|A personal message from Dr Mark Hill (May 2020)
| I have decided to take early retirement in September 2020. During the many years online I have received wonderful feedback from many readers, researchers and students interested in human embryology. I especially thank my research collaborators and contributors to the site. The good news is Embryology will remain online and I will continue my association with UNSW Australia. I look forward to updating and including the many exciting new discoveries in Embryology!
Notice - Mark Hill
Currently this page is only a template and will be updated (this notice removed when completed).
|Educational Use Only - Embryology is an educational resource for learning concepts in embryological development, no clinical information is provided and content should not be used for any other purpose.
There are a number of different prenatal and neonatal screening (newborn screening) programs in different countries testing for various "common" abnormalities and infections. An Electrocardiogram (ECG) can be used diagnostically both during prenatal and neonatal periods to assess heart rate, heart development and Cardiovascular System - Abnormalities|heart abnormalities]].
- Prenatal diagnosis - number of different techniques (non-invasive, invasive) for determining normal development
- Neonatal diagnosis (APGAR test, Guthrie test, Hearing test)
- Maternal diagnosis - often pregnancy will expose maternal health problems
Some Recent Findings
- Non-invasive fetal electrocardiography for the detection of fetal arrhythmias "A total of 500 echocardiography and NI-FECG recordings were collected from pregnant women during a routine medical visit in this multicenter study. All the cases with fetal arrhythmias (n = 12) and a matching number of control (n = 14) were used. Two perinatal cardiologists analyzed the extracted NI-FECG while blinded to the echocardiography. The NI-FECG based diagnosis was compared to the reference fetal echocardiography diagnosis....It is possible to diagnose fetal arrhythmias using the NI-FECG technique. However, this study identifies that improvement in algorithms for reconstructing the P-wave is critical to systematically resolve the mechanisms underlying the arrhythmias. The elaboration of a NI-FECG Holter device will offer new opportunities for fetal diagnosis and remote monitoring of problematic pregnancies because of its low-cost, non-invasiveness, portability and minimal set-up requirements."
Fetal Electrocardiogram Enhancement
- Enhancement of low-quality fetal electrocardiogram based on time-sequenced adaptive filtering "Extraction of a clean fetal electrocardiogram (ECG) from non-invasive abdominal recordings is one of the biggest challenges in fetal monitoring. An ECG allows for the interpretation of the electrical heart activity beyond the heart rate and heart rate variability. However, the low signal quality of the fetal ECG hinders the morphological analysis of its waveform in clinical practice. The time-sequenced adaptive filter has been proposed for performing optimal time-varying filtering of non-stationary signals having a recurring statistical character. In our study, the time-sequenced adaptive filter is applied to enhance the quality of multichannel fetal ECG after the maternal ECG is removed. To improve the performance of the filter in cases of low signal-to-noise ratio (SNR), we enhance the ECG reference signals by averaging consecutive ECG complexes. The performance of the proposed augmented time-sequenced adaptive filter is evaluated in both synthetic and real data from PhysioNet. This evaluation shows that the suggested algorithm clearly outperforms other ECG enhancement methods, in terms of uncovering the ECG waveform, even in cases with very low SNR. With the presented method, quality of the fetal ECG morphology can be enhanced to the extent that the ECG might be fit for use in clinical diagnostics. Graphical abstract The extracted fetal ECG signals from non-invasive abdominal recordings still contain a substantial amount of noise. The time-sequenced adaptive filter provides a relatively accurate estimate of the underlying fetal ECG signal when the quality of the reference channels is enhanced prior to filtering."
- Computerized analysis of cardiotocograms and ST signals is associated with significant reductions in hypoxic-ischemic encephalopathy and cesarean delivery: an observational study in 38 466 deliveries "Intrapartum cardiotocography (CTG) is widely used in high-resource countries and remains at the centre of fetal monitoring and the decision to intervene, but there is ample evidence of poor reliability in visual interpretation, as well as limited accuracy in identifying fetal hypoxia. Combined monitoring of CTG and ST segment signals was developed to increase specificity, but analysis relies heavily on CTG interpretation and is therefore also affected by the previously referred problems. Computerized analysis was developed to overcome these limitations, aiding in the quantification of parameters that are difficult to evaluate visually, such as variability, integrating the complex guidelines of combined CTG and ST analysis, and using visual and sound alerts to prompt healthcare professionals to re-evaluate features associated with fetal hypoxia."
- Quantile Score: A New Reference System for Quantitative Fetal Echocardiography Based on a Large Multicenter Study "Normative ranges of fetal echocardiographic measurements are important for quantitative diagnosis of fetal cardiovascular disease. The current normative ranges were derived from small samples and were based on the hypothesis of a normal distribution of these measurements during fetal cardiovascular growth. The aims of this study were to test the hypothesis of a normal distribution of fetal echocardiographic measurements in a large multicenter cohort and to propose a reference system without the normal distribution hypothesis to improve accuracy of fetal echocardiographic measurements. ...All fetal echocardiographic measurements showed non-normal distributions (P < .001). The normal range was underestimated by ordinary least squares regression compared with quantile regression by 30 ± 11%. The partial normalized areas under the receiver operating characteristic curve within the 20% false-positive rate were 0.62 and 0.50 for the q and Z scores, respectively."
