Thrombin mediates vagal apoptosis and dysfunction in inflammatory bowel disease. Front. Osteopath. Can. Endocrinology 154, 11681180. Physiol. Developmental milestones of the autonomic nervous system revealed via longitudinal monitoring of fetal heart rate variability. Medications youve taken, as well as gestational age could impact FHR patterns. RadioGraphics 35, 21352148. doi: 10.4103/jdmimsu.jdmimsu_194_20, Sheng, J. Which intrinsic homeostatic response is the fetus demonstrating when abrupt variable decelerations are present? Bras. 134, 396408. 14, 107114. In fact, epidural analgesia itself does not show precise or significant changes in fHRV (Lavin, 1982), but it can interact with other aspects already existing in the mother. Women Birth 32, 12. Meas. Psychobiol. This effect is believed to benefit the fetus by temporarily reducing myocardial work to compensate for diminished oxygen availability.3-6 A third consequence of chemoreceptor activation of the sympathetic system causes release of other substances such as adrenal catecholamines and vasopressin. 59: Techniques for Fetal Heart Assessment . (2001). Endocrinol. Meas. Rev. 41, 323. Birth Defects Res. Heres how to tell if youre experiencing them. 30, 12691303. Drugs 2, 419436. The effect of labor and delivery mode on electrocortical and brainstem autonomic function during neonatal transition. 20, S31S36. J. Microbiol. This paper will also focus on which factorsi.e., fetal characteristics and behaviors, maternal lifestyle and pathologies, placental health and dysfunction, labor, incubator conditions, and drug exposuremay affect the development of the vagus. (14), Shallow gradual deceleration that are late in timing and accompanied by a normal baseline and moderate baseline variability are inconsistent markers of low Apgar scores or metabolic acidosis. Epidemiology 10, 370375. Front. The different patterns of ANS development could also be due both to a different sex-specific susceptibility to environmental stimuli and a different neurodevelopmental trajectory of male and female fetuses, which could lead to sex-specific developmental intervals of maximum susceptibility to environmental exposures (Buss et al., 2009; Bale, 2016). Placenta dysbiosis can be related to antepartum infections (Aagaard et al., 2014; Doyle et al., 2017; Pelzer et al., 2017), maternal nutrition (Aagaard et al., 2014), maternal weight gain (Antony et al., 2015; Zheng et al., 2015; Benny et al., 2019), gestational diabetes mellitus (Bassols et al., 2016; Pelzer et al., 2017), use of probiotics/antibiotics (Pelzer et al., 2017), and periodontal pathogens (Fischer et al., 2019), and can lead to several adverse outcomes, such as preeclampsia and chorioamnionitis (Amarasekara et al., 2015; Doyle et al., 2017; Fischer et al., 2019; Olaniyi et al., 2020). Fetal acidosis and hypotension during repeated umbilical cord occlusions are associated with enhanced chemoreflex responses in near-term fetal sheep. (2016). 39: Fetal Homeostatic Mechanisms . U.S.A. 107, 1675716758. Drugs 5, 615627. Perinatal hypoxia contributes significantly to the possibility of perinatal brain injury (Gotsch et al., 2007). (1998). 87, 745750. 53: SECTION THREE . Clinical significance of fetal heart rate patterns during labor. The sheep in the first group maintained normal gases and all sheep in the second group developed severe acidemia.13 Deep and wide decelerations with an abrupt onset were present with all cord compressions. However, the long-term impact is currently under investigation. 