2658-6533Research Results in Biomedicine2658-653310.18413/2658-6533-2023-9-2-0-73078Medicine (miscellaneous)<strong>Doppler fetal monitoring and non-invasive fetal ECG in modern obstetrics (review)</strong><br /> &nbsp;<strong>Doppler fetal monitoring and non-invasive fetal ECG in modern obstetrics (review)</strong><br /> &nbsp;ShamarinStanislav V.ShamarinStanislav V.shamarin-med@yandex.ruEnkovaElena V.EnkovaElena V.enkova@bk.ruIppolitovaLyudmila I.IppolitovaLyudmila I.ippolitovaliuda@yandex.ruKiselevaElena V.KiselevaElena V.e.v.kiseleva@vrngmu.ruKhoperskayaОlga V.KhoperskayaОlga V.smv250587@mail.ruChernykhAlexander D.ChernykhAlexander D.alexandr.chernih2017@yandex.ru20239200

Background:&nbsp;Cardiotocography (electronic fetal monitoring) is a procedure of recoding fetal heart rate activity and uterine contractions during pregnancy and labor. The Doppler technique of cardiotocography using ultrasound transducers is widely used in obstetrics. However, in recent years there have been published articles on the subject of fetal electrocardiography (fECG) using abdominal electrodes during pregnancy and labor. Ultrasound fetal monitoring and non-invasive fetal ECG in obstetrics are two ways to obtain fetal heart rate (tachogram) recordings to diagnose fetal hypoxia or distress. Non-invasive fetal ECG in obstetric practice is not used to diagnose myocardial pathology, fetal cardiac conduction abnormalities both in pediatric and adult patients. The aim of the study:&nbsp;To evaluate the role of electronic Doppler fetal monitoring and non-invasive fetal ECG in the diagnosis of fetal hypoxia or distress. Materials and methods:&nbsp;A literature review of the role of fetal Doppler monitoring and non-invasive fetal ECG in the diagnosis of fetal hypoxia or distress in pregnancy and labor was performed using literature sources from the Pubmed, Elibrary, and Scopus databases for the past 15 years. Results:&nbsp;Analysis of the literature data has shown the widespread use of ultrasound fetal monitoring for testing for fetal hypoxia or distress compared with non-invasive fetal ECG at present. Most publications on non-invasive fetal ECG have described signal quality, with only a few literature sources devoted to the diagnosis of fetal hypoxia. Conclusion:&nbsp;Cardiotocography is the clinical method of choice for testing for fetal hypoxia or distress during pregnancy and labor. In contrast, non-invasive fetal electrocardiography is an alternative to Doppler ultrasound cardiotocography for assessment of fetal well-being. However, non-invasive fetal ECG has a lack of reliability for assessment of fetal well-being compared to Doppler ultrasound cardiotocography.

Background:&nbsp;Cardiotocography (electronic fetal monitoring) is a procedure of recoding fetal heart rate activity and uterine contractions during pregnancy and labor. The Doppler technique of cardiotocography using ultrasound transducers is widely used in obstetrics. However, in recent years there have been published articles on the subject of fetal electrocardiography (fECG) using abdominal electrodes during pregnancy and labor. Ultrasound fetal monitoring and non-invasive fetal ECG in obstetrics are two ways to obtain fetal heart rate (tachogram) recordings to diagnose fetal hypoxia or distress. Non-invasive fetal ECG in obstetric practice is not used to diagnose myocardial pathology, fetal cardiac conduction abnormalities both in pediatric and adult patients. The aim of the study:&nbsp;To evaluate the role of electronic Doppler fetal monitoring and non-invasive fetal ECG in the diagnosis of fetal hypoxia or distress. Materials and methods:&nbsp;A literature review of the role of fetal Doppler monitoring and non-invasive fetal ECG in the diagnosis of fetal hypoxia or distress in pregnancy and labor was performed using literature sources from the Pubmed, Elibrary, and Scopus databases for the past 15 years. Results:&nbsp;Analysis of the literature data has shown the widespread use of ultrasound fetal monitoring for testing for fetal hypoxia or distress compared with non-invasive fetal ECG at present. Most publications on non-invasive fetal ECG have described signal quality, with only a few literature sources devoted to the diagnosis of fetal hypoxia. Conclusion:&nbsp;Cardiotocography is the clinical method of choice for testing for fetal hypoxia or distress during pregnancy and labor. In contrast, non-invasive fetal electrocardiography is an alternative to Doppler ultrasound cardiotocography for assessment of fetal well-being. However, non-invasive fetal ECG has a lack of reliability for assessment of fetal well-being compared to Doppler ultrasound cardiotocography.

