25Objective: To assess the occurrence of ST-interval segment changes of the fetal electro-26 cardiogram (ECG) and cardiotocographic (CTG) abnormalities preceding acidaemia at birth. 27Design: Case-control study. 28Setting: University hospital labour ward. 29Sample: Newborns with severe cord artery metabolic acidaemia (pH <7.00 and lactate >10 30 mmol/l, n=24), moderate metabolic acidaemia (pH 7.00-7.09 and lactate >10; n=48), 31 acidaemia (pH 7.00-7.09; n=52), pre-acidaemia (pH 7.10-7.19; n=265), and controls (pH 32 >7.20; n=117). 33Methods: Monitoring traces were assessed blinded to outcome. 34 Main outcome measures: CTG-and ST-changes. 35Results: Any ST-event occurred significantly more often among cases with severe (79%) and 36 moderate (75%) metabolic acidaemia than among controls (50%). The difference was 37 restricted to baseline T/QRS-rises, and to the second stage of labour, during which any event 38 only occurred significantly more often among cases with severe metabolic acidaemia (62%) 39 than among controls (38%). ST-events coincided with abnormal CTG patterns in 67%, 44%, 40 40%, and 28% of cases with severe and moderate metabolic acidaemia, acidaemia and 41 preacidaemia, and in 12% of controls. ST-events with intermediary CTG were similarly 42 frequent in the case groups (0-6%) and controls (4%). The ST-guidelines stated intervention 43 in 96%, 62%, 73% and 49% in these case groups, and 23% of controls. 44Conclusions: Only two of three cases with severe and less than half of cases with moderate 45 metabolic acidaemia were preceded by ST-events coinciding with CTG abnormalities. It is 46 3 therefore important to intervene for long lasting, rapidly deteriorating, or marked 47 (preterminal) CTG abnormalities, also in the absence of 49
Morbidity decreased in late preterm infants with increasing gestational age. Underlying conditions accounted for a substantial part of the morbidity.
Objective To assess the occurrence of ST-interval segment changes of the fetal electrocardiogram (ECG) and cardiotocographic (CTG) abnormalities preceding acidaemia at birth.Design Case-control study.Setting University hospital labour ward.Sample Newborns with severe cord artery metabolic acidaemia (pH < 7.00 and lactate ‡ 10 mmol/l; n = 24), moderate metabolic acidaemia (pH 7.00-7.09 and lactate ‡ 10; n = 48), acidaemia (pH 7.00-7.09; n = 52), pre-acidaemia (pH 7.10-7.19; n = 265), and controls (pH ‡ 7.20; n = 117).Methods Monitoring traces were assessed blinded to outcome.Main outcome measures CTG and ST changes.Results Any ST event occurred significantly more often among cases with severe (79%) and moderate (75%) metabolic acidaemia than among controls (50%). The difference was restricted to baseline T/QRS rises and to the second stage of labour, during which any event only occurred significantly more often among cases with severe metabolic acidaemia (62%) than among controls (38%). ST events coincided with abnormal CTG patterns in 67, 44, 40, and 28% of cases with severe and moderate metabolic acidaemia, acidaemia, and pre-acidaemia, respectively, and in 12% of controls. ST events with intermediary CTG were similarly frequent in the case groups (0-6%) as in the controls (4%). The ST guidelines stated intervention in 96, 62, 73, and 49% of case groups and 23% of controls.Conclusions Only two of three cases with severe and less than half of cases with moderate metabolic acidaemia were preceded by ST events coinciding with CTG abnormalities. It is therefore important to intervene for long-lasting, rapidly deteriorating or marked (preterminal) CTG abnormalities, also in the absence of ST events.
Introduction Fetal growth restriction is a major risk factor for adverse perinatal outcome. As most of the growth‐restricted fetuses are small for gestational age (SGA), an efficient antenatal screening method for SGA fetuses would have a major impact on perinatal health. The aim of this study was to compare the SGA prediction rate achieved with third‐trimester routine ultrasound estimation of fetal weight (EFW) with that obtained using ultrasound examination on indication. The secondary aim was to evaluate the clinical outcome in relation to the SGA screening method. Material and Methods During 1995–2009, two perinatal centers in southern Sweden offered routine ultrasound examination at 32–34 gestational weeks to 99 265 women with singleton pregnancies. Of these, 59 452 (60%) underwent the ultrasound examination. The other population, comprising 24 868 pregnancies, was cared for in another three centers that used a risk‐based method with ultrasound examinations on indication only. Of them, 5792 (23%) underwent ultrasound examination at 32–36 gestational weeks. The deviation in the EFW from the expected one was expressed as the EFW z‐score, SGA EFW being defined as the EFW z‐score less than −2. SGA prediction ability was assessed by receiver operating characteristic (ROC) curves. Crude and adjusted risk ratios were calculated for selected variables of perinatal outcome when comparing the populations. Results The SGA prediction ability for routine ultrasound was high, area under the ROC curve was 0.90 (95% CI 0.89–0.91). For an EFW z‐score of −1, the sensitivity was 67.3% and specificity was 90.5% among routinely screened pregnancies; corresponding numbers in the ultrasound on indication population were 34.3% and 96.6%. The screened population had a lower risk of preterm birth, birthweight z‐score less than −3, and Apgar score less than 7 at 5 min with adjusted risk ratios 0.87 (95% CI 0.82–0.92), 0.75 (95% CI 0.61–0.92), and 0.77 (95% CI 0.68–0.87), respectively. No difference in perinatal mortality was detected. There were no differences in perinatal outcome between the two subcohorts of infants born SGA. Conclusions Third‐trimester routine ultrasound improves the detection of SGA antenatally compared with ultrasound performed on indication, but no convincing improvement in perinatal outcome was identified.
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