237, 655671. From 17 to 24 WGA, the spleen almost completely develops its reticular framework (Satoh et al., 2009; Hill, 2021a). Thayer, J. F., and Brosschot, J. F. (2005). Langman Medical Embryology. Regarding the ANS, brainstem, and hypothalamic centers form several connections with the other CAN structures, that is, insula, anterior cingulate gyrus, hippocampus, hypothalamus, and amygdala (Mulkey and du Plessis, 2018; Schlatterer et al., 2021). Am J Obstet Gynecol. Effect of halogen light in fetal stimulation for fetal well-being assessment. A., Zimmerman, A., Hamadia, S., Ziv, O., Gurevich, V., Fichtman, B., et al. Intrapartum care. The cervix undergoes biochemical changes that increase its elasticity. (2019). which intrinsic homeostatic response is the fetus demonstrating 40, 445456. Maternal perception, tocodynamometric findings and real-time ultrasound assessment of total fetal activity. Reprod Fertil Dev. Srensen, N., Murata, K., Budtz-Jrgensen, E., Weihe, P., and Grandjean, P. (1999). Hillman, N. H., Kallapur, S. G., and Jobe, A. H. (2012). 2000 Apr; 107(4):461-6. doi: 10.1203/01.PDR.0000130476.97700.2B, Mulkey, S. B., and du Plessis, A. Acidemia at birth, related to obstetric characteristics and to oxytocin use, during the last two hours of labor. Coll. Furthermore, without uterus protection, newborns can be particularly sensitive to sounds, which usually overcome the 45 dB limit recommended by the American Academy of Pediatrics (Almadhoob and Ohlsson, 2020), thus resulting in toxic stress (Weber and Harrison, 2019). This detects changes in the normal FHR pattern at the time of labor, reassuring your obstetrician if its safe to proceed. Behav. What could and should we do to disrupt this status quo and enable individualized insights into the various developmental effects the vagus nerve maturation and pleiotropic physiology provide? 53, 330340. (2018). doi: 10.1097/PCC.0000000000001094, Mattingly, J. E., D'Alessio, J., and Ramanathan, J. 39, 769783. Once born, newborns have to deal with the extrauterine environment that, especially for preterm babies, is constituted by the incubator. (2008). The final exciting element in the mix is the exceptional advance in Machine Learning. J. Pediatr. O. Walusinski (Basel: KARGER), 3241. Microbiol. In particular, a steep rise in PNS tone can be detected around 3738 WGA and basal fetal cardiovascular function becomes more influenced by the PNS. Taken together, non-invasive assessment of maternal and fetal health via HRV monitoring throughout the pregnancy, from its earliest stages, will enable an individualized risk profiling and outcome projection during the latter stages of gestation and during delivery, a true disruption of the status quo that will improve maternal and perinatal health outcomes. In fetal surveillance, the situation is very different. Dev. 7, 54. doi: 10.3390/jcdd7040054, Fischer, L. A., Demerath, E., Bittner-Eddy, P., and Costalonga, M. (2019). Psychoneuroendocrinology 87, 2734. Med. Fetal body weight and the development of the control of the cardiovascular system in fetal sheep. Neuroendocrinol. Front. We have attempted to produce a succinct review the physiology of fetal heart rate control that is relevant to the clinician caring for women in labor. (2017). 10. doi: 10.1016/j.preghy.2020.03.003, Moreira Neto, R., and Porovic, S. (2018). Parer JT, Ikeda T. A framework for standardized management of intrapartum fetal heart rate patterns.Am J Obstet Gynecol. Improving pregnancy outcomes in humans through studies in sheep. 77: Palpation . (2014). BJOG Int. Ther. During the 1st trimester, there are no significant differences in HRV track between male and female fetuses (McKenna et al., 2006). The hallmark of a negative feedback loop is that it counteracts a change, bringing the value of a parametersuch as temperature or blood sugarback towards it set point. Pages 78. Dev. Surg. A., and Visser, G. H. A. Lett. doi: 10.1016/j.earlhumdev.2016.05.014, DiPietro, J. doi: 10.1097/EDE.0b013e318187cc5d, Hantoushzadeh, S., Anvari Aliabad, R., and Norooznezhad, A. H. (2020). J. Perinat. 