fetal distresscardiotocographyfetal electrocardiographyfetal distresscardiotocographyfetal electrocardiographyСписок литературыZhu LA, Blanc J, Heckenroth H, et al. Fetal physiology cardiotocography training, a regional evaluation. Journal of Gynecology Obstetrics and Human Reproduction. 2021;50(6):102039. DOI: https://doi.org/10.1016/j.jogoh.2020.102039Baker&nbsp;H,&nbsp;Pilarski&nbsp;N,&nbsp;Hodgetts-Morton VA, et al. Comparison of visual and computerised antenatal cardiotocography in the prevention of perinatal morbidity and mortality.&nbsp;A systematic review and meta-analysis. European Journal of Obstetrics and Gynecology and Reproductive Biology.&nbsp;2021;263:33-43. DOI: https://doi.org/10.1016/j.ejogrb.2021.05.048Campanile M, D&#39;Alessandro P, Corte LD, et al. Intrapartum cardiotocography with and without computer analysis: a systematic review and meta-analysis of randomized controlled trials. Journal of Maternal-Fetal and Neonatal Medicine. 2020;33(13):2284-2290. DOI: https://doi.org/10.1080/14767058.2018.1542676Ayres-de-Campos D, Spong CY, Chandraharan E. FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography. FIGO Intrapartum Fetal Monitoring Expert Consensus Panel. International Journal of Gynecology and Obstetrics. 2015;131(1):13-24. DOI: https://doi.org/10.1016/j.ijgo.2015.06.020Pinas A, Chandraharan E. Continuous cardiotocography during labour: Analysis, classification and management. Best Practice and Research Clinical Obstetrics and Gynaecology. 2016;30:33-47. DOI: https://doi.org/10.1016/j.bpobgyn.2015.03.022Reinhard J, Hayes-Gill BR, Yi Q, et al. Comparison of non-invasive fetal electrocardiogram to Doppler cardiotocogram during the 1st stage of labor. Journal of Perinatal Medicine. 2010;38(2):179-185. DOI: https://doi.org/10.1515/jpm.2010.025Reinhard J, Hayes-Gill BR, Schiermeier S, et al. Intrapartum signal quality with external fetal heart rate monitoring: a two way trial of external Doppler CTG ultrasound and the abdominal fetal electrocardiogram. Archives of Gynecology and Obstetrics. 2012;286(5):1103-1107. DOI: https://doi.org/10.1007/s00404-012-2413-4Marzbanrad F, Stroux L, Clifford GD. Cardiotocography and beyond: a review of one-dimensional Doppler ultrasound application in fetal monitoring. Physiological Measurement. 2018;39(8):08TR01. DOI: https://doi.org/10.1088/1361-6579/aad4d1Knupp RJ, Andrews WW, Tita ATN. The future of electronic fetal monitoring. Best Practice and Research Clinical Obstetrics and Gynaecology. 2020;67:44-52. DOI: https://doi.org/10.1016/j.bpobgyn.2020.02.004Hamelmann P, Vullings R, Kolen AF, et al. Doppler Ultrasound Technology for Fetal Heart Rate Monitoring: A Review. IEEE transactions on ultrasonics, ferroelectrics and frequency control. 2020;67(2):226-238. DOI: https://doi.org/10.1109/TUFFC.2019.2943626Shamarin SV. International CTG standards. System analysis and management in biomedical systems. 2010;9(2):357-365. Russian.Warncke&nbsp;AB,&nbsp;Zb&auml;ren&nbsp;S,&nbsp;Bolla D, et al. Is computerized cardiotocography useful in monochorionic twins with selective intrauterine growth restriction. Journal of Maternal-Fetal and Neonatal Medicine.&nbsp;2022;35(1):116-121. DOI:&nbsp;https://doi.org/10.1080/14767058.2020.1712708Alsayyari A. Fetal cardiotocography monitoring using Legendre neural networks. Biomedizinische Technik. 2019;64(6):669-675. DOI: https://doi.org/10.1515/bmt-2018-0074Kouskouti C, Regner K, Knabl J, et al. Cardiotocography and the evolution into computerised cardiotocography in the management of intrauterine growth restriction. Archives of gynecology and obstetrics. 