Oudijk MA, Visser GH, Meijboom EJ. The fetal thymus is a structure that usually goes unnoticed during the process of prenatal diagnosis, and when it presents alterations in its morphology, can lead to confusion and cause fetal arrhythmias without an adverse clinical outcome. Saileela R, Sachdeva S, Saggu DK, Koneti NR. Signorini, G. Magenes, S. Cerutti, D. Arduini (2003) Linear and nonlinear parameters for the analysis of fetal heart rate signal from cardiotocographic recordings. It is more effective than digoxin, especially for hydropic fetal tachycardia, with no adverse fetal outcomes found [14]. CAS For this reason, a manual gain control offers a great advantage when using abdominal fetal phonocardiography for recording heart rate. With the evolution of autocorrelation in many of the newer monitors, great advances have been made in both signal quality and continuity. Prophylactic Administration of Mesenchymal Stromal Cells Does Not 2012 Jun 1;109(11):1614-8. doi: 10.1016/j.amjcard.2012.01.388. Moreover, fetal cardiac arrhythmias can have an effect on FHR signals. (8 wk-egg, 10wk-orange, 12wk-grapefruit against pelvic brim, allows to hear fetal HR) o Earliest ultrasounds are most accurate in dating. Instrumentation and Artifact Detection Including Fetal Arrhythmias The filtered signal is converted to an electrical waveform by the transducer, and it is this waveform that is used to generate and display the FHR. For fetuses with hydrops and fetal SVT with long VA interval, digoxin is rarely effective. The choice of vertical and horizontal scaling directly affects the appearance of the FHR and uterine contraction tracings. M-mode ultrasound detects the AV and VA intervals, fetal heart rate, and AV conduction. Benefit vs. Risk of Internal Monitoring Benefits Provides continuous monitoring Helpful for maternal positioning in bed, fetal movement, maternal body habitus Twins/Multiples More accurate/less artifact Helpful in detecting arrhythmias/ dysrhythmias Risks Invasive Creates portal for infection Potential injury . Donald Sch J Ultrasound Obstet Genycol. Arrhythmia vs Dysrhythmia. Artifacts vs. Arrhythmia - Autonom Health The majority of fetal arrhythmias are premature contractions. J Perinatol. fetal arrhythmia vs artifactdiscretionary housing payment hackney. In addition, the actual signal created by the fetal cardiac motion is greatly affected by the position and movement of the transducer with respect to the fetus. Italian Journal of Pediatrics Article Heart Rhythm. In fetal cases of atrioventricular blocks, an etiological treatment for the maternal antibody exposure by steroids could be an alternative remedy. 2017;7:e016597. Ethics, Husbandry, and Fetal Treatment Following institutional and external review and approval of the protocol (IACUC-UTHSCSA #20110096AP; USDA protocol #74-R-003; OLAW-NIH #D16-00048), we utilized the 125-day gestational (postmenstrual) age, 14 days ventilated baboon model of extreme prematurity described by Seidner et al. The main drawback to phonocardiographically derived FHR systems is that they are extremely sensitive to ambient noise such as maternal bowel sounds, voices in the room, certain air-conditioning systems, and, especially, noise produced by any motion of the microphone or of the bed clothing against the microphone. In the other, the instrument produced an incomprehensible record as a result of counting both maternal and fetal complexes. ted. Fetal MCG may reveal a strong association between AF and an accessory pathway [29]. Flecainide versus digoxin for fetal supraventricular tachycardia: comparison of two drug treatment protocols. Appropriate clinical measures should be taken into consideration with regard to outcomes and prognosis. Ultrasound Med Biol. Shah et al. FHR tracings from a fetal scalp electrode (FSE) are obtained by measuring the interval between consecutive fetal R waves. To produce an FHR tracing, several modulations of the reflected signal need to be used. By using Doppler ultrasound, simultaneous recordings of the atrial and ventricular waves can be obtained. BMJ Open. This section will deal with the methodology involved in the clinical application of these techniques. [9] reported that PACs were the most common fetal arrhythmias representing 55.5% (100/180), followed by bi- or trigemy (12/180, 0.7%), sinus tachycardia (18.3%, 33/180), SVT (15.6%, 28/180), and AF 0.4% (7/180). An official website of the United States government. 