86, 672677. doi: 10.1111/aji.12355, Simkin, J. E., Zhang, D., Stamp, L. A., and Newgreen, D. F. (2019). These patterns are altered by pain and could hence not only be pre-emptive for negative outcomes for labor and birth (Goldenberg et al., 2008), but also suggest their influence on the neurodevelopment of the fetal vagal system itself (Borovikova et al., 2000; Tracey, 2009; Frasch et al., 2016). This affection ultimately interferes with cerebral fetal neurodevelopment, including the nucleus accumbens and hippocampus, that are involved in CAN (Seckl and Meaney, 2004). The effect of labor on maternal and fetal circulating catecholamines. Due to the negative consequences ANS impairment can have later in life, it is paramount to rely on any protective factor that can sustain ANS maturation, starting from taking care of maternal health and lifestyle, which can greatly affect fetal development and, then, breastfeeding. J. doi: 10.1016/j.outlook.2018.11.002, Westerhuis, M. E. M. H., Kwee, A., van Ginkel, A. Anesth. Gut microbiota and gestational diabetes mellitus: a review of host-gut microbiota interactions and their therapeutic potential. One way to approach this question is to confront a simple neural system with conflicting perturbations and determine whether the outcome reflects a coordinated, homeostatic response. Development of the gonad in normal and anencephalic human fetuses. doi: 10.1016/j.scitotenv.2018.09.212. Arch. Rep. 10:17722. doi: 10.1038/s41598-020-74662-0, Kasahara, Y., Yoshida, C., Saito, M., and Kimura, Y. Copyright 2021 Cerritelli, Frasch, Antonelli, Viglione, Vecchi, Chiera and Manzotti. J. Datta Meghe Inst. The 1st stage of labor does not always occur naturally and without complications: consequently, there may be an artificial intervention that causes the induction of labor to increase uterine contractions. 57:101. doi: 10.3345/kjp.2014.57.3.101. Identified Q&As 100+ Solutions available. 92, 691693. (2019). Understanding the mechanisms of fetal heart rate control are important because they help us to infer the physiological state of the baby and gauge whether intervention is really necessary. Correlation between human nervous system development and acquisition of fetal skills: an overview. (2020). The spleen begins to develop at 5 WGA as a lobulated organ, appears clearly around 8 WGA, and initially functions as a hematopoietic center; then, during fetal development, it gradually loses both this role and its lobules (Moore et al., 2016; Hill, 2021a). Evaluation and management of endocrine hypertension during pregnancy. Delivery without labor or preterm birth is associated with lower cortisol, angiotensin, and catecholamines levels compared to labored or full-term delivery. Body temperature, heart rate, and short-term outcome of cooled infants. Sleep Med. J. Matern. Biol. Some authors but not all have shown that a reduction in long-term variability occurs after sympathetic blockade.19-22 Fetal heart rate variability is more than the simple push-pull interactions between the inhibitory and acceleratory limbs of the autonomic nervous system. As gestation proceeds, blood entering the pulmonary circulation increases (Morton and Brodsky, 2016; Tan and Lewandowski, 2020). J. Obstet. (2021). For instance, too high oxygenation can easily induce lung injury, thus increasing inflammation and stressing the already immature CAP, whereas too low oxygenation can cause neurodevelopmental impairment and HIE (Rantakari et al., 2021). Oncotarget 8, 100717100723. doi: 10.1503/cmaj.191372, Beauchaine, T. P., Gatzke-Kopp, L., and Mead, H. K. (2007). A second component of the chemoreflex response to hypoxemia is parasympathetic, mediated via the vagus nerve, resulting in a fall in heart rate. Synchronous caregiving from birth to adulthood tunes