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PubMed2003

Spontaneous fetal heart rate deceleration: an ominous sign for fetal outcome.

BACKGROUND: The aim of this study was to establish the prognostic import of spontaneous fetal heart-rate deceleration, a sign of fetal distress. METHODS: This retrospective study enrolled 169 patients with fetal heart-rate deceleration treated at Shin-Kong Wu Ho Su Memorial Hospital from 1 January 1998 to 24 November 2000. Reviewed variables included type of fetal heart-rate irregularity (including early, variable, late, and spontaneous variants), neonatal outcome, Doppler results, gestational age and weight at birth, and amniotic fluid index. RESULTS: The spontaneous form of fetal heart-rate deceleration was determined for 11 of the 169 patients (6.5%) diagnosed with fetal heart-rate deceleration, with a 5-min Apgar score below 7 observed for 5 (45.5%) of these subjects, and neonatal complications for 9 (81.8%). Mean gestational age was 32.2+/-3.8 weeks; mean birth weight was 1,560+/-723.9 g. Spontaneous deceleration has a sensitivity of 29%, specificity of 99%, positive predictive value of 81.8%, and negative predictive value of 86.1%. CONCLUSION: Although of the different fetal heart-rate deceleration types the spontaneous variant has the lowest incidence rate, the complication and mortality rates are highest and it is also associated with lower birth weight and higher incidence of pre-term labor. Failure of the fetus to cope with the compromised placental flow and uterine compression resulting from oligohydramnios may be fundamental to the etiology of spontaneous fetal-heart rate deceleration. Once diagnosed, Doppler ultrasound may be used to assess placental-vessel flow. Emergency treatment may be mandatory if deterioration is noted.

Adult↗
PubMed1979

A study of variable decelerations in association with other heart rate patterns during monitored labor.

A review of 1,011 consecutive intrapartum heart rate tracings yielded 37.3% with some degree of variable deceleration pattern. No differences in Apgar score distribution were observed in the presence of uncomplicated variable deceleration pattern when compared to those tracings marked normal. However, the presence of variable decelerations in association with other heart rate patterns resulted in lower mean Apgar scores at 1 and 5 minutes, which were significantly different from those of the fetal heart rate (FHR) normal group. Mean Apgar scores at 1 and 5 minutes were significantly different from normal when variable decelerations were noted in the presence of tachycardia and loss of variability. Mean Apgar scores were lower when bradycardia (prolonged episodes of heart rate less than 120 bpm) was present in the record when compared to normal, but the presence of variable decelerations with bradycardia did not result in different mean scores. The presence of baseline changes with loss of variability and variable decelerations appeared to result in the lowest mean scores. When bradycardia or tachycardia occurred in exclusive association with variable decelerations, the percentage of depressed newborn infants was relatively high.

Apgar Score↗
PubMed1989

Human fetal tricuspid and mitral deceleration time: changes with normal pregnancy and intrauterine growth retardation.

Studies in instrumented adults have shown an association between Doppler echocardiography-derived atrioventricular valve deceleration times and ventricular function. To determine how gestational age affects deceleration time in the tricuspid and mitral valve, pulsed Doppler ultrasonographic examinations were performed in 54 normal human fetuses. In addition, 26 fetuses with growth retardation and the absence of end-diastolic Doppler velocities in the umbilical artery were examined. Measurements were obtained from strip chart recordings; between three and five beats were used to obtain an average heart rate, ratio of peak velocity at atrial contraction to peak velocity in early diastole, and deceleration time in early diastole. Deceleration times increased during gestation from 86 +/- 27 to 116 +/- 18 msec in the tricuspid valve and from 98 +/- 25 to 132 +/- 21 msec in the mitral valve. Fetuses with growth retardation and the absence of end-diastolic Doppler velocities in the umbilical artery had longer deceleration times than those of normal fetuses (p less than 0.01). The increase in deceleration time across both atrioventricular valves in normal fetuses may be related to heart rate, an increased rate of ventricular relaxation, or an increase in ventricular compliance. The fetuses with intrauterine growth retardation and the absence of end-diastolic velocities in the umbilical artery have abnormally increased deceleration times; in the abnormal fetus this may be a result of impaired ventricular relaxation or decreased ventricular compliance.

