Abstract
Objective:
Short-term variation (STV) from computerized cardiotocogram heart rate analysis is a parameter that complements decision making, regarding the delivery of fetuses in several high-risk situations. Although studies on the effects of gestational age and fetal pathology are convincing, there is a lack of data exploring diurnal variation and the adequacy of a single measurement.
Study Design:
In this prospective observational study, fetal STV was monitored with the AN24 fetal ECG monitor (Monica Healthcare) each hour for at least 10 h in total, beginning at different times. This resulted in data covering all 24 h of the day. Seventy fetuses, low risk with respect to conditions accessible to heart rate monitoring (median 37th week of gestation) were monitored for an average of 12 h. Results of STV per hour were categorized as ‘compromised’ (STV<4 ms) or ‘healthy’, (STV⩾4 ms) to calculate the model of predictability.
Results:
The model proposed (STV of ‘healthy’ fetuses: 9.6±2.6 ms, ‘compromised’ fetuses 3.0±0.5 ms, prevalence 1%) leads to a positive predictive value of 39%, which increased to 68 or 80% given two or three pathological (STV<4 ms) measurements, respectively. Diurnal variation was not observed.
Conclusions:
Single pathological STV values should be corroborated by further measurements in a 24-h interval in otherwise low-risk fetuses before inducing delivery. This may help to avoid unnecessary early births and give the fetus valuable days for intrauterine maturity.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1038%2Fjp.2016.202/MediaObjects/41372_2017_Article_BFjp2016202_Fig1_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1038%2Fjp.2016.202/MediaObjects/41372_2017_Article_BFjp2016202_Fig2_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1038%2Fjp.2016.202/MediaObjects/41372_2017_Article_BFjp2016202_Fig3_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1038%2Fjp.2016.202/MediaObjects/41372_2017_Article_BFjp2016202_Fig4_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1038%2Fjp.2016.202/MediaObjects/41372_2017_Article_BFjp2016202_Fig5_HTML.jpg)
Similar content being viewed by others
References
Grivell RM, Alfirevic Z, Gyte GML, Devane D . Antenatal cardiotocography for fetal assessment. Cochrane Database of Syst Rev 2012; 12 (9): CD007863.
Dawes GS, Moulden M, Redman CW . The advantages of computerized fetal heart rate analysis. J Perinat Med 1991; 19 (1-2): 39–45.
Dawes GS, Moulden M, Redman CW . Short-term fetal heart rate variation, decelerations, and umbilical flow velocity waveforms before labor. Obstet Gynecol 1992; 80 (4): 673–678.
Pardey J, Moulden M, Redman CW . A computer system for the numerical analysis of nonstress tests. Am J Obstet Gynecol 2002; 186 (5): 1095–1103.
Small-for-Gestational-Age Fetus, Investigation and Management (Green-top Guidelines No. 31), 2nd edn. Royal College of Obstetricians and Gynaecologists: London, UK, 2013.
Lees CC, Marlow N, van Wassenaer-Leemhuis A, Arabin B, Bilardo CM, Brezinka C et al. 2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): a randomised trial. Lancet 2015; 385 (9983): 2162–2172.
Monica Healthcare Ltd. Reference VR Operator Manual 100-TF-020. Monica AN24™: Nottingham, (UK), 2009.
Seliger G, Stenzel A, Kowalski EM, Hoyer D, Nowack S, Seeger S et al. Evaluation of standardized, computerized Dawes/Redman heart-rate analysis based on different recording methods and in relation to fetal beat-to-beat heart rate variability. J Perinat Med 2015; 44 (7): 785–792.
Hoyer D, Kowalski EM, Schmidt A, Tetschke F, Nowack S, Rudolph A et al. Fetal autonomic brain age scores, segmented heart rate variability analysis, and traditional short term variability. Front Hum Neurosci 2014; 8: 948.
Dawes GS, Lobb M, Moulden M, Redman CW, Wheeler T . Antenatal cardiotocogram quality and interpretation using computers. BJOG 2014; 121 (Suppl 7): 2–8.
Hofmeyr F, Groenewald CA, Nel DG, Myers MM, Fifer WP, Signore C et al. Fetal heart rate patterns at 20 to 24 weeks gestation as recorded by fetal electrocardiography. J Matern Fetal Neonatal Med 2014; 27 (7): 714–718.
