25 min (n = 17) of complete umbilical cord occlusion or sham occlusion (n = 12). FHR and four measures of FHRV [short-term variation, long-term variation, standard deviation of normal to normal R-R intervals (SDNN), root mean square of successive differences) were assessed until 72 h after HI. All measures of FHRV were suppressed for the first 3-4 h in the 15 min group and 1-2 h in the 25 min group. Measures of FHRV recovered to control levels by 4 h in the 15 min group, whereas the 25 min group showed tachycardia and an increase in short-term variation and SDNN from 4 to 6 h after occlusion. The measures of FHRV then progressively

  2. Acceleration and deceleration capacity of fetal heart rate in an in-vivo sheep model.

    Directory of Open Access Journals (Sweden)

    Massimo W Rivolta

    Full Text Available BACKGROUND: Fetal heart rate (FHR variability is an indirect index of fetal autonomic nervous system (ANS integrity. FHR variability analysis in labor fails to detect early hypoxia and acidemia. Phase-rectified signal averaging (PRSA is a new method of complex biological signals analysis that is more resistant to non-stationarities, signal loss and artifacts. It quantifies the average cardiac acceleration and deceleration (AC/DC capacity. OBJECTIVE: The aims of the study were: (1 to investigate AC/DC in ovine fetuses exposed to acute hypoxic-acidemic insult; (2 to explore the relation between AC/DC and acid-base balance; and (3 to evaluate the influence of FHR decelerations and specific PRSA parameters on AC/DC computation. METHODS: Repetitive umbilical cord occlusions (UCOs were applied in 9 pregnant near-term sheep to obtain three phases of MILD, MODERATE, and SEVERE hypoxic-acidemic insult. Acid-base balance was sampled and fetal ECGs continuously recorded. AC/DC were calculated: (1 for a spectrum of T values (T = 1÷50 beats; the parameter limits the range of oscillations detected by PRSA; (2 on entire series of fetal RR intervals or on "stable" series that excluded FHR decelerations caused by UCOs. RESULTS: AC and DC progressively increased with UCOs phases (MILD vs. MODERATE and MODERATE vs. SEVERE, p<0.05 for DC [Formula: see text] = 2-5, and AC [Formula: see text] = 1-3. The time evolution of AC/DC correlated to acid-base balance (0.4<[Formula: see text]<0.9, p<0.05 with the highest [Formula: see text] for [Formula: see text]. PRSA was not independent from FHR decelerations caused by UCOs. CONCLUSIONS: This is the first in-vivo evaluation of PRSA on FHR analysis. In the presence of acute hypoxic-acidemia we found increasing values of AC/DC suggesting an activation of ANS. This correlation was strongest on time scale dominated by parasympathetic modulations. We identified the best performing [Formula: see text] parameters

  3. Thyroid hormone is required for growth adaptation to pressure load in the ovine fetal heart.

    Science.gov (United States)

    Segar, Jeffrey L; Volk, Ken A; Lipman, Michael H B; Scholz, Thomas D

    2013-03-01

    Thyroid hormone exerts broad effects on the adult heart, but little is known regarding the role of thyroid hormone in the regulation of cardiac growth early in development and in response to pathophysiological conditions. To address this issue, we determined the effects of fetal thyroidectomy on cardiac growth and growth-related gene expression in control and pulmonary-artery-banded fetal sheep. Fetal thyroidectomy (THX) and/or placement of a restrictive pulmonary artery band (PAB) were performed at 126 ± 1 days of gestation (term, 145 days). Four groups of animals [n = 5-6 in each group; (i) control; (ii) fetal THX; (iii) fetal PAB; and (iv) fetal PAB + THX] were monitored for 1 week prior to being killed. Fetal heart rate was significantly lower in the two THX groups compared with the non-THX groups, while mean arterial blood pressure was similar among groups. Combined left and right ventricle free wall + septum weight, expressed per kilogram of fetal weight, was significantly increased in PAB (6.27 ± 0.85 g kg(-1)) compared with control animals (4.72 ± 0.12 g kg(-1)). Thyroidectomy significantly attenuated the increase in cardiac mass associated with PAB (4.94 ± 0.13 g kg(-1)), while THX alone had no detectable effect on heart mass (4.95 ± 0.27 g kg(-1)). The percentage of binucleated cardiomyocytes was significantly decreased in THX and PAB +THX groups (∼16%) compared with the non-THX groups (∼27%). No differences in levels of activated Akt, extracellular signal-regulated kinase or c-Jun N-terminal kinase were detected among the groups. Markers of cellular proliferation but not apoptosis or expression of growth-related genes were lower in the THX and THX+ PAB groups relative to thyroid-intact animals. These findings suggest that in the late-gestation fetal heart, thyroid hormone has important cellular growth functions in both physiological and pathophysiological states. Specifically, thyroid hormone is required for adaptive fetal cardiac growth in

  4. Intrapartum fetal heart rate classification from trajectory in Sparse SVM feature space.

    Science.gov (United States)

    Spilka, J; Frecon, J; Leonarduzzi, R; Pustelnik, N; Abry, P; Doret, M

    2015-01-01

    Intrapartum fetal heart rate (FHR) constitutes a prominent source of information for the assessment of fetal reactions to stress events during delivery. Yet, early detection of fetal acidosis remains a challenging signal processing task. The originality of the present contribution are three-fold: multiscale representations and wavelet leader based multifractal analysis are used to quantify FHR variability ; Supervised classification is achieved by means of Sparse-SVM that aim jointly to achieve optimal detection performance and to select relevant features in a multivariate setting ; Trajectories in the feature space accounting for the evolution along time of features while labor progresses are involved in the construction of indices quantifying fetal health. The classification performance permitted by this combination of tools are quantified on a intrapartum FHR large database (≃ 1250 subjects) collected at a French academic public hospital.

  5. Fetal Heart Rate Reactivity Differs by Women's Psychiatric Status: An Early Marker for Developmental Risk?

    Science.gov (United States)

    Monk, Catherine; Sloan, Richard P.; Myers, Michael M.; Ellman, Lauren; Werner, Elizabeth; Jeon, Jiyeon; Tager, Felice; Fifer, William P.

    2004-01-01

    Objective: To determine whether there are differences in fetal heart rate (FHR) reactivity associated with women's psychiatric status. Method: In 57 women in their 36th to 38th week of pregnancy (mean age 27 [+ or -] 6 years), electrocardiogram, blood pressure (BP), respiration (RSP), and FHR were measured during baseline and a psychological…

  6. Intermittent auscultation versus continuous fetal monitoring: exploring factors that influence birthing unit nurses' fetal surveillance practice using theoretical domains framework.

    Science.gov (United States)

    Patey, Andrea M; Curran, Janet A; Sprague, Ann E; Francis, Jill J; Driedger, S Michelle; Légaré, France; Lemyre, Louise; Pomey, Marie-Pascale A; Grimshaw, Jeremy M

    2017-09-25

    Intermittent Auscultation (IA) is the recommended method of fetal surveillance for healthy women in labour. However, the majority of women receive continuous electronic monitoring. We used the Theoretical Domains Framework (TDF) to explore the views of Birthing Unit nurses about using IA as their primary method of fetal surveillance for healthy women in labour. Using a semi-structured interview guide, we interviewed a convenience sample of birthing unit nurses throughout Ontario, Canada to elicit their views about fetal surveillance. Interviews were recorded and transcribed verbatim. Transcripts were content analysed using the TDF and themes were framed as belief statements. Domains potentially key to changing fetal surveillance behaviour and informing intervention design were identified by noting the frequencies of beliefs, content, and their reported influence on the use of IA. We interviewed 12 birthing unit nurses. Seven of the 12 TDF domains were perceived to be key to changing birthing unit nurses' behaviour The nurses reported that competing tasks, time constraints and the necessity to multitask often limit their ability to perform IA (domains Beliefs about capabilities; Environmental context and resources). Some nurses noted the decision to use IA was something that they consciously thought about with every patient while others stated it their default decision as long as there were no risk factors (Memory, attention and decision processes, Nature of behaviour). They identified positive consequences (e.g. avoid unnecessary interventions, mother-centered care) and negative consequences of using IA (e.g. legal concerns) and reported that the negative consequences can often outweigh positive consequences (Beliefs about consequences). Some reported that hospital policies and varying support from care teams inhibited their use of IA (Social influences), and that support from the entire team and hospital management would likely increase their use (Social

  7. Maternal and fetal outcome in women with rheumatic heart disease: a 3-year observational study.

    Science.gov (United States)

    Rezk, Mohamed; Gamal, Awni

    2016-08-01

    To assess prospectively the maternal and fetal outcome in women with rheumatic heart disease (RHD). This was a prospective 3-year observational study carried out at Menoufia University Hospital, Egypt in which 192 patients out of 9856 pregnant women were diagnosed with RHD and divided into two groups: low- and high-risk groups based on the New York Heart Association (NYHA) functional classification. Enrolled patients were followed to assess the maternal and fetal outcome. Mitral valve disease was the commonest single valve (118/192, 51.4 %) affected by rheumatic fever. Cardiac women with NYHA class I&II characterized by having fewer pulmonary hypertension, taking cardiac medications, prior heart failure and prior cardiac surgery than those with NYHA class III&IV. On the hand, cardiac women with NYHA III&IV have poorer maternal outcome with more complications as heart failure, arrhythmias, thromboembolism, admission to cardiac ICU, delivery by cesarean section and defective lactation. Prematurity and NICU admission were significantly more in NYHA III&IV. RHD still constitutes a major cause of maternal and fetal morbidity and mortality. Multidisciplinary cooperation, proper preconception and antenatal care are the key measures to improve the outcomes of these patients.

  8. Microarray Analysis of Differential Gene Expression Profile Between Human Fetal and Adult Heart.

    Science.gov (United States)

    Geng, Zhimin; Wang, Jue; Pan, Lulu; Li, Ming; Zhang, Jitai; Cai, Xueli; Chu, Maoping

    2017-04-01

    Although many changes have been discovered during heart maturation, the genetic mechanisms involved in the changes between immature and mature myocardium have only been partially elucidated. Here, gene expression profile changed between the human fetal and adult heart was characterized. A human microarray was applied to define the gene expression signatures of the fetal (13-17 weeks of gestation, n = 4) and adult hearts (30-40 years old, n = 4). Gene ontology analyses, pathway analyses, gene set enrichment analyses, and signal transduction network were performed to predict the function of the differentially expressed genes. Ten mRNAs were confirmed by quantificational real-time polymerase chain reaction. 5547 mRNAs were found to be significantly differentially expressed. "Cell cycle" was the most enriched pathway in the down-regulated genes. EFGR, IGF1R, and ITGB1 play a central role in the regulation of heart development. EGFR, IGF1R, and FGFR2 were the core genes regulating cardiac cell proliferation. The quantificational real-time polymerase chain reaction results were concordant with the microarray data. Our data identified the transcriptional regulation of heart development in the second trimester and the potential regulators that play a prominent role in the regulation of heart development and cardiac cells proliferation.

  9. Randomized controlled trial of prenatal zinc supplementation and the development of fetal heart rate.

    Science.gov (United States)

    Merialdi, Mario; Caulfield, Laura E; Zavaleta, Nelly; Figueroa, Alberto; Dominici, Francesca; Dipietro, Janet A

    2004-04-01

    This study was undertaken to evaluate whether prenatal zinc supplementation affects maturation of fetal cardiac patterns. A randomized double-blind controlled trial among 242 low-income Peruvian women was performed. Beginning at 10 to 16 weeks' gestation, women received supplements containing 60 mg iron, 250 microg folic acid with or without 25 mg zinc. Fetal heart rate (mean FHR, variability [HRV], number of accelerations) and movements (number and amplitude of movement bouts, time spent moving) were electronically monitored monthly from 20 weeks' gestation. Developmental trends were evaluated by supplement type among 195 women who completed the trial and had no serious complications of pregnancy. Zinc supplementation was associated with lower FHR, greater number of accelerations, and greater HRV. Supplementation effects on HRV and accelerations were more pronounced after 28 weeks' gestation. No differences in motor activity were observed. Prenatal supplementation of zinc-deficient mothers may be beneficial to fetal neurobehavioral development.

  10. Extracting fetal heart beats from maternal abdominal recordings: selection of the optimal principal components

    International Nuclear Information System (INIS)

    Di Maria, Costanzo; Liu, Chengyu; Zheng, Dingchang; Murray, Alan; Langley, Philip

    2014-01-01

    This study presents a systematic comparison of different approaches to the automated selection of the principal components (PC) which optimise the detection of maternal and fetal heart beats from non-invasive maternal abdominal recordings. A public database of 75 4-channel non-invasive maternal abdominal recordings was used for training the algorithm. Four methods were developed and assessed to determine the optimal PC: (1) power spectral distribution, (2) root mean square, (3) sample entropy, and (4) QRS template. The sensitivity of the performance of the algorithm to large-amplitude noise removal (by wavelet de-noising) and maternal beat cancellation methods were also assessed. The accuracy of maternal and fetal beat detection was assessed against reference annotations and quantified using the detection accuracy score F1 [2*PPV*Se / (PPV + Se)], sensitivity (Se), and positive predictive value (PPV). The best performing implementation was assessed on a test dataset of 100 recordings and the agreement between the computed and the reference fetal heart rate (fHR) and fetal RR (fRR) time series quantified. The best performance for detecting maternal beats (F1 99.3%, Se 99.0%, PPV 99.7%) was obtained when using the QRS template method to select the optimal maternal PC and applying wavelet de-noising. The best performance for detecting fetal beats (F1 89.8%, Se 89.3%, PPV 90.5%) was obtained when the optimal fetal PC was selected using the sample entropy method and utilising a fixed-length time window for the cancellation of the maternal beats. The performance on the test dataset was 142.7 beats 2 /min 2 for fHR and 19.9 ms for fRR, ranking respectively 14 and 17 (out of 29) when compared to the other algorithms presented at the Physionet Challenge 2013. (paper)

  11. Feasibility of MRI of the fetal heart with balanced steady-state free precession sequence along fetal body and cardiac planes.

    Science.gov (United States)

    Saleem, Sahar N

    2008-10-01

    The purpose of this study was to evaluate the feasibility of imaging the fetal heart with a balanced steady-state free precession MRI sequence along the body and cardiac axes after inadequate echocardiography. After technically inadequate echocardiography, MRI was performed on 20 fetuses (mean gestational age, 24 weeks; range, 18-32 weeks) at risk of congenital heart disease. MRI was attempted along the three fetal body planes (n = 20) and cardiac axes (n = 3) without fetal sedation. The images were analyzed with an anatomic segmental approach. Each feature was classified as well visualized or poorly or not visualized. In each group, the Student's t test was used to assess the relation between visibility of fetal cardiac features and gestational age. Imaging was possible along the fetal body and cardiac axes. In the axial plane, a balanced four-chamber view was obtained in all fetuses, enabling evaluation of heart position, axis, chambers, and interventricular septum. The left and right ventricular outflow tracts were well visualized in 12 (60%) and nine (45%) of the fetuses, respectively; the three-vessel view was obtained in 10 fetuses (50%). With the combination of sagittal and coronal views, both ventricular outflow tracts were assessed in all fetuses. The superior and inferior venae cavae were identified in all fetuses, and at least one pulmonary vein was visualized in 17 fetuses (85%). There were no statistically significant differences between gestational age and lack of visualization of a cardiac feature that was attributed to fetal motion. MRI of the fetal heart with a steady-state free precession sequence in multiple planes and image analysis with an anatomic segmental approach to congenital heart disease are possible in situations that limit echocardiography.

  12. Nonreassuring fetal heart rate patterns and nucleated red blood cells in term neonates.

    Science.gov (United States)

    Kovalak, E Ebru; Dede, F Suat; Gelisen, Orhan; Dede, Hulya; Haberal, Ali

    2011-05-01

    The aim of this study was to evaluate the association between nonreassuring fetal heart rate patterns during labor and umbilical cord nucleated red blood cell counts. Nucleated red blood cell data was collected prospectively from 41 singleton term neonates presented with nonreassuring fetal heart rate patterns and/or meconium stained amniotic fluid during labor (study group) and from 45 term neonates without any evidence of nonreassuring fetal status (controls). Umbilical artery pH, blood gases and base excess were also determined to investigate the correlation between independent variables. The median nucleated red blood cells per 100 white blood cells were 13 (range 0-37) in the study group and 8 (range 0-21) in the control group. Stepwise regression analysis have identified meconium stained amniotic fluid (R(2) = 0.15, p patterns. Nucleated red blood cells in the cord blood of newborns were found to be elevated in patients with nonreassuring FHR patterns during labor. However, the wide range and the poor correlation of NRBC count with umbilical artery pH and blood gas values limit its clinical utility as a marker for fetal hypoxia.

  13. Detecting fetal heart sounds by means of Fractal Dimension analysis in the Wavelet domain.

    Science.gov (United States)

    Koutsiana, E; Hadjileontiadis, L J; Chouvarda, I; Khandoker, A H

    2017-07-01

    Phonocardiography is a low-cost technique for the detection of fetal heart sounds (FHS) that can extend clinical auscultation in mobile and home care setups. The work presented here examines the transferability of a Wavelet Transform (WT)-based method that combines also Fractal Dimension (FD) analysis, previously proposed as WT-FD for the cases of lung and bowel sound analysis [4], to the extraction of FHSs. The WT-FD method has been evaluated with 12 simulated FHS signals and has shown promising results in terms of accuracy and performance (89%) in identifying the location of heartbeat, even in cases of signals with additive noise up to (6dB). This robustness paves the way for WT-FD testing in real FHSs, recorded under clinical setting, clearly contributing to better evaluation of the fetal heart functionality.

  14. Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing.

    Science.gov (United States)

    Devane, Declan; Lalor, Joan G; Daly, Sean; McGuire, William; Cuthbert, Anna; Smith, Valerie

    2017-01-26

    The admission cardiotocograph (CTG) is a commonly used screening test consisting of a short (usually 20 minutes) recording of the fetal heart rate (FHR) and uterine activity performed on the mother's admission to the labour ward. This is an update of a review published in 2012. To compare the effects of admission cardiotocography with intermittent auscultation of the FHR on maternal and infant outcomes for pregnant women without risk factors on their admission to the labour ward. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register to 30 November 2016 and we planned to review the reference list of retrieved papers All randomised and quasi-randomised trials comparing admission CTG with intermittent auscultation of the FHR for pregnant women between 37 and 42 completed weeks of pregnancy and considered to be at low risk of intrapartum fetal hypoxia and of developing complications during labour. Two authors independently assessed trial eligibility and quality, and extracted data. Data were checked for accuracy. We included no new trials in this update. We included four trials involving more than 13,000 women which were conducted in the UK and Ireland and included women in labour. Three trials were funded by the hospitals where the trials took place and one trial was funded by the Scottish government. No declarations of interest were made in two trials; the remaining two trials did not mention declarations of interest. Overall, the studies were assessed as low risk of bias. Results reported in the 2012 review remain unchanged.Although not statistically significant using a strict P labour (RR 1.30, 95% CI 1.14 to 1.48, 3 trials, 10,753 women, I² = 79%, low quality evidence) and fetal blood sampling (RR 1.28, 95% CI 1.13 to 1.45, 3 trials, 10,757 women, I² = 0%) than women allocated to intermittent auscultation. There were no differences between groups in other secondary outcome measures including incidence and severity of hypoxic ischaemic

  15. Can Monitoring Fetal Intestinal Inflammation Using Heart Rate Variability Analysis Signal Incipient Necrotizing Enterocolitis of the Neonate?

    Science.gov (United States)

    Liu, Hai Lun; Garzoni, Luca; Herry, Christophe; Durosier, Lucien Daniel; Cao, Mingju; Burns, Patrick; Fecteau, Gilles; Desrochers, André; Patey, Natalie; Seely, Andrew J E; Faure, Christophe; Frasch, Martin G

    2016-04-01

    Necrotizing enterocolitis of the neonate is an acute inflammatory intestinal disease that can cause necrosis and sepsis. Chorioamnionitis is a risk factor of necrotizing enterocolitis. The gut represents the biggest vagus-innervated organ. Vagal activity can be measured via fetal heart rate variability. We hypothesized that fetal heart rate variability can detect fetuses with incipient gut inflammation. Prospective animal study. University research laboratory. Chronically instrumented near-term fetal sheep (n = 21). Animals were surgically instrumented with vascular catheters and electrocardiogram to allow manipulation and recording from nonanesthetized animals. In 14 fetal sheep, inflammation was induced with lipopolysaccharide (IV) to mimic chorioamnionitis. Fetal arterial blood samples were drawn at selected time points over 54 hours post lipopolysaccharide for blood gas and cytokines (interleukin-6 and tumor necrosis factor-α enzymelinked immunosorbent assay). Fetal heart rateV was quantified throughout the experiment. The time-matched fetal heart rate variability measures were correlated to the levels of interleukin-6 and tumor necrosis factor-α. Upon necropsy, ionized calcium binding adaptor molecule 1+ (Iba1+), CD11c+ (M1), CD206+ (M2 macrophages), and occludin (leakiness marker) immunofluorescence in the terminal ileum was quantified along with regional Iba1+ signal in the brain (microglia). Interleukin-6 peaked at 3 hours post lipopolysaccharide accompanied by mild cardiovascular signs of sepsis. At 54 hours, we identified an increase in Iba1+ and, specifically, M1 macrophages in the ileum accompanied by increased leakiness, with no change in Iba1 signal in the brain. Preceding this change on tissue level, at 24 hours, a subset of nine fetal heart rate variability measures correlated exclusively to the Iba+ markers of ileal, but not brain, inflammation. An additional fetal heart rate variability measure, mean of the differences of R-R intervals

  16. Heart sounds at home: feasibility of an ambulatory fetal heart rhythm surveillance program for anti-SSA-positive pregnancies.

    Science.gov (United States)

    Cuneo, B F; Moon-Grady, A J; Sonesson, S-E; Levasseur, S; Hornberger, L; Donofrio, M T; Krishnan, A; Szwast, A; Howley, L; Benson, D W; Jaeggi, E

    2017-03-01

    Fetuses exposed to anti-SSA (Sjögren's) antibodies are at risk of developing irreversible complete atrioventricular block (CAVB), resulting in death or permanent cardiac pacing. Anti-inflammatory treatment during the transition period from normal heart rhythm (fetal heart rhythm (FHR)) to CAVB (emergent CAVB) can restore sinus rhythm, but detection of emergent CAVB is challenging, because it can develop in ⩽24 h. We tested the feasibility of a new technique that relies on home FHR monitoring by the mother, to surveil for emergent CAVB. We recruited anti-SSA-positive mothers at 16 to 18 weeks gestation (baseline) from 8 centers and instructed them to monitor FHR two times a day until 26 weeks, using a Doppler device at home. FHR was also surveilled by weekly or every other week fetal echo. If FHR was irregular, the mother underwent additional fetal echo. We compared maternal stress/anxiety before and after monitoring. Postnatally, infants underwent a 12-lead electrocardiogram. Among 133 recruited, 125 (94%) enrolled. Among those enrolled, 96% completed the study. Reasons for withdrawal (n=5) were as follows: termination of pregnancy, monitoring too time consuming or moved away. During home monitoring, 9 (7.5%) mothers detected irregular FHR diagnosed by fetal echo as normal (false positive, n=2) or benign atrial arrhythmia (n=7). No CAVB was undetected or developed after monitoring. Questionnaire analysis indicated mothers felt comforted by the experience and would monitor again in future pregnancies. These data suggest ambulatory FHR surveillance of anti-SSA-positive pregnancies is feasible, has a low false positive rate and is empowering to mothers.

  17. Description, evaluation and clinical decision making according to various fetal heart rate patterns. Inter-observer and regional variability

    DEFF Research Database (Denmark)

    Lidegaard, O; Bøttcher, L M; Weber, Tom

    1992-01-01

    as pathological patterns, and normal as well as clinically asphyxiated babies. Five antepartum and six intrapartum patterns were included. A total of 1,276 descriptions and evaluations were obtained. The degree of agreement in description of fetal heart rate changes was high regarding the baseline...... departments, especially between departments far apart. It is concluded that we still need a scientific clarification of which specific heart rate changes are the best predictors of fetal stress. Artificial intelligence programs for interpreting fetal cardiotocograms and ECG signals constitute one promising...

  18. Assessment of congenital heart disease (CHD): Is there a role for fetal magnetic resonance imaging (MRI)?

    Energy Technology Data Exchange (ETDEWEB)

    Manganaro, L. [Department of Radiological Sciences, UMBERTO I Hospital, SAPIENZA University of Rome, Viale del Policlinico 155, 00161 Rome (Italy); Savelli, S. [Department of Radiological Sciences, UMBERTO I Hospital, SAPIENZA University of Rome, Viale del Policlinico 155, 00161 Rome (Italy)], E-mail: sarasavelli@hotmail.it; Di Maurizio, M.; Perrone, A.; Francioso, A.; La Barbera, L.; Totaro, P.; Fierro, F.; Tomei, A.; Coratella, F. [Department of Radiological Sciences, UMBERTO I Hospital, SAPIENZA University of Rome, Viale del Policlinico 155, 00161 Rome (Italy); Giancotti, A. [Department of Gynaecological Sciences, UMBERTO I Hospital, SAPIENZA University of Rome, Viale del Policlinico 155, 00161 Rome (Italy); Ballesio, L. [Department of Radiological Sciences, UMBERTO I Hospital, SAPIENZA University of Rome, Viale del Policlinico 155, 00161 Rome (Italy); Ventriglia, F. [Department of Pediatric Cardiology, UMBERTO I Hospital, SAPIENZA University of Rome, Viale del Policlinico 155, 00161 Rome (Italy)

    2009-10-15

    Purpose: To review our experience with fetal magnetic resonance imaging (MRI) to evaluate congenital heart disease (CHD). Methods: We performed fetal MRI in 32 fetuses with an echocardiographically assessed CHD. Both direct and indirect signs of CHD were investigated. Direct signs considered were: morpho-volumetric abnormalities of the heart; malrotations; ventricular and atrial septal defects; anomalies of the origin, size and course of the great arteries. Indirect signs considered were: difficulty to recognize a 'normal' anatomical structures in the reference projections; increase of the vascular size before a stenosis; hypertrophy of the papillary muscles; cardiomegaly and pericardial effusion. All MRI findings were compared with postnatal or autoptic findings. Results: MRI allowed the CHD to be visualised by direct signs in 17 fetuses, indirect signs in 5 and both direct and indirect signs in 9 fetuses, excluding the prenatal echocardiographic suspect of hypoplastic left heart syndrome in 1 fetus. Postnatal echocardiograms or autoptic findings confirmed a normal heart in 1 fetus and CHD in 31 fetuses including a single cardiac anomaly or syndrome in 19 fetuses, 2 associated cardiac abnormalities in 11 and 3 cardiac anomalies in 1 fetus. However, in 2 fetuses MRI detected a ventricular septal defect successively disclosed by gold standard. Conclusions: MRI is a promising method for further assessment of the cardiovascular pathologies diagnosed by echocardiography, and may be a valuable tool in assessing associated extracardiac anomalies.

  19. Deficient maternal zinc intake-but not folate-is associated with lower fetal heart rate variability.

    Science.gov (United States)

    Spann, Marisa N; Smerling, Jennifer; Gustafsson, Hanna; Foss, Sophie; Altemus, Margaret; Monk, Catherine

    2015-03-01

    Few studies of maternal prenatal diet and child development examine micronutrient status in relation to fetal assessment. Twenty-four-hour dietary recall of zinc and folate and 20min of fetal heart rate were collected from 3rd trimester pregnant adolescents. Deficient zinc was associated with less fetal heart rate variability. Deficient folate had no associations with HRV. Neither deficient zinc nor deficient folate was related to fetal heart rate. These findings, from naturalistic observation, are consistent with emerging data on prenatal zinc supplementation using a randomized control design. Taken together, the findings suggest that maternal prenatal zinc intake is an important and novel factor for understanding child ANS development. Copyright © 2015. Published by Elsevier Ireland Ltd.

  20. Deficient maternal zinc intake—but not folate—is associated with lower fetal heart rate variability

    Science.gov (United States)

    Spann, Marisa N.; Smerling, Jennifer; Gustafsson, Hanna; Foss, Sophie; Altemus, Margaret; Monk, Catherine

    2015-01-01

    Objective Few studies of maternal prenatal diet and child development examine micronutrient status in relation to fetal assessment. Methods Twenty-four-hour dietary recall of zinc and folate and 20min of fetal heart rate were collected from 3rd trimester pregnant adolescents. Results Deficient zinc was associated with less fetal heart rate variability. Deficient folate had no associations with HRV. Neither deficient zinc nor deficient folate was related to fetal heart rate. Conclusions These findings, from naturalistic observation, are consistent with emerging data on prenatal zinc supplementation using a randomized control design. Practical Implication Taken together, the findings suggest that maternal prenatal zinc intake is an important and novel factor for understanding child ANS development. PMID:25658874

  1. Description, evaluation and clinical decision making according to various fetal heart rate patterns. Inter-observer and regional variability

    DEFF Research Database (Denmark)

    Lidegaard, O; Bøttcher, L M; Weber, Tom

    1992-01-01

    departments, especially between departments far apart. It is concluded that we still need a scientific clarification of which specific heart rate changes are the best predictors of fetal stress. Artificial intelligence programs for interpreting fetal cardiotocograms and ECG signals constitute one promising......At 10 Danish obstetrical departments, 116 residents (42 senior and 74 junior) participated in a study to assess inter-observer and regional variability in the description and evaluation of and clinical decision regarding 11 fetal heart rate patterns. The 11 traces included normal as well...... as pathological patterns, and normal as well as clinically asphyxiated babies. Five antepartum and six intrapartum patterns were included. A total of 1,276 descriptions and evaluations were obtained. The degree of agreement in description of fetal heart rate changes was high regarding the baseline...

  2. Brain Injury in Neonates with Complex Congenital Heart Disease: What Is the Predictive Value of MRI in the Fetal Period?

    Science.gov (United States)

    Brossard-Racine, M; du Plessis, A; Vezina, G; Robertson, R; Donofrio, M; Tworetzky, W; Limperopoulos, C

    2016-07-01

    Brain injury in neonates with congenital heart disease is an important predictor of adverse neurodevelopmental outcome. Impaired brain development in congenital heart disease may have a prenatal origin, but the sensitivity and specificity of fetal brain MR imaging for predicting neonatal brain lesions are currently unknown. We sought to determine the value of conventional fetal MR imaging for predicting abnormal findings on neonatal preoperative MR imaging in neonates with complex congenital heart disease. MR imaging studies were performed in 103 fetuses with confirmed congenital heart disease (mean gestational age, 31.57 ± 3.86 weeks) and were repeated postnatally before cardiac surgery (mean age, 6.8 ± 12.2 days). Each MR imaging study was read by a pediatric neuroradiologist. Brain abnormalities were detected in 17/103 (16%) fetuses by fetal MR imaging and in 33/103 (32%) neonates by neonatal MR imaging. Only 9/33 studies with abnormal neonatal findings were preceded by abnormal findings on fetal MR imaging. The sensitivity and specificity of conventional fetal brain MR imaging for predicting neonatal brain abnormalities were 27% and 89%, respectively. Brain abnormalities detected by in utero MR imaging in fetuses with congenital heart disease are associated with higher risk of postnatal preoperative brain injury. However, a substantial proportion of anomalies on postnatal MR imaging were not present on fetal MR imaging; this result is likely due to the limitations of conventional fetal MR imaging and the emergence of new lesions that occurred after the fetal studies. Postnatal brain MR imaging studies are needed to confirm the presence of injury before open heart surgery. © 2016 by American Journal of Neuroradiology.

  3. Computerized analysis of fetal heart rate variability signal during the stages of labor.

    Science.gov (United States)

    Annunziata, Maria Laura; Tagliaferri, Salvatore; Esposito, Francesca Giovanna; Giuliano, Natascia; Mereghini, Flavia; Di Lieto, Andrea; Campanile, Marta

    2016-03-01

    To analyze computerized cardiotocographic (cCTG) parameters (baseline fetal heart rate, baseline FHR; short term variability, STV; approximate entropy, ApEn; low frequency, LF; movement frequency, MF; high frequency, HF) in physiological pregnancy in order to correlate them with the stages of labor. This could provide more information for understanding the mechanisms of nervous system control of FHR during labor progression. A total of 534 pregnant women were monitored on cCTG from the 37th week before the onset of spontaneous labor and during the first and the second stage of labor. Statistical analysis was performed using Kruskal-Wallis test and Wilcoxon rank-sum test with the Bonferroni adjusted α (labor, and the first and second stages of labor. Differences between some of the stages were found for ApEn, LF and for LF/(HF + MF), where the first and the third were reduced and the second was increased. cCTG modifications during labor may reflect the physiologic increased activation of the autonomous nervous system. Using computerized fetal heart rate analysis during labor it may be possible to obtain more information from the fetal cardiac signal, in comparison with the traditional tracing. © 2016 Japan Society of Obstetrics and Gynecology.

  4. Chorioamnionitis following preterm premature rupture of membranes and fetal heart rate variability.

    Directory of Open Access Journals (Sweden)

    Laurent Vandenbroucke

    Full Text Available The objective of this study was to identify prenatal markers of histological chorioamnionitis (HC during pPROM using fetal computerized cardiotocography (cCTG.Retrospective review of medical records from pregnant women referred for pPROM between 26 and 34 weeks, in whom placental histology was available, in a tertiary level obstetric service over a 5-year period. Fetal heart rate variability was assessed using cCTG. Patients were included if they were monitored at least six times in the 72 hours preceding delivery. Clinical and biological cCTG parameters during the pPROM latency period were compared between cases with or without HC.In total, 222 pPROM cases were observed, but cCTG data was available in only 23 of these cases (10 with and 13 without HC after exclusion of co-morbidities which may potentially perturb fetal heart rate variability measures. Groups were comparable for maternal age, parity, gestational age at pPROM, pPROM duration and neonatal characteristics (p>0.1. Baseline fetal heart rate was higher in the HC group [median 147.3 bpm IQR (144.2-149.2 vs. 141.3 bpm (137.1-145.4 in no HC group; p = 0.02]. The number of low variation episodes [6.4, (3.5-15.3 vs. 2.3 (1-5.2; p = 0.04] was also higher in the HC group, whereas short term variations were lower in the HC group [7.1 ms (6-7.4 vs. 8.1 ms (7.4-9; p = 0.01] within 72 hours before delivery. Differences were especially discriminant within 24 hours before delivery, with less short-term variation [5 ms (3.7-5.9 vs. 7.8 ms (5.4-8.7; p = 0.007] and high variation episodes [3.9 (4.9-3.2 vs. 0.8 (1.5-0.2; p < 0.001] in the HC group.These results show differences in fetal heart rate variability, suggesting that cCTG could be used clinically to diagnoses chorioamnionitis during the pPROM latency period.

  5. RELATION OF FETAL BLOOD-GASES AND DATA FROM COMPUTER-ASSISTED ANALYSIS OF FETAL HEART-RATE PATTERNS IN SMALL FOR GESTATION FETUSES

    NARCIS (Netherlands)

    RIBBERT, LSM; SNIJDERS, RJM; NICOLAIDES, KH; VISSER, GHA

    Fetal heart rate (FHR) monitoring and computer-assisted analysis were performed immediately before cordocentesis in 25 severely small-for-gestational age fetuses. There were significant associations between FHR variation and both umbilical vein blood Po2 (r = 0.66) and pH (r = 0.69). However, the

  6. Impact of a standardized training program on midwives’ ability to assess fetal heart anatomy by ultrasound

    International Nuclear Information System (INIS)

    Hildebrand, Eric; Abrandt Dahlgren, Madeleine; Sved, Catarina; Gottvall, Tomas; Blomberg, Marie; Janerot-Sjoberg, Birgitta

    2014-01-01

    Studies of prenatal detection of congenital heart disease (CHD) in the UK, Italy, and Norway indicate that it should be possible to improve the prenatal detection rate of CHD in Sweden. These studies have shown that training programs, visualization of the outflow tracts and color-Doppler all can help to speed up and improve the detection rate and accuracy. We aimed to introduce a more accurate standardized fetal cardiac ultrasound screening protocol in Sweden. A novel pedagogical model for training midwives in standardized cardiac imaging was developed, a model using a think-aloud analysis during a pre- and post-course test and a subsequent group reflection. The self-estimated difficulties and knowledge gaps of two experienced and two beginner midwives were identified. A two-day course with mixed lectures, demonstrations and hands-on sessions was followed by a feedback session three months later consisting of an interview and check-up. The long-term effects were tested two years later. At the post-course test the self-assessed uncertainty was lower than at the pre-course test. The qualitative evaluation showed that the color Doppler images were difficult to interpret, but the training seems to have improved their ability to use the new technique. The ability to perform the method remained at the new level at follow-up both three months and two years later. Our results indicate that by implementing new imaging modalities and providing hands-on training, uncertainty can be reduced and examination time decreased, but they also show that continuous on-site training with clinical and technical back-up is important

  7. Does heart rate variability reflect the systemic inflammatory response in a fetal sheep model of lipopolysaccharide-induced sepsis?

    International Nuclear Information System (INIS)

    Durosier, Lucien D; Cao, Mingju; Frasch, Martin G; Herry, Christophe L; Seely, Andrew J E; Cortes, Marina; Burns, Patrick; Desrochers, André; Fecteau, Gilles

    2015-01-01

    Fetal inflammatory response occurs during chorioamnionitis, a frequent and often subclinical inflammation associated with increased risk for brain injury and life-lasting neurologic deficits. No means of early detection exist. We hypothesized that systemic fetal inflammation without septic shock will be reflected in alterations of fetal heart rate (FHR) variability (fHRV) distinguishing baseline versus inflammatory response states.In chronically instrumented near-term fetal sheep (n = 24), we induced an inflammatory response with lipopolysaccharide (LPS) injected intravenously (n = 14). Ten additional fetuses served as controls. We measured fetal plasma inflammatory cytokine IL-6 at baseline, 1, 3, 6, 24 and 48 h. 44 fHRV measures were determined continuously every 5 min using continuous individualized multi-organ variability analysis (CIMVA). CIMVA creates an fHRV measures matrix across five signal-analytical domains, thus describing complementary properties of fHRV. Using principal component analysis (PCA), a widely used technique for dimensionality reduction, we derived and quantitatively compared the CIMVA fHRV PCA signatures of inflammatory response in LPS and control groups.In the LPS group, IL-6 peaked at 3 h. In parallel, PCA-derived fHRV composite measures revealed a significant difference between LPS and control group at different time points. For the LPS group, a sharp increase compared to baseline levels was observed between 3 h and 6 h, and then abating to baseline levels, thus tracking closely the IL-6 inflammatory profile. This pattern was not observed in the control group. We also show that a preselection of fHRV measures prior to the PCA can potentially increase the difference between LPS and control groups, as early as 1 h post LPS injection.We propose a fHRV composite measure that correlates well with levels of inflammation and tracks well its temporal profile. Our results highlight the potential role of HRV to study and monitor the

  8. Effects of maternal breathing rate, psychiatric status, and cortisol on fetal heart rate.

    Science.gov (United States)

    Monk, Catherine; Fifer, William P; Myers, Michael M; Bagiella, Emilia; Duong, Jimmy K; Chen, Ivy S; Leotti, Lauren; Altincatal, Arman

    2011-04-01

    Women's experiences during pregnancy are predictive of variation in neurobehavioral profiles in their children. Few studies have assessed these relationships during the prenatal period. In 113 women in the 36(th) -38(th) gestational week (mean age 26.3 ± 5.4 years), electrocardiogram, blood pressure, respiration, salivary cortisol, and fetal heart rate (HR) were measured during baseline, a psychological challenge (Stroop color-word matching task), and a standardized paced breathing protocol. Subjects underwent the Structured Clinical Interview for DSM-IV prior to testing and were grouped as: depressed, co-morbid for depression and anxiety, anxiety disorder only, and control. There was a significant main effect of maternal diagnostic group on fetal HR only during the Stroop task: fetuses of women in the co-morbid group had a greater HR increase compared to controls (p psychobiology. Copyright © 2010 Wiley Periodicals, Inc.

  9. The Effects of Maternal Opium Abuse on Fetal Heart Rate using Non-Stress Test.

    Science.gov (United States)

    Keikha, Fatemeh; Vahdani, Fahimeh Ghotbizadeh; Latifi, Sahar

    2016-11-01

    Opium is one of the most commonly abused opiates in developing countries including Iran. Considering the importance of maternal health on the newborn, we aimed to assess the effect of opium abuse on fetal heart rate (FHR) characteristics in a sample of pregnant women in Zahedan, Southeast Iran. This cross-sectional study was done on 100 pregnant women referring to Ali-Ibn-Abi Talib Hospital in Zahedan, during 2011-2013. The participants were divided into two groups comprising of opium abusers and healthy individuals. The participants received 500cc intravenous fluid containing dextrose and then non-stress test results were recorded for 20 minutes. We found no significant difference between the two groups with respect to their demographic characteristics. Fetal movements, variability, acceleration, and reactivity were significantly higher among addicted women (Popium abusers compared with the healthy women. Abnormal variability or oscillations of opium abuser group, mothers addicted to opium need specific prenatal care.

  10. Peptidomic Analysis of Fetal Heart Tissue for Identification of Endogenous Peptides Involved in Tetralogy of Fallot.

    Science.gov (United States)

    Zhang, Jingjing; Liang, Dong; Cheng, Qing; Cao, Li; Wu, Yun; Wang, Yan; Han, Shuping; Yu, Zhangbin; Cui, Xianwei; Xu, Tianhui; Ma, Dingyuan; Hu, Ping; Xu, Zhengfeng

    2017-06-01

    Tetralogy of fallot (TOF) is one of the most prevalent types of congenital heart diseases. As a category of bioactive molecules, peptides have been proved to participate in various biological processes. However, the role of endogenous peptides in the pathogenesis of TOF has not been studied. In this study, we performed a comparative peptidomic profile in the fetal heart of TOF and the control group for the first time by liquid chromatography-tandem mass spectrometry. Our data demonstrated that a total of 201 peptides derived from 176 precursor proteins were differentially expressed in the heart tissues of TOF fetuses compared with normal controls, including 41 upregulated peptides and 160 downregulated peptides. After analyzing the characteristics of these differentially expressed peptides and their precursor proteins, we found that these peptides were potentially involved in different biological processes, especially cardiogenesis and congenital anomaly of the cardiovascular system. Interestingly, we detected several extracellular matrix-derived peptides involved in our differentially expressed peptidomic profile. In summary, our study constructed a comparative peptidomic profile from the heart tissues of TOF fetuses and normal controls, and it identified a series of peptides that could potentially participate in heart development and TOF formation. The emergence of our peptidomics study indicated a new perspective to explore the pathogenesis of abnormal heart morphology, especially TOF.

  11. Accelerated MRI of the fetal heart using compressed sensing and metric optimized gating.

    Science.gov (United States)

    Roy, Christopher W; Seed, Mike; Macgowan, Christopher K

    2017-06-01

    To develop and validate a method for accelerated time-resolved imaging of the fetal heart using a combination of compressed sensing (CS) and metric optimized gating (MOG). Joint optimization of CS and MOG reconstructions was used to suppress competing artifact from random undersampling and ungated cardiac motion. Retrospectively and prospectively undersampled adult and fetal data were used to validate the proposed reconstruction algorithm qualitatively based on visual assessment, and quantitatively based on reconstruction error, blur, and MOG timing error. Excellent agreement was observed between the fully sampled and retrospectively undersampled reconstructions, up to an undersampling factor of four. Visually, differences between ECG and MOG reconstructions of adult data were negligible. This was consistent with quantitative comparisons of reconstruction error (RMSE ECG  = 0.07-0.13; RMSE MOG  = 0.08-0.13), and image blur (B ECG  = 1.03-1.20; B MOG  = 1.03-1.20). The calculated MOG timing error (2-42 ms) was comparable to the acquired temporal resolution (∼60 ms). Quantitative evaluation of retrospectively undersampled (R = 2-8) fetal data (RMSE MOG  = 0.06-0.12; B MOG  = 1.04-1.27) was comparable to the adult volunteer results. CS-MOG for dynamic imaging of the fetal heart was developed and validated. Using CS-MOG, images were obtained up to four times faster than conventional acquisitions. Magn Reson Med 77:2125-2135, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

  12. Doppler-based fetal heart rate analysis markers for the detection of early intrauterine growth restriction.

    Science.gov (United States)

    Stroux, Lisa; Redman, Christopher W; Georgieva, Antoniya; Payne, Stephen J; Clifford, Gari D

    2017-11-01

    One indicator for fetal risk of mortality is intrauterine growth restriction (IUGR). Whether markers reflecting the impact of growth restriction on the cardiovascular system, computed from a Doppler-derived heart rate signal, would be suitable for its detection antenatally was studied. We used a cardiotocography archive of 1163 IUGR cases and 1163 healthy controls, matched for gestation and gender. We assessed the discriminative power of short-term variability and long-term variability of the fetal heart rate, computed over episodes of high and low variation aiming to separate growth-restricted fetuses from controls. Metrics characterizing the sleep state distribution within a trace were also considered for inclusion into an IUGR detection model. Significant differences in the risk markers comparing growth-restricted with healthy fetuses were found. When used in a logistic regression classifier, their performance for identifying IUGR was considerably superior before 34 weeks of gestation. Long-term variability in active sleep was superior to short-term variability [area under the receiver operator curve (AUC) of 72% compared with 71%]. Most predictive was the number of minutes in high variation per hour (AUC of 75%). A multivariate IUGR prediction model improved the AUC to 76%. We suggest that heart rate variability markers together with surrogate information on sleep states can contribute to the detection of early-onset IUGR. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  13. Fetal echocardiography

    International Nuclear Information System (INIS)

    Chaubal, Nitin G.; Chaubal, Jyoti

    2009-01-01

    USG performed with a high-end machine, using a good cine-loop facility is extremely helpful in the diagnosis of fetal cardiac anomalies. In fetal echocardiography, the four-chamber view and the outflow-tract view are used to diagnose cardiac anomalies. The most important objective during a targeted anomaly scan is to identify those cases that need a dedicated fetal echocardiogram. Associated truncal and chromosomal anomalies need to be identified. This review shows how fetal echocardiography, apart from identifying structural defects in the fetal heart, can be used to look at rhythm abnormalities and other functional aspects of the fetal heart

  14. Consuming a Western diet for two weeks suppresses fetal genes in mouse hearts.

    Science.gov (United States)

    Medford, Heidi M; Cox, Emily J; Miller, Lindsey E; Marsh, Susan A

    2014-04-15

    Diets high in sugar and saturated fat (Western diet) contribute to obesity and pathophysiology of metabolic syndrome. A common physiological response to obesity is hypertension, which induces cardiac remodeling and hypertrophy. Hypertrophy is regulated at the level of chromatin by repressor element 1-silencing transcription factor (REST), and pathological hypertrophy is associated with reexpression of a fetal cardiac gene program. Reactivation of fetal genes is commonly observed in hypertension-induced hypertrophy; however, this response is blunted in diabetic hearts, partially due to upregulation of the posttranslational modification O-linked-β-N-acetylglucosamine (O-GlcNAc) to proteins by O-GlcNAc transferase (OGT). OGT and O-GlcNAc are found in chromatin-modifying complexes, but it is unknown whether they play a role in Western diet-induced hypertrophic remodeling. Therefore, we investigated the interactions between O-GlcNAc, OGT, and the fetal gene-regulating transcription factor complex REST/mammalian switch-independent 3A/histone deacetylase (HDAC). Five-week-old male C57BL/6 mice were fed a Western (n = 12) or control diet (n = 12) for 2 wk to examine the early hypertrophic response. Western diet-fed mice exhibited fasting hyperglycemia and increased body weight (P Western blot analysis showed that HDAC protein levels were not different between groups; however, relative to controls, Western diet hearts showed increased REST and decreased ANP and skeletal α-actin. Transcript levels of HDAC2 and cardiac α-actin were decreased in Western diet hearts. These data suggest that REST coordinates regulation of diet-induced hypertrophy at the level of chromatin.

  15. Recovery of signal loss adopting the residual bootstrap method in fetal heart rate dynamics.

    Science.gov (United States)

    Lee, Sun-Kyung; Park, Young-Sun; Cha, Kyung-Joon

    2018-03-19

    Fetal heart rate (FHR) data obtained from a non-stress test (NST) can be presented in a type of time series, which is accompanied by signal loss due to physical and biological causes. To recover or estimate FHR data, which is subjected to a high rate of signal loss, time series models [second-order autoregressive (AR(2)), first-order autoregressive conditional heteroscedasticity (ARCH(1)) and empirical mode decomposition and vector autoregressive (EMD-VAR)] and the residual bootstrap method were applied. The ARCH(1) model with the residual bootstrap technique was the most accurate [root mean square error (RMSE), 2.065] as it reflects the nonlinearity of the FHR data [mean absolute error (MAE) for approximate entropy (ApEn), 0.081]. As a result, the goal of predicting fetal health and identifying a high-risk pregnancy could be achieved. These trials may be effectively used to save the time and cost of repeating the NST when the fetal diagnosis is impossible owing to a large amount of signal loss.

  16. Development of the Human Placenta and Fetal Heart: Synergic or Independent?

    Directory of Open Access Journals (Sweden)

    Graham J. Burton

    2018-04-01

    Full Text Available The placenta is the largest fetal organ, and toward the end of pregnancy the umbilical circulation receives at least 40% of the biventricular cardiac output. It is not surprising, therefore, that there are likely to be close haemodynamic links between the development of the placenta and the fetal heart. Development of the placenta is precocious, and in advance of that of the fetus. The placenta undergoes considerable remodeling at the end of the first trimester of pregnancy, and its vasculature is capable of adapting to environmental conditions and to variations in the blood supply received from the mother. There are two components to the placental membranes to consider, the secondary yolk sac and the chorioallantoic placenta. The yolk sac is the first of the extraembryonic membranes to be vascularized, and condensations in the mesenchyme at ~17 days post-conception (p.c. give rise to endothelial and erythroid precursors. A network of blood vessels is established ~24 days p.c., with the vitelline vein draining through the region of the developing liver into the sinus venosus. Gestational sacs of early pregnancy failures often display aberrant development of the yolk sac, which is likely to be secondary to abnormal fetal development. Vasculogenesis occurs in the villous mesenchyme of the chorioallantoic placenta at a similarly early stage. Nucleated erythrocytes occupy the lumens of the placental capillaries and end-diastolic flow is absent in the umbilical arterial circulation throughout most of the first trimester, indicating a high resistance to blood flow. Resistance begins to fall in the umbilico-placental circulation around 12–14 weeks. During normal early pregnancy the placental capillary network is plastic, and considerable remodeling occurs in response to the local oxygen concentration, and in particular to oxidative stress. In pregnancies complicated by preeclampsia and/or fetal growth restriction, utero-placental malperfusion induces

  17. [Denoising of Fetal Heart Sound Based on Empirical Mode Decomposition Method].

    Science.gov (United States)

    Liu, Qiaoqiao; Tan, Zhixiang; Zhang, Yi; Wang, Hua

    2015-08-01

    Fetal heart sound is nonlinear and non-stationary, which contains a lot of noise when it is colleced, so the denoising method is important. We proposed a new denoising method in our study. Firstly, we chose the preprocessing of low-pass filter with a cutoff frequency of 200 Hz and the resampling. Secondly, we decomposed the signal based on empirical mode decomposition method (EMD) of Hilbert-Huang transform, then denoised some selected target components with wavelet soft threshold adaptive noise cancellation algorithm. Finally we got the clean fetal heart sound by combining the target components. In the EMD, we used a mask signal to eliminate the mode mixing problem, used mirroring extension method to eliminate the end effect, and referenced the stopping rule from the research of Rilling. This method eliminated the baseline drift and noise at once. To compare with wavelet transform (WT), mathematical morphology (MM) and the Fourier transform (FT), the SNR was improved obviously, and the RMSE was the minimum, which could satisfy the need of the practical application.

  18. Prevalence of fetal heart disease in high-risk pregnant women admitted in the public health service of Sorocaba/SP

    Directory of Open Access Journals (Sweden)

    Sara Carrel Silveira

    2011-06-01

    Full Text Available ABSTRACT Background: several pregnancy disorders (both maternal and fetal that behave as risk factor for fetal heart diseases have been described. Objective: to study such relation among pregnant women admitted in the public health service of Sorocaba and presenting pregnancy related diseases considered as risk factors for fetal heart disease. Methods and casuistic: 104 fetal echocardiograms were performed in the 28.9th week of gestation (average in 102 pregnant women with gestational diseases considered as risk factors for fetal heart disease and were grouped as follows: diabetes, hypertension, diabetes and hypertension, diabetes, hypertension and maternal age greater than 35 years, multiple births, fetal abnormalities detected by ultrasound in obstetrics, maternal age less than 17 years, maternal age greater than 35 years and pregnant women suffering from other diseases (lupus erythematosus, congenital heart disease, complicated obstetric past and use of teratogenic drugs. A morphofunctional analysis of fetal hearts was performed using conventional cuts ultrasound Doppler spectral analysis and color flow mapping. Results: mean maternal age was 30.05 years (ranging from 14 to 46 years. The most common fetal heart disease identified was interventricular communication (23%, and among the groups of pregnancy pathologies, the group of pregnant women with twin pregnancy and fetal abnormalities in the highest incidence of fetal heart disease (35%, in spit of the group of diabetic women being the most frequent (48%. Conclusion: the prevalence of fetal heart disease in our study was 16.34%. The sum of risk factors during pregnancy was not related to a greater frequency of fetal heart disease.

  19. Continuous measurement of heart rate variability following carbon ...

    African Journals Online (AJOL)

    Background: Previous studies of autonomic nervous system activity through analysis of heart rate variability (HRV) have demonstrated increased sympathetic activity during positive-pressure pneumoperitoneum. We employed an online, continuous method for rapid HRV analysis (MemCalc™, Tarawa, Suwa Trust, Tokyo, ...

  20. Two-dimensional sonographic cine imaging improves confidence in the initial evaluation of the fetal heart.

    Science.gov (United States)

    Poole, Patricia Sims; Chung, Romy; Lacoursiere, Yvette; Palmieri, Carolina Rossi; Hull, Andrew; Engelkemier, Dawn; Rochelle, Michele; Trivedi, Neha; Pretorius, Dolores H

    2013-06-01

    Initial screening sonography of the fetal heart with static images is often inadequate, resulting in repeated imaging or failure to detect abnormalities. We hypothesized that the addition of short cine clips would reduce the need for repeated imaging. Two-dimensional (2D) static sonograms and short 2D cine clips of the 4-chamber view and left and right ventricular outflow tracts were obtained from 342 patients with gestational ages of greater than 16 weeks. A diagnostic radiologist and a perinatologist retrospectively reviewed the static and cine images independently and graded them as normal, abnormal, or suboptimal. A statistically significant increase in the number of structures called normal was seen when 2D cine clips were added to static imaging for both observers (P cine images versus 61.9% with static images alone, whereas the perinatologist recorded 68.1% as normal versus 58.8%, respectively. The radiologist called 77.8% of structures normal with cine images only versus 61.9% with static images only (P cine images alone (38.9%) versus static images alone (58.8%). The use of cine loops alone resulted in no significant increase in the ability to clear the heart as normal. The maternal body mass index was inversely associated with the ability to clear structures when 2D cine images were added to static images (P cine clips to standard 2D static imaging of the fetal heart significantly improves the number of structures cleared as normal. Two-dimensional cine clips are easily obtained, add little time to a study, and require minimal archival space.

  1. Treatment with oral beta-blockers during pregnancy complicated by maternal heart disease increases the risk of fetal growth restriction

    DEFF Research Database (Denmark)

    Ersbøll, A S; Hedegaard, M; Søndergaard, L

    2014-01-01

    OBJECTIVE: To investigate the effect on fetal growth of treatment with oral beta-blockers during pregnancy in women with congenital or acquired heart disease. DESIGN: Historical matched cohort study. SETTING: Centre for Pregnant Women with Heart Disease, Copenhagen University Hospital, Denmark....... POPULATION: A cohort of 175 women with heart disease, grouped according to beta-blocker treatment, and a cohort of 627 women from the overall population matched on seven birthweight-determining factors. METHODS: Differences between groups were tested by simple descriptive statistics and assessed using......-blocker treatment was the only independent predictor of SGA, adjusting for several factors influencing fetal growth (the relative difference in expected birthweight was -12.2%; 95% CI -19.9 to -3.9%; P = 0.001). CONCLUSIONS: In a historical cohort of pregnancies complicated by maternal heart disease, treatment...

  2. Basic heart examination: feasibility study of first-trimester systematic simplified fetal echocardiography.

    Science.gov (United States)

    Quarello, E; Lafouge, A; Fries, N; Salomon, L J

    2017-02-01

    First-trimester fetal cardiac screening examinations in low-risk populations should not have to meet the specifications required for high-risk populations. Our aim was to evaluate a simplified fetal echocardiographic ('basic heart') examination for early detection of severe congenital heart defects in a low-risk population. This was a first-trimester national 'flash study', performed over a 2-week period. Each observer was requested to perform simplified echocardiography without modifying the time and methods deemed necessary for the routine first-trimester ultrasound examination, in fetuses with crown-rump length between 45 and 84 mm. This basic heart assessment used targeted cross-sections of the four-chamber view (4CV) and of the three vessels and trachea (3VT) view, using color and/or directional power Doppler. All examinations were then reviewed offline and scored for quality by a qualified expert. Sixty observers performed a total of 597 first-trimester ultrasound examinations, each performing an average of 10 (range, 1-26) procedures. Examinations were conducted transabdominally (79%; 472/597), transvaginally (3%; 17/597) or both (18%; 108/597). In 8% (45/597) of cases, the fetal back was anterior, in 18% (108/597) it was on the left side, in 63% (377/597) it was posterior and in 11% (67/597) it was on the right side. It became clear during scoring by the expert that, unlike the Herman quality score for nuchal translucency measurement, it was difficult to assess the quality of these images without taking into account normality of the heart itself. Analysis of scores showed that the 4CV was obtained successfully and was deemed normal in 86% (512/597) of the patients, in 7% (41/597) it was deemed technically infeasible and in 7% (44/597) it was deemed feasible but atypical, which may have been due to the presence of an abnormality or to poor quality of the image. The 3VT view was obtained successfully and was normal in 79% (472/597) of the patients, in 13

  3. Prospective isolation of human embryonic stem cell-derived cardiovascular progenitors that integrate into human fetal heart tissue.

    Science.gov (United States)

    Ardehali, Reza; Ali, Shah R; Inlay, Matthew A; Abilez, Oscar J; Chen, Michael Q; Blauwkamp, Timothy A; Yazawa, Masayuki; Gong, Yongquan; Nusse, Roeland; Drukker, Micha; Weissman, Irving L

    2013-02-26

    A goal of regenerative medicine is to identify cardiovascular progenitors from human ES cells (hESCs) that can functionally integrate into the human heart. Previous studies to evaluate the developmental potential of candidate hESC-derived progenitors have delivered these cells into murine and porcine cardiac tissue, with inconclusive evidence regarding the capacity of these human cells to physiologically engraft in xenotransplantation assays. Further, the potential of hESC-derived cardiovascular lineage cells to functionally couple to human myocardium remains untested and unknown. Here, we have prospectively identified a population of hESC-derived ROR2(+)/CD13(+)/KDR(+)/PDGFRα(+) cells that give rise to cardiomyocytes, endothelial cells, and vascular smooth muscle cells in vitro at a clonal level. We observed rare clusters of ROR2(+) cells and diffuse expression of KDR and PDGFRα in first-trimester human fetal hearts. We then developed an in vivo transplantation model by transplanting second-trimester human fetal heart tissues s.c. into the ear pinna of a SCID mouse. ROR2(+)/CD13(+)/KDR(+)/PDGFRα(+) cells were delivered into these functioning fetal heart tissues: in contrast to traditional murine heart models for cell transplantation, we show structural and functional integration of hESC-derived cardiovascular progenitors into human heart.

  4. Classification of Fetal Heart Rate Tracings Based on Wavelet-Transform & Self-Organizing-Map Neural Networks

    National Research Council Canada - National Science Library

    Vasios, G

    2001-01-01

    ...). We focus on the values of the standard deviation of the wavelet components (up to scale index 5) and we apply Self-Organizing-Map in order to investigate the relationship between the fetal heart rate variability in different scales and FSpO2...

  5. Classification of Fetal Heart Rate Tracings Based on Wavelet-Transform & Self-Organizing Map Neural Networks

    National Research Council Canada - National Science Library

    Vasios, G

    2001-01-01

    ...). We focus on the values of the standard deviation of the wavelet components (up to scale index 5) and we apply Self-Organizing-Map in order to investigate the relationship between the fetal heart rate variability in different scales and FSpO2...

  6. A protective antiarrhythmic role of ursodeoxycholic acid in an in vitro rat model of the cholestatic fetal heart.

    Science.gov (United States)

    Miragoli, Michele; Kadir, Siti H Sheikh Abdul; Sheppard, Mary N; Salvarani, Nicoló; Virta, Matilda; Wells, Sarah; Lab, Max J; Nikolaev, Viacheslav O; Moshkov, Alexey; Hague, William M; Rohr, Stephan; Williamson, Catherine; Gorelik, Julia

    2011-10-01

    Intrahepatic cholestasis of pregnancy may be complicated by fetal arrhythmia, fetal hypoxia, preterm labor, and, in severe cases, intrauterine death. The precise etiology of fetal death is not known. However, taurocholate has been demonstrated to cause arrhythmia and abnormal calcium dynamics in cardiomyocytes. To identify the underlying reason for increased susceptibility of fetal cardiomyocytes to arrhythmia, we studied myofibroblasts (MFBs), which appear during structural remodeling of the adult diseased heart. In vitro, they depolarize rat cardiomyocytes via heterocellular gap junctional coupling. Recently, it has been hypothesized that ventricular MFBs might appear in the developing human heart, triggered by physiological fetal hypoxia. However, their presence in the fetal heart (FH) and their proarrhythmogenic effects have not been systematically characterized. Immunohistochemistry demonstrated that ventricular MFBs transiently appear in the human FH during gestation. We established two in vitro models of the maternal heart (MH) and FH, both exposed to increasing doses of taurocholate. The MH model consisted of confluent strands of rat cardiomyocytes, whereas for the FH model, we added cardiac MFBs on top of cardiomyocytes. Taurocholate in the FH model, but not in the MH model, slowed conduction velocity from 19 to 9 cm/s, induced early after depolarizations, and resulted in sustained re-entrant arrhythmias. These arrhythmic events were prevented by ursodeoxycholic acid, which hyperpolarized MFB membrane potential by modulating potassium conductance. These results illustrate that the appearance of MFBs in the FH may contribute to arrhythmias. The above-described mechanism represents a new therapeutic approach for cardiac arrhythmias at the level of MFB. Copyright © 2011 American Association for the Study of Liver Diseases.

  7. The Effects of Maternal Opium Abuse on Fetal Heart Rate using Non-Stress Test

    Directory of Open Access Journals (Sweden)

    Fatemeh Keikha

    2016-11-01

    Full Text Available Background: Opium is one of the most commonly abused opiates in developing countries including Iran. Considering the importance of maternal health on the newborn, we aimed to assess the effect of opium abuse on fetal heart rate (FHR characteristics in a sample of pregnant women in Zahedan, Southeast Iran. Methods: This cross-sectional study was done on 100 pregnant women referring to Ali-Ibn-Abi Talib Hospital in Zahedan, during 2011-2013. The participants were divided into two groups comprising of opium abusers and healthy individuals. The participants received 500cc intravenous fluid containing dextrose and then non-stress test results were recorded for 20 minutes. Results: We found no significant difference between the two groups with respect to their demographic characteristics. Fetal movements, variability, acceleration, and reactivity were significantly higher among addicted women (P<0.0001 for all. Periodic change was 9.8 times higher among opium abusers compared with the healthy women. Abnormal variability or oscillations of <15 beats/min, which indicates lack of beat-to-beat variability, was significantly higher in the fetuses of addicted mothers (P<0.0001. Conclusion: Considering significant abnormal patterns in FHR characteristics among the opium abuser group, mothers addicted to opium need specific prenatal care.

  8. Temporal Patterns in Sheep Fetal Heart Rate Variability Correlate to Systemic Cytokine Inflammatory Response: A Methodological Exploration of Monitoring Potential Using Complex Signals Bioinformatics.

    Directory of Open Access Journals (Sweden)

    Christophe L Herry

    Full Text Available Fetal inflammation is associated with increased risk for postnatal organ injuries. No means of early detection exist. We hypothesized that systemic fetal inflammation leads to distinct alterations of fetal heart rate variability (fHRV. We tested this hypothesis deploying a novel series of approaches from complex signals bioinformatics. In chronically instrumented near-term fetal sheep, we induced an inflammatory response with lipopolysaccharide (LPS injected intravenously (n = 10 observing it over 54 hours; seven additional fetuses served as controls. Fifty-one fHRV measures were determined continuously every 5 minutes using Continuous Individualized Multi-organ Variability Analysis (CIMVA. CIMVA creates an fHRV measures matrix across five signal-analytical domains, thus describing complementary properties of fHRV. We implemented, validated and tested methodology to obtain a subset of CIMVA fHRV measures that matched best the temporal profile of the inflammatory cytokine IL-6. In the LPS group, IL-6 peaked at 3 hours. For the LPS, but not control group, a sharp increase in standardized difference in variability with respect to baseline levels was observed between 3 h and 6 h abating to baseline levels, thus tracking closely the IL-6 inflammatory profile. We derived fHRV inflammatory index (FII consisting of 15 fHRV measures reflecting the fetal inflammatory response with prediction accuracy of 90%. Hierarchical clustering validated the selection of 14 out of 15 fHRV measures comprising FII. We developed methodology to identify a distinctive subset of fHRV measures that tracks inflammation over time. The broader potential of this bioinformatics approach is discussed to detect physiological responses encoded in HRV measures.