Blood Flow Velocity↗
PubMed1983

The significance of single sporadic deceleration during a nonstress test.

The significance of single sporadic deceleration occurring during antepartum fetal heart rate monitoring was assessed. Single sporadic deceleration was defined as a drop of fetal heart rate of at least 40 bpm below baseline lasting for at least 2 min. During the year 1980, 7202 nonstress tests (NST) were performed in pregnant patients, with gestational ages ranging from 32-42 wk. Among these, 62 cases of single sporadic deceleration were observed. In 48 of these cases the single sporadic deceleration was followed by a normal reactive NST. In 14 patients NST following the single sporadic deceleration was non-reactive. In those cases oxytocin challenge test (OCT) was performed and was negative in 10 and positive in 4 cases. In the latter 4 patients labor was induced and all required cesarean section because of severe fetal distress. The remaining 58 women were followed up at the High-Risk Pregnancy Unit until spontaneous labor began, their deliveries were monitored throughout. In 8 cases out of the 58, fetal distress was observed during labor and in 4 of them cesarean section was required. The occurrence of single sporadic deceleration at gestational ages 32-42 wk is not an alarming sign providing the NST and/or O.C.T. are normal. However, the incidence of fetal distress during labor is significantly higher in fetuses with single sporadic deceleration as compared to the normal parturient population.

Female↗
PubMed2000

Randomized trial of intermittent or continuous amnioinfusion for variable decelerations.

OBJECTIVE: To determine whether continuous or intermittent bolus amnioinfusion is more effective in relieving variable decelerations. METHODS: Patients with repetitive variable decelerations were randomized to an intermittent bolus or continuous amnioinfusion. The intermittent bolus infusion group received boluses of 500 mL of normal saline, each over 30 minutes, with boluses repeated if variable decelerations recurred. The continuous infusion group received a bolus infusion of 500 mL of normal saline over 30 minutes and then 3 mL per minute until delivery occurred. The ability of the amnioinfusion to abolish variable decelerations was analyzed, as were maternal demographic and pregnancy outcome variables. Power analysis indicated that 64 patients would be required. RESULTS: Thirty-five patients were randomized to intermittent infusion and 30 to continuous infusion. There were no differences between groups in terms of maternal demographics, gestational age, delivery mode, neonatal outcome, median time to resolution of variable decelerations, or the number of times variable decelerations recurred. The median volume infused in the intermittent infusion group (500 mL) was significantly less than that in the continuous infusion group (905 mL, P =.003). CONCLUSION: Intermittent bolus amnioinfusion is as effective as continuous infusion in relieving variable decelerations in labor. Further investigation is necessary to determine whether either of these techniques is associated with increased occurrence of rare complications such as cord prolapse or uterine rupture.

Adult↗
PubMed1989

Fetal umbilical blood flow velocity waveforms using Doppler ultrasonography in patients with late decelerations.

The purpose of this study was to assess placental vascular resistance as measured by peak systolic to end-diastolic ratios (S/D) of the umbilical artery waveforms in patients with late decelerations. Fifty patients with persistent late decelerations and 50 gestational age-matched controls with reactive tracings underwent umbilical velocimetry with measurement of S/D ratios. The mean (+/- SD) S/D ratio in the late-deceleration group (4.32 +/- 1.1) was significantly higher than that of the control group (2.32 +/- 0.21) (P less than .01). Patients with late decelerations had a significantly higher incidence of adverse pregnancy outcome, as judged by the incidence of small for gestational age infants, meconium, cesarean section for fetal distress, low Apgar scores, and neonatal intensive care unit admissions, compared with the control group. However, there was no difference in the incidence of adverse pregnancy outcome in the late-deceleration group with normal S/D ratios compared with controls. The sensitivity, specificity, and positive and negative predictive values of S/D ratios in the late-deceleration group for predicting adverse pregnancy outcome were 85.7, 100, 100, and 89.6%, respectively. These data suggest that umbilical velocimetry might be able to discriminate late decelerations that constitute a false-positive test. Incorporation of umbilical velocimetry into antepartum and intrapartum fetal surveillance schemes may therefore be helpful.

Adult↗
PubMed1996

Shortened Doppler-derived mitral A wave deceleration time: an important predictor of elevated left ventricular filling pressure.

