Antenatal prediction of fetal pH in growth restricted fetuses using computer analysis of the fetal heart rate.

Abstract

We tested the accuracy of a mathematical model based on computer analysis of the fetal heart rate tracing in predicting umbilical artery pH at birth. In a previous report based on data on 38 growth-restricted fetuses, the second-order polynomial regression equation, umbilical artery pH = 7.28 + 0.002 (duration of episodes of low variation in minutes) + 0.00009 (duration of episodes of low variation in minutes), was retrospectively found to be the best model for the prediction of umbilical artery pH at birth. In the present study, this formula was prospectively tested in 29 growth restricted fetuses between 26 and 37 weeks of gestation from pregnancies with abnormal uterine and/or umbilical artery Doppler velocimetry. Computer analysis of the fetal heart rate tracing of 1 hour duration was performed within 1.5-6 hours of cesarean birth prior to the onset of labor. Umbilical artery cord blood was collected at birth with pH determined within 5 minutes of collection. Acidemia was defined as umbilical artery pH < 7.20, preacidemia pH 7.20-7.25 and nonacidemia pH > 7.25. Then, the data on all 67 growth-restricted fetuses were pooled to generate a new formula that was retrospectively assessed against the entire group. Values are reported as median (range). In the 29 prospectively evaluated cases, there was no statistical difference between the predicted and actual umbilical artery pH at birth [7.28 (7.1-7.29) vs. 7.28 (7.18-7.37), P = 0.57]. The median difference between the paired predicted and actual umbilical artery pH values was -0.001 (-0.10-0.08). The difference between the predicted and actual umbilical artery pH was zero and within +/- 0.04 in 17% (5/29) and 76% (22/29) of the cases, respectively. When the data on the 67 growth-restricted fetuses were pooled together the formula did not change. There was no difference between the predicted and actual umbilical artery pH at birth when the formula was applied to all 67 growth-restricted fetuses [7.28 (7.08-7.29) vs. 7.27 (6.97-7.37), P = 0.41]. The median difference between the paired predicted and actual pH values was -0.001 (-0.12-0.12). The difference between the predicted and actual umbilical artery pH was zero and within +/- 0.04 in 15% (10/67) and 74% (49/67) of the cases, respectively. The accuracy of the formula in correctly categorizing the umbilical artery pH at birth was: acidemia 67% (8/12), preacidemia 28% (8/29) and nonacidemia 80% (37/46), P < 0.0001. A mathematical formula using the computer analysis index of duration of episodes of low variation reliably predicted umbilical artery pH at birth. This type of noninvasive monitoring may allow for the antepartum estimation and continuous tracking of fetal pH.