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Relationship between Deceleration Morphology and Phase Rectified Signal Averaging-based Parameters during Labor

View ORCID ProfileMassimo W. Rivolta, View ORCID ProfileMoira Barbieri, View ORCID ProfileTamara Stampalija, View ORCID ProfileRoberto Sassi, View ORCID ProfileMartin G. Frasch
doi: https://doi.org/10.1101/2021.04.21.440741
Massimo W. Rivolta
1Dipartimento di Informatica, Università degli Studi di Milano, Milan, Italy
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  • For correspondence: massimo.rivolta@unimi.it
Moira Barbieri
2Unit of Fetal Medicine and Prenatal Diagnosis, Institute for maternal and child health IRCCS Burlo Garofolo, Trieste, Italy
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Tamara Stampalija
2Unit of Fetal Medicine and Prenatal Diagnosis, Institute for maternal and child health IRCCS Burlo Garofolo, Trieste, Italy
3Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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Roberto Sassi
1Dipartimento di Informatica, Università degli Studi di Milano, Milan, Italy
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Martin G. Frasch
4Department of Obstetrics and Gynecology and Center on Human Development and Disability (CHDD), School of Medicine, University of Washington, Seattle, USA
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Abstract

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 7 normoxic and 5 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. DR and DC correlated with Δτ and τu for a wide range of the PRSA parameter T (max Pearson’s correlation ρ = 0.9, p < 0.05, and ρ = 0.6, p < 0.1, respectively). 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.

Competing Interest Statement

MGF has a patent pending on abdominal ECG signal separation for FHR monitoring (WO2018160890).

Copyright 
The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license.
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Posted April 22, 2021.
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Relationship between Deceleration Morphology and Phase Rectified Signal Averaging-based Parameters during Labor
Massimo W. Rivolta, Moira Barbieri, Tamara Stampalija, Roberto Sassi, Martin G. Frasch
bioRxiv 2021.04.21.440741; doi: https://doi.org/10.1101/2021.04.21.440741
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Relationship between Deceleration Morphology and Phase Rectified Signal Averaging-based Parameters during Labor
Massimo W. Rivolta, Moira Barbieri, Tamara Stampalija, Roberto Sassi, Martin G. Frasch
bioRxiv 2021.04.21.440741; doi: https://doi.org/10.1101/2021.04.21.440741

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