  9. Establishment of a database of fetal congenital heart malformations and preliminary investigation of its clinical application

    Directory of Open Access Journals (Sweden)

    Jun-Xue Gao

    2015-06-01

    Conclusion: A database of 40 different cross-sectional fetal CHDs was established. An extensive database library of fetal CHDs, from which sonographers and students can study the anatomical features of fetal CHDs and virtualize fetal echocardiography findings via either centralized training or distance education, can be established in the future by accumulating further cases.

  10. Description, evaluation and clinical decision making according to various fetal heart rate patterns. Inter-observer and regional variability

    DEFF Research Database (Denmark)

    Lidegaard, O; Bøttcher, L M; Weber, Tom

    1992-01-01

    At 10 Danish obstetrical departments, 116 residents (42 senior and 74 junior) participated in a study to assess inter-observer and regional variability in the description and evaluation of and clinical decision regarding 11 fetal heart rate patterns. The 11 traces included normal as well as patho......At 10 Danish obstetrical departments, 116 residents (42 senior and 74 junior) participated in a study to assess inter-observer and regional variability in the description and evaluation of and clinical decision regarding 11 fetal heart rate patterns. The 11 traces included normal as well...... and the presence of silent or sinusoidal pattern (87-94% on an arbitrary 0-100% scale), and low regarding the assessment of variability and type of deceleration (50-72%). The degree of agreement in interpreting heart rate patterns was 59% (on an arbitrary 0-100% scale). Senior residents generally interpreted...

  11. Home labour induction with retrievable prostaglandin pessary and continuous telemetric trans-abdominal fetal ECG monitoring.

    Directory of Open Access Journals (Sweden)

    Zubair Rauf

    Full Text Available OBJECTIVE: To evaluate the feasibility of continuous telemetric trans-abdominal fetal electrocardiogram (a-fECG in women undergoing labour induction at home. STUDY DESIGN: Low risk women with singleton term pregnancy undergoing labour induction with retrievable, slow-release dinoprostone pessaries (n = 70 were allowed home for up to 24 hours, while a-fECG and uterine activity were monitored in hospital via wireless technology. Semi-structured diaries were analysed using a combined descriptive and interpretive approach. RESULTS: 62/70 women (89% had successful home monitoring; 8 women (11% were recalled because of signal loss. Home monitoring lasted between 2-22 hours (median 10 hours. Good quality signal was achieved most of the time (86%, SD 10%. 3 women were recalled back to hospital for suspicious a-fECG. In 2 cases suspicious a-fECG persisted, requiring Caesarean section after recall to hospital. 48/51 women who returned the diary coped well (94%; 46/51 were satisfied with home monitoring (90%. CONCLUSIONS: Continuous telemetric trans-abdominal fetal ECG monitoring of ambulatory women undergoing labour induction is feasible and acceptable to women.

  12. The roadmap of WT1 protein expression in the human fetal heart.

    Science.gov (United States)

    Duim, Sjoerd N; Smits, Anke M; Kruithof, Boudewijn P T; Goumans, Marie-José

    2016-01-01

    The transcription factor Wilms' Tumor-1 (WT1) is essential for cardiac development. Deletion of Wt1 in mice results in disturbed epicardial and myocardial formation and lack of cardiac vasculature, causing embryonic lethality. Little is known about the role of WT1 in the human fetal heart. Therefore, as a first step, we analyzed the expression pattern of WT1 protein during human cardiac development from week 4 till week 20. WT1 expression was apparent in epicardial, endothelial and endocardial cells in a spatiotemporal manner. The expression of WT1 follows a pattern starting at the epicardium and extending towards the lumen of the heart, with differences in timing and expression levels between the atria and ventricles. The expression of WT1 in cardiac arterial endothelial cells reduces in time, whereas WT1 expression in the endothelial cells of cardiac veins and capillaries remains present at all stages studied. This study provides for the first time a detailed description of the expression of WT1 protein during human cardiac development, which indicates an important role for WT1 also in human cardiogenesis. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Aldosterone inhibits the fetal program and increases hypertrophy in the heart of hypertensive mice.

    Directory of Open Access Journals (Sweden)

    Feriel Azibani

    Full Text Available BACKGROUND: Arterial hypertension (AH induces cardiac hypertrophy and reactivation of "fetal" gene expression. In rodent heart, alpha-Myosin Heavy Chain (MyHC and its micro-RNA miR-208a regulate the expression of beta-MyHC and of its intronic miR-208b. However, the role of aldosterone in these processes remains unclear. METHODOLOGY/PRINCIPAL FINDINGS: RT-PCR and western-blot were used to investigate the genes modulated by arterial hypertension and cardiac hyperaldosteronism. We developed a model of double-transgenic mice (AS-Ren with cardiac hyperaldosteronism (AS mice and systemic hypertension (Ren. AS-Ren mice had increased (x2 angiotensin II in plasma and increased (x2 aldosterone in heart. Ren and AS-Ren mice had a robust and similar hypertension (+70% versus their controls. Anatomical data and echocardiography showed a worsening of cardiac hypertrophy (+41% in AS-Ren mice (P<0.05 vs Ren. The increase of ANP (x 2.5; P<0.01 mRNA observed in Ren mice was blunted in AS-Ren mice. This non-induction of antitrophic natriuretic peptides may be involved in the higher trophic cardiac response in AS-Ren mice, as indicated by the markedly reduced cardiac hypertrophy in ANP-infused AS-Ren mice for one month. Besides, the AH-induced increase of ßMyHC and its intronic miRNA-208b was prevented in AS-Ren. The inhibition of miR 208a (-75%, p<0.001 in AS-Ren mice compared to AS was associated with increased Sox 6 mRNA (x 1.34; p<0.05, an inhibitor of ßMyHC transcription. Eplerenone prevented all aldosterone-dependent effects. CONCLUSIONS/SIGNIFICANCE: Our results indicate that increased aldosterone in heart inhibits the induction of atrial natriuretic peptide expression, via the mineralocorticoid receptor. This worsens cardiac hypertrophy without changing blood pressure. Moreover, this work reveals an original aldosterone-dependent inhibition of miR-208a in hypertension, resulting in the inhibition of β-myosin heavy chain expression through the induction

  14. The Application of an Anatomical Database for Fetal Congenital Heart Disease

    Directory of Open Access Journals (Sweden)

    Li Yang

    2015-01-01

    Conclusions: The database of fetal CHD successfully reproduced the anatomic structures and spatial relationship of different kinds of fetal CHD. This database can be widely used in anatomy and FECG teaching and training.

  15. BPNN based MECG elimination from the abdominal signal to extract fetal signal for continuous fetal monitoring - doi: 10.4025/actascitechnol.v35i2.15361

    Directory of Open Access Journals (Sweden)

    Muhammad Asraful Hasan

    2013-04-01

    Full Text Available Fetal monitoring may help with possible recognition of problems in the fetus. This research work focuses on the design of the Back-propagation Neural Network (BPNN and Adaptive Linear Neural Network (ADALINE to extract the Fetal Electrocardiogram (FECG from the Abdominal ECG (AECG. FECG is extracted to assess the fetus well-being during the pregnancy period of a mother to overcome some existing difficulties regarding the fetal heart rate (FHR monitoring system. Different sets of ECG signal has been tested to validate the algorithm performance. The accuracy of the QRS detection using the designed algorithm is 99%. This research work further made a comparison study between various methods' performance and accuracy and found that the developed algorithm gives the highest accuracy. This paper opens up a passage to biomedical scientists, researchers, and end users to advocate to extract the FECG signal from the AECG signal for FHR monitoring system by providing valuable information to help them for developing more dominant, flexible and resourceful applications.  

  16. The current status of intrapartum continuous fetal tissue pH measurements

    DEFF Research Database (Denmark)

    Nickelsen, Carsten Nahne Amtoft; Weber, Tom

    1991-01-01

    Continuous tissue pH monitoring during labor has now been possible for 15 years. Tissue pH is measured in the intercellular fluid, and the value differs in some cases from the blood pH value because of local capillary flow and local metabolism. The fetal scalp seems to be an area where tissue p......H and capillary blood pH values are very close, but in acute acidosis there may be a time lag of 10-15 min before tissue pH is equilibrated. Normal values of scalp tissue pH are 7.38 in early labor declining by 0.016 per hour during the first stage of labor and by 0.12 per hour during the second stage of labor...

  17. PREDICTION OF FETAL DISTRESS AND POOR OUTCOME OF PREGNANCY BEYOND 40 WEEKS USING DOPPLER ULTRASOUND COMPARED WITH FETAL HEART RATE MONITORING WITH NST

    Directory of Open Access Journals (Sweden)

    Supriya

    2015-06-01

    Full Text Available OBJECTIVES: Postdate pregnancy is the most common indication for Antepartum . F etal heart rate testing because of its increased perinatal morbidity and perinatal mortality. Complications are stillbirth , meconium aspiration , asphyxia , and the dysmaturity syndrome , is increased in post - term pregnancies. The most recent ACOG review of the subject of "post - term" pregnancy cites estimates of 3 - 14 % of all pregna n cies . MATERIALS AND METHODS: 55 patients with pregnancy beyond 40 weeks attending antenatal out - patient department of the Rajiv Gandhi medical college in the period between October 2014 to March 2015 were included. In present study , patients were monitored with twice weekly NST and once a week Doppler. In those with either NST nonreactive or Doppler abnormal , induction was done. Cases with normal results were monitored till 42 weeks when routine induction was done . RESULTS: A reactive non stress test in prolonged pregnancy has good negative predictive value – i.e. adverse outcomes are unlikely to occur in the setting of a reactive non - stress test – but that the positive predictive values are low . W eekly measurement of Doppler waveforms from umbilical artery (PI p=0.02 for Apgar <7 at 5 min , p=0.02 NICU admissions , p=0.003 for meconium staining of amniotic fluid and S/d ratio p=0.02 for Apgar <7 at 5 min , p=0.04 for NICU admission and biweekly NST(p=0.005 for Apgar <7 at 5 min , p=0.0219 for NICU admission , p=0.0039 for meconium staining of amniotic fluid appears to be reliable method of establishing fetal health in pregnancy beyond 40 weeks. CONCLUSION: The most sensitive tests to assess the risks to the fetus of prolonged pregnancy app ear to be combinations of fetal heart rate monitoring with NST combined with umbilical PI and S/D ratio. Reactive NST is reassuring and indicates fetal wellbeing, but non - reactive NST alone cannot be taken as an indicator of fetal jeopardy. Although individual randomized trials

  18. Neurodevelopmental Outcome in Children after Fetal Cardiac Intervention for Aortic Stenosis with Evolving Hypoplastic Left Heart Syndrome.

    Science.gov (United States)

    Laraja, Kristin; Sadhwani, Anjali; Tworetzky, Wayne; Marshall, Audrey C; Gauvreau, Kimberlee; Freud, Lindsay; Hass, Cara; Dunbar-Masterson, Carolyn; Ware, Janice; Lafranchi, Terra; Wilkins-Haug, Louise; Newburger, Jane W

    2017-05-01

    To characterize neurodevelopmental outcomes after fetal aortic valvuloplasty for evolving hypoplastic left heart syndrome and determine the risk factors for adverse neurodevelopment. Questionnaires were mailed to families of children who underwent fetal aortic valvuloplasty from 2000 to 2012, and medical records were reviewed retrospectively. The primary outcome was the General Adaptive Composite score of the Adaptive Behavior Assessment System Questionnaire-Second Edition. Other questionnaires included the Behavior Assessment System for Children, Behavior Rating Inventory of Executive Function, Ages and Stages, and Pediatric Quality of Life Inventory. Among 69 eligible subjects, 52 (75%) completed questionnaires at median age of 5.5 (range 1.3-12) years; 30 (58%) had biventricular status circulation. The General Adaptive Composite mean score (92 ± 17) was lower than population norms (P Behavior Assessment System for Children, Behavior Rating Inventory of Executive Function, Ages and Stages, Pediatric Quality of Life Inventory), most subscale scores for patients with biventricular and single ventricular status were similar. Children who underwent fetal aortic valvuloplasty have neurodevelopmental delay, similar to patients with hypoplastic left heart syndrome without fetal intervention. Achievement of biventricular circulation was not associated with better outcomes. We infer that innate patient factors and morbidity during infancy have the greatest effect on neurodevelopmental outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Prevention of hypoxic fetal complications in pregnant women with congenital heart disease and anemia

    Directory of Open Access Journals (Sweden)

    Iu. Davydova

    2016-06-01

    Full Text Available The aim of the study is — to develop a strategy of prevention of hypoxic fetal abnormalities in pregnant women with congenital heart disease, heart failure and iron deficiency anemia. Materials and methods. The study included 86 pregnant women with CHD and NYHA II–III. 68 women in the third trimester of pregnancy is diagnosed anemia (group I, 18 pregnant women with CHD, NYHA II–III without anemia (II group, the control group consisted of 24 pregnant women without cardiac disease, with physiological pregnancy. All pregnant with information registration consent studied the concentration of ferritin, hemoglobin level, morphological study of the placenta. All pregnant women were assigned to iron supplements, oral iron (III hydroxide polymaltose complex (Maltofer when hemoglobin levels above 95 g/l and the expected delivery date more than 40 days of starting treatment. When the hemoglobin level below 95 g/l of intravenously administered iron (III hydroxide sucrose complex (Venofer followed by transfer to oral iron (III. Results. In groups of pregnant I and II did not have perinatal losses, births in gestation less than 28 weeks, with a score Apgar at birth of less than 4 points. Pregnant women with cyanotic heart defects and the need for early delivery in less than 37 weeks are not included in the study. Also, there is a correlation between the degree of severity of anemia in women with CHD with HF and prematurity, and the presence of IUGR child birth asphyxia able to varying degrees (respectively, r=0.8, r=0.75 and r=0.85. Conclusions. Formation of fetoplacental unit in women with CHD on a background of heart failure occurs with complications associated with the presence of tissue hypoxia, as well as the possible impact on the process of oxidative stress. The development of iron deficiency anemia in this group is an additional risk factor for placental dysfunction, which is confirmed by morphometric and morphological studies of placentas

  20. A fetal human heart cardiac-inducing RNA (CIR) promotes the differentiation of stem cells into cardiomyocytes.

    Science.gov (United States)

    Kochegarov, Andrei; Moses-Arms, Ashley; Lemanski, Larry F

    2015-08-01

    A specific human fetal heart RNA has been discovered, which has the ability to induce myocardial cell formation from mouse embryonic and human-induced pluripotent stem cells in culture. In this study, commercially obtained RNA from human fetal heart was cloned, sequenced, and synthesized using standard laboratory approaches. Molecular analyses of the specific fetal cardiac-inducing RNA (CIR), revealed that it is a fragment of N-sulfoglucosaminesulfohydrolase and the caspase recruitment domain family member 14 precursor. Stem cells transfected with CIRs often form into spindle-shaped cells characteristic of cardiomyocytes,and express the cardiac-specific contractile protein marker, troponin-T, in addition to tropomyosin and α-actinin as detected by immunohistochemical staining. Expression of these contractile proteins showed organization into sarcomeric myofibrils characteristic of striated cardiac muscle cells. Computer analyses of the RNA secondary structures of the active CIR show significant similarities to a RNA from salamander or myofibril-inducing RNA (MIR), which also promotes non-muscle cells to differentiate into cardiac muscle. Thus, these two RNAs, salamander MIR and the newly discovered human-cloned CIR reported here, appear to have evolutionarily conserved secondary structures suggesting that both play major roles in vertebrate heart development and, particularly, in the differentiation of cardiomyocytes from non-muscle cells during development.

  1. Freqüência Cardíaca Fetal durante o Primeiro Trimestre da Gestação Fetal Heart Rate in the First Trimester of Pregnancy

    Directory of Open Access Journals (Sweden)

    Heverton Pettersen

    2001-10-01

    Full Text Available Objetivos: estabelecer curva de normalidade da freqüência cardíaca fetal (FCF entre a 10ª e a 14ª semana de gestação. Métodos: a FCF foi avaliada em 1078 fetos entre 10 e 14 semanas de gestação. Para uma melhor correlação da FCF com a idade gestacional, os fetos foram divididos em quatro grupos de acordo com a idade gestacional: Grupo I (10 semanas, Grupo II (11 semanas, Grupo III (12 semanas e Grupo IV (13 semanas. Por meio de corte sagital, o coração fetal foi visualizado e o registro da FCF foi realizado usando Modo-B e Modo-M em tempo real. Calculou-se a FCF média eletronicamente por meio da colocação dos cálipers que registravam 3 ciclos consecutivos. Resultados: a FCF variou entre 136 e 178 bpm entre os 1078 fetos estudados. Construiu-se uma curva de normalidade estabelecendo-se a mediana e os percentis 5 e 95 da FCF para cada grupo. No Grupo I a FCF variou de 158 a 184 bpm; no Grupo II, de 155 a 175 bpm; no Grupo III, de 152 a 172 bpm; no Grupo IV, de 149 a 168 bpm. Houve diminuição progressiva e significativa da FCF com o avanço da idade gestacional durante o período estudado. Conclusões: a avaliação da FCF no primeiro trimestre de gestação é um procedimento simples e que deve ser analisado não só na sua forma qualitativa (batimentos cardíacos fetais rítmicos mas também na sua forma quantitativa, já que trabalhos publicados mostram a sua relação com o prognóstico fetal.Purpose: to determine normal ranges for fetal heart rate (FHR between the 10th and 14th week of pregnancy. Methods: a total of 1078 fetuses within a crown-rump length (CRL from the 10th to the 14th week of pregnancy were evaluated. The fetuses were divided into 4 groups: Group I (10 weeks, Group II (11 weeks, Group III (12 weeks, Group IV (13 weeks. The fetal heart was seen using B-mode/M-mode at a sagital plane and FHR was recorded. FHR was electronically calculated using calipers within 3 consecutive cycles without fetal moveiments

  2. Maternal and Fetal Outcomes of Anticoagulation in Pregnant Women With Mechanical Heart Valves.

    Science.gov (United States)

    Steinberg, Zachary L; Dominguez-Islas, Clara P; Otto, Catherine M; Stout, Karen K; Krieger, Eric V

    2017-06-06

    Anticoagulation for mechanical heart valves during pregnancy is essential to prevent thromboembolic events. Each regimen has drawbacks with regard to maternal or fetal risk. This meta-analysis sought to estimate and compare the risk of adverse maternal and fetal outcomes in pregnant women with mechanical heart valves who received different methods of anticoagulation. Studies were identified using a Medline search including all publications up to June 5, 2016. Study inclusion required reporting of maternal death, thromboembolism, and valve failure, and/or fetal spontaneous abortion, death, and congenital defects in pregnant women treated with any of the following: 1) a vitamin K antagonist (VKA) throughout pregnancy; 2) low-molecular-weight heparin (LMWH) throughout pregnancy; 3) LMWH for the first trimester, followed by a VKA (LMWH and VKA); or 4) unfractionated heparin for the first trimester, followed by a VKA (UFH and VKA). A total of 800 pregnancies from 18 publications were included. Composite maternal risk was lowest with VKA (5%), compared with LMWH (16%; ratio of averaged risk [RAR]: 3.2; 95% confidence interval [CI]: 1.5 to 7.5), LMWH and VKA (16%; RAR: 3.1; 95% CI: 1.2 to 7.5), or UFH and VKA (16%; RAR: 3.1; 95% CI: 1.5 to 7.1). Composite fetal risk was lowest with LMWH (13%; RAR: 0.3; 95% CI: 0.1 to 0.8), compared with VKA (39%), LMWH and VKA (23%), or UFH and VKA (34%). No significant difference in fetal risk was observed between women taking ≤5 mg daily warfarin and those with an LMWH regimen (RAR: 0.9; 95% CI: 0.3 to 2.4). VKA treatment was associated with the lowest risk of adverse maternal outcomes, whereas the use of LMWH throughout pregnancy was associated with the lowest risk of adverse fetal outcomes. Fetal risk was similar between women taking ≤5 mg warfarin daily and women treated with LMWH. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  3. Fetal Aortic Valvuloplasty for Evolving Hypoplastic Left Heart Syndrome: Postnatal Outcomes of the First 100 Patients

    Science.gov (United States)

    Freud, Lindsay R.; McElhinney, Doff B.; Marshall, Audrey C.; Marx, Gerald R.; Friedman, Kevin G.; del Nido, Pedro J.; Emani, Sitaram M.; Lafranchi, Terra; Silva, Virginia; Wilkins-Haug, Louise E.; Benson, Carol B.; Lock, James E.; Tworetzky, Wayne

    2015-01-01

    Background Fetal aortic valvuloplasty (FAV) can be performed for severe mid-gestation aortic stenosis (AS) in an attempt to prevent progression to hypoplastic left heart syndrome (HLHS). A subset of patients has achieved a biventricular (BV) circulation after FAV. The postnatal outcomes and survival of the BV patients, compared to those managed as HLHS, have not been reported. Methods and Results We included 100 patients who underwent FAV for severe mid-gestation AS with evolving HLHS from March 2000 to January 2013. Patients were categorized based on postnatal management as BV or HLHS. Clinical records were reviewed. Eighty-eight fetuses were live-born, and 38 had a BV circulation (31 from birth, 7 converted after initial univentricular palliation). Left-sided structures, namely aortic and mitral valve sizes and LV volume, were significantly larger in the BV group at the time of birth (p-values <0.01). After a median follow-up of 5.4 years, freedom from cardiac death among all BV patients was 96±4% at 5 years and 84±12% at 10 years, which was better than HLHS patients (log-rank p=0.04). There was no cardiac mortality in patients with a BV circulation from birth. All but 1 of the BV patients required postnatal intervention; 42% underwent aortic and/or mitral valve replacement. On most recent echocardiogram, the median LV end-diastolic volume z-score was +1.7 (range: -1.3, +8.2), and 80% had normal ejection fraction. Conclusions Short- and intermediate-term survival among patients who underwent FAV and achieved a BV circulation postnatally is encouraging. However, morbidity still exists, and on-going assessment is warranted. PMID:25052401

  4. The current status of intrapartum continuous fetal tissue pH measurements

    DEFF Research Database (Denmark)

    Nickelsen, Carsten Nahne Amtof; Weber, Tom

    1991-01-01

    Continuous tissue pH monitoring during labor has now been possible for 15 years. Tissue pH is measured in the intercellular fluid, and the value differs in some cases from the blood pH value because of local capillary flow and local metabolism. The fetal scalp seems to be an area where tissue pH...... and capillary blood pH values are very close, but in acute acidosis there may be a time lag of 10-15 min before tissue pH is equilibrated. Normal values of scalp tissue pH are 7.38 in early labor declining by 0.016 per hour during the first stage of labor and by 0.12 per hour during the second stage of labor....... Tissue pH values below 7.15 are defined as pathological. The correlation coefficient to umbilical artery blood pH (0.71), success rate (67%) and electrode drift (below 0.04) from the largest study of tissue pH monitoring using glass pH electrodes (n = 337) are described....

  5. Fetal heart rate patterns in neonatal hypoxic-ischemic encephalopathy: relationship with early cerebral activity and neurodevelopmental outcome.

    LENUS (Irish Health Repository)

    Murray, Deirdre M

    2009-09-01

    Despite widespread use of fetal heart rate monitoring, the timing of injury in hypoxic-ischemic encephalopathy (HIE) remains unclear. Our aim was to examine fetal heart rate patterns during labor in infants with clinical and electroencephalographic (EEG) evidence of HIE and to relate these findings to neurodevelopmental outcome. Timing of onset of pathological cardiotocographs (CTGs) was determined in each case by two blinded reviewers and related to EEG grade at birth and neurological outcome at 24 months. CTGs were available in 35 infants with HIE (17 mild, 12 moderate, 6 severe on EEG). Admission CTGs were normal in 24\\/35 (69%), suspicious in 8\\/35 (23%), and pathological in 3\\/35 (8%). All CTGs developed nonreassuring features prior to delivery. Three patterns of fetal heart rate abnormalities were seen: group 1, abnormal CTGs on admission in 11\\/35 (31%); group 2, normal CTGs on admission with gradual deterioration to pathological in 20\\/35 cases (57%); and group 3, normal CTGs on admission with acute sentinel events in 4\\/35 (11.5%). The median (interquartile range) duration between the development of pathological CTGs and delivery was 145 (81, 221) minutes in group 2 and 22 (12, 28) minutes in group 3. There was no correlation between duration of pathological CTG trace and grade of encephalopathy (R = 0.09, P = 0.63) or neurological outcome (P = 0.75). However, the grade of encephalopathy was significantly worse in group 3 (P = 0.001), with a trend to worse outcomes. The majority of infants with HIE have normal CTG traces on admission but develop pathological CTG patterns within hours of delivery. More severe encephalopathy was associated with normal admission CTG and acute sentinel events shortly before delivery.

  6. Fetal heart rate patterns in neonatal hypoxic-ischemic encephalopathy: relationship with early cerebral activity and neurodevelopmental outcome.

    LENUS (Irish Health Repository)

    Murray, Deirdre M

    2012-01-31

    Despite widespread use of fetal heart rate monitoring, the timing of injury in hypoxic-ischemic encephalopathy (HIE) remains unclear. Our aim was to examine fetal heart rate patterns during labor in infants with clinical and electroencephalographic (EEG) evidence of HIE and to relate these findings to neurodevelopmental outcome. Timing of onset of pathological cardiotocographs (CTGs) was determined in each case by two blinded reviewers and related to EEG grade at birth and neurological outcome at 24 months. CTGs were available in 35 infants with HIE (17 mild, 12 moderate, 6 severe on EEG). Admission CTGs were normal in 24\\/35 (69%), suspicious in 8\\/35 (23%), and pathological in 3\\/35 (8%). All CTGs developed nonreassuring features prior to delivery. Three patterns of fetal heart rate abnormalities were seen: group 1, abnormal CTGs on admission in 11\\/35 (31%); group 2, normal CTGs on admission with gradual deterioration to pathological in 20\\/35 cases (57%); and group 3, normal CTGs on admission with acute sentinel events in 4\\/35 (11.5%). The median (interquartile range) duration between the development of pathological CTGs and delivery was 145 (81, 221) minutes in group 2 and 22 (12, 28) minutes in group 3. There was no correlation between duration of pathological CTG trace and grade of encephalopathy (R = 0.09, P = 0.63) or neurological outcome (P = 0.75). However, the grade of encephalopathy was significantly worse in group 3 (P = 0.001), with a trend to worse outcomes. The majority of infants with HIE have normal CTG traces on admission but develop pathological CTG patterns within hours of delivery. More severe encephalopathy was associated with normal admission CTG and acute sentinel events shortly before delivery.

  7. Fetal growth restriction results in remodeled and less efficient hearts in children

    OpenAIRE

    Crispi, Fátima; Bijnens, Bart; Figueras, Francesc; Bartrons, Joaquim; Eixarch, Elisenda; Le Noble, Ferdinand; Ahmed, Asif; Gratacos, Eduard

    2010-01-01

    BACKGROUND-: Fetal growth restriction (FGR) affects 5% to 10% of newborns and is associated with increased cardiovascular mortality in adulthood. The most commonly accepted hypothesis is that fetal metabolic programming leads secondarily to diseases associated with cardiovascular disease, such as obesity, diabetes mellitus, and hypertension. Our main objective was to evaluate the alternative hypothesis that FGR induces primary cardiac changes that persist into childhood. METHODS AND RESULTS-:...

  8. The effects of different concentrations of cocoa in the chocolate intaken by the mother on fetal heart rate.

    Science.gov (United States)

    Buscicchio, Giorgia; Lorenzi, Sara; Tranquilli, Andrea Luigi

    2013-10-01

    To analyze the effects of different concentrations (30% and 80%) of cocoa on fetal heart rate (FHR). One hundred pregnant women with uncomplicated gestation, matched for age and parity, underwent computerized FHR recording before and after the consumption of 30 g of 30% and 80% cocoa chocolate. After 1 week, those who had received 30% were shifted to 80% and vice versa to have a crossover. Computerized cardiotocography parameters (contractions, fetal movements, baseline FHR, accelerations greater than 15 bpm for 15 s, number of decelerations, minutes of high variability, short term variability in ms) were recorded and expressed as mean and SD. The differences were tested for statistical significance using the paired t test, with the significance at p cocoa intake. After 30% cocoa chocolate intake, only the number of accelerations was significantly increased. The percent change of the number of accelerations and the short-term FHR variation were significantly higher after 80% cocoa chocolate maternal intake. Maternal intake of dark chocolate has a stimulating action on fetal reactivity. The effect is more marked with high concentrations (80%) of cocoa. This finding is likely due to the pharmacological action of theobromine, a methilxanthine present in cocoa.

  9. Age-Dependent Changes in Geometry, Tissue Composition and Mechanical Properties of Fetal to Adult Cryopreserved Human Heart Valves.

    Science.gov (United States)

    van Geemen, Daphne; Soares, Ana L F; Oomen, Pim J A; Driessen-Mol, Anita; Janssen-van den Broek, Marloes W J T; van den Bogaerdt, Antoon J; Bogers, Ad J J C; Goumans, Marie-José T H; Baaijens, Frank P T; Bouten, Carlijn V C

    2016-01-01

    There is limited information about age-specific structural and functional properties of human heart valves, while this information is key to the development and evaluation of living valve replacements for pediatric and adolescent patients. Here, we present an extended data set of structure-function properties of cryopreserved human pulmonary and aortic heart valves, providing age-specific information for living valve replacements. Tissue composition, morphology, mechanical properties, and maturation of leaflets from 16 pairs of structurally unaffected aortic and pulmonary valves of human donors (fetal-53 years) were analyzed. Interestingly, no major differences were observed between the aortic and pulmonary valves. Valve annulus and leaflet dimensions increase throughout life. The typical three-layered leaflet structure is present before birth, but becomes more distinct with age. After birth, cell numbers decrease rapidly, while remaining cells obtain a quiescent phenotype and reside in the ventricularis and spongiosa. With age and maturation-but more pronounced in aortic valves-the matrix shows an increasing amount of collagen and collagen cross-links and a reduction in glycosaminoglycans. These matrix changes correlate with increasing leaflet stiffness with age. Our data provide a new and comprehensive overview of the changes of structure-function properties of fetal to adult human semilunar heart valves that can be used to evaluate and optimize future therapies, such as tissue engineering of heart valves. Changing hemodynamic conditions with age can explain initial changes in matrix composition and consequent mechanical properties, but cannot explain the ongoing changes in valve dimensions and matrix composition at older age.

  10. Age-Dependent Changes in Geometry, Tissue Composition and Mechanical Properties of Fetal to Adult Cryopreserved Human Heart Valves.

    Directory of Open Access Journals (Sweden)

    Daphne van Geemen

    Full Text Available There is limited information about age-specific structural and functional properties of human heart valves, while this information is key to the development and evaluation of living valve replacements for pediatric and adolescent patients. Here, we present an extended data set of structure-function properties of cryopreserved human pulmonary and aortic heart valves, providing age-specific information for living valve replacements. Tissue composition, morphology, mechanical properties, and maturation of leaflets from 16 pairs of structurally unaffected aortic and pulmonary valves of human donors (fetal-53 years were analyzed. Interestingly, no major differences were observed between the aortic and pulmonary valves. Valve annulus and leaflet dimensions increase throughout life. The typical three-layered leaflet structure is present before birth, but becomes more distinct with age. After birth, cell numbers decrease rapidly, while remaining cells obtain a quiescent phenotype and reside in the ventricularis and spongiosa. With age and maturation-but more pronounced in aortic valves-the matrix shows an increasing amount of collagen and collagen cross-links and a reduction in glycosaminoglycans. These matrix changes correlate with increasing leaflet stiffness with age. Our data provide a new and comprehensive overview of the changes of structure-function properties of fetal to adult human semilunar heart valves that can be used to evaluate and optimize future therapies, such as tissue engineering of heart valves. Changing hemodynamic conditions with age can explain initial changes in matrix composition and consequent mechanical properties, but cannot explain the ongoing changes in valve dimensions and matrix composition at older age.

  11. Age-Dependent Changes in Geometry, Tissue Composition and Mechanical Properties of Fetal to Adult Cryopreserved Human Heart Valves

    Science.gov (United States)

    van Geemen, Daphne; Soares, Ana L. F.; Oomen, Pim J. A.; Driessen-Mol, Anita; Janssen-van den Broek, Marloes W. J. T.; van den Bogaerdt, Antoon J.; Bogers, Ad J. J. C.; Goumans, Marie-José T. H.; Baaijens, Frank P. T.; Bouten, Carlijn V. C.

    2016-01-01

    There is limited information about age-specific structural and functional properties of human heart valves, while this information is key to the development and evaluation of living valve replacements for pediatric and adolescent patients. Here, we present an extended data set of structure-function properties of cryopreserved human pulmonary and aortic heart valves, providing age-specific information for living valve replacements. Tissue composition, morphology, mechanical properties, and maturation of leaflets from 16 pairs of structurally unaffected aortic and pulmonary valves of human donors (fetal-53 years) were analyzed. Interestingly, no major differences were observed between the aortic and pulmonary valves. Valve annulus and leaflet dimensions increase throughout life. The typical three-layered leaflet structure is present before birth, but becomes more distinct with age. After birth, cell numbers decrease rapidly, while remaining cells obtain a quiescent phenotype and reside in the ventricularis and spongiosa. With age and maturation–but more pronounced in aortic valves–the matrix shows an increasing amount of collagen and collagen cross-links and a reduction in glycosaminoglycans. These matrix changes correlate with increasing leaflet stiffness with age. Our data provide a new and comprehensive overview of the changes of structure-function properties of fetal to adult human semilunar heart valves that can be used to evaluate and optimize future therapies, such as tissue engineering of heart valves. Changing hemodynamic conditions with age can explain initial changes in matrix composition and consequent mechanical properties, but cannot explain the ongoing changes in valve dimensions and matrix composition at older age. PMID:26867221

  12. Fetal auditory responses to external sounds and mother's heart beat: detection improved by Independent Component Analysis.

    Science.gov (United States)

    Porcaro, Camillo; Zappasodi, Filippo; Barbati, Giulia; Salustri, Carlo; Pizzella, Vittorio; Rossini, Paolo Maria; Tecchio, Franca

    2006-07-26

    In this paper, we present a magnetoencephalographic study of the fetal auditory response to external stimuli and to the sound of the mother's heartbeat. We describe how an ad hoc functional selection procedure allowed us to isolate the sources in the fetal brain responding to sounds only, after the application to the recorded data of a standard Independent Component Analysis algorithm. In our experiment, acoustic stimuli were delivered to twelve healthy women with uncomplicated pregnancies at a time between 36 and 40 weeks gestational age, with their fetuses in breech presentation. Ultrasound images allowed determination of the region over the women's abdomen nearest to the fetal head, over which both the acoustic stimulator and the MEG sensors were subsequently placed. In 8 out of the 12 cases, our analysis provided consistent evidence of a fetal response both to the mother's heartbeat and to the external auditory stimulation; both were characterized by a clear prominent component at around 200 ms latency, which is widely accepted as the marker of the fetal response to auditory stimuli.

  13. Mitochondrial DNA Hypomethylation Is a Biomarker Associated with Induced Senescence in Human Fetal Heart Mesenchymal Stem Cells

    Directory of Open Access Journals (Sweden)

    Dehai Yu

    2017-01-01

    Full Text Available Background. Fetal heart can regenerate to restore its normal anatomy and function in response to injury, but this regenerative capacity is lost within the first week of postnatal life. Although the specific molecular mechanisms remain to be defined, it is presumed that aging of cardiac stem or progenitor cells may contribute to the loss of regenerative potential. Methods. To study this aging-related dysfunction, we cultured mesenchymal stem cells (MSCs from human fetal heart tissues. Senescence was induced by exposing cells to chronic oxidative stress/low serum. Mitochondrial DNA methylation was examined during the period of senescence. Results. Senescent MSCs exhibited flattened and enlarged morphology and were positive for the senescence-associated beta-galactosidase (SA-β-Gal. By scanning the entire mitochondrial genome, we found that four CpG islands were hypomethylated in close association with senescence in MSCs. The mitochondrial COX1 gene, which encodes the main subunit of the cytochrome c oxidase complex and contains the differentially methylated CpG island 4, was upregulated in MSCs in parallel with the onset of senescence. Knockdown of DNA methyltransferases (DNMT1, DNMT3a, and DNMT3B also upregulated COX1 expression and induced cellular senescence in MSCs. Conclusions. This study demonstrates that mitochondrial CpG hypomethylation may serve as a critical biomarker associated with cellular senescence induced by chronic oxidative stress.

  14. Is the short axis view of the fetal heart useful in improving the diagnostic accuracy of outlet ventricular septal defects?

    Science.gov (United States)

    Dall'Asta, Andrea; Cavalli, Claudio; Galli, Letizia; Volpe, Nicola; Weiss, Adi; Kaihura, Christine Tita; Agnetti, Aldo; Frusca, Tiziana; Ghi, Tullio

    2017-02-01

    Outlet ventricular septal defects (VSDs) are usually suspected on the five-chamber view of the fetal heart; however, postnatal confirmation occurs only in a small number of cases. The aim of this study was to evaluate if the systematic assessment of the short axis view may improve the prediction of prenatally detected outlet VSDs. Cases where isolated outlet VSD was suspected on the five-chamber view were assessed by using the short axis scanning plane for confirmation of the defect. Postnatal assessment was performed within 2 weeks from birth at our Paediatric Cardiology Unit. An outlet VSD was suspected at five-chamber view in 23 fetuses. Postnatal confirmation of the VSD occurred in 14 cases where the defect was prenatally detected both on the five chamber and the short axis views. VSDs were not confirmed at postnatal assessment only in two cases where outlet VSD was suspected on both views, whereas all the seven cases with a suspected VSD on the five-chamber view only turned out to be false positives. The short axis view of the fetal heart seems useful in confirming the presence of outlet VSDs. © 2016 John Wiley & Sons, Ltd. © 2016 John Wiley & Sons, Ltd.

  15. Fetal MSCs

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. Derived from extra embryonic tissues (amniotic fluid, placenta, cord blood, Wharton's Jelly) and fetal tissues (aborted fetuses). Derived from extra embryonic tissues (amniotic fluid, placenta, cord blood, Wharton's Jelly) and fetal tissues (aborted fetuses). In comparison ...

  16. Continuous measurement of heart rate variability following carbon ...

    African Journals Online (AJOL)

    2010-07-16

    Jul 16, 2010 ... Power spectral analysis of the electrocardiographic R-R interval [heart rate variability: (HRV)] is a well known, non- invasive method for assessing autonomic nervous activity.1. Studies using HRV analysis during positive-pressure pneumoperitoneum (PPP) have demonstrated increased sympathetic ...

  17. Association between Fetal Congenital Heart Defects and Maternal Risk of Hypertensive Disorders of Pregnancy in the Same Pregnancy and Across Pregnancies

    DEFF Research Database (Denmark)

    Boyd, Heather Allison; Basit, Saima; Behrens, Ida

    2017-01-01

    Background: Both pregnant women carrying fetuses with heart defects and women with hypertensive disorders of pregnancy often exhibit angiogenic imbalances, suggesting that the same mechanisms are involved in the pathogenesis of the former and the pathophysiology of the latter. We conducted...... a register-based cohort study to determine whether offspring congenital heart defects are associated with an increased risk of hypertensive disorders of pregnancy and whether the mechanisms driving any association are primarily maternal or fetal. Methods: Among singleton pregnancies without chromosomal...

  18. Fetal heart development in the nitrofen-induced CDH rat model: the role of mechanical and nonmechanical factors.

    Science.gov (United States)

    Correia-Pinto, Jorge; Baptista, Maria J; Pedrosa, Carla; Estevão-Costa, José; Flake, Alan W; Leite-Moreira, Adelino F

    2003-10-01

    In congenital diaphragmatic hernia (CDH), it was recently shown that early and late gestational lung underdevelopment is caused by nonmechanical and mechanical factors, respectively. Heart underdevelopment, which might predict lung hypoplasia, is commonly attributed to mechanical factors. The authors analyzed whether nonmechanical and mechanical factors affect cardiac growth and correlations between lung and heart weights during gestation. Left-sided CDH was induced in pregnant Wistar rats by administration of nitrofen on E9.5. At selected gestational ages (E18, E20, and E22), the lungs and heart were harvested, weighed, and analyzed for DNA and protein contents. Left lung and heart weights were correlated at those gestational ages. Two experimental groups: nitrofen without CDH (nitrofen), and nitrofen with CDH (CDH), were compared with normal controls. At E18, both nitrofen-exposed groups presented similar and significant left lung (LL) hypoplasia. As gestation progressed (E20 and E22), in the nitrofen group left lung (LL) hypoplasia decreased, whereas in the CDH group LL hypoplasia was exacerbated relative to normal controls. In contrast, at E18 and E20, heart-to-body weight ratios as well as cardiac DNA and protein contents were reduced significantly in all animals exposed to nitrofen, with no significant differences observed between nitrofen and CDH groups. As gestation progressed, the difference between cardiac parameters in nitrofen-exposed and normal control rats diminished, and at E22 no significant differences were documented. In the CDH group, significant correlations were seen between lung and heart weights at E18 (r = 0.65; P <.05) and E20 (r = 0.4; P <.05), whereas at term gestation (E22) no significant correlation was observed (r = 0.21, not significant). Nonmechanical factors, which might be directed by nitrofen, play a role in the pathogenesis of lung and heart hypoplasia manifested precociously in fetal life, whereas mechanical compression might

  19. An advanced algorithm for fetal heart rate estimation from non-invasive low electrode density recordings

    International Nuclear Information System (INIS)

    Dessì, Alessia; Pani, Danilo; Raffo, Luigi

    2014-01-01

    Non-invasive fetal electrocardiography is still an open research issue. The recent publication of an annotated dataset on Physionet providing four-channel non-invasive abdominal ECG traces promoted an international challenge on the topic. Starting from that dataset, an algorithm for the identification of the fetal QRS complexes from a reduced number of electrodes and without any a priori information about the electrode positioning has been developed, entering into the top ten best-performing open-source algorithms presented at the challenge. In this paper, an improved version of that algorithm is presented and evaluated exploiting the same challenge metrics. It is mainly based on the subtraction of the maternal QRS complexes in every lead, obtained by synchronized averaging of morphologically similar complexes, the filtering of the maternal P and T waves and the enhancement of the fetal QRS through independent component analysis (ICA) applied on the processed signals before a final fetal QRS detection stage. The RR time series of both the mother and the fetus are analyzed to enhance pseudoperiodicity with the aim of correcting wrong annotations. The algorithm has been designed and extensively evaluated on the open dataset A (N = 75), and finally evaluated on datasets B (N = 100) and C (N = 272) to have the mean scores over data not used during the algorithm development. Compared to the results achieved by the previous version of the algorithm, the current version would mark the 5th and 4th position in the final ranking related to the events 1 and 2, reserved to the open-source challenge entries, taking into account both official and unofficial entrants. On dataset A, the algorithm achieves 0.982 median sensitivity and 0.976 median positive predictivity. (paper)

  20. Gestational dietary protein is associated with sex specific decrease in blood flow, fetal heart growth and post-natal blood pressure of progeny.

    Science.gov (United States)

    Hernandez-Medrano, Juan H; Copping, Katrina J; Hoare, Andrew; Wapanaar, Wendela; Grivell, Rosalie; Kuchel, Tim; Miguel-Pacheco, Giuliana; McMillen, I Caroline; Rodgers, Raymond J; Perry, Viv E A

    2015-01-01

    The incidence of adverse pregnancy outcomes is higher in pregnancies where the fetus is male. Sex specific differences in feto-placental perfusion indices identified by Doppler assessment have recently been associated with placental insufficiency and fetal growth restriction. This study aims to investigate sex specific differences in placental perfusion and to correlate these changes with fetal growth. It represents the largest comprehensive study under field conditions of uterine hemodynamics in a monotocous species, with a similar long gestation period to the human. Primiparous 14 mo heifers in Australia (n=360) and UK (n=180) were either individually or group fed, respectively, diets with differing protein content (18, 14, 10 or 7% crude protein (CP)) from 60 d prior to 98 days post conception (dpc). Fetuses and placentae were excised at 98 dpc (n = 48). Fetal development an median uterine artery blood flow were assessed monthly from 36 dpc until term using B-mode and Doppler ultrasonography. MUA blood flow to the male feto-placental unit increased in early pregnancy associated with increased fetal growth. Protein restriction before and shortly after conception (-60 d up to 23 dpc) increased MUA diameter and indices of velocity during late pregnancy, reduced fetal heart weight in the female fetus and increased heart rate at birth, but decreased systolic blood pressure at six months of age. Sex specific differences both in feto-placental Doppler perfusion indices and response of these indices to dietary perturbations were observed. Further, maternal diet affected development of fetal cardiovascular system associated with altered fetal haemodynamics in utero, with such effects having a sex bias. The results from this study provide further insight into the gender specific circulatory differences present in the fetal period and developing cardiovascular system.

  1. Gestational dietary protein is associated with sex specific decrease in blood flow, fetal heart growth and post-natal blood pressure of progeny.

    Directory of Open Access Journals (Sweden)

    Juan H Hernandez-Medrano

    Full Text Available The incidence of adverse pregnancy outcomes is higher in pregnancies where the fetus is male. Sex specific differences in feto-placental perfusion indices identified by Doppler assessment have recently been associated with placental insufficiency and fetal growth restriction. This study aims to investigate sex specific differences in placental perfusion and to correlate these changes with fetal growth. It represents the largest comprehensive study under field conditions of uterine hemodynamics in a monotocous species, with a similar long gestation period to the human. Primiparous 14 mo heifers in Australia (n=360 and UK (n=180 were either individually or group fed, respectively, diets with differing protein content (18, 14, 10 or 7% crude protein (CP from 60 d prior to 98 days post conception (dpc. Fetuses and placentae were excised at 98 dpc (n = 48. Fetal development an median uterine artery blood flow were assessed monthly from 36 dpc until term using B-mode and Doppler ultrasonography. MUA blood flow to the male feto-placental unit increased in early pregnancy associated with increased fetal growth. Protein restriction before and shortly after conception (-60 d up to 23 dpc increased MUA diameter and indices of velocity during late pregnancy, reduced fetal heart weight in the female fetus and increased heart rate at birth, but decreased systolic blood pressure at six months of age.Sex specific differences both in feto-placental Doppler perfusion indices and response of these indices to dietary perturbations were observed. Further, maternal diet affected development of fetal cardiovascular system associated with altered fetal haemodynamics in utero, with such effects having a sex bias. The results from this study provide further insight into the gender specific circulatory differences present in the fetal period and developing cardiovascular system.

  2. Heart rate-mediated blood pressure control in preterm fetal sheep under normal and hypoxic-ischemic conditions.

    Science.gov (United States)

    Zwanenburg, Alex; Jellema, Reint K; Jennekens, Ward; Ophelders, Daan; Vullings, Rik; van Hunnik, Arne; van Pul, Carola; Bennet, Laura; Delhaas, Tammo; Kramer, Boris W; Andriessen, Peter

    2013-04-01

    The understanding of hypoxemia-induced changes in baroreflex function is limited and may be studied in a fetal sheep experiment before, during, and after standardized hypoxic conditions. Preterm fetal lambs were instrumented at 102 d gestation (term: 146 d). At 106 d, intrauterine hypoxia--ischemia was induced by 25 min of umbilical cord occlusion (UCO). Baroreflex-related fluctuations were calculated at 30-min intervals during the first week after UCO by transfer function (cross-spectral) analysis between systolic blood pressure (SBP) and R-R interval fluctuations, estimated in the low-frequency (LF, 0.04-0.15 Hz) band. LF transfer gain (baroreflex sensitivity) and delay (s) reflect the baroreflex function. Baseline did not differ in LF transfer gain and delay between controls and the UCO group. In controls, LF gain showed postnatal increase. By contrast, LF gain gradually decreased in the UCO group, resulting in significantly lower values 4-7 d after UCO. In the UCO group, LF delay increased and differed significantly from controls. Our results show that intrauterine hypoxia-ischemia results in reduced baroreflex sensitivity over a period of 7 d, indicating limited efficacy to buffer BP changes by adapting heart rate. Cardiovascular dysregulation may augment already present cerebral damage after systemic hypoxia-ischemia in the reperfusion period.

  3. Quantitative comparison of entropy analysis of fetal heart rate variability related to the different stages of labor.

    Science.gov (United States)

    Lim, Jongil; Kwon, Ji Young; Song, Juhee; Choi, Hosoon; Shin, Jong Chul; Park, In Yang

    2014-02-01

    The interpretation of the fetal heart rate (FHR) signal considering labor progression may improve perinatal morbidity and mortality. However, there have been few studies that evaluate the fetus in each labor stage quantitatively. To evaluate whether the entropy indices of FHR are different according to labor progression. A retrospective comparative study of FHR recordings in three groups: 280 recordings in the second stage of labor before vaginal delivery, 31 recordings in the first stage of labor before emergency cesarean delivery, and 23 recordings in the pre-labor before elective cesarean delivery. The stored FHR recordings of external cardiotocography during labor. Approximate entropy (ApEn) and sample entropy (SampEn) for the final 2000 RR intervals. The median ApEn and SampEn for the 2000 RR intervals showed the lowest values in the second stage of labor, followed by the emergency cesarean group and the elective cesarean group for all time segments (all PEntropy indices of FHR were significantly different according to labor progression. This result supports the necessity of considering labor progression when developing intrapartum fetal monitoring using the entropy indices of FHR. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. Maternal Phenylketonuria International Collaborative Study revisited: evaluation of maternal nutritional risk factors besides phenylalanine for fetal congenital heart defects.

    Science.gov (United States)

    Yano, Shoji; Moseley, Kathryn; Bottiglieri, Teodoro; Arning, Erland; Azen, Colleen

    2014-01-01

    Maternal phenylketonuria (MPKU) is known to affect fetal outcome, often being associated with microcephaly and congenital heart defects (CHD) if the maternal diet is not appropriately managed. We hypothesized that other nutrients aside from phenylalanine (Phe) may have significant effects on fetal outcome in MPKU pregnancies. The 416 pregnancies that resulted in live births reported in the Maternal PKU Collaborative Study (MPKUCS) were grouped according to whether or not the offspring were diagnosed with CHD. The groups were compared on first-trimester values of maternal data, including weight gain, plasma amino acids, protein and Phe intake, and red blood cell (RBC) folate. Patients were also grouped by first-trimester average blood Phe (≤910 μmol/L and >910 μmol/L) and then divided by total natural protein and medical food intake. The CHD group of 28 offspring had significantly higher blood Phe and lower proline, valine, methionine, isoleucine, leucine, lysine, arginine, and RBC folate. A significantly higher risk for CHD was found in the groups with lower natural protein and medical food intake, regardless of blood Phe levels. Insufficient natural protein and medical food product intake appears to be a risk factor for CHD independent of first-trimester plasma Phe levels. Low RBC folate and plasma methionine levels in the CHD group may suggest involvement of global DNA hypomethylation.

  5. Processing of fetal heart rate through non-invasive adaptive system based on recursive least squares algorithm

    Science.gov (United States)

    Fajkus, Marcel; Nedoma, Jan; Martinek, Radek; Vasinek, Vladimir

    2017-10-01

    In this article, we describe an innovative non-invasive method of Fetal Phonocardiography (fPCG) using fiber-optic sensors and adaptive algorithm for the measurement of fetal heart rate (fHR). Conventional PCG is based on a noninvasive scanning of acoustic signals by means of a microphone placed on the thorax. As for fPCG, the microphone is placed on the maternal abdomen. Our solution is based on patent pending non-invasive scanning of acoustic signals by means of a fiber-optic interferometer. Fiber-optic sensors are resistant to technical artifacts such as electromagnetic interferences (EMI), thus they can be used in situations where it is impossible to use conventional EFM methods, e.g. during Magnetic Resonance Imaging (MRI) examination or in case of delivery in water. The adaptive evaluation system is based on Recursive least squares (RLS) algorithm. Based on real measurements provided on five volunteers with their written consent, we created a simplified dynamic signal model of a distribution of heartbeat sounds (HS) through the human body. Our created model allows us to verification of the proposed adaptive system RLS algorithm. The functionality of the proposed non-invasive adaptive system was verified by objective parameters such as Sensitivity (S+) and Signal to Noise Ratio (SNR).

  6. Fetal heart rate accelerations and the risk of cerebral lesions and poor neurodevelopmental outcome in very low birthweight neonates.

    Science.gov (United States)

    Vlastos, Emanuel J; Tomlinson, Tracy M; Bildirici, Ibrahim; Sreenarasimhaiah, Sreedevi; Yusuf, Kamran; Sadovsky, Yoel; Levy, Roni

    2007-02-01

    The risk of intraventricular hemorrhage and periventricular leukomalacia correlates with fetal brain immaturity. Given that the appearance of fetal heart rate (FHR) accelerations is associated with brain maturation, we tested the hypothesis that neonatal cerebral lesions and developmental delay in very low birthweight newborns are associated with absent reactivity of the FHR tracing prior to delivery. We analyzed the FHR tracing of 97 fetuses with birthweight < 1200 g who underwent head ultrasound at day 3 and Bayley Scales of Infant Development testing at age 1 year. We used multivariate analysis to adjust for confounding variables. We found that the absence of two FHR accelerations of 10 beats per minute (bpm) for 10 seconds twice in a 20-minute window 1 hour before delivery was associated with intraventricular hemorrhage and/or periventricular leukomalacia ( P < 0.01) and a significant risk for mental and psychomotor delays by Bayley testing ( P < 0.001). The absence of accelerations of 15 bpm for 15 seconds was not associated with these abnormalities. The absence of FHR accelerations before delivery suggests a greater risk for cerebral injury and developmental delay in the very premature neonate.

  7. Impact of fetal echocardiography

    International Nuclear Information System (INIS)

    Simpson, John M

    2009-01-01

    Prenatal diagnosis of congenital heart disease is now well established for a wide range of cardiac anomalies. Diagnosis of congenital heart disease during fetal life not only identifies the cardiac lesion but may also lead to detection of associated abnormalities. This information allows a detailed discussion of the prognosis with parents. For continuing pregnancies, appropriate preparation can be made to optimize the postnatal outcome. Reduced morbidity and mortality, following antenatal diagnosis, has been reported for coarctation of the aorta, hypoplastic left heart syndrome, and transposition of the great arteries. With regard to screening policy, most affected fetuses are in the “low risk” population, emphasizing the importance of appropriate training for those who undertake such obstetric anomaly scans. As a minimum, the four chamber view of the fetal heart should be incorporated into midtrimester anomaly scans, and where feasible, views of the outflow tracts should also be included, to increase the diagnostic yield. Newer screening techniques, such as measurement of nuchal translucency, may contribute to identification of fetuses at high risk for congenital heart disease and prompt referral for detailed cardiac assessment

  8. Impact of fetal echocardiography

    Directory of Open Access Journals (Sweden)

    Simpson John

    2009-01-01

    Full Text Available Prenatal diagnosis of congenital heart disease is now well established for a wide range of cardiac anomalies. Diagnosis of congenital heart disease during fetal life not only identifies the cardiac lesion but may also lead to detection of associated abnormalities. This information allows a detailed discussion of the prognosis with parents. For continuing pregnancies, appropriate preparation can be made to optimize the postnatal outcome. Reduced morbidity and mortality, following antenatal diagnosis, has been reported for coarctation of the aorta, hypoplastic left heart syndrome, and transposition of the great arteries. With regard to screening policy, most affected fetuses are in the "low risk" population, emphasizing the importance of appropriate training for those who undertake such obstetric anomaly scans. As a minimum, the four chamber view of the fetal heart should be incorporated into midtrimester anomaly scans, and where feasible, views of the outflow tracts should also be included, to increase the diagnostic yield. Newer screening techniques, such as measurement of nuchal translucency, may contribute to identification of fetuses at high risk for congenital heart disease and prompt referral for detailed cardiac assessment.

  9. Heart Conditions and Pregnancy: Know the Risks

    Science.gov (United States)

    ... be used to detect fetal heart abnormalities. Your baby might need monitoring or treatment after delivery as well. Taking good ... labor. Your heart rate and rhythm might require monitoring throughout labor and ... and your baby's heart rate will be monitored continuously. Instead of ...

  10. Heart rate fall during acute hypoxemia: a measure of chemoreceptor response in fetal sheep

    NARCIS (Netherlands)

    Baan, J.; Boekkooi, P. F.; Teitel, D. F.; Rudolph, A. M.

    1993-01-01

    The peripheral arterial chemoreceptor response to hypoxemia in the fetus is predominantly cardiovascular, invoking a fall in heart rate and a variable change in blood pressure. No quantifiable measure of chemoreceptor activity has yet been described in the intact fetus. We described the course,

  11. Temporal and spatial performance of vector velocity imaging in the human fetal heart.

    Science.gov (United States)

    Matsui, H; Germanakis, I; Kulinskaya, E; Gardiner, H M

    2011-02-01

    To assess the spatial and temporal performance of fetal myocardial speckle tracking, using high-frame-rate (HFR) storing and Lagrangian strain analysis. Dummy electrocardiographic signaling permitted DICOM HFR in 124 normal fetuses and paired low-frame-rate (LFR) video storing at 25 Hz in 93 of them. Vector velocity imaging (VVI) tracking co-ordinates were used to compare time and spatial domain measures. We compared tracking success, Lagrangian strain, peak diastolic velocity and positive strain rate values in HFR vs. LFR video storing. Further comparisons within an HFR subset included Lagrangian vs. natural strain, VVI vs. M-mode annular displacement, and VVI vs. pulsed-wave tissue Doppler imaging (TDI) peak velocities. HFR (average 79.4 Hz) tracking was more successful than LFR (86 vs. 76%, P = 0.024). Lagrangian and natural HFR strain correlated highly (left ventricle (LV): r = 0.883, P < 0.001; right ventricle (RV): r = 0.792, P < 0.001) but natural strain gave 20% lower values, suggesting reduced reliability of measurement. Lagrangian HFR strain was similar in LV and RV and decreased with gestation (P = 0.015 and P < 0.001, respectively). LV Lagrangian LFR strain was significantly lower than the values for the RV (P < 0.001) and those using paired LV-HFR recordings (P = 0.007). Annular displacement methods correlated highly (LV = 1.046, r = 0.90, P < 0.001; RV = 1.170, r = 0.88, P < 0.001). Early diastolic waves were visible in 95% of TDI, but in only 26% of HFR and 0% of LFR recordings, and HFR-VVI velocities were significantly lower than those for TDI (P < 0.001). Doppler estimation of velocities remains superior to VVI but image gating and use of original co-ordinates should improve offline VVI assessment of fetal myocardial function. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

  12. Relationship between fetal heart rate patterns and a time course for evaluation of fetal well-being: “the 30 minutes rule” for decision of mechanical delivery

    Directory of Open Access Journals (Sweden)

    Shintaro Makino

    2017-12-01

    Conclusions: We confirmed the time indices for predicting and preventing acidosis in fetuses showing decelerations. To prevent fetal acidosis, the decision related to proper timing for performing assisted delivery by considering the time course is important.

  13. Real-time Continuous Assessment Method for Mental and Physiological Condition using Heart Rate Variability

    Science.gov (United States)

    Yoshida, Yutaka; Yokoyama, Kiyoko; Ishii, Naohiro

    It is necessary to monitor the daily health condition for preventing stress syndrome. In this study, it was proposed the method assessing the mental and physiological condition, such as the work stress or the relaxation, using heart rate variability at real time and continuously. The instantanuous heart rate (HR), and the ratio of the number of extreme points (NEP) and the number of heart beats were calculated for assessing mental and physiological condition. In this method, 20 beats heart rate were used to calculate these indexes. These were calculated in one beat interval. Three conditions, which are sitting rest, performing mental arithmetic and watching relaxation movie, were assessed using our proposed algorithm. The assessment accuracies were 71.9% and 55.8%, when performing mental arithmetic and watching relaxation movie respectively. In this method, the mental and physiological condition was assessed using only 20 regressive heart beats, so this method is considered as the real time assessment method.

  14. Change of Spectral Analysis of Fetal Heart Rate During Clinical Hypnosis: a Prospective Randomised Trial from the 20th Week of Gestation Till Term

    Science.gov (United States)

    Reinhard, J.; Hayes-Gill, B. R.; Schiermeier, S.; Hatzmann, W.; Heinrich, T. M.; Hüsken-Janßen, H.; Herrmann, E.; Louwen, F.

    2012-01-01

    Objective: To investigate the functional adaptive process of the fetal autonomic nervous system during hypnosis from the 20th week of gestation till term. Are there changes in the power spectrum analysis of fetal heart rate when the mother is having a clinical hypnosis or control period? Study Design: Fourty-nine FHR recordings were analysed. Included recordings were from singletons and abdominal fetal ECG-monitored pregnancies. All women were randomised to receive clinical hypnosis followed by a period with no intervention or vice versa. Statistical analyses were performed with the Wilcoxon signed ranks and Spearman rho correlation tests. Results: There was a significant difference found between fetal heart rate at baseline (144.3 ± 6.0) and hypnosis (142.1 ± 6.4). A difference was also detected between the standard deviation of the heart rate between baseline (6.7 ± 1.9) and hypnosis (6.8 ± 3.5). LFnu was smaller during baseline (80.2 ± 5.3) than during hypnosis (82.1 ± 5.7), whereas HFnu was significantly larger (19.8 ± 5.3 vs. 17.9 ± 5.7). There was no correlation between the gestation age and the change in LFnu, HFnu or ratio LF/HF due to the hypnosis intervention. Conclusion: The functional adaptive process of the fetal autonomic system during hypnosis is reflected by a sympathovagal shift towards increased sympathetic modulation. PMID:25284838

  15. Efeito do sevofluorano sobre a freqüência cardíaca fetal no terço final de gestação de cadelas Effect of sevoflurane on fetal heart rate in last third pregnant bitches

    Directory of Open Access Journals (Sweden)

    L.M. Matsubara

    2007-02-01

    Full Text Available Estudaram-se os efeitos do sevofluorano sobre a freqüência cardíaca nos fetos de cadelas no terço final de gestação, mediante a mensuração da freqüência cardíaca fetal com a utilização do ultra-som. Nove cadelas, sem raça definida, entre um e cinco anos de idade, com aproximadamente 45 dias de gestação, foram anestesiadas com acepromazina (0,05mg/kg, IV, propofol (5mg/kg, IV e sevofluorano. O monitoramento da freqüência cardíaca fetal foi realizado antes da medicação pré-anestésica (M0, 15 minutos após a intubação traqueal (M1, aos 30 minutos (M2 e 60 minutos (M3 do período de manutenção anestésica. A pressão arterial sistólica (PAS, média (PAM e diastólica (PAD foram obtidas pelo método não invasivo, sendo a PAM avaliada também pelo método invasivo. Por meio do monitoramento da freqüência cardíaca fetal média não se observou diferença significativa entre M0, M1 e M2, e verificou-se elevação apenas aos 60 minutos da manutenção anestésica (M3 em relação ao M0, porém sem significado clínico. O protocolo anestésico provocou diminuição significativa da pressão sangüínea arterial materna sem alterar, porém a freqüência cardíaca dos fetos.The effect of sevoflurane on fetal heart rate of 45-day fetuses was investigated through monitoring fetal heart rate by ultrasonographic evaluation in nine adult bitches aging from 1 to 5-year-old. After sedation with acepromazine (0.05mg/kg, IV, the anesthetic induction was accomplished using propofol (5mg/kg, IV and the maintenance was kept with sevoflurane. The fetal heart rate was measured before sedation (M0, 15 minutes after endotracheal intubation (M1, at 30 (M2 and 60 minutes (M3 from the beginning of general anesthesia. The systolic, diastolic and mean blood pressures were obtained by indirect techniques, while mean blood pressure were also obtained by direct technique. The measure of fetal heart rate did not show any difference between M0, M1

  16. Outcomes in Continuing Pregnancies Diagnosed with a Severe Fetal Abnormality and Implication of Antenatal Neonatology Consultation: A 10-Year Retrospective Study.

    Science.gov (United States)

    Hostalery, Laura; Tosello, Barthélémy

    2017-06-01

    To describe a population choosing to continue their pregnancy despite a severe fetal abnormality and to evaluate the role of antenatal neonatology consultation in perinatal decision-making. A 10-year (2005-2015) retrospective descriptive study in a single Multidisciplinary Prenatal Diagnosis Center in South France. A series of pregnancies with severe fetal abnormalities were collected by a person outside the decision making process and/or the child's care. Thirty-nine pregnancies were included, among which 12 couples chose the perinatal palliative care. In total, there were 25 live births (10 later died, with median of survival of 52.5 h [16-943.5]); only five infants received a palliative care plan at birth. The choice to continue a pregnancy diagnosed with severe fetal pathology is on the rise in France. Treatment options point to standardize perinatal palliative care provided by trained perinatal professionals using standardized practices.

  17. Fetal growth restriction and the programming of heart growth and cardiac insulin-like growth factor 2 expression in the lamb.

