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Author Notes:

Author e-mails: Dirk.Hoyer@med.uni-jena.de

Apart the editing role of Dirk Hoyer and Uwe Schneider, the order of the authors follows the appearance of their sections.

All authors thank the organizers of the 9th meeting of the European Study Group on Cardiovascular Oscillations ESGCO 2016 as well as the permanent International Scientific Committee of his group for fostering the present European and worldwide collaborative project.

MGS and GM acknowledge the collaboration and support of Dr M Campanile, Dr S Tagliaferri and Prof P Martinelli, Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Università Federico II, Napoli, Italy for collecting and providing CTG data.

FA, HM, SZ thank their project partners from the University Hospital of Leipzig, Prof Holger Stepan, Dr Alexander Jank, Sophia Schröder, Susanne Fritze and Julia Kage, for providing data and careful annotations.

FA would like to thank Conselho Nacional de Desenvolvimento Tecnologico (CNPq—Brazil) and TU Dresden Graduate Academy as part of the Excellence Initiative of the German Federal and State Governments for their financial support.


Research Funding:

DH and US are supported by German Research Foundation: ‘Development of a clinic suitable marker of fetal autonomic maturation’ (DFG: Ho 1634/15–12, Schn 775/7–1).

The building of the Jena Fetal Monitoring Data Base was furthermore supported by ‘Biomagnetic investigations of fetal autonomic and central nervous maturation and its disturbances due to intrauterine growth restriction and glucocorticoide administration (DFG: Ho 1634/12–2, Schn 775/2–3)’ and ‘Prenatal diagnosis-Indices of fetal developmental disturbances enabled by advanced signal identification techniques’ (Marie Curie Intra-European Fellowship, Proposal No 237290).

HG was supported by a post-doctoral grant (SFRH/BPD/69671/2010) from Fundação para a Ciência e a Tecnologia (FCT), Portugal.

LS acknowledges the support of the RCUK Digital Economy Programme, grant number EP/G036861/1 (Oxford Centre for Doctoral Training in Healthcare Innovation).

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 (‘Mobile Health Intervention to Improve Perinatal Continuum of Care in Guatemala’).


  • Science & Technology
  • Life Sciences & Biomedicine
  • Technology
  • Biophysics
  • Engineering, Biomedical
  • Physiology
  • Engineering
  • fetal development
  • autonomic nervous system
  • heart rate variability
  • nonlinear signal analysis
  • functional autonomic brain age score
  • fABAS
  • CTG
  • MCG
  • ECG
  • prenatal diagnosis

Monitoring fetal maturation-objectives, techniques and indices of autonomic function

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Journal Title:

Physiological Measurement


Volume 38, Number 5


, Pages R61-R88

Type of Work:

Article | Post-print: After Peer Review


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 into routine practice and studies of fetal developmental disturbances with implications for programming of adult diseases.

Copyright information:

© 2017 Institute of Physics and Engineering in Medicine.

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