2011;38:40612. Bethesda, MD 20894, Web Policies [38] reported that successful drug treatment with sotalol in 5/6 (83.3%) cases with no adverse effects for the mothers. These arrhythmias do not represent an expression of the physiological behavior of the ANS. It is within this group of rhythm disturbances that the majority of fetal . Application of this knowledge may prevent fetal injury and death. Arrhythmias are discovered in about 1% of fetuses. As previously discussed, amplification and filtering of the incoming signal within certain frequencies extracts FHR signals from those produced by other moving structures. Currently, ultrasound is the only widely used method of studying fetal anatomy and physiology, but it has significant limitations for assessment of cardiac rhythm. This occurs only with fetal supraventricular tachyarrhythmias (paroxysmal atrial tachycardia, atrial fibrillation, or atrial flutter), intermittent premature atrial contractions (PACs), or premature ventricular contractions (PVCs) (, An additional instance that may cause confusion is the patient with a cardiac pacemaker. Fetal atrial flutter (AF) and supraventricular tachycardia (SVT) resemble in terms of the effects of intrauterine therapies. IEEE Trans.Biomed.Eng. Hosono T, Kanagawa T, Chiba Y, Neki R, Kandori A, Tsukada K. Fetal atrial flutter recorded prenatally by magnetocardiography. After the pacing wire was advanced into the right atrium and subsequently the right ventricle, the pacing rate was set up at 140bpm. 2004;4:18594. PACs are extra heartbeats that originate in the top of the heart and usually beat . Fetal arrhythmia is a term that refers to any abnormality in the heart rate of your baby. Most are curable to a transplacental treatment by the first-line antiarrhythmic agents. The frequency increases if the reflecting interface is moving toward the signal source and decreases if the reflecting interface is moving away from the signal source. 2000;11:117. 1988;60:5125. Among other causes, the fetal arrhythmia is accountable for a significant portion of such . 2002;19:15864. 2012;28:9503. Benign fetal arrhythmias, such as premature contractions and sinus tachycardia, do not need any perinatal treatments. (eds) 11th Mediterranean Conference on Medical and Biomedical Engineering and Computing 2007. Fetal Cardiac Arrhythmias - Stanford Medicine Children's Health Fouron J. Artifact vs arrhythmia. 50, no. Sotalol, flecainide and amiodarone are used as second-line drugs when digoxin fails to achieve conversion to sinus rhythm. Transplacental administration of steroids, such as dexamethasone and betamethasone, are effective for fetal AV block caused by positive maternal autoantibodies. Part of Springer Nature. Uterine contraction intensities. Refaat M, El Dick J, Sabra M, Bitar F, Tayeh C, Abutaqa M, Arabi M. J Neonatal Perinatal Med. (2007). Circ Arrhythm Electrophysiol. https://doi.org/10.1161/JAHA.117.007164. Debates remain regarding prenatal diagnosis and treatment of fetal arrhythmias. Case report: Prenatal diagnosis of fetal non-compaction cardiomyopathy with bradycardia accompanied by. What is Sinus Rhythm with Supraventricular Ectopy? Sotalol is the best treatment for fetal AF in most cases and is a safe and effective therapy for SVT [35]. M-mode and pulsed Doppler ultrasound assessment of severe fetal bradycardia. Lecture 11 Fetal Complications Stages of Labor Assessments Variations for NB Maternity Meds Medication Hints Psych Tips Operational Stages . Fetal cardiac rhythm abnormalities are common and are encountered in about 1% to 2% of pregnancies ( 1 ). This site needs JavaScript to work properly. These arrhythmias do not represent an expression of the physiological behavior of the ANS. The treatment of choices for fetal tachyarrhythmias was listed in Table2. It is often temporary and . Ultrasound waves of sufficient intensity will generate heat. Most are brief, fleeting occurrences of slow or fast heartbeat or irregular heart rhythm. Most of the rapid fetal arrhythmia is a nonorganic lesion, mostly transient. Gembruch U, Hansmann M, Redel DA, Bald R. Intrauterine therapy of fetal tachyarrhythmias: intraperitoneal administration of antiarrhythmic drugs to the fetus in fetal tachyarrhythmias with severe hydrops fetalis. Both M-mode and Doppler echocardiography can help diagnose sinus bradycardia. Pacemaker implantation was warranted in 17 (89.5%) cases. Immediate appointments are often available. The European scaling factors accentuate apparent FHR variability and tend to make periodic changes appear more abrupt than American scaling factors. Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, 389 Longdejing Street, Chengxiang District, Putian, 351100, Fujian Province, Peoples Republic of China, You can also search for this author in Flecainide is highly effective in achieving sinus rhythm in hydropic and nonhydropic fetuses with SVT, refractory SVT or SVT with signs of heart failure. Walkinshaw SA, Welch CR, McCormack J, Walsh K. In utero pacing for fetal congenital heart block. C. Prolapsed cord. 1997;18:3616. The original electrode was a modified skin clip, but now a spiral electrode is used. Wacker-Gussmann A, Strasburger JF, Srinivasan S, Cuneo BF, Lutter W, Wakai RT. The Doppler ultrasound records ascending aorta and superior vena cava flow velocity waveforms better than the M-mode. For long VA SVT, the conversion rate to sinus rhythm did not differ significantly between the two drugs (67% vs. 50%, P=0.13). 2013;42:28593. Sotalol as first-line treatment for fetal tachycardia and neonatal follow-up. J Am Heart Assoc. An arrhythmia is an irregular rhythm of the heart in which abnormal electrical signals through the heart muscle may cause the heart to beat too fast (tachycardia), too slowly (bradycardia), or in an erratic pattern. 2023 Feb 18;13(4):779. doi: 10.3390/diagnostics13040779. Flecanide and sotalol cross the placental barrier easier, especially in hydropic fetuses, and a higher drug concentration can be achieved in the amniotic fluid. Most errors we see in FHR interpretation are related to the quality of the data acquisition and presentation, and, for this reason, an understanding of this chapter is critical for the clinician using electronic fetal monitoring in the treatment of obstetric patients. Uterine tachsystole. This is known as fetal arrhythmia. Rev Port Cardiol. Evaluation of fetal heart rate artifacts, hemodynamics and digoxin The lower panel shows the fetal scalp lead and the maternal lead electrocardiogram (ECG) tracing indicating that the dead fetus is transmitting the maternal ECG to the fetal lead. Machado MV, Tynan MJ, Curry PV, Allan LD. In comparison to flecainide or digoxin, sotalol was less effective to convert SVT to sinus rhythm. Article For more information or to schedule an appointment, call Texas Children's Fetal Center at 832-822-2229 or 1-877-FetalRx (338-2579) toll-free. van der Heijden LB, Oudijk MA, Manten GT, ter Heide H, Pistorius L, Freund MW. Circulation. Premature contractions are the most common type of fetal arrhythmia, and the prognosis is good in the near and long terms, and fetal growth and development are not affected [55]. Both, artifacts and cardiac arrhythmias represent outliers of the FHR signals, so they affect both time domain and time frequency signal analysis. Ann Pediatr Cardiol. Sotalol and flecainide have good placental transfer ability, and they should be used as first-line treatment for hydropic fetal tachyrrhythmias. Am J Cardiol. The transplacental administration of combined digoxin and flecainide is an effective regimen for SVT with long VA interval [32]. Some cases of fetal arrhythmia are benign, but others can lead to fetal heart failure and/or pose a risk both to the fetus and to . It is important to understand that with Doppler technology, it is not the actual fetal heart being heard but rather a sound that is created by the device in response to frequency changes generated by a moving interface. Intraumbilical administration of antiarrhythmic agents can be performed under ultrasound guidance, but with somewhat technical difficulty, especially when the fetus is in an unfavorable location. Before This management usually takes place during the second or third trimester. Google Scholar. For the obstetrician or obstetric nurse to interpret fetal monitor tracings correctly, it is necessary to have some understanding of the processes involved in the acquisition and processing of data relating to fetal heart rate (FHR) and uterine activity. The site is secure. [7] reported that the prevalence of fetal bradyarrhythmias was 3.4% (62/1821). In this case, a lack of (normal) rhythm. Fetal atrial flutter: electrophysiology and associations with