Importance of electronic fetal heart rate monitoring in labor to predict neonatal results

  • María Fernanda Nozar Universidad de la República, Facultad de Medicina, Clínica Ginecotocológica ¨C¨ Prof. Dr. J. Alonso, Ginecotocología, Asistente
  • Verónica Fiol Universidad de la República, Facultad de Medicina, Clínica Ginecotocológica ¨C¨ Prof. Dr. J. Alonso, Ginecotocología, Asistente
  • Alma Martínez Universidad de la República, Facultad de Medicina, Clínica Ginecotocológica "C" Prof. J. Alonso, Ginecotocología, Ex Asistente
  • José Enrique Pons Universidad de la República, Facultad de Medicina, Clínica Ginecotológica "A", Profesor Director
  • Justo Alonso Universidad de la República, Facultad de Medicina, Clínica Ginecotológica "C" Prof. J. Alonso, Profesor Director
  • Leonel Briozzo Universidad de la República, Facultad de Medicina, Clínica Ginecotocológica "C" Prof. J. Alonso, Profesor Agregado
Keywords: FETAL MONITORING, LABOR, OBSTETRIC, HEART RATE, FETAL HYPOXIA

Abstract

Introduction: acute fetal distress is a metabolic disorder leading to hypoxia and acidosis that can result in serious lesions and even death. It is one of the main causes for neonatal morbimortality.
Objective: to determine the relationship between the different fetal heart rate patterns corresponding to the suspicion of fetal hypoxia and neonatal results.
Method: a prospective study (November 2001- August 2004) was conducted at the Maternity Service of the Pereira Rossell Hospital. Population: 183 patients were selected according to the following inclusion criteria: single pregnancy, cephalic presentation, labor and electronic monitoring of the fetal heart rate indicating fetal hypoxia. Pregnancy was interrupted in all emergency cases once diagnosis had been made.
Results: average time for diagnosis at birth was 16.97 minutes, with a standard deviation of 7.7 minutes.
Diagnostic patterns were: intra-partum deceleration 2 (106 cases, 58%), persistent bradychardia (79 cases, 43%), decrease in variability (12 cases, 6%), not promising (complex varied deceleration curves, 12 cases, 6%).
Taking the acid-base state as a neonatal variable, the patterns that best predict the perinatal condition for pH levels below 7.10 is fetal bradychardia, representing positive predictive value of 31.6 ( predictive value of the positive test).
Taking into account the need to refer the newborn to the neonatal care unit, the pattern that best predicts this fact is a decrease in variability of 41.7( positive predictive value).
Conclusion: the methods used in the study to diagnose intra-partum hypoxia have low positive predictive values.