humans' social brain. (2018). Ter. doi: 10.1007/BF03009602, Prince, A. L., Ma, J., Kannan, P. S., Alvarez, M., Gisslen, T., Harris, R. A., et al. Magnesium sulfate as a tocolytic agent. Gynaecol. Struggling with daily life and enduring pain: a qualitative study of the experiences of pregnant women living with pelvic girdle pain. Reducing toxic stress in the neonatal intensive care unit to improve infant outcomes. Table 1. The high immunoreactivity of the premature infants' gut could also lead to neurodevelopmental disorders (Cao et al., 2014). Safety of selective serotonin reuptake inhibitors in pregnancy. 51, 346356. 9, 5562, Lecanuet, J. P., Granier-Deferre, C., Jacquet, A. Y., and Busnel, M. C. (1992). Perinatol. 4, 167170. Maternal perfusion in the intervillous space is generally maintained during the early part of a uterine contraction. Res. Ulmer Yaniv, A., Salomon, R., Waidergoren, S., Shimon-Raz, O., Djalovski, A., and Feldman, R. (2021). doi: 10.1073/pnas.2012900118, Urfer-Maurer, N., Ludyga, S., Stalder, T., Brand, S., Holsboer-Trachsler, E., Gerber, M., et al. Regul. Rep. 7:45645. doi: 10.1038/srep45645, Bassols, J., Serino, M., Carreras-Badosa, G., Burcelin, R., Blasco-Baque, V., Lopez-Bermejo, A., et al. In infants born before 36 WGA, there is also a 90% incidence of NEC, as the premature gastrointestinal tract has increased permeability (Garzoni et al., 2013). 37, 558562. doi: 10.1523/JNEUROSCI.3846-13.2013, Khedun, S. M., Maharaj, B., and Moodley, J. The early development of the autonomic nervous system provides a neural platform for social behavior: a polyvagal perspective. Ther. Its dominance results in what effect to the FHR baseline? The pathologies that induce chronic hypoxemia in the mother, including SBD (Pien and Schwab, 2004) and anemia, may induce dysregulations in the vagal control systems. 17, e165e176. Fetal programming of neuropsychiatric disorders. The 3rd stage commences when the fetus is delivered and ends with the delivery of the placenta (afterbirth) (Hutchison et al., 2021). If your doctor identifies reversible causes, theyll likely conduct other tests and closely monitor you. Adverse health outcomes associated with fetal alcohol exposure: a systematic review focused on immune-related outcomes. Aging 78, 117. Gynaecol. doi: 10.1016/0002-9378(82)90616-0, Jonsson, M., Nordn-Lindeberg, S., Ostlund, I., and Hanson, U. 86, 319325. Effects of antihypertensive drugs on the unborn child. 38, R61R88. 296, R702R707. 12, 354356. (2011). 28, 377382. doi: 10.1037/0012-1649.40.3.445, DiPietro, J. It is instead well known that methylmercury from seafood impairs the higher centers of cardiac autonomic function (Karita et al., 2018), leading to severe ANS abnormalities (Srensen et al., 1999; Grandjean et al., 2004; Murata et al., 2006; Gribble et al., 2015). J. Physiol. Neurosci. The frequency and size of deceleration are important indicators as well as the nature of the FHR between contractions and trends over time. Indeed, several studies have shown the vagus nerve is involved in many vital processes during fetal, perinatal, and postnatal life: from the regulation of inflammation through the CAP, which may affect each organ (Herry et al., 2019; Frasch, 2020), to the production of hormones involved in bioenergetic metabolism (Bystrova, 2009). Am. 35, 19431959. A. J. Cardiovasc. (2000). Rochester, NY: Social Science Research Network. 