Abstract
BackgroundVariable decelerations are the most frequent fetal heart rate changes that are related to labor. The objective of the study was to estimate the impact of non-significant variable decelerations (NSV) appearing during the latent phase of labor on delivery mode and neonatal outcome.MethodsWomen at term, who were in the latent phase of labor and had a singleton pregnancy, were prospectively included. Women were divided into three groups. All had a fetal heart rate tracing with normal baseline and variability. The study group was composed of women who had in addition NSV, Category II, according to the National Institute of Child Health and Human Development categorization system. Women who had Category I tracings composed the control group. Women who had non-repetitive severe variables (SV) composed a second control group (Category II-SV). Main outcome compared was mode of delivery. Secondary outcome was cord pH. One-way analysis of variance was used to compare the continuous demographic and clinical variables of the three groups. Backwards stepwise logistic regression using significant univariables was performed to determine which predicted operative delivery. P < 0.05 was considered significant.ResultsOf 1005 women who delivered during the study period 186 had Category II- NSV tracings (study group), 76 had Category II-SV and 251 had Category I tracings. Mode of delivery and indications for operative delivery were similar between women in Category II-NSV compared to Category I. In addition mean cord pH did not differ between the two groups. Conversely, women in Category II-SV, had a higher rate of cesarean or vacuum deliveries compared to the other groups (p = 0.0001). Beside, they had a significantly higher number of neonates born with cord pH between 7.0 to 7.1 (p = 0.03).ConclusionsNon-significant variable decelerations in early stages of labor are probably a non-ominous sign for neonatal outcome and have no impact on delivery mode.
Highlights
Variable decelerations are the most frequent fetal heart rate changes that are related to labor
In this study we aimed to investigate whether a difference exists in the progression of fetal heart rate (FHR) tracing to the point that required operative delivery among women who had non-significant variable decelerations early in the latent phase of labor compared to women who had a reassuring FHR tracing
Of the 492 women who were excluded, 263 were admitted in the active phase of labor, 161 were delivered by cesarean section without a trial of labor, 34 were delivered preterm, 25 were in the latent phase but had other FHR tracing abnormalities, 6 were multiple gestations and 3 women had a termination of pregnancy
Summary
Variable decelerations are the most frequent fetal heart rate changes that are related to labor. The objective of the study was to estimate the impact of non-significant variable decelerations (NSV) appearing during the latent phase of labor on delivery mode and neonatal outcome. Variable decelerations are defined as an abrupt (onset to nadir of less than 30 sec) decrease of 15 beats per minute or more of the FHR below the baseline, and lasting 15 seconds or more but less than two minutes in duration [1]. Variable decelerations are the most frequent fetal heart rate (FHR) changes that are related to labor [2]. The management and impact of variable decelerations on neonatal outcome are equivocal. No evidence of the utility or predictive value and the management of these FHR tracings were presented
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