Yüksek Riskli Gebelerde Fetal Kalp Hızı Monitorizasyon Paternleri
Özet
Yüksek Riskli Gebelerde Fetal Kalp Hızı Monitorizasyon Paternleri Fetal kalp hızı monitorizasyonu, yüksek riskli gebeliklerin takibinde hayati bir öneme sahiptir. Geçmişte fetal canlılığı değerlendirmek için elektrokardiyografi (EKG) kullanılırken, modern uygulamalar non-stress test (NST) ve biyofizik profil (BPP) gibi yöntemlere odaklanmaktadır. Özellikle intrauterin gelişme geriliği (IUGR), diyabetes mellitus, fetal anemi, sistemik lupus eritematozis (SLE) ve gebelik hipertansiyonu gibi durumlarda fetal iyilik hali ve hipoksi belirtileri yakından izlenmektedir. Umbilikal arter doppleri ve kardiyotokografi, fetal iyilik halini değerlendirmede kritik araçlardır. Bu yöntemler, hem perinatal morbidite ve mortaliteyi azaltmak hem de etkili yönetim stratejileri geliştirmek için kullanılmaktadır.
Fetal Heart Rate Monitoring Patterns in High-Risk Pregnancies Fetal heart rate monitoring plays a crucial role in managing high-risk pregnancies. While electrocardiography (ECG) was historically used to assess fetal viability, modern practices emphasize methods like non-stress tests (NST) and biophysical profiles (BPP). These tools are particularly vital in cases involving intrauterine growth restriction (IUGR), diabetes mellitus, fetal anemia, systemic lupus erythematosus (SLE), and gestational hypertension. Umbilical artery Doppler studies and cardiotocography are critical for evaluating fetal well-being and detecting signs of hypoxia. These methods are essential for reducing perinatal morbidity and mortality and developing effective management strategies.
Referanslar
Southern EM: Fetal anoxia and its possible relation to changes in the prenatal fetal elektrocardiogram. AM J Obstet Gynecol 73:233, 1957
Baschat AA. Fetal responses to placental insufficiency: an update. BJOG 2004;111: 1031–41. 6.
Society for Maternal-Fetal Medicine, Martins JG, Biggio JR, Abuhamad A. Society for Maternal-Fetal Medicine Consult Series #52: diagnosis and management of fetal growth restriction: (replaces Clinical Guideline Number 3, April 2012). Am J Obstet Gynecol 2020;223: B2–17. 2.
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins— Obstetrics and the Society for Maternal-Fetal Medicine. ACOG Practice Bulletin No. 204: fetal growth restriction. Obstet Gynecol 2019;133: e97–109.
Melamed N, Baschat A, Yinon Y, et al. FIGO (International Federation of Gynecology and Obstetrics) initiative on fetal growth: best practice advice for screening, diagnosis, and management of fetal growth restriction. Int J Gynaecol Obstet 2021;152(Suppl1):3–57
Abuhamad A, Martins JG, Biggio JR. Diagnosis and management of fetal growth restriction: the SMFM guideline and comparison with the ISUOG guideline. Ultrasound Obstet Gynecol 2021;57:880–3. 11.
Liston R, Sawchuck D, Young D. No. 197afetal health surveillance: antepartum consensus guideline. J Obstet Gynaecol Can 2018;40: e251–71. 14. Baschat AA. Co
McCowan LM, Figueras F, Anderson NH. Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy. Am J Obstet Gynecol 2018;218:S855–68
Baschat AA. Considering evidence in the management of fetal growth restriction. Ultrasound Obstet Gynecol 2021;57:25–8. 15.
Signore C, Freeman RK, Spong CY. Antenatal testing-a reevaluation: executive summary of a Eunice Kennedy Shriver National Institute of Child Health and Human Development workshop. Obstet Gynecol 2009;113:687–70
Arduini D, Rizzo G, Romanini C, Mancuso S. Computerized analysis of behavioural states in asymmetrical growth retarded fetuses. J Perinat Med 1988;16:357–63. 44.
Yum MK, Park EY, Kim CR, Hwang JH. Alterations in irregular and fractal heart rate behavior in growth restricted fetuses. Eur J Obstet Gynecol Reprod Biol 2001;94:51–8
Nijhuis IJ, ten Hof J, Mulder EJ, et al. Fetal heart rate in relation to its variation in normal and growth retarded fetuses. Eur J Obstet Gynecol Reprod Biol 2000;89:27–33. 49.