OBJECTIVES: The aim of this study was to investigate whether a new variable of mitral inflow, A wave deceleration time, identifies patients with elevated left ventricular filling pressures. BACKGROUND: In patients with an elevated left ventricular end-diastolic pressure, the increase in left ventricular pressure after atrial contraction rapidly exceeds left atrial pressure, resulting in abrupt cessation of the A wave. Therefore, we postulated that a shortening of A wave deceleration time might be a marker for elevated end-diastolic pressure. METHODS: Adequate pulsed Doppler mitral inflow velocities could be recorded in 40 of 44 consecutive patients undergoing cardiac catheterization with capillary wedge pressure in 20 patients, and within 1 h after left ventricular end-diastolic pressure recording in 20. Fifteen healthy volunteers were also studied. RESULTS: Left ventricular end-diastolic pressure was 8 to 35 mm Hg, and mean pulmonary wedge pressure was 6 to 37 mm Hg. Close correlations were found between A wave deceleration time and mean pulmonary wedge pressure (r = -0.87) and left ventricular end-diastolic pressure (r = -0.74). There were modest correlations between both pressures and peak E/A, E wave deceleration time and A wave duration, respectively; r = 0.59, -0.30 and -0.58 for capillary wedge and r = 0.25, -0.38 and -0.49 for end-diastolic pressures. A wave deceleration time </= 60 ms predicted left ventricular end-diastolic and mean pulmonary wedge pressures > 18 mm Hg, respectively, with a sensitivity of 67% and 89% and specificity of 100% for both. CONCLUSIONS: A shortened Doppler mitral inflow A wave deceleration time is a useful index of elevated left ventricular filling pressure.

Adolescent↗
PubMed1981

Vertical deceleration injuries.

Six patients simultaneously sustained vertical deceleration injuries. Vertical deceleration injuries are serious and characteristically involve major weight bearing structures with forces transmitted through the foot, leg, pelvis and vertebral column. Injuries of the lower extremity are likely to be unilateral and comminuted because the force of deceleration is applied to a small area. The severity of the injury increases by increasing the rate of deceleration and decreasing the distance through which the body is decelerated. More severe injury occurs when deceleration forces are applied to the body in the vertical axis compared with the transverse, provided that mass, velocity and stopping distance remain the same.

Acceleration↗
PubMedDate not supplied

Three-dimensional baselines for perceived self-motion during acceleration and deceleration in a centrifuge.

Three-dimensional motion trajectories were computed, representing the motions that would be perceived by a perfect processor of acceleration information during the acceleration and deceleration stages of a centrifuge run. These motions serve as "baselines" for perceived self-motion in a centrifuge, and depend on the initial perception of orientation and velocity immediately preceding the acceleration and immediately preceding the deceleration. The baselines show that a perfect processor of acceleration information perceives self-motion during centrifuge deceleration significantly differently from self-motion during centrifuge acceleration, despite the fact that the angular accelerations have equal magnitude (with opposite direction). At the same time, the baselines can be compared with subjects' reported perceptions to highlight limitations of the nervous system; limitations and peculiarities of the nervous system are identified as deviations from a baseline. As a result, peculiarities of the nervous system are held responsible for any perception of pitch or roll angular velocity or change in tilt of the body-horizontal plane of motion during the centrifuge run. On the other hand, baselines explain perception of tilt position during deceleration, linear velocity, possible lack of significant linear velocity during deceleration, and yaw angular velocity, including on-axis angular velocity during centrifuge deceleration. The results lead to several experimental questions.

Acceleration↗
PubMed2001

Deceleration of high-energy matrix-assisted laser desorption/ionization ions in an open cell for Fourier transform ion cyclotron resonance mass spectrometry.

A new method of ion deceleration in a Fourier transform ion cyclotron resonance (FTICR) open cell is described that improves the performance of FTICR-MS instruments equipped with an internal source for laser desorption/ionization. Ion deceleration occurs in the front trapping cylinder of an open cylindrical cell. Decelerating voltages up to 100 V can be applied for 10-500 micros to the front cylinder during ion introduction. The deceleration field is uniformly distributed along the cylinder length giving a "smooth" deceleration, which means that the deceleration is effective over a large time interval and a large m/z range. This results in improved trapping efficiency of high-energy ions. We demonstrate efficient trapping of high (m/z 66 kDa) mass ions and the possibility to reduce the width of the kinetic energy distribution of MALDI ions with this arrangement.

