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Clinical physiology of exercise in pregnancy: a literature review.

https://arctichealth.org/en/permalink/ahliterature184963
Source
J Obstet Gynaecol Can. 2003 Jun;25(6):473-83
Publication Type
Article
Date
Jun-2003
Author
Larry A Wolfe
Tracey L Weissgerber
Author Affiliation
School of Physical and Health Education and Department of Physiology, Queen's University, Kingston, ON, Canada.
Source
J Obstet Gynaecol Can. 2003 Jun;25(6):473-83
Date
Jun-2003
Language
English
Publication Type
Article
Keywords
Adult
Canada
Exercise - physiology
Female
Heart Rate, Fetal - physiology
Humans
Oxygen Consumption - physiology
Postpartum Period - physiology
Practice Guidelines as Topic
Pregnancy - physiology
Pregnancy outcome
Prenatal Care
Abstract
To review the existing literature on the physiology of exercise in pregnancy as a basis for clinical practice guidelines for prenatal exercise prescription.
MEDLINE search for English language abstracts and articles published between 1966 and 2003 related to physiological adaptations to pregnancy, effects of pregnancy on responses to acute exercise and aerobic conditioning, effects of acute maternal exercise on indexes of fetal well-being, impact of physical conditioning on birth weight and other pregnancy outcomes, and use of exercise to prevent or treat gestational diabetes mellitus and preeclampsia.
Maximal aerobic power (VO(2)max, L/min) is well-preserved in pregnant women who remain physically active, but anaerobic working capacity may be reduced in late gestation. The increase in resting heart rate, reduction in maximal heart rate, and resulting smaller heart rate reserve render heart rate a less precise way of estimating exercise intensity. As rating of perceived exertion (RPE) is not altered by pregnancy, the use of revised pulse rate target zones along with Borg's RPE scale is recommended to prescribe exercise intensity during pregnancy. Responses to prolonged submaximal exercise (>30 min) in late gestation include a moderate reduction in maternal blood glucose concentration, which may transiently reduce fetal glucose availability. The normal response to sustained submaximal exercise is an increase in fetal heart rate (FHR) baseline. Transient reductions in FHR reactivity, fetal breathing movements, and FHR variability may also occur in association with more strenuous exercise. Controlled prospective studies have demonstrated that moderate prenatal exercise during the second and third trimesters is useful to improve aerobic fitness and maternal-fetal physiological reserve without affecting fetal growth.
The Physical Activity Readiness Medical Examination for Pregnancy is recommended for use by physicians and midwives to provide medical clearance for prenatal exercise. Evidence-based prenatal exercise guidelines are needed to counsel healthy and fit pregnant women on the safety of involvement in more strenuous physical conditioning. Future study is also recommended to determine the usefulness of prenatal exercise in the prevention and treatment of gestational diabetes mellitus and preeclampsia.
Notes
Comment In: J Obstet Gynaecol Can. 2003 Jun;25(6):451-312806445
PubMed ID
12806449 View in PubMed
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Delay in intervention increases neonatal morbidity in births monitored with cardiotocography and ST-waveform analysis.

https://arctichealth.org/en/permalink/ahliterature106074
Source
Acta Obstet Gynecol Scand. 2014 Feb;93(2):175-81
Publication Type
Article
Date
Feb-2014
Author
Jörg Kessler
Dag Moster
Susanne Albrechtsen
Author Affiliation
Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Clinical Fetal Physiology Research Group, University of Bergen, Bergen, Norway.
Source
Acta Obstet Gynecol Scand. 2014 Feb;93(2):175-81
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Adult
Apgar score
Cardiotocography
Delivery, Obstetric
Electrocardiography
Female
Fetal Distress - diagnosis - physiopathology
Fetal Hypoxia - diagnosis - physiopathology
Fetal Monitoring - adverse effects - methods - statistics & numerical data
Heart Rate, Fetal - physiology
Humans
Infant, Newborn
Intensive Care Units, Neonatal
Kaplan-Meier Estimate
Logistic Models
Male
Norway
Practice Guidelines as Topic
Pregnancy
Pregnancy, High-Risk - physiology
Prospective Studies
Time Factors
Abstract
To assess the effect of the time interval from indication of hypoxia to delivery on neonatal outcome in high-risk pregnancies monitored with cardiotocography (CTG) and ST-waveform analysis.
Prospective observational study.
University hospital, Norway, 2004-08.
Singleton high-risk births with a gestational age above 35(+6) weeks, monitored with CTG and ST-waveform analysis.
Logistic regression analysis and Kaplan-Meier survival plots.
Neonatal morbidity in relation to the rapidity of intervention.
Of 6010 deliveries monitored with ST-waveform analysis, 1131 (19%) had an indication to intervene for fetal distress according to clinical guidelines. Those fetuses were at increased risk of an adverse neonatal outcome, and if delivered later than 20 min after the indication of hypoxia their risk increased further; i.e. transfer to the neonatal intensive care unit (NICU) from an odds ratio of 1.6 (95% confidence interval 1.2-2.2) to an odds ratio of 3.3 (95% confidence interval 2.5-4.3). The indication-to-delivery interval was longer for neonates with a 5-min Apgar score of
PubMed ID
24251909 View in PubMed
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Fetal development: voice processing in normotensive and hypertensive pregnancies.

