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Electrocardiographic changes following umbilical cord occlusion in the midgestation fetal sheep

Journal article
Authors Anna-Karin Welin
Sofia Blad
Henrik Hagberg
Karl Gustaf Rosén
Ingemar Kjellmer
Carina Mallard
Published in Acta Obstet Gynecol Scand
Volume 84
Issue 2
Pages 122-8
Publication year 2005
Published at Institute for the Health of Women and Children, Dept of Obstetrics and Gynaecology
Institute for the Health of Women and Children, Dept of Paediatrics
Institute of Physiology and Pharmacology, Dept of Physiology
Pages 122-8
Language en
Links www.ncbi.nlm.nih.gov/entrez/query.f...
Keywords Animals, Asphyxia/complications/*embryology/*physiopathology, Blood Pressure Determination, Constriction, Pathologic, Disease Models, Animal, *Electrocardiography, Female, Fetal Monitoring/*methods, *Heart Rate, Fetal, Hemodynamic Processes, Myocardial Ischemia/diagnosis/embryology/etiology, Pregnancy, *Prenatal Diagnosis, Risk Factors, Sensitivity and Specificity, Sheep, Domestic, Umbilical Cord/pathology
Subject categories Medical and Health Sciences

Abstract

BACKGROUND: Clinical studies show that analysis of the fetal electrocardiographic (FECG) ST waveform at term gives important information on the myocardial response to intrapartum asphyxia. However, it is not known whether the preterm fetus responds in a similar fashion. The objective of the present study was to evaluate the FECGST response to umbilical cord occlusion in the preterm fetal sheep. METHODS: Fetal sheep at midgestation were subjected to 25 min umbilical cord occlusion (n = 7) and compared to controls (n = 5). Changes in the FECGST waveform were recorded together with arterial blood pressure, heart rate, and acid base status during the occlusion and for 3 days afterward. RESULTS: Umbilical cord occlusion resulted in immediate bradycardia (control: 187 +/- 7 bpm versus occlusion: 102 +/- 7 bpm), hypertension (control: 43.2 +/- 1.1 mmHg versus occlusion: 59.8 +/- 2.2 mmHg), and an initial increase in the T/QRS ratio (control: 0.10 +/- 0.02 versus occlusion: 0.60 +/- 0.10, P < 0.001), followed by hypotension (21.7 +/- 1.2 mmHg), normalization of the T/QRS ratio, and in some cases the development of negative T waves toward the end of the occlusion. CONCLUSIONS: These studies show that the midgestation fetal sheep has the capacity to react to umbilical cord occlusion with a significant increase in the amplitude of the ST waveform together with an augmentation of blood pressure, which then subsides as the occlusion continues. The appearance of negative ST segment appears to signify significant cardiac dysfunction. The characteristic progression of ST-waveform changes in response to umbilical cord occlusion in midgestation fetal sheep, suggests that monitoring the ST waveform may contribute clinically important information also in the preterm individual.

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