Наукові праці. Кафедра акушерства та гінекології № 3
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Publication Noninvasive fetal electrocardiography for the detection of fetal arrhythmias(John Wiley and Sons Ltd., 2019-01-02) Behar, Joachim; Bonnemains, Laurent; Shulgin, Vyacheslav; Oster, Julien; Ostras, Oleksii; Lakhno, IgorObjective: To assess whether noninvasive fetal electrocardiography (NI‐FECG) enables the diagnosis of fetal arrhythmias. Methods: A total of 500 echocardiography and NI‐FECG recordings were collected from pregnant women during a routine medical visit in this multicenter study. All the cases with fetal arrhythmias (n = 12) and a matching number of control (n = 14) were used. Two perinatal cardiologists analyzed the extracted NI‐FECG while blinded to the echocardiography. The NI‐FECG‐based diagnosis was compared with the reference fetal echocardiography diagnosis. Results: NI‐FECG and fetal echocardiography agreed on all cases (Ac = 100%) on the presence of an arrhythmia or not. However, in one case, the type of arrhythmia identified by the NI‐FECG was incorrect because of the low resolution of the extracted fetal P‐wave, which prevented resolving the mechanism (2:1 atrioventricular conduction) of the atrial tachycardia. Conclusion: It is possible to diagnose fetal arrhythmias using the NI‐FECG technique. However, this study identifies that improvement in algorithms for reconstructing the P‐wave is critical to systematically resolve the mechanisms underlying the arrhythmias. The elaboration of a NI‐FECG Holter device will offer new opportunities for fetal diagnosis and remote monitoring of problematic pregnancies because of its low‐cost, noninvasiveness, portability, and minimal setup requirements.Publication Fuzzy Detection of Fetal Distress for Antenatal Monitoring in Pregnancy with Fetal Growth Restriction and Normal(IntechOpen, 2018-12-19) Lakhno, Igor; Guzmán-Velázquez, Bertha Patricia; Díaz-Méndez, José AlejandroMonitoring of fetal cardiac activity is a well-known approach to the assessment of fetal health. The fetal heart rate can be measured using conventional cardiotocography (CTG). However, this method does not provide the beat-to-beat variability of the fetal heart rate because of the averaging nature of the autocorrelation function that is used to estimate the heart rate from a set of heart beats enclosed in the autocorrelation function window. Therefore, CTG presents important limitations for fetal arrhythmia diagnosis. CTG has a high rate of false positives and poor inter- and intra-observer reliability, such that fetal status and the perinatal outcome cannot be predicted reliably. Non-invasive fetal electrocardiography (NI-FECG) is a promising low-cost and non-invasive continuous fetal monitoring alternative. However, there is little that has been published to date on the clinical usability of NI-FECG. The chapter will include data on the accurate diagnosing of fetal distress based on heart rate variability (HRV). A fuzzy logic inference system was designed based on a set of fetal descriptors selected from the HRV responses, as evident descriptors of fetal well-being, to increase the sensitivity and specificity of detection. This approach is found to be rather prospective for the subsequent clinical implementation.Publication Delayed neurological maturation is a cause for distress during fetal growth restriction(Trilist, 2020-07-10) Lakhno, Igor; Malikova, S.Theory of fetal programming contributes to a better understanding of the relationship of many human diseases with antenatal period pathology. Regulatory impact of nervous system is of great importance. Fetal growth restriction (FGR) is a convenient model for investigation of the abnormalities of fetal neurodevelopment. Fetal heart rate variability is a well-known approach for fetal autonomic function detection. The aim of the study was to detect several patterns of autonomic nervous regulation in FGR complicated by fetal distress or without fetal distress. Materials and methods. Totally 64 patients at 26–28 weeks of gestation were enrolled. 23 patients had normal fetal growth and were included in the Group I (control). 20 pregnant women with FGR without fetal distress were observed in Group II. 21 patients with FGR and fetal distress were included in Group III. Fetal heart rate variability and conventional cardiotocographic patterns were obtained from the RR-interval time series registered from the maternal abdominal wall via non-invasive fetal electrocardiography. Results. Suppression of the total level of heart rate variability with sympathetic overactivity was found in FGR. The maximal growth of sympathovagal balance was found in Group III. Fetal deterioration was associated with an increased quantity of decelerations, reduced level of accelerations, and decreased of short term variations and low term variations. But a decelerative pattern before 26 weeks of gestation was normal. Therefore fetal autonomic malfunction could be a result of persistent neurological immaturity in FGR. The approach based on the monitoring of fetal autonomic maturity in the diagnosing of its well-being should be tested in further studies. Conclusion. Fetal heart rate variability variables and beat-to-beat variations parameters could be the sensitive markers of neurological maturation and good predictors for fetal deterioration.Publication The Use of Fetal Noninvasive Electrocardiography(Hindawi, 2016-02-24) Lakhno, IgorPreeclampsia (PE) is one of the severe complications of pregnancy that leads to fetal deterioration. The aim was to survey the validity of fetal distress diagnostics in case of Doppler ultrasonic umbilical vein and arteries blood flow velocity investigation and ECG parameters analysis obtained from maternal abdominal signal before labor in preeclamptic patients. Fetal noninvasive ECG and umbilical arterial and venous Doppler investigation were performed in 120 patients at 34–40 weeks of gestation. And 30 of them had physiological gestation and were involved in Group I. In Group II 52 pregnant women with mild-moderate PE were observed. 38 patients with severe PE were monitored in Group III. The most considerable negative correlation was determined in pair Apgar score 1 versus T/QRS (; ). So the increased T/QRS ratio was the most evident marker of fetal distress. Fetal noninvasive ECG showed sensitivity of 96.6% and specificity of 98.4% and, therefore, was determined as more accurate method for fetal monitoring.Publication Diagnosing antenatal fetal distress(Via Medica, 2021-05-14) Lakhno, Igor; Uzel, KemineObjectives: The values of acceleration capacity and deceleration capacity are known to capture fetal neurological development. The fetal growth restriction was found to be featured by decreased variables of phase rectified signal averaging. We have speculated that acceleration capacity and deceleration capacity could be of use in the detection of antenatal fetal distress during fetal growth restriction. The study was focused on the detection of the accuracy of acceleration capacity and deceleration capacity in diagnosing fetal distress. Material and methods: In total, 124 pregnant women at 26-36 weeks of gestation were included in the study. The patients with appropriate to gestational age fetuses (n = 32) were enrolled in Group I. The patients with fetal growth restriction and an absence of fetal distress (n = 48) were observed in Group II. Lastly, the patients with fetal growth restriction and fetal distress (n = 44) were included in Group III. Fetal cardiosignals were obtained via non-invasive fetal electrocardiography. The maximally decreased acceleration capacity and deceleration capacity values were found in Group III. Results: A correlation was found between umbilical artery resistance index and acceleration capacity and deceleration capacity variables in all study groups. We have found that the application of phase rectified signal averaging in the antenatal period showed high sensitivity and specificity in fetal distress detection. Conclusions: Fetal acceleration capacity and deceleration capacity is a prospective option for the detection of fetal compromise during fetal growth restriction.