    Science.gov (United States)

    Wang, Kimberley C W; Zhang, Lei; McMillen, I Caroline; Botting, Kimberley J; Duffield, Jaime A; Zhang, Song; Suter, Catherine M; Brooks, Doug A; Morrison, Janna L

    2011-10-01

    Reduced growth in fetal life together with accelerated growth in childhood, results in a ~50% greater risk of coronary heart disease in adult life. It is unclear why changes in patterns of body and heart growth in early life can lead to an increased risk of cardiovascular disease in adulthood. We aimed to investigate the role of the insulin-like growth factors in heart growth in the growth-restricted fetus and lamb. Hearts were collected from control and placentally restricted (PR) fetuses at 137-144 days gestation and from average (ABW) and low (LBW) birth weight lambs at 21 days of age. We quantified cardiac mRNA expression of IGF-1, IGF-2 and their receptors, IGF-1R and IGF-2R, using real-time RT-PCR and protein expression of IGF-1R and IGF-2R using Western blotting. Combined bisulphite restriction analysis was used to assess DNA methylation in the differentially methylated region (DMR) of the IGF-2/H19 locus and of the IGF-2R gene. In PR fetal sheep, IGF-2, IGF-1R and IGF-2R mRNA expression was increased in the heart compared to controls. LBW lambs had a greater left ventricle weight relative to body weight as well as increased IGF-2 and IGF-2R mRNA expression in the heart, when compared to ABW lambs. No changes in the percentage of methylation of the DMRs of IGF-2/H19 or IGF-2R were found between PR and LBW when compared to their respective controls. In conclusion, a programmed increased in cardiac gene expression of IGF-2 and IGF-2R may represent an adaptive response to reduced substrate supply (e.g. glucose and/or oxygen) in order to maintain heart growth and may be the underlying cause for increased ventricular hypertrophy and the associated susceptibility of cardiomyocytes to ischaemic damage later in life.

  18. VARIABILITY OF CONTINUOUSLY MEASURED ARTERIAL PH AND BLOOD-GAS VALUES IN THE NEAR-TERM FETAL LAMB

    NARCIS (Netherlands)

    WOUDSTRA, BR; DEWOLF, BTHM; SMITS, TM; NATHANIELSZ, PW; ZIJLSTRA, WG; AARNOUDSE, JG

    1995-01-01

    In fetal sheep, arterial blood gas values show considerable spontaneous fluctuations. The aim of the present study was to obtain quantitative data on fetal blood gas variability. Accurate assessment of the intraindividual variations can hardly be obtained from intermittent blood samples, but

  19. Comparison of Immune Profiles in Fetal Hearts with Idiopathic Dilated Cardiomyopathy, Maternal Autoimmune-Associated Dilated Cardiomyopathy and the Normal Fetus.

    Science.gov (United States)

    Nield, Lynne E; von Both, Ingo; Popel, Najla; Strachan, Kate; Manlhiot, Cedric; Shannon, Patrick; McCrindle, Brian W; Atkinson, Adelle; Miner, Steven E S; Jaeggi, Edgar T; Taylor, Glenn P

    2016-02-01

    The etiology of idiopathic dilated cardiomyopathy (iDCM) remains unknown. Immune therapies have improved outcome in fetuses with DCM born to mothers with autoimmune disease (aDCM). The purpose of this retrospective study was to compare the myocardial B and T cell profiles in fetuses and neonates with idiopathic DCM (iDCM) versus autoimmune-mediated DCM (aDCM) and to describe the normal cell maturation within the human fetal myocardium. Of 60 fetal autopsy cases identified from institutional databases, 10 had aDCM (18-38 weeks), 12 iDCM (19-37 weeks) and 38 had normal hearts (11-40 weeks). Paraffin-embedded myocardium sections were stained for all lymphocyte (CD45), B cells (CD20, CD79a), T cells (CD3, CD4, CD7, CD8) and monocyte (CD68) surface markers. Two independent, blinded cell counts were performed. Normal hearts expressed all B and T cell markers in a bimodal fashion, with peaks at 22 and 37 weeks of gestation. The aDCM cohort was most distinct from normal hearts, with less overall T cell markers [EST -9.1 (2.6) cells/mm(2), p = 0.001], CD4 [EST -2.0 (0.6), p = 0.001], CD3 [EST -3.9 (1.0), p cell markers [EST -4.9 (1.8), p = 0.01] and CD79a counts [EST -2.3 (0.9), p = 0.01]. The iDCM group had less overall B cell markers [EST -4.0 (1.8), p = 0.03] and CD79a [EST -1.7 (0.9), p = 0.05], but no difference in T cell markers. Autoimmune-mediated DCM fetuses have less B and T cell markers, whereas iDCM fetuses have less B cell markers compared with normal fetal hearts. The fetal immune system may play a role in the normal development of the heart and evolution of dilated cardiomyopathy.

  20. Modular continuous wavelet processing of biosignals: extracting heart rate and oxygen saturation from a video signal.

    Science.gov (United States)

    Addison, Paul S

    2016-06-01

    A novel method of extracting heart rate and oxygen saturation from a video-based biosignal is described. The method comprises a novel modular continuous wavelet transform approach which includes: performing the transform, undertaking running wavelet archetyping to enhance the pulse information, extraction of the pulse ridge time-frequency information [and thus a heart rate (HRvid) signal], creation of a wavelet ratio surface, projection of the pulse ridge onto the ratio surface to determine the ratio of ratios from which a saturation trending signal is derived, and calibrating this signal to provide an absolute saturation signal (SvidO2). The method is illustrated through its application to a video photoplethysmogram acquired during a porcine model of acute desaturation. The modular continuous wavelet transform-based approach is advocated by the author as a powerful methodology to deal with noisy, non-stationary biosignals in general.

  1. Neonates with critical congenital heart defects: Impact of fetal diagnosis on immediate and short-term outcomes

    Directory of Open Access Journals (Sweden)

    Sylvia Michael Colaco

    2017-01-01

    Conclusions: Fetal echocardiography identifies patients with complex CHD resulting in better parental counseling, thus facilitating delivery at a tertiary care center and preoperative stabilization. This results in improved preoperative mortality and better stabilization.

  2. Cuffless and Continuous Blood Pressure Estimation from the Heart Sound Signals.

    Science.gov (United States)

    Peng, Rong-Chao; Yan, Wen-Rong; Zhang, Ning-Ling; Lin, Wan-Hua; Zhou, Xiao-Lin; Zhang, Yuan-Ting

    2015-09-17

    Cardiovascular disease, like hypertension, is one of the top killers of human life and early detection of cardiovascular disease is of great importance. However, traditional medical devices are often bulky and expensive, and unsuitable for home healthcare. In this paper, we proposed an easy and inexpensive technique to estimate continuous blood pressure from the heart sound signals acquired by the microphone of a smartphone. A cold-pressor experiment was performed in 32 healthy subjects, with a smartphone to acquire heart sound signals and with a commercial device to measure continuous blood pressure. The Fourier spectrum of the second heart sound and the blood pressure were regressed using a support vector machine, and the accuracy of the regression was evaluated using 10-fold cross-validation. Statistical analysis showed that the mean correlation coefficients between the predicted values from the regression model and the measured values from the commercial device were 0.707, 0.712, and 0.748 for systolic, diastolic, and mean blood pressure, respectively, and that the mean errors were less than 5 mmHg, with standard deviations less than 8 mmHg. These results suggest that this technique is of potential use for cuffless and continuous blood pressure monitoring and it has promising application in home healthcare services.

  3. Cuffless and Continuous Blood Pressure Estimation from the Heart Sound Signals

    Directory of Open Access Journals (Sweden)

    Rong-Chao Peng

    2015-09-01

    Full Text Available Cardiovascular disease, like hypertension, is one of the top killers of human life and early detection of cardiovascular disease is of great importance. However, traditional medical devices are often bulky and expensive, and unsuitable for home healthcare. In this paper, we proposed an easy and inexpensive technique to estimate continuous blood pressure from the heart sound signals acquired by the microphone of a smartphone. A cold-pressor experiment was performed in 32 healthy subjects, with a smartphone to acquire heart sound signals and with a commercial device to measure continuous blood pressure. The Fourier spectrum of the second heart sound and the blood pressure were regressed using a support vector machine, and the accuracy of the regression was evaluated using 10-fold cross-validation. Statistical analysis showed that the mean correlation coefficients between the predicted values from the regression model and the measured values from the commercial device were 0.707, 0.712, and 0.748 for systolic, diastolic, and mean blood pressure, respectively, and that the mean errors were less than 5 mmHg, with standard deviations less than 8 mmHg. These results suggest that this technique is of potential use for cuffless and continuous blood pressure monitoring and it has promising application in home healthcare services.

  4. Cuffless and Continuous Blood Pressure Estimation from the Heart Sound Signals

    Science.gov (United States)

    Peng, Rong-Chao; Yan, Wen-Rong; Zhang, Ning-Ling; Lin, Wan-Hua; Zhou, Xiao-Lin; Zhang, Yuan-Ting

    2015-01-01

    Cardiovascular disease, like hypertension, is one of the top killers of human life and early detection of cardiovascular disease is of great importance. However, traditional medical devices are often bulky and expensive, and unsuitable for home healthcare. In this paper, we proposed an easy and inexpensive technique to estimate continuous blood pressure from the heart sound signals acquired by the microphone of a smartphone. A cold-pressor experiment was performed in 32 healthy subjects, with a smartphone to acquire heart sound signals and with a commercial device to measure continuous blood pressure. The Fourier spectrum of the second heart sound and the blood pressure were regressed using a support vector machine, and the accuracy of the regression was evaluated using 10-fold cross-validation. Statistical analysis showed that the mean correlation coefficients between the predicted values from the regression model and the measured values from the commercial device were 0.707, 0.712, and 0.748 for systolic, diastolic, and mean blood pressure, respectively, and that the mean errors were less than 5 mmHg, with standard deviations less than 8 mmHg. These results suggest that this technique is of potential use for cuffless and continuous blood pressure monitoring and it has promising application in home healthcare services. PMID:26393591

  5. Diagnostic Accuracy of the FIGO and the 5-Tier Fetal Heart Rate Classification Systems in the Detection of Neonatal Acidemia.

    Science.gov (United States)

    Martí Gamboa, Sabina; Giménez, Olga Redrado; Mancho, Jara Pascual; Moros, María Lapresta; Sada, Julia Ruiz; Mateo, Sergio Castan

    2017-04-01

    Objective  The objective of this study was to determine ability to detect neonatal acidemia and interobserver agreement with the FIGO 3-tier and 5-tier fetal heart rate (FHR) classification systems. Design  This was a case-control study. Setting  This study was set at the University Medical Center. Population  A total of 202 FHR tracings of 102 women who delivered an acidemic fetus (umbilical arterial cord gas pH ≤ 7.10 and BE  7.10) were assessed. A subanalysis was performed for those fetuses who suffered severe metabolic acidemia (pH ≤ 7.0 and BE < - 12). Methods  Two reviewers blind to clinical and outcome data classified tracings according to the new 3-tier system proposed by the FIGO and the 5-tier system proposed by Parer and Ikeda. Main Outcome Measures  Sensitivity and specificity for detecting neonatal acidemia and interobserver agreement in classifying FHR tracings into categories of both systems were studied. Results  The 3-tier system showed a greater sensitivity and lower specificity to detect neonatal acidemia (43.6% sensitivity, 82.5% specificity) and severe metabolic acidemia (71.4% sensitivity, 74.0% specificity) compared with the 5-tier system (36.3% sensitivity, 88% specificity and 61.9% sensitivity, 80.1% specificity, respectively). Both systems were compared by area under the receiver-operating characteristic curve, with comparable predictive ability for detecting neonatal acidemia (FIGO-area under the curve [AUC]: 0.63 [95% confidence interval [CI]: 0.57-0.68] and Parer-AUC: 0.62 [95% CI: 0.56-0.67]). Interobserver agreement was moderate for both systems, but performance at each specific category showed a better agreement for the 5-tier system identifying a pathological tracing (orange or red, κ: 0.625 vs. pathological category, κ: 0.538). Conclusion  Both systems presented a comparable ability to predict neonatal acidemia, although the 5-tier system showed a better interobserver agreement identifying pathological

  6. Is midwife workload associated with quality of process of care (continuous electronic fetal monitoring [CEFM]) and neonatal outcome indicators? A prospective study in consultant-led labour wards in Scotland.

    Science.gov (United States)

    Tucker, J; Parry, G; Penney, G; Page, M; Hundley, V

    2003-10-01

    Evidence for staffing recommendations in labour wards is scant. This study aimed to test association between midwife workload with adjusted process of continuous electronic fetal monitoring (CEFM) and neonatal outcome indicators. This was a prospective workload study in 23 consultant-led labour wards in Scotland. There were 3489 livebirths during September 2000, and 1561 consecutively delivered women with CEFM case review during the mid-two weeks. Process measures were: adjusted rates of CEFM, appropriate CEFM, and time to medical response for a serious fetal heart trace abnormality. Neonatal outcome indicators were: Apgar score 48 hours, and neonatal resuscitation. Complete information was available for 99% (2553/2576) of workload time points, 99% (1559) of CEFM process, and 3083 eligible neonates. There were no associations between occupancy or staffing ratios and adjusted CEFM process, Apgar 48 hours (0.97 [0.95, 1.00]). However, there was association between increasing staffing ratios and lower odds of adjusted neonatal resuscitation (excluding bag and mask only) (0.97 [0.94, 0.99]). The direction of effect of increasing workload suggests detriment to outcome indicators, although the size of effect may be small.

  7. n-Order and maximum fuzzy similarity entropy for discrimination of signals of different complexity: Application to fetal heart rate signals.

    Science.gov (United States)

    Zaylaa, Amira; Oudjemia, Souad; Charara, Jamal; Girault, Jean-Marc

    2015-09-01

    This paper presents two new concepts for discrimination of signals of different complexity. The first focused initially on solving the problem of setting entropy descriptors by varying the pattern size instead of the tolerance. This led to the search for the optimal pattern size that maximized the similarity entropy. The second paradigm was based on the n-order similarity entropy that encompasses the 1-order similarity entropy. To improve the statistical stability, n-order fuzzy similarity entropy was proposed. Fractional Brownian motion was simulated to validate the different methods proposed, and fetal heart rate signals were used to discriminate normal from abnormal fetuses. In all cases, it was found that it was possible to discriminate time series of different complexity such as fractional Brownian motion and fetal heart rate signals. The best levels of performance in terms of sensitivity (90%) and specificity (90%) were obtained with the n-order fuzzy similarity entropy. However, it was shown that the optimal pattern size and the maximum similarity measurement were related to intrinsic features of the time series. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Noninvasive Fetal Heart Rate Monitoring: Validation of Phonocardiography-Based Fiber-Optic Sensing and Adaptive Filtering Using the NLMS Algorithm

    Directory of Open Access Journals (Sweden)

    Jan Nedoma

    2017-01-01

    Full Text Available Here we present the evaluation results of our novel noninvasive phonocardiographic-based fiber-optic sensor for fetal Heart Rate (fHR detection using adaptive filtering and the NLMS Algorithm. The sensor uses two interferometric probes encapsulated inside a PolyDiMethylSiloxane (PDMS polymer. Based on real data acquired from pregnant women in a suitable research laboratory environment, once they had given their written informed consents, we created a simplified dynamic signal model of the distribution of maternal and fetal heart sounds inside the maternal body. Building upon this signal model, we verified the functionality of our novel fiber-optic sensor and its associated adaptive filtering system using the NLMS Algorithm. The main reason why we chose this technology to develop our system was that it allows monitoring the fHR without exposing the fetus to any external energies or radiation (in contrast to the ultrasound-based Cardiotocography Method. We used objective criteria such as: Signal to Noise Ratios: SNR_in, SNR_out and Percentage Root-mean-square Difference (PRD for our evaluations.

  9. Congenital Heart Defects and Measures of Fetal Growth in Newborns with Down Syndrome or 22q11.2 Deletion Syndrome.

    Science.gov (United States)

    Matthiesen, Niels B; Agergaard, Peter; Henriksen, Tine B; Bach, Cathrine C; Gaynor, J William; Hjortdal, Vibeke; Østergaard, John R

    2016-08-01

    To estimate the association between congenital heart defects (CHD) and indices of fetal growth in Down and 22q11.2 deletion syndromes. We established 2 Danish nationwide cohorts of newborn singletons with either Down syndrome (n = 670) or 22q11.2 deletion syndrome (n = 155), born 1997-2011. In both cohorts, we analyzed the association between CHD, CHD severity, and indices of fetal growth by multivariable linear regression adjusted for potential confounders. We report mean differences in gestational age specific z-scores compared with newborns without CHD. Down syndrome and 22q11.2 deletion syndrome were both associated with lower mean birth weight and head circumference z-scores. We found no association between CHD or CHD severity and indices of fetal growth. In Down syndrome, the association between any CHD and the mean difference in head circumference z-score was 0.03 (95% CI -0.12, 0.18), and the estimate regarding birth weight z-score was 0.09 (95% CI -0.08, 0.25). The corresponding estimates in 22q11.2 deletion syndrome were 0.00 (95% CI -0.33, 0.32) and -0.09 (95% CI -0.45, 0.26). We found no association between CHD and fetal growth measures in newborns with Down syndrome or 22q11.2 deletion syndrome. Thus, in certain subtypes of CHD, the contribution of genetic factors to prenatal growth impairment may be more important than circulatory disturbances. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. [Use of a combination of non stress fetal heart rate monitoring and the oxytocin challenge test in high-risk pregnancies. The effects on perinatal mortality (author's transl)].

    Science.gov (United States)

    Galvez-Hernandez, E; Jimeno-Garcia, J M; Novo-Dominguez, A

    1981-01-01

    A protocol for antepartum supervision which included "non stress fetal monitoring" (NSFM) and the "oxytocin Challenge Test" (OCT) was followed in a series of 640 high-risk pregnancies. The perinatal mortality in this group was compared with that obtained in a group of 3,049 non-selected deliveries which occurred during the same period of time and which were not monitored in the same way. The perinatal mortality which could be attributed to placental insufficiency in the first group (the supervised group) was at 4.68 per 1000, about half that of the non-supervised group (8.72 per 1000) in spite of the low number of high risk cases in the second group. When NSFM was normal in the week before delivery there was no single perinatal death due to placental insufficiency. When the NSFM was normal and the OCT was pathological the OCT Test was probably wrong. When the NSFM test was non-reactive placental insufficiency could be predicted in only 28 per cent of the cases although a combination of NSFM with a positive OCT Test predicted correctly 91.3 per cent of the cases of placental insufficiency. We consider that there is fetal distress due to placental insufficiency when having found signs indicative of fetal distress in delivery (a pH of less than 7.25, recent passage of meconium, the Apgar score less than 7 in the first minute, and pathological fetal heart rhythm (RFC) we can find no other cause to explain the signs such as a short cord, prematurity, obstetrical trauma, prolonged pregnancy and malformations, etc.

  11. Towards Quasi-continuous Heart Rate Variability Estimation using a Patch Type Electrocardiogram Recorder

    DEFF Research Database (Denmark)

    Bodholt Saadi, Dorthe; Ahrens, Esben; Sørensen, Helge Bjarup Dissing

    2015-01-01

    Changes in different heart rate variability (HRV) measures have been found to possess predictive information in patients with many different diseases, e.g. myocardial infarction, diabetic neuropathy, and patients at risk of developing sepsis. At the same time, the emerging of patch type...... electrocardiogram recorders facilitates new possibilities for long-term monitoring, real-time data analysis, and wireless transmission of clinically relevant parameters, e.g. short-term HRV measures. This information might in the future assist the healthcare professionals in timely notification of changes...... in the risk stratification profile obtained from the HRV measures. The purpose of this study is therefore to investigate the possibilities for quasi-continuous estimation of reliable HRV measures using the ePatch heart monitor. We compared the physiologically true values of 11 selected HRV measures...

  12. Heart failure patients’ experiences with continuity of care and its relation to medication adherence: a cross-sectional study

    Science.gov (United States)

    2012-01-01

    Background A growing number of health care providers are nowadays involved in heart failure care. This could lead to discontinuity and fragmentation of care, thus reducing trust and hence poorer medication adherence. This study aims to explore heart failure patients’ experiences with continuity of care, and its relation to medication adherence. Methods We collected data from 327 primary care patients with chronic heart failure. Experienced continuity of care was measured using a patient questionnaire and by reviewing patients’ medical records. Continuity of care was defined as a multidimensional concept including personal continuity (seeing the same doctor every time), team continuity (collaboration between care providers in general practice) and cross-boundary continuity (collaboration between general practice and hospital). Medication adherence was measured using a validated patient questionnaire. The relation between continuity of care and medication adherence was analysed by using chi-square tests. Results In total, 53% of patients stated not seeing any care provider in general practice in the last year concerning their heart failure. Of the patients who did contact a care provider in general practice, 46% contacted two or more care providers. Respectively 38% and 51% of patients experienced the highest levels of team and cross-boundary continuity. In total, 14% experienced low levels of team continuity and 11% experienced low levels of cross-boundary continuity. Higher scores on personal continuity were significantly related to better medication adherence (p continuity and medication adherence. Conclusions A small majority of patients that contacted a care provider in general practice for their heart failure, contacted only one care provider. Most heart failure patients experienced high levels of collaboration between care providers in general practice and between GP and cardiologist. However, in a considerable number of patients, continuity of care

  13. Ro60-associated single-stranded RNA links inflammation with fetal cardiac fibrosis via ligation of TLRs: a novel pathway to autoimmune-associated heart block.

    Science.gov (United States)

    Clancy, Robert M; Alvarez, David; Komissarova, Elena; Barrat, Franck J; Swartz, Jordan; Buyon, Jill P

    2010-02-15

    Activation of TLR by ssRNA after FcgammaR-mediated phagocytosis of immune complexes (IC) may be relevant in autoimmune-associated congenital heart block (CHB) where the obligate factor is a maternal anti-SSA/Ro Ab and the fetal factors, protein/RNA on an apoptotic cardiocyte and infiltrating macrophages. This study addressed the hypothesis that Ro60-associated ssRNAs link macrophage activation to fibrosis via TLR engagement. Both macrophage transfection with noncoding ssRNA that bind Ro60 and an IC generated by incubation of Ro60-ssRNA with an IgG fraction from a CHB mother or affinity purified anti-Ro60 significantly increased TNF-alpha secretion, an effect not observed using control RNAs or normal IgG. Dependence on TLR was supported by the significant inhibition of TNF-alpha release by IRS661 and chloroquine. The requirement for FcgammaRIIIa-mediated delivery was provided by inhibition with an anti-CD16a Ab. Fibrosis markers were noticeably increased in fetal cardiac fibroblasts after incubation with supernatants generated from macrophages transfected with ssRNA or incubated with the IC. Supernatants generated from macrophages with ssRNA in the presence of IRS661 or chloroquine did not cause fibrosis. In a CHB heart, but not a healthy heart, TLR7 immunostaining was localized to a region near the atrioventricular groove at a site enriched in mononuclear cells and fibrosis. These data support a novel injury model in CHB, whereby endogenous ligand, Ro60-associated ssRNA, forges a nexus between TLR ligation and fibrosis instigated by binding of anti-Ro Abs to the target protein likely accessible via apoptosis.

  14. Effect of continuous and interval aerobic exercise training on baroreflex sensitivity in heart failure.

    Science.gov (United States)

    Masson, Gustavo Santos; Borges, Juliana Pereira; da Silva, Pedro Paulo Soares; da Nóbrega, Antônio Cláudio Lucas; Tibiriçá, Eduardo; Lessa, Marcos Adriano

    2016-05-01

    The ability of continuous aerobic exercise training (AET) to increase baroreflex control and cardiac function in heart failure (HF) has been well described, but the comparison between continuous and interval AET on these functions is inconclusive. To compare the effects of continuous and interval AET on cardiac function and baroreflex sensitivity (BrS) in an experimental model of HF. Rats were divided into the following groups: continuous training (HF-CT), intense interval training (HF-IIT), moderate interval training (HF-MIT), sedentary group (HF-SED), and sham sedentary (SHAM-SED). Animals underwent surgery to induce HF by ligation of the interventricular coronary artery. Six weeks after surgery, AET was started (8weeks, 3sessions/week). Echocardiography studies to assess cardiac function were performed before and after AET. At the end of the training protocols, the BrS index was assessed by stepwise intravenous infusions of sodium nitroprusside and phenylephrine. All methods of exercise prevented the HF-induced increase in left ventricular diameter in diastole observed in the HF-SED rats (0.88±0.09 vs. 1.03±0.09cm; Ptraining induced similar improvements in cardiac function but that only continuous training induced higher BrS in HF rats. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. Management of peripherally inserted central catheters (PICC) in pediatric heart failure patients receiving continuous inotropic support.

    Science.gov (United States)

    Giangregorio, Maeve; Mott, Sandra; Tong, Elizabeth; Handa, Sonia; Gauvreau, Kimberlee; Connor, Jean Anne

    2014-01-01

    The study aim was to evaluate present practice of maintaining PICC line patency in pediatric heart failure patients receiving continuous inotropes by comparing one cohort receiving low dose continuous heparin with one receiving no heparin. A case control retrospective chart review compared the two cohorts on duration of patency (measured in days) and need for thrombolytic agents. Median duration of patency for the heparin group was 24 days versus 16 days for the no heparin group (p=0.07). Use of thrombolytic agents was 28% in the heparin group compared to 50% in the no heparin group (p=0.08). Although not statistically significant, findings were clinically significant and supportive of current practice. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Inhibition of histone H3K9 acetylation by anacardic acid can correct the over-expression of Gata4 in the hearts of fetal mice exposed to alcohol during pregnancy.

    Directory of Open Access Journals (Sweden)

    Chang Peng

    Full Text Available BACKGROUND: Cardiovascular malformations can be caused by abnormalities in Gata4 expression during fetal development. In a previous study, we demonstrated that ethanol exposure could lead to histone hyperacetylation and Gata4 over-expression in fetal mouse hearts. However, the potential mechanisms of histone hyperacetylation and Gata4 over-expression induced by ethanol remain unclear. METHODS AND RESULTS: Pregnant mice were gavaged with ethanol or saline. Fetal mouse hearts were collected for analysis. The results of ethanol fed groups showed that global HAT activity was unusually high in the hearts of fetal mice while global HDAC activity remained unchanged. Binding of P300, CBP, PCAF, SRC1, but not GCN5, were increased on the Gata4 promoter relative to the saline treated group. Increased acetylation of H3K9 and increased mRNA expression of Gata4, α-MHC, cTnT were observed in these hearts. Treatment with the pan-histone acetylase inhibitor, anacardic acid, reduced the binding of P300, PCAF to the Gata4 promoter and reversed H3K9 hyperacetylation in the presence of ethanol. Interestingly, anacardic acid attenuated over-expression of Gata4, α-MHC and cTnT in fetal mouse hearts exposed to ethanol. CONCLUSIONS: Our results suggest that P300 and PCAF may be critical regulatory factors that mediate Gata4 over-expression induced by ethanol exposure. Alternatively, P300, PCAF and Gata4 may coordinate over-expression of cardiac downstream genes in mouse hearts exposed to ethanol. Anacardic acid may thus protect against ethanol-induced Gata4, α-MHC, cTnT over-expression by inhibiting the binding of P300 and PCAF to the promoter region of these genes.

  17. Continuity of care in the ambulatory sector and hospital admissions among patients with heart failure in Germany.

    Science.gov (United States)

    Vogt, Verena; Koller, Daniela; Sundmacher, Leonie

    2016-03-09

    Heart failure is one of the most cost-intensive chronic diseases and the most common cause of hospitalization. More than 60% of the treatment costs of heart failure are incurred in the inpatient sector in Germany. However, hospital admissions due to heart failure are considered to be potentially avoidable through effective and continuous ambulatory care. Our aim is to examine whether continuity in ambulatory care is associated with hospitalizations due to heart failure. Using insurance claims data from Germany's biggest statutory health insurance company, we defined three measures of continuity of care: Continuity of Care Index (COCI), Usual Provider Index (UPC) and the Sequential Continuity Index (SECON). We analyzed whether these measures are associated with hospitalization due to heart failure using separate logistic regression models. We controlled for a wide range of covariates such as sex, age and the Charlson comorbidity index. Data of 382 118 heart failure patients were included in the analyses. Index values range from 0.77 to 0.89. Results of logistic regression analyses indicate that the continuity indices COCI, UPC and SECON based on visits to general practitioners (GPs), cardiologists and internists are negatively associated with the probability of hospitalization whereas of the continuity indices based on GP visits only SECON is significantly associated with hospitalization. The results indicate that the overall continuity in the ambulatory sector is high for heart failure patients in Germany. Public policy should, nevertheless, focus on increasing sequential continuity of specialist and generalist ambulatory care as this was found to be significantly associated with a reduced likelihood of hospitalization. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  18. Anti-Ro52 antibody level is an important marker of fetal congenital heart block risk in anti-Ro/SSA antibody positive pregnancy.

    Science.gov (United States)

    Miyasato-Isoda, Mai; Waguri, Masako; Yamada, Yuko; Miyano, Akira; Wada, Yoshinao

    2017-09-21

    The aims of this study are to determine the incidence of congenital heart block (CHB) in the Japanese population and identify maternal factors predicting fetal CHB in anti-Ro/SSA antibody positive pregnancy. A retrospective study was performed using 52,147 clinical records of pregnancies followed in a single center. For 183 anti-Ro/SSA antibody-positive women, anti-Ro52 and Ro60 antibodies were measured, and the odds of CHB in relation to maternal clinical features were calculated by multivariate analysis. The receiver-operating characteristic (ROC) curves for predicting CHB were constructed for the titers of anti-Ro/SSA, anti-Ro52 and anti-Ro60 antibodies. Fetal CHB occurred in two pregnancies among those without known risks such as positive anti-Ro/SSA antibody or previous CHB-affected pregnancy, suggesting an incidence similar to that in Caucasian populations. As for the anti-Ro/SSA antibody positive pregnancies, the titers of anti-Ro/SSA, anti-Ro52 and anti-Ro60 antibodies were independent risk factors for fetal CHB and the use of corticosteroids before 18 gestational weeks was an independent protective factor. The area under the ROC was 0.84, 0.73 and 0.74 for anti-Ro52, anti-Ro60 and anti-Ro/SSA antibodies, respectively. CHB occurred in two among approximately 50,000 pregnancies without known risks such as positive anti-Ro/SSA antibody or previous delivery of CHB-affected babies. Measurement of anti-Ro52 antibody levels may be helpful in extracting a risk group of delivering CHB infants in the anti-Ro/SSA antibody positive pregnancy.

  19. Fetal body movement monitoring.

    Science.gov (United States)

    Rayburn, W F

    1990-03-01

    Recording fetal activity serves as an indirect measure of central nervous system integrity and function. The coordination of whole body movement, which requires complex neurologic control, is likely similar to that of the newborn infant. Short-term observations of the fetus are best performed using real-time ultrasound imaging. Monitoring fetal motion has been shown to be clinically worthwhile in predicting impending death or compromise, especially when placental insufficiency is longstanding. The presence of a vigorous fetus is reassuring. Perceived inactivity requires a reassessment of any underlying antepartum complication and a more precise evaluation by fetal heart rate testing or real-time ultrasonography before delivery is contemplated.

  20. Continuous multi-parameter heart rate variability analysis heralds onset of sepsis in adults.

    Directory of Open Access Journals (Sweden)

    Saif Ahmad

    Full Text Available BACKGROUND: Early diagnosis of sepsis enables timely resuscitation and antibiotics and prevents subsequent morbidity and mortality. Clinical approaches relying on point-in-time analysis of vital signs or lab values are often insensitive, non-specific and late diagnostic markers of sepsis. Exploring otherwise hidden information within intervals-in-time, heart rate variability (HRV has been documented to be both altered in the presence of sepsis, and correlated with its severity. We hypothesized that by continuously tracking individual patient HRV over time in patients as they develop sepsis, we would demonstrate reduced HRV in association with the onset of sepsis. METHODOLOGY/PRINCIPAL FINDINGS: We monitored heart rate continuously in adult bone marrow transplant (BMT patients (n = 21 beginning a day before their BMT and continuing until recovery or withdrawal (12+/-4 days. We characterized HRV continuously over time with a panel of time, frequency, complexity, and scale-invariant domain techniques. We defined baseline HRV as mean variability for the first 24 h of monitoring and studied individual and population average percentage change (from baseline over time in diverse HRV metrics, in comparison with the time of clinical diagnosis and treatment of sepsis (defined as systemic inflammatory response syndrome along with clinically suspected infection requiring treatment. Of the 21 patients enrolled, 4 patients withdrew, leaving 17 patients who completed the study. Fourteen patients developed sepsis requiring antibiotic therapy, whereas 3 did not. On average, for 12 out of 14 infected patients, a significant (25% reduction prior to the clinical diagnosis and treatment of sepsis was observed in standard deviation, root mean square successive difference, sample and multiscale entropy, fast Fourier transform, detrended fluctuation analysis, and wavelet variability metrics. For infected patients (n = 14, wavelet HRV demonstrated a 25% drop from

  1. Use of an intrapericardial, continuous-flow, centrifugal pump in patients awaiting heart transplantation.

    Science.gov (United States)

    Aaronson, Keith D; Slaughter, Mark S; Miller, Leslie W; McGee, Edwin C; Cotts, William G; Acker, Michael A; Jessup, Mariell L; Gregoric, Igor D; Loyalka, Pranav; Frazier, O H; Jeevanandam, Valluvan; Anderson, Allen S; Kormos, Robert L; Teuteberg, Jeffrey J; Levy, Wayne C; Naftel, David C; Bittman, Richard M; Pagani, Francis D; Hathaway, David R; Boyce, Steven W

    2012-06-26

    Contemporary ventricular assist device therapy results in a high rate of successful heart transplantation but is associated with bleeding, infections, and other complications. Further reductions in pump size, centrifugal design, and intrapericardial positioning may reduce complications and improve outcomes. We studied a small, intrapericardially positioned, continuous-flow centrifugal pump in patients requiring an implanted ventricular assist device as a bridge to heart transplantation. The course of investigational pump recipients was compared with that of patients implanted contemporaneously with commercially available devices. The primary outcome, success, was defined as survival on the originally implanted device, transplantation, or explantation for ventricular recovery at 180 days and was evaluated for both noninferiority and superiority. Secondary outcomes included a comparison of survival between groups and functional and quality-of-life outcomes and adverse events in the investigational device group. A total of 140 patients received the investigational pump, and 499 patients received a commercially available pump implanted contemporaneously. Success occurred in 90.7% of investigational pump patients and 90.1% of controls, establishing the noninferiority of the investigational pump (Pcentrifugal pump was noninferior to contemporaneously implanted, commercially available ventricular assist devices. Functional capacity and quality of life improved markedly, and the adverse event profile was favorable. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00751972.

  2. Continuous positive airway pressure improves exercise capacity and heart rate recovery in obstructive sleep apnea.

    Science.gov (United States)

    Maeder, Micha T; Ammann, Peter; Münzer, Thomas; Schoch, Otto D; Korte, Wolfgang; Hürny, Christoph; Myers, Jonathan; Rickli, Hans

    2009-02-06

    There is a relationship between obstructive sleep apnea (OSA) and heart failure (HF). Peak oxygen consumption (peak VO(2)), heart rate recovery, and N-terminal-pro-BNP (NT-proBNP) are strong prognostic predictors in HF. The effects of nasal continuous positive airway pressure (nCPAP) on these parameters in OSA patients are not well defined. Forty patients with newly diagnosed OSA [apnea-hypopnea index (AHI) 37 (20-65) h(-1)] underwent cardiopulmonary exercise testing for assessment of peak VO(2) and heart rate recovery at one (HRR-1) and two (HRR-2) minutes after exercise termination as well as NT-proBNP measurement at baseline and after 7.9+/-1.4 months of effective nCPAP (nightly usage>3.5 h). The effects of nCPAP were compared in patients with mild-to-moderate (AHIor=30 h(-1); n=24) OSA. In the group as a whole, peak VO(2) (baseline: 31.9+/-9.3 vs. follow-up: 33.7+/-9.0 ml/kg/min; p=0.02) and HRR-2 [38 (32-43) vs. 42 (32-47) bpm; p=0.01] but not HRR-1 [22 (15-26) vs. 22 (16-27) bpm; p=0.16] improved from baseline to follow-up. The effect on peak VO(2) was mainly driven by a trend towards an increase in patients with mild-to-moderate OSA (31.8+/-10.7 vs. 33.9+/-10.2 ml/kg/min; p=0.08), whereas an effect on HRR-1 [20 (15-23) vs. 21 (16-26) bpm; p=0.03] and HRR-2 [38 (29-42) vs. 42 (33-47) bpm; p=0.004] was observed only in those with severe OSA. NT-proBNP levels remained unchanged [21 (11-45) vs. 26 (5-52) pg/ml; p=0.6]. Treatment with nCPAP is associated with an improvement in peak VO(2) and heart rate recovery in patients with OSA.

  3. A guide for identification and continuing care of adult congenital heart disease patients in primary care.

    Science.gov (United States)

    Ellison, S; Lamb, J; Haines, A; O'Dell, S; Thomas, G; Sethi, S; Ratcliffe, J; Chisholm, S; Vaughan, J; Mahadevan, V S

    2013-03-10

    Surgical and other advances in the treatment and care of congenital heart disease have resulted in a significant increase in the number of adults with congenital heart disease (ACHD), many of whom have no regular cardiology follow-up. Optimised care for ACHD patients requires continuity of specialist and shared care and education of practitioners and patients. The challenges for managing ACHD were identified by a Health Needs Assessment in the North West and are addressed within the UK Department of Health's ACHD Commissioning Guide. An ACHD model of care was recommended in the North West of England and developed by the three North West Cardiac & Stroke Networks. Within this, a Task Group focused on the role of primary care in the identification and continuing care of ACHD patients. A feasibility study demonstrated that existing diagnostic Read Codes can identify ACHD patients on general practice registers. An ACHD Toolkit was developed to provide algorithms to guide the appropriate management of ACHD patients through primary, secondary and/or specialist ACHD care and to improve education/knowledge amongst primary care staff about ACHD and its wider implications. Early findings during the development of this Toolkit illustrate a wide disparity of provision between current and optimal management strategies. Patients lost to follow-up have already been identified and their management modified. By focusing on identifying ACHD patients in primary care and organising/delivering ACHD services, the ACHD Toolkit could help to improve quality, timeliness of care, patient experience and wellbeing. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  4. Advances in Continuous Flow Left Ventricular Assist Device Support for End-Stage Heart Failure: A Therapy in Evolution.

    Science.gov (United States)

    Saeed, Omar; Jorde, Ulrich P

    The purpose of this review is to highlight recent advances and challenges in the clinical implementation of continuous flow left ventricular assist devices (CF LVADs) in patients with advanced heart failure. Post approval studies of CF LVAD therapy continue to show a progressive improvement in survival and reduction in adverse events. Major trials are ongoing to compare outcomes of an axial flow device (Heart Mate II) and smaller centrifugal flow pumps (HeartWare VADs and Heart Mate III). Numerous studies have investigated strategies to reduce major hematologic and neurologic adverse events by evaluating hemolysis, antithrombotic therapy, and blood pressure control. This review will present the current findings that are centered around the impact of CF LVADs on improving survival and reducing adverse events through an evolution in management and design.

  5. Fetal myocardium in the kidney capsule: an in vivo model of repopulation of myocytes by bone marrow cells.

    Directory of Open Access Journals (Sweden)

    Eric Y Zhang

    Full Text Available Debate surrounds the question of whether the heart is a post-mitotic organ in part due to the lack of an in vivo model in which myocytes are able to actively regenerate. The current study describes the first such mouse model--a fetal myocardial environment grafted into the adult kidney capsule. Here it is used to test whether cells descended from bone marrow can regenerate cardiac myocytes. One week after receiving the fetal heart grafts, recipients were lethally irradiated and transplanted with marrow from green fluorescent protein (GFP-expressing C57Bl/6J (B6 donors using normal B6 recipients and fetal donors. Levels of myocyte regeneration from GFP marrow within both fetal myocardium and adult hearts of recipients were evaluated histologically. Fetal myocardium transplants had rich neovascularization and beat regularly after 2 weeks, continuing at checkpoints of 1, 2, 4, 6, 8 and12 months after transplantation. At each time point, GFP-expressing rod-shaped myocytes were found in the fetal myocardium, but only a few were found in the adult hearts. The average count of repopulated myocardium with green rod-shaped myocytes was 996.8 cells per gram of fetal myocardial tissue, and 28.7 cells per adult heart tissue, representing a thirty-five fold increase in fetal myocardium compared to the adult heart at 12 months (when numbers of green rod-shaped myocytes were normalized to per gram of myocardial tissue. Thus, bone marrow cells can differentiate to myocytes in the fetal myocardial environment. The novel in vivo model of fetal myocardium in the kidney capsule appears to be valuable for testing repopulating abilities of potential cardiac progenitors.

  6. Maternal buprenorphine treatment and fetal neurobehavioral development.

    Science.gov (United States)

    Jansson, Lauren M; Velez, Martha; McConnell, Krystle; Spencer, Nancy; Tuten, Michelle; Jones, Hendree E; King, Van L; Gandotra, Neeraj; Milio, Lorraine A; Voegtline, Kristin; DiPietro, Janet A

    2017-05-01

    Gestational opioid use/misuse is escalating in the United States; however, little is understood about the fetal effects of medications used to treat maternal opioid use disorders. The purpose of this study was to determine the effect of maternal buprenorphine administration on longitudinal fetal neurobehavioral development. Forty-nine buprenorphine-maintained women who attended a substance use disorder treatment facility with generally uncomplicated pregnancies underwent fetal monitoring for 60 minutes at times of trough and peak maternal buprenorphine levels. Data were collected at 24, 28, 32, and 36 weeks gestation. Fetal neurobehavioral indicators (ie, heart rate, motor activity, and their integration [fetal movement-fetal heart rate coupling]) were collected via an actocardiograph, digitized and quantified. Longitudinal data analysis relied on hierarchic linear modeling. Fetal heart rate, heart rate variability, and heart rate accelerations were significantly reduced at peak vs trough maternal buprenorphine levels. Effects were significant either by or after 28 weeks gestation and tended to intensify with advancing gestation. Fetal motor activity and fetal movement-fetal heart rate coupling were depressed from peak to trough at 36 weeks gestation. Polysubstance exposure did not significantly affect fetal neurobehavioral parameters, with the exception that fetuses of heavier smokers moved significantly less than those of lighter smokers at 36 weeks gestation. By the end of gestation, higher maternal buprenorphine dose was related to depression of baseline fetal cardiac measures at trough. Maternal buprenorphine administration has acute suppressive effects on fetal heart rate and movement, and the magnitude of these effects increases as gestation progresses. Higher dose (≥13 mg) appears to exert greater depressive effects on measures of fetal heart rate and variability. These findings should be balanced against comparisons to gestational methadone effects

  7. The pharmacotherapy of the HeartMate II, a continuous flow left ventricular assist device, in patients with advanced heart failure: integration of disease, device, and drug.

    Science.gov (United States)

    Jennings, Douglas L; Chambers, Rachel M; Schillig, Jessica M

    2010-10-01

    Advanced heart failure continues to be a significant cause of morbidity and mortality in the US. Patients with advanced heart failure have a poor prognosis without cardiac transplantation. The use of left ventricular assist devices (LVADs) as destination therapy for these patients is therefore expected to increase in the coming years as technology advances. The HeartMate II, a continuous flow implantable device, is currently the only LVAD that has been approved by the Food and Drug Administration for destination therapy in patients with advanced heart failure. The pharmacotherapy associated with this device is very complex and, therefore, the need for expertly trained clinical pharmacists to care for this expanding patient population will also likely increase. Unfortunately, most pharmacists are unfamiliar with the effect of LVADs on the physiology and pharmacotherapy of a patient's heart failure. The purpose of this article is to give clinical pharmacists an introduction to the most common pharmacotherapeutic issues for patients with LVADs and present practical solutions for managing common drug therapy problems.

  8. Fetal stem cells in combined treatment of chronic heart failure and their effect on morphofunctional parameters of the left ventricle myocardium and cognitive functions

    Directory of Open Access Journals (Sweden)

    Klunnyk MO

    2014-08-01

    Full Text Available Mariya O Klunnyk, Nataliia S Sych, Irina G Matiyashchuk, Olena V Ivankova, Marina V Skalozub Cell Therapy Center EmCell, Kyiv, Ukraine Aim: To investigate the effect of combined treatment with the inclusion of fetal stem cells (FSCs on the morphology and functional dynamics of the left ventricle and cognitive functions in patients with chronic heart failure (CHF. Materials and methods: A comparative study was carried out on patients with CHF to examine the effect of combined treatment, including the experimental application of FSCs, on the morphofunctional parameters of the left ventricle and cognitive functions. Patients were examined before FSC treatment (FSCT, and 1 month, 3 months, and 6 months after treatment. The control group consisted of 20 CHF patients of similar age, sex, and New York Heart Association class. Results: It has been proven that FSCs positively affect objective and subjective clinical parameters. A significant reduction of serum type B brain natriuretic peptide was reported as early as 1 month after treatment. Significant increases in the left ventricle ejection fraction and decreases of the end diastolic volume were observed 6 months after treatment. Cognitive performance tests showed improvements on the Mini-Mental State Examination and Frontal Assessment Battery (conceptualization, mental flexibility, programming, sensitivity to interference, inhibitory control, and environmental autonomy scales. The treatment resulted in significant improvements in the general score and across all cognitive areas of the Mini-Mental State Examination (recall, orientation, attention, calculation, and complex commands after 3 months, and significant improvements across all Frontal Assessment Battery areas after 6 months. In the control group, these scores showed significant increases only at 6 months after the treatment. In the study group, depression was significantly reduced within 1 month after treatment versus 3 months in the control

  9. Effects of high-intensity interval versus continuous exercise training on post-exercise heart rate recovery in coronary heart-disease patients.

    Science.gov (United States)

    Villelabeitia-Jaureguizar, Koldobika; Vicente-Campos, Davinia; Senen, Alejandro Berenguel; Jiménez, Verónica Hernández; Garrido-Lestache, María Elvira Barrios; Chicharro, Jose López

    2017-10-01

    Heart rate recovery (HRR) has been considered a prognostic and mortality indicator in both healthy and coronary patients. Physical exercise prescription has shown improvements in VO 2 peak and HRR, but most of the studies have been carried out applying continuous training at a moderate intensity, being very limited the use of protocols of high intensity interval training in coronary patients. We aimed to compare the effects of a moderate continuous training (MCT) versus a high intensity interval training (HIIT) programme on VO 2 peak and HRR. Seventy three coronary patients were assigned to either HIIT or MCT groups for 8weeks. Incremental exercise tests in a cycloergometer were performed to obtain VO 2 peak data and heart rate was monitored during and after the exercise test to obtain heart rate recovery data. Both exercise programmes significantly increase VO 2 peak with a higher increase in the HIIT group (HIIT: 4.5±4.46ml/kg/min vs MCT: 2.46±3.57ml/kg/min; p=0.039). High intensity interval training resulted in a significantly increase in HRR at the first and second minute of the recovery phase (15,44±7,04 vs 21,22±6,62, pdisease of low risk resulted in an improvement in VO 2 peak, and also improvements in post-exercise heart-rate recovery, compared with continuous training. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Fetal responses to induced maternal relaxation during pregnancy

    OpenAIRE

    DiPietro, Janet A.; Costigan, Kathleen A.; Nelson, Priscilla; Gurewitsch, Edith D.; Laudenslager, Mark L.

    2007-01-01

    Fetal responses to induced maternal relaxation during the 32nd week of pregnancy were recorded in 100 maternal-fetal pairs using a digitized data collection system. The 18-minute guided imagery relaxation manipulation generated significant changes in maternal heart rate, skin conductance, respiration period, and respiratory sinus arrhythmia. Significant alterations in fetal neurobehavior were observed, including decreased fetal heart rate (FHR), increased FHR variability, suppression of fetal...

  11. Maternal-fetal outcomes in prolonged pregnancy.

    Science.gov (United States)

    Cucco, C; Osborne, M A; Cibils, L A

    1989-10-01

    The intrapartum fetal heart rate changes, type of labor, mode of delivery, and neonatal outcome were evaluated in 379 consecutive continuously monitored prolonged pregnancies (greater than 42 weeks by history and early examination). These represent only a fraction of the total prolonged gestation population. There were 56% multiparous women, 33% less than 20 years of age, and 95% with cephalic presentation. Oxytocin was given to 76% (48% induced, 28% enhanced). Delivery was by cesarean section in 13% of patients (9% of induced cases), and 15% had forceps deliveries. Fetal heart rate alterations were observed in high proportion. Cesarean section for cephalopelvic disproportion was indicated in 60% of operations, and 13% of the fetuses weighed greater than 4000 gm. Depression occurred in 15% of infants at 1 minute and in 4% at 5 minutes. Prolonged hospital stay was seen in 9%, and postmaturity syndrome in 19%. There were four perinatal deaths (two corrected). Active induction does not appear to increase the cesarean section rate. The durations of predelivery observation may be longer because the cervices are frequently unripe. There is a high incidence of fetal heart rate alterations. Induction appears justified as an active intervention to prevent some sudden unexplained deaths.

  12. Clinical implications from monitoring fetal activity.

    Science.gov (United States)

    Rayburn, W F

    1982-12-15

    The monitoring of fetal motion in high-risk pregnancies has been shown to be worthwhile in predicting fetal distress and impending fetal death. The maternal recording of perceived fetal activity is an inexpensive surveillance technique which is most useful when there is chronic uteroplacental insufficiency or when a stillbirth may be expected. The presence of an active, vigorous fetus is reassuring, but documented fetal inactivity required a reassessment of the underlying antepartum complication and further fetal evaluation with real-time ultrasonography, fetal heart rate testing, and biochemical testing. Fetal distress from such acute changes as abruptio placentae or umbilical cord compression may not be predicted by monitoring fetal motion. Although not used for routine clinical investigation, electromechanical devices such as tocodynamometry have provided much insight into fetal behavioral patterns at many stages of pregnancy and in pregnancies with an antepartum complication.

  13. Fetal MRI; Fetales MRT

    Energy Technology Data Exchange (ETDEWEB)

    Blondin, D. [Inst. fuer Diagn. Radiologie, Uniklinikum Duesseldorf (Germany); Turowski, B. [Inst. fuer Diagn. Radiologie, Neuroradiologie, Uniklinikum Duesseldorf (Germany); Schaper, J. [Inst. fuer Diagn. Radiologie, Kinderradiologie, Uniklinikum Duesseldorf (Germany)

    2007-02-15

    Ultrasonography is the method of choice for prenatal malformation screening, but it does not always provide sufficient information for correct diagnosis or adequate abnormality evaluation. Fetal MRI is increasingly being used to complete sonographic findings. It was initially used for evaluation of cerebral abnormalities but is increasingly being applied to other fetal areas. In vivo investigation of fetal brain maturation has been enhanced by MRI. An adequate analysis of fetal chest and abdomen can be achieved with fast T2-, T1-weighted and diffusion-weighted imaging (DWI). The advantages include the great field of view and the excellent soft tissue contrast. This allows correct diagnosis of congenital diaphragmatic hernia and evaluation of the consequences on pulmonary growth. Other pulmonary malformations, such as cystic adenomatoid malformation, sequestration and brochogenic cysts, can also be easily identified. Renal position can be quickly determined using DWI sequences and renal agenesia can be easily diagnosed with only one sequence. Prenatal MRI is virtually as effective as postnatal examination, dispenses with transport of a potentially very ill newborn, and provides logistic advantages. Therefore, prenatal MRI is useful for adequate postnatal treatment of newborns with malformations. (orig.)

  14. Fluid Dynamic Characterization of a Polymeric Heart Valve Prototype (Poli-Valve) tested under Continuous and Pulsatile Flow Conditions

    Science.gov (United States)

    De Gaetano, Francesco; Serrani, Marta; Bagnoli, Paola; Brubert, Jacob; Stasiak, Joanna; Moggridge, Geoff D.; Costantino, Maria Laura

    2016-01-01

    Introduction Only mechanical and biological heart valve prostheses are currently commercially available. The former show longer durability but require anticoagulant therapy, the latter display better fluid dynamic behaviour but do not have adequate durability. New Polymeric Heart Valves (PHVs) could potentially combine the haemodynamic properties of biological valves with the durability of mechanical valves. This work presents a hydrodynamic evaluation of two groups of newly developed supra-annular tri-leaflet prosthetic heart valves made from styrenic block copolymers (SBC): Poli-Valves. Methods Two types of Poli-Valves made of SBC differing in polystyrene fraction content were tested under continuous and pulsatile flow conditions as prescribed by ISO 5840 Standard. An ad - hoc designed pulse duplicator allowed the valve prototypes to be tested at different flow rates and frequencies. Pressure and flow were recorded; pressure drops, effective orifice area (EOA), and regurgitant volume were computed to assess the valve’s behaviour. Results Both types Poli-Valves met the minimum requirements in terms of regurgitation and EOA as specified by ISO 5840 Standard. Results were compared with five mechanical heart valves (MHVs) and five tissue heart valves (THVs), currently available on the market. Conclusion Based on these results, polymeric heart valves based on styrenic block copolymers, as Poli-Valves are, can be considered as promising alternative for heart valve replacement in near future. PMID:26689146

  15. “I Was Relieved to Know That My Baby Was Safe”: Women’s Attitudes and Perceptions on Using a New Electronic Fetal Heart Rate Monitor during Labor in Tanzania

    Directory of Open Access Journals (Sweden)

    Sara Rivenes Lafontan

    2018-02-01

    Full Text Available To increase labor monitoring and prevent neonatal morbidity and mortality, a new wireless, strap-on electronic fetal heart rate monitor called Moyo was introduced in Tanzania in 2016. As part of the ongoing evaluation of the introduction of the monitor, the aim of this study was to explore the attitudes and perceptions of women who had worn the monitor continuously during their most recent delivery and perceptions about how it affected care. This knowledge is important to identify barriers towards adaptation in order to introduce new technology more effectively. We carried out 20 semi-structured individual interviews post-labor at two hospitals in Tanzania. A thematic content analysis was used to analyze the data. Our results indicated that the use of the monitor positively affected the women’s birth experience. It provided much-needed reassurance about the wellbeing of the child. The women considered that wearing Moyo improved care due to an increase in communication and attention from birth attendants. However, the women did not fully understand the purpose and function of the device and overestimated its capabilities. This highlights the need to improve how and when information is conveyed to women in labor.

  16. Fetal Tachyarrhythmia - Part II: Treatment

    Directory of Open Access Journals (Sweden)

    Martijn A. Oudijk

    2004-10-01

    Full Text Available The decision to initiate pharmacological intervention in case of fetal tachycardia depends on several factors and must be weighed against possible maternal and/or fetal adverse effects inherent to the use of antiarrhythmics. First, the seriousness of the fetal condition must be recognized. Many studies have shown that in case of fetal tachycardia, there is a significant predisposition to congestive heart failure and subsequent development of fetal hydrops and even sudden cardiac death1,2,3 Secondly, predictors of congestive heart failure have been suggested in several studies, such as the percentage of time that the tachycardia is present, the gestational age at which the tachycardia occurs4, the ventricular rate5 and the site of origin of the tachycardia6. However, the sensitivity of these predictors is low and they are therefore clinically not very useful. In addition, hemodynamic compromise may occur in less than 24 - 48 hours as has been shown in the fetal lamb7 and in tachycardic fetuses8,9. On the other hand, spontaneous resolution of the tachycardia has also been described10. Thirdly, transplacental management of fetuses with tricuspid regurgitation11, congestive heart failure or fetal hydrops is difficult12,13, probably as a result of limited transplacental transfer of the antiarrhythmic drug14,15. In case of fetal hydrops, conversion rates are decreased and time to conversion is increased13. Treatment of sustained fetal tachycardia is therefore to be preferred above expectant management, although some centers oppose this regimen and suggest that in cases with (intermittent fetal SVT not complicated by congestive heart failure or fetal hydrops, conservative management and close surveillance might be a reasonable alternative16,17,18.

  17. Comparison of pancuronium and vecuronium for fetal neuromuscular blockade during invasive procedures.

    Science.gov (United States)

    Watson, W J; Atchison, S R; Harlass, F E

    1996-01-01

    Neuromuscular blocking agents, used to arrest fetal motion for invasive intrauterine procedures, may cause temporary fetal heart rate changes. After 21 invasive procedures using either pancuronium bromide or vecuronium bromide, post-procedure fetal heart rate tracings were retrospectively compared. Pancuronium was associated with an increased fetal heart rate and decreased beat-to-beat variability for 2.5 hours after its use, whereas vecuronium caused no fetal heart rate changes. Vecuronium bromide offers advantages over pancuronium, because the decreased effect on the fetal heart allows better assessment of fetal well-being immediately following invasive intrauterine procedures.

  18. Generating pulsatility by pump speed modulation with continuous-flow total artificial heart in awake calves.

    Science.gov (United States)

    Fukamachi, Kiyotaka; Karimov, Jamshid H; Sunagawa, Gengo; Horvath, David J; Byram, Nicole; Kuban, Barry D; Dessoffy, Raymond; Sale, Shiva; Golding, Leonard A R; Moazami, Nader

    2017-12-01

    The purpose of this study was to evaluate the effects of sinusoidal pump speed modulation of the Cleveland Clinic continuous-flow total artificial heart (CFTAH) on hemodynamics and pump flow in an awake chronic calf model. The sinusoidal pump speed modulations, performed on the day of elective sacrifice, were set at ±15 and ± 25% of mean pump speed at 80 bpm in four awake calves with a CFTAH. The systemic and pulmonary arterial pulse pressures increased to 12.0 and 12.3 mmHg (±15% modulation) and to 15.9 and 15.7 mmHg (±25% modulation), respectively. The pulsatility index and surplus hemodynamic energy significantly increased, respectively, to 1.05 and 1346 ergs/cm at ±15% speed modulation and to 1.51 and 3381 ergs/cm at ±25% speed modulation. This study showed that it is feasible to generate pressure pulsatility with pump speed modulation; the platform is suitable for evaluating the physiologic impact of pulsatility and allows determination of the best speed modulations in terms of magnitude, frequency, and profiles.

  19. Fetal and neonatal thyrotoxicosis

    Directory of Open Access Journals (Sweden)

    Chandar Mohan Batra

    2013-01-01

    Full Text Available Fetal thyrotoxicosis is a rare disease occurring in 1 out of 70 pregnancies with Grave′s disease or in 1 out of 4000-50,000 deliveries. The mortality is 12-20%, usually from heart failure, but other complications are tracheal compression, infections and thrombocytopenia. It results from transfer of thyroid stimulating immunoglobulins from mother to fetus through the placenta. This transplacental transfer begins around 20 th week of pregnancy and reaches its maximum by 30 th week. These autoantibodies bind to the fetal thyroid stimulating hormone (TSH receptors and increase the secretion of the thyroid hormones. The mother has an active autoimmune thyroid disease or has been treated for it in the past. She may be absolutely euthyroid due to past treatment by drugs, surgery or radioiodine ablation, but still have active TSH receptor stimulating autoantibodies, which can cause fetal thyrotoxicosis. The other features of this disease are fetal tachycardia, fetal goiter and history of spontaneous abortions and findings of goiter, ascites, craniosyntosis, fetal growth retardation, maceration and hydrops at fetal autopsy. If untreated, this disease can result in intrauterine death. The treatment for this disease consists of giving carbimazole to the mother, which is transferred through the placenta to the fetus. The dose of carbimazole is titrated with the fetal heart rate. If the mother becomes hypothyroid due to carbimazole, thyroxine is added taking advantage of the fact that very little of thyroxine is transferred across the placenta. Neonatal thyrotoxicosis patients are very sick and require emergency treatment. The goal of the treatment is to normalize thyroid functions as quickly as possible, to avoid iatrogenic hypothyroidism while providing management and supportive therapy for the infant′s specific signs and symptoms.

  20. Fetal body weight and the development of the control of the cardiovascular system in fetal sheep.

    Science.gov (United States)

    Frasch, M G; Müller, T; Wicher, C; Weiss, C; Löhle, M; Schwab, K; Schubert, H; Nathanielsz, P W; Witte, O W; Schwab, M

    2007-03-15

    Reduced birth weight predisposes to cardiovascular diseases in later life. We examined in fetal sheep at 0.76 (n = 18) and 0.87 (n = 17) gestation whether spontaneously occurring variations in fetal weight affect maturation of autonomic control of cardiovascular function. Fetal weights at both gestational ages were grouped statistically in low (LW) and normal weights (NW) (P fetal sheep not constituting a major malnutritive condition. Mean fetal blood pressure (FBP) of all fetuses was negatively correlated to fetal weight at 0.76 but not 0.87 gestation (P fetal heart rate depended on fetal weight (P fetal weight within the normal weight span is accompanied by a different trajectory of development of sympathetic blood pressure and vagal heart rate control. This may contribute to the development of elevated blood pressure in later life. Examination of the underlying mechanisms and consequences may contribute to the understanding of programming of cardiovascular diseases.

  1. Fluid dynamic characterization of a polymeric heart valve prototype (Poli-Valve) tested under continuous and pulsatile flow conditions.

    Science.gov (United States)

    De Gaetano, Francesco; Serrani, Marta; Bagnoli, Paola; Brubert, Jacob; Stasiak, Joanna; Moggridge, Geoff D; Costantino, Maria Laura

    2015-11-01

    Only mechanical and biological heart valve prostheses are currently commercially available. The former show longer durability but require anticoagulant therapy; the latter display better fluid dynamic behavior but do not have adequate durability. New Polymeric Heart Valves (PHVs) could potentially combine the hemodynamic properties of biological valves with the durability of mechanical valves. This work presents a hydrodynamic evaluation of 2 groups of newly developed supra-annular, trileaflet prosthetic heart valves made from styrenic block copolymers (SBC): Poli-Valves. 2 types of Poli-Valves made of SBC and differing in polystyrene fraction content were tested under continuous and pulsatile flow conditions as prescribed by ISO 5840 Standard. A pulse duplicator designed ad hoc allowed the valve prototypes to be tested at different flow rates and frequencies. Pressure and flow were recorded; pressure drops, effective orifice area (EOA), and regurgitant volume were computed to assess the behavior of the valve. Both types of Poli-Valves met the minimum requirements in terms of regurgitation and EOA as specified by the ISO 5840 Standard. Results were compared with 5 mechanical heart valves (MHVs) and 5 tissue heart valves (THVs), currently available on the market. Based on these results, PHVs based on styrenic block copolymers, as are Poli-Valves, can be considered a promising alternative for heart valve replacement in the near future.

  2. Fetal echocardiography

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/007340.htm Fetal echocardiography To use the sharing features on this page, please enable JavaScript. Fetal echocardiography is a test that uses sound waves ( ultrasound ) ...

  3. Progress on the design and development of the continuous-flow total artificial heart.

    Science.gov (United States)

    Kobayashi, Mariko; Horvath, David J; Mielke, Nicole; Shiose, Akira; Kuban, Barry; Goodin, Mark; Fukamachi, Kiyotaka; Golding, Leonard A R

    2012-08-01

    Cleveland Clinic's continuous-flow total artificial heart has one motor and one rotating assembly supported by a hydrodynamic bearing. The right hydraulic output is self regulated by passive axial movement of the rotating assembly to balance itself with the left output. The purpose of this article is to present progress in four areas of development: the automatic speed control system, self-regulation to balance right/left inlet pressures and flows, hemolysis testing using calf blood, and coupled electromagnetics (EMAG) and computational fluid dynamics (CFD) analysis. The relationships between functions of motor power and speed, systemic flow, and systemic vascular resistance (SVR) were used for the sensorless speed control algorithm and demonstrated close correlations. Based on those empirical relationships, systemic flow and SVR were calculated in the system module and showed good correlation with measured pump flow and SVR. The automatic system adjusted the pump's speed to obtain the target flow in response to the calculated SVR. Atrial pressure difference (left minus right atrial pressure) was maintained within ±10 mm Hg for a wide range of SVR/pulmonary vascular resistance ratios, demonstrating a wide margin of self-regulation under fixed-speed mode and 25% sinusoidally modulated speed mode. Hemolysis test results indicated acceptable values (normalized index of hemolysis <0.01 mg/dL). The coupled EMAG/CFD model was validated for use in further device development. © 2012, Copyright the Authors. Artificial Organs © 2012, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  4. Fetal cardiac assessment

    International Nuclear Information System (INIS)

    Greene, K.R.

    1983-01-01

    The better understanding of fetal cardiovascular physiology coupled with improved technology for non-invasive study of the fetus now enable much more detailed assessment of fetal cardiac status than by heart rate alone. Even the latter, relatively simple, measurement contains much more information than was previously realized. It is also increasingly clear that no single measurement will provide the answer to all clinical dilemmas either on cardiac function or the welfare of the fetus as a whole. There are obvious clinical advantages in measuring several variables from one signal and the measurement of heart rate, heart rate variation and waveform from the ECG in labour is a potentially useful combination. Systolic time intervals or flow measurements could easily be added or used separately by combining real-time and Doppler ultrasound probes

  5. Persistent atrial fibrillation worsens heart rate variability, activity and heart rate, as shown by a continuous monitoring by implantable biventricular pacemakers in heart failure patients.

    Science.gov (United States)

    Puglisi, Andrea; Gasparini, Maurizio; Lunati, Maurizio; Sassara, Massimo; Padeletti, Luigi; Landolina, Maurizio; Botto, Giovanni Luca; Vincenti, Antonio; Bianchi, Stefano; Denaro, Alessandra; Grammatico, Andrea; Boriani, Giuseppe

    2008-07-01

    Atrial fibrillation (AF) induces loss of atrial contribution, heart rate irregularity, and fast ventricular rate. The objectives of the study were to accurately measure AF incidence and to investigate the mutual temporal patterns of AF and heart failure (HF) in patients indicated to cardiac resynchronization therapy. Four hundred ten consecutive patients (70% male, age 69 +/- 11) with advanced HF (NYHA = 3.0 +/- 0.6), low ejection fraction (EF = 27 +/- 9%), and ventricular conduction delay (QRS = 165 +/- 29 ms) received a biventricular pacemaker. Enrolled patients were divided into two groups: G1 = 249 patients with no AF history, G2 = 161 patients with history of paroxysmal/persistent AF. In a median follow-up of 13 months, AF episodes longer than 5 minutes occurred in 105 of 249 (42.2%) G1 patients and 76 of 161 (47.2%) G2 patients, while AF episodes longer than one day occurred in 14 of 249 (5.6%) G1 patients and in 36 of 161 (22.4%) G2 patients. Device diagnostics monitored daily values of patient activity, night heart rate (NHR), and heart rate variability (HRV). Comparing 30-day periods before AF onset and during persistent AF, significant (P R(2)= 0.73) with activity, with a significant lower activity associated with NHR >or= 88 bpm. AF is frequent in HF patients. Persistent AF is associated with statistically significant decrease in patient activity and HRV and NHR increase.