https://arctichealth.org/en/permalink/ahliterature163944
Source
Biol Res Nurs. 2007 Apr;8(4):272-82
Publication Type
Article
Date
Apr-2007
Author
C T Lee
C A Brown
S M J Hains
B S Kisilevsky
Author Affiliation
University of Toronto School of Nursing, Toronto, Canada.
Source
Biol Res Nurs. 2007 Apr;8(4):272-82
Date
Apr-2007
Language
English
Publication Type
Article
Keywords
Acceleration
Adult
Amniotic Fluid - physiology
Analysis of Variance
Auditory Threshold - physiology
Cardiotocography
Case-Control Studies
Clinical Nursing Research
Female
Fetal Development - physiology
Fetal Monitoring
Fetal Movement - physiology
Gestational Age
Heart Rate, Fetal - physiology
Humans
Hypertension, Pregnancy-Induced - diagnosis - physiopathology
Nursing Assessment
Ontario
Pattern Recognition, Physiological - physiology
Pregnancy
Pregnancy Complications, Cardiovascular - diagnosis - physiopathology
Tape Recording
Voice
Abstract
Recent observation of maternal voice recognition provides evidence of rudimentary memory and learning in healthy term fetuses. However, such higher order auditory processing has not been examined in the presence of maternal hypertension, which is associated with reduced and/or impaired uteroplacental blood flow. In this study, voice processing was examined in 40 fetuses (gestational ages of 33 to 41 weeks) of hypertensive and normotensive women. Fetuses received 2 min of no sound, 2 min of a tape-recorded story read by their mothers or by a female stranger, and 2 min of no sound while fetal heart rate was recorded. Results demonstrated that fetuses in the normotensive group had heart rate accelerations during the playing of their mother's voice, whereas the response occurred in the hypertensive group following maternal voice offset. Across all fetuses, a greater fetal heart rate change was observed when the amniotic fluid index was above compared to below the median (i.e., 150 mm), indicating that amniotic fluid volume may be an independent moderator of fetal auditory sensitivity. It was concluded that differential fetal responding to the mother's voice in pregnancies complicated by maternal hypertension may reflect functional elevation of sensorineural threshold or a delay in auditory system maturation, signifying functional differences during fetal life or subtle differences in the development of the central nervous system.
PubMed ID
17456588 View in PubMed
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Fetal heart rate patterns and ECG ST segment changes preceding metabolic acidaemia at birth.

https://arctichealth.org/en/permalink/ahliterature53219
Source
BJOG. 2005 Feb;112(2):160-5
Publication Type
Article
Date
Feb-2005
Author
Isis Amer-Wåhlin
Ingemar Ingemarsson
Karel Marsal
Andreas Herbst
Author Affiliation
Department of Obstetrics and Gynaecology, University Hospital Lund, S-221 85 Lund, Sweden.
Source
BJOG. 2005 Feb;112(2):160-5
Date
Feb-2005
Language
English
Publication Type
Article
Keywords
Acidosis - congenital - physiopathology
Arrhythmia - congenital - physiopathology
Cardiotocography - methods
Case-Control Studies
Electrocardiography - methods
Electrodes
Fetal Diseases - physiopathology
Heart Rate, Fetal - physiology
Humans
Infant, Newborn
Observer Variation
Research Support, Non-U.S. Gov't
Sensitivity and specificity
Abstract
OBJECTIVES: To compare the rates of abnormal ST segment patterns of the ECG and cardiotocographic (CTG) abnormalities in fetuses with metabolic acidaemia at birth and controls. To evaluate the inter-observer agreement in interpretation of ST analysis and CTG. DESIGN: Case-control study. SETTING: Three University hospitals in southern Sweden. POPULATION: Cases and controls were selected from the Swedish randomised controlled trial on intrapartum monitoring, including 4966 fetuses monitored with a scalp electrode. METHODS: Two obstetricians independently assessed the CTG and ST traces of 41 fetuses with metabolic acidaemia at birth and 101 controls, blinded to group, outcome and all clinical data. They classified each CTG trace and ST analysis as abnormal or not abnormal, and whether there was indication to intervene according to the CTG or to the CTG + ST guidelines. If their classification differed, assessment by a third obstetrician determined the final classification. MAIN OUTCOME MEASURES: Rates of CTG and ST abnormalities and decisions to intervene. Rates of inter-observer agreement. RESULTS: CTG was classified as abnormal in 50% and ST in 63% of cases with acidaemia, and in 20% and 34% of controls, respectively. CTG abnormalities were judged to be indication for intervention in 45% and CTG + ST abnormalities in 56% of cases with acidaemia, and in 15% and 8% of controls, respectively. The proportion of agreement between the two initial observers was significantly higher for ST abnormalities (94%) than for CTG abnormalities (73%), and for indication to intervene according to CTG + ST (89%) than according to CTG alone (76%). CONCLUSIONS: The inter-observer agreement rate was higher for a decision to intervene based on CTG + ST than on CTG alone.
PubMed ID
15663579 View in PubMed
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Fetal hemodynamics and adverse outcome in primary school-aged children with fetal growth restriction: a prospective longitudinal study.

