title: Checkmark fetal heart rate pattern associated with severe fetal hypoxia. A case report.
abstract: A 31-year-old nulliparous woman developed vaginal bleeding after spontaneous rupture of the membranes at 40 weeks of gestation. Fetal heart rate monitoring showed checkmark and sinusoidal patterns. A 3,281 g male neonate was delivered by emergency cesarean section, with Apgar scores of 1 and 3 at 1 and 5 min, respectively. The neonate exhibited severe acidosis with arterial blood gas pH of 6.96, and was diagnosed to have severe hypoxic-ischemic encephalopathy. An umbilical artery branch was noted in the membrane near the cervical os and found to be torn, representing hemorrhagic vasa previa. Severe fetal hypoxia resulting from hemorrhagic vasa previa might be associated with checkmark fetal heart rate pattern.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Keio University, Tokyo, Japan. tetsu-a-k@hkg.odn.ne.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kashiwagi
authors.forename: Kei
authors.initials: K
authors.lastname: Miyakoshi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ishimoto
authors.forename: Mamoru
authors.initials: M
authors.lastname: Tanaka
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Yoshimura
mesh_terms: D005260:Female; D005316:Fetal Distress / Q000209:etiology / Q000503:physiopathology*; D006340:Heart Rate, Fetal / Q000502:physiology*; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D011247:Pregnancy; D014592:Uterine Hemorrhage / Q000150:complications