  6. Three- and four-dimensional ultrasound in fetal echocardiography: an up-to-date overview

    NARCIS (Netherlands)

    Adriaanse, B.M.; Vugt, J.M.G. van; Haak, M.C.

    2016-01-01

    Congenital heart diseases (CHD) are the most commonly overlooked lesions in prenatal screening programs. Real-time two-dimensional ultrasound (2DUS) is the conventionally used tool for fetal echocardiography. Although continuous improvements in the hardware and post-processing software have resulted

  7. Remission of chronic anthracycline-induced heart failure with support from a continuous-flow left ventricular assist device.

    Science.gov (United States)

    Khan, Nadeem; Husain, Syed Arman; Husain, Syed Iman; Khalaf, Natalia; George, Joggy; Raissi, Farshad; Segura, Ana Maria; Kar, Biswajit; Bogaev, Roberta C; Frazier, O H

    2012-01-01

    We report the case of a patient who had chronic anthracycline-induced cardiomyopathy that was reversed after treatment with a left ventricular assist device. A 29-year-old woman had undergone anthracycline-based chemotherapy as a teenager in 1991 and 1992 and received a diagnosis of dilated cardiomyopathy 10 years later. Optimal medical therapy had initially controlled the symptoms of heart failure. However, in June 2006, the symptoms worsened to New York Heart Association functional class IV status. We implanted a continuous-flow left ventricular assist device as a bridge to cardiac transplantation; of note, a left ventricular core biopsy at that time showed no replacement fibrosis. The patient's clinical status improved thereafter, enabling left ventricular assist device ex-plantation after 17 months. To our knowledge, this is the first report of the use of left ventricular assist device support to reverse chronic anthracycline-induced heart failure.

  8. Diagnóstico ecocardiográfico de los tumores primarios del corazón en el feto Echocardiographic diagnosis of fetal primary heart tumors

    Directory of Open Access Journals (Sweden)

    Andrés Savío Benavides

    2009-12-01

    Full Text Available INTRODUCCIÓN. Se describen las características ecocardiográficas de los tumores cardíacos primarios en el feto y la evolución y complicaciones de éstos, con el propósito de analizar su comportamiento en dos períodos diferentes a lo largo de 20 años. MÉTODOS. El estudio se desarrolló en dos etapas. En la primera se estudiaron 1,884 embarazadas entre las 18 y 22 semanas de gestación, que acudieron a la consulta por distintos factores de riesgo obstétrico. La técnica utilizada fue la misma empleada internacionalmente, con equipos Combison 320-5 y Aloka 860 con transductores electrónicos de 3,5 y 5 MHz, y Doppler codificado en color, para el estudio de los flujos intracavitarios y los gradientes de presión. RESULTADOS. Se identificaron 6 tumores cardíacos, lo que representó el 0,3 % de los casos examinados. Cinco correspondieron a rabdomiomas, y uno, a un mixoma de la aurícula derecha. La mayoría obstruía los tractos de entrada o salida. Se observó arritmia en un caso. La sensibilidad y especificidad fueron del 100 % y 99,8 %, respectivamente. CONCLUSIONES. Se demuestra la poca frecuencia de los tumores cardíacos en el feto y la importancia de la ecocardiografía por su alta sensibilidad y especificidad.INTRODUCTION: Echocardiographic features of fetal primary heart tumors are described, as well as its natural history and its complications to analyze its behavior during two different periods along 20 years. METHODS: Study was developed in two stages. In the first one a total of 1,884 pregnants between 18 and 22 gestational weeks were studied who were seen in consultation due to different obstetric risk factors. The technique applied was similar to that at worldwide using a equipment Combison 320-5 and Aloka 860 and electronic transducers of 3,5 and 5 MHz, and color coded Doppler to study the intracavitary flux and the pressure gradient. RESULTS: Six cardiac tumors were identified representing the 0,3% of study cases. Five were

  9. The Heart of the City : Continuity and Complexity of an urban design concept

    NARCIS (Netherlands)

    Zuccaro Marchi, L.

    2013-01-01

    The “Heart of the City” theme is proposed by the MARS group as title of the 8th Congrès Internationaux d’Architecture Moderne (CIAM), held in Hoddesdon, England, from the 7th to the 14th of July 1951. Two opposite urban conditions are considered by Sert, President of CIAM, as main issues which the

  10. Maturation of the human fetal startle response: Evidence for sex-specific maturation of the human fetus1

    Science.gov (United States)

    Buss, Claudia; Davis, Elysia Poggi; Class, Quetzal A.; Gierczak, Matt; Pattillo, Carol; Glynn, Laura M.; Sandman, Curt A.

    2009-01-01

    Despite the evidence for early fetal experience exerting programming influences on later neurological development and health risk, very few prospective studies of human fetal behavior have been reported. In a prospective longitudinal study, fetal nervous system maturation was serially assessed by monitoring fetal heart rate (FHR) responses to vibroacoustic stimulation (VAS) in 191 maternal/fetal dyads. Responses were not detected at 26 weeks gestational age (GA). Sex-specific, age-characteristic changes in the FHR response to VAS were observed by 31 weeks’ GA. Males showed larger responses and continued to exhibit maturational changes until 37 weeks’ GA, females however, presented with a mature FHR startle response by 31 weeks’ GA. The results indicate that there are different rates of maturation in the male and female fetus that may have implications for sex-specific programming influences. PMID:19726143

  11. Maturation of the human fetal startle response: evidence for sex-specific maturation of the human fetus.

    Science.gov (United States)

    Buss, Claudia; Davis, Elysia Poggi; Class, Quetzal A; Gierczak, Matt; Pattillo, Carol; Glynn, Laura M; Sandman, Curt A

    2009-10-01

    Despite the evidence for early fetal experience exerting programming influences on later neurological development and health risk, very few prospective studies of human fetal behavior have been reported. In a prospective longitudinal study, fetal nervous system maturation was serially assessed by monitoring fetal heart rate (FHR) responses to vibroacoustic stimulation (VAS) in 191 maternal/fetal dyads. Responses were not detected at 26 weeks gestational age (GA). Sex-specific, age-characteristic changes in the FHR response to VAS were observed by 31 weeks' GA. Males showed larger responses and continued to exhibit maturational changes until 37 weeks' GA, females however, presented with a mature FHR startle response by 31 weeks' GA. The results indicate that there are different rates of maturation in the male and female fetuses that may have implications for sex-specific programming influences.

  12. Fetal and Neonatal Arrhythmias.

    Science.gov (United States)

    Jaeggi, Edgar; Öhman, Annika

    2016-03-01

    Cardiac arrhythmias are an important aspect of fetal and neonatal medicine. Premature complexes of atrial or ventricular origin are the main cause of an irregular heart rhythm. The finding is typically unrelated to an identifiable cause and no treatment is required. Tachyarrhythmia most commonly relates to supraventricular reentrant tachycardia, atrial flutter, and sinus tachycardia. Several antiarrhythmic agents are available for the perinatal treatment of tachyarrhythmias. Enduring bradycardia may result from sinus node dysfunction, complete heart block and nonconducted atrial bigeminy as the main arrhythmia mechanisms. The management and outcome of bradycardia depend on the underlying mechanism. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Fetal Abuse.

    Science.gov (United States)

    Kent, Lindsey; And Others

    1997-01-01

    Five cases of fetal abuse by mothers suffering from depression are discussed. Four of the women had unplanned pregnancies and had considered termination of the pregnancy. Other factors associated with fetal abuse include pregnancy denial, pregnancy ambivalence, previous postpartum depression, and difficulties in relationships. Vigilance for…

  14. Baseline albumin is associated with worsening renal function in patients with acute decompensated heart failure receiving continuous infusion loop diuretics.

    Science.gov (United States)

    Clarke, Megan M; Dorsch, Michael P; Kim, Susie; Aaronson, Keith D; Koelling, Todd M; Bleske, Barry E

    2013-06-01

    To identify baseline predictors of worsening renal function (WRF) in an acute decompensated heart failure (ADHF) patient population receiving continuous infusion loop diuretics. Retrospective observational analysis. Academic tertiary medical center. A total of 177 patients with ADHF receiving continuous infusion loop diuretics from January 2006 through June 2009. The mean patient age was 61 years, 63% were male, ~45% were classified as New York Heart Association functional class III, and the median length of loop diuretic infusion was 4 days. Forty-eight patients (27%) developed WRF, and 34 patients (19%) died during hospitalization. Cox regression time-to-event analysis was used to determine the time to WRF based on different demographic and clinical variables. Baseline serum albumin 3 g/dl or less was the only significant predictor of WRF (hazard ratio [HR] 2.87, 95% confidence interval [CI] 1.60-5.16, p=0.0004), which remained significant despite adjustments for other covariates. Serum albumin 3 g/dl or less is a practical baseline characteristic associated with the development of WRF in patients with ADHF receiving continuous infusion loop diuretics. © 2013 Pharmacotherapy Publications, Inc.

  15. Effects of continuous positive airway pressure on lung mechanics of babies after operation for congenital heart disease.

    Science.gov (United States)

    Cogswell, J J; Hatch, D J; Kerr, A A; Taylor, B

    1975-01-01

    The effect of continuous positive airway pressure (CPAP) on lung mechanics was investigated in 12 babies after operation for severe congenital heart disease. At the time of study all babies were receiving or being weaned from ventilatory support and had abnormally low lung volume or compliance. During CPAP there was a fall in the pulmonary resistance which, with a slight decrease in minute ventilation, resulted in a significant decrease in the work of breathing. It is suggested that lowering the oxygen cost of breathing may contribute to the improvement in arterial oxygenation seen when CPAP is used. PMID:801862

  16. [Chance for young electrophysiologists: the continuing education program "Fellowship heart rhythm"].

    Science.gov (United States)

    Neuzner, J; Willems, S; Klein, H U; Block, M

    2010-09-01

    Increasing workloads, growing economical pressure and developments on the German job market for young physicians create a background which threatens an adequate education and training of physicians in many places. The"Fellowship heart rhythm" program focuses on training in clinical electrophysiology complementary to established educational initiatives, such as courses for competence in pacemaker and ICD therapy of the German Cardiac Society. Participants have to be residents with a minimum of 3 years clinical experience and should be younger than 36 years old. They should be actively involved with a long-term perspective in clinical electrophysiology. Activity in the fields of pacing, defibrillator and cardiac resynchronization therapy is required. The hospital has to be able provide the possibility of invasive electrophysiology and catheter ablation including a 3-dimensional mapping system. In 6 face-to-face meetings of 3 days each, the state of the art is presented in the topics electrophysiological studies, sudden cardiac death and defibrillation, health economy/management, catheter ablation, atrial fibrillation and heart failure and arrhythmias. The first 4 years with 2 fellowship programs have demonstrated that this project enables education at a high level, strongly supporting advances in scientific interest, individual development and medical orientation. The fellowship program facilitates the development of a network of young electrophysiologists in Germany.

  17. The role of patient-held alert cards in promoting continuity of care for Heart Failure Patients.

    Science.gov (United States)

    McBride, Anne; Burey, Lorraine; Megahed, Margo; Feldman, Carolyne; Deaton, Christi

    2014-02-01

    Patients with heart failure managed by community heart failure specialist nurses (CHFSNs) may have episodes of (often unrelated) ill-health managed separately in hospital. Inadequate communication and multi-disciplinary working between these different providers can impact on the effectiveness of care. This service improvement project explored the potential of patient-held alert cards to improve communication and continuity of care for heart failure patients moving between CHFSNs and hospital settings. Alert cards were distributed to 119 patients on a community case load for presentation at hospital or emergency department. Follow-up data were obtained from practitioners and patients at 12 months. At 12 months, 38 patients from the CHFSN caseload experienced 61 hospital admissions. CHFSNs were informed of 80% of admissions by practitioners (61%) and family members (38%). They were also informed of 59% of discharges. Notification of admission by hospital staff increased from zero in the previous 12 months, to 19 notifications. CHFSNs were more involved with hospital care, and patients reported increased confidence with the alert cards. The study has shown that alert cards can increase the involvement of CHFSNs in the ongoing care and discharge planning process. They can also empower patients and carers to take an active role in their own care.

  18. Intermittent detection of fetal heart rate abnormalities identify infants at greatest risk for fresh stillbirths, birth asphyxia, neonatal resuscitation, and early neonatal deaths in a limited-resource setting: a prospective descriptive observational study at Haydom Lutheran Hospital.

    Science.gov (United States)

    Langli Ersdal, Hege; Mduma, Estomih; Svensen, Erling; Sundby, Johanne; Perlman, Jeffrey

    2012-01-01

    Intermittent fetal heart rate (FHR) monitoring during labor using an acoustic stethoscope is the most frequent method for fetal assessment of well-being in low- and middle-income countries. Evidence concerning reliability and efficacy of this technique is almost nonexistent. To determine the value of routine intermittent FHR monitoring during labor in the detection of FHR abnormalities, and the relationship of abnormalities to the subsequent fresh stillbirths (FSB), birth asphyxia (BA), need for neonatal face mask ventilation (FMV), and neonatal deaths within 24 h. This is a descriptive observational study in a delivery room from November 2009 through December 2011. Research assistants/observers (n = 14) prospectively observed every delivery and recorded labor information including FHR and interventions, neonatal information including responses in the delivery room, and fetal/neonatal outcomes (FSB, death within 24 h, admission neonatal area, or normal). 10,271 infants were born. FHR was abnormal (i.e. 160 beats/min) in 279 fetuses (2.7%) and absent in 200 (1.9%). Postnatal outcomes included FSB in 159 (1.5%), need for FMV in 695 (6.8%), BA (i.e. 5-min Apgar score neonatal resuscitation, BA, and neonatal death in a limited-resource setting. The likelihood of an abnormal FHR is magnified with labor complications. Copyright © 2012 S. Karger AG, Basel.

  19. Fetal Electrocardiogram Extraction and Analysis Using Adaptive Noise Cancellation and Wavelet Transformation Techniques.

    Science.gov (United States)

    Sutha, P; Jayanthi, V E

    2017-12-08

    Birth defect-related demise is mainly due to congenital heart defects. In the earlier stage of pregnancy, fetus problem can be identified by finding information about the fetus to avoid stillbirths. The gold standard used to monitor the health status of the fetus is by Cardiotachography(CTG), cannot be used for long durations and continuous monitoring. There is a need for continuous and long duration monitoring of fetal ECG signals to study the progressive health status of the fetus using portable devices. The non-invasive method of electrocardiogram recording is one of the best method used to diagnose fetal cardiac problem rather than the invasive methods.The monitoring of the fECG requires development of a miniaturized hardware and a efficient signal processing algorithms to extract the fECG embedded in the mother ECG. The paper discusses a prototype hardware developed to monitor and record the raw mother ECG signal containing the fECG and a signal processing algorithm to extract the fetal Electro Cardiogram signal. We have proposed two methods of signal processing, first is based on the Least Mean Square (LMS) Adaptive Noise Cancellation technique and the other method is based on the Wavelet Transformation technique. A prototype hardware was designed and developed to acquire the raw ECG signal containing the mother and fetal ECG and the signal processing techniques were used to eliminate the noises and extract the fetal ECG and the fetal Heart Rate Variability was studied. Both the methods were evaluated with the signal acquired from a fetal ECG simulator, from the Physionet database and that acquired from the subject. Both the methods are evaluated by finding heart rate and its variability, amplitude spectrum and mean value of extracted fetal ECG. Also the accuracy, sensitivity and positive predictive value are also determined for fetal QRS detection technique. In this paper adaptive filtering technique uses Sign-sign LMS algorithm and wavelet techniques with

  20. Pathophysiology of Increased Fetal Nuchal Translucency Thickness

    Directory of Open Access Journals (Sweden)

    Chih-Ping Chen

    2010-06-01

    Full Text Available Increased fetal nuchal translucency thickness is associated with trisomy 13, trisomy 18, trisomy 21, Turner syndrome, other sex chromosome abnormalities, as well as many fetal anomalies and genetic syndromes. This article provides a comprehensive review of the cardinal proposed pathophysiology including altered composition of the extracellular matrix, abnormalities of the heart and great arteries, and disturbed or delayed lymphatic development.

  1. Fetal scalp pH testing

    Science.gov (United States)

    Sometimes fetal heart monitoring doesn't provide enough information about the well-being of a baby. In these cases, testing the scalp pH can help the doctor decide whether the fetus is getting enough oxygen ...

  2. An innovative, sensorless, pulsatile, continuous-flow total artificial heart: device design and initial in vitro study.

    Science.gov (United States)

    Fukamachi, Kiyotaka; Horvath, David J; Massiello, Alex L; Fumoto, Hideyuki; Horai, Tetsuya; Rao, Santosh; Golding, Leonard A R

    2010-01-01

    We are developing a very small, innovative, continuous-flow total artificial heart (CFTAH) that passively self-balances left and right pump flows and atrial pressures without sensors. This report details the CFTAH design concept and our initial in vitro data. System performance of the CFTAH was evaluated using a mock circulatory loop to determine the range of systemic and pulmonary vascular resistance (SVR and PVR) levels over which the design goal of a maximum absolute atrial pressure difference of 10 mm Hg is achieved for a steady-state flow condition. Pump speed was then modulated at 2,600 +/- 900 rpm to induce flow and arterial pressure pulsation to evaluate the effects of speed pulsations on the system performance. An automatic control mode was also evaluated. Using only passive self-regulation, pump flows were balanced and absolute atrial pressure differences were maintained at mode adjusted pump speed to achieve targeted pump flows based on sensorless calculations of SVR and CFTAH flow. The initial in vitro testing of the CFTAH with a single, valveless, continuous-flow pump demonstrated its passive self-regulation of flows and atrial pressures and a new automatic control mode. Copyright (c) 2010 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  3. Fetal Macrosomia

    Science.gov (United States)

    ... lifestyle counts Fetal macrosomia Symptoms & causes Diagnosis & treatment Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  4. Fetal Macrosomia

    Science.gov (United States)

    ... identification of fetal macrosomia useful? European Journal of Obstetrics & Gynecology and Reproductive Biology. 2012;161:170. Negrato CA, et al. Adverse pregnancy outcomes in women with diabetes. 2012;4:41. Frequently ...

  5. Comparison of the Effects of Two Auditory Methods by Mother and Fetus on the Results of Non-Stress Test (Baseline Fetal Heart Rate and Number of Accelerations in Pregnant Women: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Roghaie Khoshkholgh

    2016-05-01

    Full Text Available Objective: To compare the effects of two auditory methods by mother and fetus on the results of NST in 2011-2012.Materials and methods: In this single-blind clinical trial, 213 pregnant women with gestational age of 37-41 weeks who had no pregnancy complications were randomly divided into 3 groups (auditory intervention for mother, auditory intervention for fetus, and control each containing 71 subjects. In the intervention groups, music was played through the second 10 minutes of NST. The three groups were compared regarding baseline fetal heart rate and number of accelerations in the first and second 10 minutes of NST. The data were analyzed using one-way ANOVA, Kruskal-Wallis, and paired T-test.Results: The results showed no significant difference among the three groups regarding baseline fetal heart rate in the first (p = 0.945 and second (p = 0.763 10 minutes. However, a significant difference was found among the three groups concerning the number of accelerations in the second 10 minutes. Also, a significant difference was observed in the number of accelerations in the auditory intervention for mother (p = 0.013 and auditory intervention for fetus groups (p < 0.001. The difference between the number of accelerations in the first and second 10 minutes was also statistically significant (p = 0.002.Conclusion: Music intervention was effective in the number of accelerations which is the indicator of fetal health. Yet, further studies are required to be conducted on the issue.

  6. Altered fetal circulation in type-1 diabetic pregnancies.

    Science.gov (United States)

    Lisowski, L A; Verheijen, P M; De Smedt, M M C; Visser, G H A; Meijboom, E J

    2003-04-01

    Type-I diabetic pregnancies are associated with congenital cardiac malformations, fetal cardiomyopathy, venous thrombosis and altered placental vascularization, even with tight maternal glucose control. The aim of this study was to investigate if, with good glucose control achieved with continuous subcutaneous insulin infusion, normal blood flow within the fetal heart can be achieved. Seventeen fetuses of women with well-controlled type-I diabetes were studied longitudinally to evaluate effects on the fetal circulation. Doppler frequency shift tracings, valve diameters and intercept angles were measured at right and left atrioventricular valve orifices at 4-week intervals starting at 15 weeks' gestation. Atrioventricular valve flow was calculated and compared to normal fetal data obtained in previous studies. Maximum and mean temporal velocities across the atrioventricular valves increased in both groups during gestation but significantly more in fetuses of type-I diabetic pregnancies. Combined ventricular output, both absolute and per kg estimated fetal weight, were also greater in these fetuses. In the normal group the ratio of the right/left ventricular output decreased significantly during gestation (from 1.34 +/- 0.28 to 1.08 +/- 0.28 standard deviations), but in type-I diabetic pregnancies this decrease did not occur (1.2 +/- 0.26 to 1.25 +/- 0.29 standard deviations)[corrected]. These data indicate that there are significant differences in the fetal circulation between normal pregnancy and well-controlled type-I diabetic pregnancy, suggesting the existence of a compensatory mechanism which increases fetal cardiac output and causes cardiac hypertrophy. Copyright 2003 ISUOG. Published by John Wiley & Sons, Ltd.

  7. Noninvasive Fetal Electrocardiography Part I: Pan-Tompkins' Algorithm Adaptation to Fetal R-peak Identification.

    Science.gov (United States)

    Agostinelli, Angela; Marcantoni, Ilaria; Moretti, Elisa; Sbrollini, Agnese; Fioretti, Sandro; Di Nardo, Francesco; Burattini, Laura

    2017-01-01

    Indirect fetal electrocardiography is preferable to direct fetal electrocardiography because of being noninvasive and is applicable also during the end of pregnancy, besides labor. Still, the former is strongly affected by noise so that even R-peak detection (which is essential for fetal heart-rate evaluations and subsequent processing procedures) is challenging. Some fetal studies have applied the Pan-Tompkins' algorithm that, however, was originally designed for adult applications. Thus, this work evaluated the Pan-Tompkins' algorithm suitability for fetal applications, and proposed fetal adjustments and optimizations to improve it. Both Pan-Tompkins' algorithm and its improved version were applied to the "Abdominal and Direct Fetal Electrocardiogram Database" and to the "Noninvasive Fetal Electrocardiography Database" of Physionet. R-peak detection accuracy was quantified by computation of positive-predictive value, sensitivity and F1 score. When applied to "Abdominal and Direct Fetal Electrocardiogram Database", the accuracy of the improved fetal Pan-Tompkins' algorithm was significantly higher than the standard (positive-predictive value: 0.94 vs. 0.79; sensitivity: 0.95 vs. 0.80; F1 score: 0.94 vs. 0.79; P<0.05 in all cases) on indirect fetal electrocardiograms, whereas both methods performed similarly on direct fetal electrocardiograms (positive-predictive value, sensitivity and F1 score all close to 1). Improved fetal Pan-Tompkins' algorithm was found to be superior to the standard also when applied to "Noninvasive Fetal Electrocardiography Database" (positive-predictive value: 0.68 vs. 0.55, P<0.05; sensitivity: 0.56 vs. 0.46, P=0.23; F1 score: 0.60 vs. 0.47, P=0.11). In indirect fetal electrocardiographic applications, improved fetal Pan-Tompkins' algorithm is to be preferred over the standard, since it provides higher R-peak detection accuracy for heart-rate evaluations and subsequent processing.

  8. Longitudinal study of computerized cardiotocography in early fetal growth restriction

    NARCIS (Netherlands)

    Wolf, H.; Arabin, B.; Lees, Christoph C.; Oepkes, D.; Prefumo, Federico; Thilaganathan, B.; Todros, T.; Visser, G.H.A.; Bilardo, Caterina M.; Derks, J. B.; Diemert, A.; Duvekot, Johannes J.; Ferrazzi, E.; Frusca, T.; Hecher, K.; Marlow, N.; Martinelli, P.; Ostermayer, E.; Papageorghiou, Aris T.; Scheepers, Hubertina C. J.; Schlembach, D.; Schneider, K. T M; Valcamonico, A.; van Wassenaer-Leemhuis, A.; Ganzevoort, W.; Aktas, Ayse; Borgione, Silvia; Brezinka, Christoph; Calvert, Sandra; Chaoui, Rabih; Cornette, Jerome M J; Diehl, Thilo; van Eyck, Jim; Fratelli, Nicola; van Haastert, Inge Lot; Johnson, Samantha; Lobmaier, Silvia; Lopriore, Enrico; Mansi, Giuseppina; Missfelder-Lobos, Hannah; Martelli, Paola; Maso, Gianpaolo; Maurer-Fellbaum, Ute; Van Charante, Nico Mensing; De Tollenaer, Susanne Mulder; Moore, Tamanna; Napolitano, Raffaele; Oberto, Manuela; Ogge, Giovanna; van der Post, Joris Am; Preston, Lucy; Raimondi, Francesco; Reiss, Irwin K M; Rigano, Serena; Schuit, Ewoud; Skabar, Aldo; Spaanderman, Marc E.; Weisglas-Kuperus, Nynke; Zimmermann, Andrea

    2017-01-01

    Objectives: To explore whether, in early fetal growth restriction (FGR), the longitudinal pattern of fetal heart rate (FHR) short-term variation (STV) can be used to identify imminent fetal distress and whether abnormalities of FHR recordings are associated with 2-year infant outcome. Methods: The

  9. Extraction of fetal electrocardiogram (ECG) by extended state ...

    Indian Academy of Sciences (India)

    Fetal heart rate (FHR) monitoring is a routine work for obtaining significant information about the fetal condition during pregnancy and labor. During pregnancy, the motivation for monitoring the fetal is to recognize pathological conditions, typically asphyxia with sufficient warning to enable intervention by the clinician.

  10. Comparison of continuous versus intermittent furosemide administration in dogs with acute heart failure

    Directory of Open Access Journals (Sweden)

    Zita Filipejová

    2016-01-01

    Full Text Available Pulmonary oedema is a life-threatening condition which should be treated promptly in the emergency room with oxygen, cage rest, and diuretic therapy. Traditionally, bolus administration of furosemide is the treatment of choice. However, there is emerging information that continuous rate infusion might be more effective than bolus injections in relieving clinical signs and producing a lower rate of complications such as azotaemia, dehydration, and electrolyte imbalances. We tested the effect of furosemide both in bolus (4–6 mg/kg intravenously and continuous rate infusion (1 mg/kg/h in 30 dogs that had been presented with fulminant pulmonary oedema during 2 days of hospitalization. No differences in the selected biochemical indicators between the groups were found. There were significant differences in blood urea nitrogen in the bolus injection group and creatinine and phosphorus in the continuous rate infusion group between days 1 and 2. The results of this study showed no differences in the approach of furosemide administration in the management of pulmonary oedema. Both methods may cause renal and electrolyte complications, however, further studies with a larger number of patients are recommended.

  11. MR evaluation of fetal demise

    International Nuclear Information System (INIS)

    Victoria, Teresa; Chauvin, Nancy Anne; Johnson, Ann M.; Kramer, Sandra Sue; Epelman, Monica; Capilla, Elena

    2011-01-01

    Fetal demise is an uncommon event encountered at MR imaging. When it occurs, recognition by the interpreting radiologist is important to initiate appropriate patient management. To identify MR findings of fetal demise. Following IRB approval, a retrospective search of the radiology fetal MR database was conducted searching the words ''fetal demise'' and ''fetal death.'' Fetuses with obvious maceration or no sonographic confirmation of death were excluded. Eleven cases formed the study group. These were matched randomly to live fetuses of similar gestational age. Images were reviewed independently by three pediatric radiologists. The deceased fetus demonstrates decreased MR soft-tissue contrast and definition of tissue planes, including loss of gray-white matter differentiation in the brain. The signal within the cardiac chambers, when visible, is bright on HASTE sequences from the stagnant blood; the heart is small. Pleural effusions and decreased lung volumes may be seen. Interestingly, the fetal orbits lose their anatomical round shape and become smaller and more elliptical; a dark, irregular rim resembling a mask may be seen. Although fetal demise is uncommonly encountered at MR imaging, radiologists should be aware of such imaging findings so prompt management can be instituted. (orig.)

  12. Normalisation of haemodynamics in patients with end-stage heart failure with continuous-flow left ventricular assist device therapy.

    Science.gov (United States)

    Gupta, Sunil; Woldendorp, Kei; Muthiah, Kavitha; Robson, Desiree; Prichard, Roslyn; Macdonald, Peter S; Keogh, Anne M; Kotlyar, Eugene; Jabbour, Andrew; Dhital, Kumud; Granger, Emily; Spratt, Phillip; Jansz, Paul; Hayward, Christopher S

    2014-10-01

    New generation continuous-flow left ventricular assist devices (LVADs) utilise centrifugal pumps. Data concerning their effect on patient haemodynamics, ventricular function and tissue perfusion is limited. We aimed to document these parameters following HeartWare centrifugal continuous-flow LVAD (HVAD) implantation and to assess the impact of post-operative right heart failure (RHF). We reviewed 53 consecutive patients (mean age 49.5 ± 14.1 yrs) with HVAD implanted in the left ventricle, at St. Vincent's Hospital, Sydney, between January 2007 and August 2012. Available paired right heart catheterisation (n=35) and echocardiography (n=39) data was reviewed to assess response of invasive haemodynamics and ventricular function to LVAD support. A total of 28 patients (53%) were implanted from interim mechanical circulatory support. Seventeen patients (32%) required short-term post-implant veno-pulmonary artery extracorporeal membrane oxygenation. At 100 ± 61 days post-implant, mean pulmonary artery pressure and mean pulmonary capillary wedge pressure decreased from 38.8 ± 7.7 to 22.9 ± 7.7 mmHg and 28.3 ± 6.4 to 13.4 ± 5.4 mmHg respectively (p<0.001). LV end diastolic diameter decreased from 71.3 ± 12.7 to 61.1 ± 13.7 mm and LV end-systolic diameter from 62.7 ± 12.3 to 53.9 ± 14.4mm (p<0.001). Aortic regurgitation remained trivial. Serum sodium increased from 133.3 ± 5.7 to 139.3 ± 2.8 mmol/L and creatinine decreased from 109.1 ± 42.5 to 74.3 ± 26.2 μmol/L (p<0.001). Across the entire cohort, the six-month survival/transplant rate was significantly lower for RHF patients (72.2%, n=18) compared to those without (96.9%, n=35, p=0.01). HVAD support improves haemodynamics, LV dimensions and renal function. Following implantation with a centrifugal continuous-flow LVAD, RHF remains a significant risk with a tendency to worse outcomes in the short to medium term. Crown Copyright © 2014. Published by Elsevier B.V. All rights reserved.

  13. Fetal responses to induced maternal relaxation during pregnancy.

    Science.gov (United States)

    DiPietro, Janet A; Costigan, Kathleen A; Nelson, Priscilla; Gurewitsch, Edith D; Laudenslager, Mark L

    2008-01-01

    Fetal responses to induced maternal relaxation during the 32nd week of pregnancy were recorded in 100 maternal-fetal pairs using a digitized data collection system. The 18-min guided imagery relaxation manipulation generated significant changes in maternal heart rate, skin conductance, respiration period, and respiratory sinus arrhythmia. Significant alterations in fetal neurobehavior were observed, including decreased fetal heart rate (FHR), increased FHR variability, suppression of fetal motor activity (FM), and increased FM-FHR coupling. Attribution of the two fetal cardiac responses to the guided imagery procedure itself, as opposed to simple rest or recumbency, is tempered by the observed pattern of response. Evaluation of correspondence between changes within individual maternal-fetal pairs revealed significant associations between maternal autonomic measures and fetal cardiac patterns, lower umbilical and uterine artery resistance and increased FHR variability, and declining salivary cortisol and FM activity. Potential mechanisms that may mediate the observed results are discussed.

  14. Continuous hemofiltration dose calculation in a newborn patient with congenital heart disease and preoperative renal failure.

    Science.gov (United States)

    Ricci, Z; Polito, A; Giorni, C; Di Chiara, L; Ronco, C; Picardo, S

    2007-03-01

    To report a case of a newborn patient with renal failure due to polycystic kidneys requiring renal replacement therapy, and total anomalous pulmonary venous return requiring major cardiosurgical intervention. Pediatric cardiosurgery operatory room and pediatric cardiologic intensive care. A 6-day-old newborn child weighing 3.1 kg. Renal function (creatinine value and urine output) was monitored during the course of the operation and intraoperative renal replacement therapy was not initiated. Serum creatinine concentration decreased from 4.4 to 3 mg/dL at cardiopulmonary bypass (CPB) start and to 1.5 at the end of surgery: the creatinine decrease was provided by the dilutional effect of CPB priming and the infusion of fresh blood from transfusions together with an adequate filtration rate (800 m/L in about 120 minutes). After the operation, extracorporeal membrane oxygenation (ECMO) for ventricular dysfunction and continuous hemofiltration for anuria refractory to medical therapy were prescribed. The hemofiltration machine was set in parallel with the ECMO machine at a blood flow rate of 60 ml/min and a predilution replacement solution infusion of 600 ml/h (4.5 ml/min of creatinine clearance once adjusted on extracorporeal circuits; 3000 mL/m2 hemofiltration): after a single hemofiltration session lasting 96 hours, serum creatinine reached optimal steady state levels around 0.5 mg/dL on postoperative day 2 and 3. Administration of intraoperative continuous hemofiltration is not mandatory in the case of a 3-kg newborn patient with established renal failure needing major cardiosurgery: hemodilution secondary to CPB, transfusion of hemoderivates, and optimal UF rate appear to be effective methods for achieving solute removal. If postoperative continuous hemofiltration is started, however, a "dialytic dose" of 4.5 ml/min allows an adequate creatinine clearance, quick achievement of a steady state of serum creatinine concentration and an eventual acceptable rate of

  15. Closed-loop helium circulation system for actuation of a continuously operating heart catheter pump.

    Science.gov (United States)

    Karabegovic, Alen; Hinteregger, Markus; Janeczek, Christoph; Mohl, Werner; Gföhler, Margit

    2017-06-09

    Currently available, pneumatic-based medical devices are operated using closed-loop pulsatile or open continuous systems. Medical devices utilizing gases with a low atomic number in a continuous closed loop stream have not been documented to date. This work presents the construction of a portable helium circulation addressing the need for actuating a novel, pneumatically operated catheter pump. The design of its control system puts emphasis on the performance, safety and low running cost of the catheter pump. Static and dynamic characteristics of individual elements in the circulation are analyzed to ensure a proper operation of the system. The pneumatic circulation maximizes the working range of the drive unit inside the catheter pump while reducing the total size and noise production.Separate flow and pressure controllers position the turbine's working point into the stable region of the pressure creation element. A subsystem for rapid gas evacuation significantly decreases the duration of helium removal after a leak, reaching subatmospheric pressure in the intracorporeal catheter within several milliseconds. The system presented in the study offers an easy control of helium mass flow while ensuring stable behavior of its internal components.

  16. Comparison of carbohydrate and lipid oxidation during continuous and intermittent exercise in patients with chronic heart failure.

    Science.gov (United States)

    Gayda, Mathieu; Normandin, Eve; Meyer, Philippe; Juneau, Martin; Nigam, Anil

    2013-08-01

    Skeletal muscle substrate oxidation was compared during moderate-intensity continuous exercise (MICE) and high-intensity intermittent exercise (HIIE) in patients with heart failure and reduced ejection fraction (HFREF). Eighteen patients (aged 60 ± 9 years; LVEF, 26 ± 7%) randomly performed MICE (22 minutes at 60% of peak power) and HIIE (30 seconds at 100% of peak power interspersed by 30 seconds' rest for 16 minutes). Carbohydrate and lipid oxidation calculated using the Frayn equation were 4.8- and 1.42-fold higher during MICE and 5- and 1.22-fold higher during HIIE (P < 0.0001). HIIE and MICE can similarly and favourably increase carbohydrate and lipid oxidation in patients with HFREF. Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  17. Renal failure requiring dialysis complicating slow continuous ultrafiltration in acute heart failure: importance of systolic perfusion pressure.

    Science.gov (United States)

    Wehbe, Edgard; Patarroyo, Maria; Taliercio, Jonathan J; Starling, Randall C; Nally, Joseph V; Tang, W H Wilson; Demirjian, Sevag

    2015-02-01

    Recent reports have raised concerns regarding renal outcomes in patients with decompensated acute heart failure (HF) treated with slow continuous ultrafiltration (SCUF). The purpose of this study was to identify risk factors for renal failure (RF) requiring dialysis in patients with acute HF initiated on SCUF. We studied 63 consecutive patients with acute HF who required SCUF because of congestion refractory to hemodynamically guided intensive medical therapy. Median serum creatinine at SCUF initiation was higher in patients who developed RF requiring dialysis [2.5 (interquartile range 1.8-3.3) vs 1.6 (1.2-2.3) mg/dL; P acute HF initiated on SCUF, onset of RF requiring dialysis is associated with high mortality. Systolic perfusion pressure which incorporates both perfusion and venous congestion parameters may present a modifiable risk factor for worsening RF during SCUF in acute HF patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Insufficient natriuretic response to continuous intravenous furosemide is associated with poor long-term outcomes in acute decompensated heart failure.

    Science.gov (United States)

    Singh, Dhssraj; Shrestha, Kevin; Testani, Jeffrey M; Verbrugge, Frederik H; Dupont, Matthias; Mullens, Wilfried; Tang, W H Wilson

    2014-06-01

    Treatment of acute decompensated heart failure (ADHF) with loop diuretics, such as furosemide, is frequently complicated by insufficient urine sodium excretion. We hypothesize that insufficient natriuretic response to diuretic therapy, characterized by lower urine sodium (UNa) and urine furosemide, is associated with subsequent inadequate decongestion, worsening renal function, and adverse long term events. We enrolled 52 consecutive patients with ADHF and measured serum and urine sodium (UNa), urine creatinine (UCr), and urine furosemide (UFurosemide) levels on a spot sample taken after treatment with continuous intravenous furosemide, and followed clinical and renal variables as well as adverse long-term clinical outcomes (death, rehospitalizations, and cardiac transplantation). We observed similar correlations between UNa:UFurosemide ratio and UNa and fractional excretion of sodium (FENa) with 24-hour net urine output (r = 0.52-0.64, all P renal function (hazard ratio [HR] 3.01; P = .02) and poorer adverse clinical outcomes (HR 1.63, P = .008) after adjusting for age and eGFR. Meanwhile, both diminished weight loss and net fluid output over 24 hours of continuous intravenous furosemide were observed when UNa:UFurosemide ratios were renal function and future adverse long-term outcomes, independently from and incrementally with decreasing intrinsic glomerular filtration. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Fetal microchimerism persists at high levels in c-kit stem cells in sensitized mothers.

    Science.gov (United States)

    Dutta, Partha; Dart, Melanie L; Schumacher, Steve M; Burlingham, William J

    2010-10-01

    We previously showed that fetal and maternal exposure to non-inherited maternal antigens (NIMA) during gestation and nursing resulted in lifelong tolerance to NIMA in some offspring. This NIMA-specific tolerance was mediated by regulatory T cells (Tregs) and was correlated with the level of multi-lineage maternal microchimerism (Mc) indicating a causative link between Mc and Treg development. To determine if transfer of fetal cells into mothers resulted in a similar tolerance to fetal cells, we used qPCR to detect rare fetal derived cells and a delayed type hypersensitivity (DTH) assay to detect fetal alloantigen-specific effector and regulatory T cells in mothers. We found that 5/8 B6 mothers of H2(b/d) offspring were sensitized to the alloantigens H2(d) and HY, indicating a dominance of alloantigen-specific effector T cells. Though these sensitized mothers did not have detectable fetal Mc (FMc) in any of the organs tested, they had very high levels of fetus-derived c-kit(+) stem cells in their bone marrow. The remaining 3/8 B6 mothers that were not sensitized to the fetal antigens had detectable FMc found mostly in heart, lungs and liver, and in 2/3, we could detect alloantigen-specific regulatory T cells. This data indicates that, as in NIMA-specific tolerance, tolerance in multiparous females to inherited paternal antigens (IPA) expressed by the fetus is associated with the presence of fetal Mc in differentiated cell subsets. Surprisingly, robust lin(-)c-kit(+) bone marrow cell fetal Mc can occur in sensitized mothers. This suggests a continuous source of allospecific priming, coupled with active elimination of mature IPA-expressing lin(+) cells by effector T cells of the maternal host.

  20. The Danish Fetal Medicine database

    DEFF Research Database (Denmark)

    Ekelund, Charlotte; Kopp, Tine Iskov; Tabor, Ann

    2016-01-01

    trimester ultrasound scan performed at all public hospitals in Denmark are registered in the database. Main variables/descriptive data: Data on maternal characteristics, ultrasonic, and biochemical variables are continuously sent from the fetal medicine units’Astraia databases to the central database via...... analyses are sent to the database. Conclusion: It has been possible to establish a fetal medicine database, which monitors first-trimester screening for chromosomal abnormalities and second-trimester screening for major fetal malformations with the input from already collected data. The database...

  1. Fetal pain

    NARCIS (Netherlands)

    Adama van Scheltema, Phebe

    2011-01-01

    Recent studies have suggested that the fetus is capable of exhibiting a stress response to intrauterine needling, resulting in alterations in fetal stress hormone levels. Intrauterine transfusions are performed by inserting a needle either in the umbilical cord root at the placental surface (PCI),

  2. [Preliminary study of the use of fetal pulse oximetry during labor].

    Science.gov (United States)

    Carbonne, B; Audibert, F; Segard, L; Sebban, E; Beyaert, B; Cabrol, D; Papiernik, E

    1995-01-01

    To assess continuous monitoring of fetal blood oxygen staturation (SpO2) during labour using a fetal pulse oxymeter. Preliminary results obtained with the Nellcor N-400 fetal pulse oxymeter at the Maternité Port-Royal-Baudelocque between November 1992 and November 1993 in cases of abnormal fetal heart rate are presented. We analyzed: the correlation between SpO2 during labour and cord vein pH as well as Apgar score, the correlation between changes in SpO2, expressed as a desaturation index, and cord vein pH as well as Apgar score. The negative predictive value of oxymetry was assessed. We found a significant positive correlation between the last SpO2 measurement during labour and umbilical vein pH as well as 1 minute Apgar score. We observed a highly significant correlation between the index of desaturation and cord vein pH as well as 1 minute Apgar score. No neonatal pH below 7.20 was observed when SpO2 was > or = 40% during labour. The negative predictive value of oxymetry was 100% in this short series of patients. If these results were confirmed in a larger series of patients, a normal SpO2 value during labour could be reassuring in case of abnormal fetal heart rate.

  3. Evaluation of Clinical Diagnosis of Fetal Distress and Perinatal Outcome in a Low Resource Nigerian Setting.

    Science.gov (United States)

    Ajah, Leonard Ogbonna; Ibekwe, Perpetus Chudi; Onu, Fidelis Agwu; Onwe, Ogah Emeka; Ezeonu, Thecla Chinonyelum; Omeje, Innocent

    2016-04-01

    Fetal distress has been shown to contribute to the increasing caesarean section rate. There has been controversy on the usefulness of clinical diagnosis of fetal distress using only the intermittent counting of the fetal heart rate and/or passage of meconium-stained liquor. To evaluate the clinical diagnosis of fetal distress and the perinatal outcome. This was a retrospective study in which the case records of the patients, who were diagnosed of fetal distress at Federal Teaching Hospital, Abakaliki, Nigeria, from January 1, 2008 to December 31, 2014, were collated. The statistical analysis was done using the Statistical Package for Social Sciences version 17 software (SPSS Inc., Chicago IL, USA). Out of the 15,640 deliveries carried out within the study period, 3,761 (24.05%) deliveries were through caesarean section. A total of 326 (8.9%) of the 3,761 caesarean sections were due to fetal distress within the study period. More so, a total of 227 (70.9%) babies were born with ≥ 7 Apgar score at the 1(st) minute of delivery. The perinatal mortality rate was 31.25 per 1000 deliveries. Though birth asphyxia was recorded more on babies of mothers that had fresh meconium-stained liquor and whose decision-intervention interval was more than 30 minutes when compared with those without any of the two conditions, there was no statistical significant difference between them. The clinical diagnosis of fetal distress is accurate in 29.1% of the cases. However, it has led to an unnecessary caesarean section in the remaining 70.9% of the parturients. In order to reduce this high trend of unnecessary caesarean sections due to clinical diagnosis of fetal distress in this environment, antepartum fetal assessment with non-stress test or biophysical profile and intrapartum use of continuous electronic fetal monitoring should be used to confirm or refute the fetal distress before any surgical intervention. Fetal blood sampling and fetal pulse oximetry should be performed in event

  4. Efeitos da estimulação vibro-acústica na velocidade do sangue da artéria cerebral média e na freqüência cardíaca fetal: 1. entre a 35ª e 41ª semanas de gestação The effect of vibratory acoustic stimulation on fetal middle cerebral artery impedance and instantaneous fetal heart rate: 1. a transversal study on fetuses with 35 to 41 weeks of gestational age

    Directory of Open Access Journals (Sweden)

    Ivo Behle

    1999-01-01

    Full Text Available RESUMO Objetivos: estudar, em fetos hígidos, quais são as respostas da freqüência cardíaca fetal basal e da resistência na artéria cerebral média à estimulação vibro-acústica padronizada. Métodos: em estado comportamental de hipo ou de inatividade fetal (apnéia e ausência de movimentos corpóreos, mediu-se o índice de pulsatilidade (IP da artéria cerebral média (ACM, bem como calculou-se a freqüência cardíaca fetal basal (FCFB pela análise da onda espectral, antes e após a aplicação de estímulo vibro-acústico (EVA por 3 segundos. Foram empregados ecógrafos de alta resolução, com Doppler pulsado e mapeamento a cores. A fonte sonora emitia som com 400 a 40.000 Hz, sob forma de varredura, com pressão sonora de 65 a 110 dB. Resultados: a média da FCFB pré-estímulo foi 139 bpm, com desvio padrão de 3,14 bpm. A média da FCFB pós-estímulo foi 153 bpm, com desvio padrão de 7,23 bpm (pSUMMARY Purpose: to examine the response of the fetal heart rate (FHR and middle cerebral artery resistance (MCA PI to vibratory stimulation (VAS in normal human fetuses. Methods: when the fetuses were without activity (in apnea and without corporal movements, we obtained baseline measurements of MCA PI and FHR before and after the application of a 3-sec vibratory acoustic stimulus. Real time ultrasonography with pulsed wave and color Doppler imaging was used for the execution of the study. The VAS was performed using a bicycle horn with 400 to 4000 Hz and sound pressure was 65 to 110 dB. Results: the FHR before VAS was 139 ± 3.14 bpm and after VAS was 153 ± 7.23 bpm (p<0.0001. The MCA PI rate before VAS was 1.84 ± 0.07 and after VAS was 1.56 ± 0.04 (p<0.001. In all cases we observed a fetal response with vigorous corporal movements, FHR rise and MCA PI reduction after VAS. Conclusions: we conclude that VAS, in human fetuses near term, for 3 sec as described in this study, determines some response, with increase in FHR and corporal

  5. Mortality trends for ischemic heart disease in China: an analysis of 102 continuous disease surveillance points from 1991 to 2009.

    Science.gov (United States)

    Wan, Xia; Ren, Hongyan; Ma, Enbo; Yang, Gonghuan

    2017-07-25

    In the past 20 years, the trends of ischemic heart disease (IHD) mortality in China have been described in divergent claims. This research analyzes mortality trends for IHD by using the data from 102 continuous Disease Surveillance Points (DSP) from 1991 to 2009. The 102 continuous DSP covered 7.3 million people during the period 1991-2000, and then were expanded to a population of 52 million in the same areas for 2004-2009. The data were adjusted by using garbage code redistribution and underreporting rate, mapped from international classification of diseases ICD-9 to ICD-10. The mortality rates for IHD were further adjusted by the crude death proportion multiplied by the total number of deaths in the mortality envelope, which was calculated by using logr t  = a + bt. Age-standard death rates (ASDRs) were computed using China's 2010 census population structure. Trend in IHD was calculated from ASDRs by using a joinpoint regression model. The IHD ASDRs increased in total in regions with an average annual percentage change (AAPC) 4.96%, especially for the Southwest (AAPC = 7.97%) and Northeast areas (AAPC = 7.10%), and for male and female subjects (with 5% AAPC) as well. In rural areas, the year 2000 was a cut-off point for mortality rate with annual percentage change increasing from 3.52% in 1991-2000 to 9.02% in 2000-2009, which was much higher than in urban areas (AAPC = 1.05%). And the proportion of deaths increased in older adults, and more male deaths occurred before age 60 compared to female deaths. By observing a wide range of areas across China from 1991 to 2009, this paper concludes that the ASDR trend for IHD increased. These trends reflect changes in the Chinese standard of living and lifestyle with diets higher in fat, higher blood lipids and increased body weight.

  6. Heart rate variability in non-apneic snorers and controls before and after continuous positive airway pressure

    Directory of Open Access Journals (Sweden)

    Mateika Jason H

    2005-07-01

    Full Text Available Abstract Background We hypothesized that sympathetic nervous system activity (SNSA is increased and parasympathetic nervous system activity (PNSA is decreased during non-rapid eye movement (NREM sleep in non-apneic, otherwise healthy, snoring individuals compared to control. Moreover, we hypothesized that these alterations in snoring individuals would be more evident during non-snoring than snoring when compared to control. Methods To test these hypotheses, heart rate variability was used to measure PNSA and SNSA in 11 normotensive non-apneic snorers and 12 control subjects before and 7-days after adapting to nasal continuous positive airway pressure (nCPAP. Results Our results showed that SNSA was increased and PNSA was decreased in non-apneic snorers during NREM compared to control. However, these changes were only evident during the study in which snoring was eliminated with nCPAP. Conversely, during periods of snoring SNSA and PNSA were similar to measures obtained from the control group. Additionally, within the control group, SNSA and PNSA did not vary before and after nCPAP application. Conclusion Our findings suggest that long-lasting alterations in autonomic function may exist in snoring subjects that are otherwise healthy. Moreover, we speculate that because of competing inputs (i.e. inhibitory versus excitatory inputs to the autonomic nervous system during snoring, the full impact of snoring on autonomic function is most evident during non-snoring periods.

  7. Short and long-term effects of continuous versus intermittent loop diuretics treatment in acute heart failure with renal dysfunction.

    Science.gov (United States)

    Palazzuoli, Alberto; Pellegrini, Marco; Franci, Beatrice; Beltrami, Matteo; Ruocco, Gaetano; Gonnelli, Stefano; Angelini, Gianni D; Nuti, Ranuccio

    2015-02-01

    Intravenous loop diuretics are still the cornerstone of therapy in acute decompensated heart failure, however, the optimal dosage and administration strategies remain poorly defined particularly in patients with an associated renal dysfunction. This is a single-center, pilot, randomized trial involving patients with acute HF and renal dysfunction. Patients were assigned to receive continuous furosemide infusion (cIV) or bolus injections of furosemide (iIV). Primary end points were the evaluation of urine output volumes, renal function, and b-type natriuretic peptide (BNP) levels during treatment time. Secondary end point included: weight loss, length of hospitalization, differences in plasma electrolytes, need for additional treatment, and evaluation of cardiac events during follow-up period. 57 patients were included in the study. The cIV group showed an increase in urine output (2,505 ± 796 vs 2140 ± 468 ml/day, p diuretics are responsible for worsening renal function and to define the best modality of administration.

  8. Effects of High-Intensity Interval Training versus Continuous Training on Physical Fitness, Cardiovascular Function and Quality of Life in Heart Failure Patients.

    NARCIS (Netherlands)

    Benda, N.M.M.; Seeger, J.P.; Stevens, G.G.; Hijmans-Kersten, B.T.P.; Dijk, A.P.J. van; Bellersen, L.; Lamfers, E.J.; Hopman, M.T.E.; Thijssen, D.H.J.

    2015-01-01

    INTRODUCTION: Physical fitness is an important prognostic factor in heart failure (HF). To improve fitness, different types of exercise have been explored, with recent focus on high-intensity interval training (HIT). We comprehensively compared effects of HIT versus continuous training (CT) in HF

  9. A PCA/ICA based Fetal ECG Extraction from Mother Abdominal Recordings by Means of a Novel Data-driven Approach to Fetal ECG Quality Assessment

    Directory of Open Access Journals (Sweden)

    Karimi Rahmati A.

    2017-03-01

    Full Text Available Background: Fetal electrocardiography is a developing field that provides valuable information on the fetal health during pregnancy. By early diagnosis and treatment of fetal heart problems, more survival chance is given to the infant. Objective: Here, we extract fetal ECG from maternal abdominal recordings and detect R-peaks in order to recognize fetal heart rate. On the next step, we find a better and more qualified extracted fetal ECG by using a novel approach. Materials and Methods: In this paper, a PCA/ICA-based algorithm is proposed for extracting fetal ECG, and fetal R-peaks are detected as well. The method validates the quality of extracted ECGs and selects the best candidate fetal ECG to provide the required morphological ECG features such as fetal heart rate and RR interval for more clinical examinations. The method was evaluated using the dataset which was provided by PhysioNet/Computing in Cardiology Challenge 2013. The dataset consists of 75 recordings of 4-channel ECGs each containing 1-minute length for training and 100 similar recordings for testing. Results: When the proposed algorithm was applied to the test set, the scores of 85.853 bpm2 for fetal heart rate and an error of 9.725 ms RMS for fetal RR-interval estimation were obtained. Conclusion: The results obtained with the mentioned algorithm shows the robustness of the research, and it is suggested to be used in practical fetal ECG monitoring systems.

  10. Normal MR imaging of fetal organs

    Energy Technology Data Exchange (ETDEWEB)

    Kawabata, Ichiro; Tamaya, Teruhiko (Gifu Univ. (Japan). Faculty of Medicine)

    1990-12-01

    MR imaging has recently been used in medical scene, especially in obstetrics. The definite prenatal diagnosis of fetal anomaly using MR imaging has proved to be useful. But MR imaging of normal fetal organs remains to be understood. There have been not complete systemical research works about normal fetus by MR imaging, up to date. MR imaging on 25 pregnant cases were carried out to get the definite diagnosis of the possible fetal anomalies. MR imaging in fetus is usually disturbed by fetal movement. Generally, diazepam to mother or muscle relaxants to fetus have been used in given cases in order to obtain good quality of imaging. Mothers were requested to walk around the lobby in hospital before examination and fetal movement was decreased, resulting in 85% good imaging. The understanding of normal findings of fetal organs by MR imagings is important for diagnosis of the fetal anomalies. For example, brain and bowel showed high signals in T{sub 1} weighted images. Lung showed high signal in T{sub 2} weighted images. Liver was demonstrated clearly in T{sub 1} weighted images and proton density images. Heart and vessels showed low signals because of flow void phenomenon. Thus, it is necessary to detect and diagnose fetal anomalies after understanding the normal findings of fetal organs in MR imaging. (author).

  11. The Danish Fetal Medicine Database

    DEFF Research Database (Denmark)

    Ekelund, Charlotte K; Petersen, Olav B; Jørgensen, Finn S

    2015-01-01

    OBJECTIVE: To describe the establishment and organization of the Danish Fetal Medicine Database and to report national results of first-trimester combined screening for trisomy 21 in the 5-year period 2008-2012. DESIGN: National register study using prospectively collected first-trimester screening...... data from the Danish Fetal Medicine Database. POPULATION: Pregnant women in Denmark undergoing first-trimester screening for trisomy 21. METHODS: Data on maternal characteristics, biochemical and ultrasonic markers are continuously sent electronically from local fetal medicine databases (Astraia Gmbh......%. The national screen-positive rate increased from 3.6% in 2008 to 4.7% in 2012. The national detection rate of trisomy 21 was reported to be between 82 and 90% in the 5-year period. CONCLUSION: A national fetal medicine database has been successfully established in Denmark. Results from the database have shown...

  12. The World Health Organization Fetal Growth Charts

    DEFF Research Database (Denmark)

    Kiserud, Torvid; Piaggio, Gilda; Carroli, Guillermo

    2017-01-01

    BACKGROUND: Perinatal mortality and morbidity continue to be major global health challenges strongly associated with prematurity and reduced fetal growth, an issue of further interest given the mounting evidence that fetal growth in general is linked to degrees of risk of common noncommunicable...... nature of the study, sample size is a limiting factor for generalization of the charts. CONCLUSIONS: This study provides WHO fetal growth charts for EFW and common ultrasound biometric measurements, and shows variation between different parts of the world....

  13. Antenatal fetal magnetocardiography: a new method for fetal surveillance?

    Science.gov (United States)

    Quinn, A; Weir, A; Shahani, U; Bain, R; Maas, P; Donaldson, G

    1994-10-01

    To establish the reliability of fetal magnetocardiography as a method of measuring the time intervals of the fetal heart during the antenatal period. A prospective study. Wellcome Biomagnetism Unit, Southern General Hospital. One hundred and six low risk pregnant women at 20 to 42 weeks gestation. Success in obtaining QRS complexes, P waves and T waves. Correlation of time intervals with fetal outcome. The technique was acceptable to pregnant women. A QRS complex was successfully demonstrated in 68 (67%) of the unaveraged traces. Using off-line averaging techniques on these 68 cases, P waves were obtained in 75% and T waves in 72%. Although good quality traces were obtained throughout the range of gestational ages, in general it was more difficult below 28 weeks. QRS duration (R2 = 7%, P = 0.02) demonstrated a positive linear correlation with increasing gestation. Of the 35 (51%) cases with umbilical vein pH analysis available, only one result was less than 7.2. No significant relation was found between measurements of the fetal waveforms and the pH results. The technique of fetal magnetocardiography provides a significant advance in the technological field for the demonstration of QRS complexes and the full PQRST waveforms in gestations from 20 weeks onwards. With further technical improvements the clinical impact of this technique can be assessed more fully.

  14. Heart failure patients' experiences with continuity of care and its relation to medication adherence: a cross-sectional study

    NARCIS (Netherlands)

    Uijen, A.A.; Bosch, M.; Bosch, W.J. van den; Bor, H.; Wensing, M.J.P.; Schers, H.J.

    2012-01-01

    ABSTRACT: BACKGROUND: A growing number of health care providers are nowadays involved in heart failure care. This could lead to discontinuity and fragmentation of care, thus reducing trust and hence poorer medication adherence. This study aims to explore heart failure patients' experiences with

  15. Fetal Programming and Cardiovascular Pathology

    Science.gov (United States)

    Alexander, Barbara T.; Dasinger, John Henry; Intapad, Suttira

    2016-01-01

    Low birth weight serves as a crude proxy for impaired growth during fetal life and indicates a failure for the fetus to achieve its full growth potential. Low birth weight can occur in response to numerous etiologies that include complications during pregnancy, poor prenatal care, parental smoking, maternal alcohol consumption or stress. Numerous epidemiological and experimental studies demonstrate that birth weight is inversely associated with blood pressure and coronary heart disease. Sex and age impact the developmental programming of hypertension. In addition, impaired growth during fetal life also programs enhanced vulnerability to a secondary insult. Macrosomia, which occurs in response to maternal obesity, diabetes and excessive weight gain during gestation, is also associated with increased cardiovascular risk. Yet, the exact mechanisms that permanently change the structure, physiology and endocrine health of an individual across their lifespan following altered growth during fetal life are not entirely clear. Transmission of increased risk from one generation to the next in the absence of an additional prenatal insult indicates an important role for epigenetic processes. Experimental studies also indicate that the sympathetic nervous system, the renin angiotensin system, increased production of oxidative stress and increased endothelin play an important role in the developmental programming of blood pressure in later life. Thus, this review will highlight how adverse influences during fetal life and early development program an increased risk for cardiovascular disease including high blood pressure and provide an overview of the underlying mechanisms that contribute to the fetal origins of cardiovascular pathology. PMID:25880521

  16. Fetal programming and cardiovascular pathology.

    Science.gov (United States)

    Alexander, Barbara T; Dasinger, John Henry; Intapad, Suttira

    2015-04-01

    Low birth weight serves as a crude proxy for impaired growth during fetal life and indicates a failure for the fetus to achieve its full growth potential. Low birth weight can occur in response to numerous etiologies that include complications during pregnancy, poor prenatal care, parental smoking, maternal alcohol consumption, or stress. Numerous epidemiological and experimental studies demonstrate that birth weight is inversely associated with blood pressure and coronary heart disease. Sex and age impact the developmental programming of hypertension. In addition, impaired growth during fetal life also programs enhanced vulnerability to a secondary insult. Macrosomia, which occurs in response to maternal obesity, diabetes, and excessive weight gain during gestation, is also associated with increased cardiovascular risk. Yet, the exact mechanisms that permanently change the structure, physiology, and endocrine health of an individual across their lifespan following altered growth during fetal life are not entirely clear. Transmission of increased risk from one generation to the next in the absence of an additional prenatal insult indicates an important role for epigenetic processes. Experimental studies also indicate that the sympathetic nervous system, the renin angiotensin system, increased production of oxidative stress, and increased endothelin play an important role in the developmental programming of blood pressure in later life. Thus, this review will highlight how adverse influences during fetal life and early development program an increased risk for cardiovascular disease including high blood pressure and provide an overview of the underlying mechanisms that contribute to the fetal origins of cardiovascular pathology. © 2015 American Physiological Society.

  17. Continuous-Time Semi-Markov Models in Health Economic Decision Making: An Illustrative Example in Heart Failure Disease Management.

    Science.gov (United States)

    Cao, Qi; Buskens, Erik; Feenstra, Talitha; Jaarsma, Tiny; Hillege, Hans; Postmus, Douwe

    2016-01-01

    Continuous-time state transition models may end up having large unwieldy structures when trying to represent all relevant stages of clinical disease processes by means of a standard Markov model. In such situations, a more parsimonious, and therefore easier-to-grasp, model of a patient's disease progression can often be obtained by assuming that the future state transitions do not depend only on the present state (Markov assumption) but also on the past through time since entry in the present state. Despite that these so-called semi-Markov models are still relatively straightforward to specify and implement, they are not yet routinely applied in health economic evaluation to assess the cost-effectiveness of alternative interventions. To facilitate a better understanding of this type of model among applied health economic analysts, the first part of this article provides a detailed discussion of what the semi-Markov model entails and how such models can be specified in an intuitive way by adopting an approach called vertical modeling. In the second part of the article, we use this approach to construct a semi-Markov model for assessing the long-term cost-effectiveness of 3 disease management programs for heart failure. Compared with a standard Markov model with the same disease states, our proposed semi-Markov model fitted the observed data much better. When subsequently extrapolating beyond the clinical trial period, these relatively large differences in goodness-of-fit translated into almost a doubling in mean total cost and a 60-d decrease in mean survival time when using the Markov model instead of the semi-Markov model. For the disease process considered in our case study, the semi-Markov model thus provided a sensible balance between model parsimoniousness and computational complexity. © The Author(s) 2015.

  18. Effects of l-arginine supplementation associated with continuous or interval aerobic training on chronic heart failure rats.

    Science.gov (United States)

    Barcelos, Giovanna Tedesco; Rossato, Douglas Dalcin; Perini, Júlia Luiza; Pinheiro, Lucas Pereira; Carvalho, Carol; Jaenisch, Rodrigo Boemo; Rhoden, Cláudia Ramos; Lago, Pedro Dal; Nunes, Ramiro Barcos

    2017-11-01

    Chronic heart failure (CHF) is related with exercise intolerance and impaired nitric oxide (NO) production, which can lead to several functional capacity alterations. Considering the possible superiority of aerobic interval training compared to continuous training and the capacity of l-arginine to restore the NO pathway, the aim of the present study was to investigate whether these treatments are beneficial to exercise capacity, muscle mass preservation and hemodynamic, inflammatory and oxidative stress parameters in CHF rats. Thirty-eight male Wistar rats post 6weeks of myocardial infarction (MI) surgery were randomly assigned into 6 CHF groups: sedentary (SED, n=6); SED+Arg (n=7); ACT (n=8); ACT+Arg (n=5); AIT (n=7); AIT+Arg (n=5). Exercise test capacity (ETC) was performed pre and post 8weeks of intervention. Supplemented rats received Arg (1g/kg) by oral gavage (7×/week). Exercise training was performed on a rat treadmill (5×/week). Hemodynamic variables, tissue collection, congestion, inflammatory cytokines, and oxidative parameters were evaluated at the end of protocols. All trained groups showed a superior exercise capacity compared to SED groups on the post-intervention test (psupplementation was able to improve hemodynamic responses (left ventricular systolic pressure (LVSP), systolic blood pressure (SBP), +dP/dt max , and -dP/dt max (psupplementation (ACT+Arg and AIT+Arg) revealed higher gastrocnemius mass compared to the SED group (psupplementation was important to attenuate muscle loss. Moreover, interval training associated with Arg supplementation elicits greater improvements in hemodynamic parameters, contributing to reduction in pulmonary congestion, and demonstrated particular responses in the inflammatory profile and in the antioxidant status. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Coping with continuous human disturbance in the wild: insights from penguin heart rate response to various stressors.

