Наукові праці. Кафедра акушерства та гінекології № 3

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Antihypertensive drugs impact on the regulation of maternal and fetal cardiac activity in pregnant women with preeclampsia
(Yerevan State Medical University, 2015-02-28) Lakhno, Igor
Preeclampsia is a serious complication of pregnancy that leads to maternal multiple organ failure and fetal growth retardation. The objective of the study was to investigate the parameters of cardiac activity of mother and fetus affected by antihypertensive therapy for pregnant women with preeclampsia. Types of central maternal hemodynamics based on bioimpedance cardiography, parameters of maternal heart rate variability and fetal electrocardiogram in 72 preeclampsia patients with 32-38 weeks of gestation were examined. The control group was comprised of 30 women with factors associated with physiological pregnancy. In the presence of mild preeclampsia, an increased capacity of the central and peripheral sympathetic regulation of the hemodynamics and almost constant power of the vagal tone were observed. These changes were essential for the hyperkinetic type of central maternal hemodynamics. In the presence of moderate and severe PE, relative hypersympathicotonia associated with reduced heart rate variability was observed. It was accompanied by generalized vascular spasm and decreased cardiac index. The use of carvedilol has contributed to the correction of hypersympatheticotonia with decreased autonomic balance in pregnant women with mild preeclampsia. The use of methyldopa and nifedipine has not had any normalizing effect on total spectrum and separate branches of maternal heart rate variability in pregnant women with moderate and severe preeclampsia. The effect of antihypertensive drugs on the fetal cardiac activity was also not determined.
Autonomic imbalance captures maternal and fetal circulatory response to pre-eclampsia
(BMC Part of Springer Nature, 2017-02-08) Lakhno, Igor
Background Pre-eclampsia (PE) is a gestational disease featured by hypertension, arterial systemic vasculopathy, multiple organ failure and fetal compromise. The aim of the investigation was to determine the role of maternal respiratory sinus arrhythmia (RSA) in regulation of the fetal circulatory system in case of healthy pregnancy and in PE. Methods The investigation of maternal and fetal HRV and fetal CTG variables in 106 patients at 34–40 weeks of gestation was performed. 30 of them had healthy pregnancy and were involved in the Group I. In Group II 44 pregnant women with mild-moderate PE were observed. 32 patients with severe PE were monitored in Group III. Result The maternal sympathetic overactivity modulated HRV in PE by suppressing total power (TP) and parasympathetic tone. The lack of RSA was explored in preeclamptic patients. The centralization of hemodynamics was a result of the hypersympatheticotonia in severe PE. Fetal circulatory response to PE featured by an increased sympathetic tone. The modulated fetal CTG variables captured the suppression of fetal biophysical activity and the development of fetal distress in severe PE. Strong relationship between maternal and fetal TPs, maternal and fetal RMSSDs was found in healthy pregnancy. The correlations between the maternal and fetal TPs, the maternal and fetal RMSSDs in the patients with severe PE were disturbed. Conclusion The maternal RSA propagated its influence on the fetal autonomic nervous regulation in normal gestation. The maternal and fetal hemodynamic coupling was reduced in PE.
The Autonomic Repercussions of Fetal and Maternal Interaction in Pre-eclampsia
(De Gruyter, 2017-05-29) Lakhno, Igor
Pre-eclampsia (PE) is one of the severe complications of pregnancy that leads to fetal deterioration. Th e aim of the investigation was to determine the role of maternal respiratory sinus arrhythmia (RSA) in regulation of fetal circulatory system in case of healthy pregnancy and in PE. Th e investigation of maternal and fetal HRV and umbilical venous blood fl ow velocity spectral analysis in 106 patients at 34-40 weeks of gestation was performed. 30 of them had healthy pregnancy and were involved in the Group I. In Group II 44 pregnant women with mild-moderate PE were observed. 32 patients with severe PE were monitored in Group III. Th e maternal sympathetic overactivity modulated HRV in PE. Th e suppression of RSA was explored in preeclamptic patients. Th e Doppler spectrograms of the umbilical veinous blod fl ow had the oscillatory peak with a frequency about 0.5 Hz. Th e above peak characterized the participation of the maternal RSA in fetal hemodynamics. Strong relationship between maternal RMSSD and amplitude of RSA associated peak, maternal and fetal RMSSDs was found in healthy pregnancy. No considerable relationship was revealed between the maternal RMSSD and the amplitude of 0.5 Hz frequency peak, the maternal and fetal RMSSDs in the patients with severe PE. Th e maternal RSA propagated its infl uence on the fetal umbilical venous blood fl ow and the fetal autonomic nervous regulation in normal gestation. Th e control of fetal hemodynamics diminished in the mild-moderate PE and even disappeared in severe PE.
