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

• Type of Material: Article
• Authors: Lisa Stroux, University of Oxford; Christopher W. Redman, University of Oxford; Antoniya Georgieva, University of Oxford; Stephen J. Payne, University of Oxford; Gari Clifford, Emory University
• Language: English
• Date: 2017-11-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Nordic Federation of Societies of Obstetrics and Gynecology
• Final Published Version (URL): http://dx.doi.org/10.1111/aogs.13228
• Title of Journal or Parent Work: Acta Obstetricia et Gynecologica Scandinavica
• ISSN: 0001-6349
• Volume: 96
• Issue: 11
• Start Page: 1322
• End Page: 1329
• Grant/Funding Information: AG was supported by the Action Medical Research and the Henry Smith Charity.; GC acknowledges the support of the National Institutes of Health, the Fogarty International Center and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, grant number 1R21HD084114-01.; LS acknowledges the support of the RCUK Digital Economy Programme grant number EP/G036861/1 (Oxford Centre for Doctoral Training in Healthcare Innovation).
• Keywords: AVERAGE; BIRTH-WEIGHT; TRIAL; BEHAVIORAL STATES; low-cost automated fetal monitoring; intrauterine growth restriction; Cardiotocography; SYMPHYSIS-FUNDAL HEIGHT; Life Sciences & Biomedicine; heart rate variability; FLOW; OUTCOMES; Obstetrics & Gynecology; SLEEP; FETUSES; TRUFFLE; Doppler; Science & Technology
• Research Categories: Engineering, Biomedical; Health Sciences, Obstetrics and Gynecology

Abstract

Introduction: 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. Material and methods: 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. Results: 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%. Conclusion: We suggest that heart rate variability markers together with surrogate information on sleep states can contribute to the detection of early-onset IUGR.