https://arctichealth.org/en/permalink/ahliterature280347
Source
Acta Obstet Gynecol Scand. 2017 Jan;96(1):69-77
Publication Type
Article
Date
Jan-2017
Author
Noora Korkalainen
Juha Räsänen
Tuula Kaukola
Hanna Kallankari
Mikko Hallman
Kaarin Mäkikallio
Source
Acta Obstet Gynecol Scand. 2017 Jan;96(1):69-77
Date
Jan-2017
Language
English
Publication Type
Article
Keywords
Apgar score
Birth Weight - physiology
Cardiomegaly - diagnostic imaging - epidemiology
Child
Developmental Disabilities - epidemiology
Diastole - physiology
Female
Fetal Growth Retardation - epidemiology - physiopathology
Finland - epidemiology
Heart Rate, Fetal - physiology
Humans
Hydrops Fetalis - diagnostic imaging - epidemiology
Longitudinal Studies
Placental Circulation - physiology
Pregnancy
Premature Birth - epidemiology
Prospective Studies
Pulsatile Flow - physiology
Umbilical Arteries - diagnostic imaging - physiopathology
Umbilical Veins - diagnostic imaging - physiopathology
Abstract
Fetal growth restriction is associated with short-term and long-term mortality and morbidity. We hypothesized that adverse outcome in children with fetal growth restriction at primary school age is associated with fetoplacental circulatory abnormalities.
Comprehensive ultrasonographic assessment of fetoplacental hemodynamics was performed in 72 growth-restricted fetuses prenatally, and short-term outcome data were collected. At the median age of 9 years, mortality and morbidity were determined using medical charts and questionnaires. The impact of abnormal fetoplacental hemodynamics on mortality and morbidity with significant developmental disorders or delay were studied.
Fetal growth restriction children with adverse long-term outcome were delivered earlier and with lower birthweights than were those with non-compromised outcome. Seventy percent of the fetal growth restriction group showed non-compromised long-term outcomes and participated in mainstream education at the appropriate age level. Absent/retrograde diastolic flow in the umbilical artery (p 
PubMed ID
28032647 View in PubMed
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Fetal ST segment heart rate analysis in labor: improvement of intervention criteria using interpolated base deficit.

https://arctichealth.org/en/permalink/ahliterature78058
Source
J Matern Fetal Neonatal Med. 2007 Jan;20(1):47-52
Publication Type
Article
Date
Jan-2007
Author
Mansano Roy Z
Beall Marie H
Ross Michael G
Author Affiliation
Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, California 90509, USA. rmansano@obgyn.humc.edu
Source
J Matern Fetal Neonatal Med. 2007 Jan;20(1):47-52
Date
Jan-2007
Language
English
Publication Type
Article
Keywords
Acidosis - diagnosis - physiopathology
Cesarean Section - statistics & numerical data
Electrocardiography - methods
Female
Fetal Distress - diagnosis
Fetal Monitoring - methods
Heart Rate, Fetal - physiology
Humans
Pregnancy
Pregnancy outcome
Retrospective Studies
Abstract
OBJECTIVE: The addition of ST waveform analysis (STAN, Neoventa, Sweden) to fetal heart rate (FHR) tracings has been demonstrated to improve fetal outcome and reduce operative delivery rates, though the actual level of fetal acidosis at which STAN indicates intervention has not been assessed. We sought to determine if FHR ST segment analysis recommends intervention at appropriate levels of fetal acidosis. METHODS: FHR tracings of 10 acidotic and 10 non-acidotic infants with FHR tracings having a minimum of one STAN flag were retrospectively analyzed. Fetal base deficit (BD) was calculated by interpolation throughout the FHR tracing and STAN 'action' and 'ignore' flags assigned a fetal BD value. A secondary analysis was performed with a revised interpretation of FHR reassuring status. RESULTS: The mean (+/-SD) BD of the first STAN action was significantly greater than the first 'ignore' (4.0+/-2.1 vs. 3.0+/-0.8 mmol/L, p
PubMed ID
17437199 View in PubMed
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Heart rate development and sensory-evoked cardiac responses in perinatal rats.