Journal Article↗
PubMed1983

Saline amnioinfusion for relief of variable or prolonged decelerations. A preliminary report.

Variable decelerations are of frequent concern to the practicing obstetrician. Oligohydramnios resulting in cord and/or placental compression is probably the most common cause of variable decelerations. We performed intrauterine saline amnioinfusion in 42 patients having repetitive variable or prolonged decelerations that did not respond to conventional therapy, such as maternal position changes and oxygen administration. Saline amnioinfusion was effective for relief of repetitive variable decelerations in 19 of 28 patients and prolonged decelerations in 12 of 14 patients. No neonatal or maternal complications occurred. This preliminary study suggests that amnioinfusion therapy may become a useful adjunct in the management of repetitive variable and prolonged decelerations.

Adult↗
PubMed1982

Fetal heart rate decelerations following the administration of meperidine-promethazine during labor.

A deceleration response lasting up to 7 min was observed in 53 fetuses (out of 1910 studied) following the administration of 75 mg meperidine and 25 mg promethazine intravenously to the mothers during labor. Thirty-six of these fetuses reacted with baseline tachycardia following the deceleration with or without loss of baseline variability. Seven fetuses showed a variable deceleration pattern and six fetuses reacted with a late deceleration pattern following the first deceleration. Two newborns from the group showing a late deceleration pattern were delivered with an apgar score below 7 in 5 min. The probable mechanisms and significance of these changes are discussed.

Anesthesia, Obstetrical↗
PubMed1979

Mechanisms of late decelerations in the fetal heart rate. A study with autonomic blocking agents in fetal lambs.

Fetal heart rate decelerations resembling the late deceleration FHR pattern were produced in fetal sheep by periodic occlusion of the maternal common hypogastric artery for 30-60 sec. Transient fetal hypertension also occurred during the occlusions. Alpha-adrenergic blockade with phentolamine eliminated or markedly reduced the hypertensive response. FHR decelerations still occurred intermittently with some occlusions; however, their character was greatly altered. After parasympathetic blockade with atropine, the decelerations were replaced by periodic FHR accelerations during the occlusions. These accelerations were, in turn, eliminated by the beta-adrenergic blocking agent, propranolol. In the presence of combined parasympathetic, alpha- and beta-adrenergic blockade, the FHR remained essentially constant during the hypogastric artery occlusions in non-acidemic fetuses. FHR decelerations persisted after parasympathetic or total autonomic blockade when the fetuses were significantly hypoxic, as judged by depressed arterial blood pH and base excess values. Beat-to-beat variability of the baseline FHR persisted in the face of severe hypoxia and acidosis. These observations demonstrate that reflex mechanisms are involved importantly in the genesis of late deceleration FHR patterns in the acutely hypoxemic fetus, but that direct depression of myocardial rhythmicity becomes a factor as hypoxic acidosis develops.

Acetylcholine↗
PubMed1996

Independent and incremental prognostic value of Doppler-derived mitral deceleration time of early filling in both symptomatic and asymptomatic patients with left ventricular dysfunction.