Comparison of pre- and postoperative techniques in the assessment of histological tumor grading in patients with endometrial carcinoma: a descriptive cross-sectional study
(Medical Communications Sp. z o.o., 2019-12-31) Uzel, Kemine; Lakhno, Igor
Introduction: This study aimed to compare histological grades in patients with endometrial cancer assessed by pre- and postoperative techniques. Methods: We retrospectively reviewed the records of 43 patients operated on for endometrial cancer between 2012 and 2019. The primary dependent variables included histological grade assessed by preoperative probe curettage and postoperative analysis of surgical specimens. The independent variables included age, surgery type (laparoscopy or laparotomy), pre- and postoperative hemoglobin levels, and the length of hospital stay. Results: The mean age was 62.14 ± 9.14 years, and the length of hospitalization time was 6.51 ± 3.46 days. The mean values of pre- and postoperative hemoglobin levels were 12.44 ± 1.51 mg/dL and 10.91 ± 1.28 mg/dL, respectively. According to the grading results of probe curettage, grade 1, 2, and 3 tumors were found in 21 (48.8%), 19 (44.2%), and 3 (7.0%) patients, whereas the paraffin sections revealed grade 1, 2, and 3 in 12 (27.9%), 22 (51.2%), and 9 (20.9%) patients, respectively. There was a fair but statistically significant agreement between the pre- and postoperative grading (kappa = 0.365, p = 0.001). Discussion: This study confirms literature reports that preoperative histological tumor grade fairly predicts final histological results. Caution is warranted when making clinical decisions solely based on probe curettage. Further improvements in preoperative diagnostic techniques in endometrial cancer are needed.
Comparison of the effects of testosterone on pre- and posthysterectomy findings in transgender Individuals
(Japan University of Health Sciences & Japan International Cultural Exchange Foundation, 2021-08-15) Uzel, Kemine; Lakhno, Igor; Eminli, Itibar
Objective: This study aimed to investigate the effect of testosterone on complications and blood parameters in transgender individuals undergoing hysterectomy. Methods: This case-control study was carried out by examining the files and records in the hospital automation system of individuals who underwent laparoscopic hysterectomy and oophorectomy for a female to male transgender change in our hospital. To achieve normal male physiologic testosterone levels, transgender individuals (n = 12) were given intramuscular testosterone esters for two years before surgery. The drug dose was initially administered every three weeks, then adjusted according to the patients response. The control group (n=20) was selected from women who underwent hysterectomy and oophorectomy in the same hospital and study period. Results: When the research and control groups were compared concerning blood values, there was no significant difference in preoperative white blood cell (Z = 0.262, p = 0.795), neutrophil (Z = 0.384, p = 0.704), and lymphocyte levels (Z = 0.481, p = 0.634). However, a significant difference was found in the postoperative levels of the same measurements (Z = 2.457, p = 0.020; Z= 7.310, p = < 0.001; and Z = 6.586, p < 0.001, respectively). Regarding preoperative and postoperative measurements, leukocyte and neutrophil levels increased, while lymphocyte and hemoglobin levels decreased in both groups (p < 0.001). Besides, the study group had higher creatinine levels than the control group (Z = 3.817, p = 0.001). Conclusion: Testosterone has anti-inflammatory effects. Additionally, it substantially influences hemoglobin. Thus, testosterone can be considered as an option in selected cases. However, it's potentially harmful effect on the kidneys should always be kept in mind.