https://arctichealth.org/en/permalink/ahliterature59840
Source
Physiol Behav. 1990 Jun;47(6):1075-82
Publication Type
Article
Date
Jun-1990
Author
A E Ronca
J R Alberts
Author Affiliation
Department of Psychology, Indiana University, Bloomington 47405.
Source
Physiol Behav. 1990 Jun;47(6):1075-82
Date
Jun-1990
Language
English
Publication Type
Article
Keywords
Animals
Animals, Newborn - physiology
Arousal - physiology
Electrocardiography
Female
Fetal Heart - innervation
Gestational Age
Heart Rate, Fetal - physiology
Pregnancy
Rats
Rats, Inbred Strains
Receptors, Sensory - physiology
Research Support, U.S. Gov't, P.H.S.
Taste - physiology
Taste Buds - physiology
Abstract
Sensory-evoked changes in heart rate (HR) are often used to assess sensory function in infants, but HR measures have not been applied in studies of perinatal sensory function. Normative HR data are needed to judge whether baseline characteristics and response properties of the late fetal and newborn heart are appropriate as a dependent measure in sensory studies. We compared parameters of HR development and phasic cardiac responses to stimulation across the perinatal period in Norway rats. EKG was measured in cesarean-delivered prenatal rats (embryonic day 20-day of birth; conception = E0) and compared to both cesarean and vaginally delivered neonates (day of birth-postnatal day 2; birth = P0). Resting heart rate increased monotonically across the perinatal period, except between E21 and DOB (Experiment 1). During an hour-long test, HR was strong and stable. Variations in HR across successive measurement intervals (10 sec) were uniformly low (less than 2%) in all age groups. In Experiment 2, fetuses and neonates responded with dramatic HR decelerations (20-80 bpm) to an intraoral infusion of lemon extract. HR responses did not appear to be reflexively mediated by changes in respiration. These findings suggest that parameters of resting HR and cardiac responses to stimulation are well suited to studies of perinatal sensory function.
PubMed ID
2395912 View in PubMed
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Interobserver agreement in the assessment of intrapartum automated fetal electrocardiography in singleton pregnancies.

https://arctichealth.org/en/permalink/ahliterature86604
Source
Acta Obstet Gynecol Scand. 2008;87(5):536-40
Publication Type
Article
Date
2008
Author
Ojala Kati
Mäkikallio Kaarin
Haapsamo Mervi
Ijäs Hilkka
Tekay Aydin
Author Affiliation
Department of Obstetrics and Gynaecology, Oulu University Hospital, Oulu, Finland. kati.ojala@oulu.fi
Source
Acta Obstet Gynecol Scand. 2008;87(5):536-40
Date
2008
Language
English
Publication Type
Article
Keywords
Cardiotocography - methods
Electrocardiography - methods
Female
Fetus
Heart Rate, Fetal - physiology
Humans
Observer Variation
Perinatal Care - methods
Pregnancy
Abstract
OBJECTIVE: To study interobserver agreement in the assessment of intrapartum automated fetal electrocardiogram ST interval analysis (STAN). DESIGN: Observational study. SETTING: Labor ward in tertiary level university hospital. Sample. Two hundred (140 reassuring and 60 non-reassuring) STAN recordings on non-selected women with singleton, vertex, term pregnancies were selected from our archive. Samples of 60-min were analysed from the end of each recording, excluding the last 30 min before delivery. METHODS: Three consultants, who had undergone STAN training and had clinical experience in using STAN, reviewed the recordings using cardiotocography (CTG) and ST information with no clinical data. The reviewers were asked to follow STAN guidelines and 1 to classify the CTG as normal, intermediary, abnormal, or preterminal, and 2 to make a clinical decision on labor management. MAIN OUTCOME MEASURES: Interobserver agreement evaluated by weighted kappa (kappa(w)) values and the proportion of agreement. RESULTS: In CTG classification, the interobserver agreement between three observers was moderate (kappa(w), 0.47-0.48). The proportion of agreement was 56-59%. In clinical decision-making, kappa(w) values varied from 0.47 to 0.60, and the proportion of agreement was 80-86%. CONCLUSIONS: In non-selected term pregnancies, the interobserver agreement among experienced obstetricians in the classification of CTG and clinical decision-making according to STAN guidelines is moderate at best.
PubMed ID
18446537 View in PubMed
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Marked fetal acidosis and specific changes in power spectrum analysis of fetal heart rate variability recorded during the last hour of labour.

