Наукові праці. Кафедра акушерства та гінекології № 3
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Publication The impact of preeclampsia on fetal ECG morphology and heart rate variability(Polish Society of Perinatal Medicine, 2014-03-15) Lakhno, IgorThe 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.Publication EP19.21: Disturbed uterine artery hemodynamics is a possible predictor of fetal autonomic malfunction(John Wiley & Sons Ltd, 2019-09-30) Vasylieva, Iryna; Lakhno, IgorObjectives 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.Publication The utility of phase rectified signal averaging in diagnosing fetal distress(John Wiley & Sons Ltd, 2020-10-15) Vasylieva, Iryna; Lakhno, IgorObjectives Fetal heart rate variability is known as a marker of fetal wellbeing. The variables of phase rectified signal averaging – acceleration capacity and deceleration capacity (AC/DC) – were found to have a significant prognostic value in fetal growth restriction (FGR). Methods A total of 168 pregnant women at 26–28 weeks were examined. The patients with AGA fetases (N = 36) were enrolled in group 1. eFGR without fetal distress (N = 64) were group 2. eFGR with fetal distress (N = 68) = group 3. We used Cardiolab Babycard equipment (the "KhAI Medica" Scientific Research Centre, Ukraine) to non-invasive fetal electrocardiography. Fetal distress was diagnosed via Doppler ultrasound in case of the RD UA, absent A-wave in the DV, and umbilical vein pulsations.The results thus obtained were analysed with an ANOVA test. The significance was set at p-value <0.05. The correlations coefficients were estimated with Spearman's test. Results The maximally decreased AC/DC values were in Group 3 (p < 0.05). The variables of phase rectified signal averaging were lower in Group 2 than in Group 1 (p < 0.05) but higher than in Group 3 (p < 0.05). Thus, the delayed neurological maturation and the autonomic malfunction could be the reasons for fetal distress in FGR. The considerable correlation was detected in the appropriate to gestational age fetuses (R = 0.64, p < 0.05). In Groups 2 and 3, the force of correlation was almost similar (respectively, R = 0.62, p < 0.05; R = 0.68, p < 0.05). Therefore, AC/DC is a prospective marker for the detection of fetal compromise. This result was supported by a significant correlation in the pair “AC/DC vs umbilical blood pH” in all groups. The coefficients of correlation were: R = 0.70, p < 0.05; R = 0.68, p < 0.05; R = 0.72, p < 0.05 in Group 1, 2 and 3, respectively. Conclusions Fetal AC/DC variable is a sensitive tool for the detection of fetal distress in FGR.Publication Novel Possibilities for the Diagnosis of Fetal Distress in Pre-eclamptic Women(Jaypee Brothers, 2015-08-01) Lakhno, IgorObjective Fetal deterioration has been known as a result of acute or chronic disturbances in the system of ‘motherplacenta- fetus’. Pre-eclampsia (PE) is a maternal gestational disease caused by abnormal placentation that could provoke fetal distress. Aim The aim of the investigation was to survey the accuracy of fetal distress diagnostics in case of traditional cardiotocography (CTG) waveform evaluation and electrocardiography (ECG) parameters analysis obtained from maternal abdominal signal before and during labor in pre-eclamptic patients. Materials and methods One hundred and thirty-nine pregnant ladies at 32 to 40 weeks of gestation were enrolled in the study. There were 30 women with physiological pregnancy and normal fetal condition according to hemodynamic Doppler values and fetal ECG parameters in group I. In group II, 64 patients with mild and moderate PE were involved whom were performed fetal ECG noninvasive monitoring and hemodynamic Doppler. In group III, 45 patients with severe PE were monitored with fetal noninvasive ECG and hemodynamic Doppler. Results It was determined that fetal autonomic tone was suppressed with the relative increase of low frequency branch in pre-eclamptic patients. The increased value of the amplitude of mode and stress index was associated with abnormal myocardial adrenergic stimulation. It has induced pQ and QT shortening, increased T/QRS ratio. Fetal cardiac response was determined as gradual reduce of autonomic regulation. The most considerable negative correlation was determined in pair Apgar score 1 vs T/QRS (R = – 0.48; p < 0.05). The QT interval duration has revealed positive correlation with Apgar score 1 (R = 0.44; p < 0.05). Additional to the conventional CTG analysis evaluation of noninvasive fetal ECG parameters has contributed to better diagnostic of distress. Conclusion Fetal noninvasive ECG has showed sensitivity 100.0% and specificity 93.8% and, therefore, was more accurate and convenient method for fetal monitoring than conventional CTG.Publication 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 AlejandroMonitoring 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.Publication 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.Publication The Use of Fetal Noninvasive Electrocardiography(Hindawi, 2016-02-24) Lakhno, IgorPreeclampsia (PE) is one of the severe complications of pregnancy that leads to fetal deterioration. The aim was to survey the validity of fetal distress diagnostics in case of Doppler ultrasonic umbilical vein and arteries blood flow velocity investigation and ECG parameters analysis obtained from maternal abdominal signal before labor in preeclamptic patients. Fetal noninvasive ECG and umbilical arterial and venous Doppler investigation were performed in 120 patients at 34–40 weeks of gestation. And 30 of them had physiological gestation and were involved in Group I. In Group II 52 pregnant women with mild-moderate PE were observed. 38 patients with severe PE were monitored in Group III. The most considerable negative correlation was determined in pair Apgar score 1 versus T/QRS (; ). So the increased T/QRS ratio was the most evident marker of fetal distress. Fetal noninvasive ECG showed sensitivity of 96.6% and specificity of 98.4% and, therefore, was determined as more accurate method for fetal monitoring.Publication 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, AlexanderFetal 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.Publication Diagnosing antenatal fetal distress(Via Medica, 2021-05-14) Lakhno, Igor; Uzel, KemineObjectives: 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.