OBJECTIVES: This study sought to investigate the relative and incremental prognostic value of demographic, historical, clinical, echocardiographic and mitral Doppler variables in patients with left ventricular systolic dysfunction. BACKGROUND: The prognostic value of diastolic abnormalities as assessed by mitral Doppler echocardiography has yet to be defined. METHOD: A total of 508 patients with left ventricular ejection fraction < or = 35% were followed up for a mean (+/- SD) period of 29 +/- 11 months. RESULTS: During the follow-up period, 148 patients (29.1%) were admitted to the hospital for congestive heart failure, and 100 patients (19.7%) died. By Cox model analysis, Doppler-derived mitral deceleration time of early filling < or = 125 ms (relative risk [RR] 1.93, 95% confidence interval [CI] 1.4 to 3.7), New York Heart Association functional class III or IV (RR 1.49, 95% CI 1.4 to 2.3), ejection fraction < or = 25% (RR 1.85, 95% CI 1.6 to 2.9), third heart sound (RR 2.06, 95% CI 1.8 to 3.2), age > 60 years (RR 1.95, 95% CI 1.8 to 3.1) and left atrial area > 18 cm2 (RR 1.73, 95% CI 1.6 to 2.7) were all found to be independent and additional predictors of all-cause mortality, and deceleration time was the single best predictor (chi-square 37.80). When all these significant variables were analyzed in hierarchic order, after age, functional class, third sound, ejection fraction and left atrial area, deceleration time still added significant prognostic information (global chi-square from 9.2 to 104.7). Also, deceleration time was the strongest independent predictor of hospital admission for congestive heart failure (RR 4.88, 95% CI 3.7 to 6.9) and cumulative events (congestive heart failure or all-cause mortality, or both; RR 2.44, 95% CI 2.0 to 3.8) in both symptomatic and asymptomatic patients. CONCLUSIONS: Deceleration time of early filling is a powerful independent predictor of poor prognosis in patients with left ventricular systolic dysfunction, whether symptomatic or asymptomatic. A short (< or = 125 ms) deceleration time by mitral Doppler echocardiography adds important prognostic information compared with other clinical, functional and echocardiographic variables.

Cohort Studies↗
PubMed1996

Is noninvasive determination of pulmonary artery pressure feasible using deceleration phase Doppler flow velocity characteristics in mechanically ventilated children with congenital heart disease?

Noninvasive determination of pulmonary hemodynamics is important for the management of congenital heart disease complicated by pulmonary hypertension. Flow deceleration is less influenced by right ventricular function and would allow more accurate estimation of pulmonary hemodynamics than acceleration. Respiratory influences on pulmonary blood flow are exaggerated by mechanical ventilation. Doppler-derived pulmonary artery (PA) blood flow velocity characteristics were therefore compared with pulmonary hemodynamic parameters in 42 mechanically ventilated children, aged 0.2 to 14.8 years (mean +/- SD 6.7 +/- 4.9). Mean PA pressure ranged from 11 to 47 mm Hg (21 +/- 9 mm Hg). Pulmonary hypertension was present in 14 patients. Significant differences were found between patients with and without pulmonary hypertension in maximal velocity (1.03 +/- 0.22 vs 0.88 +/- 0.18 m/s), acceleration time (119 +/- 39 vs 136 +/- 29 ms), maximal acceleration (17.6 +/- 6.4 vs 13.1 +/- 4.0 m/s2), mean acceleration (9.3 +/- 2.6 vs 6.7 +/- 2.0 m/s2), and mean deceleration (4.5 +/- 1.0 vs 3.8 +/- 0.8 m/s2). In contrast to our hypothesis of the deceleration phase-derived parameters, only maximal deceleration correlated with PA pressure. Acceleration parameters showed closer relations with PA pressures, but correlations were generally low and did not permit accurate prediction of PA pressure (SEE 5 to 11 mm Hg), PA resistance (SEE 1.14 U. m2) or PA driving force (SEE 7 mm Hg). An analysis that took respiratory phase into account did not improve correlations. Measurement of mean acceleration, maximal deceleration, and rate-corrected preejection period permitted for accurate discrimination between the presence or absence of pulmonary hypertension, with positive and negative predictive values being 92% and 90%. In mechanically ventilated children with congenital heart disease, accurate noninvasive PA pressure assessment is not possible. Accurate predictions for the presence of pulmonary hypertension can be made by measurement of both acceleration and deceleration parameters.

Adolescent↗
PubMed1985

Saline amnioinfusion for relief of repetitive variable decelerations: a prospective randomized study.

A prospective randomized study was undertaken in order to further investigate the effect of intrauterine saline amnioinfusion for the relief of repetitive variable decelerations in the first stage of labor. Intrauterine saline amnioinfusion corrects the oligohydramnios that makes the cord more vulnerable to compression during uterine contractions. Included in this study were 96 patients who had repetitive variable decelerations not relieved either by changes in position or by oxygen. Randomization resulted in 49 patients in the infusion group and 47 patients in the noninfusion group. Relief of variable decelerations was 51% in the infusion group, as compared to 4.2% in the noninfusion group. Relief of variable decelerations was more dramatic in the nulliparous infusion group (66.7%) than in the noninfusion group (0%). In the nulliparous patients there was a significant decrease in the rate of cesarean sections for fetal distress, being 14.8% in the infusion group as compared to 47.6% in the noninfusion group. This study clearly showed that saline amnioinfusion is a logical, simple, safe, and effective therapy for the relief of repetitive variable decelerations in the first stage of labor and can lower the incidence of cesarean sections for fetal distress in nulliparous patients. Furthermore, amnioinfusion was much superior to changes in position in treating repetitive variable decelerations.

