Change in Heart Rate Variability in Relation to a Significant ST Event Associates With Newborn Metabolic Acidosis

Abstract

Objective To find whether low-to-high frequency (LF/HF) ratio of fetal heart rate (FHR) variability changes in relation to a significant ST-event during delivery, and if the change is predictive of metabolic acidosis of the newborn. Design A case–control study. Setting Data from a multicentre project. Subjects Acidotic and control fetuses with abnormal cardiotocography together with a ST-event in fetal electrocardiogram (ECG). Methods We studied intrapartum FHR variability with spectral analysis from 34 fetuses with a significant ST-event in the fetal ECG. LF/HF ratio of FHR variability was measured within a period of 1 hour before and 1 hour after a significant ST-event. Sensitivity and specificity of the change in LF/HF ratio of FHR variability in prediction of metabolic acidosis (pH ≤ 7.05 and base deficit value > 12.0 mmol/l) of the newborn were described by means of the receiver operating characteristic curve. Main outcome measures Change in LF/HF ratio of FHR in relation to a significant ST-event. Results We found that a relative change in LF/HF ratio greater than 30% in relation to a significant ST-event predicted cord arterial metabolic acidosis with a sensitivity of 89% (95% CI 68–100%) and specificity of 80% (95% CI 64–96%). Conclusions Relative changes in LF/HF ratio of FHR variability in relation to a significant ST-event are more pronounced in fetuses born with metabolic acidosis.