2017;295(4):811-816. DOI: https://doi.org/10.1007/s00404-016-4282-8Warrick PA, Hamilton EF. Information theoretic measures of perinatal cardiotocography synchronization. Mathematical Biosciences and Engineering. 2020;17(3):2179-2192. DOI: https://doi.org/10.3934/mbe.2020116Gragnano E, Saccone G, Tagliaferri S, et al. Computerized cardiotocography in singleton gestations with diabetes mellitus: a retrospective study. Minerva Obstetrics and Gynecology. 2022;74(2):161-164. DOI: https://doi.org/10.23736/s2724-606x.21.04786-2Castelijn B, Hollander K, Hensbergen JF, et al. Peripartum fetal distress in diabetic women: a retrospective case-cohort study. BMC Pregnancy and Childbirth. 2018;18(1):228. DOI: https://doi.org/10.1186/s12884-018-1880-4Seliger G, Petroff D, Seeger S, et al. Diurnal variations of short-term variation and the impact of multiple recordings on measurement accuracy. Journal of Perinatology. 2017;37(3):231-235. DOI: https://doi.org/10.1038/jp.2016.202Shamarin SV. Electronic fetal monitoring in Russia. System analysis and management in biomedical systems. 2015;14(3):510-515. Russian.Ayres-de-Campos D, Nogueira-Reis Z. Technical characteristics of current cardiotocographic monitors. Best Practice and Research in Clinical Obstetrics and Gynaecology. 2016;30:22-32. DOI: https://doi.org/10.1016/j.bpobgyn.2015.05.005Hamelmann P, Kolen A, Schmitt L, et al. Ultrasound transducer positioning aid for fetal heart rate monitoring. Annual International Conference of the IEEE Engineering in Medicine and Biology Society. 2016:4105-4108. DOI: https://doi.org/10.1109/EMBC.2016.7591629Sbrollini A, Agostinelli A, Marcantoni I, et al. &nbsp;eCTG: an automatic procedure to extract digital cardiotocographic signals from digital images. Comput Methods Programs Biomed. 2018;156:133-139. DOI: https://doi.org/10.1016/j.cmpb.2017.12.030Chowdhury S, Frasch MG, Lucchini M, et al. A Novel Method for the Extraction of Fetal ECG Signals from Wearable Devices. Annual International Conference of the IEEE Engineering in Medicine and Biology Society. 2022:1319-1322. DOI: https://doi.org/10.1109/EMBC48229.2022.9870899Wacker-Gussmann A, Plankl C, Sewald M, et al. Fetal cardiac time intervals in healthy pregnancies - an observational study by fetal ECG (Monica Healthcare System). Journal of Perinatal Medicine. 2018;46(6):587-592. DOI: https://doi.org/10.1515/jpm-2017-0003Lempersz C, Noben L, Osta G, et al. Intrapartum non-invasive electrophysiological monitoring: A prospective observational study. Acta Obstetricia et Gynecologica Scandinavica. 2020;99(10):1387-1395. DOI: https://doi.org/10.1111/aogs.13873S&auml;nger N, Hayes-Gill BR, Schiermeier S, et al. Prenatal Foetal Non-invasive ECG instead of Doppler CTG - A Better Alternative. Geburtshilfe und Frauenheilkunde. 2012;72(7):630-633. DOI: https://doi.org/10.1055/s-0032-1315012Prikhodko AM, Romanov AYu, Tysyachnyy OV, et al. Modern principles of cardiotocography in childbirth. Meditsinskiy sovet = Medical Council. 2020;3:90-97. Russian. DOI: https://doi.org/10.21518/2079-701X-2020-3-90-97Shamarin SV. International CTG analysis: FIGO and other. System analysis and management in biomedical systems. 2016;15(4):723-733. Russian.Fuchs T, Pomorski M, Grobelak K, et al. Signal loss during fetal heart rate monitoring using maternal abdominal surface electrodes between 28 and 42 weeks of pregnancy. Advances in Clinical and Experimental Medicine. 2014;23(5):813-819. DOI: https://doi.org/10.17219/acem/37258Arya B, Govindan R, Krishnan A, et al. Feasibility of Noninvasive Fetal Electrocardiographic Monitoring in a Clinical Setting. Pediatric Cardiology. 