Fetal heart rate monitoring patterns in women with amniotic fluid proteomic profiles indicative of inflammation.
We hypothesized that abnormal fetal heart rate monitoring patterns (FHR-MPs) occur more often in pregnancies complicated by intra-amniotic inflammation. Therefore, our objective was to examine the relationships among FHR-MP abnormalities, intra-amniotic inflammation and/or infection, acute histological chorioamnionitis, and early-onset neonatal sepsis (EONS) in pregnancies complicated by preterm birth. Additionally, the ability of various FHR-MPs to predict EONS was investigated. FHR-MPs from 87 singleton premature neonates delivered within 48 hours from amniocentesis (gestational age, mean +/- SD: 28.9 +/- 3.3 weeks) were analyzed blindly using strict National Institute of Child Health and Human Development criteria. Strips were evaluated at three time points: at admission, at amniocentesis, and prior to delivery. Intra-amniotic inflammation was established based on a previously validated proteomic fingerprint (mass-restricted score). Diagnoses of histological chorioamnionitis and EONS were based on well-recognized pathological, clinical, and laboratory criteria. We determined that fetuses of women with severe intra-amniotic inflammation had a higher FHR baseline throughout the entire monitoring period and an increased frequency of a nonreactive FHR-MP at admission. Of all FHR-MPs, a nonreassuring test at admission had 32% sensitivity, 95% specificity, 73% positive predictive value, 77% negative predictive value, and 76% accuracy in predicting EONS. Although a nonreassuring FHR-MP at admission was significantly associated with EONS after correcting for gestational age (odds ratio, 5.6; 95% confidence interval, 1.2 to 26.2; P = 0.030), the majority of the neonates that developed EONS had an overall reassuring FHR-MP. Nonreassuring FHR-MPs at either amniocentesis or delivery had no association with EONS. We conclude that in cases complicated by preterm birth, a nonreassuring FHR-MP at the initial evaluation is a specific but not a sensitive predictor of EONS. An abnormal FHR-MP can thus raise the level of awareness that a fetus with EONS may be born, but it is not a useful clinical indicator of the need for antibiotic treatment of the neonate.
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA.
Catalin S
CS
Buhimschi
Sonya
S
Abdel-Razeq
Michael
M
Cackovic
Christian M
CM
Pettker
Antonette T
AT
Dulay
Mert Ozan
MO
Bahtiyar
Eduardo
E
Zambrano
Ryan
R
Martin
Errol R
ER
Norwitz
Vineet
V
Bhandari
Irina A
IA
Buhimschi
D000328:Adult; D017668:Age of Onset; D000653:Amniotic Fluid / Q000737:chemistry*; D015148:Cardiotocography; D002821:Chorioamnionitis / Q000453:epidemiology / Q000378:metabolism; D005260:Female; D005316:Fetal Distress / Q000175:diagnosis*; D005323:Fetal Monitoring; D006340:Heart Rate, Fetal / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology* / Q000378:metabolism; D007249:Inflammation / Q000378:metabolism*; D013058:Mass Spectrometry; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology* / Q000378:metabolism; D040901:Proteomics; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000453:epidemiology* / Q000378:metabolism