The value of the short-term fetal heart rate variation for timing the delivery of growth-retarded fetuses.
OBJECTIVE
To assess the clinical value of the short-term fetal heart rate variation (STV) for timing the delivery of severely growth-retarded fetuses, many associated with pre-eclampsia.


METHODS
Retrospective cohort study.


METHODS
John Radcliffe Maternity Hospital, Oxford, UK.


METHODS
Two hundred and fifty-seven fetuses with a birthweight less than third percentile and a last computerised cardiotocography performed within 24 h of delivery.


METHODS
Analysis of the relationship between antepartum STV and the perinatal outcome.


METHODS
Stillbirth rate and the acid-base status at birth.


RESULTS
There were no stillbirths or neonatal deaths (NNDs) within 24 h in the study population. Decreasing STV was correlated with earlier deliveries (P < 0.001), lower birthweight (P < 0.001), lower umbilical artery pH at birth (P < 0.001), worse acid-base status at birth (P < 0.001) and worse postnatal outcome (P < 0.002). The STV was able to predict the presence or absence of acidaemia and metabolic acidaemia (area under the receiver operating characteristic curve 0.70 and 0.75, respectively, P < 0.001). The risk of metabolic acidaemia increased as the antepartum STV decreased, the optimum cutoff level being < or = 3.0 milliseconds (positive and negative predictive values 64.6 and 86.6%). An STV < or = 3.0 milliseconds was associated with markedly higher rate of metabolic acidaemia and early NNDs compared with an STV > 3.0 milliseconds (54.2 versus 10.5% and 8.3 versus 0.5%, respectively; P < 0.001). The deaths of the former group were all due to extreme prematurity and very low birthweight.


CONCLUSIONS
The antepartum STV is an important marker of perinatal outcome in severely growth-retarded fetuses. Timing the delivery of the most preterm and small fetuses remains a difficult task.
Serra
V
V
Unidad de Medicina Materno-Fetal, Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain. vicente.serra-serra@uv.es
Moulden
M
M
Bellver
J
J
Redman
C W G
CW
D000137:Acid-Base Imbalance; D000293:Adolescent; D000328:Adult; D015148:Cardiotocography; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005317:Fetal Growth Retardation / Q000503:physiopathology*; D005865:Gestational Age; D006340:Heart Rate, Fetal / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors