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A differential analysis of the cardiotocogram allows conclusions äs to the functional state of the fetus. However, the interpretations of changes in the heart rate depend to a large extent on the experience of the examiner because of the poorly defined deliminations of specific pattems of heart rate changes. New techniques enable the recording of the pre-ejection period (PEP) of the human fetal heart; i.e., the time between ventricular excitation and aortic pressure rise, continuously parallel with the CTG [3, 12, 16, 24, 27]. The PEP is a measure of the myocardial contractility. Thus, with adrenergic Stimulation the cardiac contractility increases and the PEP is shortened. On the other hand, an increase in peripheral resistance leads to a lengthening of the PEP äs does a decrease of ventricular filling. Recent experiments in fetal lambs [20, 21, 37, 52, 53] showed in acute and chronic experiments [20,29] that in acute hypoxia the PEP falls below the normal ränge, and that with compression the PEP is increased while the relation of the PEP to duration of systole (relative PEP = PEPr) is constant. Furthermore, with umbilical cord complications characteristic PEP changes are seen and chronic and acute hypoxia lead to changes in the baseline level of the PEP. This study de als with the question whether the results of animal experiments from PEP recording together with the CTG apply to the human fetus during birth and whether the characteristics of the PEP and heart rate allow conclusions äs to the pathophysiology of umbilical cord complications. Curriculum vitae

Characteristic changes of the pre-ejection period of the human fetal heart during umbilical cord complications