Adaptation of the fetus to sequential cardiotocographic examinations and the development of closed loops of self-regulation

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Abstract

Objective: To study changes in fetal heart rate variability (HRV) during antenatal cardiotocographic (CTG) monitoring.

Materials and methods: This study included data from 13,520 CTG recordings obtained from 3,380 pregnant women. The analysis was performed using clustering methods and statistical analysis of HRV.

Results: The initial increase in HRV was identified as a response to the stimulus, whereas subsequent reductions reflected the development of self-regulatory mechanisms. Strategy-type habituation (STH) correlated with the maturity of fetal regulatory systems. In some cases, HRV reduction was associated with dysregulation and neonatal complications.

Conclusion: HRV dynamics can serve as an objective and quantitative criterion for assessing fetal physiological states and predicting potential deviations. Antenatal CTG monitoring revealed a consistent pattern of fetal HRV changes, which may indicate adaptive processes. The initial HRV increase is a response to the stimulus, whereas the subsequent reduction reflects the formation of self-regulatory mechanisms. The key parameter is STH, which enables the assessment of fetal regulatory system maturity. Furthermore, it has been established that HRV reduction under certain conditions may be linked to dysregulation and neonatal complications. The study results suggest that HRV dynamics can be utilized as a quantitative criterion for assessing fetal physiological states.

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About the authors

Victor V. Loginov

Academician Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology

Author for correspondence.
Email: v_loginov@oparina4.ru
ORCID iD: 0000-0002-4929-8763

PhD (Bio), Head of the Laboratory of Neurophysiology

Russian Federation, 4, Academic Oparin St., Moscow, 117997

Denis G. Davydov

Academician Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology

Email: d_davydov@oparina4.ru
ORCID iD: 0000-0003-3747-7403

PhD (Psychology), Senior Researcher at the Laboratory of Neurophysiology

Russian Federation, 4, Academic Oparin St., Moscow, 117997

Andrey M. Prikhodko

Academician Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology

Email: a_prikhodko@oparina4.ru
ORCID iD: 0000-0002-6615-2360

Dr. Med. Sci., Physician at the 1st Maternity Department, Teaching Assistant at the Department of Obstetrics and Gynecology, Researcher at the Innovative Technologies Department of the Obstetrics Institute

Russian Federation, 4, Academic Oparin St., Moscow, 117997

Oleg R. Baev

Academician Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology; Sechenov First Moscow State Medical University

Email: o_baev@oparina4.ru
ORCID iD: 0000-0001-8572-1971

Dr. Med. Sci., Professor, Head of the 1st Maternity Department; Professor at the Department of Obstetrics, Gynecology, Perinatology, and Reproductology

Russian Federation, 4, Academic Oparin St., Moscow, 117997; Bldg. 2, 8, Trubetskaya St., Moscow, 119991

Natalia E. Kan

Academician Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology

Email: kan-med@mail.ru
ORCID iD: 0000-0001-5087-5946

Dr. Med. Sci., Professor, Deputy Director for Science

Russian Federation, 4, Academic Oparin St., Moscow, 117997

Victor L. Tyutyunnik

Academician Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology

Email: tioutiounnik@mail.ru
ORCID iD: 0000-0002-5830-5099

Dr. Med. Sci., Professor, Leading Researcher at the Center for Scientific and Clinical Research

Russian Federation, 4, Academic Oparin St., Moscow, 117997

Andrey Yu. Romanov

Academician Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology

Email: romanov1553@yandex.ru
ORCID iD: 0000-0003-1821-8684

PhD, Head of the Department of Planning and Support of Scientific Projects

Russian Federation, 4, Academic Oparin St., Moscow, 117997

Dmitry N. Degtyarev

Academician Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology; Sechenov First Moscow State Medical University

Email: d_degtiarev@oparina4.ru
ORCID iD: 0000-0001-8975-2425

Dr. Med. Sci., Professor, Head of the Department of Neonatology; Deputy Director for Science

Russian Federation, 4, Academic Oparin St., Moscow, 117997; Bldg. 2, 8, Trubetskaya St., Moscow, 119991

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2. Fig. 1. Distribution of CTG recordings in patients by gestational age

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3. Fig. 2. A. Dynamics of the decrease in average HRV values in healthy foetuses during the first CTG recording, referred to as ‘Rapid Habituation’ (RH); analysis period 50. B. Dynamics of average HRV values in four consecutive CTG recordings – ‘Slow Habituation’ (SH). Analysis periods: blue – 10; red – 20; green – 30; orange – 50; yellow – 100 RR intervals, respectively

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4. Fig. 3. A. MP of average HRV values (from 3,380 pregnant women) in four consecutive CTG recordings; epoch – 20 RR intervals. B. Two optimally selected clusters across the entire patient group

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5. Fig. 4. Dynamics of mean HRV values during separate, special, 5th CTG registration with 3 consecutive on/off switches of the ultrasound sensor (n = 19)

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