Familial cystic hygroma with normal karyotype.
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Biomedical subjects
Publications and source records attributed to S Vindla.
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OBJECTIVE: To investigate the acute and chronic changes in fetal heart rate and fetal activity in association with maternal smoking by means of a computerized fetal behavior assessment program. STUDY DESIGN: In 13 term nonsmokers and 13 term smokers, fetal behavior was analyzed for 2 consecutive periods of >60 minutes. In between these 2 periods, the smokers were allowed to smoke 1 cigarette, the nonsmokers were allowed a short break of comparable time span. Fetal heart rate variation and fetal activity were recorded by a single 1.5-MHZ ultrasound transducer. The percentage of time spent in low and high fetal heart rate variation and fetal activity were analyzed by computer before and after the short break for nonsmokers and before and after the smokers smoked the 1 cigarette. Smoking-induced changes in Doppler umbilical artery recordings were also investigated. Chronic exposure to cigarette smoke was objectively evaluated by measuring the carbon monoxide concentration in expired air in all participating women after breath holding. RESULTS: Fetuses chronically exposed to cigarette smoke spent significantly more time in a low fetal heart rate variation pattern, while fetal activity was decreased both in high and low fetal heart rate variation periods. After maternal smoking, no acute changes were observed in fetal heart rate variation, yet a reduction in fetal activity was noted; however, this only reached statistical significance in periods of high fetal heart rate variation. No significant change in mean fetal heart rate was observed, yet a significant reduction in the frequency of accelerations was noted. Smoking caused an acute and transient increase in the mean pulsatility index in the umbilical artery. CONCLUSION: The computer program was able to detect changes in fetal behavioral variables in association with acute and chronic smoking. These changes may be suggestive of altered neurodevelopmental maturation possibly resulting from chronic fetal hypoxemia. This computer program offers a real possibility that analysis of fetal behavioral variables can be brought into routine clinical practice. Incorporating an analysis of these behavioral variables into smoking cessation programs may render them more successful.
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Unstimulated (passive) and stimulated behaviour, in the form of fetal heart rate (FHR) and activity (FA)) was studied in 32 normal fetuses and 14 fetuses with intrauterine growth restriction (IUGR). FHR and FA were recorded using a single 1.5 MHz ultrasound transducer and analysed by computer. A 5 s vibroacoustic stimulus (VAS) (electronic artificial larynx) was used for the stimulation studies. The IUGR fetuses had significantly different patterns of both unstimulated and stimulated behaviour compared to normally grown fetuses. When unstimulated they had lower FA rates than the normally grown fetuses but this was only statistically significant at 28-31 weeks. They also spent a significantly lower proportion of time exhibiting high FHR variation at 28-31 weeks. Following VAS the IUGR fetuses had lower FA responses at all gestations and lower FHR responses from 32 weeks, though only the differences in FA response at 28-31 weeks were statistically significant. Of the 14 fetuses with IUGR, all but one exhibited passive behaviour (ERR and/or FA) that was outside the 10-90th range, for normally grown fetuses, whilst 6 of the 14 had responses to VAS that were within the normal range. We do not feel that computerised assessment of stimulated behaviour in preterm IUGR fetuses confers any advantage over passive observations.
Fetal behaviour [fetal heart rate (FHR) variation and movements (FA)] was studied in 27 normally grown fetuses and in 18 fetuses with intrauterine growth restriction (IUGR). FHR and FA were recorded using a single 1.5 MHz ultrasound transducer and analyzed by computer. The IUGR fetuses had significantly lower FA rates than the normally grown fetuses at all gestation times. They also spent a significantly lower proportion of time exhibiting high FHR variation at 28-31 weeks. Only two of the eighteen IUGR fetuses had abnormal biophysical profile scores (BPS) at the time of recording and yet all but one of them had either FHR or FA patterns that were outside the 10-90th centile range for the normally grown fetuses, suggesting that FHR and FA abnormalities predated BPS changes. More of the IUGR fetuses had abnormalities of FA than FHR. Finally, within the IUGR fetuses, those with small head circumferences (less than 3rd centile) had lower FA rates during periods of both low and high FHR variation, though this was only statistically significant for periods of low FHR variation (P < 0.05). This preliminary study offers the possibility that such objective evaluation of fetal behaviour could be used in a clinical setting and provide a more sensitive method of fetal assessment than the BPS.
An observational study was undertaken to evaluate a computerized fetal behavior program in a clinical setting. Behavior of normal fetuses was compared with that of fetuses with a variety of congenital abnormalities. Forty-three fetuses were studied at 28-36 weeks; 26 were normal (49 recordings) and 16 had congenital abnormalities (26 recordings; ten had structural abnormalities of the central nervous system, one had Down's syndrome and five had other abnormalities). Behavior was recorded with the use of Doppler ultrasound. The duration of each recording was 60 min or more in all but two instances. The behavioral criteria studied were (1) the relative percentage of time spent in low and high fetal heart rate (FHR) variation; and (2) the percentage of time fetal activity was detected in low and high FHR variation. Fetuses with abnormalities exhibited varying patterns of behavior: only eight had patterns of FHR variation that were within the 10th and 90th centiles for normal fetuses and only one fetus exhibited a fetal activity pattern that was between the 10th and 90th centiles for the normal group. All the abnormal fetuses had a FHR pattern and/or fetal activity rate outside the 10th or 90th centiles. This study suggests that such a computerized behavioral analysis program may serve as a functional adjunct to the evaluation of a fetus with structural abnormalities.
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Unstimulated (passive) and stimulated behaviour [fetal heart rate (FHR) and movements (FA)] was studied in 32 normal fetuses and 10 fetuses with congenital abnormalities (CA). FHR and FA were recorded using a single 1.5-MHz ultrasound transducer and analysed by computer. A 5-second vibroacoustic stimulus (VAS) ('electronic artificial larynx') was used for the stimulation studies. Thus, passive and stimulated behaviour could be studied in a group of fetuses with known pathologies. One hour was used as the recording time for the passive studies and 20 min for the stimulation studies (10 min pre- and 10 min post-VAS). All CA fetuses had abnormalities of FHR and/or FA on recording passive behaviour compared to normal fetuses. However, 4 of the 10 fetuses with CA had responses to VAS that were within the normal range for both FHR and FA. We do not feel that computerised assessment of stimulated behaviour in fetuses with CA confers any advantage over analysis of passive behaviour.
Conventional analysis of fetal behaviour is laborious and time-consuming. For it to have a role in a clinical setting, practical and more objective methods are necessary. We describe a computerised fetal behavioural analysis programme. Fetal behaviour (in the form of heart rate and movement) was recorded using a conventional Doppler ultrasound transducer. Data are presented comparing the method with conventional forms of behavioural analysis and documenting its limitations.