Key result
Small-for-dates fetuses had significantly lower average acceleration and deceleration capacities compared to controls (lower by 1.5 SD and 1.7 SD, respectively; p<0.0001).
Why the study?
Does the measurement of average acceleration and deceleration capacity (AAC and ADC) differentiate better between normal and small-for-dates fetuses than short term variability (STV)?
Observational (n=120)
Does the measurement of average acceleration and deceleration capacity (AAC and ADC) differentiate better between normal and small-for-dates fetuses than short term variability (STV)?
Average acceleration and deceleration capacity derived from high-resolution fetal ECG may provide better differentiation between normal and small-for-dates fetuses than traditional short-term variability.
May support AAC/ADC for fetal monitoring; hypothesis-generating and leaves open superiority to STV or outcome impact.
OBJECTIVE: To study fetal heart rate (FHR), its short term variability (STV), average acceleration capacity (AAC), and average deceleration capacity (ADC) throughout uncomplicated gestation, and to perform a preliminary comparison of these FHR parameters between small-for dates (SFD) and control fetuses. METHODS: Prospective observational study of 7 h FHR-recordings obtained with a fetal-ECG monitor in the second half of uncomplicated pregnancies (n = 90) and pregnancies complicated by fetal SFD (n = 30). FHR and STV were calculated according to established analysis. True beat-to-beat FHR, recorded at 1 ms accuracy, was used to calculate AAC and ADC using Phase Rectified Signal Averaging (PRSA). Mean values of FHR, STV, AAC, and ADC derived from recordings in SFD fetuses were compared with the reference curves. RESULTS: Compared with the control group the mean z-scores for STV, AAC, and ADC in SFD fetuses were lower by 1.0 SD, 1.5 SD, and 1.7 SD, respectively (p < 0.0001 for all comparisons). In SFD fetuses, both the AAC and ADC z-scores were lower than the STV z-scores (p < 0.02 and p < 0.002, respectively). CONCLUSIONS: Analysis of the AAC and ADC as recorded with a high resolution fECG recorder may differentiate better between normal and SFD fetuses than STV.
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Graatsma et al. (2012) conducted an observational in Fetal growth restriction (Small-for-dates) (n=120). Small-for-dates (SFD) status vs. Uncomplicated pregnancies (control fetuses) was evaluated on Average acceleration capacity (AAC) and average deceleration capacity (ADC) z-scores (AAC lower by 1.5 SD, ADC lower by 1.7 SD, p=< 0.0001). Small-for-dates fetuses had significantly lower average acceleration and deceleration capacities compared to controls (lower by 1.5 SD and 1.7 SD, respectively; p<0.0001).
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