Fetal heart rate patterns in red blood cell isoimmunized pregnancies

Nicolaides, Kypros H.; Sadovsky, G.; Cetin, Emine

doi:10.1016/0002-9378(89)90518-8

Cited by 16 publications

(10 citation statements)

References 14 publications

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“…This procedure is for practical reasons usually not repeated more often than once a week, while electronic FHR monitoring, if necessary, is easily repeated several times a day. NICOLAIDES et al [5,6] have recently reported, that although fetal anemia is associated with a pathological FHR pattern, the present classification criteria do not allow for prediction of the degree of anemia. The aim of the present study was to compare characteristics of the nonstress test (NST), performed within a few hours before fetal blood sampling, with the actual fetal blood status.…”

Section: Introductionmentioning

confidence: 78%

“…With a few exceptions, a pathological NST was equivalent the abnormally low values of Hgb and Hct (Hgb < 51 g/1 and Hct < 15%). Ni-COLAIDES et al [6] evaluated different NST classification systems in a study of fetal anemia in the third trimester and found a predictive value of a pathological test of 50-100%. The corresponding figure in the present study was 87%, although the majority of cases was second trimester gestations.…”

Section: Discussionmentioning

confidence: 99%

“…The anemic fetus may react with circulatory changes such as increased umbilical vein blood flow [3] or a change of fetal heart rate (FHR) [2,5,6,9]. A sinusoidal FHR pattern has been reported in 12-40% of Rh isoimmunizations [2].…”

Section: Introductionmentioning

confidence: 99%

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Fetal heart rate responses to anemia in Rh isoimmunization

Olofsson

Stangenberg²,

Selbing³

et al. 1990

Jpme

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On 52 occasions 24 Rh immunized women were monitored with a nonstress test (NST) prior to fetal blood sampling. Cardiotocographic characteristics were recorded for each NST. Fetal blood was analysed for hemoglobin and hematocrit. Fetal hemoglobin and hematocrit were positively correlated to long-term variability, acceleration amplitude and negatively correlated to deceleration amplitude (linear regression analysis; p less than 0.05). Decelerations were almost without exception associated with low concentrations of hemoglobin and hematocrit. In fetuses of 32 weeks' gestation or more, a loss of variability (less than or equal to 5 bpm) was associated with severe anemia. Hemoglobin and hematocrit were significantly lower in the group with a pathological NST (n = 15) compared with the group with a normal NST (n = 37) (Mann-Whitney U test; p less than 0.05). The predictive value of a pathological test was 13/15 concerning hemoglobin and hematocrit; whereas, the predictive value of a normal test was poor. A pathological NST, especially when decelerative, is a good predictor of fetal anemia, but a normal NST is no guarantee for a normal blood status.

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Section: Introductionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Fetal heart rate responses to anemia in Rh isoimmunization

Olofsson

Stangenberg²,

Selbing³

et al. 1990

Jpme

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“…However, it is also true that a nonreactive NST does not always reflect fetal deteriora tion. In other words, NST is not an ulti mately reliable tool for the detection of fetal deterioration, although Nicolaides et al [6,7] reported an association between FHR pat terns and fetal hypoxemia or anemia. On the other hand, a reactive NST was proved to be a sign that the fetus was not in bad condi tion, in which the pH was over 7.30, p02 over 20 mm Hg and PCO2 under 45 mm Hg in umbilical venous blood.…”

Section: Discussionmentioning

confidence: 99%

Reevaluation of Nonstress Test by Umbilical Venous Blood Profile Using Cordocentesis

Okamura

Endoh²,

Watanabe³

et al. 1989

Fetal Diagn Ther

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Fetal blood sampling by cordocentesis was performed in 85 cases of fetuses with either nonimmune hydrops fetalis, anomalies, intrauterine growth retardation, maternal immunological disorders, Rh incompatibility, hydronephrosis, polyhydramnios, maternal preeclampsia or fetal tumor. Fetal heart rate monitoring was also recorded before cordocentesis. We evaluated the usefulness of the nonstress test (NST) with regard to fetal hematologic gas profiles including pH, pO₂ and pCO₂. When the acceleration was classified into reactive and nonreactive group, pH and pO₂ were significantly higher in the reactive group than in the nonreactive group. pCO₂ was significantly lower in the former than the latter. However, the sensitivity and specificity of the reactive NST predicting fetal umbilical venous pO₂ over 20 mm Hg was 79.7 and 68.7%, respectively. The false-positive rate of nonreactive NST predicting hypoxemia below 20 mm Hg pO₂ was 44%. As a consequence, we cannot always rely on the NST, and should perform fetal blood sampling to assess fetal condition for further management.

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“…We have recently reported on the rela tionship between FHR patterns and the fetal hemoglobin concentration, oxygen content and oxygen tension in 33 red cell-isoimmu nized patients at 32-36 weeks of gestation [3]. The FHR patterns were analyzed accord ing to 25 different classifications.…”

Section: Introductionmentioning

confidence: 99%

Heart Rate Patterns in Fetal Anemia

Sadovsky

Visser

Nicolaides³

1988

Fetal Diagn Ther

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Fetal heart rate (FHR) was monitored immediately before cordocentesis on 105 occasions in 49 red cell-isoimmunized patients at 27–37 weeks of gestation. The fetal hemoglobin concentration, oxygen tension and oxygen content were measured and the values related to the FHR patterns, which were classified as reactive, non-reactive, decelerative (isolated or repetitive), terminal or sinusoidal. In 88% of non-anemic fetuses the FHR pattern was reactive. Extreme deficits in fetal hemoglobin concentration or oxygen content (> 9 standard deviations below the appropriate normal mean for gestation) were consistently associated with sinusoidal and repetitive decelerative patterns. However, with lesser degrees of fetal compromise the relationship between the various FHR patterns and fetal anemia or hypoxemia was less clearly defined.

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Fetal heart rate patterns in red blood cell isoimmunized pregnancies

Cited by 16 publications

References 14 publications

Fetal heart rate responses to anemia in Rh isoimmunization

Fetal heart rate responses to anemia in Rh isoimmunization

Reevaluation of Nonstress Test by Umbilical Venous Blood Profile Using Cordocentesis

Heart Rate Patterns in Fetal Anemia

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