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Diurnal variations of short-term variation and the impact of multiple recordings on measurement accuracy

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Abstract

Objective:

Short-term variation (STV) from computerized cardiotocogram heart rate analysis is a parameter that complements decision making, regarding the delivery of fetuses in several high-risk situations. Although studies on the effects of gestational age and fetal pathology are convincing, there is a lack of data exploring diurnal variation and the adequacy of a single measurement.

Study Design:

In this prospective observational study, fetal STV was monitored with the AN24 fetal ECG monitor (Monica Healthcare) each hour for at least 10 h in total, beginning at different times. This resulted in data covering all 24 h of the day. Seventy fetuses, low risk with respect to conditions accessible to heart rate monitoring (median 37th week of gestation) were monitored for an average of 12 h. Results of STV per hour were categorized as ‘compromised’ (STV<4 ms) or ‘healthy’, (STV⩾4 ms) to calculate the model of predictability.

Results:

The model proposed (STV of ‘healthy’ fetuses: 9.6±2.6 ms, ‘compromised’ fetuses 3.0±0.5 ms, prevalence 1%) leads to a positive predictive value of 39%, which increased to 68 or 80% given two or three pathological (STV<4 ms) measurements, respectively. Diurnal variation was not observed.

Conclusions:

Single pathological STV values should be corroborated by further measurements in a 24-h interval in otherwise low-risk fetuses before inducing delivery. This may help to avoid unnecessary early births and give the fetus valuable days for intrauterine maturity.

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Acknowledgements

We thank Ariane Stenzel for support during data acquisition and Regina Grosse for editing the manuscript.

Note: Definition of Interventional Study or Clinical Trial (https://clinicaltrials.gov/ct2/aboutstudies/ glossary#interventional-study): a clinical study in which participants are assigned to receive one or more nterventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes.The study presented in this manuscript is a non-interventional, prospective observational study. Although the data was recorded during fetal monitoring, the results with respect to 24-h variance were obtained in a post-processing procedure not related clinical management and blinded to the clinical investigators. No clinical intervention was based on any of the findings. Therefore, this study did not qualify to be registered according to the above definition.

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Correspondence to G Seliger.

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Seliger, G., Petroff, D., Seeger, S. et al. Diurnal variations of short-term variation and the impact of multiple recordings on measurement accuracy. J Perinatol 37, 231–235 (2017). https://doi.org/10.1038/jp.2016.202

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  • DOI: https://doi.org/10.1038/jp.2016.202

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