Baschat AA, Galan HL, Bhide A, et al. Doppler and biophysical assessment in growth restricted fetuses: distribution of test results. Ultrasound Obstet Gynecol 2006;27:41–7.
Signore C, Freeman RK, Spong CY. Antenatal testing-a reevaluation: executive summary of a Eunice Kennedy Shriver National Institute of Child Health and Human Development workshop. Obstet Gynecol 2009;113:687–701
Arbeille P, Maulik D, Fignon A, et al. Assessment of the fetal PO2 changes by cerebral and umbilical Doppler on lamb fetuses during acute hypoxia. Ultrasound Med Biol 1995;21:861–70.
Macrosomia in Infants of Insulin-Dependent Diabetic Mothers , Michael A. Berk; Francis Mimouni; Menachem Miodovnik; Vicki Hertzberg; Jennifer Valuck ;doi.org/10.1542/peds.83.6.1029
de Veciana M. Diabetes ketoacidosis in pregnancy. Semin Perinatol. 2013;37:267–73.
Parker JA, Conway DL. Diabetic ketoacidosis in pregnancy. Obstet Gynecol Clin North Am. 2007;34:533–43. xii.
Parker JA, Conway DL. Diabetic ketoacidosis in pregnancy. Obstet Gynecol Clin North Am. 2007;34:533–43. xii.
de Veciana M. Diabetes ketoacidosis in pregnancy. Semin Perinatol. 2013;37:267–73
The fetus at risk for anemia. Am J Obstet Gynecol 2015.
Modanlou HD, Murata Y. Sinusoidal heart rate pattern: reappraisal of its definition and clinical significance. J Obstet Gynaecol Res 2004;30:169–80. 10.1111/j.1447-0756.2004.00186.x [PubMed] [CrossRef] [Google Scholar]
Athiel Y, Maisonneuve E, Bléas C, et al.. Reduced fetal movement during pregnancy: is the Kleihauer-Betke test really useful? J Gynecol Obstet Hum Reprod 2020:101748. 10.1016/j.jogoh.2020.101748 [PubMed] [CrossRef] [Google Scholar]
H.D. Modanlou, R.K. Freeman Sinusoidal fetal heart rate pattern: its definition and clinical significance Am J Obstet Gynecol, 142 (1982), pp. 1033-1038
Borchers AT, Naguwa SM, Shoenfeld Y, Gershwin ME. The geoepidemiology of systemic lupus erythematosus. Autoimmun Rev 2010;9: A277–87. 2.
Pons-Estel GJ, Alarcón GS, Scofield L, Reinlib L, Cooper GS. Understanding the epidemiology and progression of systemic lupus erythematosus. Semin Arthritis Rheum 2010;39:257–68.
Rivera TL, Izmirly PM, Birnbaum BK, et al. Disease progression in mothers of children enrolled in the Research Registry for Neonatal lupus. Ann Rheum Dis 2009;68:828–35
Giannouli S, Voulgarelis M, Ziakas PD, Tzioufas AG. Anaemia in systemic lupus erythematosus: from pathophysiology to clinical assessment. Ann Rheum Dis 2006;65:144–8.
Brucato A, Frassi M, Franceschini F, et al. Risk of congenital complete heart block in newborns of mothers with anti-Ro/SSA antibodies detected by counterimmunoelectrophoresis: a prospective study of 100 women. Arthritis Rheum 2001;44:1832–5.
Buyon JP, Hiebert R, Copel J, et al. Autoimmune-associated congenital heart block: demographics, mortality, morbidity and recurrence rates obtained from a national neonatal lupus registry. J Am Coll Cardiol 1998;31:1658–66. 62.
Andreoli L, Bertsias GK, Agmon-Levin N, et al. EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis 2017;76:476–85. 121. Jaeggi ET, Hamilton RM, Sil
American College of Obstetricians and Gynecologists. Indications for outpatient antenatal fetal surveillance: ACOG Committee Opinion, Number 828. Obstet Gynecol 2021;137:e177–97.
Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet 2010;376:631–44. (Level III)
Sibai BM, Stella CL. Diagnosis and management of atypical preeclampsia-eclampsia. Am J Obstet Gynecol 2009; 200:481.e1–7. (Level III)
hornton CE, Makris A, Ogle RF, Tooher JM, Hennessy A. Role of proteinuria in defining pre-eclampsia: clinical outcomes for women and babies. Clin Exp Pharmacol Physiol 2010;37:466–70. (Level II-3)
Obstet Gynecol 2019 Jan;133(1):e26-e50. doi: 10.1097/AOG.0000000000003020.
ACOG Practice Bulletin No. 203: Chronic Hypertension in Pregnancy American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics Collaborators expand PMID: 30575676 DOI: 10.1097/AOG.0000000000003020
Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020 Jun;135(6):e237-e260. doi: 10.1097/AOG.0000000000003891. PMID: 32443079.
Brown, M.A. ∙ Hague, W.M. ∙ Higgins, J. The detection, investigation and management of hypertension in pregnancy: full consensus statement Aust N Z J Obstet Gynaecol. 2000; 40:139-155
Brown, M.A. ∙ Lindheimer, M.D. ∙ de Swiet, M. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP) Hypertens Pregnancy. 2001; 20:IX-XIV
Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy Obstet Gynecol. 2013; 122:1122-1131
American College of Obstetricians and Gynecologists. Gestational Hypertension and Preeclampsia. ACOG Practice Bulletin no. 202 Obstet Gynecol. 2019; 133:e1-e25
The classification, diagnosis and management of the hypertensive disorders of pregnancy: a revised statement from the ISSHP, Tranquilli, A.L. ∙ Dekker, G. ∙ Magee, L. Pregnancy Hypertens. 2014; 4:97-104
Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice, Brown, M.A. ∙ Magee, L.A. ∙ Kenny, L.C. Hypertension. 2018; 72:24-43
Tanner MS, Davey MA, Mol BW, Rolnik DL. The evolution of the diagnostic criteria of preeclampsia-eclampsia. Am J Obstet Gynecol. 2022 Feb;226(2S):S835-S843. doi: 10.1016/j.ajog.2021.11.1371. PMID: 35177221.
Rouse DJ, Owen J, Goldenberg RL, Cliver SP. Determinants of the optimal time in gestation to initiate antenatal fetal testing: a decision-analytic approach. Am J Obstet Gynecol. 1995 Nov;173(5):1357-63. doi: 10.1016/0002-9378(95)90615-0. PMID: 7503167.
Freeman RK. Barden: Interpreting fetal heart tracings, in Queenan JT (ed): Mana- gement of High-Risk Pregnancy. Oradell .NJ. Medical economics co; 1980; pp.171- 182
Klaven M. Boscda MA (EDS): uterine acti- vity monitoring, in A Guide to Fetal Moni- toring. Waltham, MA, Hewlett-Packard, 1973, pp. 58-75
Alvarez H, Pose SV, Caldeyro - Barcia R.La contractuidad uterina en la toxemia gravi- dica. Proc first Peruv Cons Obstet Gynecol 1959;2:281.
Hammacher K, Huter KA, Bokelman J, et al: fetal heart frequency and perinatal condi- tion of fetus and newborn 166: 349-360 1968
Referanslar
Southern EM: Fetal anoxia and its possible relation to changes in the prenatal fetal elektrocardiogram. AM J Obstet Gynecol 73:233, 1957
Baschat AA. Fetal responses to placental insufficiency: an update. BJOG 2004;111: 1031–41. 6.
Society for Maternal-Fetal Medicine, Martins JG, Biggio JR, Abuhamad A. Society for Maternal-Fetal Medicine Consult Series #52: diagnosis and management of fetal growth restriction: (replaces Clinical Guideline Number 3, April 2012). Am J Obstet Gynecol 2020;223: B2–17. 2.
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins— Obstetrics and the Society for Maternal-Fetal Medicine. ACOG Practice Bulletin No. 204: fetal growth restriction. Obstet Gynecol 2019;133: e97–109.
Melamed N, Baschat A, Yinon Y, et al. FIGO (International Federation of Gynecology and Obstetrics) initiative on fetal growth: best practice advice for screening, diagnosis, and management of fetal growth restriction. Int J Gynaecol Obstet 2021;152(Suppl1):3–57
Abuhamad A, Martins JG, Biggio JR. Diagnosis and management of fetal growth restriction: the SMFM guideline and comparison with the ISUOG guideline. Ultrasound Obstet Gynecol 2021;57:880–3. 11.