    Science.gov (United States)

    Viblanc, Vincent A; Smith, Andrew D; Gineste, Benoit; Groscolas, René

    2012-07-11

    A central question for ecologists is the extent to which anthropogenic disturbances (e.g. tourism) might impact wildlife and affect the systems under study. From a research perspective, identifying the effects of human disturbance caused by research-related activities is crucial in order to understand and account for potential biases and derive appropriate conclusions from the data. Here, we document a case of biological adjustment to chronic human disturbance in a colonial seabird, the king penguin (Aptenodytes patagonicus), breeding on remote and protected islands of the Southern ocean. Using heart rate (HR) as a measure of the stress response, we show that, in a colony with areas exposed to the continuous presence of humans (including scientists) for over 50 years, penguins have adjusted to human disturbance and habituated to certain, but not all, types of stressors. When compared to birds breeding in relatively undisturbed areas, birds in areas of high chronic human disturbance were found to exhibit attenuated HR responses to acute anthropogenic stressors of low-intensity (i.e. sounds or human approaches) to which they had been subjected intensely over the years. However, such attenuation was not apparent for high-intensity stressors (i.e. captures for scientific research) which only a few individuals experience each year. Habituation to anthropogenic sounds/approaches could be an adaptation to deal with chronic innocuous stressors, and beneficial from a research perspective. Alternately, whether penguins have actually habituated to anthropogenic disturbances over time or whether human presence has driven the directional selection of human-tolerant phenotypes, remains an open question with profound ecological and conservation implications, and emphasizes the need for more knowledge on the effects of human disturbance on long-term studied populations.

  20. Coping with continuous human disturbance in the wild: insights from penguin heart rate response to various stressors

    Directory of Open Access Journals (Sweden)

    Viblanc Vincent A

    2012-07-01

    Full Text Available Abstract Background A central question for ecologists is the extent to which anthropogenic disturbances (e.g. tourism might impact wildlife and affect the systems under study. From a research perspective, identifying the effects of human disturbance caused by research-related activities is crucial in order to understand and account for potential biases and derive appropriate conclusions from the data. Results Here, we document a case of biological adjustment to chronic human disturbance in a colonial seabird, the king penguin (Aptenodytes patagonicus, breeding on remote and protected islands of the Southern ocean. Using heart rate (HR as a measure of the stress response, we show that, in a colony with areas exposed to the continuous presence of humans (including scientists for over 50 years, penguins have adjusted to human disturbance and habituated to certain, but not all, types of stressors. When compared to birds breeding in relatively undisturbed areas, birds in areas of high chronic human disturbance were found to exhibit attenuated HR responses to acute anthropogenic stressors of low-intensity (i.e. sounds or human approaches to which they had been subjected intensely over the years. However, such attenuation was not apparent for high-intensity stressors (i.e. captures for scientific research which only a few individuals experience each year. Conclusions Habituation to anthropogenic sounds/approaches could be an adaptation to deal with chronic innocuous stressors, and beneficial from a research perspective. Alternately, whether penguins have actually habituated to anthropogenic disturbances over time or whether human presence has driven the directional selection of human-tolerant phenotypes, remains an open question with profound ecological and conservation implications, and emphasizes the need for more knowledge on the effects of human disturbance on long-term studied populations.

  1. Maternal methadone dosing schedule and fetal neurobehavior

    Science.gov (United States)

    Jansson, Lauren M.; DiPietro, Janet A.; Velez, Martha; Elko, Andrea; Knauer, Heather; Kivlighan, Katie T.

    2008-01-01

    Objective Daily methadone maintenance is the standard of care for opiate dependency during pregnancy. Previous research has indicated that single-dose maternal methadone administration significantly suppresses fetal neurobehaviors. The purpose of this study was to determine if split-dosing would have less impact on fetal neurobehavior than single-dose administration. Methods Forty methadone-maintained women were evaluated at peak and trough maternal methadone levels on single- and split-dosing schedules. Monitoring sessions occurred at 36 and 37 weeks gestation in a counterbalanced study design. Fetal measures included heart rate, variability, accelerations, motor activity and fetal movement-heart rate coupling (FM-FHR). Maternal measures included heart period, variability, skin conductance, respiration and vagal tone. Repeated measure analysis of variance was used to evaluate within-subject changes between split- and single-dosing regimens. Results All fetal neurobehavioral parameters were suppressed by maternal methadone administration, regardless of dosing regimen. Fetal parameters at peak were significantly lower during single vs. split methadone administration. FM-FHR coupling was less suppressed from trough to peak during split-dosing vs. single-dosing. Maternal physiologic parameters were generally unaffected by dosing condition. Conclusion Split- dosed fetuses displayed less neurobehavioral suppression from trough to peak maternal methadone levels as compared to single-dosed fetuses. Split-dosing may be beneficial for methadone-maintained pregnant women. PMID:19085624

  2. Mortality trends for ischemic heart disease in China: an analysis of 102 continuous disease surveillance points from 1991 to 2009

    Directory of Open Access Journals (Sweden)

    Xia Wan

    2017-07-01

    Full Text Available Abstract Background In the past 20 years, the trends of ischemic heart disease (IHD mortality in China have been described in divergent claims. This research analyzes mortality trends for IHD by using the data from 102 continuous Disease Surveillance Points (DSP from 1991 to 2009. Method The 102 continuous DSP covered 7.3 million people during the period 1991–2000, and then were expanded to a population of 52 million in the same areas for 2004–2009. The data were adjusted by using garbage code redistribution and underreporting rate, mapped from international classification of diseases ICD-9 to ICD-10. The mortality rates for IHD were further adjusted by the crude death proportion multiplied by the total number of deaths in the mortality envelope, which was calculated by using logrt = a + bt. Age-standard death rates (ASDRs were computed using China’s 2010 census population structure. Trend in IHD was calculated from ASDRs by using a joinpoint regression model. Results The IHD ASDRs increased in total in regions with an average annual percentage change (AAPC 4.96%, especially for the Southwest (AAPC = 7.97% and Northeast areas (AAPC = 7.10%, and for male and female subjects (with 5% AAPC as well. In rural areas, the year 2000 was a cut-off point for mortality rate with annual percentage change increasing from 3.52% in 1991–2000 to 9.02% in 2000–2009, which was much higher than in urban areas (AAPC = 1.05%. And the proportion of deaths increased in older adults, and more male deaths occurred before age 60 compared to female deaths. Conclusion By observing a wide range of areas across China from 1991 to 2009, this paper concludes that the ASDR trend for IHD increased. These trends reflect changes in the Chinese standard of living and lifestyle with diets higher in fat, higher blood lipids and increased body weight.

  3. Critical Imperative for the Reform of British Interpretation of Fetal Heart Rate Decelerations: Analysis of FIGO and NICE Guidelines, Post-Truth Foundations, Cognitive Fallacies, Myths and Occam's Razor.

    Science.gov (United States)

    Sholapurkar, Shashikant L

    2017-04-01

    Cardiotocography (CTG) has disappointingly failed to show good predictability for fetal acidemia or neonatal outcomes in several large studies. A complete rethink of CTG interpretation will not be out of place. Fetal heart rate (FHR) decelerations are the most common deviations, benign as well as manifestation of impending fetal hypoxemia/acidemia, much more commonly than FHR baseline or variability. Their specific nomenclature is important (center-stage) because it provides the basic concepts and framework on which the complex "pattern recognition" of CTG interpretation by clinicians depends. Unfortunately, the discrimination of FHR decelerations seems to be muddled since the British obstetrics adopted the concept of vast majority of FHR decelerations being "variable" (cord-compression). With proliferation of confusing waveform criteria, "atypical variables" became the commonest cause of suspicious/pathological CTG. However, National Institute for Health and Care Excellence (NICE) (2014) had to disband the "typical" and "atypical" terminology because of flawed classifying criteria. This analytical review makes a strong case that there are major and fundamental framing and confirmation fallacies (not just biases) in interpretation of FHR decelerations by NICE (2014) and International Federation of Gynecology and Obstetrics (FIGO) (2015), probably the biggest in modern medicine. This "post-truth" approach is incompatible with scientific practice. Moreover, it amounts to setting oneself for failure. The inertia to change could be best described as "backfire effect". There is abundant evidence that head-compression (and other non-hypoxic mediators) causes rapid rather than shallow/gradual decelerations. Currently, the vast majority of decelerations are attributed to unproven cord compression underpinned by flawed disproven pathophysiological hypotheses. Their further discrimination based on abstract, random, trial and error criteria remains unresolved suggesting a

  4. Fetal syringomyelia.

    Science.gov (United States)

    Guo, Anne; Chitayat, David; Blaser, Susan; Keating, Sarah; Shannon, Patrick

    2014-08-06

    We explored the prevalence of syringomyelia in a series of 113 cases of fetal dysraphism and hindbrain crowding, of gestational age ranging from 17.5 to 34 weeks with the vast majority less than 26 weeks gestational age. We found syringomyelia in 13 cases of Chiari II malformations, 5 cases of Omphalocele/Exostrophy/Imperforate anus/Spinal abnormality (OEIS), 2 cases of Meckel Gruber syndrome and in a single pair of pyopagus conjoined twins. Secondary injury was not uncommon, with vernicomyelia in Chiari malformations, infarct like histology, or old hemorrhage in 8 cases of syringomyelia. Vernicomyelia did not occur in the absence of syrinx formation. The syringes extended from the sites of dysraphism, in ascending or descending patterns. The syringes were usually in a major proportion anatomically distinct from a dilated or denuded central canal and tended to be dorsal and paramedian or median. We suggest that fetal syringomyelia in Chiari II malformation and other dysraphic states is often established prior to midgestation, has contributions from the primary malformation as well as from secondary in utero injury and is anatomically and pathophysiologically distinct from post natal syringomyelia secondary to hindbrain crowding.

  5. The World Health Organization Fetal Growth Charts

    DEFF Research Database (Denmark)

    Kiserud, Torvid; Piaggio, Gilda; Carroli, Guillermo

    2017-01-01

    BACKGROUND: Perinatal mortality and morbidity continue to be major global health challenges strongly associated with prematurity and reduced fetal growth, an issue of further interest given the mounting evidence that fetal growth in general is linked to degrees of risk of common noncommunicable d...

  6. Fetal monitoring indications for delivery and 2-year outcome in 310 infants with fetal growth restriction delivered before 32 weeks' gestation in the TRUFFLE study

    NARCIS (Netherlands)

    Visser, G.H.A.; Bilardo, Caterina M.; Derks, J. B.; Ferrazzi, E.; Fratelli, Nicola; Frusca, T.; Ganzevoort, W.; Lees, Christoph C.; Napolitano, Raffaele; Todros, T.; Wolf, H.; Hecher, K.; Marlow, N.; Arabin, B.; Brezinka, C.; Diemert, A.; Duvekot, Johannes J.; Martinelli, P.; Ostermayer, E.; Papageorghiou, Aris T.; Schlembach, D.; Schneider, K. T M; Thilaganathan, B.; Valcamonico, A.; Aktas, Ayse; Borgione, Silvia; Chaoui, Rabih; Cornette, Jerome M J; Diehl, Thilo; van Eyck, J.; van Haastert, I. C.; Kingdom, J.C.; Lobmaier, Silvia; Lopriore, E.; Missfelder-Lobos, Hannah; Mansi, Giuseppina; Martelli, Paola; Maso, Gianpaolo; Marsal, K.; Maurer-Fellbaum, Ute; Mensing van Charante, N.; Mulder-De Tollenaer, Susanne; Oberto, Manuela; Oepkes, D.; Ogge, Giovanna; van der Post, Joris A. M.; Prefumo, Federico; Preston, Lucy; Raimondi, Francesco; Rattue, H.; Reiss, Irwin K M; Scheepers, L. S.; Skabar, Aldo; Spaanderman, M.; Thornton, J.G.; Valensise, H.; Weisglas-Kuperus, N.; Zimmermann, Andrea

    2017-01-01

    Objective: In the TRUFFLE (Trial of Randomized Umbilical and Fetal Flow in Europe) study on the outcome of early fetal growth restriction, women were allocated to one of three groups of indication for delivery according to the following monitoring strategies: (1) reduced fetal heart rate (FHR)

  7. A PCA/ICA based Fetal ECG Extraction from Mother Abdominal Recordings by Means of a Novel Data-driven Approach to Fetal ECG Quality Assessment.

    Science.gov (United States)

    Karimi Rahmati, A; Setarehdan, S K; Araabi, B N

    2017-03-01

    Fetal electrocardiography is a developing field that provides valuable information on the fetal health during pregnancy. By early diagnosis and treatment of fetal heart problems, more survival chance is given to the infant. Here, we extract fetal ECG from maternal abdominal recordings and detect R-peaks in order to recognize fetal heart rate. On the next step, we find a better and more qualified extracted fetal ECG by using a novel approach. In this paper, a PCA/ICA-based algorithm is proposed for extracting fetal ECG, and fetal R-peaks are detected as well. The method validates the quality of extracted ECGs and selects the best candidate fetal ECG to provide the required morphological ECG features such as fetal heart rate and RR interval for more clinical examinations. The method was evaluated using the dataset which was provided by PhysioNet/Computing in Cardiology Challenge 2013. The dataset consists of 75 recordings of 4-channel ECGs each containing 1-minute length for training and 100 similar recordings for testing. When the proposed algorithm was applied to the test set, the scores of 85.853 bpm2 for fetal heart rate and an error of 9.725 ms RMS for fetal RR-interval estimation were obtained.

  8. Medio ambiente fetal Fetal environment

    Directory of Open Access Journals (Sweden)

    César Bernardo Ospina Arcila

    1996-04-01

    Full Text Available Con base en el artículo clásico "Monte Everest in utero" se hace un análisis de la situación que afronta el feto con respecto a la disponibilidad de oxígeno; para una mejor comprensión del sufrimiento fetal se revisan los siguientes conceptos: presión barométrica, presión parcial del oxígeno atmosférico, presión parcial del oxígeno inspirado, presión barométrica intranasal, ecuación del gas alveolar y difusión de gases a través de la membrana alvéolo capilar. Based on the classical paper by Eastman "Mount Everest in utero" an analysis is made of the situation faced by the fetus with respect to the availability of oxygen; for a better under. standing of fetal distress the following concepts are reviewed: barometric pressure, partial pressure of atmosferic oxygen, partial pressure of inspired oxygen, barometric intranasal pressure, alveolar gas equation and gas diffusion through alveolo-capilar membrane.

  9. Design of the Multi-Sensor Monitoring in Congestive Heart Failure (MUSIC) study: prospective trial to assess the utility of continuous wireless physiologic monitoring in heart failure.

    Science.gov (United States)

    Anand, Inder S; Greenberg, Barry H; Fogoros, Richard N; Libbus, Imad; Katra, Rodolphe P

    2011-01-01

    Remote monitoring of heart failure (HF) patients may help in the early detection of acute HF decompensation before the onset of symptoms. Appropriate early intervention in these patients may reduce HF-related hospitalizations and costs. The MUSIC (Multi-Sensor Monitoring in Congestive Heart Failure) study comprises 2 multicenter nonrandomized phases (MUSIC-Development and MUSIC-Validation) designed to develop and validate an algorithm for the prediction of acute HF decompensation using multiple physiologic signals obtained from an external, adherent, multisensor system capable of intermittent transmission of physiologic signals. Data obtained from MUSIC-Development will be used to develop the algorithm to predict HF decompensation. The algorithm will be validated in MUSIC-Validation with the objectives of ≥ 60% sensitivity for correctly predicting an acute HF event, a false-positive patient status signal rate of ≤ 1.0 per patient-year, and a safety endpoint of ≤ 5% of patients experiencing significant adverse skin conditions related to the prolonged wearing of the adherent device. A total of 542 patients in New York Heart Association functional class III-IV HF, with ejection fraction ≤ 40% and a recent HF admission, are enrolled in MUSIC-Development (n = 180) and MUSIC-Validation (n = 362). All patients are remotely monitored for 90 days using the Corventis multisensor system that transmits bioimpedance, electrocardiogram, and accelerometer data. The MUSIC study has completed patient enrollment and follow-up in both phases. Once algorithm development is complete from the MUSIC-Development phase, the sequestered data set from the MUSIC-Validation phase will be used for algorithm validation. Published by Elsevier Inc.

  10. 21 CFR 884.2640 - Fetal phonocardiographic monitor and accessories.

    Science.gov (United States)

    2010-04-01

    ... phonocardiographic monitor is a device designed to detect, measure, and record fetal heart sounds electronically, in... includes the following accessories: signal analysis and display equipment, patient and equipment supports...

  11. Blood pressure and heart rate during orthostatic stress and walking with continuous postoperative thoracic epidural bupivacaine/morphine

    DEFF Research Database (Denmark)

    Møiniche, S; Hjortsø, N C; Blemmer, T

    1993-01-01

    lower heart rate (approximately 10 bpm) 48 h after surgery at rest and during orthostatic stress in the epidural group. There was no significant difference between groups in number of patients with a reduction > 20 mmHg (2.7 kPa) in systolic blood pressure during orthostatic stress (two in each group...... and during mobilisation was superior compared to systemic morphine and NSAID. There were no significant differences between groups in haemodynamic responses (BP and heart rate) during rest, orthostatic stress and after walking assessed before, 24 and 48 h after operation except for a clinically unimportant...

  12. Monitorização materno-fetal durante procedimento odontológico em portadora de cardiopatia valvar Monitoreo maternofetal durante procedimiento odontológico en portadora de cardiopatía valvular Maternal-fetal monitoring during dental procedure in patients with heart valve disease

    Directory of Open Access Journals (Sweden)

    Itamara Lucia Itagiba Neves

    2009-11-01

    , electrocardiografía ambulatoria materna y cardiotocografía de 31 portadoras de cardiopatía reumática, entre la 28ª y la 37ª semana de gestación, divididas en dos grupos según la presencia o no del vasoconstrictor. RESULTADOS: Se observó reducción significativa de los valores de frecuencia cardíaca materna en los dos grupos, durante el procedimiento, al compararlo con los demás períodos (p 0,05. Lo mismo ocurrió (p > 0,05 con el número de contracciones uterinas, nivel de variabilidad de la línea de base y número de aceleraciones de la frecuencia cardíaca fetal. CONCLUSIÓN: El uso de 1,8 ml de lidocaína 2% asociado a la adrenalina se mostró seguro y eficaz en procedimiento odontológico restaurador durante la gestación de mujeres con cardiopatía valvular reumática.BACKGROUND: The effects of local dental anesthesia with lidocaine and epinephrine on cardiovascular parameters of pregnant women with heart valve diseases and their fetuses are not fully understood. OBJECTIVES: To assess and analyze cardiotocographic, blood pressure and electrocardiographic parameters of pregnant women with rheumatic heart valve disease undergoing local anesthesia with 1.8mL of lidocaine 2% with or without epinephrine 1:100,000 during restorative dental treatment. METHODS: Maternal ambulatory blood pressure and electrocardiographic monitoring as well as cardiotocography of 31 patients with rheumatic heart disease were performed between the 28th and 37th week of gestation. The patients were divided into two groups, those with or without vasoconstrictor. RESULTS: A significant reduction in maternal heart rate was shown in both groups during the procedure in comparison with the other periods (p0.05. The same occurred (p>0.05 with the number of uterine contractions, baseline level and variability, and number of accelerations of fetal heart rate. CONCLUSION: The use of 1.8mL of lidocaine 2% in combination with epinephrine was safe and efficient in restorative dental procedures during

  13. Beneficial effect of continuous normobaric hypoxia on ventricular dilatation in rats with post-infarction heart failure

    Czech Academy of Sciences Publication Activity Database

    Hrdlička, Jaroslav; Neckář, Jan; Papoušek, František; Vašinová, Jana; Alánová, Petra; Kolář, František

    2016-01-01

    Roč. 65, č. 5 (2016), s. 867-870 ISSN 0862-8408 R&D Projects: GA MZd(CZ) NV15-27735A; GA ČR(CZ) GAP303/12/1162 Institutional support: RVO:67985823 Keywords : chronic hypoxia * heart failure * myocardial infarction Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery Impact factor: 1.461, year: 2016

  14. Magnitude and Time Course of Changes Induced by Continuous-Flow Left Ventricular Assist Device Unloading in Chronic Heart Failure: Insights into Cardiac Recovery

    Science.gov (United States)

    Drakos, Stavros G.; Wever-Pinzon, Omar; Selzman, Craig H.; Gilbert, Edward M.; Alharethi, Rami; Reid, Bruce B.; Saidi, Abdulfattah; Diakos, Nikolaos A.; Stoker, Sandi; Davis, Erin S.; Movsesian, Matthew; Li, Dean Y.; Stehlik, Josef; Kfoury, Abdallah G.

    2013-01-01

    Objective To prospectively investigate the longitudinal effects of continuous-flow left ventricular assist device (LVAD) unloading on myocardial structure and systolic and diastolic function. Background The magnitude, timeline and sustainability of changes induced by continuous-flow LVAD on the structure and function of the failing human heart are unknown. Methods Eighty consecutive patients with clinical characteristics consistent with chronic heart failure requiring implantation of a continuous-flow LVAD were prospectively enrolled. Serial echocardiograms (1, 2, 3, 4, 6, 9 and 12 months) and right heart catheterizations were performed after LVAD implant. Cardiac recovery was assessed on the basis of improvement in systolic and diastolic function indices on echocardiography that were sustained during LVAD turn-down studies. Results After 6 months of LVAD unloading, 34% of patients had a relative LVEF increase above 50% and 19% of patients, both ischemic and nonischemic, achieved an LVEF≥40%. LV systolic function improved as early as 30 days, the greatest degree of improvement was achieved by 6 months of mechanical unloading and persisted over the 1- year follow up. LV diastolic function parameters also improved as early as 30 days post LVAD unloading and this improvement persisted over time. LV end-diastolic and end-systolic volumes decreased as early as 30 days post LVAD unloading (113 vs. 77ml/m2, p<0.01 and 92 vs. 60ml/m2, p<0.01, respectively). LV mass decreased as early as 30 days post LVAD unloading (114 vs. 95g/m2, p<0.05) and continued to do so over the 1-year follow-up but did not reach values below the normal reference range suggesting no atrophic remodeling after prolonged LVAD unloading. Conclusion Continuous-flow LVAD unloading induced in a subset of patients, both ischemic and nonischemic, early improvement in myocardial structure and systolic and diastolic function that was largely completed within 6 months, with no evidence of subsequent

  15. Hypoplastic left heart syndrome

    Directory of Open Access Journals (Sweden)

    Thiagarajan Ravi

    2007-05-01

    Full Text Available Abstract Hypoplastic left heart syndrome(HLHS refers to the abnormal development of the left-sided cardiac structures, resulting in obstruction to blood flow from the left ventricular outflow tract. In addition, the syndrome includes underdevelopment of the left ventricle, aorta, and aortic arch, as well as mitral atresia or stenosis. HLHS has been reported to occur in approximately 0.016 to 0.036% of all live births. Newborn infants with the condition generally are born at full term and initially appear healthy. As the arterial duct closes, the systemic perfusion becomes decreased, resulting in hypoxemia, acidosis, and shock. Usually, no heart murmur, or a non-specific heart murmur, may be detected. The second heart sound is loud and single because of aortic atresia. Often the liver is enlarged secondary to congestive heart failure. The embryologic cause of the disease, as in the case of most congenital cardiac defects, is not fully known. The most useful diagnostic modality is the echocardiogram. The syndrome can be diagnosed by fetal echocardiography between 18 and 22 weeks of gestation. Differential diagnosis includes other left-sided obstructive lesions where the systemic circulation is dependent on ductal flow (critical aortic stenosis, coarctation of the aorta, interrupted aortic arch. Children with the syndrome require surgery as neonates, as they have duct-dependent systemic circulation. Currently, there are two major modalities, primary cardiac transplantation or a series of staged functionally univentricular palliations. The treatment chosen is dependent on the preference of the institution, its experience, and also preference. Although survival following initial surgical intervention has improved significantly over the last 20 years, significant mortality and morbidity are present for both surgical strategies. As a result pediatric cardiologists continue to be challenged by discussions with families regarding initial decision

  16. Natural history of 107 cases of fetal aortic stenosis from a European multicenter retrospective study

    NARCIS (Netherlands)

    Gardiner, H. M.; Kovacevic, A.; Tulzer, G.; Sarkola, T.; Herberg, U.; Dangel, J.; Öhman, A.; Bartrons, J.; Carvalho, J. S.; Jicinska, H.; Fesslova, V.; Averiss, I.; Mellander, M.; Bulock, Frances; Shebani, Suhair; Clur, Sally Ann; Daehnert, Ingo; Salvo, Giovanni Di; Heying, Ruth; Gewillig, Marc; Grijseels, Els; Koopmann, Laurens; Makikallio, Kaarin; Tekay, Aydin; Leskinen, Markku; Manning, Nicky; Archer, Nick; Oberhoffer, Renate; Romeo, Cristina; Sørensen, Keld Ejvind; Richens, Trevor; Schmidt, Klaus; Seale, Anna; Jowett, Victoria; Tissot, Cecile; Tomek, Viktor; Uhlemann, Frank; Vejlstrup, Niels; Weil, Jochen

    2016-01-01

    Fetal aortic valvuloplasty (FV) aims to prevent fetal aortic valve stenosis progressing into hypoplastic left heart syndrome (HLHS), which results in postnatal univentricular (UV) circulation. Despite increasing numbers of FVs performed worldwide, the natural history of the disease in fetal life

  17. Fetal cardiac rhabdomyoma: case report

    Directory of Open Access Journals (Sweden)

    Seyed Mostafa Ghavami

    2016-07-01

    Full Text Available Background: The primary manifestation of cardiac tumors in embryonic period is a very rare condition. Cardiac rhabdomyomas most frequently arise in the ventricular myocardium, they may also occur in the atria and the epicardial surface. In spite of its benign nature, the critical location of the tumor inside the heart can lead to lethal arrhythmias and chamber obstruction. Multiple rhabdomyomas are strongly associated with tuberous sclerosis which is associated with mental retardation and epilepsy of variable severity. Ultrasonography as a part of routine prenatal screening, is the best method for the diagnosis of cardiac rhabdomyomas. In the review of articles published in Iran, fetal cardiac rhabdomyoma was not reported. Case presentation: We report a case of cardiac rhabdomyoma on a 24-year-old gravid 1, referred to Day Medical Imaging Center for routine evaluation of fetal abnormalities at 31 weeks of her gestational age. Ultrasonographic examination displayed a homogenous echogenic mass (13×9mm, originating from the left ventricle of the fetal heart. It was a normal pregnancy without any specific complications. Other organs of the fetus were found normal and no cardiac abnormalities were appeared. No Pericardial fluid effusion was found. The parents did not have consanguineous marriage. They did not also have any specific disease such as tuberous sclerosis. Conclusion: The clinical features of cardiac rhabdomyomas vary widely, depending on the location, size, and number of tumors in the heart. Although cardiac rhabdomyoma is a benign tumor in many affected fetuses, an early prenatal diagnosis of the tumor is of great significance in making efficient planning and providing adequate follow up visits of the patients and the complications such as, heart failure and outlet obstruction of cardiac chambers.

  18. Beneficial aspects of real time flow measurements for the management of acute right ventricular heart failure following continuous flow ventricular assist device implantation

    Directory of Open Access Journals (Sweden)

    Spiliopoulos Sotirios

    2012-11-01

    Full Text Available Abstract Background Optimal management of acute right heart failure following the implantation of a left ventricular assist device requires a reliable estimation of left ventricular preload and contractility. This is possible by real-time pump blood flow measurements. Clinical case We performed implantation of a continuous flow left ventricular assist device in a 66 years old female patient with an end-stage heart failure on the grounds of a dilated cardiomyopathy. Real-time pump blood flow was directly measured by an ultrasonic flow probe placed around the outflow graft. Diagnosis The progressive decline of real time flow and the loss of pulsatility were associated with an increase of central venous pressure, inotropic therapy and progressive renal failure suggesting the presence of an acute right heart failure. Diagnosis was validated by echocardiography and thermodilution measurements. Treatment Temporary mechanical circulatory support of the right ventricle was successfully performed. Real time flow measurement proved to be a useful tool for the diagnosis and ultimately for the management of right heart failure including the weaning from extracorporeal membrane oxygenation.

  19. Fetal motion estimation from noninvasive cardiac signal recordings.

    Science.gov (United States)

    Biglari, Hadis; Sameni, Reza

    2016-11-01

    Fetal motility is a widely accepted indicator of the well-being of a fetus. In previous research, it has be shown that fetal motion (FM) is coherent with fetal heart rate accelerations and an indicator for active/rest cycles of the fetus. The most common approach for FM and fetal heart rate (FHR) assessment is by Doppler ultrasound (DUS). While DUS is the most common approach for studying the mechanical activities of the heart, noninvasive fetal electrocardiogram (ECG) and magnetocardiogram (MCG) recording and processing techniques have been considered as a possible competitor (or complement) for the DUS. In this study, a fully automatic and robust framework is proposed for the extraction, ranking and alignment of fetal QRS-complexes from noninvasive fetal ECG/MCG. Using notions from subspace tracking, two measures, namely the actogram and rotatogram, are defined for fetal motion tracking. The method is applied to four fetal ECG/MCG databases, including twin MCG recordings. By defining a novel measure of causality, it is shown that there is significant coherency and causal relationship between the actogram/rotatogram and FHR accelerations/decelerations. Using this measure, it is shown that in many cases, the actogram and rotatogram precede the FHR variations, which supports the idea of motion-induced FHR accelerations/decelerations for these cases and raises attention for the non-motion-induced FHR variations, which can be associated to the fetal central nervous system developments. The results of this study can lead to novel perspectives of the fetal sympathetic and parasympathetic brain systems and future requirements of fetal cardiac monitoring.

  20. Hypoxia: From Placental Development to Fetal Programming.

    Science.gov (United States)

    Fajersztajn, Lais; Veras, Mariana Matera

    2017-10-16

    Hypoxia may influence normal and different pathological processes. Low oxygenation activates a variety of responses, many of them regulated by hypoxia-inducible factor 1 complex, which is mostly involved in cellular control of O 2 consumption and delivery, inhibition of growth and development, and promotion of anaerobic metabolism. Hypoxia plays a significant physiological role in fetal development; it is involved in different embryonic processes, for example, placentation, angiogenesis, and hematopoiesis. More recently, fetal hypoxia has been associated directly or indirectly with fetal programming of heart, brain, and kidney function and metabolism in adulthood. In this review, the role of hypoxia in fetal development, placentation, and fetal programming is summarized. Hypoxia is a basic mechanism involved in different pregnancy disorders and fetal health developmental complications. Although there are scientific data showing that hypoxia mediates changes in the growth trajectory of the fetus, modulates gene expression by epigenetic mechanisms, and determines the health status later in adulthood, more mechanistic studies are needed. Furthermore, if we consider that intrauterine hypoxia is not a rare event, and can be a consequence of unavoidable exposures to air pollution, nutritional deficiencies, obesity, and other very common conditions (drug addiction and stress), the health of future generations may be damaged and the incidence of some diseases will markedly increase as a consequence of disturbed fetal programming. Birth Defects Research 109:1377-1385, 2017.© 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  1. Awareness of fetal echo in Indian scenario

    International Nuclear Information System (INIS)

    Warrier, Dhanya; Saraf, Rahul; Maheshwari, Sunita; Suresh, PV; Shah, Sejal

    2012-01-01

    Fetal echocardiography is a well established sensitive tool to diagnose congenital heart disease (CHD) in utero. One of the determinants of effective utilization of fetal echocardiography is its awareness in the general population. The present hospital based study was undertaken to assess the awareness of the need for fetal echocardiography amongst Indian parents. One thousand one hundred and thirty eight consecutive parents who visited the pediatric cardiology outpatient department of a tertiary care centre over a period of two months were asked to fill up a questionnaire that included their demographic data, educational status, history of CHD in children, awareness of fetal echocardiography and source of information and timing of fetal echocardiogram if performed. The data was categorized and awareness was noted in different groups. The awareness in the study population was 2.2%. Awareness was found to be similar across the study population irrespective of the demographics and high risk status of the parents. The awareness of fetal echocardiography, an important tool in reducing the incidence of complex CHD, thereby impacting public health, is alarmingly low in the population studied. Appropriate action to increase awareness of fetal echocardiography needs to be looked into

  2. Effects of short-term continuous positive airway pressure on myocardial sympathetic nerve function and energetics in patients with heart failure and obstructive sleep apnea: a randomized study.

    Science.gov (United States)

    Hall, Allison B; Ziadi, Maria C; Leech, Judith A; Chen, Shin-Yee; Burwash, Ian G; Renaud, Jennifer; deKemp, Robert A; Haddad, Haissam; Mielniczuk, Lisa M; Yoshinaga, Keiichiro; Guo, Ann; Chen, Li; Walter, Olga; Garrard, Linda; DaSilva, Jean N; Floras, John S; Beanlands, Rob S B

    2014-09-09

    Heart failure with reduced ejection fraction and obstructive sleep apnea (OSA), 2 states of increased metabolic demand and sympathetic nervous system activation, often coexist. Continuous positive airway pressure (CPAP), which alleviates OSA, can improve ventricular function. It is unknown whether this is due to altered oxidative metabolism or presynaptic sympathetic nerve function. We hypothesized that short-term (6-8 weeks) CPAP in patients with OSA and heart failure with reduced ejection fraction would improve myocardial sympathetic nerve function and energetics. Forty-five patients with OSA and heart failure with reduced ejection fraction (left ventricular ejection fraction 35.8±9.7% [mean±SD]) were evaluated with the use of echocardiography and 11C-acetate and 11C-hydroxyephedrine positron emission tomography before and ≈6 to 8 weeks after randomization to receive short-term CPAP (n=22) or no CPAP (n=23). Work metabolic index, an estimate of myocardial efficiency, was calculated as follows: (stroke volume index×heart rate×systolic blood pressure÷Kmono), where Kmono is the monoexponential function fit to the myocardial 11C-acetate time-activity data, reflecting oxidative metabolism. Presynaptic sympathetic nerve function was measured with the use of the 11C-hydroxyephedrine retention index. CPAP significantly increased hydroxyephedrine retention versus no CPAP (Δretention: +0.012 [0.002, 0.021] versus -0.006 [-0.013, 0.005] min(-1); P=0.003). There was no significant change in work metabolic index between groups. However, in those with more severe OSA (apnea-hypopnea index>20 events per hour), CPAP significantly increased both work metabolic index and systolic blood pressure (Penergetics. In those with more severe OSA, CPAP may improve cardiac efficiency. Further outcome-based investigation of the consequences of CPAP is warranted. http://www.clinicaltrials.gov. Unique identifier: NCT00756366. © 2014 American Heart Association, Inc.

  3. Complete maternal and fetal recovery after prolonged cardiac arrest.

    Science.gov (United States)

    Selden, B S; Burke, T J

    1988-04-01

    A case of complete maternal and fetal recovery after prolonged cardiac arrest from massive lidocaine overdose is presented. A 27-year-old woman at 15 weeks gestation had a complete neurologic recovery after 22 minutes of CPR, including 19 minutes of electromechanical dissociation and asystole, with normal fetal heart function and fetal motion confirmed by ultrasound immediately after resuscitation. The patient delivered a healthy and neurologically normal infant at 40 weeks gestation. This is the longest cardiac arrest in early pregnancy reported in the medical literature with normal maternal and fetal outcome.

  4. Characterization of fetal body movement recorded by the Hewlett-Packard M-1350-A fetal monitor.

    Science.gov (United States)

    Melendez, T D; Rayburn, W F; Smith, C V

    1992-09-01

    The purpose of this study was to evaluate the ability of a commercially available monitor, the Hewlett-Packard M-1350-A fetal monitor, to record and discriminate between various fetal body movements. Twenty-four patients between 29 and 42 weeks' gestation were monitored over a 20 to 30 minute period simultaneously by the Hewlett-Packard instrument and ultrasonography. All 593 single or clustered fetal movements recorded by the monitor were seen ultrasonographically as being extremity movements that were either isolated or combined with trunk motion. Discriminating between these two types of movements was not possible on the basis of the duration of recorded movements. All adequate fetal heart rate accelerations were attributed to combined trunk and extremity movements. Detection of fetal hiccups was less exact, and recording of fetal hand, mouth, breathing, and rapid eye movements was beyond the sensitivity of the monitor. Signal artifacts were attributable to either motion of the maternal abdomen or Doppler transducer and became less of a problem with experience. Fetal extremity movements were recorded with accuracy by this new fetal monitor.

  5. Fetal monitoring during nonobstetric surgery: revisiting guidelines: a case report.

    Science.gov (United States)

    Rothschild, Tod J; Morel, Bruce; Pace, Benjamin; Fuks, Aleksandr M

    2015-01-01

    Nonobstetric surgery during pregnancy is not an infrequent occurrence. Guidelines for fetal monitoring during nonobstetric surgery are limited. We describe a case of appendectomy during third trimester, complicated by in utero fetal demise (IUFD). A 30-year-old, Caucasian woman underwent open appendectomy for suspected acute appendicitis. The procedure was complicated by IUFD. Fetal monitoring was done prior to but not during surgery. Guidelines for fetal monitoring were revised, recommending continuous electronic fetal monitoring when possible during third trimester nonobstetric surgery after appropriate patient counseling. A subsequent series of 5 uncomplicated appendectomies demonstrated no difficulty in implementing these guidelines. Continuous electronic fetal monitoring during third trimester nonobstetric surgery should be available and implemented after appropriate patient counseling. This approach reduces the risk of fetal mortality.

  6. Incidence of ventricular arrhythmias in patients on long-term support with a continuous-flow assist device (HeartMate II)

    DEFF Research Database (Denmark)

    Andersen, Mads; Videbaek, Regitze; Boesgaard, Søren

    2009-01-01

    The incidence of ventricular tachycardia (VT) or ventricular fibrillation (VF) in patients supported with a continuous-flow left ventricular assist device (LVAD) has not been investigated in detail. In 23 consecutive recipients of a HeartMate II, we analyzed the incidence of VT/VF during a total...... of 266 months of follow-up. Sustained VT or VF occurred in 52% of the patients, with the majority of arrhythmias occurring in the first 4 weeks after LVAD implantation. VT/VF requiring implantable cardioverter-defibrillator (ICD) shock or external defibrillation occurred in 8 patients and significant...

  7. Estudo morfométrico do coração fetal: sua utilização como parâmetro para análise ecocardiográfica Morphometric study of the fetal heart: a parameter for echocardiographic analysis

    Directory of Open Access Journals (Sweden)

    Jennecy Sales Cavalcanti

    2008-04-01

    diameter of ventricular cavity of fetal hearts. MATERIALS AND METHODS: Twenty fetal hearts at gestational age between 28 and 36 weeks were dissected. A paquimeter with 1/10 mm accuracy was utilized for the following morphological measurements: anteroposterior and transverse diameters, mitral and tricuspid valves areas and perimeters. RESULTS: Anteroposterior and transverse diameters of the left atrioventricular valve measured 10.35 ± 1.62 mm and 9.90 ± 1.79 mm, respectively; and anteroposterior and transverse diameters of the right atrioventricular valve measured 10.98 ± 1.90 mm and 9.51 ± 1.81 mm, respectively. Mitral valve area and perimeter were, respectively, 84.06 ± 25.09 mm² and 29.87 ± 3.96 mm. Tricuspid valve area and perimeter were, respectively, 84.49 ± 26.79 mm² and 28.44 ± 3.85 mm. The thicknesses of the anterior and posterior right ventricular walls were, respectively, 5.00 ± 1.70 mm and 3.83 ± 0.91 mm. The thicknesses of the anterior and posterior left ventricular walls were, respectively, 4.25 ±0.87 mm and 4.14 ± 0.89 mm. The thickness of the interventricular septum measured 4.10 ± 1.13 mm. The anteroposterior diameter of the right ventricle was 9.25 ± 0.85 mm, and the transverse diameter was 8.24 ± 0.42 mm. The anteroposterior diameter of the left ventricle measured 9.95 ± 0.37 mm, and transverse diameter measured 9.20 ± 0.40 mm. CONCLUSION: The role of morphometric data of fetal atrioventricular valves is highly significant in the echocardiographic diagnosis of possible congenital cardiac malformations.

  8. Challenge of Fetal Mortality

    Science.gov (United States)

    ... Technical Information Service NCHS The Challenge of Fetal Mortality Recommend on Facebook Tweet Share Compartir NCHS Data ... and ethnicity What is the impact of fetal mortality on U.S. families? In 2005, a total of ...

  9. [Physical training as interval or continuous training in chronic heart failure for improving functional capacity, hemodynamics and quality of life--a controlled study].

    Science.gov (United States)

    Nechwatal, R M; Duck, C; Gruber, G

    2002-04-01

    We conducted a three-week randomized trial comparing the improvement of functional capacity by exercise training in chronic heart failure by the steady-state (EF 27.3%, n = 20) and the interval modus (EF 29.3%, n = 20) with a control group (EF = 26.6%, n = 10). Minimal EF was 10%, the lowest maximal oxygen consumption was 9.3 ml/kg/min and the lowest cardiac output was 1.9 l/min; 9 patients had been evaluated for HTX. VO2 at the anaerobic threshold and at maximal exercise increased in the continuous exercise group by 1.4 or 1.6 ml/kg/min, respectively, corresponding to an increase of 13.7% (p clinically stable patients with heart failure and even those already having been evaluated for cardiac transplantation profit from short-term physical training. Both training modalities seem equally suited to improve functional capacity. However interval training leads to more pronounced improvement in hemodynamics compared to the steady-state exercise, whereas the later had a greater impact on psychological well-being and quality of life. Patients with heart failure and severe peripheral deconditioning tolerate higher workloads with more peripheral stress by an interval training modus. Long-term training modalities need to be established to further improve and stabilize functional status.

  10. Aerobic Interval vs. Continuous Training in Patients with Coronary Artery Disease or Heart Failure: An Updated Systematic Review and Meta-Analysis with a Focus on Secondary Outcomes.

    Science.gov (United States)

    Pattyn, Nele; Beulque, Randy; Cornelissen, Véronique

    2018-03-03

    In a previous meta-analysis including nine trials comparing aerobic interval training with aerobic continuous training in patients with coronary artery disease, we found a significant difference in peak oxygen uptake favoring aerobic interval training. The objective of this study was to (1) update the original meta-analysis focussing on peak oxygen uptake and (2) evaluate the effect on secondary outcomes. We conducted a systematic review with a meta-analysis by searching PubMed and SPORTDiscus databases up to March 2017. We included randomized trials comparing aerobic interval training and aerobic continuous training in patients with coronary artery disease or chronic heart failure. The primary outcome was change in peak oxygen uptake. Secondary outcomes included cardiorespiratory parameters, cardiovascular risk factors, cardiac and vascular function, and quality of life. Twenty-four papers were identified (n = 1080; mean age 60.7 ± 10.7 years). Aerobic interval training resulted in a higher increase in peak oxygen uptake compared with aerobic continuous training in all patients (1.40 mL/kg/min; p interval training in all patients. Other cardiorespiratory parameters, cardiovascular risk factors, and quality of life were equally affected. This meta-analysis adds further evidence to the clinically significant larger increase in peak oxygen uptake following aerobic interval training vs. aerobic continuous training in patients with coronary artery disease and chronic heart failure. More well-designed randomized controlled trials are needed to establish the safety of aerobic interval training and the sustainability of the training response over longer periods.

  11. Effects of high intensity interval versus moderate continuous training on markers of ventilatory and cardiac efficiency in coronary heart disease patients.

    Science.gov (United States)

    Cardozo, Gustavo G; Oliveira, Ricardo B; Farinatti, Paulo T V

    2015-01-01

    We tested the hypothesis that high intensity interval training (HIIT) would be more effective than moderate intensity continuous training (MIT) to improve newly emerged markers of cardiorespiratory fitness in coronary heart disease (CHD) patients, as the relationship between ventilation and carbon dioxide production (VE/VCO2 slope), oxygen uptake efficiency slope (OUES), and oxygen pulse (O2P). Seventy-one patients with optimized treatment were randomly assigned into HIIT (n = 23, age = 56 ± 12 years), MIT (n = 24, age = 62 ± 12 years), or nonexercise control group (CG) (n = 24, age = 64 ± 12 years). MIT performed 30 min of continuous aerobic exercise at 70-75% of maximal heart rate (HRmax), and HIIT performed 30 min sessions split in 2 min alternate bouts at 60%/90% HRmax (3 times/week for 16 weeks). No differences among groups (before versus after) were found for VE/VCO2 slope or OUES (P > 0.05). After training the O2P slope increased in HIIT (22%, P 0.05), while decreased in CG (-20%, P < 0.05) becoming lower versus HIIT (P = 0.03). HIIT was more effective than MIT for improving O2P slope in CHD patients, while VE/VCO2 slope and OUES were similarly improved by aerobic training regimens versus controls.

  12. Biomedical Instruments for Fetal and Neonatal Surveillance

    Energy Technology Data Exchange (ETDEWEB)

    Rolfe, P [Oxford BioHorizons Ltd. (United Kingdom); Scopesi, F [Gaslini Institute, University of Genoa (Italy); Serra, G [Gaslini Institute, University of Genoa (Italy)

    2006-10-15

    Specialised instruments have been developed to aid the care of the fetus and the newborn baby. Miniature sensors using optical, electrical, chemical, mechanical and magnetic principles have been produced for capturing key measurands. These include temperature, pressure, flow and dimension, as well as several specific molecules such as glucose, oxygen and carbon dioxide. During pregnancy ultrasound imaging and blood flow techniques provide valuable information concerning fetal abnormalities, fetal growth, fetal breathing and fetal heart rate. Signal processing and pattern recognition can be useful for deriving indicators of fetal distress and clinical status, based on biopotentials as well as ultrasound signals. Fetal pH measurement is a critical requirement during labour and delivery. The intensive care of ill preterm babies involves provision of an optimal thermal environment and respiratory support. Monitoring of blood gas and acid-base status is essential, and this involves both blood sampling for in vitro analysis as well as the use of invasive or non-invasive sensors. For the future it will be vital that the technologies used are subjected to controlled trials to establish benefit or otherwise.

  13. Biomedical Instruments for Fetal and Neonatal Surveillance

    International Nuclear Information System (INIS)

    Rolfe, P; Scopesi, F; Serra, G

    2006-01-01

    Specialised instruments have been developed to aid the care of the fetus and the newborn baby. Miniature sensors using optical, electrical, chemical, mechanical and magnetic principles have been produced for capturing key measurands. These include temperature, pressure, flow and dimension, as well as several specific molecules such as glucose, oxygen and carbon dioxide. During pregnancy ultrasound imaging and blood flow techniques provide valuable information concerning fetal abnormalities, fetal growth, fetal breathing and fetal heart rate. Signal processing and pattern recognition can be useful for deriving indicators of fetal distress and clinical status, based on biopotentials as well as ultrasound signals. Fetal pH measurement is a critical requirement during labour and delivery. The intensive care of ill preterm babies involves provision of an optimal thermal environment and respiratory support. Monitoring of blood gas and acid-base status is essential, and this involves both blood sampling for in vitro analysis as well as the use of invasive or non-invasive sensors. For the future it will be vital that the technologies used are subjected to controlled trials to establish benefit or otherwise

  14. Electrocardiographic changes following umbilical cord occlusion in the midgestation fetal sheep.

    Science.gov (United States)

    Welin, Anna-Karin; Blad, Sofia; Hagberg, Henrik; Rosén, K G; Kjellmer, Ingemar; Mallard, Carina

    2005-02-01

    Clinical studies show that analysis of the fetal electrocardiographic (FECG) ST waveform at term gives important information on the myocardial response to intrapartum asphyxia. However, it is not known whether the preterm fetus responds in a similar fashion. The objective of the present study was to evaluate the FECGST response to umbilical cord occlusion in the preterm fetal sheep. Fetal sheep at midgestation were subjected to 25 min umbilical cord occlusion (n = 7) and compared to controls (n = 5). Changes in the FECGST waveform were recorded together with arterial blood pressure, heart rate, and acid base status during the occlusion and for 3 days afterward. Umbilical cord occlusion resulted in immediate bradycardia (control: 187 +/- 7 bpm versus occlusion: 102 +/- 7 bpm), hypertension (control: 43.2 +/- 1.1 mmHg versus occlusion: 59.8 +/- 2.2 mmHg), and an initial increase in the T/QRS ratio (control: 0.10 +/- 0.02 versus occlusion: 0.60 +/- 0.10, P sheep has the capacity to react to umbilical cord occlusion with a significant increase in the amplitude of the ST waveform together with an augmentation of blood pressure, which then subsides as the occlusion continues. The appearance of negative ST segment appears to signify significant cardiac dysfunction. The characteristic progression of ST-waveform changes in response to umbilical cord occlusion in midgestation fetal sheep, suggests that monitoring the ST waveform may contribute clinically important information also in the preterm individual.

  15. Effects of prenatal music stimulation on fetal cardiac state, newborn anthropometric measurements and vital signs of pregnant women: A randomized controlled trial.

    Science.gov (United States)

    García González, J; Ventura Miranda, M I; Manchon García, F; Pallarés Ruiz, T I; Marin Gascón, M L; Requena Mullor, M; Alarcón Rodriguez, R; Parron Carreño, T

    2017-05-01

    Music has been used for medicinal purposes throughout history due to its variety of physiological, psychological and social effects. To identify the effects of prenatal music stimulation on the vital signs of pregnant women at full term, on the modification of fetal cardiac status during a fetal monitoring cardiotocograph, and on anthropometric measurements of newborns taken after birth. A randomized controlled trial was implemented. The four hundred and nine pregnant women coming for routine prenatal care were randomized in the third trimester to receive either music (n = 204) or no music (n = 205) during a fetal monitoring cardiotocograph. All of the pregnant women were evaluated by measuring fetal cardiac status (basal fetal heart rate and fetal reactivity), vital signs before and after a fetal monitoring cardiotocograph (maternal heart rate and systolic and diastolic blood pressure), and anthropometric measurements of the newborns were taken after birth (weight, height, head circumference and chest circumference). The strip charts showed a significantly increased basal fetal heart rate and higher fetal reactivity, with accelerations of fetal heart rate in pregnant women with music stimulation. After the fetal monitoring cardiotocograph, a statistically significant decrease in systolic blood pressure, diastolic blood pressure and heart rate in women receiving music stimulation was observed. Music can be used as a tool which improves the vital signs of pregnant women during the third trimester, and can influence the fetus by increasing fetal heart rate and fetal reactivity. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Ramp Study Hemodynamics, Functional Capacity, and Outcome in Heart Failure Patients with Continuous-Flow Left Ventricular Assist Devices

    DEFF Research Database (Denmark)

    Jung, Mette H; Gustafsson, Finn; Houston, Brian

    2016-01-01

    Ramp studies-measuring changes in cardiac parameters as a function of serial pump speed changes (revolutions per minute [rpm])-are increasingly used to evaluate function and malfunction of continuous-flow left ventricular assist devices (CF-LVADs). We hypothesized that ramp studies can predict fu...

  17. Continuous-Time Semi-Markov Models in Health Economic Decision Making : An Illustrative Example in Heart Failure Disease Management

    NARCIS (Netherlands)

    Cao, Qi; Buskens, Erik; Feenstra, Talitha; Jaarsma, Tiny; Hillege, Hans; Postmus, Douwe

    Continuous-time state transition models may end up having large unwieldy structures when trying to represent all relevant stages of clinical disease processes by means of a standard Markov model. In such situations, a more parsimonious, and therefore easier-to-grasp, model of a patient's disease

  18. Effect of Admission Oral Diuretic Dose on Response to Continuous versus Bolus Intravenous Diuretics in Acute Heart Failure: An Analysis from DOSE-AHF

    Science.gov (United States)

    Shah, Ravi V.; McNulty, Steven; O'Connor, Christopher M.; Felker, G. Michael; Braunwald, Eugene; Givertz, Michael M.

    2014-01-01

    Background Results from the Diuretic Optimization Strategies in Acute Heart Failure (DOSE-AHF) study suggest that an initial continuous infusion of loop diuretics is not superior to bolus dosing with regard to clinical endpoints in AHF. We hypothesized that outpatient furosemide dose was associated with congestion and poorer renal function, and explored the hypothesis that a continuous infusion may be more effective in patients on higher outpatient diuretic doses. Methods DOSE-AHF randomized 308 patients within 24 hours of admission to high vs. low initial intravenous diuretic dose given as either a continuous infusion or bolus. We compared baseline characteristics and assessed associations between mode of administration (bolus vs. continuous) and outcomes in patients receiving high-dose (≥120 mg furosemide equivalent, n=177) versus low-dose (diuretics. Results Patients on higher doses of furosemide were less frequently on renin-angiotensin system inhibitors (P=.01), and had worse renal function and more advanced symptoms. There was a significant interaction between outpatient dose and mode of therapy (P=0.01) with respect to net fluid loss at 72 hours after adjusting for creatinine and intensification strategy. Admission diuretic dose was associated with an increased risk of death or rehospitalization at 60 days (adjusted HR=1.08 per 20-mg increment in dose, 95% CI 1.01–1.16, P=.03). Conclusions In acute HF, patients on higher diuretic doses have greater disease severity, and may benefit from an initial bolus strategy. PMID:23194486

  19. [Prenatal diagnosis and outcome of fetal bradyarrhythmias].

    Science.gov (United States)

    Tollens, M; Schneider, K T M; Lang, D; Oberhoffer, R

    2004-04-01

    The purpose of this study was to evaluate the clinical outcome of fetuses with bradyarrhythmias or complete heart block (CHB) in the setting of fetal structural heart disease (CHD) or of maternal collagenosis with and without treatment. A retrospective analysis of echocardiographic studies performed in 14 fetuses (mean gestational age 25.5, range 19 - 36 weeks) referred for exclusion or diagnosis of bradyarrhytmias was performed. Maternal SS-A/Ro and SS-B/La antibodies were measured by ELISA. 14 fetuses showed bradyarrhythmias or complete heart block in combination with severe cardiac malformations (n = 7) or with positive maternal antibodies (n = 7). Only one of the fetuses with CHD survived infancy as opposed to 5/7 fetuses with complete atrioventricular block in the setting of maternal collagenosis. Maternal treatment with corticosteroids did not seem to influence the rhythm disorder. Fetal echography is a safe method to detect bradyarrhythmias or complete atrioventricular block. When associated with structural heart defects, fetal prognosis is poorer than in combination with maternal collagenosis.

  20. [Maternal and fetal outcomes with aortic dissection in pregnant patients with Marfan syndrome].

    Science.gov (United States)

    Yang, Puyu; Zhang, Jun; Li, Yanna; Wang, Hui; Zheng, Jun

    2015-05-01

    cardiovascular surgery, the order of which was implemented cesarean section under general anesthesia firstly and then operated cardiovascular surgery with cardiopulmonary bypass and heparinization. Two were conducted cardiovascular surgery after termination of pregnancy by early artificial abortion operation or hysterotomy. 1 was conducted Bentall surgery at 18 weeks of pregnancy, after that the patient was receiving warfarin until the fetal brain hemorrhage was examined by ultrasound at 31 weeks of pregnancy; the patient was conducted cesarean section due to intrauterine fetal death. 1 was conducted heart surgery at 24 weeks of pregnancy and continue the pregnancy to 30 weeks, was conducted cesarean section due to severe early-onset preeclampsia at 30 weeks of pregnancy. (5) Among 7 patients, three patients underwent heart surgery with cardiopulmonary bypass combined with cesarean section. Two patients terminated pregnancy after heart surgery. Two patients terminated pregnancy before heart surgery. Six patients were alive and one patient died of multiple organ failure. (6) 3 cases of newborn with birth body mass between 1 080 to 1 490 g.1 case of birth died after 14 d. 2 cases for newborns were alive without exception. Aortic dissection poses serious risk for pregnant women with Marfan syndrome and the fetus, and the mortality rates for both the mother and the fetus are high. Early diagnosis and appropriate treatment should be based on maternal and fetal conditions (such as aortic dissection, gestational age). When fetus is mature, cardiovascular surgery should be carried out with cesarean section. A multi-disciplinary team between obstetric and cardiovascular surgery is crucial to the outcome of these critical patients.

  1. Fetal stimulation by pulsed diagnostic ultrasound.

    Science.gov (United States)

    Fatemi, M; Ogburn, P L; Greenleaf, J F

    2001-08-01

    To show that pulsed ultrasound from a clinical ultrasonic imaging system can stimulate the fetus. Stimulation is defined mainly as increased fetal gross body movements in response to excitation. Fetuses of a group of 9 volunteer women (mean gestational age, 33.37 weeks; range, 25-40 weeks) were evaluated for body movement under 3 different conditions: (1) control, with no ultrasound exposure; (2) ultrasound in continuous wave Doppler mode; and (3) pulsed ultrasound in pulsed Doppler and B modes. A conventional external fetal monitor, with negligible ultrasonic output, was used to monitor fetal gross body motions. After an initial rest period of 3 minutes with 1 or no fetal motion, fetuses were monitored for an additional 3 minutes under the exposure criterion defined for each condition. Resulting fetal motions under the 3 conditions were compared using the Wilcoxon signed rank test. The test showed that fetuses moved significantly more frequently under condition 3 (mean +/- SD, 3.43 +/- 1.93 movements per minute) than under condition 1 (0.40 +/- 7.33 movements per minute) or condition 2 (0.63 +/- 7.67 movements per minute); P = .004 and .016, respectively. Fetal movements under conditions 1 and 2 did not differ significantly. Diagnostic ultrasound may stimulate fetal body motion.

  2. Neuromuscular electrical stimulation improves exercise tolerance in patients with advanced heart failure on continuous intravenous inotropic support use-randomized controlled trial.

    Science.gov (United States)

    Forestieri, Patrícia; Bolzan, Douglas W; Santos, Vinícius B; Moreira, Rita Simone Lopes; de Almeida, Dirceu Rodrigues; Trimer, Renata; de Souza Brito, Flávio; Borghi-Silva, Audrey; de Camargo Carvalho, Antonio Carlos; Arena, Ross; Gomes, Walter J; Guizilini, Solange

    2018-01-01

    To evaluate the impact of a short-term neuromuscular electrical stimulation program on exercise tolerance in hospitalized patients with advanced heart failure who have suffered an acute decompensation and are under continuous intravenous inotropic support. A randomized controlled study. Initially, 195 patients hospitalized for decompensated heart failure were recruited, but 70 were randomized. Patients were randomized into two groups: control group subject to the usual care ( n = 35); neuromuscular electrical stimulation group ( n = 35) received daily training sessions to both lower extremities for around two weeks. The baseline 6-minute walk test to determine functional capacity was performed 24 hours after hospital admission, and intravenous inotropic support dose was daily checked in all patients. The outcomes were measured in two weeks or at the discharge if the patients were sent back home earlier than two weeks. After losses of follow-up, a total of 49 patients were included and considered for final analysis (control group, n = 25 and neuromuscular electrical stimulation group, n = 24). The neuromuscular electrical stimulation group presented with a higher 6-minute walk test distance compared to the control group after the study protocol (293 ± 34.78 m vs. 265.8 ± 48.53 m, P Neuromuscular electrical stimulation group also demonstrated a significantly higher dose reduction of dobutamine compared to control group after the study protocol (2.72 ± 1.72 µg/kg/min vs. 3.86 ± 1.61 µg/kg/min, P = 0.001, respectively). A short-term inpatient neuromuscular electrical stimulation rehabilitation protocol improved exercise tolerance and reduced intravenous inotropic support necessity in patients with advanced heart failure suffering a decompensation episode.

  3. Effect of Preoperative Atrial Fibrillation on Patients with Chronic Heart Failure Who Undergo Long-Term Continuous-Flow LVAD Implantation.

    Science.gov (United States)

    Kurihara, Chitaru; Critsinelis, Andre; Kawabori, Masashi; Sugiura, Tadahisa; Civitello, Andrew B; Morgan, Jeffrey A

    2018-02-24

    Although preoperative atrial fibrillation (AF) is common in patients undergoing continuous-flow left ventricular assist device (CF-LVAD) implantation, how AF affects outcomes remains unclear. We analyzed our single-center experience with CF-LVAD implantation to determine whether preoperative AF was associated with inferior outcomes. From November 2003 through March 2016, 526 patients with chronic heart failure underwent implantation with the HeartMate II (HMII; n = 403) or HeartWare VAD (HVAD; n = 123). We identified 229 patients (165 HMII, 65 HVAD) who had preoperative AF and compared them with non-preoperative AF patients regarding the incidence of postoperative stroke, as well as long-term survival. After implantation, 139 patients had a stroke (78 non-preoperative AF patients [26.2%], 61 preoperative AF patients [26.6%]; p = 0.84). The rate of events per patient-year was 0.19 in non-preoperative AF patients and 0.22 in preoperative AF patients (p = 0.84). Survival was not significantly different between the two groups (p = 0.60). In Cox regression, preoperative AF was not associated with postoperative stroke (odds ratio: 1.13; 95% confidence interval [CI]: 0.74-1.74; p = 0.55) or survival (hazard ratio: 0.93; 95% CI: 0.71-1.25; p = 0.66). We conclude that in CF-LVAD recipients, preoperative AF did not diminish perioperative or long-term survival or increase the risk of postoperative stroke. These findings suggest that performing concomitant AF ablation during CF-LVAD implantation may be unnecessary.

  4. Frecuencia cardiaca y movimientos fetales posterior a la administracion de betametasona para maduración pulmonar fetal

    Directory of Open Access Journals (Sweden)

    Yolima Ruiz Lopez

    2013-05-01

    Full Text Available El objetivo de la investigación fue demostrar las modificaciones de la frecuencia cardiaca y los movimientos fetales producidas por la administración de betametasona para maduración pulmonar fetal. Se realizó una investigación de tipo explicativa, prospectiva y longitudinal con un diseño cuasi-experimental y una muestra no probabilística de 106 gestantes entre 24 y 34 semanas, con diagnóstico de amenaza de parto pretérmino tratadas con betametasona (12 mg intramuscular cada 24 horas por dos dosis que acudieron al Hospital Central “Dr. Urquinaona”. Se evaluaron los movimientos fetales y frecuencia cardiaca materna y fetal. No se encontraron diferencias significativas en la frecuencia cardiaca materna comparado con los valores iniciales (p = ns. Se observó que el valor inicial de la frecuencia cardiaca fetal fue de 135,1±9,7 latidos por minuto para aumentar luego a 137,2±8,9 latidos por minuto (p = ns para presentar un nuevo aumento hasta (142,9±9,9 latidos por minuto que fue significativo comparado con los valores iniciales (p < 0,05. Se observó una disminución significativa de movimientos fetales medidos en 30 minutos después de la primera inyección (23,1±6,0 movimientos comparado con 14,8±7,0 movimientos, para aumentar después de la segunda inyección pero aun presentando valores significativamente más bajos comparado con los valores iniciales (20,0 ±6,7 movimientos; p < 0,05. Se concluye que la administración de betametasona para maduración pulmonar fetal produce incremento significativo en la frecuencia cardiaca y reducción marcada de los movimientos fetales. Abstract Fetal heart rate and movements after betamethasone administration for fetal lung maturity The objective of research was to demonstrate fetal heart rate and movements modifications by the use of betamethasone for fetal lung maturity. An explicative, prospective and longitudinal research was done with a quasi-experimental design and a non

  5. [Fetal responses to different methods of electrocution of pregnant sows].

    Science.gov (United States)

    Peisker, Nina; Preissel, Anne-Kathrin; Ritzmann, Mathias; Schuster, Tibor; Thomes, Rainer; Henke, Julia

    2008-01-01

    The fetal stress responses in sows euthanized by electrical current during their second and last trimester of pregnancy (G1 and G2) were evaluated. Three methods of euthanasia of pregnant sows generally applicable to cases of epizootic or emergency slaughter were investigated: 1. conventional application of electrical current to the head and heart (HH); 2. application of electrical current to the head, heart and the uterus (HHU); 3. application of electrical current to the head, heart and from the upper body to the vagina (HHV). Fetuses were delivered by cesarean section at intervals of 3 to 4 minutes and remained attached to the sow by the umbilical cord. Fetal vitality, reflexes, heart rate, blood pressure, rectal body temperature, intracardial arteriovenous pCO2, pH and lactic acid were monitored for a period of 30 minutes. No method was found to kill the fetal pigs immediately. In fetuses at G1 there were no significant differences between the HH and HHU and HHV methods. Fetuses at G2 showed a significantly faster decrease in heart rate and blood pressure as well as a shorter period of time for the absence of fetal body movements and reflexes for the HHT method, compared to the other methods. Since it is not yet known to what extent the fetal pig experiences pain and suffering, the prolonged process of dying for the in utero fetus due to hypoxia which includes struggling and gasps is inconsistent with criteria for humane euthanasia and animal welfare.

  6. [Fetal death in utero].

    Science.gov (United States)

    Rudigoz, R C; Revillard, J P; Audra, P; Luciani, F; Malvolti, B; Griot, J P; Frappart, L; Lafont, S

    1986-11-01

    152 cases of fetal death in utero are reported. The most frequent etiologies were: vasculorenal syndromes: 28.3 p. cent, idiopathic DPPNIs and RCIUs: 28 p. cent, accidental causes (trauma, funicular syndromes): 19.5 p. cent. Cause of death was unknown or imprecise in 18.4 p. cent of cases. Repeated fetal deaths in utero were rare: 5 observations. The authors consider the management of fetal death in utero, associated immunological problems and how to deal with subsequent pregnancies.

  7. Fetal breathing and movement

    International Nuclear Information System (INIS)

    Lindstrom, K.; Marsal, K.

    1983-01-01

    Objective investigation of fetal motor activity largely depends on the availability of non-invasive, safe and reliable measurement techniques. Until recently such methods were not available, and therefore most of their knowledge concerning fetal physiology had to be derived from experiments on animals. Introduction of modern techniques, particularly those based on ultrasound, into perinatal research opened up new possibilities of objectively measuring fetal motor function in humans. The development of the ultrasound real-time B-mode technique rapidly attracted the interest of physiologists and clinicians in this field of fetal medicine

  8. Prenatal pharmacotherapy for fetal anomalies: a 2011 update

    Science.gov (United States)

    Hui, Lisa; Bianchi, Diana W.

