Download PDF
Am J Perinatol 2016; 33(07): 665-670
DOI: 10.1055/s-0036-1571316
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Nonreassuring Fetal Status in the Second Stage of Labor: Fetal Monitoring Features and Association with Neonatal Outcomes

Jourdan E. Triebwasser
1   Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
,
Ryan Colvin
2   Pediatrics Computing Facility, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
George A. Macones
3   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
Alison G. Cahill
3   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
› Author Affiliations
Further Information

Publication History

15 April 2015

03 December 2015

Publication Date:
10 February 2016 (online)

Also available at
    Permissions and Reprints

Abstract

Objective To examine features of electronic fetal monitoring that prompt a diagnosis of nonreassuring fetal status (NRFS) and their association with acidemia.

Study Design We identified all operative (cesarean or operative vaginal) deliveries from a retrospective cohort study of term singletons delivered in the second stage. The primary exposure was indication for delivery, NRFS versus other. We compared fetal monitoring features in the 30 minutes prior to delivery. In those delivered for NRFS, we assessed features associated with acidemia (pH < 7.2). Logistic regression adjusted for confounders.

Results Of 5,388 patients, 770 (14%) were delivered operatively. NRFS (77%) was associated with acidemia (adjusted odds ratio 3.7, 95% confidence interval 2.1–6.5). Total deceleration area, repetitive late decelerations, and marked variability were associated with NRFS. However, only number of prolonged decelerations and total deceleration area were associated with acidemia in the NRFS group.

Conclusion The majority of deliveries for NRFS and the features that prompt that diagnosis are not associated with acidemia.

Keywords

nonreassuring fetal status - indication - operative delivery - fetal monitoring - second stage
 

  • References

  • 1 Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML. Births: final data for 2002. Natl Vital Stat Rep 2003; 52 (10) 1-113
    PubMedGoogle Scholar
  • 2 Thacker SB, Stroup DF, Chang M. Continuous electronic heart rate monitoring for fetal assessment during labor. Cochrane Database Syst Rev 2001; (2) CD000063
    PubMedGoogle Scholar
  • 3 Macones GA, Hankins GD, Spong CY, Hauth J, Moore T. The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring: update on definitions, interpretation, and research guidelines. Obstet Gynecol 2008; 112 (3) 661-666
    CrossrefPubMedGoogle Scholar
  • 4 Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol 2012; 120 (5) 1181-1193
    CrossrefPubMedGoogle Scholar
  • 5 Cahill AG, Roehl KA, Odibo AO, Macones GA. Association and prediction of neonatal acidemia. Am J Obstet Gynecol 2012; 207 (3) 206.e1-206.e8
    CrossrefPubMedGoogle Scholar
  • 6 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol 2009; 114 (1) 192-202
    CrossrefPubMedGoogle Scholar
  • 7 Jackson M, Holmgren CM, Esplin MS, Henry E, Varner MW. Frequency of fetal heart rate categories and short-term neonatal outcome. Obstet Gynecol 2011; 118 (4) 803-808
    CrossrefPubMedGoogle Scholar
  • 8 Low JA, Victory R, Derrick EJ. Predictive value of electronic fetal monitoring for intrapartum fetal asphyxia with metabolic acidosis. Obstet Gynecol 1999; 93 (2) 285-291
    CrossrefPubMedGoogle Scholar
  • 9 Larma JD, Silva AM, Holcroft CJ, Thompson RE, Donohue PK, Graham EM. Intrapartum electronic fetal heart rate monitoring and the identification of metabolic acidosis and hypoxic-ischemic encephalopathy. Am J Obstet Gynecol 2007; 197 (3) 301.e1-301.e8
    CrossrefPubMedGoogle Scholar
  • 10 Schmidt S, Koslowski S, Sierra F, Meyer-Wittkopf M, Heller G. Clinical usefulness of pulse oximetry in the fetus with non-reassuring heart rate pattern?. J Perinat Med 2000; 28 (4) 298-305
    CrossrefPubMedGoogle Scholar