- Diurnal rhythm of fetal heart rate in third trimester of pregnancy (Article in Chinese) "To investigate the diurnal rhythms of fetal heart rate in third trimester of pregnancy. Methods: From June 2014 and October 2017, 97 cases of low-risk pregnancy women who received antenatal care and deliveried in Peking University Third Hospital were collected. Totally 130 cases of fetal heart rate and maternal holter monitoring data were analyzed. All cases were singleton pregnancy, cephalic position and had normal perinatal outcome. ...Fetal heart baseline (FHB)、fetal heart baseline variation (FHBV)、fetal heart rate acceleration area and maternal heart rate all presented diurnal rhythms. (1) FHB rose in daytime and decreased at night with the minimum value at 2:00-5:00, and didn't decline further at night with the advancing of gestational age (P=0.548). (2) FHBV was similar to FHB, which rose in daytime and decreased at night, but declined smaller at night with the advancing of gestational age, especially after 37 weeks (P<0.01). (3) Fetal heart rate acceleration area reduced in daytime and enlarged at night, and enlarged more with the advancing of gestational age. (4) The diurnal rhythm of maternal heart rate was consistent with fetal heart rate. FHB lagged behind maternal heart rate for 1-2 hours when declining to the nocturnal nadir but been basically in sync with maternal heart rate when recovered."
|More recent papers
This table allows an automated computer search of the external PubMed database using the listed "Search term" text link.
- This search now requires a manual link as the original PubMed extension has been disabled.
- The displayed list of references do not reflect any editorial selection of material based on content or relevance.
- References also appear on this list based upon the date of the actual page viewing.
References listed on the rest of the content page and the associated discussion page (listed under the publication year sub-headings) do include some editorial selection based upon both relevance and availability.
More? References | Discussion Page | Journal Searches | 2019 References | 2020 References
Search term: Fetal Heart Rate | Fetal Electrocardiogram | Neonatal Electrocardiogram
|These papers originally appeared in the Some Recent Findings table, but as that list grew in length have now been shuffled down to this collapsible table.
See also the Discussion Page for other references listed by year and References on this current page.
- Antenatal cardiotocography for fetal assessment "Cardiotocography (CTG) is a continuous recording of the fetal heart rate obtained via an ultrasound transducer placed on the mother's abdomen. CTG is widely used in pregnancy as a method of assessing fetal well-being, predominantly in pregnancies with increased risk of complications. ...There is no clear evidence that antenatal CTG improves perinatal outcome, but further studies focusing on the use of computerised CTG in specific populations of women with increased risk of complications are warranted."
- Normal Ranges of Embryonic Length, Embryonic Heart Rate, Gestational Sac Diameter and Yolk Sac Diameter at 6-10 Weeks "We examined 4,698 singleton pregnancies with ultrasound measurements of CRL, HR, GSD and YSD at 6-10 weeks and CRL at 11-13 weeks resulting in the live birth after 36 weeks of phenotypically normal neonates with birth weight above the 5th centile. Gestational age was derived from CRL at the 11- to 13-week scan using the formula of Robinson and Fleming."
A new site developed by NIH "GeneTests" provides medical genetics information resources available at no cost to all interested persons. It contains educational information, a directory of genetic testing laboratories and links to other databases such as OMIM.
Links: Gene Tests
- ↑ Behar JA, Bonnemains L, Shulgin V, Oster J, Ostras O & Lakhno I. (2019). Non-invasive fetal electrocardiography for the detection of fetal arrhythmias. Prenat. Diagn. , , . PMID: 30602066 DOI.
- ↑ 2.0 2.1 Fotiadou E, van Laar JOEH, Oei SG & Vullings R. (2018). Enhancement of low-quality fetal electrocardiogram based on time-sequenced adaptive filtering. Med Biol Eng Comput , , . PMID: 29938302 DOI.
- ↑ Lopes-Pereira J, Costa A, Ayres-de-Campos D, Costa-Santos C, Amaral J & Bernardes J. (2018). Computerized analysis of cardiotocograms and ST signals is associated with significant reductions in hypoxic-ischemic encephalopathy and cesarean delivery: an observational study in 38 466 deliveries. Am. J. Obstet. Gynecol. , , . PMID: 30594567 DOI.
- ↑ Gu X, Zhu H, Zhang Y, Han J, Zhang H, Liu Y, Wang A, Liu B, Xue J, Sun B, Weng Z, Ge S & He Y. (2018). Quantile Score: A New Reference System for Quantitative Fetal Echocardiography Based on a Large Multicenter Study. J Am Soc Echocardiogr , , . PMID: 30591282 DOI.
- ↑ Li SF, Wang Y, Li GF, Zhao YY, Chen L & Zhang S. (2018). [Diurnal rhythm of fetal heart rate in third trimester of pregnancy]. Zhonghua Fu Chan Ke Za Zhi , 53, 849-854. PMID: 30585024
- ↑ Grivell RM, Alfirevic Z, Gyte GM & Devane D. (2012). Antenatal cardiotocography for fetal assessment. Cochrane Database Syst Rev , 12, CD007863. PMID: 23235650 DOI.
- ↑ Papaioannou GI, Syngelaki A, Poon LC, Ross JA & Nicolaides KH. (2010). Normal ranges of embryonic length, embryonic heart rate, gestational sac diameter and yolk sac diameter at 6-10 weeks. Fetal. Diagn. Ther. , 28, 207-19. PMID: 20847544 DOI.
Search PubMed: x-ray neonatal diagnosis | x-ray neonatal screening
External Links Notice - The dynamic nature of the internet may mean that some of these listed links may no longer function. If the link no longer works search the web with the link text or name. Links to any external commercial sites are provided for information purposes only and should never be considered an endorsement. UNSW Embryology is provided as an educational resource with no clinical information or commercial affiliation.
- Glossary: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | Numbers | Symbols | Term Link
Cite this page: Hill, M.A. (2020, June 1) Embryology Electrocardiogram. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Electrocardiogram
- What Links Here?
- © Dr Mark Hill 2020, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G