The development of fetal acidosis in the presence of an abnormal fetal heart rate tracing: I. The average for gestational age fetus

Abstract

An abnormal fetal heart rate (FHR) tracing is a sensitive indicator of positivity that disease exists, but the intrinsic predictive value of such a tracing is disappointingly low because of the large number of false positive results. Abnormal FHR tracings, defined as those having a persistent quantitative score of 4 or less, were measured against time and outcome. A baseline fetal scalp blood sample was taken. Twenty fetuses were acidotic at the first blood samle. There were 121 study cases, all of which were ≥37 weeks' gestational age. All fetuses were average for gestational age. Amniotic fluid was clear, internal FHR tracings were initially normal, and the first pH was normal. A relative acidosis-free interval could be demonstrated during the first 90 to 100 minutes. Following this time period rapid cumulative acidosis was seen, which varied according to the FHR pattern observed. The P50 acidosis values for various patterns were late decelerations, 115 minutes; variable decelerations, 145 minutes; and flat line tracings, 185 minutes.