Liston R, Sawchuck D, Young D. No. 197afetal health surveillance: antepartum consensus guideline. J Obstet Gynaecol Can 2018;40: e251–71. 14. Baschat AA. Co
McCowan LM, Figueras F, Anderson NH. Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy. Am J Obstet Gynecol 2018;218:S855–68
Baschat AA. Considering evidence in the management of fetal growth restriction. Ultrasound Obstet Gynecol 2021;57:25–8. 15.
Signore C, Freeman RK, Spong CY. Antenatal testing-a reevaluation: executive summary of a Eunice Kennedy Shriver National Institute of Child Health and Human Development workshop. Obstet Gynecol 2009;113:687–70
Arduini D, Rizzo G, Romanini C, Mancuso S. Computerized analysis of behavioural states in asymmetrical growth retarded fetuses. J Perinat Med 1988;16:357–63. 44.
Yum MK, Park EY, Kim CR, Hwang JH. Alterations in irregular and fractal heart rate behavior in growth restricted fetuses. Eur J Obstet Gynecol Reprod Biol 2001;94:51–8
Nijhuis IJ, ten Hof J, Mulder EJ, et al. Fetal heart rate in relation to its variation in normal and growth retarded fetuses. Eur J Obstet Gynecol Reprod Biol 2000;89:27–33. 49.
Baschat AA, Galan HL, Bhide A, et al. Doppler and biophysical assessment in growth restricted fetuses: distribution of test results. Ultrasound Obstet Gynecol 2006;27:41–7.
Signore C, Freeman RK, Spong CY. Antenatal testing-a reevaluation: executive summary of a Eunice Kennedy Shriver National Institute of Child Health and Human Development workshop. Obstet Gynecol 2009;113:687–701
Arbeille P, Maulik D, Fignon A, et al. Assessment of the fetal PO2 changes by cerebral and umbilical Doppler on lamb fetuses during acute hypoxia. Ultrasound Med Biol 1995;21:861–70.
Macrosomia in Infants of Insulin-Dependent Diabetic Mothers , Michael A. Berk; Francis Mimouni; Menachem Miodovnik; Vicki Hertzberg; Jennifer Valuck ;doi.org/10.1542/peds.83.6.1029
de Veciana M. Diabetes ketoacidosis in pregnancy. Semin Perinatol. 2013;37:267–73.
Parker JA, Conway DL. Diabetic ketoacidosis in pregnancy. Obstet Gynecol Clin North Am. 2007;34:533–43. xii.
Parker JA, Conway DL. Diabetic ketoacidosis in pregnancy. Obstet Gynecol Clin North Am. 2007;34:533–43. xii.
de Veciana M. Diabetes ketoacidosis in pregnancy. Semin Perinatol. 2013;37:267–73
The fetus at risk for anemia. Am J Obstet Gynecol 2015.
Modanlou HD, Murata Y. Sinusoidal heart rate pattern: reappraisal of its definition and clinical significance. J Obstet Gynaecol Res 2004;30:169–80. 10.1111/j.1447-0756.2004.00186.x [PubMed] [CrossRef] [Google Scholar]
Athiel Y, Maisonneuve E, Bléas C, et al.. Reduced fetal movement during pregnancy: is the Kleihauer-Betke test really useful? J Gynecol Obstet Hum Reprod 2020:101748. 10.1016/j.jogoh.2020.101748 [PubMed] [CrossRef] [Google Scholar]
H.D. Modanlou, R.K. Freeman Sinusoidal fetal heart rate pattern: its definition and clinical significance Am J Obstet Gynecol, 142 (1982), pp. 1033-1038
Borchers AT, Naguwa SM, Shoenfeld Y, Gershwin ME. The geoepidemiology of systemic lupus erythematosus. Autoimmun Rev 2010;9: A277–87. 2.
Pons-Estel GJ, Alarcón GS, Scofield L, Reinlib L, Cooper GS. Understanding the epidemiology and progression of systemic lupus erythematosus. Semin Arthritis Rheum 2010;39:257–68.
Rivera TL, Izmirly PM, Birnbaum BK, et al. Disease progression in mothers of children enrolled in the Research Registry for Neonatal lupus. Ann Rheum Dis 2009;68:828–35
Giannouli S, Voulgarelis M, Ziakas PD, Tzioufas AG. Anaemia in systemic lupus erythematosus: from pathophysiology to clinical assessment. Ann Rheum Dis 2006;65:144–8.