References

(1) Moss W, Darmstadt GL, Marsh DR, Black RE, Santosham M. Research priorities for the reduction of perinatal and neonatal morbidity and mortality in developing country communities. J Perinatol 2002; 22: 484-95.
(2) Gardosi J. Monitoring technology and clinical perspective. Baillieres Clin Obstet Gynaecol 1996; 10(2): 325-39.
(3) Alberman E, Blatchley N, Botting B, Schuman J, Dunn A. Medical causes on stillbirth certificates in England and Wales: distribution and results of hierarchical classifications tested by the Office for National Statistics. Br J Obstet Gynaecol 1997; 104(9): 1043-9.
(4) American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Relationship between perinatal factors and neurologic outcome. In: Poland RL, Freeman RK, eds. Guidelines for perinatal care. 3a. ed. Elk Grove Village: AAP, 1992: 221-4.
(5) Briozzo L, Sosa Fuertes C, Martínez A, Rodríguez F, Ferreiro G, Panizza R, et al. Análisis de la prevalencia de sufrimiento fetal agudo, asfixia perinatal y síndrome hipóxico isquémico en la maternidad del Centro Hospitalario Pereira Rossell. Arch Gin Obstet 2003; 41(3): 84-91.
(6) Caldeyro Barcia R, Pose S, Poseiro J, Méndez Bauer C. Monitoreo fetal en el parto: frecuencia cardíaca y equilibrio ácido base fetal. Montevideo: CLAP, 1973. (Publicación científica, 519).
(7) Dillner L. Babies’ deaths linked to suboptimal care. BMJ 1995; 310: 757.
(8) Caldeyro Barcia R. Estudio de la anoxia fetal intrauterina mediante el ECG fetal y el registro continúo de la frecuencia cardíaca fetal. Congreso Latinoamericano de Obstetricia y Ginecología, 3. México, 1958.
(9) Caldeyro Barcia R. Fetal monitoring. In: Report Subcommitte on Health. Washington: Subcommitte on Health, 1978.
(10) Caldeyro Barcia R, Beiniarz J, Poseiro J, Méndez Bauer C, Pose S, Beauquis A, et al. Significado de los cambios registrados en la frecuencia cardíaca fetal durante el parto. Congreso Mexicano de Ginecología y Obstetricia, 4. México, 1963.
(11) Caldeyro Barcia R, Casacuberta C, Bustos R, Giussi G, Gulin L, Escarcena L, et al. Correlation of intrapartum changes in fetal heart rate with blood oxygen and acid-base state. In: Adamsons K, ed. Diagnosis and treatment of fetal disorders. New York: Springer Verlag, 1969: 205-25.
(12) Caldeyro Barcia R, Méndez Bauer C, Poseiro J, Escarcena L, Pose S, Bierniarz J, et al. Control of human fetal heart rate during labor. In: Cassels D, ed. The heart and circulation in the newborn and infant. New York: Grune and Stratton, 1966: 7-36.
(13) Caldeyro Barcia R, Méndez Bauer C, Poseiro J, Pose S. Fetal monitoring in labor, in maternal and child health practices. In: Wallace M, Gold E, Lis E, ed. Maternal and child health practices. Springfield: Charles Thomas, 1973: 332-94.
(14) Briozzo L, Alonso J, Martínez A. Análisis computarizado de la variabilidad de la frecuencia cardíaca fetal como predictor de acidosis perinatal durante el trabajo de parto. Rev Med Urug 1999; 15: 110-25.
(15) Thacker S, Stroup D, Chang M. Continuos electronic heart rate monitoring for fetal assessment during labor. Cochrane Database Syst Rev 2001; (2): CD000063.
(16) Nozar F, Fiol V, Briozzo L. Análisis de la prevalencia de sufrimiento fetal agudo y síndrome hipóxico-isquémico en la maternidad del Centro Hospitalario Pereira Rossell. Arch Gin Obstet 2005; 43(1): 45-9.
(17) Electronic fetal heart rate monitoring: research guidelines for interpretation. National Institute of Child and Human Development Research Planning Workshop. Am J Obstet Gynecol 1997; 177: 1385-90.
(18) Briozzo L. Análisis computarizado de la variabilidad de la frecuencia cardiaca fetal durante el trabajo de parto [tesis doctoral]. Montevideo, ene. 2001.
(19) Briozzo L, Alonso J, Martínez A. Análisis computarizado de la frecuencia cardíaca fetal como predictor de acidosis perinatal durante el trabajo de parto. Rev Méd Urug 1999; 15: 110-25.
(20) Saling E, Schneider D. Biochemical supervision of the foetus during labour. J Obstet Gynaecol Br Commonw 1967; 74: 799-811.
(21) Neilson JP, Mistry RT. Fetal electrocardiogram plus heart rate recording for fetal monitoring during labour. Cochrane Database Syst Rev 2000; (2): CD000116.
(22) Capurro H, Konichezky S, Fonseca D, Caldeyro-Barcia R. A simplified method for diagnosis of gestational age in the newborn infant. J Pediatr 1978; 93: 120-2.
Published
2008-06-30
How to Cite
1.
Nozar MF, Fiol V, Martínez A, Pons JE, Alonso J, Briozzo L. Importance of electronic fetal heart rate monitoring in labor to predict neonatal results. Rev. Méd. Urug. [Internet]. 2008Jun.30 [cited 2024Nov.17];24(2):94-101. Available from: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/578
Issue
Vol 24 No 2 (2008): Revista Médica del Uruguay
Section
Original Articles
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