COVID-19 mimicked fetal hemolytic disease: a case report
(Publishing House Professional Event, 2023-03-31) Lakhno, Igor
The pandemic of COVID-19 changed the traditional approaches to the management of gestational complications. Today there is still a lack of information about the impact of COVID-19 on the pregnancy course, in particular, about its role in relation to Rh-conflict during pregnancy. The paper focused on a rare presentation of Rh-conflict pregnancy and COVID-19. 32 years old G3 P2 pregnant women with Rh-negative had a third pregnancy. The injection of anti-D immunoglobulin after the first abortion was not performed. The second pregnancy finished with a term delivery and the birth of a fetus with hemolytic disease. During the third pregnancy, the woman fell ill with COVID-19 in the 26th week. The bilateral pneumonia was diagnosed. The treatment included antibiotics, antiviral, antithrombotic, and anti-inflammatory drugs. No signs of fetal hemolytic disease were found via ultrasonography. But the abnormal level of anti-D antibodies – 1:1024 was detected. From the 28th weeks of pregnancy till the delivery the test for anti-D antibodies was constant – 1:4. The variables of utero-placental, fetal (blood flow velocity in a middle cerebral artery), and umbilical hemodynamics were normal during the third trimester. But fetal moderate hepato- and splenomegaly were found at 36 weeks of gestation. The patient delivered at 38 weeks of gestation a female newborn 3100 g, 52 cm with a 7→8 Apgar score. The laboratory investigation detected a hemoglobin value of 202.6 mg/dL in a child. The blood analysis showed total bilirubin of 44.2 mg/dL, direct bilirubin of 1.0 mg/dL, and a negative result on the direct Coombs test. The baby received phototherapy for 3 days. Total bilirubin was decreased (15.2 mg/dL). The newborn was discharged from a hospital with the mother on the fifth day. COVID-19 could change the placental permeability and increase the titer of anti-D antibodies. But it did not contribute to fetal and newborn hemolytic disease.
Delayed neurological maturation is a cause for distress during fetal growth restriction
(Trilist, 2020-07-10) Lakhno, Igor; Malikova, S.
Theory of fetal programming contributes to a better understanding of the relationship of many human diseases with antenatal period pathology. Regulatory impact of nervous system is of great importance. Fetal growth restriction (FGR) is a convenient model for investigation of the abnormalities of fetal neurodevelopment. Fetal heart rate variability is a well-known approach for fetal autonomic function detection. The aim of the study was to detect several patterns of autonomic nervous regulation in FGR complicated by fetal distress or without fetal distress. Materials and methods. Totally 64 patients at 26–28 weeks of gestation were enrolled. 23 patients had normal fetal growth and were included in the Group I (control). 20 pregnant women with FGR without fetal distress were observed in Group II. 21 patients with FGR and fetal distress were included in Group III. Fetal heart rate variability and conventional cardiotocographic patterns were obtained from the RR-interval time series registered from the maternal abdominal wall via non-invasive fetal electrocardiography. Results. Suppression of the total level of heart rate variability with sympathetic overactivity was found in FGR. The maximal growth of sympathovagal balance was found in Group III. Fetal deterioration was associated with an increased quantity of decelerations, reduced level of accelerations, and decreased of short term variations and low term variations. But a decelerative pattern before 26 weeks of gestation was normal. Therefore fetal autonomic malfunction could be a result of persistent neurological immaturity in FGR. The approach based on the monitoring of fetal autonomic maturity in the diagnosing of its well-being should be tested in further studies. Conclusion. Fetal heart rate variability variables and beat-to-beat variations parameters could be the sensitive markers of neurological maturation and good predictors for fetal deterioration.
Diagnosing antenatal fetal distress
(Via Medica, 2021-05-14) Lakhno, Igor; Uzel, Kemine
Objectives: The values of acceleration capacity and deceleration capacity are known to capture fetal neurological development. The fetal growth restriction was found to be featured by decreased variables of phase rectified signal averaging. We have speculated that acceleration capacity and deceleration capacity could be of use in the detection of antenatal fetal distress during fetal growth restriction. The study was focused on the detection of the accuracy of acceleration capacity and deceleration capacity in diagnosing fetal distress. Material and methods: In total, 124 pregnant women at 26-36 weeks of gestation were included in the study. The patients with appropriate to gestational age fetuses (n = 32) were enrolled in Group I. The patients with fetal growth restriction and an absence of fetal distress (n = 48) were observed in Group II. Lastly, the patients with fetal growth restriction and fetal distress (n = 44) were included in Group III. Fetal cardiosignals were obtained via non-invasive fetal electrocardiography. The maximally decreased acceleration capacity and deceleration capacity values were found in Group III. Results: A correlation was found between umbilical artery resistance index and acceleration capacity and deceleration capacity variables in all study groups. We have found that the application of phase rectified signal averaging in the antenatal period showed high sensitivity and specificity in fetal distress detection. Conclusions: Fetal acceleration capacity and deceleration capacity is a prospective option for the detection of fetal compromise during fetal growth restriction.
