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The overarching goal of the present work is to contribute to theunderstanding of the relations between fetal heart rate (FHR) temporal dynamicsand the well-being of the fetus, notably in terms of predicting cardiovasculardecompensation (CVD). It makes uses of an established animal model of humanlabor, where fourteen near-term ovine fetuses subjected to umbilical cordocclusions (UCO) were instrumented to permit regular intermittent measurementsof metabolites, pH, and continuous recording of electrocardiogram (ECG) andsystemic arterial blood pressure (to identify CVD) during UCO. ECG-derived FHRwas digitized at the sampling rate of 1000 Hz and resampled to 4Hz, as used inclinical routine. We focused on four FHR variability features which are tunableto temporal scales of FHR dynamics, robustly computable from FHR sampled at$4$Hz and within short-time sliding windows, hence permitting a time-dependent,or local, analysis of FHR which helps dealing with signal noise. Results showthe sensitivity of the proposed features for early detection of CVD,correlation to metabolites and pH, useful for early acidosis detection and theimportance of coarse time scales (2.5 to 8 seconds) which are not disturbed bythe low FHR sampling rate. Further, we introduce the performance of anindividualized self-referencing metric of the distance to healthy state, basedon a combination of the four features. We demonstrate that this novel metric,applied to clinically available FHR temporal dynamics alone, accuratelypredicts the time occurrence of CVD which heralds a clinically significantdegradation of the fetal health reserve to tolerate the trial of labor.

frontiers in pediatrics

Distance to healthy cardiovascular dynamics from fetal heart rate  scale-dependent features in pregnant sheep model of human labor predicts  cardiovascular decompensation