A very-short-term intermittency of fetal heart rates and developmental milestone

Abstract

We noticed that fetal heart rates (FHR) of immature fetuses intermittently showed unstable sudden and brief falls below baseline FHR that occur over a few or several heartbeats. The frightening falls do not occur in mature fetuses. In nonlinear dynamics, the degree of such abrupt falls in time series is quantified as intermittency. We aimed to investigate the nature and maturational changes of intermittency of the FHR in normal fetuses and to present the intermittency values of normal fetuses according to gestational weeks. FHR data of 450 normal fetuses between 23 and 40 wk of gestation were studied. We performed multifractal analysis and highlighted a very-short-term intermittency (C1α, 4 ≤ scale > 16 heartbeats). The C1α values exhibited a strong negative linear correlation (r = -0.732, p = 0.0001) with the gestational weeks. At 27-28, 29-30, 33-34, and 37-38 gestational weeks, the C1α values were significantly lower than those of the previous 2 or 4 gestational weeks. The maturation of normal fetuses is related to decreasing the severity of the unstable sudden and brief falls in FHR that is measured by C1α, the very-short-term intermittency. The C1α values according to the gestational weeks that we presented can be used as credible normal milestone values when estimating the degree of maturity of certain FHR. Because the C1α captures the degree of the unstable fall in FHR, the C1α may also be used in identifying sick fetuses that are associated with hemodynamic instability and sudden bradycardia.