2015;36(5):1042-1049. DOI: https://doi.org/10.1007/s00246-015-1118-4Reinhard J, Hatzmann H, Schiermeier S. Foetal electrocardiography (ECG) is an alternative to Doppler ultrasound cardiotocogram (CTG) for antenatal assessment of foetal well-being--preliminary results. Journal of Obstetrics and Neonatology. 2008;212(6):226-9. DOI: https://doi.org/10.1055/s-0028-1098718Graatsma EM, Miller J, Mulder EJ, et al. Maternal body mass index does not affect performance of fetal electrocardiography. American Journal of Perinatology. 2010;27(7):573-577. DOI: https://doi.org/10.1055/s-0030-1248945S&auml;nger N, Louwen F, Reinhard J, et al. Signal quality of non-invasive fetal electrocardiogram in vaginal breech delivery: a case-controlled study. Archives of Gynecology and Obstetrics. 2013;288(5):1017-20. DOI: https://doi.org/10.1007/s00404-013-2860-6Reinhard J, Hayes-Gill B, Yuan J, et al. Intrapartum ST segment analyses (STAN) using simultaneous invasive and non-invasive fetal electrocardiography: a report of 6 cases. Zeitschrift fur Geburtshilfe und Neonatologie. 2014;218(3):122-127. DOI: https://doi.org/10.1055/s-0034-1375606DiPietro J,&nbsp;Watson&nbsp;H,&nbsp;Raghunathan RS. Measuring fetal heart rate and variability: Fetal cardiotocography versus electrocardiography. Developmental Psychobiology.&nbsp;2022;64(1):e22230. DOI:&nbsp;https://doi.org/10.1002/dev.22230Kisilevsky BS, Brown СA. Comparison of fetal and maternal heart rate measures using electrocardiographic and cardiotocographic methods. Infant Behavior and Development. 2016;42:142-151. DOI: https://doi.org/10.1016/j.infbeh.2015.12.004Enkova EV, Shamarin SV, Bychkov VI, et al. The comparative review of the ultrasound Doppler cardiotocography (CTG) and indirect fetal electrocardiography (FECG) for assessment of fetal well-being. Research Journal of Pharmaceutical, Biological and Chemical Sciences. 2017;8(2):1196-1201.Georgieva A, Papageorghiou AT, Payne SJ, et al. Authors&#39; reply: Computerised interpretation of fetal heart rate patterns and correlation with fetal acidaemia. International Journal of Obstetrics and Gynaecology. 2014;121(13):1747-1748. DOI: https://doi.org/10.1111/1471-0528.13040Holzmann M, Wretler S, Cnattingius S, et al. Cardiotocography patterns and risk of intrapartum fetal academia. Journal of Perinatal Medicine. 2015;43(4):473-479. DOI: https://doi.org/10.1515/jpm-2014-0105Shrestha S, Shrestha I. Admission Cardiotocography in Predicting Perinatal Outcome. Kathmandu University Medical Journal.&nbsp;2019;17(67):201-205.Huhn EA, M&uuml;ller MI, Meyer AH, et al. Quality Predictors of Abdominal Fetal Electrocardiography Recording in Antenatal Ambulatory and Bedside Settings. Fetal Diagnosis and Therapy. 2017;41(4):283-292. DOI: https://doi.org/10.1159/000448946Crawford A, Anyadi P, Stephens L, et al. A mixed-methods evaluation of continuous electronic fetal monitoring for an extended period. Acta Obstetricia et Gynecologica Scandinavica. 2018;97(12):1515-1523. DOI: https://doi.org/10.1111/aogs.13446Ibrahim S, Jarefors E, Nel DG, et al. Effect of maternal position and uterine activity on periodic maternal heart rate changes before elective cesarean section at term. Acta Obstetricia et Gynecologica Scandinavica. 2015;94(12):1359-66. DOI: https://doi.org/10.1111/aogs.12763Kapaya H, DimelowER, Anumba D. Is portable foetal electrocardiogram monitor feasible for foetal heart rate monitoring of small for gestational age foetuses in the home environment. Journal of Obstetrics and Gynaecology. 2019;39(8):1081-1086. DOI: https://doi.org/10.1080/01443615.2019.1587394Bhatia SS, Burgess WH, Skinner JR. Fetal Tachycardia in the Delivery Room: Fetal Distress, Supraventricular Tachycardia, or Both. American Journal of Perinatology Reports. 