Graatsma E, Jacod B, van Egmond L, Mulder EJ, Visser GH . Fetal electrocardiography: feasibility of long-term fetal heart rate recordings. BJOG 2009; 116 (2): 334–338.
Anceschi MM, Ruozi-Berretta A, Piazze JJ, Cosmi E, Cerekja A, Meloni P et al. Computerized cardiotocography in the management of intrauterine growth restriction associated with Doppler velocimetry alterations. Int J GynObstet 2004; 86: 365–370.
Marie C, Sinoquet C, Barasinski C, Lémery D, Vendittelli F . Does maternal race influence the short-term variation of the fetal heart rate? An historical cohort study. Eur J Obstet Gynecol Reprod Biol 2015; 193: 102–107.
De Vries JIP, Visser GHA, Mulder EJH, Prechtl HF . Diurnal and other variations in fetal movement and heart rate patterns at 20 - 22 weeks. Early Human Development 1987; 15 (6): 333–348.
Visser G, Goodman JD, Levine DH, Dawes GS . Diurnal and other cyclic variations in human fetal heart rate near term. Am J Obstet Gynecol 1982; 142: 535–544.
Suzuki T, Kimura Y, Murotsuki J, Murakami T, Uehara S, Okamura K . Detection of a biorhythm of human fetal autonomic nervous activity by a power spectral analysis. Am J Obstet Gynecol 2001; 185: 1247–1252.
Morokumaa S, Horimotob N, Nakano H . Diurnal changes in the power spectral characteristics of eye movements and heart rate variability in the human fetus at term. Early Human Development 2001; 64: 27–36.
Lange S, Van Leeuwen P, Geue D, Hatzmann W, Grönemeyer D . Influence of gestational age, heart rate, gender and time of day on fetal heart rate variability. Med Biol Eng Comput 2005; 43 (4): 481–486.
Piéri JF, Crowe JA, Hayes-Gill BR, Spencer CJ, Bhogal K, James DK . Compact longterm recorder for the transabdominal foetal and maternal electrocardiogram. Med Biol Eng Comput 2001; 39 (1): 118–125.
R Core Team.. R: A language and environment for statistical computing. R Foundation for Statistical Computing: Vienna, Austria, 2014.
Juergen Gross and bug fixes by Uwe Ligges, 2012. nortest: Tests for Normality. R package version 1.0-2.
Serra V, Moulden M, Bellver J, Redman CW . The value of the short-term fetal heart rate variation for timing the delivery of growth-retarded fetuses. BJOG 2008; 115: 1101–1107.
Petrikovsky BM, Kaplan GP . Diurnal non-stress test variations in healthy term fetuses. A call for evening appointments for fetal testing. Early Hum Dev 1996; 44 (2): 127–130.
Ozkaya E, Baser E, Cinar M, Korkmaz V, Kucukozkan T . Does diurnal rhythm have an impact on fetal biophysical profile? J Matern Fetal Neonatal Med 2012; 25 (4): 335–338.
Wolf H, Arabin B, Lees CC, Oepkes D, Prefumo F, Thilaganathan B et al. A longitudinal study of computerised cardiotocography in early fetal growth restriction. Ultrasound Obstet Gynecol 2016 (e-pub ahead of print; doi:10.1002/uog.17215).
Acknowledgements
We thank Ariane Stenzel for support during data acquisition and Regina Grosse for editing the manuscript.
Note: Definition of Interventional Study or Clinical Trial (https://clinicaltrials.gov/ct2/aboutstudies/ glossary#interventional-study): a clinical study in which participants are assigned to receive one or more nterventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes.The study presented in this manuscript is a non-interventional, prospective observational study. Although the data was recorded during fetal monitoring, the results with respect to 24-h variance were obtained in a post-processing procedure not related clinical management and blinded to the clinical investigators. No clinical intervention was based on any of the findings. Therefore, this study did not qualify to be registered according to the above definition.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Seliger, G., Petroff, D., Seeger, S. et al. Diurnal variations of short-term variation and the impact of multiple recordings on measurement accuracy. J Perinatol 37, 231–235 (2017). https://doi.org/10.1038/jp.2016.202
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/jp.2016.202
- Springer Nature America, Inc.