The value of the short-term fetal heart rate variation for timing the delivery of growth-retarded fetuses.

Journal article

OBJECTIVE: To assess the clinical value of the short-term fetal heart rate variation (STV) for timing the delivery of severely growth-retarded fetuses, many associated with pre-eclampsia. DESIGN: Retrospective cohort study. SETTING: John Radcliffe Maternity Hospital, Oxford, UK. POPULATION: Two hundred and fifty-seven fetuses with a birthweight less than third percentile and a last computerised cardiotocography performed within 24 h of delivery. METHODS: Analysis of the relationship between antepartum STV and the perinatal outcome. MAIN OUTCOME MEASURES: Stillbirth rate and the acid-base status at birth. RESULTS: There were no stillbirths or neonatal deaths (NNDs) within 24 h in the study population. Decreasing STV was correlated with earlier deliveries (P < 0.001), lower birthweight (P < 0.001), lower umbilical artery pH at birth (P < 0.001), worse acid-base status at birth (P < 0.001) and worse postnatal outcome (P < 0.002). The STV was able to predict the presence or absence of acidaemia and metabolic acidaemia (area under the receiver operating characteristic curve 0.70 and 0.75, respectively, P < 0.001). The risk of metabolic acidaemia increased as the antepartum STV decreased, the optimum cutoff level being < or = 3.0 milliseconds (positive and negative predictive values 64.6 and 86.6%). An STV < or = 3.0 milliseconds was associated with markedly higher rate of metabolic acidaemia and early NNDs compared with an STV > 3.0 milliseconds (54.2 versus 10.5% and 8.3 versus 0.5%, respectively; P < 0.001). The deaths of the former group were all due to extreme prematurity and very low birthweight. CONCLUSIONS: The antepartum STV is an important marker of perinatal outcome in severely growth-retarded fetuses. Timing the delivery of the most preterm and small fetuses remains a difficult task.

Authors: Serra, V; Moulden, M; Bellver, J; Redman, C

• Publication status: Published
• Journal: BJOG : an international journal of obstetrics and gynaecology
• Volume: 115
• Issue: 9
• Pages: 1101-1107
• Publication date: 2008-08-01
• DOI: 10.1111/j.1471-0528.2008.01774.x
• EISSN: 1471-0528
• ISSN: 1470-0328
• Language: English
• Keywords: Retrospective Studies; Humans; Fetal Growth Retardation; Female; Male; Adolescent; Time Factors; Gestational Age; Heart Rate, Fetal; Cardiotocography; Acid-Base Imbalance; Delivery, Obstetric; Adult; Infant, Newborn