Marked variability in intrapartum electronic fetal heart rate patterns: association with neonatal morbidity and abnormal arterial cord gas

Brock Polnaszek, Julia D López, Reece Clark, Nandini Raghuraman, George A Macones, Alison G Cahill, Brock Polnaszek, Julia D López, Reece Clark, Nandini Raghuraman, George A Macones, Alison G Cahill

Abstract

Objective: Investigate marked variability in fetal heart rate (FHR) patterns before delivery and its association with neonatal morbidity and abnormal arterial cord gases.

Study design: Prospective cohort of laboring patients at term. Composite neonatal morbidity (respiratory distress, mechanical ventilation, suspected sepsis, meconium aspiration syndrome, therapeutic hypothermia, hypoxic-ischemic encephalopathy, seizure, and death) and abnormal arterial cord gases (pH < 7.10, lactate ≥ 4 mmol/L, base deficit < -12 mEq/L) were assessed with multivariable logistic regression.

Result: Three hundred and ninety (4.5%) neonates had marked variability in FHR patterns before delivery. There was no difference in composite neonatal morbidity (aRR 1.22; 95% CI 0.91-1.63), though neonates with marked variability in FHR patterns were more likely to have a respiratory distress (aRR 1.85; 95% CI 1.25-2.70). There was an increased risk of composite abnormal arterial cord gases (aRR 1.66; 95% CI 1.47-1.88).

Conclusion: Marked variability in FHR patterns was not associated with composite neonatal morbidity but was associated with abnormal arterial cord gases.

Conflict of interest statement

Financial Disclosure: The authors did not report any potential conflicts of interest. Each author has indicated that he or she has met the journal’s requirements for authorship.

Figures

Figure 1.
Figure 1.
Flowchart of study participants a Marked variability in FHR patterns was defined as fluctuations in FHR amplitude of > 25 beats per minute based on 10-minute epochs, excluding accelerations and decelerations from baseline in the last 120 minutes bAcidemia defined as umbilical artery pH <7.10
Figure 2.
Figure 2.
Time marked variability in FHR patterns occurred by 10-minute epochs in the last 120 minutes before delivery (N=390)

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Source: PubMed

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