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Clinical Application of Pulse Transit Time and Correlation With Intrapartum Fetal Heart Rate Monitoring: A Preliminary Study of 18 Full-Term Infants

Department of Obstetrics and Gynecology and Perinatal Center, Faculty of Medicine, University of Miyazaki, Japan

Hiroshi Sameshima, MD

Department of Obstetrics and Gynecology and Perinatal Center, Faculty of Medicine, University of Miyazaki, Japan, hsameshima{at}fc.miyazaki-u.ac.jp

Tsuyomu Ikenoue, MD

Department of Obstetrics and Gynecology and Perinatal Center, Faculty of Medicine, University of Miyazaki, Japan

The authors show that pulse transit time and blood pressure are reciprocal in fetal goat models. They applied this technique in clinical settings to correlate changes in pulse transit time with fetal heart rate monitoring patterns and acid-base status. In 18 uncomplicated pregnancies, pulse transit time was obtained from electrocardiograms to pulse oximeter waveform and averaged during each baseline period, defined by the interpretation of fetal heart rate monitoring. According to a > 10% change from the control value, chronological changes were categorized into shortened, unchanged, and prolonged. Pulse transit time was available in 82% ± 11% of the recordings. In 15 fetuses, 2 (13%) showed prolonged, 7 (47%) showed shortened, and 6 (40%) showed unchanged conditions. Comparisons of the shortened and unchanged categories revealed that severe variable deceleration was significantly increased, and half or more fetuses showed hypoxemia in the shortened category. Shortening of pulse transit time, theoretically indicating a hypertensive condition, was more frequently associated with severe variable decelerations, suggesting that the pulse transit time may supplement the interpretation of fetal heart rate monitoring.

Key Words: Pulse transit time • fetal heart rate monitoring • fetal oxygen saturation • hypoxemia.

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