Dysautonomia involvement in maternal cardiac arrhythmia
(Balkan Medical Union, 2022-03-08) Lakhno, Igor; Kniazkova, Iryna; Lakhno, Olga; Uzel, Kemine
Introduction. The role of autonomic imbalance in maternal cardiac arrhythmia (CA) is still debatable. The objective of the study was to assess the relationship between maternal autonomic tone and CA in pregnant women. Materials and methods. The cross-sectional study was carried out among pregnant women admitted to Kharkiv Municipal Perinatal Center between 1 December 2015 and 31 July 2020. 117 patients at 28-36 weeks of gestation were enrolled. 20 of them had sinus rhythm and were included in Group I (control). In Group II, 55 pregnant women with CA and cardiovascular comorbidity were observed. 42 patients with idiopathic CA were monitored in Group III. The daily electrocardiogram and heart rate variability (HRV) were obtained. The density of ectopic beats (DEB) was defined as the percentage of ectopic to total beats. Results. The investigation of the HRV revealed heterogeneity in the groups of study. The enhanced sympathetic activity was determined in women with CA and structural heart disease. Pregnant women with idiopathic CA demonstrated a parasympathetic pattern of autonomic nervous regulation. The revealed relations between DEB and sympathetic or parasympathetic regulation demonstrate an increased sympathetic tone in patients with structural heart disease. In women with idiopathic CA, parasympathetic regulation played a significant role in the scenario of cardiac ectopy. Conclusions. The idiopathic CA could be the result of abnormally elevated parasympathetic regulation in the second half of pregnancy.
Editorial: The repercussions of maternal inflammation in pre-eclampsia on fetal health and neurodevelopment
(Frontiers, 2024-05-29) Lakhno, Igor; Reyes-Lagos, José Javier; Adam, Ishag; Brownfoot, Fiona C.
Inflammation is a crucial and inevitable biological response in humans, playing an essential role in defense against infections and tissue repair. It is known as a basic pathological process. Inflammatory response is involved in the pathogenic scenario of several obstetrical syndromes. The main trigger for maternal inflammation is a disturbed placentation. HLA (Human Leukocyte Antigen) incompatibility between maternal and fetal tissues significantly influences the risk of preterm birth and pre-eclampsia. Therefore, immune-induced inflammation is a part of pre-eclampsia.
Effect of B-Lynch Suture: Bleeding Control and Asherman's Syndrome
(Jaypee Brothers, 2021-03-16) Uzel, Kemine; Lakhno, Igor
Aim and objective: The study was aimed to investigate possible complications such as intrauterine synechiae following the B-Lynch suture, which was used to control postpartum hemorrhage (PPH). Materials and methods: Our study included 36 patients, which underwent B-Lynch suture due to PPH from 2013 to 2015. Results: Asherman's syndrome was found in 3 (8.3%) of 36 patients who participated in the study. Two patients with Asherman's syndrome had a history of placenta accreta and one patient placenta previa. Conclusion: Compared to procedures that require experiences such as hysterectomy or internal iliac artery ligation, B-Lynch suture is a high-level PPH approach that preserves fertility potential with preventing complications.
EP19.21: Disturbed uterine artery hemodynamics is a possible predictor of fetal autonomic malfunction
(John Wiley & Sons Ltd, 2019-09-30) Vasylieva, Iryna; Lakhno, Igor
Objectives Since abnormal trophoblastic invasion is known as a reason of great obstetric syndrome the issue is to find out additional markers for the detection of fetal compromise. A chronic placental insufficiency is an initial event in fetal malnutrition and deterioration. Fetal neurological maturation could be detected by monitoring heart rate variability (HRV). The validity of the amplitude of mode (AMo) and stress index (SI) in the diagnosing of fetal distress is known. In this study, we were interested in these variables of HRV in fetal growth restriction (FGR) and fetal deterioration. Methods Totally 197 pregnant women at the end of I trimester with an increased average pulsatility index (aPI) in uterine arteries (>1.5 MoM, FMF score) were enrolled in this research. This cohort was divided into two groups. Women with normal fetal growth (N = 129) were included in Group I. Pregnant ladies with FGR (N = 68) were observed in Group II. Fetal HRV variables were investigated using non-invasive fetal electrocardiography technique with the application of the Cardiolab Babycard equipment (Scientific and research centre “KhAI Medica”, Ukraine). The records were done at the term of gestation 26-27 weeks. The results thus obtained were analysed with an ANOVA test to compare data between groups. The significance was set at p-value <0.05. Relative risk (RR) for fetal compromise was calculated. Results The percentage of fetal growth restriction in the study population was 34.5%. The variables of AMo and SI in Group II was significantly higher than in normal growth Group: SI –1862.4; AMo –80.3% and SI –525.1; AMo – 67.3%, relatively (p < 0.05). The rate of fetal compromise detected by Doppler ultrasound was 14.0% and 44.1%. RR for fetal compromise was 3.407 (95% CI – 1,059 – 26,777). Therefore, FGR was featured by an autonomic malfunction and considerable rise of fetal deterioration. Conclusions Fetal HRV variables could be of use in the prediction of fetal compromise.
