Poster Session 3
Rachel L. Wiley, MD, MPH (she/her/hers)
MFM Fellow
University of California, San Diego
San Diego, California, United States
Kristen A. Cagino, MD
Maternal Fetal Medicine Fellow
UT Houston
Houston, Texas, United States
Aaron W. Roberts, MD
Assistant Professor
McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Claudia J. Ibarra, MD, MPH (she/her/hers)
MFM Fellow
McGovern Medical School at UTHealth
Houston, TX, United States
Shareen Patel, MD
Resident
McGovern Medical School at UTHealth
Houston, Texas, United States
Christina Cortes, MD (she/her/hers)
Resident
McGovern Medical School at UTHealth
Houston, Texas, United States
Khalil M. Chahine, MD
Resident
McGovern Medical School at UTHealth
Houston, Texas, United States
Natalie L. Neff, MD
Maternal Fetal Medicine Fellow
McGovern Medical School at UT Health
Houston, Texas, United States
Kimen S. Balhotra, MD (she/her/hers)
Maternal Fetal Medicine Fellow
McGovern Medical School at UTHealth
Houston, TX, United States
Tala Ghorayeb, MD
McGovern Medical School at UTHealth
Houston, Texas, United States
Holly Flores, DO
Resident
University of Texas Health Science Center
Houston, Texas, United States
Hector M. Mendez-Figueroa, MD
Associate Professor
McGovern Medical School at UTHealth
Houston, Texas, United States
Suneet P. Chauhan, MD
Director of MFM Research
Delaware Center of Maternal-Fetal Medicine at Christiana Care
Delaware, Delaware, United States
To ascertain if independent features of term fetal heart rate tracings (FHRT) are associated with adverse neonatal outcomes.
Study Design:
FHRTs of consecutive deliveries within 15 months at a Level IV center were reviewed by physicians blinded to outcomes. In 20-min segments, the last 60 minutes available before delivery of all term (> 37 weeks), non-anomalous singletons who labored were included. Each feature (variability, decelerations, accelerations) was independently categorized as present < vs. > 50% of the time 60 minutes before delivery. The primary outcome was the rate of composite adverse neonatal outcome (CANO; defined in Table 1). Odds ratio (OR), likelihood ratio (LR) with post-test probability (PTB).
Results:
Of 5,160 deliveries, 3,166 (61%) met the inclusion criteria for analysis, of which 49 (1.5%) had CANO. Baseline characteristics differed by age, hypertensive disorders, and neuraxial anesthesia use (Table 1). Individually, absent variability (0.2% vs. 2.0%, unadjusted OR 10.8, 95% CI 1.28-91.5), marked variability (0.4% vs. 6.1%, unadjusted OR 14.5, 95% CI 4.02 – 52.0) and severe variable decelerations (4.5% vs 16.3%, unadjusted OR 4.18, 95% CI 1.92-9.09) were associated with CANO if present the majority of the time. Moderate variability or the presence of accelerations were not associated with reduced CANO. Moderate variable decelerations were associated with reduced CANO (15.4% vs. 4.1%, OR 0.24, 95% CI 0.06 – 0.97). LR varied from 0.2 (moderate variables) to 14 (marked variability), with post-test probability being 0 and 18%, respectively (Table 2).
Conclusion:
Among term deliveries, during the last 60 min of labor, some FHT elements are individually associated with adverse outcomes. CANO is possible for every 1 in 7 for minimal variability, 1 in 5 for marked variability and 1 in 18 for severe variable decelerations. The presence of majority of time with moderate variability or accelerations were not associated with reduced rates of CANO. Further exploration of the elements of FHRTs that predict adverse outcomes and interventions that mitigate them are warranted.
