Association and Prediction of Neonatal Acidemia

Effect of Growth Restriction on Fetal Heart Rate Patterns in the Second Stage of Labor

“…The aim of the parent study was to estimate the correlation between FHR patterns in the second stage of labor and acidemia at birth. 8 Women included in the cohort had term (! 37 weeks), cephalic, nonanomalous, singleton gestations who reached the second stage of labor.…”

Litigation related to intrapartum fetal surveillance

“…Although the severity of acidemia increases with increasing severity of the patterns, the classifications are poor predictors of fetal acidemia or subsequent injury [35]. In the ACOG classification, Category I represents a "normal" CTG pattern without the threat of acidemia.…”

Intrapartum Fetal Monitoring

“…11,12 There are, however, specific elements of category II patterns, such as tachycardia, bradycardia, absent or minimal variability, absence of accelerations, and late or prolonged decelerations, which have been associated with acidemia. 11,[13][14][15][16][17][18] Prior studies have attempted to further subcategorize category II tracings into 3 different tiers based on the presumed threat of fetal acidemia.…”

“…A recent study found that the total deceleration area (depth  duration) in the 30-minute preceding delivery had the best predictive ability for fetal acidemia over repetitive late decelerations, repetitive prolonged decelerations, repetitive variable decelerations, or tachycardia. 12 Additional work needs to be done to understand the association between EFM patterns like these, which are outside the NICHD framework, and their clinical usefulness.…”

“…19,20 Despite certain category II features being associated with acidemia, as with category III patterns, these elements of category II tracings have a low-positive predictive value for acidemia or adverse outcomes. 12 There are some interventions recommended for particular components of category II tracings. Recurrent variable decelerations, thought to be a physiologic response to repetitive compression of the umbilical cord, are not themselves pathologic.…”