Fetal autonomic malfunction as a marker of fetal distress in growth-restricted fetuses: three case reports
(Korean society of obstetrics and gynecology, 2019-10-10) Lakhno, Igor; Schmidt, Alexander
Fetal growth restriction (FGR) is characterized by fetal compromise and delayed neurological maturation. We report 3 cases of early FGR in the 26th week of gestation, based on hemodynamic Doppler monitoring, conventional cardiotocography, and non-invasive fetal electrocardiography (NI-FECG). Fetal heart rate variability (HRV), beat-to-beat variations, and fetal autonomic brain age scores (fABASs) were normal despite the absence of umbilical diastolic flow in the first case and the pregnancy continued to 30 weeks. NI-FECG helped achieve better fetal maturity. Fetal HRV and fABASs were low in the second and third cases. Fetal demise occurred soon in both cases. We conclude that NI-FECG could be a prospective method for the detection of fetal distress in early FGR.
Fetal Non-invasive Electrocardiography Contributes to Better Diagnostics of Fetal Distress: A Cross-sectional Study Among Patients with Pre-eclampsia
(Academy of Medicine Singapore, 2015-11-20) Lakhno, Igor
Introduction: Fetal distress is a result of acute or chronic disturbances in the system of “mother-placenta-fetus” in pre-eclampsia (PE). The aim of the investigation was to compare the accuracy of antenatal fetal distress diagnostics in cases of traditional cardiotocography (CTG) waveform evaluation and analysis of morphological non-invasive electrocardiogram (ECG) parameters in anterpartum patients with PE. Materials and Methods: Fetal noninvasive ECG antenatal recordings of 122 pregnant patients at 34 to 40 weeks of gestation were examined. In Group I, there were 32 women with physiological gestation and normal fetal condition according to haemodynamic Doppler values. Group II involved 48 patients with mild and moderate PE whom were performed Doppler investigation. In Group III, 42 patients with severe PE were monitored with haemodynamic Doppler. Results: Fetal autonomic tone was lower with the relative increase of low frequency (LF) branch in the patients of preeclamptic group. The increased value of the amplitude of mode (AMo) and stress index (SI) was associated with adrenergic overactivity. It has induced pQ and QT shortening, increased T/QRS ratio and decelerations appearance. The rate of antenatal fetal distress retrospectively was 31.1 % in PE. The traditional analysis of CTG parameters has showed sensitivity (72.7%) and specifi city (87.1%). In addition to the conventional CTG analysis, evaluation of ECG parameters has contributed to better diagnostics of fetal distress. Sensitivity and specificity of non-invasive fetal ECG were absolutely equal in this study (100%). Conclusion: The results suggest that fetal non-invasive ECG monitoring is more objective than conventional CTG.
