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Abstract   Introduction  This study evaluated the association between fetal heart rate variability (HRV) and the occurrence of hypoxic–ischemic encephalopathy in a fetal sheep model.    Material and methods  The experimental protocol created a hypoxic condition with repeated cord occlusions in three phases (A, B, C) to achieve acidosis to pH &lt;7.00. Hemodynamic, gasometric and HRV parameters were analyzed during the protocol, and the fetal brain, brainstem and spinal cord were assessed histopathologically 48 h later. Associations between the various parameters and neural injury were compared between phases A, B and C using Spearman's rho test.    Results  Acute anoxic–ischemic brain lesions in all regions was present in 7/9 fetuses, and specific neural injury was observed in 3/9 fetuses. The number of brainstem lesions correlated significantly and inversely with the HRV fetal stress index ( r  = −0.784;  p  = 0.021) in phase C and with HRV long‐term variability ( r  = −0.677;  p  = 0.045) and short‐term variability ( r  = −0.837;  p  = 0.005) in phase B. The number of neurological lesions did not correlate significantly with other markers of HRV.    Conclusions  Neural injury caused by severe hypoxia was associated with HRV changes; in particular, brainstem damage was associated with changes in fetal‐specific HRV markers.

Associations between fetal heart rate variability and umbilical cord occlusions‐induced neural injury: An experimental study in a fetal sheep model