rhythms involving an accessory pathway. Springer Nature. Fetal Arrhythmia Diagnosis and Pharmacologic Management & Gynecol. Qin J, Deng Z, Tang C, Zhang Y, Hu R, Li J, Hua Y, Li Y. In hydropic cases, a same trend was observed (86% vs. 38%, P=0.07 for flecainide vs. digoxin), while the successful rate of combined flecainide with amiodarone was 100%. Currently, in cardiotocographic devices, Doppler methodology involves autocorrelation techniques to recognize heart beats, so evaluation of inter-beats time-interval is very improved. [41] Freedom from arrhythmia on maintenance therapy was 93 and 90% at 1 and 3months, respectively. However, they can be severe sometimes leading to cardiac compromise. Comani S, Liberati M, Mantini D, Gabriele E, Brisinda D, Di Luzio S, et al. 2022 Jul 15;12(7):1722. doi: 10.3390/diagnostics12071722. Fetal arrhythmias: prenatal evaluation and intrauterine therapeutics, https://doi.org/10.1186/s13052-020-0785-9, https://radiopaedia.org/articles/fetal-premature-ventricular-contractions, https://doi.org/10.1136/bmjopen-2017-016597, http://medcraveonline.com/JCCR/JCCR-09-00322.php, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Fetal Arrhythmias | GLOWM A case report. 1,7. A transducer innovation employed by second-generation monitors is pulsed Doppler. Rebelo et al. Difference Between Arrhythmia and Dysrhythmia Detecting fetal arrhythmias vs artifact. Hydrops fetalis resolved in 62.5% (5/8) fetuses, with a mean resolution time of 28.4days [42]. Please enable it to take advantage of the complete set of features! Measurement of the VA interval by Doppler echocardiography helps distinguish short VA interval from long VA interval types of fetal tachycardias, such as AV nodal reentrant tachycardia and permanent junctional reciprocating tachycardia [15]. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Sudden infant death syndrome (SIDS) has remained a challenge to overcome for the medical practitioner. The highest point of the waveform is detected and recorded as a heart beat, even though it may not appear at the same time in each waveform. . Friday, June 10, 2022posted by 6:53 AM . Google Scholar. It can be helpful in making prenatal diagnoses of a variety of fetal arrhythmias, such as complete AV block, premature contractions, paroxysmal SVT and Wolff-Parkinson-White syndrome and long QT syndrome [19]. 2016;32:3528. 50(3):36575, CrossRef For fetuses with hydrops, the placental transfer of the digoxin is limited. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips. OB/Geri Exam 1 Study Guide - OB/Geri Exam 1 Study Guide Geri: Intro Maternal or Fetal Heart Rate? Avoiding Intrapartum Misidentification 2002;17:757. It also extracts 16 significant features from multiple domains, including (time, frequency, and time-frequency features. Fetal complete AV block with structural heart disease often shows a worse prognosis, such as fetal demise or pacemaker implant requirement. This is a preview of subscription content, access via your institution. Successful in utero transesophageal pacing for severe drug-resistant tachyarrhythmia. Fetal tachycardia is a faster heart rate than expected. Unable to display preview. These can include tachycardia-an increased heart rate-or bradycardia, which is a slowed heartbeat. [23] reported that PACs required antiarrhythmic treatments with digoxin, verapamil, or both in 14% of the cases. J Arrhythm. If the electrodes are changed more often - especially for overweight people or people, who sweat very intensely - the occurrence of artifacts are avoided. For AF persisting for 5days, flecainide use achieved a much better heart rate control than soltalol [35]. J Matern Fetal Neonatal Med. Also, because of the high sensitivity to ambient noise, the technique is unsatisfactory for monitoring during the active phase of labor (. PubMed These arrhythmias do not represent an expression of the physiological behavior of the ANS. 2018;31:40712. This safe, noninvasive test shows the structure of the heart and helps determine the type of arrhythmia. With older monitors, the quality of the Doppler-created FHR tracing is directly related to the orientation of the signal to the fetal heart, the amount of fetal movement, and the degree of constant attention by nursing personnel of maintaining an adequate signal while caring for the patient. Jaeggi ET, Nii M. Fetal Brady- and tachyarrhythmias: new and accepted diagnostic and treatment methods. Maternal anti-SSA/SSB antibody positivity is another cause of fetal AV block. Fetal Arrhythmia Diagnosis and Pharmacologic Management Unauthorized use of these marks is strictly prohibited. 