Fuzzy Detection of Fetal Distress for Antenatal Monitoring in Pregnancy with Fetal Growth Restriction and Normal
(IntechOpen, 2018-12-19) Lakhno, Igor; Guzmán-Velázquez, Bertha Patricia; Díaz-Méndez, José Alejandro
Monitoring of fetal cardiac activity is a well-known approach to the assessment of fetal health. The fetal heart rate can be measured using conventional cardiotocography (CTG). However, this method does not provide the beat-to-beat variability of the fetal heart rate because of the averaging nature of the autocorrelation function that is used to estimate the heart rate from a set of heart beats enclosed in the autocorrelation function window. Therefore, CTG presents important limitations for fetal arrhythmia diagnosis. CTG has a high rate of false positives and poor inter- and intra-observer reliability, such that fetal status and the perinatal outcome cannot be predicted reliably. Non-invasive fetal electrocardiography (NI-FECG) is a promising low-cost and non-invasive continuous fetal monitoring alternative. However, there is little that has been published to date on the clinical usability of NI-FECG. The chapter will include data on the accurate diagnosing of fetal distress based on heart rate variability (HRV). A fuzzy logic inference system was designed based on a set of fetal descriptors selected from the HRV responses, as evident descriptors of fetal well-being, to increase the sensitivity and specificity of detection. This approach is found to be rather prospective for the subsequent clinical implementation.
Gestational trophoblastic diseases-diagnosis and risk factors: A case series
(ScopeMed Publishing, 2019-07-04) Uzel, Kemine; Basol, Gulfem; Kale, Ahmet; Lakhno, Igor
Aim of study: The aim of our study is to investigate the role of the age, gravida, parity, blood group in the development of GTD also significance of the b-hCG levels and pelvic ultrasonography in diagnosis and treatment of this patients. Comparisons of GTD incidence between Turkey and different regions of the world. Materials and Metods: This retrospective study included 1813 patients which underwent vacuum aspiration from 2010 to2018 years in Derince Training and Research Hospital, Kocaeli, Turkey. Files of 18 patients compatible with GTD in pathology were retrospectively scanned. Result: As a result of the study, the average age of patients were27.06, pathology results were found in 14 patients (77,7%) partial mol, in 2 patients (11,1%) complete mol, invasive mol in 1 patient (5,6%) and choriocarcinoma in 1 patient (5,6%). In these cases, 1 case of lung metastasis and 3 patients received chemotherapy treatment. There was no mortality associated with the disease during follow-up. Conclusion: The calculated GTD incidence was 1,5 per 1000 births. Radiologist plays a main role in the first diagnosis of GTD and basis disease management and early finding of its complications. Although serum b- hCG is a useful biochemical marker for GTD. Ultrasound is the initial line radiological examination in approving the diagnosis of GTD in a case suspected on the basis of clinical detections and b- hCG levels. We believe that diagnosis, adequate treatment and follow-up will make easy the cure of GTD and the incidence can be calculated more exacly by performing wide community-based studies.
Heart rate variability categories of fluctuation amplitude and complexity: diagnostic markers of fetal development and its disturbances
(IOP Science, 2019-06-28) Hoyer, Dirk; Schmidt, Alexander; Gustafson, Kathleen; Lobmaier, Silvia; Lakhno, Igor; van Leeuwen, Peter; Cysarz, Dirk; Preisl, Hubert; Schneider, Uwe
Objective: In fetal diagnosis the myriad and diversity of heart rate variability (HRV) indices prevents a comparable routine evaluation of disturbances in fetal development and well-being. The work aims at the extraction of a small set of HRV key indices that could help to establish a universal, overarching tool to screen for any disturbance. Approach: HRV indices were organized in categories of short-term (prefix s) and long-term (prefix l) amplitude fluctuations (AMP), complexity (COMP), and patterns (PATTERN) and common representatives for each category were extracted. This procedure was done with respect to the diagnostic value in the evaluation of the maturation age throughout the second and complete third trimester of pregnancy as well as to potential differences associated with maternal life-style factors (physical exercise, smoking), nutrient intervention (docosahexaenoic acid (DHA) supplementation), and complications of pregnancy (gestational diabetes mellitus (GDM), intra-uterine growth restriction (IUGR)). Main results: We found a comprehensive minimal set that includes [lAMP: short term variation (STV), initially introduced in cardiotocography, sAMP: heart rate increase across one interbeat interval of phase rectified averaged signal - acceleration capacity (ACst1), lCOMP: scale 4 multi-scale entropy (MSE4), PATTERN: skewness] for the maturation age prediction, and partly overlapping [lAMP: STV, sAMP: ACst1, sCOMP: Lempel Ziv complexity (LZC)] for the discrimination of the deviations. Significance: The minimal set of category-based HRV representatives allows for a screening of fetal development and well-being. These results are an important step towards a universal and comparable diagnostic tool for the early identification of developmental disturbances. Novelty & Significance Fetal development and its disturbances have been reported to be associated with a multiplicity of HRV indices. Furthermore, these HRV indices change with maturation. We propose the abstraction of HRV categories defined by short- and long-term fluctuation amplitude, complexity, and pattern indices that cover all relevant aspects of maturational age, behavioral influences and a series of pathological disturbances. The study data are provided by multiple centers. Our approach is an important step towards the goal of a standardized diagnostic tool for early identification of fetal developmental disturbances with respect to the reduction of serious complications in the later life.