    2015-01-01

    Fetal therapy can be defined as any prenatal treatment administered to the mother with the primary indication to improve perinatal or long-term outcomes for the fetus or newborn. This review provides an update of the pharmacological therapies that are solely directed at the fetus with anomalies and outlines a future transcriptomic approach. Fetal anomalies targeted with prenatal pharmacotherapy are a heterogeneous group of structural, endocrine, and metabolic conditions, including congenital cystic adenomatoid malformation (CCAM), congenital adrenal hyperplasia, congenital heart block, fetal tachyarrhythmias, inborn errors of metabolism, fetal thyroid disorders, and polyhydramnios. To date, the majority of pharmacotherapies for fetal anomalies have been evaluated only in retrospective, uncontrolled studies. The way forward will be with an evidence-based approach to prenatal pharmacological interventions. PMID:21638296

  9. Fetal response to abbreviated relaxation techniques. A randomized controlled study.

    Science.gov (United States)

    Fink, Nadine S; Urech, Corinne; Isabel, Fornaro; Meyer, Andrea; Hoesli, Irène; Bitzer, Johannes; Alder, Judith

    2011-02-01

    stress during pregnancy can have adverse effects on the course of pregnancy and on fetal development. There are few studies investigating the outcome of stress reduction interventions on maternal well-being and obstetric outcome. this study aims (1) to obtain fetal behavioral states (quiet/active sleep, quiet/active wakefulness), (2) to investigate the effects of maternal relaxation on fetal behavior as well as on uterine activity, and (3) to investigate maternal physiological and endocrine parameters as potential underlying mechanisms for maternal-fetal relaxation-transferral. the behavior of 33 fetuses was analyzed during laboratory relaxation/quiet rest (control group, CG) and controlled for baseline fetal behavior. Potential associations between relaxation/quiet rest and fetal behavior (fetal heart rate (FHR), FHR variation, FHR acceleration, and body movements) and uterine activity were studied, using a computerized cardiotocogram (CTG) system. Maternal heart rate, blood pressure, cortisol, and norepinephrine were measured. intervention (progressive muscle relaxation, PMR, and guided imagery, GI) showed changes in fetal behavior. The intervention groups had higher long-term variation during and after relaxation compared to the CG (p=.039). CG fetuses had more FHR acceleration, especially during and after quiet rest (p=.027). Women in the PMR group had significantly more uterine activity than women in the GI group (p=.011) and than CG women. Maternal heart rate, blood pressure, and stress hormones were not associated with fetal behavior. this study indicates that the fetus might participate in maternal relaxation and suggests that GI is superior to PMR. This could especially be true for women who tend to direct their attention to body sensations such as abdominal activity. 2010 Elsevier Ltd. All rights reserved.

  10. Fetal cardiac arrhythmia detection and in utero therapy

    OpenAIRE

    Strasburger, Janette F.; Wakai, Ronald T.

    2010-01-01

    The human fetal heart develops arrhythmias and conduction disturbances in response to ischemia, inflammation, electrolyte disturbances, altered load states, structural defects, inherited genetic conditions, and many other causes. Yet sinus rhythm is present without altered rate or rhythm in some of the most serious electrophysiological diseases, which makes detection of diseases of the fetal conduction system challenging in the absence of magnetocardiographic or electrocardiographic recording...

  11. Fetal cardiac arrhythmia detection and in utero therapy.

    Science.gov (United States)

    Strasburger, Janette F; Wakai, Ronald T

    2010-05-01

    The human fetal heart develops arrhythmias and conduction disturbances in response to ischemia, inflammation, electrolyte disturbances, altered load states, structural defects, inherited genetic conditions, and many other causes. Yet sinus rhythm is present without altered rate or rhythm in some of the most serious electrophysiological diseases, which makes detection of diseases of the fetal conduction system challenging in the absence of magnetocardiographic or electrocardiographic recording techniques. Life-threatening changes in QRS or QT intervals can be completely unrecognized if heart rate is the only feature to be altered. For many fetal arrhythmias, echocardiography alone can assess important clinical parameters for diagnosis. Appropriate treatment of the fetus requires awareness of arrhythmia characteristics, mechanisms, and potential associations. Criteria to define fetal bradycardia specific to gestational age are now available and may allow detection of ion channelopathies, which are associated with fetal and neonatal bradycardia. Ectopic beats, once thought to be entirely benign, are now recognized to have important pathologic associations. Fetal tachyarrhythmias can now be defined precisely for mechanism-specific therapy and for subsequent monitoring of response. This article reviews the current and future diagnostic techniques and pharmacologic treatments for fetal arrhythmia.

  12. Fetal Cardiac Doppler Signal Processing Techniques: Challenges and Future Research Directions

    Directory of Open Access Journals (Sweden)

    Saeed Abdulrahman Alnuaimi

    2017-12-01

    Full Text Available The fetal Doppler Ultrasound (DUS is commonly used for monitoring fetal heart rate and can also be used for identifying the event timings of fetal cardiac valve motions. In early-stage fetuses, the detected Doppler signal suffers from noise and signal loss due to the fetal movements and changing fetal location during the measurement procedure. The fetal cardiac intervals, which can be estimated by measuring the fetal cardiac event timings, are the most important markers of fetal development and well-being. To advance DUS-based fetal monitoring methods, several powerful and well-advanced signal processing and machine learning methods have recently been developed. This review provides an overview of the existing techniques used in fetal cardiac activity monitoring and a comprehensive survey on fetal cardiac Doppler signal processing frameworks. The review is structured with a focus on their shortcomings and advantages, which helps in understanding fetal Doppler cardiogram signal processing methods and the related Doppler signal analysis procedures by providing valuable clinical information. Finally, a set of recommendations are suggested for future research directions and the use of fetal cardiac Doppler signal analysis, processing, and modeling to address the underlying challenges.

  13. Fetal Cardiac Doppler Signal Processing Techniques: Challenges and Future Research Directions.

    Science.gov (United States)

    Alnuaimi, Saeed Abdulrahman; Jimaa, Shihab; Khandoker, Ahsan H

    2017-01-01

    The fetal Doppler Ultrasound (DUS) is commonly used for monitoring fetal heart rate and can also be used for identifying the event timings of fetal cardiac valve motions. In early-stage fetuses, the detected Doppler signal suffers from noise and signal loss due to the fetal movements and changing fetal location during the measurement procedure. The fetal cardiac intervals, which can be estimated by measuring the fetal cardiac event timings, are the most important markers of fetal development and well-being. To advance DUS-based fetal monitoring methods, several powerful and well-advanced signal processing and machine learning methods have recently been developed. This review provides an overview of the existing techniques used in fetal cardiac activity monitoring and a comprehensive survey on fetal cardiac Doppler signal processing frameworks. The review is structured with a focus on their shortcomings and advantages, which helps in understanding fetal Doppler cardiogram signal processing methods and the related Doppler signal analysis procedures by providing valuable clinical information. Finally, a set of recommendations are suggested for future research directions and the use of fetal cardiac Doppler signal analysis, processing, and modeling to address the underlying challenges.

  14. Accounting for Fetal Origins

    DEFF Research Database (Denmark)

    Dalgaard, Carl-Johan Lars; Hansen, Casper Worm; Strulik, Holger

    2017-01-01

    The Fetal Origins hypothesis has received considerable empirical support, both within epidemiology and economics. The present study compares the ability of two rival theoretical frameworks in accounting for the kind of path dependence implied by the Fetal Origins Hypothesis. We argue that while...

  15. Acute maternal exercise during the third trimester of pregnancy, influence on foetal heart rate. (Ejercicio físico durante el tercer trimestre de embarazo, influencia en la frecuencia cardiaca fetal.

    Directory of Open Access Journals (Sweden)

    María Zakynthinaki

    2008-10-01

    Full Text Available AbstractA substantial amount of research has investigated the influence of physical exercise during pregnancy on certain maternal and foetal parameters. Regarding the behaviour of the foetal heart rate (FHR during the maternal exercise certain controversy exists; as several investigations have studied this parameter obtaining varied results. To test the hypotheses that the foetal heart rate (FHR increases during maternal exercise, performed on a static bicycle during the third trimester. To know if the magnitude of the increase is related to gestational age or parity. This research involved a collaboration with the Gynaecology and Obstetrics Service of “Severo Ochoa” Hospital (Madrid and Universidad Politécnica de Madrid (UPM. The approval of the Committee of Investigation as well as of the Ethical Commission of the Hospital was obtained. Twenty healthy pregnant women have been studied, in the last trimester. No women showed any medical complications in their pregnancy or contraindications for the practice of physical exercise. Informed consent was obtained. The exercise protocol consisted in the first part (rest, followed by a session of 20 minutes of moderate work (static bicycle exercise and then rest until the FHR returned to the pre-exercise levels. Data for the evaluation of the FHR was obtained using an Electronic Foetal Monitor, Philips FM 20; and an Accurex Plus, Polar Electro OY was used for the control of the maternal heart rate. The clinical history of the pregnant women provided data about medical and personal factors. For the statistical analysis, Pearson correlation and Student’s t test for unpaired data were used. Our results show increases (11 - 36 beats/min, mean= 24 beats/min of the FHR in all the studied cases. The gestational age shows no correlation with increments of FHR (Pearson 0.06 and there are larger increments of FHR in secundigravid (mean=152 ± 6.0 beats/min than in primigravid (mean=147 ± 4.6 beats

  16. Continuous renal replacement therapy with a polymethyl methacrylate membrane hemofilter suppresses inflammation in patients after open-heart surgery with cardiopulmonary bypass.

    Science.gov (United States)

    Mukaida, Hiroshi; Matsushita, Satoshi; Inotani, Takahiro; Nakamura, Atsushi; Amano, Atsushi

    2018-02-05

    Cardiopulmonary bypass (CPB) induces a complex inflammatory response involving an increase in inflammatory cytokines, called postperfusion syndrome. Previous studies demonstrated that adsorption of the serum cytokines can reduce acute inflammation and improve clinical outcomes. In this study, patients were placed on continuous renal replacement therapy (CRRT) with a polymethyl methacrylate (PMMA) membrane hemofilter immediately after the start of an open-heart surgery with CPB and throughout the postoperative course to prevent postperfusion syndrome. The aim of this study was to assess whether continuous CRRT using a PMMA filter (PMMA-CRRT) could affect cytokine expression and improve perioperative outcomes. We designed a randomized controlled trial, which included 19 consecutive adult patients on maintenance dialysis and 7 consecutive adult patients who were not on maintenance dialysis (NHD group). Patients on maintenance dialysis were randomly divided into two groups: Ten patients who received CRRT with a polysulfone membrane hemofilter (PS group) and nine patients who received CRRT with a PMMA membrane (PMMA group). Blood samples were collected from the radial or brachial artery at five different time points. Comparisons between the PS, PMMA, and NHD groups revealed a significant main effect of time on changes in serum IL-6 and IL-8 concentrations (p < 0.01) and an interaction (p < 0.05) between time and group. Plasma IL-6 and IL-8 levels after surgery were significantly lower in the PMMA group than in the PS group, while other cytokines measured in this study were not significantly different. In addition, clinical outcomes were not significantly different between the groups. The continuous use of PMMA-CRRT throughout the perioperative period suppressed serum IL-6 and IL-8 concentrations, although there were no differences in clinical outcomes.

  17. Fetal growth and later maternal death, cardiovascular disease and diabetes

    DEFF Research Database (Denmark)

    Lykke, Jacob A; Paidas, Michael J; Triche, Elizabeth W

    2012-01-01

    Low birthweight of the offspring has been associated with increased risk of early death and ischemic heart disease in the mother. However, other measurements of fetal growth than the basic birthweight are more accurate. We investigated the relation between the standardized birthweight by gestatio......Low birthweight of the offspring has been associated with increased risk of early death and ischemic heart disease in the mother. However, other measurements of fetal growth than the basic birthweight are more accurate. We investigated the relation between the standardized birthweight...... by gestational age and gender and the ponderal index and the mother's subsequent mortality and cardiovascular morbidity....

  18. Fetal MRI: An approach to practice: A review

    Directory of Open Access Journals (Sweden)

    Sahar N. Saleem

    2014-09-01

    Full Text Available MRI has been increasingly used for detailed visualization of the fetus in utero as well as pregnancy structures. Yet, the familiarity of radiologists and clinicians with fetal MRI is still limited. This article provides a practical approach to fetal MR imaging. Fetal MRI is an interactive scanning of the moving fetus owed to the use of fast sequences. Single-shot fast spin-echo (SSFSE T2-weighted imaging is a standard sequence. T1-weighted sequences are primarily used to demonstrate fat, calcification and hemorrhage. Balanced steady-state free-precession (SSFP, are beneficial in demonstrating fetal structures as the heart and vessels. Diffusion weighted imaging (DWI, MR spectroscopy (MRS, and diffusion tensor imaging (DTI have potential applications in fetal imaging. Knowing the developing fetal MR anatomy is essential to detect abnormalities. MR evaluation of the developing fetal brain should include recognition of the multilayered-appearance of the cerebral parenchyma, knowledge of the timing of sulci appearance, myelination and changes in ventricular size. With advanced gestation, fetal organs as lungs and kidneys show significant changes in volume and T2-signal. Through a systematic approach, the normal anatomy of the developing fetus is shown to contrast with a wide spectrum of fetal disorders. The abnormalities displayed are graded in severity from simple common lesions to more complex rare cases. Complete fetal MRI is fulfilled by careful evaluation of the placenta, umbilical cord and amniotic cavity. Accurate interpretation of fetal MRI can provide valuable information that helps prenatal counseling, facilitate management decisions, guide therapy, and support research studies.

  19. Transitional change in rat fetal cell proliferation in response to ghrelin and des-acyl ghrelin during the last stage of pregnancy

    Energy Technology Data Exchange (ETDEWEB)

    Inoue, Yoshiyuki; Nakahara, Keiko [Department of Veterinary Physiology, Faculty of Agriculture, University of Miyazaki, Miyazaki 889-2192 (Japan); Kangawa, Kenji [Department of Biochemistry, National Cardiovascular Center Research Institute, Fujishirodai 5-7-1, Suita, Osaka 565-8565 (Japan); Murakami, Noboru, E-mail: a0d201u@cc.miyazaki-u.ac.jp [Department of Veterinary Physiology, Faculty of Agriculture, University of Miyazaki, Miyazaki 889-2192 (Japan)

    2010-03-12

    Expression of mRNA for the ghrelin receptor, GHS-R1a, was detected in various peripheral and central tissues of fetal rats, including skin, bone, heart, liver, gut, brain and spinal cord, on embryonic day (ED)15 and ED17. However, its expression in skin, bone, heart and liver, but not in gut, brain and spinal cord, became relatively weak on ED19 and disappeared after birth (ND2). Ghrelin and des-acyl ghrelin facilitated the proliferation of cultured fetal (ED17, 19), but not neonatal (ND2), skin cells. On the other hand, with regard to cells from the spinal cord and hypothalamus, the proliferative effect of ghrelin continued after birth, whereas the effect of des-acyl ghrelin on neurogenesis in these tissues was lost at the ED19 fetal and ND2 neonatal stages. Immunohistochemistry revealed that the cells in the hypothalamus induced to proliferate by ghrelin at the ND2 stage were positive for nestin and glial fibrillary acidic protein. These results suggest that in the period immediately prior to, and after birth, rat fetal cells showing proliferation in response to ghrelin and des-acyl ghrelin are at a transitional stage characterized by alteration of the expression of GHS-R1a and an undefined des-acyl ghrelin receptor, their responsiveness varying among different tissues.

  20. Continuation versus discontinuation of oxytocin in the active phase of labour

    DEFF Research Database (Denmark)

    Bor, Isil Pinar; Ledertoug, Susanne; Boie, Sidsel

    2016-01-01

    ). The incidence of fetal heart rate abnormalities (51 versus 20%) and uterine hyperstimulation (12 versus 2%) was significantly greater in the continued than the discontinued oxytocin group. The incidence of tachysystole, caesarean deliveries, postpartum haemorrhage, third degree perineal tears and adverse......: The primary outcome was duration of the active phase of labour, defined as the time period from 5 cm of cervical dilation until delivery. Secondary outcomes were mode of delivery, uterine tachysystole, hyperstimulation, abnormalities in fetal heart rate, postpartum haemorrhage rate, perineal tears......OBJECTIVE: To investigate whether discontinuation of oxytocin infusion increases the duration of the active phase of labour and reduces maternal and neonatal complications. DESIGN: Randomised controlled trial. SETTING: Department of Obstetrics and Gynaecology, Regional Hospital of Randers, Denmark...

  1. 76 FR 38109 - National Advisory Council on Maternal, Infant and Fetal Nutrition: Notice of Meeting

    Science.gov (United States)

    2011-06-29

    ... Food and Nutrition Service National Advisory Council on Maternal, Infant and Fetal Nutrition: Notice of... National Advisory Council on Maternal, Infant and Fetal Nutrition. DATES: Date and Time: July 19-21, 2011... Maternal, Infant, and Fetal Nutrition will meet to continue its study of the Special Supplemental Nutrition...

  2. Heart Health - Brave Heart

    Science.gov (United States)

    ... Bar Home Current Issue Past Issues Cover Story Heart Health Brave Heart Past Issues / Winter 2009 Table of Contents For ... you can have a good life after a heart attack." Lifestyle Changes Surviving—and thriving—after such ...

  3. Health-care encounters create both discontinuity and continuity in daily life when living with chronic heart failure—A grounded theory study

    Science.gov (United States)

    Östman, Malin; Ung, Eva Jakobsson; Falk, Kristin

    2015-01-01

    Living with chronic heart failure (CHF) often involves lifelong contact with health care, more or less frequently, depending on fluctuating health-generating disruptions in everyday life. To reduce the influence on continuity in life, health-care professionals should preferably focus on supporting patients in managing their daily lives, based on their perspective. The aim of this study was to describe how the interaction in health-care encounters contributes to either continuity or discontinuity in the daily life for persons with CHF. Interviews with 18 participants were carried out, using the grounded theory method, through data collection and analysis. Two core concepts were constructed from data which reveal a model that illuminates the characteristics of the encounters, the actions of health-care professionals and the normative discourse. Patient-centred agenda consists of the categories: “Experiencing a subordinate approach,” “Objectifying during the encounter” and “Expected to be compliant.” This describes how health-care professionals enhance discontinuity in daily life by using a paternalistic approach in the encounter. Person-centred agenda consists of the categories: “Experiencing an empowering approach,” “Person-centredness during the encounter” and “Expected to be capable.” It describes how participants perceive that health-care professionals enable them to deal with everyday life which enhances continuity. The findings highlight the importance of health-care professionals’ attitudes and communication in encounters with patients. Health care must be designed to support and promote patients’ own strategic thinking by strengthening their self-image to enhance continuity in everyday life. The experience of discontinuity is based on the prevailing health-care culture which focuses on disease and medical treatment and regards it as superior to the illness experience in an everyday life context. We therefore strongly suggest a

  4. Power Spectral Analysis of Short-Term Heart Rate Variability in Healthy and Arrhythmia Subjects by the Adaptive Continuous Morlet Wavelet Transform

    Directory of Open Access Journals (Sweden)

    Ram Sewak SINGH

    2017-12-01

    Full Text Available Power spectral analysis of short-term heart rate variability (HRV can provide instant valuable information to understand the functioning of autonomic control over the cardiovascular system. In this study, an adaptive continuous Morlet wavelet transform (ACMWT method has been used to describe the time-frequency characteristics of the HRV using band power spectra and the median value of interquartile range. Adaptation of the method was based on the measurement of maximum energy concentration. The ACMWT has been validated on synthetic signals (i.e. stationary, non-stationary as slow varying and fast changing frequency with time modeled as closest to dynamic changes in HRV signals. This method has been also tested in the presence of additive white Gaussian noise (AWGN to show its robustness towards the noise. From the results of testing on synthetic signals, the ACMWT was found to be an enhanced energy concentration estimator for assessment of power spectral of short-term HRV time series compared to adaptive Stockwell transform (AST, adaptive modified Stockwell transform (AMST, standard continuous Morlet wavelet transform (CMWT and Stockwell transform (ST estimators at statistical significance level of 5%. Further, the ACMWT was applied to real HRV data from Fantasia and MIT-BIH databases, grouped as healthy young group (HYG, healthy elderly group (HEG, arrhythmia controlled medication group (ARCMG, and supraventricular tachycardia group (SVTG subjects. The global results demonstrate that spectral indices of low frequency power (LFp and high frequency power (HFp of HRV were decreased in HEG compared to HYG subjects (p<0.0001. While LFp and HFp indices were increased in ARCMG compared to HEG (p<0.00001. The LFp and HFp components of HRV obtained from SVTG were reduced compared to other group subjects (p<0.00001.

  5. Myocardial fibrosis and pro-fibrotic markers in end-stage heart failure patients during continuous-flow left ventricular assist device support.

    Science.gov (United States)

    Lok, Sjoukje I; Nous, Fay M A; van Kuik, Joyce; van der Weide, Petra; Winkens, Bjorn; Kemperman, Hans; Huisman, Andre; Lahpor, Jaap R; de Weger, Roel A; de Jonge, Nicolaas

    2015-09-01

    During support with a left ventricular assist device (LVAD), partial reverse remodelling takes place in which fibrosis plays an important role. In this study, we analysed the histological changes and expression of fibrotic markers in patients with advanced heart failure (HF) during continuous-flow LVAD (cf-LVAD) support. In 25 patients, myocardial tissue at the time of LVAD implantation (pre-LVAD) was compared with tissue from the explanted left ventricle (post-LVAD). Interstitial fibrosis and cardiomyocyte size were analysed pre- and post-LVAD. Plasma was obtained from all patients before and during LVAD support. Plasma levels, cardiac mRNA and protein expression of brain natriuretic peptide (BNP), galectin-3 (Gal-3), connective tissue growth factor (CTGF), osteopontin (OPN) and transforming growth factor β-1 were determined. Fibrosis increased during cf-LVAD unloading (P markers remained elevated in comparison with controls. cf-LVAD support is associated with lengthening of cardiomyocytes, without alterations in diameter size. Remarkably, myocardial fibrosis increased as well as circulating pro-fibrotic markers. Whether the morphological changes are a direct effect of reduced pulsatility during cf-LVAD support or due to HF progression requires further investigation. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  6. Infection, Oxidative Stress, and Changes in Circulating Regulatory T Cells of Heart Failure Patients Supported by Continuous-Flow Ventricular Assist Devices.

    Science.gov (United States)

    Mondal, Nandan K; Sobieski, Michael A; Pham, Si M; Griffith, Bartley P; Koenig, Steven C; Slaughter, Mark S; Wu, Zhongjun J

    The objective of this study was to investigate the changes in oxidative stress (OS) and circulating regulatory T cells (Tregs) of the immune system in patients supported by continuous-flow ventricular assist device (CF-VAD) with or without infection. We recruited 16 CF-VAD patients (5 with infection and 11 without infection) and 7 healthy volunteers. Generation of reactive oxygen species (ROS) from lymphocytes, superoxide dismutase (SOD) in erythrocyte, total antioxidant capacity (TAC), and oxidized low-density lipoprotein (oxLDL) in plasma were measured. Circulating Tregs were evaluated by flow cytometry. Heart failure (HF) patients had elevated OS than healthy volunteers as evident from higher lymphocyte ROS, elevated oxLDL, as well as depleted SOD and TAC levels. At baseline, HF patients had decreased percentage of Tregs (5.12 ± 1.5% vs. 8.14 ± 3.01%, p infection illustrated 35% and 44% rise in ROS and oxLDL, respectively, 31% decrease in TAC, and marked rise in percentage of Tregs (14.27 ± 3.17% vs. 9.38 ± 3.41%, p infection. Elevated OS and rise in Tregs were more prominent in CF-VAD patients with infection. In conclusion, OS and compromised immune system may be important indicators of systemic response of the body to CF-VAD among HF patients with infection.

  7. Maternal complications and pregnancy outcome in women with mechanical prosthetic heart valves treated with enoxaparin.

    Science.gov (United States)

    McLintock, C; McCowan, L M E; North, R A

    2009-11-01

    To determine maternal and fetal outcomes in women with mechanical heart valves managed with therapeutic dose enoxaparin during pregnancy. Retrospective audit. Hospital-based high-risk antenatal clinics. Pregnant women with mechanical heart valves attending high-risk antenatal clinics, treated with enoxaparin (1 mg/kg twice daily) during pregnancy. Women with mechanical heart valves treated with enoxaparin at any stage during pregnancy (1997-2008) identified using a database of women with mechanical heart valves attending the high-risk clinics and a prospective database of women prescribed enoxaparin for any indication during pregnancy. Maternal outcomes included thromboembolic and haemorrhagic complications. Pregnancy and fetal outcomes included miscarriage, stillbirth, baby death and live birth, small-for-gestational-age infants, warfarin embryopathy and warfarin-related fetal loss. Thirty-one women underwent 47 pregnancies. In 34 pregnancies (72.3%), anticoagulation was with predominantly enoxaparin and 13 (27.7%) pregnancies women received mainly warfarin, with enoxaparin given in the first trimester and/or peri-delivery. Seven (14.9%) thrombotic complications occurred, of which five (10.6%) were associated with enoxaparin treatment. Non-compliance or sub-therapeutic anti-Xa levels contributed in each case. Antenatal and postpartum haemorrhagic complications occurred in eight (17%) and 15 (32%) pregnancies respectively. Of 35 pregnancies continuing after 20 weeks' gestation, 96% (22/23) of women taking predominantly enoxaparin had a surviving infant compared with 75% (9/12) in women taking primarily warfarin. Four perinatal deaths occurred, three attributable to warfarin. Compliance with therapeutic dose enoxaparin and aspirin during pregnancy in women with mechanical heart valves is associated with a low risk of valve thrombosis and good fetal outcomes, but close monitoring is essential.

  8. Fetal Alcohol Spectrum Disorders

    Science.gov (United States)

    Alcohol can harm your baby at any stage during a pregnancy. That includes the earliest stages, before ... can cause a group of conditions called fetal alcohol spectrum disorders (FASDs). Children who are born with ...

  9. Severely impaired von Willebrand factor-dependent platelet aggregation in patients with a continuous-flow left ventricular assist device (HeartMate II)

    DEFF Research Database (Denmark)

    Klovaite, Jolanta; Gustafsson, Finn; Mortensen, Svend A

    2009-01-01

    OBJECTIVES: This study investigated the influence of the mechanical blood pump HeartMate II (HMII) (Thoratec Corporation, Pleasanton, California) on blood coagulation and platelet function. BACKGROUND: HMII is an implantable left ventricular assist device used for the treatment of heart failure...

  10. Fetal and neonatal responses following maternal exposure to mobile phones

    International Nuclear Information System (INIS)

    Rezk, Ahmed Y.; Abdulqawi, K.; Mustafa, Randa M.; El-Azm, Tark M. Abo; Al-Inany, H.

    2008-01-01

    Objective was to study fetal and neonatal heart rate (HR) and cardiac output (COP), following acute maternal exposure to electromagnetic fields (EMF) emitted by mobile phones. The present study was carried out at Benha University Hospital and El-Shorouq Hospital, Cairo, Egypt, from October 2003 to March 2004, Ninety women with uncomplicated pregnancies aged 18-33 years and 30 full term healthy newborn infants were included. The pregnant mothers were exposed to EMF emitted by mobile telephones while on telephone dialing mode for 10 minutes during pregnancy and after birth. The main outcome was measurements of fetal and neonatal HR and COP. A statistical significant increase in fetal and neonatal HR and statistical significant decrease in stroke volume and COP before and after use of mobile phone were noted. All these changes are attenuated with increase in gestational age. Exposures of pregnant women to mobile phones significantly increase fetal and neonatal HR and significantly decreased the COP. (author)

  11. Bio-magnetic signatures of fetal breathing movement

    International Nuclear Information System (INIS)

    Ulusar, U D; Wilson, J D; Murphy, P; Govindan, R B; Preissl, H; Lowery, C L; Eswaran, H

    2011-01-01

    The purpose of fetal magnetoencephalography (fMEG) is to record and analyze fetal brain activity. Unavoidably, these recordings consist of a complex mixture of bio-magnetic signals from both mother and fetus. The acquired data include biological signals that are related to maternal and fetal heart function as well as fetal gross body and breathing movements. Since fetal breathing generates a significant source of bio-magnetic interference during these recordings, the goal of this study was to identify and quantify the signatures pertaining to fetal breathing movements (FBM). The fMEG signals were captured using superconducting quantum interference devices (SQUIDs) The existence of FBM was verified and recorded concurrently by an ultrasound-based video technique. This simultaneous recording is challenging since SQUIDs are extremely sensitive to magnetic signals and highly susceptible to interference from electronic equipment. For each recording, an ultrasound-FBM (UFBM) signal was extracted by tracing the displacement of the boundary defined by the fetal thorax frame by frame. The start of each FBM was identified by using the peak points of the UFBM signal. The bio-magnetic signals associated with FBM were obtained by averaging the bio-magnetic signals time locked to the FBMs. The results showed the existence of a distinctive sinusoidal signal pattern of FBM in fMEG data

  12. Effects of Continuous Triiodothyronine Infusion on Citric Acid Cycle in the Normal Immature Swine Heart under Extracorporeal Membrane Oxygenation in vivo

    Energy Technology Data Exchange (ETDEWEB)

    Kajimoto, Masaki [Seattle Children' s Research Inst., Seattle, WA (United States); O' Kelly-Priddy, Colleen M. [Seattle Children' s Research Inst., Seattle, WA (United States); Univ. of Washington, Seattle, WA (United States); Ledee, Dolena R. [Seattle Children' s Research Inst., Seattle, WA (United States); Xu, Chun [Seattle Children' s Research Inst., Seattle, WA (United States); Isern, Nancy G. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Olson, Aaron [Seattle Children' s Research Inst., Seattle, WA (United States); Univ. of Washington, Seattle, WA (United States); Portman, Michael A. [Seattle Children' s Research Inst., Seattle, WA (United States); Univ. of Washington, Seattle, WA (United States)

    2014-02-13

    Extracorporeal membrane oxygenation (ECMO) is frequently used in infants with postoperative cardiopulmonary failure. ECMO also suppresses circulating triiodothyronine (T3) levels and modifies myocardial metabolism. We assessed the hypothesis that T3 supplementation reverses ECMO induced metabolic abnormalities in the immature heart. Twenty-two male Yorkshire pigs (age 25-38 days) with ECMO were received [2-13C]lactate, [2,4,6,8-13C]octanoate (medium chain fatty acid) and [U-13C]long-chain fatty acids as metabolic tracers either systemically (totally physiological intracoronary concentration) or directly into the coronary artery (high substrate concentration) for the last 60 minutes of each protocol. Nuclear magnetic resonance (NMR) analysis of left ventricular tissue determined the fractional contribution (Fc) of these substrates to the citric acid cycle (CAC). Fifty percent of the pigs in each group received intravenous T3 supplement (bolus at 0.6 μg/kg and then continuous infusion at 0.2 μg/kg/hour) during ECMO. Under both substrate loading conditions T3 significantly increased lactate-Fc with a marginal increase in octanoate-Fc. Both T3 and high substrate provision increased myocardial energy status indexed by [Phosphocreatine]/[ATP]. In conclusion, T3 supplementation promoted lactate metabolism to the CAC during ECMO suggesting that T3 releases inhibition of pyruvate dehydrogenase. Manipulation of substrate utilization by T3 may be used therapeutically during ECMO to improve resting energy state and facilitate weaning.

  13. Effects of High-Intensity Interval Training versus Continuous Training on Physical Fitness, Cardiovascular Function and Quality of Life in Heart Failure Patients.

    Directory of Open Access Journals (Sweden)

    Nathalie M M Benda

    Full Text Available Physical fitness is an important prognostic factor in heart failure (HF. To improve fitness, different types of exercise have been explored, with recent focus on high-intensity interval training (HIT. We comprehensively compared effects of HIT versus continuous training (CT in HF patients NYHA II-III on physical fitness, cardiovascular function and structure, and quality of life, and hypothesize that HIT leads to superior improvements compared to CT.Twenty HF patients (male:female 19:1, 64±8 yrs, ejection fraction 38±6% were allocated to 12-weeks of HIT (10*1-minute at 90% maximal workload-alternated by 2.5 minutes at 30% maximal workload or CT (30 minutes at 60-75% of maximal workload. Before and after intervention, we examined physical fitness (incremental cycling test, cardiac function and structure (echocardiography, vascular function and structure (ultrasound and quality of life (SF-36, Minnesota living with HF questionnaire (MLHFQ.Training improved maximal workload, peak oxygen uptake (VO2peak related to the predicted VO2peak, oxygen uptake at the anaerobic threshold, and maximal oxygen pulse (all P<0.05, whilst no differences were present between HIT and CT (N.S.. We found no major changes in resting cardiovascular function and structure. SF-36 physical function score improved after training (P<0.05, whilst SF-36 total score and MLHFQ did not change after training (N.S..Training induced significant improvements in parameters of physical fitness, although no evidence for superiority of HIT over CT was demonstrated. No major effect of training was found on cardiovascular structure and function or quality of life in HF patients NYHA II-III.Nederlands Trial Register NTR3671.

  14. Continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in the postoperative period of major heart surgery.

    Science.gov (United States)

    Bouza, Emilio; Pérez, María Jesús; Muñoz, Patricia; Rincón, Cristina; Barrio, José María; Hortal, Javier

    2008-11-01

    Aspiration of endotracheal secretions is a major step in the prevention of ventilator-associated pneumonia (VAP). We compared conventional and continuous aspiration of subglottic secretions (CASS) procedures in ventilated patients after major heart surgery (MHS). Randomized comparison during a 2-year period. A total of 714 patients were randomized (24 patients were excluded from the study; 359 CASS patients; 331 control subjects). The results for CASS patients and control subjects (per protocol and intention-to-treat analysis) were as follows: VAP incidence, 3.6% vs 5.3% (p = 0.2) and 3.8% vs 5.1%, respectively; incidence density, 17.9 vs 27.6 episodes per 1,000 days of mechanical ventilation (MV) [p = 0.18] and 18.9 vs 28.7 episodes per 1,000 days of MV, respectively; hospital antibiotic use in daily defined doses (DDDs), 1,213 vs 1,932 (p 48 h, the comparisons of CASS patients and control subjects were as follows: VAP incidence, 26.7% vs 47.5% (p = 0.04), respectively; incidence density, 31.5 vs 51.6 episodes per 1,000 days of MV, respectively (p = 0.03); median length of ICU stay, 7 vs 16.5 days (p = 0.01), respectively; hospital antibiotic use, 1,206 vs 1,877 DDD (p VAP (relative risk [RR], 6.07; 95% confidence interval [CI], 2.20 to 16.60; p VAP in patients who are at risk. CASS use should be encouraged, at least in patients undergoing MHS.

  15. Right atrial hemangioma in the newborn: Utility of fetal imaging

    International Nuclear Information System (INIS)

    Baird, Christopher; Blalock, Shannon; Bengur, Resai; Ikemba, Catherine

    2012-01-01

    We present a rare primary right atrial tumor diagnosed in-utero with fetal echocardiography, and further characterized as a congenital hemangioma with magnetic resonance imaging. Surgical resection was done six days after birth. This case illustrates the complementary roles of evolving advanced imaging techniques for fetuses and infants with congenital heart disease that allows for surgery early in the neonatal period

  16. True Umbilical Cord Knot Leading to Fetal Demise | Ikechebelu ...

    African Journals Online (AJOL)

    She had onset of labor at a GA of 40 weeks and 5 days following cervical ripening with two courses of 50 μg misoprostol inserted at the posterior fornix 6 h apart. The fetal heart tones were monitored using Doppler sonicaid. They remained normal throughout labor that lasted 13 h. She subsequently had spontaneous vertex ...

  17. SLC9B1 methylation predicts fetal intolerance of labor.

    Science.gov (United States)

    Knight, Anna K; Conneely, Karen N; Kilaru, Varun; Cobb, Dawayland; Payne, Jennifer L; Meilman, Samantha; Corwin, Elizabeth J; Kaminsky, Zachary A; Dunlop, Anne L; Smith, Alicia K

    2018-01-01

    Fetal intolerance of labor is a common indication for delivery by Caesarean section. Diagnosis is based on the presence of category III fetal heart rate tracing, which is an abnormal heart tracing associated with increased likelihood of fetal hypoxia and metabolic acidemia. This study analyzed data from 177 unique women who, during their prenatal visits (7-15 weeks and/or 24-32 weeks) to Atlanta area prenatal care clinics, consented to provide blood samples for DNA methylation (HumanMethylation450 BeadChip) and gene expression (Human HT-12 v4 Expression BeadChip) analyses. We focused on 57 women aged 18-36 (mean 25.4), who had DNA methylation data available from their second prenatal visit. DNA methylation patterns at CpG sites across the genome were interrogated for associations with fetal intolerance of labor. Four CpG sites (P value intolerance of labor. DNA methylation and gene expression were negatively associated when examined longitudinally during pregnancy using a linear mixed-effects model. Positive predictive values of methylation of these four sites ranged from 0.80 to 0.89, while negative predictive values ranged from 0.91 to 0.92. The four CpG sites were also associated with fetal intolerance of labor in an independent cohort (the Johns Hopkins Prospective PPD cohort). Therefore, fetal intolerance of labor could be accurately predicted from maternal blood samples obtained between 24-32 weeks gestation. Fetal intolerance of labor may be accurately predicted from maternal blood samples obtained between 24-32 weeks gestation by assessing DNA methylation patterns of SLC9B1. The identification of pregnant women at elevated risk for fetal intolerance of labor may allow for the development of targeted treatments or management plans.

  18. Does ST analysis of fetal ECG reduce cesarean section rate for fetal distress?

    Science.gov (United States)

    Straface, Gianluca; Scambia, Giovanni; Zanardo, Vincenzo

    2017-08-01

    Each pregravidic, gestational or intrapartum complication may, per se, have a different impact on the operative delivery rate, regardless of which fetal monitoring system was adopted. We wanted to verify if CTG plus ST interval analysis (STAN) of fetal ECG might be able to reduce the number of operative delivery for fetal distress in high-risk pregnancies compared to low-risk women monitored with CTG alone. In this cohort study, we evaluated 100 high-risk pregnancies consecutively with STAN® S31 (Neoventa Medical, Gotenburg, Sweden) and 160 low-risk pregnancies consecutively with continuous CTG (Hewlett Packard, 50 IP, Palo Alto, CA). We found that STAN monitoring, although associated with a higher total operativity rate, both vaginal (11% versus 3.12%, p = 0.015) and cesarean (17% versus 4.37%, p = 0.001), reduced the cesarean section rate performed for fetal distress (29.41% versus 85.71%, p = 0.023) compared with low-risk CTG monitoring group. CTG plus ST interval analysis of fetal ECG reduced the risk of operative cesarean delivery for fetal distress in high-risk gestations.

  19. Assessment of autonomic neurodevelopment in the mouse fetuses by using fetal electrocardiography.

    Science.gov (United States)

    Khandoker, Ahsan H; Al Khoori, Thuraia; Ito, Takuya; Sugibayashi, Rika; Kimura, Yoshitaka

    2016-08-01

    Fetal Electrocardiography (FECG) offers unique capabilities for assessment of beat-to-beat fetal heart rate (FHR) and fetal heart rate variability (FHRV), which are indirect markers of autonomic nervous system, its development. In this study the fetal ECG signals, FHR and FHRV are successfully recorded to assess the neurodevelopment in fetal mice in the second and third trimester from days 12.5 to 18.5 by using direct insertion of fetal ECG electrodes in the uterine. FHR increases from day 12.5 till 15.5 reaching a plateau and then shows a sudden increase on the day 18.5. Development of fetal increasing heart rate variability (FHRV) is clearly evident from the results. Short term FHRV (RMSSD) corresponding to parasympathetic nervous system activity and long term FHRV (SDNN) corresponding to sympathetic and parasympathetic nervous system activities increases till day 16.5 and then decreases from day 17.5. The increases in large fluctuations were noticed on days 17.5 and 18.5, which were thought to have caused by uterine contractions before delivery. The ability to assess FHR and FHRV in fetal mice makes a valuable tool for neurodevelopment research in perinatal medicine.

  20. Development and significance of a fetal electrocardiogram recorded by signal-averaged high-amplification electrocardiography.

    Science.gov (United States)

    Hayashi, Risa; Nakai, Kenji; Fukushima, Akimune; Itoh, Manabu; Sugiyama, Toru

    2009-03-01

    Although ultrasonic diagnostic imaging and fetal heart monitors have undergone great technological improvements, the development and use of fetal electrocardiograms to evaluate fetal arrhythmias and autonomic nervous activity have not been fully established. We verified the clinical significance of the novel signal-averaged vector-projected high amplification ECG (SAVP-ECG) method in fetuses from 48 gravidas at 32-41 weeks of gestation and in 34 neonates. SAVP-ECGs from fetuses and newborns were recorded using a modified XYZ-leads system. Once noise and maternal QRS waves were removed, the P, QRS, and T wave intervals were measured from the signal-averaged fetal ECGs. We also compared fetal and neonatal heart rates (HRs), coefficients of variation of heart rate variability (CV) as a parasympathetic nervous activity, and the ratio of low to high frequency (LF/HF ratio) as a sympathetic nervous activity. The rate of detection of a fetal ECG by SAVP-ECG was 72.9%, and the fetal and neonatal QRS and QTc intervals were not significantly different. The neonatal CVs and LF/HF ratios were significantly increased compared with those in the fetus. In conclusion, we have developed a fetal ECG recording method using the SAVP-ECG system, which we used to evaluate autonomic nervous system development.

  1. Normal ranges for fetal electrocardiogram values for the healthy fetus of 18-24 weeks of gestation: a prospective cohort study.

    Science.gov (United States)

    Verdurmen, Kim M J; Lempersz, Carlijn; Vullings, Rik; Schroer, Christian; Delhaas, Tammo; van Laar, Judith O E H; Oei, S Guid

    2016-08-17

    The fetal anomaly ultrasound only detects 65 to 81 % of the patients with congenital heart disease, making it the most common structural fetal anomaly of which a significant part is missed during prenatal life. Therefore, we need a reliable non-invasive diagnostic method which improves the predictive value for congenital heart diseases early in pregnancy. Fetal electrocardiography could be this desired diagnostic method. There are multiple technical challenges to overcome in the conduction of the fetal electrocardiogram. In addition, interpretation is difficult due to the organisation of the fetal circulation in utero. We want to establish the normal ranges and values of the fetal electrocardiogram parameters in healthy fetuses of 18 to 24 weeks of gestation. Women with an uneventful singleton pregnancy between 18 and 24 weeks of gestation are asked to participate in this prospective cohort study. A certified and experienced sonographist performs the fetal anomaly scan. Subsequently, a fetal electrocardiogram recording is performed using dedicated signal processing methods. Measurements are performed at two institutes. We will include 300 participants to determine the normal values and 95 % confidence intervals of the fetal electrocardiogram parameters in a healthy fetus. We will evaluate the fetal heart rate, segment intervals, normalised amplitude and the fetal heart axis. Three months postpartum, we will evaluate if a newborn is healthy through a questionnaire. Fetal electrocardiography could be a promising tool in the screening program for congenital heart diseases. The electrocardiogram is a depiction of the intimate relationship between the cardiac nerve conduction pathways and the structural morphology of the fetal heart, and therefore particularly suitable for the detection of secondary effects due to a congenital heart disease (hypotrophy, hypertrophy and conduction interruption).

  2. Sudden onset congestive heart failure with a continuous murmur: ruptured sinus of Valsalva aneurysm complicated by anomalous origin of the left coronary artery.

    Science.gov (United States)

    Seto, Arnold H; Hermer, Alan; Kern, Morton

    2008-01-01

    Ruptured sinus of Valsalva aneurysm is an unusual cause for congestive heart failure, and anomalous coronary arteries have rarely been found in association. A 47-year-old man developed sudden onset heart failure due to a ruptured noncoronary sinus of Valsalva fistula to the right atrium. Coronary angiography revealed an anomalous left coronary artery arising from the right coronary sinus, limiting percutaneous options for repair. We review the incidence, complications, and management of sinus of Valsalva aneurysms and anomalous left coronary arteries.

  3. Ultrasound diagnosis and monitoring of fetal tachyarrhythmias

    Directory of Open Access Journals (Sweden)

    Yu.А. Ivaniv

    2017-12-01

    Full Text Available The aim – to evaluate the efficiency of prenatal echocardiography in detecting, differential diagnosis and monitoring fetuses with tachyarrhythmias. Materials and methods. Investigations performed in a single center from April 1996 to July 2016 were analysed. During this study 2,073 pregnant women were examined and 213 cases of fetal arrhythmia were found (10.3 %. Prenatal echocardiography was conducted by general protocol, each examination were fixed and saved in electronic and paper form. Results. During this period 25 cases of fetal tachyarrhythmias were diagnosed, representing 11.7 % of all cases of arrhythmia and 1.2 % of all fetal heart examinations. In five fetuses tachyarrhythmia was combined with structural heart disorders, which constitutes 20 % among all tachyarrhythmias. Most fetal tachyarrhythmias (21 were diagnosed during third trimester of pregnancy. The most common fetal tachyarrhythmia was atrioventricular «re-entry» tachycardia – 14 cases (56 %. None case of this group was combined with structural cardiac pathology, however, almost half were accompanied by hemodynamic complications. Drug treatment was effective in this group. Atrial fibrillation was second prevalent in our study, 4 cases (16 % – dangerous arrhythmia, which in most fetuses caused circulatory failure, being combined with congenital heart defect or myocardial pathology. Drug treatment in this group is less effective, depending on comorbidity and age pregnancy. We diagnosed 4 cases of sinus tachycardia (16 %, largely having benign course in the prenatal period and not requiring drug treatment. Prognosis of pregnancy is determined by concomitant diseases of the fetus. One case (4 % of atrial flutter required preterm delivery through the hemodynamic complications. Ectopic atrial tachycardia was diagnosed in two fetuses (8 %. This arrhythmia is insensitive to medical treatment and may persist after birth. Conclusions. Clinical management of pregnancy, the need

  4. An efficient unsupervised fetal QRS complex detection from abdominal maternal ECG.

    Science.gov (United States)

    Varanini, M; Tartarisco, G; Billeci, L; Macerata, A; Pioggia, G; Balocchi, R

    2014-08-01

    Non-invasive fetal heart rate is of great relevance in clinical practice to monitor fetal health state during pregnancy. To date, however, despite significant advances in the field of electrocardiography, the analysis of abdominal fetal ECG is considered a challenging problem for biomedical and signal processing communities. This is mainly due to the low signal-to-noise ratio of fetal ECG and difficulties in cancellation of maternal QRS complexes, motion and electromyographic artefacts. In this paper we present an efficient unsupervised algorithm for fetal QRS complex detection from abdominal multichannel signal recordings combining ICA and maternal ECG cancelling, which outperforms each single method. The signal is first pre-processed to remove impulsive artefacts, baseline wandering and power line interference. The following steps are then applied: maternal ECG extraction through independent component analysis (ICA); maternal QRS detection; maternal ECG cancelling through weighted singular value decomposition; enhancing of fetal ECG through ICA and fetal QRS detection. We participated in the Physionet/Computing in Cardiology Challenge 2013, obtaining the top official scores of the challenge (among 53 teams of participants) of event 1 and event 2 concerning fetal heart rate and fetal interbeat intervals estimation section. The developed algorithms are released as open-source on the Physionet website.

  5. Heart murmurs

    Science.gov (United States)

    Chest sounds - murmurs; Heart sounds - abnormal; Murmur - innocent; Innocent murmur; Systolic heart murmur; Diastolic heart murmur ... The heart has 4 chambers: Two upper chambers (atria) Two lower chambers (ventricles) The heart has valves that close ...

  6. Fetal tissue research: an ongoing story of professionally responsible success.

    Science.gov (United States)

    Gelber, Shari E; McCullough, Laurence B; Chervenak, Frank A

    2015-12-01

    Therapies derived from fetal tissue research are some of the greatest success stories in medicine. Research using fetal tissue has allowed for development of vaccines for numerous diseases including polio, rubella, and measles. These vaccines have saved countless lives, improved quality of life, and decreased the need for induced abortion secondary to congenital infection. Research using cell lines derived from fetal tissue has assisted in better understanding disease pathogenesis and has served to produce human proteins as research reagents and therapies. Ongoing research points to the potential for fetal tissue to be used to cure debilitating diseases such as Parkinson disease. These scientific and medical advances are dependent on the use of fetal tissue from aborted fetuses. While the practice of induced abortion despite societal benefit may be theologically objectionable to some, these practices are professionally responsible. Federal regulations exist to discourage patients from being influenced by the societal benefit of fetal research in arriving at the decision to terminate as well as to prevent researchers from influencing a patient's decision. After a patient has chosen termination of pregnancy, it is consistent with professional responsibility to allow her to choose the disposition of the cadaveric fetal tissue. While some may view induced abortion and societal benefit from this practice as an ethical burden, the principle of justice makes it ethically obligatory to bear this ethical burden. The success story of cadaveric fetal tissue research and treatment should continue unhindered, to fulfill professional responsibility to current and future patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Maternal attitudes to fetal monitoring.

    Science.gov (United States)

    Hansen, P K; Smith, S F; Nim, J; Neldam, S; Osler, M

    1985-07-01

    During a randomized clinical trial concerning alternative methods of intrapartum fetal surveillance (electronic fetal monitoring (EFM) and auscultation (AUS)) an investigatory interview was carried out. Out of 655 expecting mothers the antepartum preference of EFM was 39.5%, of AUS 32.3% and 28.1% were undecided (UD). EFM was especially preferred by obstetrical high-risk patients. Reasons for preference of AUS were a natural childbirth, a non-technological milieu, and the lack of supposed discomfort from sensors and belts. The pregnant women found as major advantages of EFM continuous observation and the possibility of quick intervention. Postpartum 385 patients were again interviewed. The majority upheld the original preference if that method was used. If the non-preferred method had been applied many would stick to the primary preference although a tendency to prefer the experienced method was seen. The patients who antepartum preferred AUS, but had EFM, became more positive toward the method, and a significantly increased number were positively influenced by the EFM signal/trace and found the method promoting their partner's involvement in labor. Enforced immobility, however, was a major disadvantage as well as the technical milieu. If EFM is to be accepted by a majority of women giving birth it is necessary to increase the pregnant women's knowledge of the method and to take milieu factors into consideration in order to reduce the intrinsic depersonalization of EFM.

  8. Improvement in rheumatic fever and rheumatic heart disease management and prevention using a health centre-based continuous quality improvement approach.

    Science.gov (United States)

    Ralph, Anna P; Fittock, Marea; Schultz, Rosalie; Thompson, Dale; Dowden, Michelle; Clemens, Tom; Parnaby, Matthew G; Clark, Michele; McDonald, Malcolm I; Edwards, Keith N; Carapetis, Jonathan R; Bailie, Ross S

    2013-12-18

    Rheumatic heart disease (RHD) remains a major health concern for Aboriginal Australians. A key component of RHD control is prevention of recurrent acute rheumatic fever (ARF) using long-term secondary prophylaxis with intramuscular benzathine penicillin (BPG). This is the most important and cost-effective step in RHD control. However, there are significant challenges to effective implementation of secondary prophylaxis programs. This project aimed to increase understanding and improve quality of RHD care through development and implementation of a continuous quality improvement (CQI) strategy. We used a CQI strategy to promote implementation of national best-practice ARF/RHD management guidelines at primary health care level in Indigenous communities of the Northern Territory (NT), Australia, 2008-2010. Participatory action research methods were employed to identify system barriers to delivery of high quality care. This entailed facilitated discussion with primary care staff aided by a system assessment tool (SAT). Participants were encouraged to develop and implement strategies to overcome identified barriers, including better record-keeping, triage systems and strategies for patient follow-up. To assess performance, clinical records were audited at baseline, then annually for two years. Key performance indicators included proportion of people receiving adequate secondary prophylaxis (≥80% of scheduled 4-weekly penicillin injections) and quality of documentation. Six health centres participated, servicing approximately 154 people with ARF/RHD. Improvements occurred in indicators of service delivery including proportion of people receiving ≥40% of their scheduled BPG (increasing from 81/116 [70%] at baseline to 84/103 [82%] in year three, p = 0.04), proportion of people reviewed by a doctor within the past two years (112/154 [73%] and 134/156 [86%], p = 0.003), and proportion of people who received influenza vaccination (57/154 [37%] to 86/156 [55%], p

  9. Human fetal anatomy: MR imaging.

    Science.gov (United States)

    Weinreb, J C; Lowe, T; Cohen, J M; Kutler, M

    1985-12-01

    Twenty-four pregnant women carrying 26 fetuses (two sets of twins) were imaged with magnetic resonance (MR) imaging at 0.35 T following sonographic evaluation. Each study was retrospectively evaluated to determine which of 33 normal fetal structures were visible on the images and which imaging parameters were most useful for depicting fetal anatomy. Fetal motion degraded fetal images in all but two cases, both with oligohydramnios and in the third trimester of gestation. Nevertheless, many fetal structures were identifiable, particularly in the third trimester. Visualization of fetal anatomy improved with intravenous maternal sedation in five cases. Relatively T1-weighted images occasionally offered the advantage of less image degradation owing to fetal motion and improved contrast between different fetal structures. More T2 weighting was believed to be advantageous in one case for outlining the fetal head and in one case for delineation of the brain. In many cases, structures were similarly identifiable (though with different signal intensities) regardless of the parameters selected. The authors conclude that MR imaging of many fetal structures is currently unsatisfactory and is probably of limited value, particularly in the first and second trimesters. However, the relative frequency and detail with which the fetal head and liver can be depicted indicate that these may be areas for further investigation, and the potential utility of imaging fetal fat warrants further investigation.

  10. Fetal alcohol syndrome

    Science.gov (United States)

    ... you are pregnant or trying to get pregnant. Prevention Avoiding alcohol during pregnancy prevents FAS. Counseling can help women ... the A.D.A.M. Editorial team. Fetal Alcohol Spectrum Disorders Read more ... HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A. ...

  11. Evidence of cardiac involvement in the fetal inflammatory response syndrome: disruption of gene networks programming cardiac development in nonhuman primates.

    Science.gov (United States)

    Mitchell, Timothy; MacDonald, James W; Srinouanpranchanh, Sengkeo; Bammler, Theodor K; Merillat, Sean; Boldenow, Erica; Coleman, Michelle; Agnew, Kathy; Baldessari, Audrey; Stencel-Baerenwald, Jennifer E; Tisoncik-Go, Jennifer; Green, Richard R; Gale, Michael J; Rajagopal, Lakshmi; Adams Waldorf, Kristina M

    2018-04-01

    Most early preterm births are associated with intraamniotic infection and inflammation, which can lead to systemic inflammation in the fetus. The fetal inflammatory response syndrome describes elevations in the fetal interleukin-6 level, which is a marker for inflammation and fetal organ injury. An understanding of the effects of inflammation on fetal cardiac development may lead to insight into the fetal origins of adult cardiovascular disease. The purpose of this study was to determine whether the fetal inflammatory response syndrome is associated with disruptions in gene networks that program fetal cardiac development. We obtained fetal cardiac tissue after necropsy from a well-described pregnant nonhuman primate model (pigtail macaque, Macaca nemestrina) of intrauterine infection (n=5) and controls (n=5). Cases with the fetal inflammatory response syndrome (fetal plasma interleukin-6 >11 pg/mL) were induced by either choriodecidual inoculation of a hypervirulent group B streptococcus strain (n=4) or intraamniotic inoculation of Escherichia coli (n=1). RNA and protein were extracted from fetal hearts and profiled by microarray and Luminex (Millipore, Billerica, MA) for cytokine analysis, respectively. Results were validated by quantitative reverse transcriptase polymerase chain reaction. Statistical and bioinformatics analyses included single gene analysis, gene set analysis, Ingenuity Pathway Analysis (Qiagen, Valencia, CA), and Wilcoxon rank sum. Severe fetal inflammation developed in the context of intraamniotic infection and a disseminated bacterial infection in the fetus. Interleukin-6 and -8 in fetal cardiac tissues were elevated significantly in fetal inflammatory response syndrome cases vs controls (P1.5-fold change, Pfetal heart (analysis of variance). Altered expression of select genes was validated by quantitative reverse transcriptase polymerase chain reaction that included several with known functions in cardiac injury, morphogenesis, angiogenesis

  12. Congenital heart defects in europe: prevalence and perinatal mortality, 2000 to 2005

    DEFF Research Database (Denmark)

    Dolk, Helen; Loane, Maria; Garne, Ester

    2011-01-01

    This study determines the prevalence of Congenital Heart Defects (CHD), diagnosed prenatally or in infancy, and fetal and perinatal mortality associated with CHD in Europe.......This study determines the prevalence of Congenital Heart Defects (CHD), diagnosed prenatally or in infancy, and fetal and perinatal mortality associated with CHD in Europe....

  13. Fetal magnetic resonance imaging. Diagnostics in congenital diaphragmatic hernia; Fetale Magnetresonanztomographie. Diagnostik bei kongenitaler Zwerchfellhernie

    Energy Technology Data Exchange (ETDEWEB)

    Kilian, A.K.; Buesing, K.A.; Neff, K.W. [Fakultaet fuer Klinische Medizin der Universitaet Heidelberg, Institut fuer Klinische Radiologie, Universitaetsklinikum Mannheim (Germany); Schaible, T. [Fakultaet fuer Klinische Medizin der Universitaet Heidelberg, Kinderklinik, Universitaetsklinikum Mannheim (Germany)

    2006-02-15

    Ultrasonography is the primary imaging modality for the evaluation of fetal or maternal anomalies. This method is safe, relatively inexpensive, easily accessible, and allows real-time imaging. Continuous technical improvements in ultrasonography in the last 10-15 years have led to improved diagnostic accuracy for fetal malformations. In cases of complex anomalies magnetic resonance imaging (MRI) can provide additional information. MRI has evolved as a valuable diagnostic method for evaluating fetal pathology. Particularly with regard to similarity of liver and lung parenchyma in ultrasonography, diagnosis of congenital diaphragmatic hernia (CDH) can be difficult. Beside morphological aspects, e.g., herniation of abdominal contents into the chest, small amounts of compressed lung can be visualized on MRI. The feasibility of using volumetric measurement on MRI may be helpful to predict high-risk fetuses and facilitate decisions to assure adequate prenatal and postnatal management to improve postnatal outcome. (orig.) [German] Der Ultraschall dient in der Schwangerschaft routinemaessig als Screeningmethode fuer fetale und maternale Anomalien, da dieser als sicher fuer Kind und Mutter, guenstig, allseits verfuegbar gilt und die Moeglichkeit einer Real-time-Darstellung bietet. Insbesondere aufgrund der Weiterentwicklung in den letzten 10-15 Jahren verfuegt der Ultraschall ueber eine hohe Aussagekraft bzgl. fetaler Fehlbildungen. In einzelnen Faellen, z. B. bei komplexen Fehlbildungen, kann die Magnetresonanztomographie (MRT) suffiziente Zusatzinformationen liefern. Aus diesem Grund hat sich die fetale MRT zur Diagnostik fetaler Fehlbildungen bewaehrt. Die Diagnose einer kongenitalen Zwerchfellhernie (congenital diaphragmatic hernia, CDH) kann im Ultraschall gerade durch sonographische Aehnlichkeit von Leber und Lunge erschwert sein. Im Falle einer CDH bietet die MRT neben der reinen Morphologie, u. a. der Ausdehnung der nach intrathorakal hernierten Abdominalorgane, die

  14. Continuous intravenous infusion of prostaglandin E1 improves myocardial perfusion reserve in patients with ischemic heart disease assessed by positron emission tomography: a pilot study.

    Science.gov (United States)

    Huang, Chi-Lun; Wu, Yen-Wen; Wang, Shoei-Shen; Tseng, Chuen-Den; Chiang, Fu-Tien; Hsu, Kwan-Lih; Lee, Chii-Ming; Tzen, Kai-Yuan

    2011-08-01

    Recent investigation has demonstrated that prostaglandin E(1) (PGE(1)) therapy increased capillary density in explanted hearts. Dynamic (13)N-ammonia positron emission tomography (PET) is reliable for non-invasive measurement of myocardial blood flow and myocardial perfusion reserve (MPR). The aim of this study was to investigate the effects of PGE(1) therapy during 4 weeks on reduction of myocardial perfusion abnormalities and increase of MPR in the patients with ischemic heart disease. In this double-blind, placebo-controlled trial, we randomly assigned 11 patients who had symptomatic heart failure and documented myocardial ischemia to 4 weeks intravenous infusion of PGE(1) (2.5 ng/kg/min; 8 patients, age 60 ± 13 years) or saline (3 patients, age 57 ± 13 years). Dynamic (13)N-ammonia PET scans at rest and during adenosine stress were obtained at baseline and 12 weeks after treatment completion. Quantitative size/severity of perfusion defects and MPR change from baseline to follow-up PET were determined using a 17-segment model. Compared with the control group, baseline MPR in the PGE(1) group was significantly lower (1.96 ± 0.78 vs. 2.71 ± 0.73; P ischemic heart disease. This may be an attractive therapeutic approach for no-option patients with severe ischemic cardiomyopathy.

  15. Continuous intravenous infusion of prostaglandin E1 improves myocardial perfusion reserve in patients with ischemic heart disease assessed by positron emission tomography. A pilot study

    International Nuclear Information System (INIS)

    Huang Chilun; Wu Yenwen; Wang Shoeishen; Tseng Chuenden; Chiang Futien; Lee Chiiming; Tzen Kaiyuan; Hsu Kwanlih

    2011-01-01

    Recent investigation has demonstrated that prostaglandin E 1 (PGE 1 ) therapy increased capillary density in explanted hearts. Dynamic 13 N-ammonia positron emission tomography (PET) is reliable for non-invasive measurement of myocardial blood flow and myocardial perfusion reserve (MPR). The aim of this study was to investigate the effects of PGE 1 therapy during 4 weeks on reduction of myocardial perfusion abnormalities and increase of MPR in the patients with ischemic heart disease. In this double-blind, placebo-controlled trial, we randomly assigned 11 patients who had symptomatic heart failure and documented myocardial ischemia to 4 weeks intravenous infusion of PGE 1 (2.5 ng/kg/min; 8 patients, age 60±13 years) or saline (3 patients, age 57±13 years). Dynamic 13 N-ammonia PET scans at rest and during adenosine stress were obtained at baseline and 12 weeks after treatment completion. Quantitative size/severity of perfusion defects and MPR change from baseline to follow-up PET were determined using a 17-segment model. Compared with the control group, baseline MPR in the PGE 1 group was significantly lower (1.96±0.78 vs. 2.71±0.73; P 1 infusion (1.96±0.78 to 2.16±0.77; P 1 infusion sustained MPR improvement in patients with ischemic heart disease. This may be an attractive therapeutic approach for no-option patients with severe ischemic cardiomyopathy. (author)

  16. Real-time 3-dimensional fetal echocardiography with an instantaneous volume-rendered display: early description and pictorial essay.

    Science.gov (United States)

    Sklansky, Mark S; DeVore, Greggory R; Wong, Pierre C

    2004-02-01

    Random fetal motion, rapid fetal heart rates, and cumbersome processing algorithms have limited reconstructive approaches to 3-dimensional fetal cardiac imaging. Given the recent development of real-time, instantaneous volume-rendered sonographic displays of volume data, we sought to apply this technology to fetal cardiac imaging. We obtained 1 to 6 volume data sets on each of 30 fetal hearts referred for formal fetal echocardiography. Each volume data set was acquired over 2 to 8 seconds and stored on the system's hard drive. Rendered images were subsequently processed to optimize translucency, smoothing, and orientation and cropped to reveal "surgeon's eye views" of clinically relevant anatomic structures. Qualitative comparison was made with conventional fetal echocardiography for each subject. Volume-rendered displays identified all major abnormalities but failed to identify small ventricular septal defects in 2 patients. Important planes and views not visualized during the actual scans were generated with minimal processing of rendered image displays. Volume-rendered displays tended to have slightly inferior image quality compared with conventional 2-dimensional images. Real-time 3-dimensional echocardiography with instantaneous volume-rendered displays of the fetal heart represents a new approach to fetal cardiac imaging with tremendous clinical potential.

