Poster Session 4
Christina Cortes, MD (she/her/hers)
Resident
McGovern Medical School at UTHealth
Houston, Texas, 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
Rachel L. Wiley, MD, MPH (she/her/hers)
MFM Fellow
University of California, San Diego
San Diego, California, 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
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
Fabrizio Zullo, MD (he/him/his)
Ob/Gyn Resident
University of Rome La Sapienza
Rome, Lazio, Italy
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
The objective was to determine if features of fetal heart rate tracings (FHRT) were associated with an increased rate of neonatal adverse outcomes among preterm deliveries at 32.0 – 36.6 weeks.
Study Design:
A retrospective review of all available FHRT among non-anomalous singletons attempting labor at 32.0 to 36.6 weeks. The study was conducted at a Level IV maternal center during a consecutive 15-month period. Obstetricians reviewing FHRT were blinded to the maternal characteristics, gestational age, and peripartum outcomes. Features of FHRT were dichotomized by time spent during the last hour before delivery (<50% vs. ≥50%). The primary outcome was the rate of composite neonatal adverse outcomes (CNAO). Chi-square test was used to compare groups, and likelihood ratios (LR) were calculated for FHRT features that differed significantly for those with and without CNAO. A priori, LR greater than 10 was considered a useful diagnostic test (Jeschker R et al JAMA 1994).
Results:
Of 5,160 patients, 672 (13%) met the inclusion criteria. CNAO occurred in 57 (8.5%) newborns. Maternal characteristics (age, nulliparity, race/ethnicity, tobacco use, and hypertensive disorders) were similar between groups (Table 1). Compared to those without, minimal variability was significantly more likely to occur with CNAO (11.2% vs. 24.6% p< 0.01). Two features of FHRT occurred significantly less often with CNAO: moderate variability (85.4% vs. 66.7%, p < 0.01) and presence of accelerations (66.8% vs. 50.9% p < 0.02). The LR of the three features which differed significantly among those with and without CANO ranged from 1 to 2. Notably, there was no significant difference between CNAO with any of the following: prolonged decelerations, combination of decelerations, and recurrent decelerations (Table 2).
Conclusion:
Though certain features of fetal heart rate tracings differed significantly in those with and without composite neonatal adverse outcomes at 32.0 to 36.6 weeks, the likelihood ratios of 1 to 2 suggest these characteristics are poor predictors of adverse neonatal outcomes in this cohort.