Amnion↗
PubMed1987

Heart rate variation and movement incidence in growth-retarded fetuses: the significance of antenatal late heart rate decelerations.

In 37 intrauterine growth-retarded fetuses, combined 1-hour recordings of fetal heart rate and body movements were made within 24 hours of elective cesarean section. Fetal body movements were recorded simultaneously by use of real-time ultrasound. The study group was divided into two subgroups, according to the presence (n = 29) or absence (n = 8) of antepartum late heart rate decelerations. Correlations were made with umbilical blood gas values obtained immediately after cesarean section. Baseline heart rate variation was reduced below the normal range in 88% of the intrauterine growth-retarded fetuses with decelerations but in only 37% of the group without decelerations. A reduction in fetal heart rate accelerations and body movements and an increase in mean heart rate also were observed only in the group with decelerations. Late heart rate decelerations were associated with low PO2 values in both umbilical artery and vein. It is concluded that in intrauterine growth-retarded fetuses reduced heart rate variation and movement incidence correlate with the presence of late heart rate decelerations before birth and with hypoxemia at birth.

Cesarean Section↗
PubMed2006

Intrapartum late deceleration develops more frequently in pre-eclamptic women with severe proteinuria.

AIM: Our purpose was to investigate the effect of proteinuria associated with pre-eclampsia on intrapartum fetal heart rate patterns. METHODS: A retrospective study was performed involving 79 pregnant women with pre-eclampsia and 19 pregnant women with gestational hypertension (GH). Pre-eclampsia was then classified into two groups according to the degree of proteinuria (> or = or < 3 + dipstick), which was classified as severe urinary protein (UP; n = 35) and mild UP (n = 44) at delivery. Intrapartum fetal heart rate (FHR) monitoring was classified as either no deceleration, moderate variable deceleration, severe variable deceleration (sVD), prolonged deceleration (PD), occasional deceleration or recurrent late deceleration (rLD). We evaluated the prevalence of non-reassuring FHR (sVD, PD or rLD), the prevalence of intrauterine growth restriction (IUGR), and cord blood gas status in the three groups. The prevalence of non-reassuring FHR and cord blood gas status of these three groups was also compared with their prevalence in 65 women with low-risk pregnancies. Multiple logistic regression analysis was performed to determine the association between rLD and maternal-fetal parameters. RESULTS: Levels of systolic and diastolic blood pressure were similar among the three groups. Severe UP was diagnosed significantly earlier, was associated with significantly lower gestational age, and infants with lighter birth weight (P < 0.05) compared with GH and mild UP. The prevalence of IUGR in severe UP was higher than in GH (54%v. 21%, P < 0.05); however, no differences were found in the prevalence of IUGR between mild and severe UP (43%v. 54%, P = 0.33). The prevalence of non-reassuring FHR in GH was not statistically significant in the low-risk pregnancies (5%v. 9%, P = 0.58). In mild and severe UP, the non-reassuring FHRs were more predominant (30% and 43%, respectively) than in low-risk pregnancies and GH (P < 0.05). The rLD was more common in the group with severe UP and accounted for 40% of all FHR patterns. There was no difference in the incidence of low pH among the groups. However, fetuses in pregnancies involving severe UP were significantly hypoxemic when compared with others. Multiple logistic regression analysis showed that worsening proteinuria (odds ratio [OR], 5.5; 95% confidence interval [CI], 2.4-12.9) and IUGR (OR, 3.8; 95% CI, 1.2-11.5) increased the risk of rLD. Rates of preterm birth at less than 32 weeks (OR, 0.7; 95% CI, 0.2-2.5) and severe hypertension (OR, 0.5; 95% CI, 0.2-1.3) were not significant. CONCLUSION: In pre-eclampsia, the presence of severe proteinuria is associated with an increased likelihood of rLD.

Adult↗