Abstract
Objective
To assess the association of fetal heart rate short-term variability (STV) pattern
during term labor with both neonatal composite morbidity (cord blood pH ≤ 7.10 and/or
neonatal intensive care unit admission and/or Apgar score at 5 min <7) and small for
gestational age (SGA) status.
Study design
Retrospective cohort in a single academic institution between January 2016 and December
2018. A total of 1896 women that delivered a singleton during labor in cephalic presentation
after 37 weeks of gestation were included (948 women with SGA neonates and 948 women
with appropriate weight for gestational age (AGA) neonates that were matched to women
with SGA neonates based on maternal age, parity, induction of labor, gestational diabetes,
gestational age at delivery and a history of one cesarean section using propensity
score matching). STV was compared at labor onset (cervical dilation ≤ 4 cm), in the
first stage of labor (cervical dilation = 6 cm) and in the second stage of labor (cervical
dilation = 10 cm). A generalized linear mixed model was used to assess the association
between SGA status, neonatal composite morbidity and STV.
Results
After adjustment for maternal origin, term, gestational diabetes, labor length, SGA
status was not associated with any change in STV during labor (mean adjusted STV:
−0.20 ms, 95 %CI[-0.58–0.17], p = 0.284 at labor onset, 0.29 ms, 95 %CI[-0.1– 0.68],
p = 0.155, in the first stage of labor and 0.36 ms, 95 %CI[-0.02–0.74], p = 0.065
in the second stage of labor). In case of neonatal composite morbidity mean adjusted
STV was lower in the first stage of labor (mean adjusted STV: −1.29 ms, 95 %CI[-2.1
– −0.43], p = 0.003) and in the second stage of labor (mean adjusted STV: −1.15 ms,
95 %CI[-1.96 – −0.34], p = 0.005). The results were similar with the addition of delivery
mode and meconium-stained amniotic fluid in the model or non-reassuring fetal heart
rate and meconium-stained amniotic fluid.
Conclusions
This work suggests that STV decrease during term labor is associated with fetal well-being,
independently of fetal weight. This suggests that further prospective studies should
consider the evaluation of this parameter in the prediction of neonatal compromise.
Keywords
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Article info
Publication history
Published online: September 03, 2022
Accepted:
August 27,
2022
Received in revised form:
August 23,
2022
Received:
April 3,
2022
Identification
Copyright
© 2022 Published by Elsevier B.V.