63, 649656. Dev. J. Expo. 39, 608618. Magnesium sulfate, maternal hypothermia, and fetal bradycardia with loss of heart rate variability. Heart rate variability analysis can give paramount hints about the fetus' or newborn's well-being and allow clinicians to predict the occurrence of even deadly complications (Table 1) (Stone et al., 2013; Al-Shargabi et al., 2017; Massaro et al., 2017; Chiera et al., 2020; Frasch, 2020). The fetal heart rate results from the combined effect of several fluctuating influences mediated through extrinsic cardiac control mechanisms (sympathetic and parasympathetic nerves and circulating catecholamines), as well as intrinsic cardiac factors (myocardium and its conducting system). (2014). Monitoring fetal maturationobjectives, techniques and indices of autonomic function. Med. The regulatory patterns of sympathovagal balance show sex-specific differences as pregnancy progresses (Buss et al., 2009). Compared to cesarean section (CS), spontaneous labor without analgesia seems to improve cardiovagal modulation as shown by HF increase and LF decrease, despite several HRV metrics tend to increase in the postnatal days regardless of delivery mode (Kozar et al., 2018). Labor in humans is certainly associated with physiological changes, most of which are regulated by ANS (Sanghavi and Rutherford, 2014; Soma-Pillay et al., 2016). (2008). Health Rep. 2, 304314. During the 2nd trimester, the body becomes covered with lanugo, a fine downy hair that plays a paramount role in neurodevelopment. Curr. Hormones, pregnancy, and autoimmune diseases. Based on their experiments in sheep, this group of fetal physiologists has proposed a different sequence of events to explain decelerations: namely contractions induce a reduction in uteroplacental blood flow and/or cord compression causing a reduction in fetal pO2 that triggers the chemoreflex whose magnitude is related to the degree of hypoxia. doi: 10.1080/14767058.2018.1509067, Brown, A., and Johnston, R. (2013). Placenta Microbiome Diversity Is Associated with Maternal Pre-Pregnancy Obesity and Placenta Biogeography. Therefore, the present paper aims to review the fetal and perinatal development by focusing on the development of the ANS and, in particular, of the vagus nerve to identify possible critical windows that could impact their maturation. The relationship of the fetal head size to the pelvis is important. The long-term consequences of developing cardiac control systems and ANS are hence under investigation (Frasch and Giussani, 2020). Respiratory System Development - Embryology. Immunol. 2In this physiological model, the final steps in two pathways involve hypertension produced directly by umbilical artery obstruction or indirectly by peripheral vasoconstriction. Biol. Curr. Baroreceptor and chemoreceptor responses to umbilical cord - PubMed Sleep patterns in late pregnancy and risk of preterm birth and fetal growth restriction. Dev. Although there are not evident depressive effects on non-stress test reactivity or variability in the case of daily opioid use for chronic pain (Brar et al., 2020), the current guidelines recommend a prescription at the lowest effective dose (Ray-Griffith et al., 2018). Saving the brain one heartbeat at a time: perspectives. Available online at: http://www.ncbi.nlm.nih.gov/books/NBK470566/ (accessed February 22, 2021). Classic teaching on the mechanisms of variable decelerations is outlined in Figure 2. (1998). Res. Another unexpected mechanism that buffers the raise in intrinsic activity is the presence of the ether-a-go-go-related gen K + channel since its activation is illustrated to increase with size reduction. Reflex control of immunity. (2010). doi: 10.1016/j.jpeds.2003.10.058, Graven, S. N., and Browne, J. V. (2008). Mercury exposure and heart rate variability: a systematic review. doi: 10.1080/j.1600-0412.2003.820101.x, Jansson, L. M., DiPietro, J. 179, 551569. doi: 10.1159/000488106, Morton, S. U., and Brodsky, D. (2016). Q. J. Exp. Environmental magnetic field in a neonatal intensive care unit. The human brain at stage 16, including the initial evagination of the neurohypophysis. Dev. Fetal heart rate, heart rate variability, and heart rate/movement coupling in the safe passage study. This increases the flow of deoxygenated blood to your heart and body, including your uterus and placenta. Dev. Assessment of cardiac autonomic function in relation to methylmercury neurotoxicity. Publ. Res. Anatomy and Physiology. 