Effect of maternal anxiety and music on fetal movements and fetal heart rate patterns

Objective.?Aimed to investigate (a) the effect of non-stress test (NST) and music on maternal anxiety (b) the effect of maternal anxiety and music on fetal heart rate (FHR) changes.

Material and method.?The two hundred and one pregnant women coming for routine prenatal care were randomized to receive either music (n?=?96) or no music (n?=?105) during NST. Before and after the test, these women were asked to complete the Spielberg State-Trait Anxiety Inventory on two interviews; primary outcome was considered as a maternal state anxiety score before and after NST. Secondary outcome was the baseline FHR, the number of fetal movement, large accelerations, dubious NST, variable decelerations, and the minimum procedure time.

Results.?Before NST, the mean state anxiety score of the music and control groups was found as 38.1?±?8.8 and 38.08?±?8.2, respectively (p?>?0.05). On the other hand, after NST, the mean state anxiety score of the music and control groups was found as 35.5?±?8.2 and 40.2?±?9.2, respectively (p?<?0.001). While in control group, NST brought about a statistically significant increase in a state anxiety score (38.08?±?8.2 versus 40.2?±?9.2, p?<?0.001), listening to music during NST resulted in decrease in a state anxiety score of the study group but it was not statistically significant (38.1?±?8.8 versus 35.5?±?8.2, p?>?0.05). The baseline FHR of the music group was significantly higher than that of the control group (134.09?±?7.2 versus 130.3?±?5.7, p?<?0.001).The number of fetal movement in the music group was significantly higher than that of the control group (8.9?±?4.7 versus 5.9?±?3.9, p?<?0.001). The number of large accelerations in music group was significantly higher than that of the control group (5.7?±?2.1 versus 4.5?±?2.04, p?<?0.001). The minimum procedure time in music group was significantly lower than that of control group (13.4?±?5.2 versus 15.6?±?6.1, p?<?0.05). The number of dubious NST and variable decelerations was found to be similar for both groups (p?>?0.05).

Conclusion.?NST has anxiogenic effects on mothers and listening to music during the test has positive impact on both maternal and fetal parameters but it is an open question whether maternal anxiety during pregnancy may affect fetal accelerations to such an extent that it could influence clinical judgments.     

Effect of maternal intravenous glucose administration on fetal heart rate patterns and fetal breathing

This study was undertaken to evaluate the effect of maternal intravenous (IV) administration of glucose on fetal breathing and its associated fetal heart patterns. Sixteen healthy women at term gestation participated in the study. The outcome of each of the pregnancies was normal. Fetal breathing and fetal electrocardiograms were simultaneously recorded by real time sonography and a fetal monitor respectively, and then digitized into a microcomputer. These women were studied for a 25-minute control period, given 50 gm of glucose IV and then, 20 minutes later, restudied for an additional 25-minute period. The results indicate that fetal breathing movements lasted for 24.8 +/- 6.2 percent of the time during the control period (mean +/- SEM) and were increased to 63.2 +/- 11.5 percent following the injection of glucose (P less than 0.01). Fetal heart rate decreased during fetal breathing by 2.3 and 2.1 beats per minute, before and after glucose administration, respectively (NS). Fetal breathing was associated with increased beat-to-beat variability by 1.32 +/- 0.5 and 1.27 +/- 0.3, before and after glucose administration, respectively (NS). This study confirms previous reports that the amount of time the fetus spends making breathing movements is significantly increased following maternal glucose administration, and demonstrates that the injection of glucose does not alter the modulation of fetal heart rate and beat-to-beat variability by fetal breathing.     

Effect of electromagnetic field emitted by cellular phones on fetal heart rate patterns

The study was planned to determine the effects of electromagnetic fields produced by cellular phones on baseline fetal heart rate, acceleration and deceleration. Forty pregnant women undergoing non-stress test were admitted to the study. Non-stress test was obtained while the subjects were holding the CP on stand by mode and on dialing mode, each for 5 min. Similar recordings were taken while there were no phones around for 10 min. Electromagnetic fields produced by cellular phones do not cause any demonstrable affect in fetal heart rate, acceleration and deceleration.     

Hydrographic magnetic resonance imaging of the fetal eye

Previous work has shown that fetal hydrographic magnetic resonance imaging (MRI) provided additional information complementary to T2-weighted single-shot fast spin echo (ssFSE) images. The objective of this study was to determine if hydrographic MRI provides better conspicuity of fetal eye structures compared with ssFSE MRI. ssFSE and hydrographic images were retrospectively examined in 82 consecutive fetal studies with normal central nervous system without sensitivity encoding. Relative signal intensity values on ssFSE and hydrographic MRI were obtained for vitreous and sclera. Ratios of the signal intensity of vitreous to the signal intensity of sclera were calculated to determine conspicuity. Similar measurements were obtained in a smaller separate data set (n = 41) using hydrographic imaging with sensitivity encoding techniques. The hydrographic images significantly demonstrated greater conspicuity (ratio of vitreous to sclera) than ssFSE images. This was consistent for both sensitivity encoding and no-sensitivity encoding groups. The difference in conspicuity was on average approximately two times greater in the hydrographic images compared with ssFSE images. Hydrographic MRI of the fetal eye provides on average two times greater conspicuity of fetal eye structures than ssFSE imaging. This enhancement is not affected by gestational age or the use of sensitivity encoding parallel imaging techniques.     

Effect of atropine on fetal heart rate

The effect of atropine on the foetal heart rate (FHR) was examined in 56 normal pregnancies. 40 mcg/kg atropine was administered. According to the results of the examinations the FHR was not effected by atropine in the 8.--13. weeks of gestation. The FHR was effected by the applied dose of atropine only after the 17th week increasing over the physiological oscillation. In the course of pregnancy FHR was increased by atropine in every case it nearly raised to FHR values observed in the 8.--13 weeks still not effected by atropine.     

