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Cited by 59Blood groups and transfusionHeart Rate Variability and Autonomic ControlMaternal and Perinatal Health Interventions

Sinusoidal heart rate pattern: reappraisal of its definition and clinical significance

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Modanlou, Houchang D., Murata, Yuji·2004·Journal of obstetrics and gynaecology research
DOI 10.1111/j.1447-0756.2004.00186.x
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Abstract

OBJECTIVES: To address the clinical significance of sinusoidal heart rate (SHR) pattern and review its occurrence, define its characteristics, and explain its physiopathology. BACKGROUND: In 1972, Manseau et al. and Kubli et al. described an undulating wave form alternating with a flat or smooth baseline fetal heart rate (FHR) in severely affected, Rh-sensitized and dying fetuses. This FHR pattern was called 'sinusoidal' because of its sine waveform. Subsequently, Modanlou et al. described SHR pattern associated with fetal to maternal hemorrhage causing severe fetal anemia and hydrops fetalis. Both Manseau et al. and Kubli et al. stated that this particular FHR pattern, whatever its pathogenesis, was an extremely significant finding that implied severe fetal jeopardy and impending fetal death. UNDULATING FHR PATTERN: Undulating FHR pattern may be due to the following: (1) true SHR pattern; (2) drugs; (3) pre-mortem FHR pattern; (4) pseudo-SHR pattern; and (5) equivocal FHR patterns. FETAL CONDITIONS ASSOCIATED WITH SHR PATTERN: SHR pattern has been reported with the following fetal conditions: (1) severe fetal anemia of several etiologies; (2) effects of drugs, particularly narcotics; (3) fetal asphyxia/hypoxia; (4) fetal infection; (5) fetal cardiac anomalies; (6) fetal sleep cycles; and (7) sucking and rhythmic movements of fetal mouth. DEFINITION OF TRUE SHR PATTERN: Modanlou and Freeman proposed the following definition for the interpretation of true SHR pattern: (a) stable baseline FHR of 120-160 bpm; (b) amplitude of 5-15 bpm, rarely greater; (c) frequency of 2-5 cycles per minute; (d) fixed or flat short-term variability; (e) oscillation of the sinusoidal wave from above and below a baseline; and (f) no areas of normal FHR variability or reactivity. PHYSIOPATHOLOGY: Since its early recognition, the physiopathology of SHR became a matter of debate. Murata et al. noted a rise of arginine vasopressin levels in the blood of posthemorrhagic/anemic fetal lamb. Further works by the same authors revealed that with chemical or surgical vagotomy, arginine vasopressin infusion produced SHR pattern, thus providing the role of autonomic nervous system dysfunction combined with the increase in arginine vasopressin as the etiology. CONCLUSION: SHR is a rare occurrence. A true SHR is an ominous sign of fetal jeopardy needing immediate intervention. The correct diagnosis of true SHR pattern should also include fetal biophysical profile and the absence of drugs such as narcotics.

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  • Several studies suggest that acute abruption is a significant contributor to category III fetal heart rate patterns due to terminal bradycardia and sinusoidal fetal heart rate patterns.

    “Several studies suggest that acute abruption is a significant contributor to category III FHR patterns due to terminal bradycardia and sinusoidal FHR patterns (62, 64–68).”

    From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [67]

    The “Pre-mortem fetal heart rate patterns” section (page unavailable) links severe placental abruption to catastrophic fetal compromise and says a sinusoidal pattern may appear in rare cases of severe intrapartum asphyxia. It does not establish that acute abruption is a significant contributor to category III patterns or specifically link it to terminal bradycardia. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • In cases of decreased fetoplacental blood flow and hypoxia, sinusoidal fetal heart rate patterns can be seen prior to the terminal bradycardia.

    “In cases of decreased fetoplacental blood flow and hypoxia, sinusoidal FHR patterns can be seen prior to the terminal bradycardia (FIGURE 9) (66–68).”

