Key result
Sampling fetal HRV at 1000 Hz detects worsening hypoxic-acidemia earlier than standard 4 Hz.
Why the study?
The impact of fetal heart rate variability sampling rate on the ability to detect fetal acidemia during labor was not established.
Does a 4 Hz sampling rate for fetal heart rate variability monitoring detect fetal acidemia as effectively as a 1000 Hz sampling rate in near-term ovine fetuses?
Does a 4 Hz sampling rate for fetal heart rate variability monitoring detect fetal acidemia as effectively as a 1000 Hz sampling rate in near-term ovine fetuses?
p-value: p=<0.01
The current clinical sampling rate of 4 Hz for fetal heart rate monitors fails to detect early worsening hypoxic-acidemia compared to a 1000 Hz sampling rate, suggesting a need for more sensitive acquisition methods.
BACKGROUND: To evaluate the impact of sampling rate on the predictive capability of continuous fetal heart rate (FHR) variability (fHRV) monitoring for detecting fetal acidemia during labor, we tested the performance of the root mean square of successive differences (RMSSD) in R-R intervals from the ECG when acquired with the sampling rate of 4 Hz currently available in FHR monitors, in comparison to the gold standard of 1000 Hz. METHODS: Near-term ovine fetuses (N = 9) were chronically prepared with precordial electrodes for recording ECG, vascular catheters for blood sampling, and an umbilical cord occluder. For 1 min every 2.5 min, animals underwent mild partial umbilical cord occlusions (UCO) × 1 h, moderate partial UCO × 1 h, then complete UCO × 2 h, or until arterial pH reached <7.00. Arterial blood samples were drawn at baseline and every 20 min during the UCO series. RMSSD was calculated continuously in 5 min windows using an automated, standardized system (CIMVA.com). RESULTS are presented as mean ± SEM with significance assumed for p < 0.05. RESULTS: Repetitive UCO resulted in pH decreasing from 7.35 ± 0.01 to 7.00 ± 0.03. In all nine animals, RMSSD increased from 16.7 ± 1.0 ms at baseline to 44.4 ± 2.3 ms, 70 ± 15 min prior to reaching the pH nadir when sampled at 1000 Hz. When sampled at 4 Hz, RMSSD at baseline measured 36.1 ± 6.0 ms and showed no significant increase during the UCO series until the pH nadir was reached. Consequently, early detection of severe hypoxic-acidemia would have been missed in all fetuses. CONCLUSION: RMSSD as a measure of fHRV when calculated from FHR sampled at 1000 Hz allowed for the early detection of worsening hypoxic-acidemia in each fetus. However, when calculated at the low sampling rate of 4 Hz used clinically, RMSSD remained unchanged until terminally when the nadir pH was reached. For early detection of fetal acidemia during labor, more sensitive means of acquiring FHR are therefore recommended than currently deployed, e.g., trans-abdominal fetal ECG.
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Lucien Daniel Durosier (2014) studied Fetal acidemia (n=9). Fetal ECG sampling at 1000 Hz vs. Fetal ECG sampling at 4 Hz was evaluated on Change in root mean square of successive differences (RMSSD) of R-R intervals prior to pH nadir (p=<0.01). Fetal heart rate variability sampled at 1000 Hz allowed early detection of worsening hypoxic-acidemia, whereas the clinical standard of 4 Hz failed to detect changes until terminal acidemia.
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