Fast-scan magnetic resonance imaging of fetal anomalies.

OBJECTIVE--To identify those congenital fetal anomalies, previously identified by ultrasound scanning, in which fast-scan magnetic resonance imaging (F-SMRI) would give additional information for the perinatal management of the infants. DESIGN--Observational clinical study. SETTING--Hospital Department of Obstetrics and Gynaecology/Resonance Research Centre. SUBJECTS--Seven women carrying eight fetuses in whom congenital abnormalities had been identified using ultrasound scans. The duration of the pregnancies was 28 to 39 weeks gestation. INTERVENTIONS--Fast-scan magnetic resonance imaging at between 28 and 39 weeks gestation. MAIN OUTCOME MEASURES--Identification of fetal abnormalities. RESULTS AND CONCLUSIONS--F-SMRI was of limited value in the diagnosis of further assessment of fetuses with abnormalities of accumulation of tissue fluid. Renal anomalies were poorly identified unless associated with cystic formation of the kidney. Further study is required in the imaging of fetal central nervous system anomalies. Until echoplanar imaging is more widely available, MRI does not contribute to the diagnosis of cardiac anomalies. F-SMRI appears to be most useful in the diagnosis and management of soft tissue gastro intestinal abnormalities.     

Effects of maternal central hemodynamics on fetal heart rate patterns

BACKGROUND: This study was undertaken to evaluate the effects of maternal central hemodynamics on fetal heart rate patterns near term, with special regard to the maternal body position. METHODS: Brief non-stress test and bioimpedance cardiography were carried out in the supine position, then repeated in a full left lateral decubitus position of mothers with singular, 36-39 week-old normal pregnancies in 106 cases. Computer-aided data were processed by SPSS statistic program. RESULTS: Due to the appearance of inferior vena cava syndrome, examinations had to be interrupted in 6 cases. Analysis of 100 complete registrations revealed a significantly increased number of accelerations, overall and short-term variations, and longer high episodes with lower basal fetal heart rates were found in the lateral decubitus than in the supine maternal position. Turning to the left resulted in a significant increase of the stroke volume; however, due to decreasing pulse rate, the cardiac output remained unchanged. Parameters of non-stress test showed correlations to hemodynamic indices. In the supine position, the short-term variation correlated with cardiac output (r=0.232, p=0.020); in the left lateral position, the number of accelerations correlated with stroke volume (r=0.221, p=0.027) and cardiac output (r=0.220, p=0.028). Changes of stroke volume due to altered body position correlated to similar changes of overall variation (r=0.264, p=0.018), and marginally to those of short-term variation (r=0.221, p=0.051). CONCLUSION: Maternal central hemodynamics influences fetal heart rate patterns in connection with different maternal body position.     

The effect of uterine rupture on fetal heart rate patterns

The high success rate of vaginal birth after cesarean section (VBAC) and its low association with complications has led to VBACs being attempted at all types of facilities, including birth centers. It must be kept in mind that unpredictable uterine rupture can occur and that uterine rupture necessitates emergency intervention. The only reported predictable feature of fetal heart rate patterns in response to uterine rupture is the sudden onset of fetal bradycardia. Fetal patterns are presented to illustrate this finding.     

Abnormal fetal heart rate patterns and placental inflammation

Can acute inflammation in the placental membranes, amniotic fluid, or both, predispose to the development of abnormal fetal heart rate patterns? One hundred cases in which bradycardia was noted were compared with 48 cases in which abnormal fetal heart rate patterns did not occur. Case and control subjects were matched to provide an equivalent risk of developing ascending infection in the two groups. Fetoplacental weight ratio and the presence of other placental diseases were also considered. The presence of acute inflammation in the umbilical cord (p = 0.03), amnion (p = 0.01), and choriodecidua (p = 0.03), and higher grades of inflammation in chorionic plate (p = 0.03) were linked to the presence of abnormal fetal heart rate patterns. No other placental factors were associated with increased risk of fetal bradycardia. The association of abnormal fetal heart rate patterns with acute inflammation suggests that intra-amniotic inflammation is important in the genesis of fetal bradycardias. The inflamed amniotic fluid could alter fetal metabolism via effects on the pulmonary or gastrointestinal systems or effects on umbilical and chorionic vessels.     

Relationship of early intrapartum fetal heart rate patterns to subsequent patterns and fetal outcome

This study evaluated subsequent fetal heart rate (FHR) patterns and fetal outcome in laboring women with normal or abnormal initial FHR patterns. Four hundred term gravidas presenting in the latent phase of labor were studied. Ninety (22.5%) exhibited abnormalities on the initial tracing, with the majority of those abnormalities (58.9%) including mild variable decelerations, either alone or in combination with other abnormalities. An analysis of the outcome for those patients revealed a significant increase in cesarean delivery for fetal distress and depressed one-minute Apgar scores when compared to patients with initially normal tracings. Analysis of subsequent FHR patterns in that group showed a significant increase in the incidence of atypical variable declerations and bradycardia. Patients with more than one abnormality on the initial FHR tracing showed a greater incidence of loss of variability, loss of reactivity and bradycardia on subsequent FHR tracings. Likewise, pregnancy outcome for this group was remarkable for an increased risk of meconium staining, cesarean delivery for fetal distress and depressed one-minute Apgar scores. An abnormal initial FHR tracing seems to be associated with the subsequent development of ominous FHR patterns and increased fetal morbidity, particularly when more than one abnormality is present on the initial tracing.