  17. Pulsed-wave tissue Doppler echocardiography for the analysis of fetal cardiac arrhythmias.

    Science.gov (United States)

    Tutschek, B; Schmidt, K G

    2011-10-01

    Rhythm analysis of the fetal heart is hampered by the inability to routinely obtain electrocardiographic recordings of the fetus. Doppler studies of fetal cardiac tissue movements, assessing cardiac movements both qualitatively and quantitatively, have recently been described. We used a conventional high-resolution ultrasound system to obtain rhythm data from pulsed-wave tissue Doppler signals of the fetal heart in normal cardiac rhythm and in a variety of fetal cardiac arrhythmias. Fifty-five fetuses with normal (sinus) rhythm, 45 fetuses with rhythm disturbances and two neonates (one with arrhythmia and one with normal sinus rhythm) were studied. Using a conventional high-resolution ultrasound system equipped for fetal studies, but without specific tissue Doppler hardware or software, we performed pulsed-wave tissue Doppler echocardiography (PW-TDE) of atrioventricular valve ring excursions to study the atrial and ventricular mechanical actions. In the neonates, electrocardiograms were also recorded. PW-TDE in normal fetuses shows a typical pattern of tissue motion parallel to the long axis of the heart and in the opposite direction to the blood flow, both in systole and diastole. This pattern is easily obtained from the tricuspid valve annulus in normal sinus rhythm and shows characteristic changes in various fetal arrhythmias. PW-TDE of atrioventricular valve annulus movement patterns may prove to be a valuable additional tool for assessing fetal cardiac arrhythmias. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

  18. Massive fetomaternal hemorrhage as a cause of severe fetal anemia

    Directory of Open Access Journals (Sweden)

    Dobrosavljević Aleksandar

    2016-01-01

    Full Text Available Introduction. Fetomaternal hemorrhage (FMH is a transfu-sion of fetal blood into the maternal circulation. A volume of transfused fetal blood required to cause severe, life-threatening fetal anemia, is not clearly defined. Some authors suggest vol-umes of 80 mL and 150 mL as a threshold which defines mas-sive FMH. Therefore, a rate of massive FMH is 1 : 1,000 and 1 : 5,000 births, respectively. Fetal and neonatal anemia is one of the most serious complications of the FMH. Clinical manifesta-tions of FMH are nonspecific, and mostly it presented as re-duced fetal movements and changes in cardiotocography (CTG. The standard for diagnosing FMH is Kleihaurer-Betke test. Case report. A 34-year-old gravida (G 1, para (P 1 was hospitalized due to uterine contractions at 39 weeks of gesta-tion. CTG monitoring revealed sinusoidal fetal heart rate and clinical examination showed complete cervical dilatation. Im-mediately after admission, the women delivered vaginally. Ap-gar scores were 1 and 2 at the first and fifth minute, respec-tively. Immediately baby was intubated and mechanical ventila-tion started. Initial analysis revealed pronounced acidosis and severe anemia. The patient received intravenous fluid therapy with sodium-bicarbonate as well as red cell transfusion. With all measures, the condition of the baby improved with normaliza-tion of hemoglobin level and blood pH. Kleihaurer-Betke test revealed the presence of fetal red cells in maternal circulation, equivalent to 531 mL blood loss. The level of maternal fetal hemoglobin (HbF and elevated alpha fetoprotein also con-firmed the diagnosis of massive FMH. Conclusion. For the successful diagnosis and management of FMH direct commu-nication between the obstetrician and the pediatrician is neces-sary as presented in this report.

  19. Massive fetomaternal hemorrhage as a cause of severe fetal anemia.

    Science.gov (United States)

    Dobrosavljević, Aleksandar; Martić, Jelena; Rakić, Snežana; Pažin, Vladimir; Janković-Ražnatović, Svetlana; Srećković, Svetlana; Dobrosavljević, Branko

    2016-11-01

    Fetomaternal hemorrhage (FMH) is a transfu-sion of fetal blood into the maternal circulation. A volume of transfused fetal blood required to cause severe, life-threatening fetal anemia, is not clearly defined. Some authors suggest vol-umes of 80 mL and 150 mL as a threshold which defines mas-sive FMH. Therefore, a rate of massive FMH is 1 : 1,000 and 1 : 5,000 births, respectively. Fetal and neonatal anemia is one of the most serious complications of the FMH. Clinical manifesta-tions of FMH are nonspecific, and mostly it presented as re-duced fetal movements and changes in cardiotocography (CTG). The standard for diagnosing FMH is Kleihaurer-Betke test. A 34-year-old gravida (G) 1, para (P) 1 was hospitalized due to uterine contractions at 39 weeks of gesta-tion. CTG monitoring revealed sinusoidal fetal heart rate and clinical examination showed complete cervical dilatation. Im-mediately after admission, the women delivered vaginally. Ap-gar scores were 1 and 2 at the first and fifth minute, respec-tively. Immediately baby was intubated and mechanical ventila-tion started. Initial analysis revealed pronounced acidosis and severe anemia. The patient received intravenous fluid therapy with sodium-bicarbonate as well as red cell transfusion. With all measures, the condition of the baby improved with normaliza-tion of hemoglobin level and blood pH. Kleihaurer-Betke test revealed the presence of fetal red cells in maternal circulation, equivalent to 531 mL blood loss. The level of maternal fetal hemoglobin (HbF) and elevated alpha fetoprotein also con-firmed the diagnosis of massive FMH. For the successful diagnosis and management of FMH direct commu-nication between the obstetrician and the pediatrician is neces-sary as presented in this report.

  20. Fetal Vibroacoustic Stimulation in Computerized Cardiotocographic Analysis: The Role of Short-Term Variability and Approximate Entropy

    Directory of Open Access Journals (Sweden)

    Maria Laura Annunziata

    2012-01-01

    Full Text Available The aim of this study was to evaluate the impact of vibroacoustic stimulation (VAS on computerized cardiotocography short-term variability (STV and approximate entropy (ApEn in both low- and high-risk pregnancies. VAS was performed on 121 high- and 95 low-risk pregnancies after 10 minutes of continuous quiet, while their FHR parameters were monitored and recorded by cCTG analysis. Fetal heart rate was recorded using a computer-assisted equipment. Baseline FHR, accelerations, decelerations, STV, long-term irregularity (LTI, ApEn, and fetal movements (FMs were calculated for defined observational periods before VAS and after 10 minutes. Data were also investigated in relationship with the perinatal outcome. In each group of patients, FHR after VAS remained almost unmodified. Fetal movements significantly increased after VAS in both groups. Results show that only in the high-risk pregnancies, the increase of STV and the decrease of ApEn after VAS were significantly associated with favorable perinatal outcomes.

  1. Fetal warfarin syndrome.

    Science.gov (United States)

    Sathienkijkanchai, Achara; Wasant, Pornswan

    2005-11-01

    Fetuses exposed to Warfarin in the first trimester of pregnancy have an increased risk of embryopathy which consists of nasal hypoplasia and stippled epiphyses, known as fetal warfarin syndrome or warfarin embryopathy. We herein report a first case of an infant with fetal warfarin syndrome in Thailand. The patient was an offspring of a 34-year-old mother with history of SLE and arterial embolism for several years. She had an unplanned pregnancy while taking warfarin. The patient developed difficulty breathing in the first few hours after birth from severe nasal hypoplasia. He also had short limbs, brachydactyly, nail hypoplasia, and calcifications in the epiphyseal regions of humeri, femora and vertebrae radiographically. The patient eventually died from respiratory failure at 6 months of age.

  2. Bloqueo auriculoventricular completo fetal

    OpenAIRE

    Bustos,Paola; Santiago,Claudia; Bahamondes,Francisco; Jaramillo,Luis

    2002-01-01

    Uno de los disturbios más graves del ritmo cardíaco fetal es el bloqueo aurículoventricular completo o de 3er grado (BAVC), condición de fácil detección clínica y ecocardiográfica, y muchas veces de altísima mortalidad fetal, que indica la necesidad de intervención terapéutica urgente. Se presenta el caso clínico de una paciente que teniendo el antecedente de un RN anterior con el mismo diagnóstico, se envía a nuestro servicio con bradiarritmia en el feto actual, para realizar estudio y trata...

  3. Fetal varicella syndrome

    Directory of Open Access Journals (Sweden)

    Ramachandra S

    2010-01-01

    Full Text Available Fetal varicella syndrome is a rare condition of the newborn, presenting with cutaneous scars, limb defects and ocular and central nervous system abnormalities. It is due to varicella or zoster developing in the fetus following maternal varicella infection during early pregnancy. We are reporting one such patient who presented with a linear, depressed, erythematous scar over the left forearm and axillary fold, with a history of maternal chicken pox during the first trimester of pregnancy.

  4. Nonprimary Cytomegalovirus Fetal Infection.

    Science.gov (United States)

    Rodrigues, Sofia; Gonçalves, Daniela; Taipa, Ricardo; Rodrigues, Maria do Céu

    2016-04-01

    Cytomegalovirus (CMV) is the most common congenital viral infection, causing hearing, visual and psychomotor impairment. Preexisting maternal CMV immunity substantially reduces, but not eliminates, the risk of fetal infection and affectation. This article is about a case of nonprimary maternal CMV infection during pregnancy, with vertical transmission, resulting in severe fetal affectation. Preconceptional analysis indicated maternal CMV past infection. Pregnancy progressed uneventfully until the 20th week ultrasound (US), which revealed cerebral abnormalities: thin and hyperechogenic cerebral cortex with prominent lateral ventricles, bilateral periventricular hyperechogenicities, cerebellar vermis hypoplasia and absent corpus callosum. The MRI suggested these findings were compatible with congenital infection rather than primary brain malformation.The fetal karyotype was normal. The title of CMV's IgG antibodies almost tripled. Since the first semester, analysis of the polymerase chain reaction (PCR) for CMV DNA in the amniotic fluid was negative. The pregnancy was terminated at 23 weeks. Neuropathological findings at autopsy showed severe brain lesions associated with CMV infection. Thieme Publicações Ltda Rio de Janeiro, Brazil.

  5. Fetal Alcohol Spectrum Disorders.

    Science.gov (United States)

    Williams, Janet F; Smith, Vincent C

    2015-11-01

    Prenatal exposure to alcohol can damage the developing fetus and is the leading preventable cause of birth defects and intellectual and neurodevelopmental disabilities. In 1973, fetal alcohol syndrome was first described as a specific cluster of birth defects resulting from alcohol exposure in utero. Subsequently, research unequivocally revealed that prenatal alcohol exposure causes a broad range of adverse developmental effects. Fetal alcohol spectrum disorder (FASD) is the general term that encompasses the range of adverse effects associated with prenatal alcohol exposure. The diagnostic criteria for fetal alcohol syndrome are specific, and comprehensive efforts are ongoing to establish definitive criteria for diagnosing the other FASDs. A large and growing body of research has led to evidence-based FASD education of professionals and the public, broader prevention initiatives, and recommended treatment approaches based on the following premises:▪ Alcohol-related birth defects and developmental disabilities are completely preventable when pregnant women abstain from alcohol use.▪ Neurocognitive and behavioral problems resulting from prenatal alcohol exposure are lifelong.▪ Early recognition, diagnosis, and therapy for any condition along the FASD continuum can result in improved outcomes.▪ During pregnancy:◦no amount of alcohol intake should be considered safe;◦there is no safe trimester to drink alcohol;◦all forms of alcohol, such as beer, wine, and liquor, pose similar risk; and◦binge drinking poses dose-related risk to the developing fetus. Copyright © 2015 by the American Academy of Pediatrics.

  6. Fetal magnetic resonance: technique applications and normal fetal anatomy

    International Nuclear Information System (INIS)

    Martin, C.; Darnell, A.; Duran, C.; Mellado, F.; Corona, M

    2003-01-01

    Ultrasonography is the preferred diagnostic imaging technique for intrauterine fetal examination. Nevertheless, circumstances sometimes dictate the use of other techniques in order to analyze fetal structures. The advent of ultra rapid magnetic resonance (MR) sequencing has led to the possibility of doing MR fetal studies, since images are obtained in an extradordiarily short time and are not affected by either maternal or fetal movements. It does not employ ionizing radiations, it provides high-contrast images and it can obtain such images in any plane of space without being influenced by either the child bearer's physical characteristics of fetal position. MR provides good quality images of most fetal organs. It is extremely useful in analysing distinct structures, as well as permitting an evaluation of cervical structures, lungs, diaphragms, intra-abdominal and retroperitoneal structures, and fetal extremities. It can also provide useful information regarding the placenta,umbilical cord, amniotic fluid and uterus. The objective of this work is to describe MR technique as applied to intrauterine fetal examination, and to illustrate normal fetal anatomy as manifested by MR and its applications. (Author) 42 refs

  7. Cirugía fetal

    Directory of Open Access Journals (Sweden)

    DR. B. Juan Luis Leiva

    2014-11-01

    Full Text Available El campo de la cirugía fetal es de reciente comienzo y rápida evolución. Con el avance en las herramientas de diagnóstico antenatal, la capacidad de diagnóstico de condiciones fetales susceptibles de ser tratadas in utero ha dado paso a una serie de procedimientos destinados a dar solución a situaciones que, de no ser por estas intervenciones, terminarían en un resultado adverso perinatal. Las técnicas descritas para la terapia fetal incluyen procedimientos percutáneos guiados por ultrasonido, cirugía fetal abierta y cirugía mínimamente invasiva. En este artículo se presentan las diversas condiciones fetales tributarias de cirugía fetal y se discuten las opciones terapéuticas actuales para cada una.

  8. A Case of Alloimmune Thrombocytopenia, Hemorrhagic Anemia-Induced Fetal Hydrops, Maternal Mirror Syndrome, and Human Chorionic Gonadotropin–Induced Thyrotoxicosis

    Directory of Open Access Journals (Sweden)

    Venu Jain

    2013-05-01

    Full Text Available Fetal/neonatal alloimmune thrombocytopenia (FNAIT can be a cause of severe fetal thrombocytopenia, with the common presentation being intracranial hemorrhage in the fetus, usually in the third trimester. A very unusual case of fetal anemia progressed to hydrops. This was further complicated by maternal Mirror syndrome and human chorionic gonadotropin–induced thyrotoxicosis. Without knowledge of etiology, and possibly due to associated cardiac dysfunction, fetal transfusion resulted in fetal demise. Subsequent testing revealed FNAIT as the cause of severe hemorrhagic anemia. In cases with fetal anemia without presence of red blood cell antibodies, FNAIT must be ruled out as a cause prior to performing fetal transfusion. Fetal heart may adapt differently to acute hemorrhagic anemia compared with a more subacute hemolytic anemia.

  9. MRI of the fetal spine

    International Nuclear Information System (INIS)

    Simon, Erin M.

    2004-01-01

    Magnetic resonance imaging of the fetal spine is a vital complement to fetal sonographic examination. Assessing the wide spectrum of spinal dysraphism, as well as spinal neoplasia, allows for more correct prenatal diagnoses, patient care planning, and patient counselling. Proper appraisal of the value of experimental procedures, such as fetal myelomeningocoele repair, requires a high level of diagnostic accuracy for the selection and follow-up of appropriate candidates. (orig.)

  10. MRI of the fetal spine

    Energy Technology Data Exchange (ETDEWEB)

    Simon, Erin M. [Departement of Radiology, Children' s Hospital of Philadelphia, PA (United States)

    2004-09-01

    Magnetic resonance imaging of the fetal spine is a vital complement to fetal sonographic examination. Assessing the wide spectrum of spinal dysraphism, as well as spinal neoplasia, allows for more correct prenatal diagnoses, patient care planning, and patient counselling. Proper appraisal of the value of experimental procedures, such as fetal myelomeningocoele repair, requires a high level of diagnostic accuracy for the selection and follow-up of appropriate candidates. (orig.)

  11. Fetal Alcohol Syndrome

    Science.gov (United States)

    ... as a hole in the heart. Delayed development. Vision or hearing problems. As they grow older, these children may have behavior problems. They may experience learning disabilities, trouble with memory and attention, and hyperactivity. Symptoms tend to get ...

  12. Thrombus Formation Patterns in HeartMate II Continuous-Flow Left Ventricular Assist Devices: A Multifactorial Phenomenon Involving Kounis Syndrome?

    Science.gov (United States)

    Kounis, Nicholas G; Soufras, George D; Davlouros, Periklis; Tsigkas, Grigorios; Hahalis, George

    2014-01-01

    Metallic devices are increasingly used in contemporary cardiological practice. They include coronary stents, artificial cardiac valves, bioprostheses for transcatheter aortic valve replacement, closure devices for patent foramen ovale and atrial septal defects, pacemakers, defibrillators, and left ventricular assist devices. Metals constitute the main components of these devices. Metal anions eluted from the components attached to circulating proteins can act as sensitizers able to induce hypersensitivity inflammation and thrombosis. Allergy to nickel occurs in up to one fourth of the population in several areas of the world and is the most frequent cause of allergic contact dermatitis. The HeartMate II device is made from titanium with ruby bearing. Titanium metal ions from HeartMate II are eluted through the action of blood, saline, proteins, and mechanical stress that can induce hypersensitivity and immune dysfunctions rendering titanium no longer biologically inert. An unexpected high rate of thrombosis with substantial morbidity and mortality has been observed with the use of this device, making the search of causality of thrombosis mandatory to predict and prevent this daunting complication. Although the cause of thrombosis seems to be multifactorial, careful history-taking regarding hypersensitivities, monitoring of inflammatory mediators, and lymphocyte transformation studies should be always performed in sensitive patients.

  13. Freqüência cardíaca fetal e doplervelocimetria das artérias umbilicais entre a 18ª e a 20ª semana de gestação em pacientes com diabete melito pré-gestacional Fetal heart rate and umbilical artery Dopplervelocimetry between the 18th and 20th weeks of gestation in pregnancies complicated by pregestational diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Roseli Mieko Yamamoto Nomura

    2006-08-01

    ães diabéticas apresentam, nesse período, maturação neurológica dos sistemas reguladores da FCF semelhante ao grupo controle. Não foram detectadas anormalidades na resistência ao fluxo útero-placentário nesse período, em gestações complicadas pelo diabete melito pré-gestacional.PURPOSE: to analyze the fetal heart rate (FHR and umbilical artery Dopplervelocimetry between 18th and 20th weeks of gestation in pregnant women complicated by pregestational diabetes mellitus. METHODS: twenty-eight pregnancies with pregestational diabetes and 27 normal pregnant women were analyzed prospectively, in a cross-sectional and case-control study. The inclusion criteria were the following: singleton pregnancy between 18 and 29 weeks, no other associated maternal diseases and no fetal abnormality. Ultrasonography was performed and FHR was calculated by the interval between the beginnings of two consecutive cardiac cycles, in the three umbilical artery Doppler sonograms, obtained in the umbilical cord near to the placental insertion, using color Doppler. Five consecutive FHR cycles from each sonogram were measured, to analyze mean FHR and its variation. The following Doppler indices were studied: systolic/diastolic ratio, pulsatility index (PI and resistance index (RI. Student's t test and Mann-Whitney Utest were applied to comparative study. p values were considered significant when p<0.05. Results: no significant difference was observed in mean FHR between the studied groups (diabetic group: 149.2 bpm, control group: 147.2 bpm; p = 0.12. FHR variation revealed similar results between the groups (diabetic group: 5.3 bpm; control group: 5.3 bpm; p=0.50. No significant difference was found in the Doppler indices S/D (p=0.79, PI (p=0.25 and RI (p=0.71 between the groups. CONCLUSIONS: the absence of differences in FHR characteristics between the 18th and 20th gestational weeks indicates similar neurological maturation of FHR regulatory systems in this period, between fetuses of

  14. Massive Fetal Ascites: Vaginal Delivery After Trans- Abdominal Fetal ...

    African Journals Online (AJOL)

    We report a care of acute fetal acites diagnosed by ultrasonograhy at 29 weeks gestation in a primigravida who used herbel fertility drugs for conception and through the fist 8 weeks of gestation. Under ultrasound guidance the fetal peritoneal cavity was canulated via the material abdomen with an 18G intravenous canular.

  15. HEPATITIS ALOINMUNE FETAL

    Directory of Open Access Journals (Sweden)

    Fernando Álvarez C., Dr.

    2015-07-01

    Full Text Available La hepatitis aloinmune fetal, conocida anteriormente como hemocromatosis neonatal, ha demostrado en los últimos años ser una enfermedad completamente distinta a la hemocromatosis del adulto, tanto en su etiología como en su la fisiopatología. Este conocimiento abre nuevas perspectivas tanto en la prevención de la enfermedad en futuros embarazos, así como en el tratamiento con inmunoglobulina endovenosa en la madre durante el embarazo y eventualmente el tratamiento postnatal, en el que el trasplante de hígado juega un rol primordial.

  16. Effect of Fetal Sex on Maternal and Obstetric Outcomes

    Directory of Open Access Journals (Sweden)

    Mohammed Al-Qaraghouli

    2017-06-01

    Full Text Available Fetal sex plays an important role in modifying the course and complications related to pregnancy and may also have an impact on maternal health and well-being both during and after pregnancy. The goal of this article is to review and summarize the findings from published research on physiologic and pathologic changes that may be affected by fetal sex and the effect of these changes on the maternal and obstetrical outcomes. This will help create awareness that fetal sex is not just a random chance event but an interactive process between the mother, the placenta, and the fetus. The reported effects of male sex on the course of pregnancy and delivery include higher incidence of preterm labor in singletons and twins, failure of progression in labor, true umbilical cord knots, cord prolapse, nuchal cord, higher cesarean section rate, higher heart rate variability with increased frequency, and duration of decelerations without acidemia and increased risk of gestational diabetes mellitus through the poor beta cells function. Similarly, female fetal sex has been reported to modify pregnancy and delivery outcomes including altered fetal cardiac hemodynamics, increased hypertensive diseases of pregnancy, higher vulnerability of developing type 2 DM after pregnancy possibly because of influences on increased maternal insulin resistance. Placental function is also influenced by fetal sex. Vitamin D metabolism in the placenta varies by fetal sex; and the placenta of a female fetus is more responsive to the relaxing action of magnesium sulfate. Male and female feto-placental units also vary in their responses to environmental toxin exposure. The association of fetal sex with stillbirths is controversial with many studies reporting higher risk of stillbirth in male fetuses; although some smaller and limited studies have reported more stillbirths with female fetus pregnancies. Maternal status such as BMI may in turn also affect the fetus and the placenta in a

  17. Heart Failure

    Science.gov (United States)

    Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Heart failure does not mean that your heart has stopped ... and shortness of breath Common causes of heart failure are coronary artery disease, high blood pressure and ...

  18. Restrictive dermopathy and fetal behaviour

    NARCIS (Netherlands)

    Mulder, EJH; Beemer, FA; Stoutenbeek, P

    We report three siblings from consecutive pregnancies affected with restrictive dermopathy (RD). During the second pregnancy, fetal behavioural development and growth were studied extensively using ultrasound at 1-4 week intervals. Dramatic and sudden changes occurred in fetal body movements and

  19. Ultrasonic Fetal Cephalometry: Percentiles Curve

    Science.gov (United States)

    Flamme, P.

    1972-01-01

    Measurements by ultrasound of the biparietal diameter of the fetal head during pregnancy are a reliable guide to fetal growth. As a ready means of comparison with the normal we constructed from 4,170 measurements in 1,394 cases a curve showing the percentiles distribution of biparietal diameters for each week of gestation. PMID:5070162

  20. Drug treatment of fetal tachycardias

    NARCIS (Netherlands)

    Oudijk, Martijn A.; Ruskamp, Jopje M.; Ambachtsheer, Barbara E.; Ververs, Tessa F. F.; Stoutenbeek, Philip; Visser, Gerard H. A.; Meijboom, Erik J.

    2002-01-01

    The pharmacological treatment of fetal tachycardia (FT) has been described in various publications. We present a study reviewing the necessity for treatment of FT, the regimens of drugs used in the last two decades and their mode of administration. The absence of reliable predictors of fetal hydrops

  1. A novel algorithm for prediction and detection of hypoglycemia based on continuous glucose monitoring and heart rate variability in patients with type 1 diabetes

    DEFF Research Database (Denmark)

    Cichosz, Simon Lebech; Frystyk, Jan; Hejlesen, Ole

    2014-01-01

    prior to each blood glucose sample were used to decide if that particular point in time was below the hypoglycemic threshold of 3.9 mmol/L. A total of 903 samples were analyzed by the novel algorithm, which yielded a sensitivity of 79% and a specificity of 99%. The algorithm was able to detect 16......, but with a modest accuracy. Therefore, our aim was to investigate whether a novel algorithm that adds information of the complex dynamic/pattern of heart rate variability (HRV) could improve the accuracy of hypoglycemia as detected by a CGM device. Data from 10 patients with type 1 diabetes studied during insulin......-induced hypoglycemia were obtained. Blood glucose samples were used as reference. HRV patterns and CGM data were combined in a mathematical prediction algorithm. Detection of hypoglycemic periods, performed by the algorithm, was treated as a pattern recognition problem and features/patterns derived from HRV and CGM...

  2. 75 FR 38771 - National Advisory Council on Maternal, Infant and Fetal Nutrition: Notice of Meeting

    Science.gov (United States)

    2010-07-06

    ...: 2010-16331] DEPARTMENT OF AGRICULTURE Food and Nutrition Service National Advisory Council on Maternal... National Advisory Council on Maternal, Infant and Fetal Nutrition. Date and Time: July 27-29, 2010, 9 a.m... Maternal, Infant and Fetal Nutrition will meet to continue its study of the Special Supplemental Nutrition...

  3. The natural history of fetal long QT syndrome.

    Science.gov (United States)

    Cuneo, Bettina F; Strasburger, Janette F; Wakai, Ronald T

    Fetal magnetocardiography (fMCG), the magnetic analog of ECG, has provided invaluable insight into the mechanisms of fetal arrhythmias. In the past 15years, we have evaluated over 300 fetuses with arrhythmia by fMCG. We review the unique characteristics and natural history of the long QT syndrome (LQTS) rhythms. We reviewed the fMCGs of subjects referred with suspected LQTS based on either a positive family history or echo diagnosis of the LQTS rhythms (sinus bradycardia, ventricular tachycardia, or 2:1 AV conduction) to the Biomagnetism laboratory in the Department of Medical Physics, UW-Madison. We recorded fMCGs using a 37-channel (Magnes, 4D Neuroimaging, Inc., San Diego, CA) superconducting quantum interference device (SQUID) biomagnetometer, housed in a magnetically-shielded room for 1200-6000s. Signal processing was used to remove maternal interference. Cardiac intervals (R-R, p, QRS, QT) were measured and compared to published normals. We correlated fetal heart rate (FHR) patterns and effects of fetal movement on FHR and rhythm using actocardiography. Thirty-nine fetuses were studied at a mean of 28 (19-38) weeks of gestation. All had structurally normal hearts. One was on amiodarone for suspected supraventricular tachycardia and hydrops. Five had serial fMCGs. Isolated sinus bradycardia with a QTc >490ms was found in 35: 33 had a KCNQ1 mutation There was one false positive and one false negative LQTS diagnosis. Four fetuses had torsades de pointes (TdP) and 3 had periods of 2:1 conduction and either KCNH2 or SCN5A mutations. TdP was rarely initiated with a preceding long-short pattern and did not degenerate into ventricular fibrillation. One fetus with TdP died in utero, 2 with fetal TdP had postnatal cardiac arrest. Fetal LQTS is diagnosed by an fMCG QTc >490ms with an 89% sensitivity and specificity. TdP are seen with uncharacterized, KCNH2 or SCN5A R1623q mutations. Fetal TdP occurs when QTc ≥620ms. Identifying fetal LQTS and defining its rhythms by f

  4. Heart Anatomy

    Science.gov (United States)

    ... kilometers), which is far enough to circle the earth more than twice! See also on other sites: ... For the Public Heart Information Center Project Heart Women’s Heart Health Clinical Trials 6770 Bertner Avenue Houston, ...

  5. Toxicokinetics of domoic acid in the fetal rat.

    Science.gov (United States)

    Maucher Fuquay, Jennifer; Muha, Noah; Wang, Zhihong; Ramsdell, John S

    2012-03-29

    Domoic acid (DA) is a potent neurotoxin that has both marine wildlife and human health impacts, including developmental effects during prenatal exposure in rodent models. However, little is known regarding DA toxicokinetics in the fetal unit during maternal-fetal transfer. Tissue distribution and toxicokinetics of DA were investigated in pregnant rats and their pups just prior to birth at gestational day 20. Pregnant Sprague Dawley rats were given an intravenous dose of 1.0 mg DA/kg and samples of maternal plasma, fetal plasma, placenta, amniotic fluid and fetal brain were taken at intervals over 24 h. Toxicokinetic parameters were determined using WinNonLin software analysis. Maternal plasma DA log concentration-time curves fit a two compartment pharmacokinetic profile, with alpha and beta half-lives of elimination of 26.9 and 297 min, respectively. Placenta had a C(max) of 752 ng/mL and a terminal half-life of 577 min. Maternal-fetal transfer between the plasma compartments was 31% with a fetal plasma C(max) of 86 ng/mL at 60 min and terminal half-life of 553 min. Amniotic fluid and fetal brain had overall averages of 27±12 ng/mL and 8.12 ng/g, respectively, and did not show evidence of elimination over 24 h. The longer fetal retention of DA, particularly in amniotic fluid, indicates that the fetus may be continually re-exposed during gestation, which could potentially lead to a disease state even at small exposure dose. This has implications for the California sea lions (Zalophus californianus), which exhibit an epilepsy-like disease that arises months after DA producing blooms. Published by Elsevier Ireland Ltd.

  6. [Maternal-placental interactions and fetal programming].

    Science.gov (United States)

    Kadyrov, M; Moser, G; Rath, W; Kweider, N; Wruck, C J; Pufe, T; Huppertz, B

    2013-06-01

    Pregnancy-related complications not only represent a risk for maternal and fetal morbidity and mortality, but are also a risk for several diseases later in life. Many epidemiological studies have shown clear associations between an adverse intrauterine environment and an increased risk of diabetes, hypertension, cardiovascular disease, depression, obesity, and other chronic diseases in the adult. Some of these syndromes could be prevented by avoiding adverse stimuli or insults including psychological stress during pregnancy, intake of drugs, insufficient diet and substandard working conditions. Hence, all of these stimuli have the potential to alter health later in life. The placenta plays a key role in regulating the nutrient supply to the fetus and producing hormones that control the fetal as well as the maternal metabolism. Thus, any factor or stimulus that alters the function of the hormone producing placental trophoblast will provoke critical alterations of placental function and hence could induce programming of the fetus. The factors that change placental development may interfere with nutrient and oxygen supply to the fetus. This may be achieved by a direct disturbance of the placental barrier or more indirectly by, e. g., disturbing trophoblast invasion. For both path-ways, the respective pathologies are known: while preeclampsia is caused by alterations of the villous trophoblast, intra-uterine growth restriction is caused by insufficient invasion of the extravillous trophoblast. In both cases the effect can be undernutrition and/or fetal hypoxia, both of which adversely affect organ development, especially of brain and heart. However, the mechanisms responsible for disturbances of trophoblast differentiation and function remain elusive. © Georg Thieme Verlag KG Stuttgart · New York.

  7. Aneurismectomia de ventrículo esquerdo com o coração batendo ininterruptamente: resultados imediatos Left ventricular aneurysmectomy with continuous beating heart: early results

    Directory of Open Access Journals (Sweden)

    Valquíria Pelisser Campagnucci

    2006-03-01

    Full Text Available OBJETIVO: O índice médio de mortalidade operatória na aneurismectomia de ventrículo esquerdo é de 15%. Formas de proteção miocárdica especificamente para este procedimento têm sido pouco discutidas. Este trabalho tem por finalidade a avaliação dos resultados imediatos do tratamento cirúrgico do aneurisma da parede anterior de ventrículo esquerdo, sob circulação extracorpórea, com o coração batendo ininterruptamente. MÉTODO: Análise retrospectiva de 34 prontuários de pacientes submetidos a aneurismectomia anterior, associada ou não à revascularização do miocárdio, no período de janeiro de 1997 a maio de 2005. Foram avaliados 20 doentes do sexo masculino e 14 do sexo feminino, com média de idade de 52 anos (28 a 76 anos. Todos os pacientes foram operados sob circulação extracorpórea em normotermia, sem pinçamento aórtico, mantendo-se o coração batendo o tempo todo. Foram analisados: mortalidade perioperatória, complicações tromboembólicas, tempo de circulação extracorpórea, tempo de assistência ventilatória invasiva e permanência na Unidade de Terapia Intensiva (UTI. RESULTADOS: Não houve mortalidade perioperatória. Não observamos complicações tromboembólicas. O tempo de circulação extracorpórea foi, em média, de 85min (25-150min. O tempo de assistência ventilatória invasiva foi, em média, de 18h (8-96h e de permanência na UTI, 3,1 dias (2- 14 dias. CONCLUSÃO: A manutenção dos batimentos cardíacos pela tática de não pinçamento aórtico para proteção miocárdica constitui-se num método eficiente e seguro para aneurismectomia de parede anterior de ventrículo esquerdo.OBJECTIVE: Operative mortality after left ventricular aneurysmectomy is close to 15%. Specifically for this procedure, forms of myocardial protection have been little discussed. The purpose of this study was to evaluate immediate results of left anterior ventricular aneurysmectomy using the beating heart approach

  8. Efectos del entrenamiento continuo e interválico de carga externa similar sobre la frecuencia cardiaca Effects of continuous and interval training similar external load on heart rate

    Directory of Open Access Journals (Sweden)

    J. L. Tuimil

    2010-09-01

    , who performed: CC= 8 km at 70% VAM and CI= 4x(1000m at 90% VAM+1000m at 50% VAM. Heart rate was registered during sessions and FCB before and after of the training session. The difference in the mean heart rate between both training modes not statistically significant. However, the mean heart rate of the CC (FCCC (Z=2,240; p<0,05 and CI (FCCI (Z=2,380; p<0,05 were significantly higher than the calculated 70% heart rate reserve (FCR70%. The FCB was only significantly higher after CI (Z=2,319; p<0,05. In conclusion, two different training modes, but of equal average intensity, can produce a similar mean heart rate. The intensity of the programed run based on the VAM is significantly higher than one based on the FCR. The strongly increase in FCB can be influenced by the interval training method.
    KEY WORDS: mean H.R., reserve H.R., basal H.R., MAS, continuous training, interval training.

  9. Role of the placenta in fetal programming: underlying mechanisms and potential interventional approaches.

    Science.gov (United States)

    Jansson, Thomas; Powell, Theresa L

    2007-07-01

    Adverse influences during fetal life alter the structure and function of distinct cells, organ systems or homoeostatic pathways, thereby 'programming' the individual for an increased risk of developing cardiovascular disease and diabetes in adult life. Fetal programming can be caused by a number of different perturbations in the maternal compartment, such as altered maternal nutrition and reduced utero-placental blood flow; however, the underlying mechanisms remain to be fully established. Perturbations in the maternal environment must be transmitted across the placenta in order to affect the fetus. Here, we review recent insights into how the placenta responds to changes in the maternal environment and discuss possible mechanisms by which the placenta mediates fetal programming. In IUGR (intrauterine growth restriction) pregnancies, the increased placental vascular resistance subjects the fetal heart to increased work load, representing a possible direct link between altered placental structure and fetal programming of cardiovascular disease. A decreased activity of placental 11beta-HSD-2 (type 2 isoform of 11beta-hydroxysteroid dehydrogenase) activity can increase fetal exposure to maternal cortisol, which programmes the fetus for later hypertension and metabolic disease. The placenta appears to function as a nutrient sensor regulating nutrient transport according to the ability of the maternal supply line to deliver nutrients. By directly regulating fetal nutrient supply and fetal growth, the placenta plays a central role in fetal programming. Furthermore, perturbations in the maternal compartment may affect the methylation status of placental genes and increase placental oxidative/nitrative stress, resulting in changes in placental function. Intervention strategies targeting the placenta in order to prevent or alleviate altered fetal growth and/or fetal programming include altering placental growth and nutrient transport by maternally administered IGFs (insulin

  10. Fetal tachyarrhythmia: literature data and case study

    Directory of Open Access Journals (Sweden)

    Lukianova I.S.

    2016-03-01

    Full Text Available Fetal tachyarrhythmia is unfeigned in most cases and occurs in about 1–3% of the total number of pregnancies. Most of it's kinds are ectopic intraatrial reductions. FA is usually diagnosed during the routine, starting from 18 weeks of gestation, ultrasound assessment of the fetal heart rate. Approximately 10% of fetuses with rhythm disorders are at high risk of sudden death. Supraventricular tachycardia and atrial fibrillation are the most common causes of sudden death, the same is observed for bradyarrhythmias: manifest sinus bradycardia (hypoxic genesis and expressed AV-blockade. The examination of all fetuses with arrhythmia was strongly recommended in cases of intrauterine cardiac arrest or death of the fetus in families. Arrhythmias which have been revealed during scheduled prenatal examination of the fetuses are in need of expert echocardiography assessment to determine the extent of possible pre- and postnatal risk of sudden death and the paril of arrhythmogenic cardiomyopathy formation. In case of identified life-threatening arrhythmia in fetus the pharmacological therapy, which greatly affects the favorable outcome is strongly recommended. It should be based on hemodynamic of pregnant and aimed to prevent the development of decompensation or arrhythmogenic cardiomyopathy.

  11. Fetal malnutrition and long-term outcomes.

    Science.gov (United States)

    Fall, Caroline H D

    2013-01-01

    Epidemiological studies have shown that lower birthweight is associated with a wide range of adverse outcomes in later life, including poorer 'human capital' (shorter stature, lower cognitive performance), increased risk factors for later disease (higher blood pressure and reduced glucose tolerance, and lung, kidney and immune function), clinical disease (diabetes, coronary heart disease, chronic lung and kidney disease), and increased all-cause and cardiovascular mortality. Higher birthweight is associated with an increased risk of cancer and (if caused by gestational diabetes) obesity and diabetes. The 'developmental origins of health and disease' hypothesis proposes that fetal nutrition has permanent effects on growth, structure and metabolism ('programming'). This is supported by studies in animals showing that maternal under- and overnutrition during pregnancy can produce similar abnormalities in the adult offspring. Common chronic diseases could potentially be prevented by achieving optimal fetal nutrition, and this could have additional benefits for survival and human capital. Recent follow-up of children born after randomized nutritional interventions in pregnancy provides weak evidence of beneficial effects on growth, vascular function, lipid concentrations, glucose tolerance and insulin resistance. Animal studies indicate that epigenetic phenomena may be an important mechanism underlying programming, and that nutritional interventions may need to start preconceptionally. Copyright © 2013 Nestec Ltd., Vevey/S. Karger AG, Basel.

  12. Fetal cells in the pregnant mouse are diverse and express a variety of progenitor and differentiated cell markers.

    Science.gov (United States)

    Fujiki, Yutaka; Johnson, Kirby L; Peter, Inga; Tighiouart, Hocine; Bianchi, Diana W

    2009-07-01

    To better understand fetomaternal cell trafficking during pregnancy, we used a mouse model to determine the cell surface markers expressed on fetal cells, based on the hypothesis that fetal progenitor cells have the capacity to repair maternal organs, whereas more differentiated cells might initiate graft versus host disease. Wild-type females were mated to either homozygous or hemizygous transgenic males and euthanized in the peripartum period. Using dual color flow cytometry, we analyzed fetal transgene positive cells for the presence of nine markers (ITGAM, ITGB1, PECAM, CD34, CD44, PTPRC, ENG, SLAMF1, and CXCR4) to begin to identify the phenotype and degree of differentiation of fetal cells in nine maternal organs (lung, liver, spleen, blood, bone marrow, kidney, heart, thymus, and brain). Fetal cells were found in all maternal organs following either type of mating, albeit always at a higher frequency following mating with homozygous males. Some organs (e.g., lung and liver) had a wide variety of fetal cell markers present, while other organs (e.g., bone marrow and spleen) had a skewed distribution of fetal cell markers. Fetal cells in the murine pregnant female are diverse. Our results suggest that the fetal cells comprise a mixed population of progenitor and differentiated cells, with different relative proportions in different maternal organs. Future studies will address whether fetal cells cross the placental barrier in a differentiated state or as a homogenous population and subsequently differentiate in target maternal organs.

  13. Six Years in the Life of a Mother Bear - The Longest Continuous Heart Rate Recordings from a Free-Ranging Mammal

    Science.gov (United States)

    Laske, Timothy G.; Iaizzo, Paul A.; Garshelis, David L.

    2017-01-01

    Physiological monitoring of free-ranging wild animals is providing new insights into their adaptations to a changing environment. American black bears (Ursus americanus) are highly adaptable mammals, spending up to half the year hibernating, and the remainder of the year attempting to gain weight on a landscape with foods that vary seasonally and year to year. We recorded heart rate (HR) and corresponding activity of an adult female black bear over the course of six years, using an implanted monitor. Despite yearly differences in food, and an every-other year reproductive cycle, this bear exhibited remarkable consistency in HR and activity. HR increased for 12 weeks in spring, from minimal hibernation levels (mean 20-25 beats/minute [bpm]; min 10 bpm) to summer active levels (July daytime: mean 95 bpm). Timing was delayed following one cold winter. In August the bear switched from primarily diurnal to nocturnal, coincident with the availability of baits set by legal hunters. Activity in autumn was higher when the bear was with cubs. Birthing of cubs in January was identified by a transient increase in HR and activity. Long-term physiological and behavioral monitoring is valuable for understanding adaptations of free-ranging animals to climate change, food availability, and human-related stressors.

  14. Maternal melatonin administration mitigates coronary stiffness and endothelial dysfunction, and improves heart resilience to insult in growth restricted lambs.

    Science.gov (United States)

    Tare, Marianne; Parkington, Helena C; Wallace, Euan M; Sutherland, Amy E; Lim, Rebecca; Yawno, Tamara; Coleman, Harold A; Jenkin, Graham; Miller, Suzanne L

    2014-06-15

    Intrauterine growth restriction (IUGR) is associated with impaired cardiac function in childhood and is linked to short- and long-term morbidities. Placental dysfunction underlies most IUGR, and causes fetal oxidative stress which may impact on cardiac development. Accordingly, we investigated whether antenatal melatonin treatment, which possesses antioxidant properties, may afford cardiovascular protection in these vulnerable fetuses. IUGR was induced in sheep fetuses using single umbilical artery ligation on day 105-110 of pregnancy (term 147). Study 1: melatonin (2 mg h(-1)) was administered i.v. to ewes on days 5 and 6 after surgery. On day 7 fetal heart function was assessed using a Langendorff apparatus. Study 2: a lower dose of melatonin (0.25 mg h(-1)) was administered continuously following IUGR induction and the ewes gave birth normally at term. Lambs were killed when 24 h old and coronary vessels studied. Melatonin significantly improved fetal oxygenation in vivo. Contractile function in the right ventricle and coronary flow were enhanced by melatonin. Ischaemia-reperfusion-induced infarct area was 3-fold greater in IUGR hearts than in controls and this increase was prevented by melatonin. In isolated neonatal coronary arteries, endothelium-dependent nitric oxide (NO) bioavailability was reduced in IUGR, and was rescued by modest melatonin treatment. Melatonin exposure also induced the emergence of an indomethacin-sensitive vasodilation. IUGR caused marked stiffening of the coronary artery and this was prevented by melatonin. Maternal melatonin treatment reduces fetal hypoxaemia, improves heart function and coronary blood flow and rescues cardio-coronary deficit induced by IUGR. © 2014 The Authors. The Journal of Physiology © 2014 The Physiological Society.

  15. Fetal MRI on a multi-element digital coil platform

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    Serai, Suraj D.; Merrow, Arnold C.; Kline-Fath, Beth M. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, 3333 Burnett Ave., MLC 5031, Cincinnati, OH (United States)

    2013-09-15

    Fetal MRI has an increasing list of indications and is most commonly employed when anomalies detected by prenatal ultrasonography require further characterization. This may occur when sonography is technically challenging or where specific MRI findings will determine pre- and postnatal management, including critical in utero and/or peripartum interventions. In these circumstances, there are high expectations for MRI to sort out complex diagnostic dilemmas through exquisite anatomical imaging that fetal surgeons and obstetricians can comprehend and relay to their patients. These expectations, in light of evolving clinical innovations, continue to drive advances in fetal imaging. Increasing signal-to-noise ratio (SNR) is fundamental to improving MR image quality, and proper coil selection is a key component of this pursuit. Since the introduction of parallel imaging techniques, the numbers of elements in phased-array coils have been continuously increased to achieve high SNR and shorter scan times. With the invention of a digital coil platform, it is now possible to connect combinations of multiple coil elements to enhance SNR beyond the capabilities of the adult eight-channel torso-coil routinely used in fetal imaging. This paper describes the application of multi-element radiofrequency coils on a digital broadband imaging platform with unique coil combinations to perform dedicated fetal MRI. (orig.)

  16. Prenatal diagnosis of fetal unilateral lung agenesis complicated with cardiac malposition

    Science.gov (United States)

    2013-01-01

    Background Fetal unilateral lung agenesis, complicated with cardiac shifting, is a rare anomaly, the diagnosis of which remains a challenge for many sonographers in routine screening programs. The present study describes a systematic approach for the diagnosis of fetal unilateral lung agenesis and cardiac malpositions in routine prenatal screening. Methods A total of 18 cases of fetal unilateral lung agenesis complicated with cardiac malposition were reviewed. A systematic method was proposed to identify the fetal left side and right side according to the fetal head position and posture by acquiring a long axis and transverse view of the fetus. Fetal unilateral lung agenesis was diagnosed by evaluation of the ipsilateral pulmonary artery. The diagnosis was confirmed by postnatal echocardiography, digital radiology, and computed tomography after birth or by autopsy findings. Results The left-sided fetal heart with the cardiac apex rotating to the left and posterior were confirmed in all 7 left lung agenesis cases, while the rightward shifting of the fetal heart together with the cardiac axis deviating to the right were confirmed in all 11 cases of right lung agenesis. The disappearance of the ipsilateral pulmonary artery was confirmed in all 18 cases of unilateral lung agenesis. Cardiac anomalies were present in a total of 7 of the18 cases of lung agenesis with 4 of 7 in cases of left lung agenesis and 3 of 11 in cases of right agenesis. Conclusions The systematic approach introduced in the current report is helpful in the diagnosis of fetal unilateral lung agenesis complicated with cardiac malposition. The information provided by this study may be helpful to better understand unilateral lung agenesis anatomically and to facilitate its potential examination. PMID:23530545

  17. Comparison between human fetal and adult skin

    NARCIS (Netherlands)

    Coolen, N.A.; Schouten, K.C.; Middelkoop, E.; Ulrich, M.

    2010-01-01

    Healing of early-gestation fetal wounds results in scarless healing. Since the capacity for regeneration is probably inherent to the fetal skin itself, knowledge of the fetal skin composition may contribute to the understanding of fetal wound healing. The aim of this study was to analyze the

  18. Primary care fetal assessment - low-cost fetal arousal testing

    African Journals Online (AJOL)

    tic cells iver utopsy l ever, . 1990; fr J mphasis ry. 1971;. lQ Dis oducmg. IVe phoma: 1993; rd·. 3rd ed. ant of ,ts. 10: ,th. 83: 51: SAMJ. SHORT. REPORT. Primary care fetal ... Education of mothers about the importance of fetal movements is used to ... thumb and middle finger supporting the rim of the top of the can. The index ...

  19. Regulation of myocardial glucose transporters GLUT1 and GLUT4 in chronically anemic fetal lambs.

    Science.gov (United States)

    Ralphe, J Carter; Nau, Peter N; Mascio, Christopher E; Segar, Jeffrey L; Scholz, Thomas D

    2005-10-01

    Little is known about the chronic adaptations that take place in the fetal heart to allow for increased substrate delivery in response to chronic stress. Because glucose is an important fuel for the fetal cardiomyocytes, we hypothesized that myocardial glucose transporters 1 and 4 (GLUT1 and GLUT4, respectively) are up-regulated in the fetal sheep heart that is chronically stressed by anemia. Fetal sheep at 128 d gestation underwent daily isovolumic hemorrhage and determination of myocardial blood flow, oxygen consumption, and substrate utilization. At the end of 3 or 7 d of anemia, myocardial levels of GLUT1 and GLUT4 mRNA and protein were measured and subcellular localization was determined. Despite stable heart rate and blood pressure, anemia caused a nearly 4-fold increase in right and left ventricular (RV and LV) free wall blood flow. No significant change in myocardial glucose uptake was found and serum insulin levels remained stable. Both 3-d RV and LV and 7-d RV mRNA and protein levels of GLUT1 and GLUT4 were unchanged; 7-d LV GLUT1 and GLUT4 mRNA levels were also stable. However, LV GLUT1 protein levels declined significantly, whereas LV GLUT4 protein levels were increased. In the steady state, GLUT4 protein localized to the sarcolemma membrane. These findings suggest that the glucose transporters are post-transcriptionally regulated in myocardium of chronically anemic fetal sheep with changes that mimic normal postnatal development. Unlike the postnatal heart, localization of GLUT4 to the cell membrane suggests the importance of GLUT4 in basal glucose uptake in the stressed fetal heart.

  20. Heart Attack

    Science.gov (United States)

    Each year almost 800,000 Americans have a heart attack. A heart attack happens when blood flow to the heart suddenly ... it's important to know the symptoms of a heart attack and call 9-1-1 if you or ...

  1. Heart Transplantation

    Science.gov (United States)

    A heart transplant removes a damaged or diseased heart and replaces it with a healthy one. The healthy heart comes from a donor who has died. It is the last resort for people with heart failure when all other treatments have failed. The ...

  2. Heart Diseases

    Science.gov (United States)

    ... re like most people, you think that heart disease is a problem for others. But heart disease is the number one killer in the U.S. ... disability. There are many different forms of heart disease. The most common cause of heart disease is ...

  3. Effects of L-glutamine supplementation on maternal and fetal hemodynamics in gestating ewes exposed to alcohol.

    Science.gov (United States)

    Sawant, Onkar B; Ramadoss, Jayanth; Hankins, Gary D; Wu, Guoyao; Washburn, Shannon E

    2014-08-01

    Not much is known about effects of gestational alcohol exposure on maternal and fetal cardiovascular adaptations. This study determined whether maternal binge alcohol exposure and L-glutamine supplementation could affect maternal-fetal hemodynamics and fetal regional brain blood flow during the brain growth spurt period. Pregnant sheep were randomly assigned to one of four groups: saline control, alcohol (1.75-2.5 g/kg body weight), glutamine (100 mg/kg body weight) or alcohol + glutamine. A chronic weekend binge drinking paradigm between gestational days (GD) 99 and 115 was utilized. Fetuses were surgically instrumented on GD 117 ± 1 and studied on GD 120 ± 1. Binge alcohol exposure caused maternal acidemia, hypercapnea, and hypoxemia. Fetuses were acidemic and hypercapnic, but not hypoxemic. Alcohol exposure increased fetal mean arterial pressure, whereas fetal heart rate was unaltered. Alcohol exposure resulted in ~40 % reduction in maternal uterine artery blood flow. Labeled microsphere analyses showed that alcohol induced >2-fold increases in fetal whole brain blood flow. The elevation in fetal brain blood flow was region-specific, particularly affecting the developing cerebellum, brain stem, and olfactory bulb. Maternal L-glutamine supplementation attenuated alcohol-induced maternal hypercapnea, fetal acidemia and increases in fetal brain blood flow. L-Glutamine supplementation did not affect uterine blood flow. Collectively, alcohol exposure alters maternal and fetal acid-base balance, decreases uterine blood flow, and alters fetal regional brain blood flow. Importantly, L-glutamine supplementation mitigates alcohol-induced acid-base imbalances and alterations in fetal regional brain blood flow. Further studies are warranted to elucidate mechanisms responsible for alcohol-induced programming of maternal uterine artery and fetal circulation adaptations in pregnancy.

  4. Fetal programming of renal function.

    Science.gov (United States)

    Dötsch, Jörg; Plank, Christian; Amann, Kerstin

    2012-04-01

    Results from large epidemiological studies suggest a clear relation between low birth weight and adverse renal outcome evident as early as during childhood. Such adverse outcomes may include glomerular disease, hypertension, and renal failure and contribute to a phenomenon called fetal programming. Other factors potentially leading to an adverse renal outcome following fetal programming are maternal diabetes mellitus, smoking, salt overload, and use of glucocorticoids during pregnancy. However, clinical data on the latter are scarce. Here, we discuss potential underlying mechanisms of fetal programming, including reduced nephron number via diminished nephrogenesis and other renal (e.g., via the intrarenal renin-angiotensin-aldosterone system) and non-renal (e.g., changes in endothelial function) alterations. It appears likely that the outcomes of fetal programming may be influenced or modified postnatally, for example, by the amount of nutrients given at critical times.

  5. Syphilis during pregnancy: a preventable threat to maternal-fetal health.

    Science.gov (United States)

    Rac, Martha W F; Revell, Paula A; Eppes, Catherine S

    2017-04-01

    Syphilis remains the most common congenital infection worldwide and has tremendous consequences for the mother and her developing fetus if left untreated. Recently, there has been an increase in the number of congenital syphilis cases in the United States. Thus, recognition and appropriate treatment of reproductive-age women must be a priority. Testing should be performed at initiation of prenatal care and twice during the third trimester in high-risk patients. There are 2 diagnostic algorithms available and physicians should be aware of which algorithm is utilized by their testing laboratory. Women testing positive for syphilis should undergo a history and physical exam as well as testing for other sexually transmitted infections, including HIV. Serofast syphilis can occur in patients with previous adequate treatment but persistent low nontreponemal titers (Syphilis can infect the fetus in all stages of the disease regardless of trimester and can sometimes be detected with ultrasound >20 weeks. The most common findings include hepatomegaly and placentomegaly, but also elevated peak systolic velocity in the middle cerebral artery (indicative of fetal anemia), ascites, and hydrops fetalis. Pregnancies with ultrasound abnormalities are at higher risk of compromise during syphilotherapy as well as fetal treatment failure. Thus, we recommend a pretreatment ultrasound in viable pregnancies when feasible. The only recommended treatment during pregnancy is benzathine penicillin G and it should be administered according to maternal stage of infection per Centers for Disease Control and Prevention guidelines. Women with a penicillin allergy should be desensitized and then treated with penicillin appropriate for their stage of syphilis. The Jarisch-Herxheimer reaction occurs in up to 44% of gravidas and can cause contractions, fetal heart rate abnormalities, and even stillbirth in the most severely affected pregnancies. We recommend all viable pregnancies receive the first

  6. Analysis of fetal movements by Doppler actocardiogram and fetal B-mode imaging.

    Science.gov (United States)

    Maeda, K; Tatsumura, M; Utsu, M

    1999-12-01

    We have presented that fetal surveillance may be enhanced by use of the fetal actocardiogram and by computerized processing of fetal motion as well as fetal B-mode ultrasound imaging. Ultrasonic Doppler fetal actogram is a sensitive and objective method for detecting and recording fetal movements. Computer processing of the actograph output signals enables powerful, detailed, and convenient analysis of fetal physiologic phenomena. The actocardiogram is a useful measurement tool not only in fetal behavioral studies but also in evaluation of fetal well-being. It reduces false-positive, nonreactive NST and false-positive sinusoidal FHR pattern. It is a valuable tool to predict fetal distress. The results of intrapartum fetal monitoring are further improved by the antepartum application of the actocardiogram. Quantified fetal motion analysis is a useful, objective evaluation of the embryo and fetus. This method allows monitoring of changes in fetal movement, as well as frequency, amplitude, and duration. Furthermore, quantification of fetal motion enables evaluation of fetal behavior states and how these states relate to other measurements, such as changes in FHR. Numeric analysis of both fetal actogram and fetal motion from B-mode images is a promising application in the correlation of fetal activity or behavior with other fetal physiologic measurements.

  7. Maternal Intuition of Fetal Gender

    Directory of Open Access Journals (Sweden)

    Michael McFadzen

    2017-08-01

    Full Text Available Purpose: Fetal gender speculation is a preoccupation of many expecting parents, and pregnant women commonly profess to intuitively know the gender of their unborn babies. This study objectively compared pregnant mothers’ perceptions of fetal gender to sonographically proven gender determinations. Also, success rates from previously published studies, noninvasive prenatal testing and a myriad of gender determination methods were observed and reported for context. Methods: All pregnant women presenting for second-trimester screening ultrasound (at 17–23 weeks gestation in the obstetrics department of a single health center were asked to participate. A medical sonographer described the ultrasound examination, obtained appropriate consent and medical history. Each mother was asked if she had any perception as to the fetal gender and her answer documented. Mothers who had foreknowledge of fetal gender were excluded. Frequencies of actual gender were compared with observed frequencies of the maternal prediction using chi-squared test. Results: Approximately 40% (n = 411 of our study population (N = 1,026 indicated having an intuition or perception of fetal gender. These women correctly predicted the gender of their babies 51% of the time (P = 0.6571. Women who expressed a “strong” degree of intuition (n = 53 fared better, accurately predicting fetal gender at a rate of 62%, though the difference in this smaller subcohort also failed to demonstrate statistical significance (P = 0.0741. Conclusions: Intuition of fetal gender is professed by almost half of mothers though, when present, is no better at accurately predicting fetal gender than flipping a coin.

  8. The effect of N-2-cyano-ethylamphetamine. HCl on total lipid contents of placenta and some material and fetal tissues of the rat.

    Science.gov (United States)

    Kulay, L; Oliveira-Filho, R M; Siciliano, S F; Kulay, M N

    1978-12-01

    Female rats received 1.25 mg/kg body weight of N-2-cyano-ethylamphetamine. HCl (Fenproporex chlorhydrate) by oral route, once daily from the 5th to the 21st day of pregnancy, and compared to untreated pregnant rats, showed an increased total lipid content in maternal blood and fetal hearts; liver and heart have had total lipids decrease, while in placenta and fetal livers they were not observed significant differences.

  9. Fetal ascites. A report of 3 autopsy cases.

    Science.gov (United States)

    Sakamoto, A; Matsuo, K; Kawai, K; Yoshida, K; Fukuda, K; Nakano, M; Nakatani, A; Tsuchiyama, H; Tagawa, H

    1987-09-01

    Three rare autopsy cases of fetal ascites were presented and the etiology of each case was described. Case 1 was a male neonate, delivered by cesarean section at 32 weeks' gestation, and died of respiratory failure. The abdomen was remarkably distended with 1020 ml of ascites. The etiology of Case 1 remained unknown even after macroscopic and microscopic examinations. We considered this as "idiopathic" fetal ascites. Case 2 was a female neonate, delivered at 31 weeks' gestation, with marked abdominal distension and cyanosis. Autopsy revealed 435 ml of ascites, and she was considered to have had "polysplenia syndrome" with cardiovascular malformations. Intrauterine heart failure due to cardiac anomalies was thought to be the cause of this ascites. In case 3 embryotomy was carried out under the diagnosis of fetal ascites by ultrasound examination at 22 weeks' gestation. An urachal cyst connected to the dilated urinary bladder and deficiency of musculature of the abdominal wall composed of loose connective tissue with calcification were observed. The abdominal wall was ruptured and 1,960 ml of ascites was measured. Polycystic kidney with renal dysplasia was also found. Case 3 showed "Prune-Berry syndrome" and fetal ascites may have arisen from these anomalies.

  10. Epigenetic regulation and fetal programming.

    Science.gov (United States)

    Gicquel, Christine; El-Osta, Assam; Le Bouc, Yves

    2008-02-01

    Fetal programming encompasses the role of developmental plasticity in response to environmental and nutritional signals during early life and its potential adverse consequences (risk of cardiovascular, metabolic and behavioural diseases) in later life. The first studies in this field highlighted an association between poor fetal growth and chronic adult diseases. However, environmental signals during early life may lead to adverse long-term effects independently of obvious effects on fetal growth. Adverse long-term effects reflect a mismatch between early (fetal and neonatal) environmental conditions and the conditions that the individual will confront later in life. The mechanisms underlying this risk remain unclear. However, experimental data in rodents and recent observations in humans suggest that epigenetic changes in regulatory genes and growth-related genes play a significant role in fetal programming. Improvements in our understanding of the biochemical and molecular mechanisms at play in fetal programming would make it possible to identify biomarkers for detecting infants at high risk of adult-onset diseases. Such improvements should also lead to the development of preventive and therapeutic strategies.

  11. Pregnancy Outcome in Women with Mechanical Prosthetic Heart Valves Treated with Unfractionated Heparin (UFH) or Enoxaparin.

    Science.gov (United States)

    Khader, Khalid Abd Aziz Mohamad; Saad, Ahmed Samy; Abdelshafy, Mohammed

    2016-10-01

    This study was carried out to determine the maternal (including thromboembolic and hemorrhagic complications) and fetal outcomes (including miscarriage, stillbirth, baby death, and live birth) in women with mechanical heart valves managed with therapeutic doses of unfractionated heparin (UFH) versus enoxaparin during pregnancy. This is a prospective comparative, nonrandomized study. Pregnant women with mechanical heart valves presenting to high-risk pregnancy unit of Benha University Hospital, Egypt were treated with UFH 15,000 U/12 h versus enoxaparin (Clexane) 1 mg/kg SC/12 h during pregnancy and the results were analyzed. 40 pregnant women were included in the study. In 20 pregnant women, anticoagulation was with UFH, and 20 pregnant women received enoxaparin. One (3 %) thrombotic complication occurred with enoxaparin treatment. Noncompliance or subtherapeutic levels contributed to this outcome in this case. Antenatal hemorrhage occurred in 4 (10 %) and postpartum hemorrhagic complications in 5 (12.5 %) pregnancies. Of the 32 pregnant women who continued after 20 weeks' gestation, 100 % (17/17) of the women taking predominantly UFH had a surviving infant compared with 93 % (14/15) of the women taking primarily enoxaparin (p = 0.25). One intrauterine fetal death occurred in the enoxaparin group. There was no significant difference in the live birth rates between the two groups (p = 0.31). Compliance with therapeutic dose of UFH during pregnancy in women with mechanical heart valves is associated with a low risk of valve thrombosis and good fetal outcomes, but meticulous monitoring is essential.

  12. Effects of maternal obstructive sleep apnoea on fetal growth: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Alison M Fung

    Full Text Available OBJECTIVE: The objective of this study is to determine whether obstructive sleep apnea (OSA is associated with reduced fetal growth, and whether nocturnal oxygen desaturation precipitates acute fetal heart rate changes. STUDY DESIGN: We performed a prospective observational study, screening 371 women in the second trimester for OSA symptoms. 41 subsequently underwent overnight sleep studies to diagnose OSA. Third trimester fetal growth was assessed using ultrasound. Fetal heart rate monitoring accompanied the sleep study. Cord blood was taken at delivery, to measure key regulators of fetal growth. RESULTS: Of 371 women screened, 108 (29% were high risk for OSA. 26 high risk and 15 low risk women completed the longitudinal study; 14 had confirmed OSA (cases, and 27 were controls. The median (interquartile range respiratory disturbance index (number of apnoeas, hypopnoeas or respiratory related arousals/hour of sleep was 7.9 (6.1-13.8 for cases and 2.2 (1.3-3.5 for controls (p<0.001. Impaired fetal growth was observed in 43% (6/14 of cases, vs 11% (3/27 of controls (RR 2.67; 1.25-5.7; p = 0.04. Using logistic regression, only OSA (OR 6; 1.2-29.7, p = 0.03 and body mass index (OR 2.52; 1.09-5.80, p = 0.03 were significantly associated with impaired fetal growth. After adjusting for body mass index on multivariate analysis, the association between OSA and impaired fetal growth was not appreciably altered (OR 5.3; 0.93-30.34, p = 0.06, although just failed to achieve statistical significance. Prolonged fetal heart rate decelerations accompanied nocturnal oxygen desaturation in one fetus, subsequently found to be severely growth restricted. Fetal growth regulators showed changes in the expected direction- with IGF-1 lower, and IGFBP-1 and IGFBP-2 higher- in the cord blood of infants of cases vs controls, although were not significantly different. CONCLUSION: OSA may be associated with reduced fetal growth in late pregnancy. Further

  13. Fetal Valproate Syndrome.

    Science.gov (United States)

    Mutlu-Albayrak, Hatice; Bulut, Cahide; Çaksen, Hüseyin

    2017-04-01

    There have been several reports of congenital malformations in the offspring of mothers who took valproic acid (VPA) during pregnancy as a treatment for epilepsy. Herein, we describe four cases with typically similar facial features of fetal valproate syndrome accompanied to minor skeletal abnormalities. The first case was a 16-month-old girl, presenting with facial dysmorphism, and finger abnormalities. Her mother took VPA (1500 mg/d) up to the 10 th gestational week and at a dosage of 1000 mg/d through the pregnancy. The second patient was 5-year-old boy with speech disability, bilateral cryptorchidism, facial dysmorphism, and finger abnormalities whose mother took VPA (1000 mg/d) through pregnancy. The third 19-month-old patient was the brother of the second patient who had facial dysmorphism, bilateral cryptorchidism, and finger abnormalities. His mother also took VPA (1000 mg/d) through pregnancy. The fourth 3-year and 6 month-old boy with minor facial dysmorphism and sternum deformity was exposed to VPA (500 mg/d) in utero. In conclusion, there is a recognizable spectrum of abnormalities in some infants exposed to VPA without dose-depence and the common facial dysmorphic features and minor skeletal abnormalities that may occur within the both low and high dose VPA use. Copyright © 2016. Published by Elsevier B.V.

  14. Fetal abdominal wall defects.

    Science.gov (United States)

    Prefumo, Federico; Izzi, Claudia

    2014-04-01

    The most common fetal abdominal wall defects are gastroschisis and omphalocele, both with a prevalence of about three in 10,000 births. Prenatal ultrasound has a high sensitivity for these abnormalities already at the time of the first-trimester nuchal scan. Major unrelated defects are associated with gastroschisis in about 10% of cases, whereas omphalocele is associated with chromosomal or genetic abnormalities in a much higher proportion of cases. Challenges in management of gastroschisis are related to the prevention of late intrauterine death, and the prediction and treatment of complex forms. With omphalocele, the main difficulty is the exclusion of associated conditions, not all diagnosed prenatally. An outline of the postnatal treatment of abdominal wall defects is given. Other rarer forms of abdominal wall defects are pentalogy of Cantrell, omphalocele, bladder exstrophy, imperforate anus, spina bifida complex, prune-belly syndrome, body stalk anomaly, and bladder and cloacal exstrophy; they deserve multidisciplinary counselling and management. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Screening for fetal aneuploidy.

    Science.gov (United States)

    Rink, Britton D; Norton, Mary E

    2016-02-01

    Screening is currently recommended in pregnancy for a number of genetic disorders, chromosomal aneuploidy, and structural birth defects in the fetus regardless of maternal age or family history. There is an overwhelming array of sonographic and maternal serum-based options available for carrying out aneuploidy risk assessment in the first and/or second trimester. As with any screening test, the patient should be made aware that a "negative" test or "normal" ultrasound does not guarantee a healthy baby and a "positive" test does not mean the fetus has the condition. The woman should have both pre- and post-test counseling to discuss the benefits, limitations, and options for additional testing. Rapid advancements of genetic technologies have made it possible to screen for the common aneuploidies traditionally associated with advanced maternal age with improved levels of accuracy beyond serum and ultrasound based testing. Prenatal screening for fetal genetic disorders with cell-free DNA has transformed prenatal care with yet unanswered questions related to the financial, ethical, and appropriate application in the provision of prenatal risk assessment. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Noninvasive Fetal ECG analysis

    Science.gov (United States)

    Clifford, Gari D.; Silva, Ikaro; Behar, Joachim; Moody, George B.