The hemodynamic repercussions of the autonomic modulations in growth-restricted fetuses
(Elsevier, 2017-01-16) Lakhno, Igor
Objectives Idiopathic fetal growth restriction is considered to be associated with hemodynamic abnormalities. The study was aimed to the investigation of the relationship between fetal and maternal autonomic balance, arterial and venous hemodynamic Doppler indices and CTG variables in case of normal fetal development and fetal growth restriction. Method 106 patients at 32–40 weeks of gestation were enrolled in the study. 30 of them had healthy pregnancy and were involved in Group I. In Group II, 44 pregnant women with fetal growth restriction and normal umbilical hemodynamic Doppler indices were observed. 32 patients with fetal growth restriction and an absent or reversed end-diastolic umbilical flow were monitored in Group III. The curves of maximum blood flow velocity were isolated and their spectral components were determined from the umbilical Doppler spectrograms. The maternal and fetal heart rate variability, conventional CTG patterns were obtained from RR-interval time series registered from maternal abdominal wall electrocardiographically. Results The increased adrenergic regulation has modulated parasympathetic impact on fetal cardiovascular system. The decreased reactivity was mirrored in low LTV, lack of accelerations and an increased score of decelerations. The CTG findings were also featured by the revealed correlations demonstrated an obvious relationship between fetal and maternal hemodynamics in healthy pregnancy. It was possible to speculate that a controlling signal of 0.5 Hz has played a significant role in the umbilical venous blood flow. The decreased fetal autonomic tone and the fetal and maternal hemodynamic decoupling were found in growth-retarded fetuses. Conclusion Fetal heart rate pattern was influenced by maternal and fetal autonomic tone. Maternal cardiovascular oscillations were reflected in the umbilical circulation in healthy pregnancy Fetal distress was featured by sympathetic overactivity and the reduction of vagal tone. Such autonomic modulations was manifested by the decelerative pattern of CTG and deteriorated umbilical hemodynamics.
HRV descriptors for fetal distress assessment in pregnancy with fetal growth restriction
(CSREA Press, 2018-07-16) Guzmán-Velázquez, Bertha Patricia; Lakhno, Igor; Díaz-Méndez, Alejandro
This paper focused on the fetal wellbeing assessment, through the selection of HRV descriptors as evident markers of fetal distress. The study of behavior in experiments with control groups of healthy pregnant women and pregnant women with fetal growth restriction allows obtaining quantitative descriptors that help assess the loss of fetal well-being. The results show that SI (Sp=1, Se=0.9882), and AMo (Sp=0.8118, Se=0.9882) are evident markers of fetal distress.
The impact of preeclampsia on fetal ECG morphology and heart rate variability
(Polish Society of Perinatal Medicine, 2014-03-15) Lakhno, Igor
The aim of the investigation was a survey of the fetal HRV and ECG parameters in preeclampsia. It was performed fetal noninvasive ECG recordings in 94 pregnant women at 34-41 weeks of gestation and 66 of them were preeclamptic patients. The fetal deterioration in preeclampsia was characterized by lowered fetal heart rate variability and all its fractal components. The autonomic tone was diminished in direct proportion to the severity degree of preeclampsia. The mean value of short term vagal mediated parameters: RMSSD (root mean square of successive differences), pNN50 (the proportion of the number of pairs of successive NNs that differ by more than 50 ms divided by total number of NNs), HF (high frequency) and STV (short term variability) was also decreased. The relative predominance of the central sympathetic baroreflex mediated regulation of fetal hemodynamic was the main event in the preeclampsia induced scenario. The increased value of AMo (the amplitude of mode) and SI (stress index) was associated with abnormal myocardial adrenergic stimulation. It has induced pQ and QT shortening, increased T/QRS ratio and decelerations appearance. The augmented sympathetic tone played the significant role in fetal rigid rhythm and decelerations appearance and has formed the fetal myocardium hypoxic injury and suppressed sinus node response.