TITLE:
Association between Fetal Heart Rate Monitoring during Labor and Neonatal Acidosis in Full-Term Newborns: A Retrospective Multicenter Cohort Study
AUTHORS:
Anne-Charlotte Faivre, Salma Tazi, Jan Chrusciel, Stéphane Sanchez, Nathalie Bednarek, René Gabriel, Perrine Moussy, Olivier Graesslin
KEYWORDS:
Fetal Heart Rate, Neonatal Acidosis, Third Stage of Labor, Newborn
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.10 No.9,
September
23,
2020
ABSTRACT: Introduction: Fetal heart rate monitoring during labor is used to study fetal
well-being and predict neonatal acidosis of newborn. Fetal heart rate
monitoring is analyzed by the obstetrical team and categorized according to the
FIGO guidelines. An important limitation of this diagnostic tool is an inter-
and intra-observer variability, leading to subjective cardiotocography
interpretation and classification. Our objective was to study the association
between the categories of fetal heart rate analysis (according to FIGO
classification) and neonatal acidosis of full-term newborns. Study design: This is a multicenter retrospective cohort study conducted between 2014 and
2018 in the Grand-Est region. We searched and included retrospectively children
hospitalized in a pediatric intensive care unit in one of the participating
hospitals with an ICD-10 coding type “P91.6” corresponding to “Hypoxic Ischemic
Encephalopathy”. Maternal, pregnancy, delivery, and newborn characteristics
were collected and compared by univariate logistic regression with multiple
imputation. Odds Ratio and 95% confidence intervals (CI) were calculated using
the model and presented. Multiple imputation with m = 100 imputations was
tested, using Rubin rules to combine the results. Results: 55 patients
were included in the study. Fetal heart rate tracings classified in Category 3
as “pathological” according to FIGO guidelines were significantly associated
with an increased risk of severe neonatal acidosis. Late decelerations and
bradycardia during labor were associated with severe neonatal acidosis. Conclusion: Severe neonatal acidosis may be suspected by interpretation of fetal heart rate
during labor. Fetal bradycardia and late decelerations are predictive of the
severity of neonatal acidosis. This study emphasizes the need to screen severe
neonatal acidosis and allows the identification of populations most at risk.
Repeated team training and upgrading of fetal heart rate study would further
reduce the incidence of neonatal acidosis.