Characterization of Fetal Heart Rate Tracings During Eclamptic Seizures [15P

Abstract

INTRODUCTION: The well-known association of fetal bradycardia following maternal eclampsia has not been described in detail. We sought to characterize fetal heart rate tracing at the time of an intrapartum maternal eclamptic seizure and the changes in obstetric management that may result. METHODS: This was a retrospective study of fetal heart rate tracings recorded during an eclamptic seizure and the resultant obstetrical management of our institution from August 2009 to December 2016. Eclampsia was diagnosed according to criteria of the ACOG Executive Summary. Tracings were reviewed independently by three physicians based on the National Institute of Child Health and Human Development Criteria. Maternal and fetal outcomes were then analyzed. RESULTS: A total of 70 women were diagnosed with eclampsia during this time period. Nineteen women experienced a confirmed intrapartum seizure while on fetal heart rate monitors. Of those who experienced an intrapartum seizure, 16 of the 19 patients (84%) developed fetal heart rate decelerations with a mean duration of 6±4 minutes. For all women, the mean duration from the eclamptic seizure to delivery was 244±263 minutes. As a result of the fetal heart rate tracings, two patients underwent a change in obstetric management with a resultant emergent cesarean delivery due to profound bradycardia to the 50s without recovery. There were no neonatal deaths and three neonatal intensive care admissions. CONCLUSION: Management of fetal bradycardia during eclamptic seizures remains challenging. Despite a period of prolonged fetal bradycardia associated with intrapartum eclampsia, close observation resulted in a favorable neonatal outcome in the majority of cases.