Intrapartum deceleration and acceleration areas are associated with neonatal encephalopathy

Abstract

Objective To investigate whether an association exists between deceleration and acceleration areas on continuous fetal cardiotocography (CTG) and neonatal encephalopathy (NE). Methods A single center, retrospective case–control study was conducted to compare CTG characteristics of low‐risk pregnancies (35 weeks of gestation or more), complicated by moderate to severe NE with two matched controls for every case. Controls were matched by gestational age and cord blood pH. We analyzed the intrapartum CTG recordings by calculation of the deceleration and acceleration areas and the ratio between the two. Results During the period between 2013 and 2019, we identified 95 cases of low‐risk pregnancies that were complicated by moderate to severe NE in our center. Thirty‐three (34.7%) deliveries were excluded, mostly because of an insufficient duration of the CTG recordings. The remaining 62 cases were matched with 123 controls. We found that NE was significantly associated with an increased total deceleration area, a decreased total acceleration area, and a lower acceleration‐to‐deceleration ratio. Conclusions NE was significantly associated with increased total deceleration area, decreased total acceleration area, and a lower acceleration‐to‐deceleration ratio, independent of cord blood pH. Development of a computerized real‐time analysis of fetal heart rate tracings may contribute to making these measurements a more valid clinical tool.

Fetal heart rate responses in chronic hypoxaemia with superimposed repeated hypoxaemia consistent with early labour: a controlled study in fetal sheep

“…19 Nonetheless, DA and DC remain promising, objective predictors for intrapartum compromise. [8][9][10]14,16,17,58 Additional biomarkers may help improve their utility. For example, we have previously shown that hypoxaemic fetuses developed a significantly greater rise in T/QRS ratio during repeated UCOs, 47 suggesting that it may be complementary to DA and/or DC.…”

“…Deceleration area predicted neonatal acidaemia in large retrospective 8 and prospective cohorts 9 . Further, DA was more predictive of acidaemia than fetal heart rate (FHR) variability or numbers of late decelerations, 14 and of neonatal encephalopathy in recent retrospective cohort studies 16 . The computational index DC predicted both fetal acidaemia and neonatal compromise in a cohort of 22 790 births 10 and predicted acidaemia better than short‐term variation 13 .…”

“…9 Further, DA was more predictive of acidaemia than fetal heart rate (FHR) variability or numbers of late decelerations, 14 and of neonatal encephalopathy in recent retrospective cohort studies. 16 The computational index DC predicted both fetal acidaemia and neonatal compromise in a cohort of 22 790 births 10 and predicted acidaemia better than short-term variation. 13 DC is derived from a modern signal processing technique called phase rectified signal averaging, which was originally described in the setting of myocardial infarction in adults 18 but is easily adapted to quantify FHR decelerations.…”

“…[1][2][3][4][5][6][7] Recent studies suggest that deceleration area (DA) and decelerationrelated metrics such as deceleration capacity (DC) may be more effective predictors than standard clinical assessment. [8][9][10][11][12][13][14][15][16][17] These indices quantify the total burden of decelerations including depth, duration and frequency.…”

“…Cardiotocography (CTG) monitoring during labour shows poor ability to predict fetal acidaemia or hypoxia‐ischaemia, and reliable indices of fetal wellbeing are needed 1–7 . Recent studies suggest that deceleration area (DA) and deceleration‐related metrics such as deceleration capacity (DC) may be more effective predictors than standard clinical assessment 8–17 . These indices quantify the total burden of decelerations including depth, duration and frequency.…”