Relationship Between Deceleration Morphology and Phase Rectified Signal Averaging-Based Parameters During Labor

During labor, uterine contractions trigger the response of the autonomic nervous system (ANS) of the fetus, producing sawtooth-like decelerations in the fetal heart rate (FHR) series. Under chronic hypoxia, ANS is known to regulate FHR differently with respect to healthy fetuses. In this study, we h...

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Autores principales:	Massimo W. Rivolta, Moira Barbieri, Tamara Stampalija, Roberto Sassi, Martin G. Frasch
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	phase-rectified signal averaging (PRSA) animal model fetal heart rate (FHR) electronic fetal monitoring (EFM) heart rate variability (HRV) fetal hypoxia Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/d3eb4a622f774d22afbc0eae7f9c728e
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spelling	oai:doaj.org-article:d3eb4a622f774d22afbc0eae7f9c728e2021-11-30T22:53:51ZRelationship Between Deceleration Morphology and Phase Rectified Signal Averaging-Based Parameters During Labor2296-858X10.3389/fmed.2021.626450https://doaj.org/article/d3eb4a622f774d22afbc0eae7f9c728e2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.626450/fullhttps://doaj.org/toc/2296-858XDuring labor, uterine contractions trigger the response of the autonomic nervous system (ANS) of the fetus, producing sawtooth-like decelerations in the fetal heart rate (FHR) series. Under chronic hypoxia, ANS is known to regulate FHR differently with respect to healthy fetuses. In this study, we hypothesized that such different ANS regulation might also lead to a change in the FHR deceleration morphology. The hypothesis was tested in an animal model comprising nine normoxic and five chronically hypoxic fetuses that underwent a protocol of umbilical cord occlusions (UCOs). Deceleration morphologies in the fetal inter-beat time interval (FRR) series were modeled using a trapezoid with four parameters, i.e., baseline b, deceleration depth a, UCO response time τu and recovery time τr. Comparing normoxic and hypoxic sheep, we found a clear difference for τu (24.8±9.4 vs. 39.8±9.7 s; p < 0.05), a (268.1±109.5 vs. 373.0±46.0 ms; p < 0.1) and Δτ = τu − τr (13.2±6.9 vs. 23.9±7.5 s; p < 0.05). Therefore, the animal model supported the hypothesis that hypoxic fetuses have a longer response time τu and larger asymmetry Δτ as a response to UCOs. Assessing these morphological parameters during labor is challenging due to non-stationarity, phase desynchronization and noise. For this reason, in the second part of the study, we quantified whether acceleration capacity (AC), deceleration capacity (DC), and deceleration reserve (DR), computed through Phase-Rectified Signal Averaging (PRSA, known to be robust to noise), were correlated with the morphological parameters. DC, AC and DR were correlated with τu, τr and Δτ for a wide range of the PRSA parameter T (Pearson's correlation ρ > 0.8, p < 0.05). In conclusion, deceleration morphologies have been found to differ between normoxic and hypoxic sheep fetuses during UCOs. The same difference can be assessed through PRSA based parameters, further motivating future investigations on the translational potential of this methodology on human data.Massimo W. RivoltaMoira BarbieriTamara StampalijaTamara StampalijaRoberto SassiMartin G. FraschFrontiers Media S.A.articlephase-rectified signal averaging (PRSA)animal modelfetal heart rate (FHR)electronic fetal monitoring (EFM)heart rate variability (HRV)fetal hypoxiaMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	phase-rectified signal averaging (PRSA) animal model fetal heart rate (FHR) electronic fetal monitoring (EFM) heart rate variability (HRV) fetal hypoxia Medicine (General) R5-920
spellingShingle	phase-rectified signal averaging (PRSA) animal model fetal heart rate (FHR) electronic fetal monitoring (EFM) heart rate variability (HRV) fetal hypoxia Medicine (General) R5-920 Massimo W. Rivolta Moira Barbieri Tamara Stampalija Tamara Stampalija Roberto Sassi Martin G. Frasch Relationship Between Deceleration Morphology and Phase Rectified Signal Averaging-Based Parameters During Labor