    From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [67]

    The “Pre-mortem fetal heart rate patterns” section (page unavailable) says a sinusoidal pattern may appear in rare cases of severe intrapartum hypoxia before fetal death, and describes a similar premortem pattern followed by a gradual fall in baseline heart rate. It does not specifically establish the claimed sequence of decreased fetoplacental blood flow, sinusoidal pattern, and terminal bradycardia. (LLM, conf=0.82)

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Research works printed but not linked: 10

  1. Manseau P, Vaquier J, Chavinie J, Sureau C. Le rythme cardiaque foetal sinusoidal. Aspect evocateur de souffrance foetale au cours de la grossesse. J Gynecol Obstet Biol Reprod 1972; 1: 343.
  2. Kubli F, Ruttgers H, Haller U, Bogdan C, Ramzin M. Die antepartale fetale Herzfrequenz; II. Verhalten von Grundfre- quenz, Fluktuation und Dezerationen bei antepartalem Fruchttod. Z Gerburtshilfe Perinatol 1972; 176: 309.
  3. Young BK, Katz M, Wilson SJ. Sinusoidal fetal heart rate. I. Clinical significance. Am J Obstet Gynecol 1980; 136: 587.
  4. Agosti S, Santarone M, Zuliani G, Colombo F, Pardi G. Comparsa di ritmo sinusoidale durante registrazioni cardi- tocografiche in gravidanze complicate da immunizzazione materno fetale. Ann Ostet Ginecol Med Perinat 1980; 101: 107.
  5. Busacca M, Gementi P, Stefanoni NS, Luchini S. Il tracciato sinusoidale. Sua incidenza e rilvanza clinica. Ann Ostet Ginecol Med Perinat 1982; 103: 272.
  6. Garite TJ, Modanlou HD, Freeman RK. Sinusoidal fetal heart rate pattern (letter). Am J Obstet Gynecol 1981; 139: 226.
  7. Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC, Huath JC, Wenstrom KD. Intrapartum assessment. Sinusoidal heart rates. Section IV, normal labor and delivery. In: Williams Obstetrics, 21st edn. New York: McGraw-Hill. p. 339, 2003.
  8. Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC, Hauth JC, Wenstrom KD. Intrapartum Assessment. Second-stage labor fetal heart rate patterns. In: Williams Obstetrics, 21st edn, Section IV. New York: McGraw-Hill, 2001; p. 346.
  9. Hatjis CG, Meis PJ. Sinusoidal fetal heart rate pattern associ- ated with butrophanol administration. Obstet Gynecol 1986; 67: 377.
  10. Ito T, Maeda K, Takahashi H, Nagata N, Nakajima K, Ter- akawa N. Differentiation between physiologic sinusoidal FHR pattern by fetal actocardiogram. J Perinat Med 1994; 22: 39.

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Authors
Modanlou, H. D., & Murata, Y.
Affiliations
  • University of California, Irvine (US)
  • The University of Osaka (JP)
Corresponding author
Modanlou, Houchang D.
ORCID
Modanlou, Houchang D.
Venue
Journal of obstetrics and gynaecology research
Publisher
Wiley
Published
2004-05-07
Volume
30
Issue
3
Pages
169-180
ISSN
  • 1341-8076 (ISSN-L)
  • 1447-0756
DOI
10.1111/j.1447-0756.2004.00186.x
OpenAlex
W2121568822
Cited by
59
References
97
Citations by year
2026: 4 · 2025: 1 · 2024: 3 · 2023: 4 · 2022: 1 · 2021: 7 · 2020: 4 · 2019: 4 · 2018: 2 · 2017: 1 · 2016: 2 · 2015: 5 · 2014: 1 · 2013: 1 · 2012: 5
FWCI
0.04
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of obstetrics and gynaecology research (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Topics
  • Health Sciences › Medicine › Hematology › Blood groups and transfusion
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
Keywords
fetal heart rate, fetal anemia, hydrops fetalis, vasopressin, autonomic dysfunction, fetal hypoxia, fetal asphyxia, fetal infection, fetal cardiac anomalies, Rh isoimmunization, fetal death, fetal drug effects, fetal heart rate variability
MeSH terms
Arrhythmias, Cardiac, Fetal Distress, Heart Rate, Fetal, Humans, Cardiotocography

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