Deceleration area and fetal acidemia.
OBJECTIVE
To compare the predictive ability for neonatal acidemia of individual components of intrapartum cardiotocography (CTG) described by National Institute of Child Health and Human Development (NICHD) system and deceleration area.


METHODS
Case-control study.


METHODS
Spanish tertiary obstetrical hospital.


METHODS
CTG patterns of 102 acidemic fetus (umbilical arterial cord gas pH ≤7.10, base deficit (BD) > 8) and 102 nonacidemic controls (umbilical arterial cord gas pH > 7.10).


METHODS
Two reviewers blind to clinical and outcome data analyzed the last thirty minutes before delivery of 204 fetal heart rate (FHR) tracings, extracting those features defined by NICHD and certain measures of FHR decelerations, including deceleration area, not considered by this system.


METHODS
The primary outcome was the predictive ability of NICHD features and non-NICHD deceleration measures for fetal acidemia. The secondary outcome was the impact of deceleration area in the last 30 min of labor on gasometry components (pH, BD and lactate).


RESULTS
Minimal variability (area under the curve (AUC) 0.74), total number of late (AUC: 0.75) and prolonged decelerations (0.77) were the three NICHD features with the greatest predictive ability for fetal acidemia in the last thirty minutes of labor. Total deceleration area demonstrated the highest discrimination power (AUC: 0.83) of all the analyzed elements. For each cm2the area increases in the last 30 min of labor, pH decreases 0.08 units, BD increases 0.272 mEq/L and lactate 0.183 mEq/L.


CONCLUSIONS
Total deceleration area showed the greatest predictive ability for fetal acidemia and its measure could help to estimate intrapartum fetal acid-base status.
a Obstetrics Department and.
Sabina
http://orcid.org/0000-0002-6767-9084
S
Martí Gamboa
a Obstetrics Department and.
Maria
http://orcid.org/0000-0002-3493-3138
M
Lapresta Moros
a Obstetrics Department and.
Jara
http://orcid.org/0000-0002-5869-4450
J
Pascual Mancho
b Preventive Medicine Department , Miguel Servet University Hospital , Zaragoza , Spain.
Carlos
http://orcid.org/0000-0002-7703-4060
C
Lapresta Moros
a Obstetrics Department and.
Sergio
http://orcid.org/0000-0001-5294-5709
S
Castán Mateo
D000138:Acidosis / Q000175:diagnosis*; D000328:Adult; D015148:Cardiotocography; D003654:Deceleration; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult
Cardiotocography; deceleration area; fetal buffer system; fetal heart rate decelerations; neonatal acidemia