Abstract
Background: Predicting perinatal outcomes based on patterns of fetal heart rate (FHR) remains a challenge. The aim of this study was to evaluate intrapartum FHR variability as predictor for neonatal acidemia and APGAR score.Methods: This was a retrospective observational study of 552 childbirths. Multivariable linear regression models were used to assess the association between FHR variability and each of the following outcomes: arterial cord blood pH and base deficit, Apgar 1, and 5 scores. Variables used for adjustment were maternal age, comorbidities (gestational diabetes, preeclampsia, maternal fever, and hypertension), parity, gravidity, uterine contractions, and newborn gestational age, and weight at birth.Results: The following factors were associated with an increased risk of metabolic acidosis and low Apgar scores at birth: increased mean and coefficient of variation (CV) of the FHR, type of delivery and decreased parity. Each 10-beat/min increase in the FHR was associated with an increase of 0.43 mEq/L in the base deficit, and a decrease of 0.01 in the pH, 0.2 in the Apgar 1, and 0.14 in the Apgar 5 scores. Each 10% increase in the CV of the FHR was associated with an increase of 4.05 mEq/L in the base deficit and a decrease of 0.13 in the pH, 1.31 in the Apgar 1, and 0.86 in the Apgar 5 scores.Conclusion: These data suggest the intrapartum FHR variability is physiologically relevant and can be used for predicting the acidemia and Apgar scores at birth of the newborn infants without severe cases of morbidity and from uncomplicated pregnancies.
Highlights
Contemporary research aims to identify reliable and early markers for the neonatal acidemia and the physical condition of a newborn infant (Devane et al, 2012, 2017)
There is no consensus regarding sensitivity and specificity of cardiotocography classifications in predicting acidemia, with three guidelines for cardiotocography interpretation provided by the International Federation of Gynecology and Obstetrics (FIGO), American College of Obstetrics and Gynecology (ACOG), and National Institute for Health and Care Excellence (NICE) (Bhatia et al, 2017; Santo et al, 2017)
Mean of fetal heart rate (FHR) was not associated with maternal age, history of diabetes mellitus or hypertension or preeclampsia, delivery type, gravidity, parity, gestational week, and mean of uterine contractions
Summary
Contemporary research aims to identify reliable and early markers for the neonatal acidemia and the physical condition of a newborn infant (Devane et al, 2012, 2017). It is theorized that intrapartum cardiotocography FHR could detect fetal hypoxia and/or acidosis allowing a timely intervention to reduce adverse neonatal outcomes such as postnatal cerebral palsy. This is based on the theory that intrapartum hypoxia may lead to alterations in the fetal central nervous system that directly affects the electrical activity of the fetal heart and could induce neonatal cerebral palsy (Garabedian et al, 2017). Predicting perinatal outcomes based on patterns of fetal heart rate (FHR) remains a challenge. The aim of this study was to evaluate intrapartum FHR variability as predictor for neonatal acidemia and APGAR score
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