2020;10(4):e380-e385. DOI: https://doi.org/10.1055/s-0040-1718900Dawes GS, Lobb M, Moulden M, et al. Antenatal cardiotocogram quality and interpretation using computers. International Journal of Obstetrics and Gynaecology. 2014;121(7):2-8. DOI: https://doi.org/10.1111/1471-0528.13208Demidov VN, Voronkova MA, Vakhterkina KG, et al. New diagnostic capabilities of a Russian-made antenatal fetal monitor. Obstetrics and Gynecology. 2018;8:143-150. Russian. DOI: https://dx.doi.org/10.18565/aig.2018.8.143-150Crequit S, Tataru C, Coste E, et al. Association of fetal heart rate short term variability pattern during term labor with neonatal morbidity and small for gestational age status. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2022;278:77-89. DOI: https://doi.org/10.1016/j.ejogrb.2022.08.026Nazir L, Lakhta G, Anees K, et al. Admission Cardiotocography as a Predictor of Low Apgar Score: An Observational, Cross-Sectional Study. Cureus. 2021;13(4):e14530. DOI: https://doi.org/10.7759/cureus.14530Warmerdam GJ, Vullings R, Laar JV, et al. Detection rate of fetal distress using contraction-dependent fetal heart rate variability analysis. Physiological Measurement. 2018;39(2):025008. DOI: https://doi.org/10.1088/1361-6579/aaa925Strasser SM, Kwee A, Visser GH. Spontaneous tachysystole as sign of serious perinatal conditions. Journal of Maternal-Fetal and Neonatal Medicine. 2010;23(7):736-741. DOI: https://doi.org/10.3109/14767050903300951Leathersich SJ, Vogel JP, Tran TS, et al. Acute tocolysis for uterine tachysystole or suspected fetal distress. Cochrane Database of Systematic Reviews. 2018;7(7):CD009770. DOI: https://doi.org/10.1002/14651858.CD009770.pub2Tarvonen M,&nbsp;Hovi P,&nbsp;Sainio S,&nbsp;et al. Intrapartal cardiotocographic patterns and hypoxia-related perinatal outcomes in pregnancies complicated by gestational diabetes mellitus. Acta Diabetologica.&nbsp;2021;58(11):1563-1573. DOI:&nbsp;https://doi.org/10.1007/s00592-021-01756-0Redman CW. Avoiding CTG misinterpretation: A review of the latest Dawes-Redman CTG analysis [Internet]. British Journal of Midwifery. Clinical practice. 2014 [cited 2023 January 20];1-4. Available from: https://irp.cdn-website.com/a7c96b08/files/uploaded/BJM_Avoiding_CTG_misinterpretation_-_Redman__Moulden.pdfNoben L, Westerhuis ME, Laar JO, et al. Feasibility of non-invasive Foetal electrocardiography in a twin pregnancy. BMC Pregnancy and Childbirth. 2020;20(1):215. DOI: https://doi.org/10.1186/s12884-020-02918-8Keenan E, Udhayakumar RK, Karmakar CK, et al. Entropy Profiling for Detection of Fetal Arrhythmias in Short Length Fetal Heart Rate Recordings. Annual International Conference of the IEEE Engineering in Medicine and Biology Society. 2020:621-624. DOI: https://doi.org/10.1109/EMBC44109.2020.9175892Behar JA, Bonnemains L, ShulginV, et al. Noninvasive fetal electrocardiography for the detection of fetal arrhythmias. Prenatal Diagnosis. 2019;39(3):178-187. DOI: https://doi.org/10.1002/pd.5412Fisenko AM, Savel&rsquo;eva GM, Karaganova EY. The significance of cardiotocography and lactate test in assessment of fetal wellbeing in labour. Gynecology, Obstetrics and Perinatology. 2018;17(6):63-68. Russian. DOI: https://doi.org/10.20953/1726-1678-2018-6-63-68Vikhareva ON, Baev OR, Voevodin SM, at al. The use of cardiotocography in childbirth. Clinical protocol [Internet]. Obstetrics and gynecology. 2015 [cited 2022 May 22];4:12-13. Russian. Available from: https://umrd.ru/files/SPECIALISTAM/Protokoly/protokol_md_15_.pdfLempersz C, Noben L, Vries B, et al. The Noninvasive Fetal Electrocardiogram During Labor: A Review of the Literature. Obstetrical and Gynecological Survey. 2020;75(6):369-380. DOI: https://doi.org/10.1097/OGX.0000000000000798