Brucato A, Frassi M, Franceschini F, et al. Risk of congenital complete heart block in newborns of mothers with anti-Ro/SSA antibodies detected by counterimmunoelectrophoresis: a prospective study of 100 women. Arthritis Rheum 2001;44:1832–5.
Buyon JP, Hiebert R, Copel J, et al. Autoimmune-associated congenital heart block: demographics, mortality, morbidity and recurrence rates obtained from a national neonatal lupus registry. J Am Coll Cardiol 1998;31:1658–66. 62.
Andreoli L, Bertsias GK, Agmon-Levin N, et al. EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis 2017;76:476–85. 121. Jaeggi ET, Hamilton RM, Sil
American College of Obstetricians and Gynecologists. Indications for outpatient antenatal fetal surveillance: ACOG Committee Opinion, Number 828. Obstet Gynecol 2021;137:e177–97.
Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet 2010;376:631–44. (Level III)
Sibai BM, Stella CL. Diagnosis and management of atypical preeclampsia-eclampsia. Am J Obstet Gynecol 2009; 200:481.e1–7. (Level III)
hornton CE, Makris A, Ogle RF, Tooher JM, Hennessy A. Role of proteinuria in defining pre-eclampsia: clinical outcomes for women and babies. Clin Exp Pharmacol Physiol 2010;37:466–70. (Level II-3)
Obstet Gynecol 2019 Jan;133(1):e26-e50. doi: 10.1097/AOG.0000000000003020.
ACOG Practice Bulletin No. 203: Chronic Hypertension in Pregnancy American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics Collaborators expand PMID: 30575676 DOI: 10.1097/AOG.0000000000003020
Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020 Jun;135(6):e237-e260. doi: 10.1097/AOG.0000000000003891. PMID: 32443079.
Brown, M.A. ∙ Hague, W.M. ∙ Higgins, J. The detection, investigation and management of hypertension in pregnancy: full consensus statement Aust N Z J Obstet Gynaecol. 2000; 40:139-155
Brown, M.A. ∙ Lindheimer, M.D. ∙ de Swiet, M. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP) Hypertens Pregnancy. 2001; 20:IX-XIV
Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy Obstet Gynecol. 2013; 122:1122-1131
American College of Obstetricians and Gynecologists. Gestational Hypertension and Preeclampsia. ACOG Practice Bulletin no. 202 Obstet Gynecol. 2019; 133:e1-e25
The classification, diagnosis and management of the hypertensive disorders of pregnancy: a revised statement from the ISSHP, Tranquilli, A.L. ∙ Dekker, G. ∙ Magee, L. Pregnancy Hypertens. 2014; 4:97-104
Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice, Brown, M.A. ∙ Magee, L.A. ∙ Kenny, L.C. Hypertension. 2018; 72:24-43
Tanner MS, Davey MA, Mol BW, Rolnik DL. The evolution of the diagnostic criteria of preeclampsia-eclampsia. Am J Obstet Gynecol. 2022 Feb;226(2S):S835-S843. doi: 10.1016/j.ajog.2021.11.1371. PMID: 35177221.
Rouse DJ, Owen J, Goldenberg RL, Cliver SP. Determinants of the optimal time in gestation to initiate antenatal fetal testing: a decision-analytic approach. Am J Obstet Gynecol. 1995 Nov;173(5):1357-63. doi: 10.1016/0002-9378(95)90615-0. PMID: 7503167.
Freeman RK. Barden: Interpreting fetal heart tracings, in Queenan JT (ed): Mana- gement of High-Risk Pregnancy. Oradell .NJ. Medical economics co; 1980; pp.171- 182
Klaven M. Boscda MA (EDS): uterine acti- vity monitoring, in A Guide to Fetal Moni- toring. Waltham, MA, Hewlett-Packard, 1973, pp. 58-75
Alvarez H, Pose SV, Caldeyro - Barcia R.La contractuidad uterina en la toxemia gravi- dica. Proc first Peruv Cons Obstet Gynecol 1959;2:281.
Hammacher K, Huter KA, Bokelman J, et al: fetal heart frequency and perinatal condi- tion of fetus and newborn 166: 349-360 1968
