Poster Session 3
Fabrizio Zullo, MD (he/him/his)
Ob/Gyn Resident
University of Rome La Sapienza
Rome, Lazio, Italy
Roby Lauren, MD
Christiana Care Health System
Newark, Delaware, United States
Cassidy A. O'Sullivan, MD
OB/GYN Resident
Christiana Care Health System
Newark, Delaware, United States
Ha L. Tran, MD
Nemours Children's Hospital
Wilmington, Delaware, United States
Giuseppe Rizzo, MD
Sapienza Università di Roma (ROMA)
Rome, Lazio, Italy
Kelley Kovatis, MD
Christiana Care Health System
Newark, Delaware, United States
Matthew K. Hoffman, MD, MPH
Marie E. Pinizzotto, M.D., Endowed Chair of Obstetrics and Gynecology at Christiana Care
Christiana Care Health System
Newark, Delaware, United States
Anthony C. Sciscione, DO
Program Director
Christiana Care Health System
Newark, Delaware, United States
Suneet P. Chauhan, MD
Director of MFM Research
Delaware Center of Maternal-Fetal Medicine at Christiana Care
Delaware, Delaware, United States
The significance of a change in baseline fetal heart rate tracing (FHRT) is unclear. We aim to estimate the incidence of change in FHR baseline in deliveries at 22.0 to 31.6 weeks gestational age (wga) and associated neonatal morbidity or mortality.
Study Design:
A retrospective review of all deliveries from Jan to Dec 2023 at a tertiary care referral hospital. The inclusion criteria included delivery at 22-31 wga, of a non-anomalous singleton, where at least 40 minutes of a FHRT was available, and neonatal resuscitation was initiated. A physician—blinded to maternal characteristics and peripartum outcomes—reviewed the FHRT (0-120 min proximal to delivery, at 20 min epochs). FHR baseline variation was assessed by calculating a delta (D) between the last and the first epoch. Neonatal outcomes were abstracted. The primary outcome was long term neonatal morbidity or mortality (LTNMM); the secondary outcomes were Apgar score of 4-6 at 5-min and short-term neonatal morbidity or mortality (STNMM). Descriptive statistics with 95% confidence intervals (CI) were calculated, and non-overlapping CI was considered significant.
Results:
Among the 6,521 deliveries, 169 (2%) occurred at 22-31.6 wga, of which 97 (57%) met the inclusion criteria. Magnesium sulfate was administered in 97% of the newborns and antenatal corticosteroids in 98%. A positive variation (+ D) in baseline occurred in 26/97 (26%) patients, and the likelihood of LTNMM in this cohort was 9/26 (34%; 95% CI 18.4-55.3). A negative variation (- D) in baseline occurred in 29/97 patients (29%), and the likelihood of LTNMM in this cohort was 11/29 (37%; 95% CI 21-57).
A neutral variation (D=0) occurred in 42/97 (43.3%) of cases with a LTNM rate of 18/42 (42%; 95% CI 2858. Each analyzed cohort, even when stratified for discreet changes, had overlapping CI for all outcomes examined (Table 1).
Conclusion: Among newborns delivered at 22.0 to 31.6 weeks, change in baseline was noted in the majority and, irrespective of direction, it was not associated with adverse fetal outcome.