524, 12591269. Little has changed in the physical devices that record fetal heart rate and contractions. Increases baseline b. Decreases baseline b. Normal and abnormal US findings in early first-trimester pregnancy: review of the society of radiologists in ultrasound 2012 consensus panel recommendations. Teratol. ArXiv201102000 Eess Q-Bio. As the vagus nerve affects the body metabolism in a pleiotropic manner, such a review could help better understand the networks underlying this effect and how to harness them for improving fetal and neonatal health (Castel et al., 2020). Semin. 181:108894. doi: 10.1016/j.envres.2019.108894, Bhide, A., and Acharya, G. (2018). Placental microbiome and its role in preterm birth. Nature 405, 458462. which intrinsic homeostatic response is the fetus demonstrating Animal labs provide an opportunity to measure exactly what is happening internally as external conditions are manipulated. Early Hum. Among antihypertensive drugs, methyldopa does not seem to particularly affect fetal well-being. doi: 10.1111/mono.v80.3, DiPietro, J. If the above steps dont prove useful in dealing with late decelerations, especially when they recur and last more than 30 minutes, delivery is a wise option. J. Clin. During the 3rd trimester, distinct fetal behavioral states (i.e., quiet sleep, active sleep, quiet awake, and active awake) become increasingly recognizable through the analysis of heart rate (HR), eye movement, and GMs, as corticothalamic and brainstem areas develop more complex interactions (Brndle et al., 2015; Borsani et al., 2019). BJOG Int. doi: 10.1016/s0025-6196(12)62272-1, Benny, P., Al-Akwaa, F. M., Dirkx, C., Schlueter, R. J., Wolfgruber, T. K., Chern, I. Y., et al. doi: 10.1038/35013070, Borre, Y. E., O'Keeffe, G. W., Clarke, G., Stanton, C., Dinan, T. G., and Cryan, J. F. (2014). Drugs including theophylline, caffeine, and methylxanthine, used to support respiratory functions have the potential of altering sleep quality and induce drowsiness. Immunol. Cardiovascular System - Spleen Development - Embryology. 336, 287297. doi: 10.1016/0378-3782(86)90187-8, Shuffrey, L. C., Myers, M. M., Odendaal, H. J., Elliott, A. J., du Plessis, C., Groenewald, C., et al. J. Obstet. Clin. 2:38. doi: 10.3389/fped.2014.00038, Edlow, A. G. (2017). Auton. Microbiome of the placenta in pre-eclampsia supports the role of bacteria in the multifactorial cause of pre-eclampsia. doi: 10.1542/peds.2015-4271, Conradt, E., Crowell, S. E., and Lester, B. M. (2018). Occupational exposure to chemicals and fetal growth: the generation R study. Sci. (2018). Pediatr. Am. Gynaecol. 36, 23692378. J. Clin. Coordinating Different Homeostatic Processes - ScienceDirect 119, 814. 63, 281287. Available online at: http://www.ncbi.nlm.nih.gov/books/NBK539789/ (accessed April 23, 2021). A., Porges, S. W., Scanlon, J. W., Alemi, B., and Scanlon, K. B. Goldstein, D. S. (2006). 26:101221. doi: 10.1016/j.siny.2021.101221. Reconsidering fetal pain. Similar hints can also be gained by monitoring organ development due to the research regarding the CAP and the systemic interactions of the vagus nerve (Bonaz et al., 2021). J. Nurs. J. Obstet. Core temperature variation is associated with heart rate variability independent of cardiac index: a study of 278 trauma patients. (2014). J. Matern. Heart rate variability analysis allows early asphyxia detection in ovine fetus. Pathogen-induced heart rate changes associated with cholinergic nervous system activation. Med. Transient loss of variability usually is associated with benign conditions like fetal sleep or maternal medications. The evidence so far shows that the intrinsic fHRV is influenced by the fetal ANS activity and, conversely, also shapes the ANS activity into the postnatal period, at least in part via the afferent fibers of the vagus nerve (Herry et al., 2021). Neonatal Individ. 