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#Grand Rounds

Is There an Association Between Certain FHR Characteristics and Neonatal Encephalopathy?

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BACKGROUND AND PURPOSE: 

  • Frey et al. (BJOG, 2018) sought to determine if fetal heart rate (FHR) characteristics, specifically category III, were associated with neonatal encephalopathy (NE)

METHODS: 

  • Retrospective case-control study 
    • Women delivering a singleton, non-anomalous infant ≥36 weeks’ gestation 
    • Emergency cesarean without labor were excluded  
    • Cases: Women whose infants were diagnosed with NE  
      • ICD10 codes and maternal/neonatal chart review  
      • Definition based on ACOG and AAP Task Force recommendations 
    • Controls: Women whose infants were unaffected
      • Frequency matched to cases by year   
  • Two MFM physicians blinded to the outcome independently reviewed FHR tracings  
    • On admission that was on average 60 minutes duration  
    • During the last 30 minutes of tracing prior to delivery 
    • NICHD/ACOG guidelines for reading and interpreting FHR tracings  
  • Primary outcome  
    • Presence of specific FHR categories and characteristics

RESULTS: 

  • 109 in the NE group | 233 in the control group 
  • More women in the NE group had category II or III tracings  
    • NE: 54.1% category II | 3.7% category III  
    • Controls: 18.9% category II | 0% category III  
  • Category II FHR tracings were observed in 89% of women prior to delivery and were not independently associated with NE 
  • Category III FHR prior to delivery was observed in 
    • 17.4% in the NE group  
    • 0.9% in the control group  
    • Adjusted odds ratio (aOR) 44.99; 95% CI, 7.23–279.97  
  • NE was associated with 
    • Bradycardia 
    • Minimal/absent variability 
    • Late decelerations (any and recurrent)  
    • Prolonged decelerations 
  • Accelerations were protective of NE 
    • aOR 0.35; 95% CI, 0.21-0.58 
  • Similar associations were found when the cases were limited to subgroups  
    • NE with arterial cord pH <7.1  
    • Category II tracings

CONCLUSION: 

  • Category III tracings are overall uncommon, but seen in approximately 17% of NE infants  
  • Most FHR tracings in NE cases were category II prior to delivery 
    • Some individual characteristics were associated with NE  
  • The authors support the current 3 tier system, suggesting that future research should consider further discrimination among category II tracings  

Obstetric interventions will not prevent all cases of NE; however, our data suggest that there is an association between certain EFM patterns and this clinically important neonatal outcome.

Learn More – Primary Sources: 

An evaluation of fetal heart rate characteristics associated with neonatal encephalopathy: a case‐control study

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Related ObG Topics:

Which Fetal Heart Monitoring Parameters Best Predict Fetal Acidemia?
Electronic Fetal Monitoring vs. Intermittent Auscultation

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