SONOGRAPHIC COMPARISON OF FETAL HEART RATE IN GESTATIONAL HYPERTENSIVE AND NORMOTENSIVE MOTHERS IN THE SECOND AND THIRD TRIMESTER
DOI:
https://doi.org/10.71000/mwpskm12Keywords:
Fetal heart rate, Blood pressure, Gestational Hypertension, Gestational Age, Maternal Age, M-mode Ultrasound, Pregnancy Trimester, , Second.Abstract
Background: Hypertensive disorders during pregnancy are among the leading causes of maternal and fetal morbidity and mortality worldwide. These conditions can significantly alter maternal cardiovascular dynamics, which in turn may impact fetal heart rate (FHR)—a key indicator of fetal well-being. Monitoring FHR through sonographic techniques provides critical insights into fetal health, particularly in pregnancies complicated by gestational hypertension.
Objective: To evaluate and compare fetal heart rate patterns between gestational hypertensive and normotensive mothers during the second and third trimesters using ultrasound imaging.
Methods: A comparative analytical study was conducted at the Radiology Department of Services Hospital Lahore, Pakistan, over six months from February 2019 to July 2019. After obtaining ethical approval from the Institutional Review Committee of the University of Lahore, a total of 130 pregnant women in their second and third trimesters were enrolled through convenience sampling. Among them, 21 women (16.1%) were diagnosed with gestational hypertension and 109 (83.8%) were normotensive. All participants underwent standardized obstetric ultrasound using a MINDRAY-DP-22 machine with a 3.5 MHz convex transducer. Gestational age and FHR were assessed using a four-chamber cardiac view, and FHR was recorded using M-mode ultrasound. Descriptive statistics were reported using mean, standard deviation, and percentage, while group comparisons were analyzed using the independent samples t-test.
Results: The mean fetal heart rate in gestational hypertensive mothers was significantly higher (173.71 ± 9.93 bpm) compared to normotensive mothers (150.23 ± 5.82 bpm) with a p-value of 0.000. The mean gestational age was 24.48 ± 3.20 weeks in the hypertensive group and 26.37 ± 4.16 weeks in the normotensive group. Most hypertensive cases occurred in the second trimester (n = 13, 16.4%) and among women aged 26–31 years.
Conclusion: Fetal heart rate was markedly elevated in pregnancies complicated by gestational hypertension, particularly during the second trimester. These findings underscore the influence of maternal blood pressure on fetal autonomic regulation and reinforce the value of early and regular sonographic monitoring in hypertensive pregnancies.
References
Zhang J, Xiao S, Zhu Y, Zhang Z, Cao H, Xie M, et al. Advances in the Application of Artificial Intelligence in Fetal Echocardiography. J Am Soc Echocardiogr. 2024;37(5):550-61.
Smith NA, Vinet É. Ambulatory Fetal Heart Monitoring: The New Kid on The Block? Arthritis Rheumatol. 2024;76(3):345-7.
Morales-Roselló J, Loscalzo G, Perez G, Payá AS, Jakaitė V, Perales-Marín A. Association of first trimester fetal heart rate and nuchal translucency with preterm birth. J Matern Fetal Neonatal Med. 2022;35(25):5572-9.
Altit G, Lapointe A, Kipfmueller F, Patel N. Cardiac function in congenital diaphragmatic hernia. Semin Pediatr Surg. 2024;33(4):151438.
Youssef L, Castellani R, Valenzuela-Alcaraz B, Sepulveda-Martinez Á, Crovetto F, Crispi F. Cardiac remodeling from the fetus to adulthood. J Clin Ultrasound. 2023;51(2):249-64.
Depla AL, De Wit L, Steenhuis TJ, Slieker MG, Voormolen DN, Scheffer PG, et al. Effect of maternal diabetes on fetal heart function on echocardiography: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2021;57(4):539-50.
Vasciaveo L, Zanzarelli E, D'Antonio F. Fetal cardiac function evaluation: A review. J Clin Ultrasound. 2023;51(2):215-24.
Oliveira M, Dias JP, Guedes-Martins L. Fetal Cardiac Function: Myocardial Performance Index. Curr Cardiol Rev. 2022;18(4):e271221199505.
van Amerom JF, Goolaub DS, Schrauben EM, Sun L, Macgowan CK, Seed M. Fetal cardiovascular blood flow MRI: techniques and applications. Br J Radiol. 2023;96(1147):20211096.
Aguet J, Seed M, Marini D. Fetal cardiovascular magnetic resonance imaging. Pediatr Radiol. 2020;50(13):1881-94.
Maher S, Seed M. Fetal Cardiovascular MR Imaging. Magn Reson Imaging Clin N Am. 2024;32(3):479-87.
Pavlicek J, Klaskova E, Kapralova S, Prochazka M, Vrtel R, Gruszka T, et al. Fetal heart rhabdomyomatosis: a single-center experience. J Matern Fetal Neonatal Med. 2021;34(5):701-7.
van den Wildenberg S, van Beynum IM, Havermans MEC, Boersma E, DeVore GR, Simpson JM, et al. Fetal Speckle Tracking Echocardiography Measured Global Longitudinal Strain and Strain Rate in Congenital Heart Disease: A Systematic Review and Meta-Analysis. Prenat Diagn. 2024;44(12):1479-97.
Karim JN, Bradburn E, Roberts N, Papageorghiou AT. First-trimester ultrasound detection of fetal heart anomalies: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2022;59(1):11-25.
Moon-Grady AJ, Donofrio MT, Gelehrter S, Hornberger L, Kreeger J, Lee W, et al. Guidelines and Recommendations for Performance of the Fetal Echocardiogram: An Update from the American Society of Echocardiography. J Am Soc Echocardiogr. 2023;36(7):679-723.
Yeo L, Romero R. New and advanced features of fetal intelligent navigation echocardiography (FINE) or 5D heart. J Matern Fetal Neonatal Med. 2022;35(8):1498-516.
Carvalho JS. Risk stratification for irregular fetal heart rhythm: practical approach to management. Ultrasound Obstet Gynecol. 2022;60(6):717-20.
Gómez-Montes E, Herraiz I, Villalain C, Galindo A. Second trimester echocardiography. Best Pract Res Clin Obstet Gynaecol. 2025;100:102592.
Cui M, Bezprozvannaya S, Hao T, Elnwasany A, Szweda LI, Liu N, et al. Transcription factor NFYa controls cardiomyocyte metabolism and proliferation during mouse fetal heart development. Dev Cell. 2023;58(24):2867-80.e7.
Karadaev M, Fasulkov I, Vasilev N, Atanasova S. The use of ultrasonographic measurement of the heart size and fetal heart rate variation for gestational age determination in local Bulgarian goats. Vet Med Sci. 2021;7(5):1736-42.
Kent L. Thornburg, PhD;Rachel Drake, BA,BS; Amy M.Valent,DO.Maternal hypertension affects heart growth in offspring. J Am heart Assoc.2020;9: e016538.
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