2007 Sep;197(3):236.e1-11. The neurodevelopmental impact of prenatal infections at different times of pregnancy: the earlier the worse? Meas. Hypertension 54, 6370. Res. Ther. (2007). As several vital systems are forming around the end of the 2nd trimester (e.g., alveolar ductal development and surfactant secretion begin at 24 WGA), babies born prematurely before 26 WGA have a higher chance of dying or developing neurodevelopmental disability (Moore et al., 2016; Morton and Brodsky, 2016; Hill, 2021c). Fetal physiology and the transition to extrauterine life. 78, 17881798. Category II Application An antenatal marker of neurodevelopmental outcomes in infants with congenital heart disease. Microglia, the missing link in maternal immune activation and fetal neurodevelopment; and a possible link in preeclampsia and disturbed neurodevelopment? Dalton KJ, Dawes GS, Patrick JE. Heart J. Biol. doi: 10.1002/14651858.CD010333.pub3, AlSaif, S., Mumtaz, S., and Wray, S. (2015). Clin. Oxytocin promotes functional coupling between paraventricular nucleus and both sympathetic and parasympathetic cardioregulatory nuclei. Fetal development assessed by heart rate patternstime scales of complex autonomic control. Choline: exploring the growing science on its benefits for moms and babies. Eur. From 25 WGA until birth, the vagus nerve myelination, the vagal control by the nucleus ambiguus, and, thus, the PNS rapidly develop, as testified by the appearance of short-term variability in frequency-domain HRV metrics (e.g., HF) and the proportional reduction of long-term variability metrics (e.g., LF), more related to SNS and baroreflex functions (Mulkey and du Plessis, 2018, 2019; Schlatterer et al., 2021). Sensors placed against the fetal cheek measure the reflected light in two specific wavelengths and from this the percentage of fetal oxygen saturation can be estimated. Increases baseline b. Decreases baseline b. This phenomenon has the potential of altering ANS in three ways, especially in preterm or vulnerable infants. Rep. 9:11020. doi: 10.1038/s41598-019-47306-1, Mulkey, S. B., Kota, S., Swisher, C. B., Hitchings, L., Metzler, M., Wang, Y., et al. They suggested that late decelerations tend to occur in a fetus with limited reserves that is exposed to modest reductions in uterine blood flow that would not cause bradycardia in a healthy fetus. doi: 10.1016/j.ntt.2010.09.003, Jarczok, M. N., Aguilar-Raab, C., Koenig, J., Kaess, M., Borniger, J. C., Nelson, R. J., et al. The homeostatic response that preserves the . doi: 10.1088/0967-3334/37/9/1436, Lu-Culligan, A., and Iwasaki, A. 27, 12451250. Gomes, E. L. D. F. D., Santos, C. M. D., Santos, A. D. C. S., Silva, A. G. D., Frana, M. A. M., Romanini, D. S., et al. 8, 3841, Pelzer, E., Gomez-Arango, L. F., Barrett, H. L., and Nitert, M. D. (2017). J Physiol. doi: 10.1016/j.psyneuen.2017.10.004, Uvns-Moberg, K., Ekstrm-Bergstrm, A., Berg, M., Buckley, S., Pajalic, Z., Hadjigeorgiou, E., et al. Thanaboonyawat, I., Wataganara, T., Boriboonhiransarn, D., Viboonchart, S., and Tontisirin, P. (2006). Liston R, Crane J, Hamilton E, Hughes O, Kuling S, MacKinnon C, McNamara H, Milne K, Richardson B, Trpanie MJ; Working Group on Fetal Health Surveillance in Labor, Executive and Council, Maternal-Fetal Medicine Committee, Clinical Practice Guideline Committee, and ALARM Committee, Society of Obstetricians and Gynaecologists Canada; Canadian Medical Protection Association.

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