Intrapartum cardiotocography with simultaneous maternal heart rate registration improves neonatal outcome - 02/04/24
Abstract |
Background |
Intrapartum cardiotocographic monitoring of fetal heart rate by abdominal external ultrasound transducer without simultaneous maternal heart rate recording has been associated with increased risk of early neonatal death and other asphyxia-related neonatal outcomes. It is unclear, however, whether this increase in risk is independently associated with fetal surveillance method or is attributable to other factors.
Objective |
This study aimed to compare different fetal surveillance methods and their association with adverse short- and long-term fetal and neonatal outcomes in a large retrospective cohort of spontaneous term deliveries.
Study Design |
Fetal heart rate and maternal heart rate patterns were recorded by cardiotocography during labor in spontaneous term singleton cephalic vaginal deliveries in the Hospital District of Helsinki and Uusimaa, Finland between October 1, 2005, and September 30, 2023. According to the method of cardiotocography monitoring at birth, the cohort was divided into the following 3 groups: women with ultrasound transducer, women with both ultrasound transducer and maternal heart rate transducer, and women with internal fetal scalp electrode. Umbilical artery pH and base excess values, low 1- and 5-minute Apgar scores, need for intubation and resuscitation, neonatal intensive care unit admission for asphyxia, neonatal encephalopathy, and early neonatal death were used as outcome variables.
Results |
Among the 213,798 deliveries that met the inclusion criteria, the monitoring type was external ultrasound transducer in 81,559 (38.1%), both external ultrasound transducer and maternal heart rate recording in 62,268 (29.1%), and fetal scalp electrode in 69,971 (32.7%) cases, respectively. The rates of both neonatal encephalopathy (odds ratio, 1.48; 95% confidence interval, 1.08–2.02) and severe acidemia (umbilical artery pH <7.00 and/or umbilical artery base excess ≤−12.0 mmol/L) (odds ratio, 2.03; 95% confidence interval, 1.65–2.50) were higher in fetuses of women with ultrasound transducer alone compared with those of women with concurrent external fetal and maternal heart rate recording. Monitoring with ultrasound transducer alone was also associated with increased risk of neonatal intubation for resuscitation (odds ratio, 1.22; 95% confidence interval, 1.03–1.44). A greater risk of severe neonatal acidemia was observed both in the ultrasound transducer (odds ratio, 2.78; 95% confidence interval, 2.23–3.48) and concurrent ultrasound transducer and maternal heart rate recording (odds ratio, 1.37; 95% confidence interval, 1.05–1.78) groups compared with those monitored with fetal scalp electrodes. No difference in risk of neonatal encephalopathy was found between newborns monitored with concurrent ultrasound transducer and maternal heart rate recording and those monitored with fetal scalp electrodes.
Conclusion |
The use of external ultrasound transducer monitoring of fetal heart rate without simultaneous maternal heart rate recording is associated with higher rates of neonatal encephalopathy and severe neonatal acidemia. We suggest that either external fetal heart rate monitoring with concurrent maternal heart rate recording or internal fetal scalp electrode be used routinely as a fetal surveillance tool in term deliveries.
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Key words : cardiotocography, electronic fetal monitoring, fetal heart rate, maternal heart rate, neonatal outcome, perinatal asphyxia
Plan
The authors report no conflict of interest. |
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M.T. has received support from the Foundation for Pediatric Research in Finland, Finska Läkaresällskapet, Olga and Vilho Linnamo Foundation, and a Special Governmental Subsidy for Clinical Research, Finland. S.A. has received grants from Finska Läkaresällskapet, the Foundation for Pediatric Research in Finland, and a Special Governmental Subsidy for Clinical Research, Finland. Open access funding provided by University of Helsinki including Helsinki University Central Hospital. The sponsors had no role in the study design; collection, analysis, or interpretation of data; writing of the report; or the decision to submit the report for publication. |
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Data from this study are available on reasonable request from the corresponding author. The data are not publicly available because of privacy and ethical restrictions. |
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Cite this article as: Tarvonen M, Markkanen J, Tuppurainen V, et al. Intrapartum cardiotocography with simultaneous maternal heart rate registration improves neonatal outcome. Am J Obstet Gynecol 2024;230:379.e1-12. |
Vol 230 - N° 4
P. 379.e1-379.e12 - avril 2024 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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