Наукові праці. Кафедра акушерства та гінекології № 3
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Publication VP24.04: The delayed fetal neurological maturation in women with threatened preterm labour(Wiley&sons, 2021-10-15) Vasyliva, Iryna; Lakhno, IgorObjectives The uterine activity separated from maternal abdominal signal could contribute to better diagnosing of threatened preterm birth. This signal is being obtained via equipment for fetal non-invasive electrocardiography. The detection of acceleration capacity (AC) and deceleration capacity (DC) variables reflects the fetal neurological development. Methods Totally examined 192 pregnant women. The US cervicometry was performed at 16 weeks of gestation. The patients with normal cervical length (> 30 mm) were enrolled in Group I (n = 34). The US investigation of cervical length and fetal AC/DC detection via transabdominal non-invasive electrocardiography at 26, 32, and 38 weeks of gestation were used in Group II (n = 84). The investigation of uterine activity was additionally performed in women in Group III (n = 74). Fetal cardio signals and maternal uterine activity were obtained via non-invasive fetal electrocardiography using Cardiolab Babycard equipment (the “KhAI Medica” Scientific Research centre, Ukraine). The monitoring of fetal AC/DC was also performed in Group I. The results were analysed with an ANOVA test. Results The level of AC/DC was minimal in all groups at 26 weeks. This fact reflects the immaturity of autonomic regulation. But later on, the decreased values of AC/DC were found in Group II and Group III at 32 and 38 weeks of gestation. Thus, the threatened preterm delivery has a negative projection on fetal neurodevelopment. The sensitivity and the specificity of the threatened preterm labour detection were in Group II and Group III respectively: 86.49% (95% CI – 76.55% to 93.32%) and 58.82% (95% CI – 40.70% to 75.35%); 98.46% (95% CI – 91.72% to 99.96%) and 90.91% (95 % CI – 58.72% to 99.77%). The use of uterine activity has improved the accuracy of threatened preterm labour diagnosing. Conclusions The application of uterine activity extracted from electrophysiological maternal abdominal signal contributed to better diagnosing of the threatened preterm labour. Fetal neurodevelopment is retarded in case of the threatened preterm birth.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 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, UweObjective: 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.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 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, IgorIntroduction: 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.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.