Fetal heart rate changes on the cardiotocograph trace secondary to maternal COVID-19 infection

Anna Gracia-Perez-Bonfils, Oscar Martinez-Perez, Elisa Llurba, Edwin Chandraharan, Anna Gracia-Perez-Bonfils, Oscar Martinez-Perez, Elisa Llurba, Edwin Chandraharan

Abstract

Objective: To determine the cardiotocograph (CTG) changes in women with symptomatic COVID-19 infection.

Study design: 12 anonymised CTG traces from 2 hospitals in Spain were retrospectively analysed by 2 independent assessors. CTG parameters were studied based on fetal pathophysiological responses to inflammation and hypoxia that would be expected based on the pathogenesis of COVID-19 patients. Correlation was made with perinatal outcomes (Apgar score at 5 min and umbilical cord pH).

Results: All fetuses showed an increased baseline FHR > 10 percent compared to the initial recording, in addition to absence of accelerations. 10 out of 12 CTG traces (83.3 percent) demonstrated late or prolonged decelerations and 7 out of 12 fetuses (58.3 percent) showed absence of cycling. Not a single case of sinusoidal pattern was observed. ZigZag pattern was found in 4 CTG traces (33 percent). Excessive uterine activity was observed in all CTG traces where uterine activity was monitored (10 out of 12). Apgar scores at 5 min were normal (>7) and absence of metabolic acidosis was found in the umbilical cord arterial pH (pH > 7.0) in the cases that were available (11 and 9, respectively).

Conclusion: Fetuses of COVID-19 patients showed a raised baseline FHR (>10 percent), loss of accelerations, late decelerations, ZigZag pattern and absence of cycling probably due to the effects of maternal pyrexia, maternal inflammatory response and the "cytokine storm". However, the perinatal outcomes appear to be favourable. Therefore, healthcare providers should optimise the maternal environment first to rectify the reactive CTG changes instead of performing an urgent operative intervention.

Keywords: COVID-19; CTG; Cardiotocograph; Cytokine storm; Physiological CTG interpretation; ZigZag pattern.

Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Copyright © 2020 Elsevier B.V. All rights reserved.

Figures

Fig. 1
Fig. 1
Absence of accelerations in the CTG trace of a patient with COVID-19 infection.
Fig. 2
Fig. 2
Late decelerations in the CTG trace of a patient with COVID-19 infection.
Fig. 3
Fig. 3
Prolonged deceleration in the CTG trace of a patient with COVID-19 infection.
Fig. 4
Fig. 4
Absence of cycling in the CTG trace of a patient with COVID-19 infection.
Fig. 5
Fig. 5
ZigZag pattern (exaggerated variability) in the CTG trace of a patient with COVID-19 infection.

References

    1. Pinas A., Chandraharan E. Continuous cardiotocography during labour: analysis, classification and management. Best Pract Res Clin Obstet Gynaecol. 2016 doi: 10.1016/j.bpobgyn.2015.03.022.
    1. Chandraharan E., Sabaratnam A. Prevention of birth asphyxia : responding appropriately to cardiotocograph (CTG) traces. Best Pract Res Clin Obstet Gynaecol. 2007;21(4):609–624. doi: 10.1016/j.bpobgyn.2007.02.008.
    1. Li X., Geng M., Peng Y., Meng L., Lu S. Molecular immune pathogenesis and diagnosis of COVID-19. J Pharm Anal. 2020;19(xxxx):1–7. doi: 10.1016/j.jpha.2020.03.001.
    1. Zhang Y., Gao Y., Qiao L., Wang W., Chen D. Inflammatory Response Cells During Acute Respiratory Distress Syndrome in Patients With Coronavirus Disease 2019 (COVID-19) Ann Intern Med. 2020 doi: 10.7326/L20-0227.
    1. Terpos E., Ntanasis-Stathopoulos I., Elalamy I. Hematological findings and complications of COVID-19. Am J Hematol. 2020 doi: 10.1002/ajh.25829.
    1. Karami P., Naghavi M., Feyzi A. Mortality of a pregnant patient diagnosed with COVID-19: a case report with clinical, radiological, and histopathological findings. Travel Med Infect Dis. 2020;(April):101665. doi: 10.1016/j.tmaid.2020.101665.
    1. Mason R.J. Pathogenesis of COVID-19 from a cell biologic perspective. Eur Respir J. 2020 doi: 10.1183/13993003.00607-2020.
    1. Rasmussen S.A., Smulian J.C., Lednicky J.A., Wen T.S., Jamieson D.J. Coronavirus Disease 2019 (COVID-19) and Pregnancy: What obstetricians need to know. Am J Obstet Gynecol. 2020;2019 doi: 10.1016/j.ajog.2020.02.017.
    1. Alzamora M.C., Paredes T., Caceres D., Webb C.M., Valdez L.M., La Rosa M. Severe COVID-19 during pregnancy and possible vertical transmission. Am J Perinatol. 2020;1(212) doi: 10.1055/s-0040-1710050.
    1. Chen H., Guo J., Wang C. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395(10226):809–815. doi: 10.1016/S0140-6736(20)30360-3.
    1. Gracia-Perez-Bonfils A., Vigneswaran K., Cuadras D., Chandraharan E. Does the saltatory pattern on cardiotocograph (CTG) trace really exist? The ZigZag pattern as an alternative definition and its correlation with perinatal outcomes. J Matern Fetal Neonatal Med. 2019:1–9. doi: 10.1080/14767058.2019.1686475.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever