Fetal pulse oximetry: correlation with intrapartum fetal heart rate patterns and neonatal outcome.
ABSTRACT To determine how fetal pulse oximetry behaves in various cardiotocographic (CTG) tracings and correlates with neonatal outcome.
Pregnant women undergoing active labor with singleton pregnancies of 32-42 weeks were enrolled. CTG recordings were reassuring or nonreassuring (namely variable or persisting late decelerations). Pulse oximetry values during labor and changing throughout deceleration and recovery phases, duration and frequency of pulse oximetry recordings <30%, and neonatal outcome were determined. One-way anova, Tukey test, chi(2)-test and multiple logistic regression model were used for statistical analysis where appropriate.
A total of 156 pregnant subjects were divided into three groups: reassuring fetal heart rate (FHR) patterns (group 1, n=78 [50%]), late decelerations (group 2, n=16 [10.3%]) and variable decelerations (group 3, n=62 [39.7%]). The initial and final pulse oximetry readings, pulse values in first stage of labor, the duration and the frequency of pulse oximetry recordings <30% were significantly different between groups (P<0.001, P<0.001, P<0.001, P=0.001, P<0.001). Fetal acidosis was significantly more frequent with late decelerations (23.1%, P=0.004). A multiple logistic regression model demonstrated that the initial pulse oximetry value during active labor was the most predictive variable of neonatal well-being (P<0.001).
Decreased fetal pulse oximetry values, especially prolonged and recurrent recordings <30% are well-correlated with abnormal FHR patterns, indicating an association with fetal compromise and metabolic acidosis. Going through active labor with a lower initial value of FSpO(2) more frequently leads to an altered FHR pattern and subsequent adverse fetal outcome.
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ABSTRACT: The dominant culture in labor and birth is the medical model, not the midwifery model of woman-centered care. Consensus among professional and governmental groups is that, based on the evidence, intermittent auscultation is safer to use in healthy women with uncomplicated pregnancies than electronic fetal monitoring (EFM). Barriers impact the laboring woman's ability to give informed choice regarding fetal monitoring. Lack of informed choice denies a woman her right to be in control of her birth experience, and is in opposition to a woman's right to autonomy and self-determination.Journal of Perinatal Education 01/2013; 22(3):156-65.
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ABSTRACT: To compare the intrapartum fetal heart rate (FHR) characteristics and selected birth outcomes of nonanomalous trisomy 21 (T21) fetuses to matched controls. Nonanomalous, non-growth-restricted T21 infants were identified and matched by gestational age to presumed euploid controls. We excluded women with scheduled cesarean deliveries and multiple gestations. The incidence of abnormal FHR patterns within 3 hours of delivery and birth outcomes were compared between T21 fetuses and controls. The presence of any abnormal FHR pattern was the primary outcome. Birth outcomes included 5-minute Apgar <7, neonatal intensive care unit admission, and cesarean delivery for fetal indications. Forty-four T21 infants and 44 controls were compared. Of the T21 infants, 83% were postnatally diagnosed. No significant differences were noted in the primary outcome (68% versus 59%, p = 0.37) or birth outcomes. T21 is not associated with an increased incidence of abnormal FHR patterns or adverse birth outcomes compared with presumed euploid fetuses.American Journal of Perinatology 03/2012; 29(6):415-8. · 1.57 Impact Factor