https://arctichealth.org/en/permalink/ahliterature63244
Source
BJOG. 2005 Apr;112(4):418-23
Publication Type
Article
Date
Apr-2005
Author
Saila M Siira
Tiina H Ojala
Tero J Vahlberg
Jarmo O Jalonen
Ilkka A Välimäki
Karl G Rosén
Eeva M Ekholm
Author Affiliation
Research Centre of Applied and Preventive Cardiovascular Medicine (CAPC), University of Turku, Kiinamyllynkatu 10, 20520 Turku, Finland.
Source
BJOG. 2005 Apr;112(4):418-23
Date
Apr-2005
Language
English
Publication Type
Article
Keywords
Acidosis - diagnosis - physiopathology
Cardiotocography - standards
Comparative Study
Delivery, Obstetric - methods
Electrocardiography - standards
Female
Fetal Diseases - diagnosis - physiopathology
Heart Rate, Fetal - physiology
Humans
Hydrogen-Ion Concentration
Pregnancy
Prospective Studies
Research Support, Non-U.S. Gov't
Spectrum Analysis - standards
Time Factors
Umbilical Arteries
Abstract
OBJECTIVE: To assess whether intrapartum acidosis affects specific components of fetal heart rate variability. DESIGN: Prospective clinical study. SETTING: Twelve Nordic delivery units. SUBJECTS: Fetal heart rate variability was studied in 334 fetuses divided into two groups according to cord pH value: the acidotic group (cord arterial pH or =7.05 at birth, n= 319). METHODS: In spectral analysis of fetal heart rate variability, frequencies were integrated over the total frequency band (0.04-1.0 Hz), low-frequency band (0.04-0.15 Hz) and high-frequency band (0.15-1.0 Hz). We also calculated the low-to-high frequency ratio. MAIN OUTCOME MEASURES: The spectral bands of fetal heart rate variability were compared between the acidotic and control fetuses. RESULTS: We found that during the last hour of monitoring, baseline fetal heart rate gradually decreased, whereas total, low-frequency and high-frequency fetal heart rate variability initially increased but then, near the delivery, decreased in the acidotic fetuses when compared with the controls. Low-to-high frequency ratio was greater in the acidotic group during the whole study period (P= 0.002). Cord artery pH was inversely associated with total fetal heart rate variability (P
PubMed ID
15777438 View in PubMed
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[Need for extensive education when implementing new foetal monitoring technology]

https://arctichealth.org/en/permalink/ahliterature84073
Source
Ugeskr Laeger. 2007 Sep 24;169(39):3294-7
Publication Type
Article
Date
Sep-24-2007
Author
Colov Nina S Palmgren
Author Affiliation
Gentofte Hospital, Gynaekologisk-obstetrisk Afdeling. npc@dadlnet.dk
Source
Ugeskr Laeger. 2007 Sep 24;169(39):3294-7
Date
Sep-24-2007
Language
Danish
Publication Type
Article
Keywords
Cardiotocography
Clinical Competence
Denmark
Education, Medical, Continuing
Female
Fetal Monitoring - methods - standards
Heart Rate, Fetal - physiology
Humans
Nurse Midwives - education
Obstetric Labor Complications - diagnosis
Obstetrics - education
Practice Guidelines
Pregnancy
Abstract
ST-waveform analysis of the foetal electrocardiogram (STAN) has been shown to reduce the frequency of metabolic acidosis in newborns and to reduce the rate of caesarean sections. However, STAN technology requires an extensive educational effort during the initial implementation with certification of all midwives and doctors involved. This study shows that the positive results of using STAN could be reproduced over a five-year-period after completion of the initial teaching effort and certification of personnel and when STAN was part of everyday life at the labour ward at Gentofte Hospital.
PubMed ID
17953889 View in PubMed
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17 records – page 1 of 2.