Original Paper Received: September 10, 2014 Accepted after revision: February 9, 2015 Published online: April 17, 2015

Fetal Diagn Ther DOI: 10.1159/000380820

Short-Term Variation of the Fetal Heart Rate for Predicting Neonatal Acidosis in Preeclampsia Eva Marie Aernout a Patrick Devos b Philippe Deruelle a, c Véronique Houfflin-Debarge a, c Damien Subtil a, d   

 

 

 

a

 

Pôle Femme Mère Nouveau-né, Hôpital Jeanne de Flandre, b Department of Biostatistics, c EA 4489, IMPRT, Faculté de Médecine Henri Warembourg, and d EA 2694, Université Lille Nord de France, Lille, France  

 

 

 

Abstract Introduction: The aim of this study was to measure the performance of short-term variation (STV) in predicting the onset of neonatal acidosis in fetuses at risk due to maternal preeclampsia. Material and Methods: This retrospective study examined data from a series of 159 women with singleton pregnancies, hospitalized for preeclampsia in a level 3 reference maternity hospital in northern France, with an STV measurement in the 24 h preceding cesarean delivery and a measurement of the newborn’s arterial cord pH at birth. The main outcome was determined by a correlation between STV and neonatal pH. Results: The last computerized fetal heart rate analysis took place a mean of 7.9 ± 6.3 h before birth, and neonatal acidosis was diagnosed in 38 newborns (23.9%). Although STV and umbilical artery pH at birth were significantly correlated (ρ = 0.16, p < 0.05), the performance of STV in predicting neonatal acidosis was poor, with an area under the ROC curve of 0.63. The sensitivity reached only

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50.0% and the specificity 71.9% at the best STV threshold for predicting acidosis. Conclusion: The performance of STV for screening for neonatal acidosis is poor in women with preeclampsia. The divergent results between studies are probably due to the variable intervals between STV measurement and birth. © 2015 S. Karger AG, Basel

Introduction

The occurrence of neonatal acidosis – regardless of whether the birth is preterm or not – is a poor prognostic factor because it is associated with an increased risk of intraventricular hemorrhage and long-term neurological sequelae [1, 2]. In situations with a risk of acidosis during pregnancy, surveillance of fetal well-being is justified and relies principally on visual analysis of the fetal heart rate (FHR) [3] and is sometimes, despite its limitations, combined with ultrasound assessment of signs of well-being [4]. Nonetheless, this surveillance of FHR is difficult because of its low specificity [5], especially at early gestational ages [6]. Eva Marie Aernout Hôpital Jeanne de Flandre Université Lille Nord de France 1 rue Eugène Avinée, FR–59037 Lille Cedex (France) E-Mail eva.aernout @ gmail.com

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Key Words Computerized cardiotocography · Fetal heart rate · Short-term variation · Neonatal acidosis · Preeclampsia

Material and Methods This retrospective study examined data from a series of patients with preeclampsia hospitalized in our level 3 reference maternity hospital, which delivers around 4,500 infants annually, over an 11.5-year period from March 22, 1996 (when our department opened) to September 22, 2007. The inclusion criteria were a singleton pregnancy, hospitalization for moderate or severe preeclampsia, at least one STV measurement by computerized FHR analysis in the 24 h preceding cesarean delivery before labor, and a measurement of the newborn’s arterial cord pH at birth. When several measurements took place during this 24-hour period, only the last STV value, the one closest to birth, was used. In all cases, the computerized analysis was performed with the Oxford 8000 and 8002 systems (Sonicaid; Oxford Medical Ltd., Old Woking, UK). The National Ethics Committee for Research in Gynecology and Obstetrics (CEROG) approved the study protocol and examined the research. It was found to conform to generally accepted scientific principles and medical research ethical standards (submission No.: CEROG OBS 2012-1003, date of approval: November 28th, 2012). Preeclampsia was diagnosed when blood pressure was ≥140/90 mm Hg and proteinuria was >300 mg/l or 2+ on the urinary dipstick. Preeclampsia was considered severe if any of the following signs was observed: systolic blood pressure ≥160 mm Hg, diastolic blood pressure ≥110 mm Hg, oliguria

Short-Term Variation of the Fetal Heart Rate for Predicting Neonatal Acidosis in Preeclampsia.

The aim of this study was to measure the performance of short-term variation (STV) in predicting the onset of neonatal acidosis in fetuses at risk due...
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