    2014-01-01

    Despite the important advances achieved in the field of adult electrocardiography signal processing, the analysis of the non-invasive fetal electrocardiogram (NI-FECG) remains a challenge. Currently no gold standard database exists which provides labelled FECG QRS complexes (and other morphological parameters), and publications rely either on proprietary databases or a very limited set of data recorded from few (or more often, just one) individuals. The PhysioNet/Computing in Cardiology Challenge 2013 enables to tackle some of these limitations by releasing a set of NI-FECG data publicly to the scientific community in order to evaluate signal processing techniques for NI-FECG extraction. The Challenge aim was to encourage development of accurate algorithms for locating QRS complexes and estimating the QT interval in noninvasive FECG signals. Using carefully reviewed reference QRS annotations and QT intervals as a gold standard, based on simultaneous direct FECG when possible, the Challenge was designed to measure and compare the performance of participants’ algorithms objectively. Multiple challenge events were designed to test basic FHR estimation accuracy, as well as accuracy in measurement of inter-beat (RR) and QT intervals needed as a basis for derivation of other FECG features. This editorial reviews the background issues, the design of the Challenge, the key achievements, and the follow-up research generated as a result of the Challenge, published in the concurrent special issue of Physiological Measurement. PMID:25071093

  17. Cyanotic Congenital Heart Defects – literature review

    Directory of Open Access Journals (Sweden)

    Vlad Drăgoi

    2017-11-01

    Full Text Available Congenital heart defects are one of the most interesting and important chapters regarding abnormal fetal growth pathology. The objective of this article is to present a literature review for the main cyanotic congenital heart defects. The ones presented in the article are: tetralogy of Fallot, transposition of the great vessels, double outlet right ventricle, truncus arteriosus, total anomalous pulmonary venous circulation and additional information regarding very rare malformations such as pentalogy of Cantrell and Uhl anomaly. An early and precise identification of congenital heart defects is an important step in an accurate follow-up of a potential problematic pregnancy. Knowing the sonographic aspect, associated pathology and the current available treatment procedures are vital for the fetal outcome and for the physician to adapt the right management in every situation that might appear during the pregnancy and in the neonatal period.

  18. Quantitative Ultrasound Texture Analysis for Differentiating Preterm From Term Fetal Lungs.

    Science.gov (United States)

    Ghorayeb, Sleiman R; Bracero, Luis A; Blitz, Matthew J; Rahman, Zara; Lesser, Martin L

    2017-07-01

    To differentiate preterm (quantitative texture analysis of ultrasound images. This study retrospectively evaluated singleton gestations with valid dating at 20 weeks' gestational age (GA) or later between January 2015 and December 2015. Images were obtained from Voluson E8 ultrasound systems (GE Healthcare, Milwaukee, WI). A region of interest was selected in each fetal lung image at the level of the 4 heart chambers from an area that appeared most representative of the overall lung tissue and had the least shadow. Ultrasonic tissue heterogeneity (heterogeneity index) based on dynamic range calculation was determined for all lung images. This quantification was performed with a custom-made software program that used a dithering technique based on the Floyd-Steinberg algorithm, in which the pixels are transformed into a binary map. Regression analysis was used to determine the correlation and functional association between the heterogeneity index and GA. A receiver operating characteristic curve was used to identify the optimal heterogeneity index cutoff point for differentiating preterm from term fetal lungs. A total of 425 fetal lung ultrasound images (313 preterm and 112 term) were analyzed. Quantitative texture analysis predicted GA with sensitivity and specificity of 87.9% and 92.0%, respectively, based on the optimal receiver operating characteristic cutoff point. Quantitative ultrasound texture analysis of fetal lung tissue can differentiate preterm fetal lungs from term fetal lungs. Our data suggest that decreased fetal lung heterogeneity on ultrasound imaging is associated with preterm fetuses. © 2017 by the American Institute of Ultrasound in Medicine.

  19. Prenatal Diagnosis of Fetal Encephalomalacia after Maternal Diabetic Ketoacidosis

    Directory of Open Access Journals (Sweden)

    Rozalyn Love

    2014-11-01

    Full Text Available Introduction - Encephalomalacia in a developing fetus is a rare and devastating neurological finding on radiologic imaging. Maternal diabetic ketoacidosis (DKA can lead to metabolic and vascular derangements which can cause fetal encephalomalacia. Case - We report the case of a 27-year-old pregnant woman with White's Class C diabetes mellitus who presented in the 25th week of gestation with DKA. Four weeks after her discharge, marked fetal cerebral ventriculomegaly was noted on ultrasound. A subsequent fetal magnetic resonance imaging (MRI demonstrated extensive, symmetric cystic encephalomalacia, primarily involving both cerebral hemispheres. The pregnancy was continued with close fetal and maternal surveillance. The patient underwent a repeat cesarean delivery in her 37th week. The infant had a 1 month neonatal intensive care unit stay with care rendered by a multiple disciplinary team of pediatric subspecialists. The postnatal course was complicated by global hypotonia, poor feeding, delayed development and ultimately required anticonvulsants for recurrent seizures. He died at the age of 9 months from aspiration during a seizure. Discussion - Although the maternal mortality from DKA has declined, DKA still confers significant neurological fetal morbidity to its survivors.

  20. Increased ventricular preload is compensated by myocyte proliferation in normal and hypoplastic fetal chick left ventricle

    Czech Academy of Sciences Publication Activity Database

    Dealmeida, A.; McQuinn, T. C.; Sedmera, David

    2007-01-01

    Roč. 100, - (2007), s. 1363-1370 ISSN 0009-7330 Institutional research plan: CEZ:AV0Z50450515 Keywords : chick embryo * hemodynamics * fetal surgery * hypoplastic left heart syndrome Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery Impact factor: 9.721, year: 2007

  1. Antenatal evaluation of fetal interrupted aortic arch type B

    Directory of Open Access Journals (Sweden)

    Ali Babacan

    2015-06-01

    Full Text Available Interruption of the aortic arch (IAA is a rare, severe form of congenital heart defect characterized by complete anatomical discontinuity between two adjacent segments of the aortic arch. The data on the features and outcomes of fetal IAA are limited. Three anatomical types have been described according to the site of interruption. The current recommendations for screening on the obstetric fetal anomaly scan include identification of a 4-chamber view, all 4 valves, and the outflow tracts, all of which can appear to be normal to the ultrasonographer in fetuses with conotruncal anomalies. Although the identification of IAA on a prenatal echocardiogram can be challenging, a number of anatomic features can facilitate the diagnosis. We aim to present the features and outcome of a case of IAA type B referred to our centre in the light of literatures.

  2. Routine prenatal screening for congenital heart disease: what can be expected? A decision-analytic approach

    NARCIS (Netherlands)

    E. Buskens (Erik); E.W. Steyerberg (Ewout); J. Hess (Jakob); J.W. Wladimiroff (Juriy); D.E. Grobbee (Diederick)

    1997-01-01

    textabstractOBJECTIVES: This study assessed the potential impact of fetal ultrasound screening on the number of newborns affected by cardiac anomalies. METHODS: A decision model was developed that included the prevalence and history of congenital heart disease,

  3. DNA methylation abnormalities in congenital heart disease.

    Science.gov (United States)

    Serra-Juhé, Clara; Cuscó, Ivon; Homs, Aïda; Flores, Raquel; Torán, Núria; Pérez-Jurado, Luis A

    2015-01-01

    Congenital heart defects represent the most common malformation at birth, occurring also in ∼50% of individuals with Down syndrome. Congenital heart defects are thought to have multifactorial etiology, but the main causes are largely unknown. We have explored the global methylation profile of fetal heart DNA in comparison to blood DNA from control subjects: an absolute correlation with the type of tissue was detected. Pathway analysis revealed a significant enrichment of differential methylation at genes related to muscle contraction and cardiomyopathies in the developing heart DNA. We have also searched for abnormal methylation profiles on developing heart-tissue DNA of syndromic and non-syndromic congenital heart defects. On average, 3 regions with aberrant methylation were detected per sample and 18 regions were found differentially methylated between groups. Several epimutations were detected in candidate genes involved in growth regulation, apoptosis and folate pathway. A likely pathogenic hypermethylation of several intragenic sites at the MSX1 gene, involved in outflow tract morphogenesis, was found in a fetus with isolated heart malformation. In addition, hypermethylation of the GATA4 gene was present in fetuses with Down syndrome with or without congenital heart defects, as well as in fetuses with isolated heart malformations. Expression deregulation of the abnormally methylated genes was detected. Our data indicate that epigenetic alterations of relevant genes are present in developing heart DNA in fetuses with both isolated and syndromic heart malformations. These epimutations likely contribute to the pathogenesis of the malformation by cis-acting effects on gene expression.

  4. Two cases of fetal goiter

    Directory of Open Access Journals (Sweden)

    Ashish Saini

    2012-01-01

    Full Text Available Introduction: Anterior fetal neck masses are rarely encountered. Careful routine ultrasound screening can reveal intrauterine fetal goiters (FGs. The incidence of goitrous hypothyroidism is 1 in 30,000-50,000 live births. The consequences of both FG and impaired thyroid function are serious. Aims and Objectives: To emphasize role of ultrasound in both invasive and non-invasive management of FG. Materials and Methods: Two pregnant patients, during second trimester, underwent routine antenatal ultrasound revealing FG, were investigated and managed. Results: Case 1: Revealed FG with fetal hypothyroidism. Intra-amniotic injection l-thyroxine given. Follow-up ultrasound confirmed the reduction of the goiter size. At birth, thyroid dyshormogenesis was suspected and neonate discharged on 50 mcg levothyroxine/day with normal growth and development so far. Case 2: Hypothyroid mother with twin pregnancy revealed FG, in twin 1, confirmed on magnetic resonance imaging (1.5 × 1.63 cm. The other twin had no thyroid swelling. Cordocentesis confirmed hypothyroidism in twin 1. Maternal thyroxine dose increased as per biochemical parameters leading to reduction in FG size. Mother delivered preterm and none of the twins had thyroid swelling. Fetal euthyroidism was confirmed on biochemical screening. Conclusion: FG during pregnancy should be thoroughly evaluated, diagnosed and immediately treated; although in utero options for fetal hypothyroidism management are available, emphasis should be laid on non-invasive procedures. Newer and better resolution techniques in ultrasonography are more specific and at the same time are less harmful.

  5. Heart Failure

    DEFF Research Database (Denmark)

    Jorsal, Anders; Wiggers, Henrik; McMurray, John J V

    2018-01-01

    This article briefly discusses the epidemiology of heart failure and diabetes and summarizes the key findings from the recent cardiovascular outcome trials in patients with type 2 diabetes, with a focus on heart failure as an endpoint.......This article briefly discusses the epidemiology of heart failure and diabetes and summarizes the key findings from the recent cardiovascular outcome trials in patients with type 2 diabetes, with a focus on heart failure as an endpoint....

  6. Taquiarritmia fetal: Una revisión práctica Fetal tachyarrhythmia

    Directory of Open Access Journals (Sweden)

    Juan F Jaramillo D

    2009-02-01

    Full Text Available Las frecuencias anormalmente rápidas sobre un corazón con una estructura menos distensible, rodeado por una coraza que sólo le permite defenderse con la frecuencia cardiaca para sostener el gasto cardiaco, hacen que este sea un corazón con márgenes estrechos de tolerancia frente a las taquiarritmias. Las frecuencias persistentes y superiores a 220 latidos por minuto, generan presiones anormalmente altas sobre todo el corazón y el sistema venoso. Hidrops y edema placentario son secuelas finales antes de la muerte fetal, y aún hasta este punto se pueden controlar y revertir. Aunque en teoría cualquier tipo de arritmias común en la vida extrauterina se podría desencadenar en el feto, 90% de éstas están incluidas en la taquicardia supraventricular reciprocante y en el flutter. Ambos tipos de arritmias pueden responder a la digoxina, aunque algunas son refractarias a este medicamento. La aplicación de ultrasonido sobre el corazón, permite no sólo descartar anomalías cardiacas asociadas, sino realizar protocolos de tratamiento. La medición de la relación de los tiempos ventrículo atrial:atrio ventricular, permite considerar otro tipo de arritmias como la taquicardia ectópica de la unión y la forma permanente reciprocante de la unión, etc., e incluir otros anti-arrítmicos, como amiodarona, flecainida, sotalol, entre otros. La principal vía de uso de los anti-arrítmicos es la transplacentaria. Por lo tanto, no sólo el feto se expone a posibles efectos secundarios, sino también la madre. Un grupo multidisciplinario enfrentará esta situación con el fin de ofrecer el mejor resultado para los dos.A heart with a not much distensible structure, surrounded by a membrane, and only able to react with the heart rate for maintaining its cardiac output, has a narrow margin of tolerance in front of tachyarrhythmias. Persistent heart rates >200/min generate abnormally high pressure on the heart and the venous system. Hydrops and placental

  7. Postnatal Outcomes of Fetal Supraventricular Tachycardia: a Multicenter Study.

    Science.gov (United States)

    Hinkle, Kevin A; Peyvandi, Shabnam; Stiver, Corey; Killen, Stacy A S; Weng, Hsin Yi; Etheridge, Susan P; Puchalski, Michael D

    2017-10-01

    Supraventricular tachycardia (SVT), the most common fetal tachycardia, can be difficult to manage in utero. We sought to better understand predictors of the postnatal clinical course in neonates who experienced fetal SVT. We hypothesized that fetuses with hydrops or those with refractory SVT (failure of first-line SVT therapy) are more likely to experience postnatal SVT. This was a retrospective multicenter cohort study of subjects diagnosed with fetal SVT between 2006 and 2014. Fetuses with structural heart disease were excluded. Descriptive comparative statistics and univariate analysis with logistic regression were utilized to determine factors that most strongly predicted postnatal SVT and preterm delivery. The cohort consisted of 103 subjects. Refractory SVT was found in 37% (N = 38) of the cohort with this group more likely to be delivered prematurely (median = 36 vs. 37.5 weeks, p = 0.04). Refractory SVT did not increase the risk of postnatal SVT (p = 0.09). Postnatal SVT was seen in 61% (N = 63). Of those, 68% (N = 43) had postnatal SVT at ≤2 days of age. Postnatal SVT was associated with a later fetal SVT diagnosis (median = 30 vs. 27.5 weeks, p = 0.006). We found a strong correlation between postnatal SVT and later gestational age at fetal SVT diagnosis. Subjects with refractory SVT or hydrops did not have a higher risk of postnatal SVT. We propose strong consideration for term delivery in the absence of significant clinical compromise. Further studies to assess whether outcomes vary for preterm delivery versus expectant management in those with refractory SVT should be performed.

  8. Heart attack

    Science.gov (United States)

    ... part in support groups for people with heart disease . Outlook (Prognosis) After a heart attack, you have a higher ... P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier Saunders; 2014: ...

  9. Anatomy of the heart of Guinea pig fetuses in late gestation (Cavia porcellus [Linnaeus, 1758])

    OpenAIRE

    Mariangela de Toledo Barbino; Claudia Marinovic Oliveira; Erika Toledo Fonseca; Phelipe de Oliveira Favaron; Márcio Nogueira Rodrigues; Maria Angélica Miglino

    2011-01-01

    This study has been developed in order to describe the anatomy of the heart of Guinea pig (Cavia porcellus [Linnaeu,1758]) fetuses in late gestation and to obtain anatomical characteristics that can support and help the understanding of the physiology of fetal circulation. Fetuses have been collected from three female in late gestation, which were described and photographed macroscopically, trhough light microscopy in HE and scanning electronic microscopy. The fetal heart is divided into four...

  10. High frequency ultrasound for in vivo pregnancy diagnosis and staging of placental and fetal development in mice.

    Directory of Open Access Journals (Sweden)

    Adelaide Greco

    Full Text Available BACKGROUND: Ultrasound is a valuable non-invasive tool used in obstetrics and gynecology to monitor the growth and well being of the human fetus. The laboratory mouse has recently emerged as an appropriate model for fetal and perinatal studies because morphogenetic processes in mice exhibit adequate homology to those in humans, and genetic manipulations are relatively simple to perform in mice. High-frequency ultrasound (HFUS has recently become available for small animal preclinical imaging and can be used to study pregnancy and development in the mouse. The objective of the current study was to assess the main applications of HFUS in the evaluation of fetal growth and placental function and to better understand human congenital diseases. METHODOLOGY/PRINCIPAL FINDINGS: On each gestational day, at least 5 dams were monitored with HFUS; a total of ∼200 embryos were examined. Because it is not possible to measure each variable for the entire duration of the pregnancy, the parameters were divided into three groups as a function of the time at which they were measured. Univariate analysis of the relationship between each measurement and the embryonic day was performed using Spearman's rank correlation (Rs. Continuous linear regression was adopted for multivariate analysis of significant parameters. All statistical tests were two-sided, and a p value of 0.05 was considered statistically significant. CONCLUSIONS/SIGNIFICANCE: The study describes the main applications of HFUS to assess changes in phenotypic parameters in the developing CD1 mouse embryo and fetus during pregnancy and to evaluating physiological fetal and placental growth and the development of principal organs such as the heart, kidney, liver, brain and eyes in the embryonic mouse. A database of normal structural and functional parameters of mouse development will provide a useful tool for the better understanding of morphogenetic and cardiovascular anomalies in transgenic and mutant

  11. Fetal exposure in diagnostic radiology

    International Nuclear Information System (INIS)

    Baker, M.L.; Vandergrift, J.F.; Dalrymple, G.V.

    1979-01-01

    The problem of possible radiation damage to the fetus or embryo as a result of diagnostic radiography during pregnancy, particularly in the early stages, is discussed. Recommendations of therapeutic abortion after fetal exposure require an adequate knowledge of the doses involved. In the absence of actual dose measurements or estimates, approximate exposure levels may be determined from the literature. A summary of published values for radiography involving the lower abdomen is given. Data is also presented from a series of fetal exposures resulting mostly from routine diagnostic radiography when pregnancy was not known at the time but was established later. Results of actual dose measurements using a phantom and of dose calculations based on published values are in reasonable agreement indicating that literature values of dose provide a satisfactory alternative to measurement. These data suggest that diagnostic radiography rarely, if ever, results in fetal exposures high enough to justify therapeutic abortion. (author)

  12. Fetal Alcohol Syndrome & Effects: A Continuing Education Offering

    Science.gov (United States)

    1988-01-01

    drunkard" (Medelson, 1980). A generation Later in 1899, William Sullivan , physician at a Liverpool prison, published the first recognized scientific...shows ip at the party, he arrives in time to see George, a football fanatic, break out a keg of beer to toast what he hopes will be his middle...lirnebacer son. He draws a large mugful for his pregnant wife-- after all, on TV all football jocks drink beer! His son might as well get an early head-sart

  13. Monitoring fetal maturation-objectives, techniques and indices of autonomic function.

    Science.gov (United States)

    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

    2017-05-01

    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

  14. 3D ultrasound in fetal spina bifida.

    Science.gov (United States)

    Schramm, T; Gloning, K-P; Minderer, S; Tutschek, B

    2008-12-01

    3D ultrasound can be used to study the fetal spine, but skeletal mode can be inconclusive for the diagnosis of fetal spina bifida. We illustrate a diagnostic approach using 2D and 3D ultrasound and indicate possible pitfalls.

  15. Fetal scalp blood sampling during labor

    DEFF Research Database (Denmark)

    Chandraharan, Edwin; Wiberg, Nana

    2014-01-01

    Fetal cardiotocography is characterized by low specificity; therefore, in an attempt to ensure fetal well-being, fetal scalp blood sampling has been recommended by most obstetric societies in the case of a non-reassuring cardiotocography. The scientific agreement on the evidence for using fetal...... scalp blood sampling to decrease the rate of operative delivery for fetal distress is ambiguous. Based on the same studies, a Cochrane review states that fetal scalp blood sampling increases the rate of instrumental delivery while decreasing neonatal acidosis, whereas the National Institute of Health...... and Clinical Excellence guideline considers that fetal scalp blood sampling decreases instrumental delivery without differences in other outcome variables. The fetal scalp is supplied by vessels outside the skull below the level of the cranial vault, which is likely to be compressed during contractions...

  16. Births and deaths including fetal deaths

    Data.gov (United States)

    U.S. Department of Health & Human Services — Access to a variety of United States birth and death files including fetal deaths: Birth Files, 1968-2009; 1995-2005; Fetal death file, 1982-2005; Mortality files,...

  17. Metabolic requirements for fetal growth.

    Science.gov (United States)

    Milley, J R; Simmons, M A

    1979-09-01

    Table 1 outlines a metabolic balance sheet for the sheep fetus. It is clear that maternal substrate concentrations as well as placental function are important in assuring the provision of adequate substrate to meet fetal metabolic and growth requirements. It is intriguing that the fetus appears to use substrates not usually regarded as important in extrauterine diets (lactate) and to use substrates for catabolic purposes normally thought to be primarily anabolic substrates (amino acids). This information emphasizes the hazards of extrapolating metabolic and nutritional patterns seen in extrauterine life in reaching conclusions concerning the fetus. It likewise emphasizes the importance of ongoing studies in maternal and fetal nutrition and metabolism.

  18. Fetal dosimetry in diagnostic radiology

    International Nuclear Information System (INIS)

    Faulkner, Keith

    2002-01-01

    One of the most difficult areas in which to provide radiation protection advice is in the area of the exposure of the fetus. Both staff and patients may be exposed to ionizing radiation. Dosimetry approaches for both cases are different and the advice to the exposed individual varies. Irrespective of whether the irradiation of the fetus is unintended, the fetal dose must be calculated. This requires detailed knowledge of the radiographic technique used. The method of estimation will be described in detail as well as estimation of fetal risks

  19. Heart rate and flow velocity variability as determined from umbilical Doppler velocimetry at 10-20 weeks of gestation.

    Science.gov (United States)

    Ursem, N T; Struijk, P C; Hop, W C; Clark, E B; Keller, B B; Wladimiroff, J W

    1998-11-01

    1. The aim of this study was to define from umbilical artery flow velocity waveforms absolute peak systolic and time-averaged velocity, fetal heart rate, fetal heart rate variability and flow velocity variability, and the relation between fetal heart rate and velocity variables in early pregnancy.2.A total of 108 women presenting with a normal pregnancy from 10 to 20 weeks of gestation consented to participate in a cross-sectional study design. Doppler ultrasound recordings were made from the free-floating loop of the umbilical cord.3. Umbilical artery peak systolic and time-averaged velocity increased at 10-20 weeks, whereas fetal heart rate decreased at 10-15 weeks of gestation and plateaued thereafter. Umbilical artery peak systolic velocity variability and fetal heart rate variability increased at 10-20 and 15-20 weeks respectively.4. The inverse relationship between umbilical artery flow velocity and fetal heart rate at 10-15 weeks of gestation suggests that the Frank-Starling mechanism regulates cardiovascular control as early as the late first and early second trimesters of pregnancy. A different underlying mechanism is suggested for the observed variability profiles in heart rate and umbilical artery peak systolic velocity. It is speculated that heart rate variability is mediated by maturation of the parasympathetic nervous system, whereas peak systolic velocity variability reflects the activation of a haemodynamic feedback mechanism.

  20. Development of Fetal Movement between 26 and 36 Weeks’ Gestation in Response to Vibro-acoustic Stimulation

    Directory of Open Access Journals (Sweden)

    Marybeth eGrant-Beuttler

    2011-12-01

    Full Text Available Background: Ultrasound observation of fetal movement has documented general trends in motor development and fetal age when motor response to stimulation is observed. Evaluation of fetal movement quality, in addition to specific motor activity, may improve documentation of motor development and highlight specific motor responses to stimulation. Aims: The aim of this investigation was to assess fetal movement at 26 and 36 weeks gestation during three conditions (baseline, immediate response to vibro-acoustic stimulation (VAS, and post-response. Design: A prospective, longitudinal design was utilized. Subjects: Twelve normally developing fetuses, 8 females and 4 males, were examined with continuous ultrasound imaging. Outcome measures: The Fetal Neurobehavioral Coding System (FENS was used to evaluate the quality of motor activity during 10-second epochs over the three conditions. Results: Seventy-five percent of the fetuses at the 26 week assessment and 100% of the fetuses at the 36 week assessment responded with movement immediately following stimulation. Significant differences in head, fetal breathing, general, limb, and mouthing movements were detected between the 26 week and 36 week assessments. Movement differences between conditions were detected in head, fetal breathing, limb, and mouthing movements. Conclusions: Smoother and more complex movement was observed with fetal maturation. Following VAS stimulation, an immediate increase of large, jerky movements suggest instability in fetal capabilities. Fetal movement quality changes over gestation may reflect sensorimotor synaptogenesis in the central nervous system, while observation of immature movement patterns following VAS stimulation may reflect movement pattern instability.

  1. Antepartum Fetal Monitoring and Spectral Analysis of Preterm Birth Risk

    Science.gov (United States)

    Păsăricără, Alexandru; Nemescu, Dragoş; Arotăriţei, Dragoş; Rotariu, Cristian

    2017-11-01

    The monitoring and analysis of antepartum fetal and maternal recordings is a research area of notable interest due to the relatively high value of preterm birth. The interest stems from the improvement of devices used for monitoring. The current paper presents the spectral analysis of antepartum heart rate recordings conducted during a study in Romania at the Cuza Voda Obstetrics and Gynecology Clinical Hospital from Iasi between 2010 and 2014. The study focuses on normal and preterm birth risk subjects in order to determine differences between these two types or recordings in terms of spectral analysis.

  2. Fetal effects of combined spinal-epidural vs epidural labour analgesia: a prospective, randomised double-blind study.

    Science.gov (United States)

    Patel, N P; El-Wahab, N; Fernando, R; Wilson, S; Robson, S C; Columb, M O; Lyons, G R

    2014-05-01

    We have compared fetal heart rate patterns, Apgar scores and umbilical cord gas values following initiation of labour analgesia using either combined spinal-epidural or epidural. One hundred and fifteen healthy women requesting neuraxial analgesia in the first stage of labour were randomly assigned to receive either combined spinal-epidural (n = 62) or epidural analgesia (n = 53). Fetal heart rate traces, recorded for 30 min before and 60 min after neuraxial block, were categorised as normal, suspicious or pathological according to national guidelines. Sixty-one fetal heart rate tracings were analysed in the combined spinal-epidural group and 52 in the epidural group. No significant differences were found in fetal heart rate patterns, Apgar scores or umbilical artery and vein acid-base status between groups. However, in both combined spinal-epidural and epidural groups, there was a significant increase in the incidence of abnormal fetal heart rate patterns following neuraxial analgesia (p analgesia in the combined spinal-epidural group and zero before compared with 11 after in the epidural group. These changes comprised increased decelerations (p = 0.0045) (combined spinal-epidural group nine before and 14 after analgesia, epidural group four before and 16 after), increased late decelerations (p analgesia, epidural group zero before and eight after), and a reduction in acceleration rate (p = 0.034) (combined spinal-epidural group mean (SD) 12.2 (6.7) h(-1) before and 9.9 (6.1) h(-1) after analgesia, epidural group 11.0 (7.3) h(-1) before and 8.4 (5.9) h(-1) after). These fetal heart rate changes did not affect neonatal outcome in this healthy population. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

  3. Sotalol in the treatment of fetal dysrhythmias

    NARCIS (Netherlands)

    Oudijk, M. A.; Michon, M. M.; Kleinman, C. S.; Kapusta, L.; Stoutenbeek, P.; Visser, G. H.; Meijboom, E. J.

    2000-01-01

    Background-Fetal tachycardia may cause hydrops fetalis and lead to fetal death. No unanimity of opinion exists regarding the optimum treatment. This study evaluates our experience with transplacental sotalol therapy to treat fetal tachycardias in terms of safety and efficacy. Methods and Results-The

  4. Use of fetal analgesia during prenatal surgery.

    Science.gov (United States)

    Bellieni, Carlo V; Tei, M; Stazzoni, G; Bertrando, S; Cornacchione, S; Buonocore, G

    2013-01-01

    Recent progresses in fetal surgery have raised concern on fetal pain, its long-term consequences and the risks of sudden fetal movements induced by pain. In several studies, surgeons have directly administered opioids to the fetus, while others have considered sufficient the maternally administered analgesics. We performed a review of the literature to assess the state of the art. We performed a PubMed search to retrieve the papers that in the last 10 years reported studies of human fetal surgery and that described whether any fetal analgesia was administered. We retrieved 34 papers. In three papers, the procedure did not hurt the fetus, being performed on fetal annexes, in two papers, it was performed in the first half of pregnancy, when pain perception is unlikely. In 10 of the 29 remaining papers, fetal surgery was performed using direct fetal analgesia, while in 19, analgesia was administered only to the mother. In most cases, fetal direct analgesia was obtained using i.m. opioids, and muscle relaxant. Rare drawbacks on either fetuses or mothers due to fetal analgesia were reported. Fetal direct analgesia is performed only in a minority of cases and no study gives details about fetal reactions to pain. More research is needed to assess or exclude its possible long-term drawbacks, as well as the actual consequences of pain during surgery.

  5. Practice Bulletin No. 173: Fetal Macrosomia.

    Science.gov (United States)

    2016-11-01

    Suspected fetal macrosomia is encountered commonly in obstetric practice. As birth weight increases, the likelihood of labor abnormalities, shoulder dystocia, birth trauma, and permanent injury to the neonate increases. The purpose of this document is to quantify those risks, address the accuracy and limitations of methods for estimating fetal weight, and suggest clinical management for a pregnancy with suspected fetal macrosomia.

  6. Extraction of the fetal ECG in noninvasive recordings by signal decompositions

    International Nuclear Information System (INIS)

    Christov, I; Simova, I; Abächerli, R

    2014-01-01

    No signal processing technique has been able to reliably deliver an undistorted fetal electrocardiographic (fECG) signal from electrodes placed on the maternal abdomen because of the low signal-to-noise ratio of the fECG recorded from the maternal body surface. As a result, this led to increased rates of Caesarean deliveries of healthy infants. In an attempt to solve the problem, Physionet/Computing in Cardiology announced the 2013 Challenge: noninvasive fetal ECG. We are suggesting a method for cancellation of the maternal ECG consisting of: maternal QRS detection, heart rate dependant P-QRS-T interval selection, location of the fiducial points inside this interval for best matching by cross correlation, superimposition of the intervals, calculation of the mean signal of the P-QRS-T interval, and sequential subtraction of the mean signal from the whole fECG recording. Three signal decomposition methods were further applied in order to enhance the fetal QRSs (fQRS): principal component analysis, root-mean-square and Hotelling’s T-squared. A combined lead of all decompositions was synthesized and fQRS detection was performed on it. The current research differs from the Challenge in that it uses three signal decomposition methods to enhance the fECG. The new results for 97 recordings of test set B are: 305.657 for Event 4: Fetal heart rate (FHR) and 23.062 for Event 5: Fetal RR interval (FRR). (paper)

  7. Sequential Total Variation Denoising for the Extraction of Fetal ECG from Single-Channel Maternal Abdominal ECG.

    Science.gov (United States)

    Lee, Kwang Jin; Lee, Boreom

    2016-07-01

    Fetal heart rate (FHR) is an important determinant of fetal health. Cardiotocography (CTG) is widely used for measuring the FHR in the clinical field. However, fetal movement and blood flow through the maternal blood vessels can critically influence Doppler ultrasound signals. Moreover, CTG is not suitable for long-term monitoring. Therefore, researchers have been developing algorithms to estimate the FHR using electrocardiograms (ECGs) from the abdomen of pregnant women. However, separating the weak fetal ECG signal from the abdominal ECG signal is a challenging problem. In this paper, we propose a method for estimating the FHR using sequential total variation denoising and compare its performance with that of other single-channel fetal ECG extraction methods via simulation using the Fetal ECG Synthetic Database (FECGSYNDB). Moreover, we used real data from PhysioNet fetal ECG databases for the evaluation of the algorithm performance. The R-peak detection rate is calculated to evaluate the performance of our algorithm. Our approach could not only separate the fetal ECG signals from the abdominal ECG signals but also accurately estimate the FHR.

  8. Sequential Total Variation Denoising for the Extraction of Fetal ECG from Single-Channel Maternal Abdominal ECG

    Directory of Open Access Journals (Sweden)

    Kwang Jin Lee

    2016-07-01

    Full Text Available Fetal heart rate (FHR is an important determinant of fetal health. Cardiotocography (CTG is widely used for measuring the FHR in the clinical field. However, fetal movement and blood flow through the maternal blood vessels can critically influence Doppler ultrasound signals. Moreover, CTG is not suitable for long-term monitoring. Therefore, researchers have been developing algorithms to estimate the FHR using electrocardiograms (ECGs from the abdomen of pregnant women. However, separating the weak fetal ECG signal from the abdominal ECG signal is a challenging problem. In this paper, we propose a method for estimating the FHR using sequential total variation denoising and compare its performance with that of other single-channel fetal ECG extraction methods via simulation using the Fetal ECG Synthetic Database (FECGSYNDB. Moreover, we used real data from PhysioNet fetal ECG databases for the evaluation of the algorithm performance. The R-peak detection rate is calculated to evaluate the performance of our algorithm. Our approach could not only separate the fetal ECG signals from the abdominal ECG signals but also accurately estimate the FHR.

  9. Sequential Total Variation Denoising for the Extraction of Fetal ECG from Single-Channel Maternal Abdominal ECG

    Science.gov (United States)

    Lee, Kwang Jin; Lee, Boreom

    2016-01-01

    Fetal heart rate (FHR) is an important determinant of fetal health. Cardiotocography (CTG) is widely used for measuring the FHR in the clinical field. However, fetal movement and blood flow through the maternal blood vessels can critically influence Doppler ultrasound signals. Moreover, CTG is not suitable for long-term monitoring. Therefore, researchers have been developing algorithms to estimate the FHR using electrocardiograms (ECGs) from the abdomen of pregnant women. However, separating the weak fetal ECG signal from the abdominal ECG signal is a challenging problem. In this paper, we propose a method for estimating the FHR using sequential total variation denoising and compare its performance with that of other single-channel fetal ECG extraction methods via simulation using the Fetal ECG Synthetic Database (FECGSYNDB). Moreover, we used real data from PhysioNet fetal ECG databases for the evaluation of the algorithm performance. The R-peak detection rate is calculated to evaluate the performance of our algorithm. Our approach could not only separate the fetal ECG signals from the abdominal ECG signals but also accurately estimate the FHR. PMID:27376296

  10. Ultrasonic prediction of fetal mass

    African Journals Online (AJOL)

    1983-02-19

    Feb 19, 1983 ... A reliable and cost-effective method of establishing fetal maturity ... This is the optimal time since during this period the rate of growth is .... error. Larger errors could not specifically be related to longer intervals. On the contrary,S out of the 10 correct estimates were calculated more than 3 weeks before birth.

  11. Accidental Haemorrhage and Fetal Prognosis

    African Journals Online (AJOL)

    1974-04-17

    Apr 17, 1974 ... perinatal mortality associated with accidental haemorrhage. The importance of clinical signs in determining fetal ... presented with antepartum haemorrhage, and where a retroplacental clot was found postpartum. .... rupture of membranes and oxytocin infusion. This was done in spite of intra-uterine death in ...

  12. Fetal programming and environmental exposures ...

    Science.gov (United States)

    Fetal programming is an enormously complex process that relies on numerous environmental inputs from uterine tissue, the placenta, the maternal blood supply, and other sources. Recent evidence has made clear that the process is not based entirely on genetics, but rather on a delicate series of interactions between genes and the environment. It is likely that epigenctic (“above the genome”) changes are responsible for modifying gene expression in the developing fetus, and these modifications can have long-lasting health impacts. Determining which epigenetic regulators are most vital in embryonic development will improve pregnancy outcomes and our ability to treat and prevent disorders that emerge later in life. “Fetal Programming and Environmental Exposures: Implications for Prenatal Care and Preterm Birth’ began with a keynote address by Frederick vom Saal, who explained that low-level exposure to endocrine disrupting chemicals (EDCs) perturbs hormone systems in utero and can have negative effects on fetal development. vom Saal presented data on the LOC bisphenol A (BPA), an estrogen-mimicking compound found in many plastics. He suggested that low-dose exposure to LOCs can alter the development process and enhance chances of acquiring adult diseases, such as breastcancer, diabetes, and even developmental disorders such as attention deficit disorder (ADHD).’ Fetal programming is an enormously complex process that relies on numerous environmental inputs

  13. Fetal programming of neuropsychiatric disorders.

    Science.gov (United States)

    Faa, Gavino; Manchia, Mirko; Pintus, Roberta; Gerosa, Clara; Marcialis, Maria Antonietta; Fanos, Vassilios

    2016-09-01

    Starting from the Developmental Origins of Health and Disease (DOHaD) hypotheses proposed by David Barker, namely fetal programming, in the past years, there is a growing evidence of the major role played by epigenetic factors during the intrauterine life and the perinatal period. Furthermore, it has been assessed that these factors can affect the health status in infancy and even in adulthood. In this review, we focus our attention on the fetal programming of the brain, analyzing the most recent literature concerning the epigenetic factors that can influence the development of neuropsychiatric disorders such as bipolar disorders, major depressive disorders, and schizophrenia. The perinatal epigenetic factors have been divided in two main groups: maternal factors and fetal factors. The maternal factors include diet, smoking, alcoholism, hypertension, malnutrition, trace elements, stress, diabetes, substance abuse, and exposure to environmental toxicants, while the fetal factors include hypoxia/asphyxia, placental insufficiency, prematurity, low birth weight, drugs administered to the mother or to the baby, and all factors causing intrauterine growth restriction. A better comprehension of the possible mechanisms underlying the pathogenesis of these diseases may help researchers and clinicians develop new diagnostic tools and treatments to offer these patients a tailored medical treatment strategy to improve their quality of life. Birth Defects Research (Part C) 108:207-223, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  14. Fetal cardiac cine imaging using highly accelerated dynamic MRI with retrospective motion correction and outlier rejection.

    Science.gov (United States)

    van Amerom, Joshua F P; Lloyd, David F A; Price, Anthony N; Kuklisova Murgasova, Maria; Aljabar, Paul; Malik, Shaihan J; Lohezic, Maelene; Rutherford, Mary A; Pushparajah, Kuberan; Razavi, Reza; Hajnal, Joseph V

    2018-01-01

    Development of a MRI acquisition and reconstruction strategy to depict fetal cardiac anatomy in the presence of maternal and fetal motion. The proposed strategy involves i) acquisition and reconstruction of highly accelerated dynamic MRI, followed by image-based ii) cardiac synchronization, iii) motion correction, iv) outlier rejection, and finally v) cardiac cine reconstruction. Postprocessing entirely was automated, aside from a user-defined region of interest delineating the fetal heart. The method was evaluated in 30 mid- to late gestational age singleton pregnancies scanned without maternal breath-hold. The combination of complementary acquisition/reconstruction and correction/rejection steps in the pipeline served to improve the quality of the reconstructed 2D cine images, resulting in increased visibility of small, dynamic anatomical features. Artifact-free cine images successfully were produced in 36 of 39 acquired data sets; prolonged general fetal movements precluded processing of the remaining three data sets. The proposed method shows promise as a motion-tolerant framework to enable further detail in MRI studies of the fetal heart and great vessels. Processing data in image-space allowed for spatial and temporal operations to be applied to the fetal heart in isolation, separate from extraneous changes elsewhere in the field of view. Magn Reson Med 79:327-338, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine.

  15. Protocol of the sepsivit study : A prospective observational study to determine whether continuous heart rate variability measurement during the first 48 hours of hospitalisation provides an early warning for deterioration in patients presenting with infection or sepsis to the emergency department of a Dutch academic teaching hospital

    NARCIS (Netherlands)

    Quinten, Vincent M; van Meurs, Matijs; Renes, Maurits H; Ligtenberg, Jack J M; Ter Maaten, Jan C

    2017-01-01

    INTRODUCTION: One in five patients with sepsis deteriorates within 48 hours after hospital admission. Regrettably, a clear tool for the early detection of deterioration is still lacking. The SepsiVit study aims to determine whether continuous heart rate variability (HRV) measurement can provide an

  16. Protocol of the sepsivit study a prospective observational study to determine whether continuous heart rate variability measurement during the first 48 hours of hospitalisation provides an early warning for deterioration in patients presenting with infection or sepsis to the emergency department of a Dutch academic teaching hospital

    NARCIS (Netherlands)

    Quinten, Vincent M.; van Meurs, Matijs; Renes, Maurits H.; Ligtenberg, Jack J. M.; ter Maaten, Jan C.

    2017-01-01

    Introduction One in five patients with sepsis deteriorates within 48 hours after hospital admission. Regrettably, a clear tool for the early detection of deterioration is still lacking. The SepsiVit study aims to determine whether continuous heart rate variability (HRV) measurement can provide an

  17. Applicability of initial optimal maternal and fetal electrocardiogram combination vectors to subsequent recordings

    Science.gov (United States)

    Yan, Hua-Wen; Huang, Xiao-Lin; Zhao, Ying; Si, Jun-Feng; Liu, Tie-Bing; Liu, Hong-Xing

    2014-11-01

    A series of experiments are conducted to confirm whether the vectors calculated for an early section of a continuous non-invasive fetal electrocardiogram (fECG) recording can be directly applied to subsequent sections in order to reduce the computation required for real-time monitoring. Our results suggest that it is generally feasible to apply the initial optimal maternal and fetal ECG combination vectors to extract the fECG and maternal ECG in subsequent recorded sections.

  18. The Effect of Vibroacoustic Stimulation and Music on Fetal Movement

    Directory of Open Access Journals (Sweden)

    Masoume Pirhadi

    2015-09-01

    Full Text Available Introduction Fetal movement started at the 7th weeks of pregnancy and by the end of pregnancy will gradually be perfect and harmonious. Near-term fetuses can discriminate acoustic features, such as frequencies and spectra, and process complex auditory streams. In this study, we aimed to evaluate fatal movement in response to music and vibration stimulation. Materials and Methods This study is a clinical trial that was conducted in two groups and two-steps. Participants were pregnant women (primigravida who have referring to the Shahid Beheshti Hospital in Isfahan during 2013 to receive routine prenatal care. The 64 pregnant women (32-36 weeks were randomly assigned to the groups of Vibroacoustic stimulation (n= 32 and Music (n=32. They were stimulated immediately after the first non stress test and before the second test. The researchers’ evaluated and analyzed possible changes in non-stress test results using SPSS software version 20. Results Mean age of the subjects in vibroacoustic group and in music group were (25.5±2.6 (24.9±4.4 respectively. Paired t-test showed there was no relationship between the average number of acceleration of the fetal heart rate before and after the intervention (P>0.05.On the other hand, there was a significant correlation between the average number of fetal movements in the music group before and after the intervention (P

  19. Estimation of fetal weight by ultrasonic examination.

    Science.gov (United States)

    Wu, Mei; Shao, Guangrui; Zhang, Feixue; Ruan, Zhengmin; Xu, Ping; Ding, Hongyu

    2015-01-01

    This study was to evaluate the accuracy and clinical application of a new technique in the fetal weight estimation by ultrasound. The fetal biparietal diameter (BPD), head circumference (HC) and femur length (FL) were measured by ultrasound examination within one week before delivery. Two different fetal abdominal sectors were measured for the assessment of abdominal circumference (AC). The fetal weight of 516 singleton fetuses was estimated according to above measurements and their actual birth weight was recorded after delivery. There were no significant differences in the fetal AC or body weight evaluated before delivery and recorded after delivery. This new technique is more convenient and applicable for the evaluation of fetal AC as compared to standard method, and seems to be reliable and accurate for the assessment of fetal weight.

  20. Fetal anatomy revealed with fast MR sequences.

    Science.gov (United States)

    Levine, D; Hatabu, H; Gaa, J; Atkinson, M W; Edelman, R R

    1996-10-01

    Although all the imaging studies in this pictorial essay were done for maternal rather than fetal indications, fetal anatomy was well visualized. However, when scans are undertaken for fetal indications, fetal motion in between scout views and imaging sequences may make specific image planes difficult to obtain. Of the different techniques described in this review, we preferred the HASTE technique and use it almost exclusively for scanning pregnant patients. The T2-weighting is ideal for delineating fetal organs. Also, the HASTE technique allows images to be obtained in 430 msec, limiting artifacts arising from maternal and fetal motion. MR imaging should play a more important role in evaluating equivocal sonographic cases as fast scanning techniques are more widely used. Obstetric MR imaging no longer will be limited by fetal motion artifacts. When complex anatomy requires definition in a complicated pregnant patient, MR imaging should be considered as a useful adjunct to sonography.

  1. Antithyroid drug-induced fetal goitrous hypothyroidism

    DEFF Research Database (Denmark)

    Bliddal, Sofie; Rasmussen, Ase Krogh; Sundberg, Karin

    2011-01-01

    Maternal overtreatment with antithyroid drugs can induce fetal goitrous hypothyroidism. This condition can have a critical effect on pregnancy outcome, as well as on fetal growth and neurological development. The purpose of this Review is to clarify if and how fetal goitrous hypothyroidism can...... be prevented, and how to react when prevention has failed. Understanding the importance of pregnancy-related changes in maternal thyroid status when treating a pregnant woman is crucial to preventing fetal goitrous hypothyroidism. Maternal levels of free T(4) are the most consistent indication of maternal...... and fetal thyroid status. In patients with fetal goitrous hypothyroidism, intra-amniotic levothyroxine injections improve fetal outcome. The best way to avoid maternal overtreatment with antithyroid drugs is to monitor closely the maternal thyroid status, especially estimates of free T(4) levels....

  2. Fetal Alcohol Spectrum Disorders (FASD): an Approach to Effective Prevention

    OpenAIRE

    Roozen, Sylvia; Black, Diane; Peters, Gjalt-Jorn; Kok, Gerjo; Townend, David; Nijhuis, Jan; Koek, Ger; Curfs, Leopold

    2016-01-01

    Purpose of Review The objective of the current contribution is to propose an evidence-based, six-step approach to develop effective programs for prevention of fetal alcohol spectrum disorders. Recent Findings Despite widespread campaigns aimed to reduce prenatal alcohol exposure, the number of affected children continues to be high. Current strategies to reduce prenatal alcohol exposure may be ineffective or counterproductive. However, proven principles of health promotion could be applied to...

  3. Radiation absorbed dose to the human fetal thyroid

    International Nuclear Information System (INIS)

    Watson, E.E.

    1992-01-01

    The embryo/fetus is recognized to be particularly susceptible to damage from exposure to radiation. Many advisory groups have studied available information concerning radiation doses and radiation effects with the goal of reducing the risk to the embryo/fetus. Of particular interest are radioactive isotopes of iodine. Radioiodine taken into the body of a pregnant woman presents a possible hazard for the embryo/fetus. The fetal thyroid begins to concentrate iodine at about 13 weeks after conception and continues to do so throughout gestation. At term, the organic iodine concentration in the fetal blood is about 75% of that in the mother's blood. This paper presents a review the models that have been proposed for the calculation of the dose to the fetal thyroid from radioisotopes of iodine taken into the body of the pregnant woman as sodium iodide. A somewhat different model has been proposed, and estimates of the radiation dose to the fetal thyroid calculated from this model are given for each month of pregnancy from 123 I , 124 I , 125 I , and 131 I

  4. C-14-activity incorporation into the protein of fetal organs of guinea pigs with different maternal placental blood flow and fetal arterial O2-saturation

    International Nuclear Information System (INIS)

    Duenzl, B.

    1981-01-01

    In anaesthesised gravid guinea-pigs the dilate, end section of a placental radial artery was connected to the A.carotis via a flow meter and a throttle in order to measure and widely alter the maternal placental blood flow. Blood samples are taken from the fetal A.carotis, the fetal arterial O 2 -saturation and the Hb-content were determined. By altering the maternal placental blood circulation the fetal arterial O 2 -concentration can stabilised at various levels. In order to study the protein synthesis, under these conditions one infused 185 kBq C-14-leucine over a period of 3 hours into the jugular vein of the fetus. During infusion the radioactive concentrations in whole plasma and plasma water were measured. After the infusion the radioactive concentrations in the tissue fluid, the intracellular fluid and the acid-insoluble tissue fraction (protein) of the heart, kidenys, liver, the muscles of the upper end lower part of the body, the brain and the placenta were measured. The following deductions were drawn from the findings: The maternal placental blood flow vitally influences the activity incorporation per activity concentration in the plasma water. These findings agree with the hypotheses that the maternal blood circulation has an essential influence on the fetal proteins synthesis and that this influence can be attributed to the connection between placenta connection blood flow and oxygen saturation of fetal arterial blood. (orig.) [de

  5. Heart transplant

    Science.gov (United States)

    ... hospital for 7 to 21 days after a heart transplant. The first 24 to 48 hours will likely be in ... follow your self-care instructions. Biopsies of the heart muscle are ... after transplant, and then less often after that. This helps ...

  6. Taquiarritmias supraventriculares no feto. Experiência de uma unidade de referência em cardiologia fetal Fetal supraventricular tachyarrhythmias. Experience of a fetal cardiology reference center

    Directory of Open Access Journals (Sweden)

    Paulo Zielinsky

    1998-05-01

    referred for fetal cardiac evaluation. RESULTS: There were 17 fetuses with the diagnosis of supraventricular tachycardia (SVT and 8 patients with atrial flutter (AF. Gestational age ranged from 26 to 40 weeks. Twelve patients were hydropic at presentation (6 with SVT and 6 AF. Four fetuses with SVT showed structural abnormalities (two with Ebsten's anomaly and two with VSD. All patients were admitted to the Fetal Cardiology Unit for monitoring and treatment. Among 17 fetuses with SVT, twelve showed good response to digoxin administration, but this drug was not useful in any of the patients with flutter. In two patients with SVT and in six with AF, the pregnancy was interrupted to perform post-natal cardioversion. The mortality rate was 3/17 in the SVT group (including 2 patients with ebstein's anomaly and 0/8 in the flutter group CONCLUSION: Fetal supraventricular tachyarrithmias are rare in the general population. Nevertheless, the fetus may present with severe heart failure and death. Considering the satisfactory therapeutic response, accurate diagnosis and early treatment of these conditions are extremely important.

  7. Primary syphilis and nonimmune fetal hydrops in a penicillin-allergic woman. A case report.

    Science.gov (United States)

    ElTabbakh, G H; Elejalde, B R; Broekhuizen, F F

    1994-05-01

    The incidence of congenital syphilis is on the rise. Penicillin continues to be the drug of choice for it during pregnancy. A penicillin-allergic woman with primary stage syphilis who was treated initially with erythromycin presented with fever and nonimmune fetal hydrops secondary to an intrauterine syphilitic infection. Following desensitization and penicillin therapy the fetal hydrops disappeared, the pregnancy continued to term, and the patient delivered a small-for-gestational-age but other-wise normal infant who continued to do well up to 1 year of age.

  8. Pulmonary Hypoplasia Caused by Fetal Ascites in Congenital Cytomegalovirus Infection Despite Fetal Therapy

    Directory of Open Access Journals (Sweden)

    Kazumichi Fujioka

    2017-11-01

    Full Text Available We report two cases of pulmonary hypoplasia due to fetal ascites in symptomatic congenital cytomegalovirus (CMV infections despite fetal therapy. The patients died soon after birth. The pathogenesis of pulmonary hypoplasia in our cases might be thoracic compression due to massive fetal ascites as a result of liver insufficiency. Despite aggressive fetal treatment, including multiple immunoglobulin administration, which was supposed to diminish the pathogenic effects of CMV either by neutralization or immunomodulatory effects, the fetal ascites was uncontrollable. To prevent development of pulmonary hypoplasia in symptomatic congenital CMV infections, further fetal intervention to reduce ascites should be considered.

  9. Fetal monitor for non-stress-test screening at home.

    Science.gov (United States)

    Horio, H; Murakami, M; Chiba, Y; Inada, H

    1998-01-01

    A fetal monitoring device developed for non-stress-test (NST) screening at home works on battery power, and is so small and lightweight (152 x 120 x 64 mm, 600 g) that a pregnant woman can monitor fetal Doppler ultra-sound and record fetal heart rate (FHR) and uterine contraction (UC) data on an attached memory IC card at any time and in any place away from a hospital. The physician can evaluate these data, transmitted via public telephone lines, using a built-in modem in the monitor. The combination of the memory IC card as a temporary storage device with the intermittent data transmission to the host provides endless data storage. The input-output relationship of the device was quantitatively evaluated using a Doppler ultrasound heart rate simulator. Forty pregnant women participated in an evaluation of this system. The total number of NST data transmissions was 648, and the total amount of data received was more than 6.7 Mbytes. Of the 648 transmissions, 475 were adequate for clinical interpretation. Of the 101 failed NST data transmissions, 85 resulted from patient handling errors. However, 82.4% of these errors resulted in reexamination and transfer of new data by the patients, who were aware of the insufficiency of the original data. The main cause of the noise in the data was zero-count data; this noise rate accounted for 4.1% of the data abnormalities. A questionnaire survey found that 96% of the participants wanted to use the monitor again in their next pregnancies, and 83% would recommend its use to pregnant friends. The system was easily used and accepted by pregnant women, and the NST data obtained were sufficient for clinical interpretation.

  10. Utility of fetal cardiac magnetic resonance imaging to assess fetuses with right aortic arch and right ductus arteriosus.

    Science.gov (United States)

    Dong, Su-Zhen; Zhu, Ming

    2018-06-01

    To evaluate the utility of fetal cardiac magnetic resonance imaging (MRI) to diagnose right aortic arch (RAA) with right ductus arteriosus. This retrospective study included six fetuses with right aortic arch and right ductus arteriosus. The six fetal cases were examined using a 1.5-T magnetic resonance unit. The steady-state free precession (SSFP) and single-shot turbo spin echo (SSTSE) sequences were used to evaluate the fetal heart and airway. The gestational age of the six fetuses ranged from 22 to 35 weeks (mean, 26.5 weeks). The age of the pregnant women ranged from 23 to 40 years (mean 31 years). Fetal cardiac MRI diagnosed the six fetal cases with RAA with right ductus arteriosus correctly. Among the six fetuses, four were associated with other congenital heart defects. In three of six cases, the diagnoses established using prenatal echocardiography (echo) was correct when compared with postnatal diagnosis. Fetal cardiac MRI is a useful complementary tool to assess fetuses with RAA and right ductus arteriosus.

  11. Large-scale discovery of enhancers from human heart tissue.

    Science.gov (United States)

    May, Dalit; Blow, Matthew J; Kaplan, Tommy; McCulley, David J; Jensen, Brian C; Akiyama, Jennifer A; Holt, Amy; Plajzer-Frick, Ingrid; Shoukry, Malak; Wright, Crystal; Afzal, Veena; Simpson, Paul C; Rubin, Edward M; Black, Brian L; Bristow, James; Pennacchio, Len A; Visel, Axel

    2011-12-04

    Development and function of the human heart depend on the dynamic control of tissue-specific gene expression by distant-acting transcriptional enhancers. To generate an accurate genome-wide map of human heart enhancers, we used an epigenomic enhancer discovery approach and identified ∼6,200 candidate enhancer sequences directly from fetal and adult human heart tissue. Consistent with their predicted function, these elements were markedly enriched near genes implicated in heart development, function and disease. To further validate their in vivo enhancer activity, we tested 65 of these human sequences in a transgenic mouse enhancer assay and observed that 43 (66%) drove reproducible reporter gene expression in the heart. These results support the discovery of a genome-wide set of noncoding sequences highly enriched in human heart enhancers that is likely to facilitate downstream studies of the role of enhancers in development and pathological conditions of the heart.

  12. Fetal evaluation of spine dysraphism

    Energy Technology Data Exchange (ETDEWEB)

    Bulas, Dorothy [George Washington University Medical Center, Division of Diagnostic Imaging and Radiology, Children' s National Medical Center, Washington, DC (United States)

    2010-06-15

    Spinal dysraphism or neural tube defects (NTD) encompass a heterogeneous group of congenital spinal anomalies that result from the defective closure of the neural tube early in gestation with anomalous development of the caudal cell mass. Advances in ultrasound and MRI have dramatically improved the diagnosis and therapy of spinal dysraphism and caudal spinal anomalies both prenatally and postnatally. Advances in prenatal US including high frequency linear transducers and three dimensional imaging can provide detailed information concerning spinal anomalies. MR imaging is a complementary tool that can further elucidate spine abnormalities as well as associated central nervous system and non-CNS anomalies. Recent studies have suggested that 3-D CT can help further assess fetal spine anomalies in the third trimester. With the advent of fetal therapy including surgery, accurate prenatal diagnosis of open and closed spinal dysraphism becomes critical in appropriate counselling and perinatal management. (orig.)

  13. Idiopathic polyhydramnios and fetal gender.

    Science.gov (United States)

    Stanescu, A D; Banica, R; Olaru, G; Ghinda, E; Birdir, Cahit

    2015-05-01

    To determine the relationship between idiopathic polyhydramnios and fetal gender in the absence of fetal or maternal abnormalities. This was a retrospective population-based register study. 295 women with singleton pregnancies complicated by idiopathic polyhydramnios (amniotic fluid index (AFI) higher than 24 cm) who were delivered at our institution from January 2002 till December 2012 were included. Only pregnancies with an uncomplicated outcome were accepted in this study. The incidence of the male to female fetuses was compared with the one in the general population. Among pregnancies complicated by idiopathic polyhydramnios, the following gender distribution was found: 72.9% male and 37.1% female. The distribution in the general population was 51.5% female and 48.5% male. The mean AFI was significantly increased in male fetuses (p polyhydramnios is more frequent in male normal fetuses than in female ones.

  14. Fetal origin of vascular aging

    Directory of Open Access Journals (Sweden)

    Shailesh Pitale

    2011-01-01

    Full Text Available Aging is increasingly regarded as an independent risk factor for development of cardiovascular diseases such as atherosclerosis and hypertension and their complications (e.g. MI and Stroke. It is well known that vascular disease evolve over decades with progressive accumulation of cellular and extracellular materials and many inflammatory processes. Metabolic syndrome, obesity and diabetes are conventionally recognized as risk factors for development of coronary vascular disease (CVD. These conditions are known to accelerate ageing process in general and vascular ageing in particular. Adverse events during intrauterine life may programme organ growth and favour disease later in life, popularly known as, ′Barker′s Hypothesis′. The notion of fetal programming implies that during critical periods of prenatal growth, changes in the hormonal and nutritional milieu of the conceptus may alter the full expression of the fetal genome, leading to permanent effects on a range of physiological.

  15. Clinical significance of perceptible fetal motion.

    Science.gov (United States)

    Rayburn, W F

    1980-09-15

    The monitoring of fetal activity during the last trimester of pregnancy has been proposed to be useful in assessing fetal welfare. The maternal perception of fetal activity was tested among 82 patients using real-time ultrasonography. All perceived fetal movements were visualized on the scanner and involved motion of the lower limbs. Conversely, 82% of all visualized motions of fetal limbs were perceived by the patients. All combined motions of fetal trunk with limbs were preceived by the patients and described as strong movements, whereas clusters of isolated, weak motions of the fetal limbs were less accurately perceived (56% accuracy). The number of fetal movements perceived during the 15-minute test period was significantly (p fetal motion was present (44 of 45 cases) than when it was absent (five of 10 cases). These findings reveal that perceived fetal motion is: (1) reliable; (2) related to the strength of lower limb motion; (3) increased with ruptured amniotic membranes; and (4) reassuring if considered to be active.

  16. Fetal valproat sendromu Olgu Sunumu

    OpenAIRE

    Kalyoncu, Derya; Çetinçelik, Ümran; Çetinkaya, Feyzullah

    2009-01-01

    Fetal valproate syndrome which is seen in children of epileptic mothers who have taken sodium valproate during their pregnancy is characterized by typical facial appearance major and minor malformations and neurodevelopmental delay A case with facial features including epicanthal folds depressed nasal bridge hypertelorism retrognathia low set ears and peripheral pulmonary artery stenosis patent ductus arteriosus and overlapping toes is presented for reminding this syndrome Turk Arch Ped 2009;...

  17. Fetal programming in meat production.

    Science.gov (United States)

    Du, Min; Wang, Bo; Fu, Xing; Yang, Qiyuan; Zhu, Mei-Jun

    2015-11-01

    Nutrient fluctuations during the fetal stage affects fetal development, which has long-term impacts on the production efficiency and quality of meat. During the early development, a pool of mesenchymal progenitor cells proliferate and then diverge into either myogenic or adipogenic/fibrogenic lineages. Myogenic progenitor cells further develop into muscle fibers and satellite cells, while adipogenic/fibrogenic lineage cells develop into adipocytes, fibroblasts and resident fibro-adipogenic progenitor cells. Enhancing the proliferation and myogenic commitment of progenitor cells during fetal development enhances muscle growth and lean production in offspring. On the other hand, promoting the adipogenic differentiation of adipogenic/fibrogenic progenitor cells inside the muscle increases intramuscular adipocytes and reduces connective tissue, which improves meat marbling and tenderness. Available studies in mammalian livestock, including cattle, sheep and pigs, clearly show the link between maternal nutrition and the quantity and quality of meat production. Similarly, chicken muscle fibers develop before hatching and, thus, egg and yolk sizes and hatching temperature affect long-term growth performance and meat production of chicken. On the contrary, because fishes are able to generate new muscle fibers lifelong, the impact of early nutrition on fish growth performance is expected to be minor, which requires further studies. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Fetal growth and developmental programming.

    Science.gov (United States)

    Galjaard, Sander; Devlieger, Roland; Van Assche, Frans A

    2013-01-01

    The environment in utero and in early neonatal life may induce a permanent response in the fetus and the newborn, leading to enhanced susceptibility to later diseases. This review concentrates on the role and mechanisms of events during the antenatal and immediate postnatal period resulting in later life diseases, concentrating on abnormal growth patterns of the fetus. Fetal overgrowth is related to exposure to a diabetic intra uterine environment, increasing the vulnerability to transgenerational obesity and hence an increased sensitivity to more diabetic mothers. This effect has been supported by animal data. Fetal growth restriction is complex due to malnutrition in utero, catch up growth due to a high caloric intake and low physical activity in later life. Metabolic changes and a transgenerational effect of intra uterine malnutrition has been supported by animal data. In recent years the discovery of alterations of the genome due to different influences during embryonic life, called epigenetics, has led to the phenomenon of fetal programming resulting in changing transgenerational metabolic effects.

  19. [Modern fetal autopsy oriented to clinical demands using technical information methods].

    Science.gov (United States)

    Tennstedt, C; Hufnagl, P; Nguyen-Dobinsky, T N; Chaoui, R; Bollmann, R; Urban, M; Körner, H; Tietz, S; Tietz, P; Dietel, M

    1997-11-01

    Modern ultrasonic diagnostic instruments with high resolution and color Doppler sonography allow the obstetrician to describe pathological findings very precisely and at an early stage of pregnancy. The use of high-resolution ultrasound makes it possible to detect heart malformations already between the 8th and 10th week of gestation. This development has essentially changed the clinical requirements on fetal autopsy which in its traditional way no longer meets the increased demands. Unless the pathologists faces this challenge the importance of fetal autopsy will diminish. Modern image databases and communication techniques allow the pathologist to have direct access to text and images of pre-findings by other clinics. Great importance, however, must be attached to the interdisciplinary cooperation with obstetricians and geneticists. We report on routine fetal autopsy by using an interdisciplinary database an the Charité.

  20. The Jarisch-Herxheimer reaction and fetal monitoring changes in pregnant women treated for syphilis.

    Science.gov (United States)

    Myles, T D; Elam, G; Park-Hwang, E; Nguyen, T

    1998-11-01

    To estimate the incidence of the Jarisch-Herxheimer reaction in pregnant women undergoing treatment of syphilis and the incidence of changes in uterine activity or fetal heart rate (FHR). Pregnant women of at least 24 weeks' gestation diagnosed as needing treatment of syphilis were reviewed retrospectively. Patients were admitted for their first dose of benzathine penicillin, and the FHR was recorded continuously before and for 24 hours after injection. The occurrence of the Jarisch-Herxheimer reaction was noted, and all available FHR records for this admission were reviewed. Evaluations for changes in the FHR pattern and uterine activity were made. Statistical comparisons used Student t, Fischer exact, and chi2 tests, when applicable (significance P gestational age was 30.8 weeks. We found 20 cases of probable Jarisch-Herxheimer reaction (40%). Thirteen of 31 patients (41.9%) developed regular uterine contractions, median onset, 10 hours. All resolved within 24 hours of treatment. Patients with uterine contractions had a greater mean increase in temperature (1.15F versus 0.68F, P gestational age was associated with the occurrence of recurrent variable decelerations (29.6 weeks versus 32.3 weeks, P < .05). No patients required delivery at the time of treatment. The incidence of Jarisch-Herxheimer reaction in treated syphilitic pregnancies is about 40%; similar proportions of patients develop regular uterine contractions and recurrent variable decelerations.

  1. Lethal fetal and early neonatal presentation of adenylosuccinate lyase deficiency: observation of 6 patients in 4 families.

    Science.gov (United States)

    Mouchegh, Katharina; Zikánová, Marie; Hoffmann, Georg F; Kretzschmar, Benno; Kühn, Thomas; Mildenberger, Eva; Stoltenburg-Didinger, Gisela; Krijt, Jakub; Dvoráková, Lenka; Honzík, Tomás; Zeman, Jiri; Kmoch, Stanislav; Rossi, Rainer

    2007-01-01

    To characterize a new lethal fetal and early postnatal variant of adenylosuccinate lyase (ADSL) deficiency. This was a retrospective analysis of 6 patients with very early presentation of ADSL deficiency. Most of the 6 patie