Fetal heart rate monitoring casebook. Checkmark fetal heart rate pattern and normal neonatal outcome.

BACKGROUND: A checkmark pattern of the fetal heart rate (FHR) had been seen in association with hypoxia in human and animal fetuses. CASE: We report a checkmark pattern in a fetus of a 26-year-old primigravida who underwent induction of labor at term. Scalp pH was 7.32. Comprehensive ultrasound examination revealed normal results. The neonate was born in satisfactory condition. Apgar scores were 7 and 10 at 1 at 5 minutes of life, respectively. CONCLUSION: Checkmark FHR pattern may be a benign finding; however, if it is detected, it should be closely monitored.     

Fetal heart rate observations in the brain-damaged infant

The objective of this study was to describe the fetal heart rate patterns and underlying pathophysiologic changes in the brain-damaged fetus. Fetuses with brain damage from hypoxic ischemic encephalopathy do not manifest uniform fetal heart rate patterns. However, these fetuses do show distinct fetal heart rate patterns that permit categorization based on their admission heart rate, subsequent changes in their baseline rate; and neonatal findings. Based on the observations of infants brain damaged in utero because of hypoxic ischemic encephalopathy, the intrapartum fetal management will depend on the admission fetal heart rate pattern, and the subsequent changes in the baseline rate.     

Fetal heart rate cyclicity during preterm labor

The cyclic variation in fetal heart rate (FHR) patterns in preterm fetuses throughout labor was studied with a retrospective analysis of 49 FHR tracings. All fetuses were born preterm in good condition, and 92% exhibited the ability to change FHR cycles. A cycle was defined as an FHR pattern with consistent long-term variability in terms of amplitude range. The FHR cycles were significantly shorter in the second stage of labor as compared to the latent and active phases. Cycles of markedly diminished variability (less than or equal to 2.5 beats per minute) were observed in 16% of the fetuses during the latent phase and had a mean duration of 42 minutes, in 21% of the fetuses during the active phase with a mean duration of 68.3 minutes and in 8% of the fetuses during the second stage with a mean duration of 28.5 minutes. Knowledge of the normal length and frequency of FHR cycles is imperative for the correct interpretation of intrapartum FHR patterns in preterm fetuses.     

Fetal heart rate and survival of the very premature newborn

OBJECTIVE: Our purpose was to study the likelihood of survival of infants who are born before 28 weeks of gestation and to examine the influence of fetal heart rate findings on neonatal death. STUDY DESIGN: In this retrospective study, we analyzed the mortality rate of infants at 2 months of age as a function of various obstetric and prenatal indicators. RESULTS: At 2 months, 207 of 325 children were still alive. The survival rate was also a function of gestational age, birth weight, the administration of corticosteroids, multiple pregnancies, and fetal heart rate. Fetal heart rate had the greatest effect on the mortality rate. Children with a reactive rate were 4 times more likely to survive than children with a flat tracing (P =.003; odd ratio, 4; 95% CI, 12.1; 39.8). CONCLUSION: The results in our study lead us to think that recording the fetal heart rate before and during labor may be useful in the prediction of perinatal death and may help obstetric decision-making.     

Fetal heart rate monitoring in the upright pregnant woman

In a prospective study were performed methods for electronic supervision in 163 lying and standing patients beyond the end of pregnancy. Results of the nonstress test (NST) and standing challenge test (SCT) were correlated with late and severe variable decelerations of fetal heart rate during labor, Apgar scores at 5 minutes and pH in arterial cord blood. The correlation of NST and SCT results and the various measures of fetal and neonatal condition indicated that an individual fetus at risk cannot be identified with a high degree of accuracy. There were no significant differences for sensitivity, specificity, positive predictive value and negative predictive value if NST were compared with SCT. The clinical implications of these findings are discussed.     

Fetal heart rate patterns and sudden infant death syndrome

OBJECTIVE: To determine differences in electronic fetal monitoring patterns between infants who died of sudden infant death syndrome and controls. DESIGN: Case-control study (N = 127). SETTING: A tertiary-level women's hospital in Providence, Rhode Island. PARTICIPANTS: Infants born between 1990 and 1998 who subsequently died of sudden infant death syndrome and controls. Demographic and clinical data included medical maternal charts and fetal monitoring records. RESULTS: Compared with controls (n = 98), the mothers whose infants subsequently died of sudden infant death syndrome (n = 29) had lower birthweight babies (sudden infant death syndrome 2,840 vs. controls 3,385 g; p < .01), were younger (22 vs. 28 years; p < .01), were more likely to receive Medicaid health insurance (odds ratio 4.6; confidence interval 1.9-11.2), were more likely to be unmarried (odds ratio 5.2; confidence interval 2.1-12.8), had less intention to breastfeed (26% vs. 57%), and were more likely to smoke (odds ratio 4.6; confidence interval 9-11.2). MAIN OUTCOME MEASURES: There were no statistical differences in fetal heart rate variability or sleep/wake cycles detected between groups. CONCLUSION: Statistical differences were found in demographic characteristics between sudden infant death syndrome mother-infant couples and their controls. However, no differences were detected in the intrapartum electronic fetal monitoring records, specifically in variability and sleep/wake cycles.