Assessment of fetal heart rate and fetal movements in detecting oxygen deprivation in-utero.

This article reviews the physiological principles underlying the application of assessment of fetal movements and fetal heart rate (FHR) in detecting fetal hypoxia. Studies in both fetal sheep and healthy human fetuses are discussed including those which have demonstrated the importance of appreciating the existence of rest-activity cycles under normal physiological conditions. The role of adenosine in mediating the hypoxic inhibition of fetal breathing movements (FBMs) is reviewed as is the previously unrecognized importance of fetal gasping as a possible new measure of fetal hypoxia.

[1]  C. Ducsay,et al.  Fetal breathing, sleep state and cardiovascular adaptations to anaemia in sheep. , 1992, The Journal of physiology.

[2]  J. Patrick,et al.  Accelerations of the human fetal heart rate at 38 to 40 weeks' gestational age. , 1984, American journal of obstetrics and gynecology.

[3]  B. Koos,et al.  Adenosine stimulates breathing in fetal sheep with brain stem section. , 1992, Journal of applied physiology.

[4]  F. Manning Dynamic Ultrasound-Based Fetal Assessment: The Fetal Biophysical Profile Score , 1995, Clinical obstetrics and gynecology.

[5]  B. Koos,et al.  Adenosine A(2A) receptors mediate hypoxic inhibition of fetal breathing in sheep. , 2002, American journal of obstetrics and gynecology.

[6]  K. J. Dalton,et al.  Breathing patterns before death in fetal lambs. , 1976, American journal of obstetrics and gynecology.

[7]  B. Richardson,et al.  Patterns of Human Fetal Breathing During the Last 10 Weeks of Pregnancy , 1980, Obstetrics and gynecology.

[8]  P. Gluckman,et al.  Lesions in the upper lateral pons abolish the hypoxic depression of breathing in unanaesthetized fetal lambs in utero. , 1987, The Journal of physiology.

[9]  R. Harding,et al.  Effects of reduced uterine blood flow on electrocortical activity, breathing, and skeletal muscle activity in fetal sheep. , 1986, American journal of obstetrics and gynecology.

[10]  Y. Okada,et al.  The levels of adenosine and its metabolites in the guinea pig and rat brain during complete ischemia—in vivo study , 1998, Brain Research.

[11]  R. Gagnon,et al.  Behavioral activity during prolonged hypoxemia in fetal sheep. , 1988, Journal of applied physiology.

[12]  G. Dawes,et al.  Effects of hypercapnia on tracheal pressure, diaphragm and intercostal electromyograms in unanaesthetized fetal lambs , 1982, The Journal of physiology.

[13]  B. Koos,et al.  Fetal breathing, sleep state, and cardiovascular responses to adenosine in sheep. , 1990, Journal of applied physiology.

[14]  L. Longo,et al.  Fetal breathing adaptation to prolonged hypoxaemia in sheep. , 1988, Journal of developmental physiology.

[15]  T. F. Murray,et al.  Source of extracellular brain adenosine during hypoxia in fetal sheep 1 First published on thwe World Wide Web on 4 November 1997. 1 , 1997, Brain Research.

[16]  B. Koos,et al.  Adenosine A(1) and A(2A) receptors modulate sleep state and breathing in fetal sheep. , 2001, Journal of applied physiology.

[17]  G. Dawes,et al.  Measurement of fetal forelimb movements in the lamb in utero. , 1981, American journal of obstetrics and gynecology.

[18]  R. Gagnon,et al.  Effect of prolonged hypoxemia on fetal heart rate accelerations and decelerations in sheep. , 1989, American journal of obstetrics and gynecology.

[19]  D. Rurak,et al.  Increased oxygen consumption associated with breathing activity in fetal lambs. , 1983, Journal of applied physiology: respiratory, environmental and exercise physiology.

[20]  S. Neldam,et al.  FETAL MOVEMENTS AS AN INDICATOR OF FETAL WELLBEING , 1980, The Lancet.

[21]  M. Nakazawa,et al.  Adenosine: A Retaliatory Metabolite or Not? , 1990 .

[22]  D. Walker,et al.  Breathing in fetal lambs: the effect of brain stem section. , 1983, The Journal of physiology.

[23]  K. Maršál,et al.  Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: a Swedish randomised controlled trial , 2001, The Lancet.

[24]  P. Johnson,et al.  Respiratory function of the larynx in developing sheep and the influence of sleep state. , 1980, Respiration physiology.

[25]  C. Martin,et al.  Breathing movements before death in the primate fetus (Macaca mulatta). , 1979, American journal of obstetrics and gynecology.

[26]  J. Patrick,et al.  The nonstress test: how long is enough? , 1981, American journal of obstetrics and gynecology.

[27]  B. Koos,et al.  Hypoxic inhibition of breathing in fetal sheep: relationship to brain adenosine concentrations. , 1994, Journal of applied physiology.

[28]  R. Harding,et al.  Relationship between accelerations and decelerations in heart rate and skeletal muscle activity in fetal sheep. , 1985, Journal of developmental physiology.

[29]  A. Pack,et al.  Activity of adenosine deaminase in the sleep regulatory areas of the rat CNS. , 2000, Brain research. Molecular brain research.

[30]  G. Dawes,et al.  Intermittent breathing before death in fetal lambs. , 1978, American journal of obstetrics and gynecology.

[31]  A. Hohimer,et al.  The effect of centrally administered adenosine on fetal breathing movements. , 1991, Respiration physiology.

[32]  K. Greene,et al.  Changes in the ST waveform of the fetal lamb electrocardiogram with hypoxemia. , 1982, American journal of obstetrics and gynecology.

[33]  A. Hohimer,et al.  Central chemical regulation of breathing movements in fetal lambs. , 1983, Respiration Physiology.

[34]  L Kruger,et al.  Thalamic lesions dissociate breathing inhibition by hypoxia and adenosine in fetal sheep. , 2000, American journal of physiology. Regulatory, integrative and comparative physiology.

[35]  B. Richardson,et al.  Circulatory responses to prolonged hypoxemia in fetal sheep. , 1988 .

[36]  R. Harding,et al.  Effect of intermittent umbilical cord occlusion on fetal respiratory activity and brain adenosine in late-gestation sheep. , 2002, Reproduction, fertility, and development.

[37]  K. Boddy,et al.  Foetal respiratory movements, electrocortical and cardiovascular responses to hypoxaemia and hypercapnia in sheep , 1974, The Journal of physiology.

[38]  J. Pearson,et al.  Fetal activity and fetal wellbeing: an evaluation. , 1976, British medical journal.

[39]  A. Hohimer,et al.  Acute anemic hypoxemia produces a transient depression in fetal respiratory activity. , 1987, Journal of applied physiology.

[40]  G. Dawes,et al.  Respiratory movements and rapid eye movement sleep in the foetal lamb , 1972, The Journal of physiology.

[41]  B. Richardson,et al.  Patterns of gross fetal body movements over 24-hour observation intervals during the last 10 weeks of pregnancy. , 1982, American journal of obstetrics and gynecology.

[42]  E. Sadovsky,et al.  Daily Fetal Movement Recording and Fetal Prognosis , 1973, Obstetrics and gynecology.

[43]  M. Fung,et al.  Medullary loci critical for expression of gasping in adult rats. , 1994, The Journal of physiology.

[44]  C Sureau,et al.  Nonstressed fetal heart rate monitoring in the antepartum period. , 1996, American journal of obstetrics and gynecology.