Computerized measurement of heart rate variation in fetal anemia caused by rhesus alloimmunization

OBJECTIVE: The purpose of this study was to examine the relationship between fetal heart rate variation and fetal hematocrit. STUDY DESIGN: In 36 red-cell alloimmunized pregnancies (mean gestational age 30, range 25 to 36 weeks) 65 computerized fetal heart rate recordings were obtained before ultrasonographically guided fetal blood sampling for the measurement of fetal hematocrit. The recordings were captured and analyzed by a microcomputer on-line. Fetal heart rate variation in anemic fetuses was accurately measured. RESULTS: Significant positive correlations between short-term or long-term heart rate variation and fetal hematocrit have been demonstrated even after adjusting for the effect of gestation (r = 0.60, n = 65, p < 0.01, y = 19.264 + 0.913x - 0.003x2; r = 0.52, n = 65, p < 0.01, y = 21.13 + 0.858x - 0.003x2, respectively). The relationship was best described by a quadratic model. When short-term variation was <5 milliseconds or long-term variation was <30 milliseconds, the positive predictive values for fetal hematocrit of <30 were 85% and 90%, and the negative predictive values 56% and 57%, respectively. CONCLUSION: Computerized recording and analysis of fetal heart rate variation may prove to be a useful noninvasive tool for assessing fetal anemia in red-cell alloimmunization.