description	During labor, uterine contractions trigger the response of the autonomic nervous system (ANS) of the fetus, producing sawtooth-like decelerations in the fetal heart rate (FHR) series. Under chronic hypoxia, ANS is known to regulate FHR differently with respect to healthy fetuses. In this study, we hypothesized that such different ANS regulation might also lead to a change in the FHR deceleration morphology. The hypothesis was tested in an animal model comprising nine normoxic and five chronically hypoxic fetuses that underwent a protocol of umbilical cord occlusions (UCOs). Deceleration morphologies in the fetal inter-beat time interval (FRR) series were modeled using a trapezoid with four parameters, i.e., baseline b, deceleration depth a, UCO response time τu and recovery time τr. Comparing normoxic and hypoxic sheep, we found a clear difference for τu (24.8±9.4 vs. 39.8±9.7 s; p < 0.05), a (268.1±109.5 vs. 373.0±46.0 ms; p < 0.1) and Δτ = τu − τr (13.2±6.9 vs. 23.9±7.5 s; p < 0.05). Therefore, the animal model supported the hypothesis that hypoxic fetuses have a longer response time τu and larger asymmetry Δτ as a response to UCOs. Assessing these morphological parameters during labor is challenging due to non-stationarity, phase desynchronization and noise. For this reason, in the second part of the study, we quantified whether acceleration capacity (AC), deceleration capacity (DC), and deceleration reserve (DR), computed through Phase-Rectified Signal Averaging (PRSA, known to be robust to noise), were correlated with the morphological parameters. DC, AC and DR were correlated with τu, τr and Δτ for a wide range of the PRSA parameter T (Pearson's correlation ρ > 0.8, p < 0.05). In conclusion, deceleration morphologies have been found to differ between normoxic and hypoxic sheep fetuses during UCOs. The same difference can be assessed through PRSA based parameters, further motivating future investigations on the translational potential of this methodology on human data.
format	article
author	Massimo W. Rivolta Moira Barbieri Tamara Stampalija Tamara Stampalija Roberto Sassi Martin G. Frasch
author_facet	Massimo W. Rivolta Moira Barbieri Tamara Stampalija Tamara Stampalija Roberto Sassi Martin G. Frasch
author_sort	Massimo W. Rivolta
title	Relationship Between Deceleration Morphology and Phase Rectified Signal Averaging-Based Parameters During Labor
title_short	Relationship Between Deceleration Morphology and Phase Rectified Signal Averaging-Based Parameters During Labor
title_full	Relationship Between Deceleration Morphology and Phase Rectified Signal Averaging-Based Parameters During Labor
title_fullStr	Relationship Between Deceleration Morphology and Phase Rectified Signal Averaging-Based Parameters During Labor
title_full_unstemmed	Relationship Between Deceleration Morphology and Phase Rectified Signal Averaging-Based Parameters During Labor
title_sort	relationship between deceleration morphology and phase rectified signal averaging-based parameters during labor
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/d3eb4a622f774d22afbc0eae7f9c728e
work_keys_str_mv	AT massimowrivolta relationshipbetweendecelerationmorphologyandphaserectifiedsignalaveragingbasedparametersduringlabor AT moirabarbieri relationshipbetweendecelerationmorphologyandphaserectifiedsignalaveragingbasedparametersduringlabor AT tamarastampalija relationshipbetweendecelerationmorphologyandphaserectifiedsignalaveragingbasedparametersduringlabor AT tamarastampalija relationshipbetweendecelerationmorphologyandphaserectifiedsignalaveragingbasedparametersduringlabor AT robertosassi relationshipbetweendecelerationmorphologyandphaserectifiedsignalaveragingbasedparametersduringlabor AT martingfrasch relationshipbetweendecelerationmorphologyandphaserectifiedsignalaveragingbasedparametersduringlabor
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Relationship Between Deceleration Morphology and Phase Rectified Signal Averaging-Based Parameters During Labor

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