Cardiac systolic time intervals and other parameters of myocardial contractility as indices of fetal acid-base status
Baillière's Clinical Obstetrics and Gynaecology
R M Lewinsky
Electronic fetal heart rate monitoring has become the standard method for the assessment of fetal status during labour. Unfortunately, the hoped-for benefit from implementation of this technique has not been realized. The non-specific nature of FHR changes has led to undesirable side-effects, especially an increase in inappropriate operative interventions. Thus, there is an obvious need for methods which will improve upon the accuracy of FHR monitoring. There is substantial evidence for a tight coupling of fetal acid-base balance and myocardial contractility. This relationship has been established in experimental animal studies where fetuses were gradually rendered hypoxic and acidaemic while myocardial contractility was assessed by dP/dtmax and end-systolic elastance (Ees). Furthermore, the correlation between pH and indices of contractility extends over the entire range of clinical importance rather than being a terminal event. Systolic time intervals have long been recognized as good indicators of myocardial contractility. Recent advances in technology, have made their measurement in the human fetus by non-invasive means feasible. Substantial evidence has been accumulated, from both animal and human studies, to indicate that...Continue Reading
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