Clinical significance of fetal heart rate patterns during labor: II. Late decelerations

Abstract

Among a population of high-risk patients in labor who had continuous “direct” electronic monitoring, 147 presented late decelerations and 598 had no decelerations at the time the first stage was completed, or a cesarean section decided upon. A variety of clinical aspects of mother and fetus were analyzed, considering some alterations observed in the FHR pattern. Apgar scores were lower among decelerations, and there was a negative correlation between these two. Maternal pathology, other than PRM, was higher among decelerations and these required enhancement more often. There was very high association with tachycardia, saltatory, and fixed baseline among decelerations, and these infants were very often distressed and born depressed. Within the group of decelerations, small fetuses had lower Apgar scores. There was a negative correlation between number of decelerations and Apgar score. The small fetuses had a high incidence of tachycardia and fixed baseline, saltatory being almost absent. Their neonatal outcome was poor. A comparison of fetal response to distress was done considering age of gestation (premature, term, and postmature) and found to be different. The mechanisms involved in late deceleration are discussed, reviewing the published experimental work. When interpreting FHR patterns, age of gestation should be one of the most important considerations.