2009;35:6239. FETAL HEART RATE DERIVED BY DIRECT (INTERNAL) FETAL ELECTROCARDIOGRAPHY. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Yellow Raft unfolds with a distinctive rhythm as the reader moves backwards and forwards in time, encountering first the story of Rayona, then the story of her mother Christine, and finally the story of Aunt Ida, whose real relationship to the first two becomes one of the novels more powerful revelations. It has been reported that short VA interval occurred in 67 fetuses (80%) and long VA in 17 (20%). Indian Pacing Electrophysiol J. Long QT syndrome can cause 2:1 AV block or sinus bradycardia. Fetal Arrhythmia: Causes and Treatment - Healthline : Illustration: arrhythmia in the HRV-spectrogram Privacy May be caused by fetal arrhythmias, recording of MHR, or the wrong paper speed. A case report. In: Jarm, T., Kramar, P., Zupanic, A. In Europe, standard factors are 20 BPM/cm (vertical) and 1 or 2 cm/minute (horizontal). -stimulants, such as ritodrine, terbutaline, and salbutamol, and steroids have been reported to be effective transplacental treatments for fetal AV block, and they may increase fetal ventricular rate by 1020% and reverse hydrops as well. Would you like email updates of new search results? Europ. Hajdu J, Pete B, Harmath A, Varadi V, Papp Z. Fetal arrhythmias: a clinical review. The outcomes of intrauterine therapy of fetal tachyarrhythmias depend on the types or etiology of fetal arrhythmias and fetal conditions. J Matern Fetal Neonatal Med. The signal actually received is a composite consisting of bursts with various amplitudes and frequencies. The raw fetal ECG signal is amplified and fed into a beatto-beat cardiotachometer (, Most fetal ECG systems will not record R-R intervals less than 250 milliseconds, which corresponds to a rate of 240 BPM. ; 33 (3): 2415, O. Sibony, J. P. Fouillot, M. Benaoudia, A. Benhalla, J. F. Oury, C. Sureau, P. Blot (1994) Quantification of the heart rate variability by spectral analysis of fetal well-being and fetal distress. Treatment of Fetal and Neonatal Arrhythmias | USC Journal Stirnemann et al. The phonocardiographic signal is clearer than the Doppler signal, resulting in less artifactual jitter. For this reason, phonocardiography historically was widely used for antepartum FHR monitoring. vol. Stirnemann J, Maltret A, Haydar A, Stos B, Bonnet D, Ville Y. 4 Normal fetal heart rates range from 120-160bpm at 30 weeks' gestation and 110-150bpm at term. 2018;122:A20644. A 28-year-old healthy woman was referred at 30 weeks of gestation because of fetal tachy-brady-arrhythmia, but cw-Doppler assessment of umbilical artery blood flow revealed periods of . Am J Obstet Gynecol. Clinical presentation, management, and postnatal outcomes of fetal tachyarrhythmias: a 10-year single-center experience. By using Doppler ultrasound, simultaneous recording of the atrial and ventricular waves can be obtained. In 2 cases, maternal QRS complexes which were detectable at the fetal scalp electrode were counted, resulting in misleading recordings. 2008;31(Suppl 1):S503. The institutional Review Board approves this study. This article reviews heart rate monitoring . Prenat Diagn. Fetal Cardiac Arrhythmia | Texas Children's Pavilion for Women Fetal heart arrhythmias and doppler ultrasound. Of these arrhythmias, 10% are considered potential sources of morbidity. Sustained fetal arrhythmias that predispose to the occurrence of hydrops fetalis, cardiac dysfunction or eventual fetal demise require active treatments. Ultrasonic signals can penetrate human tissue. The proposed framework uses only a single abdomen ECG. An ECG signal consists of P, . fetal arrhythmia vs artifact. The normal heart rate for a fetus is anywhere between 120 and 160 beats per minute.This is a rare condition, occurring in only 1-2% of pregnancies, and is normally a temporary, benign occurrence. Assessment of fetal arrhythmia by simultaneous Doppler recording of flow patterns in the ascending aorta and superior vena cava. National Library of Medicine Fetal complete heart block. Sotalol as first-line treatment for fetal tachycardia and neonatal follow-up. Fetal Arrhythmia | Types, Causes and Treatment Tutschek B, Schmidt KG. IFMBE Proceedings, vol 16. A 10-year observational study on the pregnant women demonstrated 29 cases of fetal arrhythmias: 12 (41.4%) of which were fetal tachycardias (10 cases with SVT, 2 cases with atrial flutter (AF)), 5 (17.2%) were fetal bradyarrhythmias (all 5 cases with AV block), and 12 (41.4%) were fetal irregular cardiac rhythms (premature atrial beats) [4]. [53] reported, for fetuses with complete AV block with poor responses to transplacental therapies, fetal transthoracic ventricular pacing ensures temporary fetal ventricular rate acceleration. Figure 4.4. Population ageing is a severe demographical challenge in the near future. 1):167269. 2008;4:17248. The two most common congenital heart defects associated with AV block are left atrial isomerism and discordant AV connection. PMC Note the two rates are identical in detail. The fetuses with benign arrhythmias, such as PACs <11 beats per minute (bpm) and sinusal tachycardias, did not need any treatment before or after birth, whereas those with postnatal arrhythmias associated with hemodynamic fluctuations require interventions, as they may lead to preterm delivery in some occasions [9]. This can help us confirm the diagnosis and discuss possible options for . Role of Maternal Artifact in Fetal Heart Rate Pattern Interp - LWW Ultrasound Obstet Gynecol. An example commonly used to describe the Doppler shift is the audible change in pitch (frequency) noticed by a stationary observer of the whistle from a rapidly moving train. Disclaimer. D. Maternal fever. However, depending on the monitor and the existing maternal R wave, amplification of the incoming signal may continue until, on occasion, counting of the maternal heart rate (MHR) from the scalp of the dead fetus results (, FETAL HEART RATE DERIVED BY INDIRECT (EXTERNAL) DOPPLER ULTRASOUND, In the antepartum period, and often during the intrapartum period, it is neither feasible nor always necessary to use the direct fetal ECG signal to record the FHR. 2005;10:50414. The clinical outcome and prognosis of patients are usually determined by the type and extent of cardiac malformation [55]. Arrhythmia Electrophysiol Rev. [54] described percutaneous transvenous intracardiac cardiac pacing performed in a case of fetal AV block via the fetal umbilical vein under ultrasound guidance. Google Scholar, F. Figueras, S. Albela, S. Bonino, M. Palacio, E. Barrau, S. Hernandez, C. Casellas, O. Coll, V. Cararach (2005) Visual analysis of antepartum fetal heart rate tracings: inter- and intra-observer agreement and impact of knowledge of neonatal outcome. fetal arrhythmia vs artifact - tutanc.org YSM: Substantial contribution to the conception and design of the work; and the acquisition, analysis, and interpretation of data for the work; drafting the work and revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy and integrity of any part of the work are appropriately investigated and resolved. B. Maternal hypotension. Fetal arrhythmia is an abnormal fetal heartbeat or rhythm. AlSoufi M. Successful treatment of fetal tachycardia by sotalol. Both authors read and approved the final manuscript. Fetal Monitoring IP Assessment 2022 PYLE.pptx - Intrapartal Mller cells in eyes of 39 human fetuses (11-38 weeks of gestation, WOG) and 6 infants (5 died of abusive head trauma, AHT, aged 1-9 months) were immunohistochemically stained and investigated for spatial and temporal immunoreaction of nestin, CD44, collagen IX and GFAP, which are . Christoffels VM, Moorman AF. PubMed 11th Mediterranean Conference on Medical and Biomedical Engineering and Computing 2007, https://doi.org/10.1007/978-3-540-73044-6_205, Shipping restrictions may apply, check to see if you are impacted, Tax calculation will be finalised during checkout. The literature reporting on prenatal diagnosis and treatment of fetal arrhythmias published in the recent two decades were retrieved, collected and analyzed. Strasburger JF. PubMed In addition, any fetal kicking or motion produces a very loud noise that will saturate the automatic gain system on the monitors amplifier, resulting in complete loss of recording for several seconds while waiting for the amplifier to reopen. The modes of administration, intraumbilical, intraamniotic, intraperitoneal, intramuscular and intracardiac, have been selected as routes of administration.