Correlation between total deceleration area in CTG records and cord blood pH in pregnancies with IUGR

Neta Geva; Yael Geva; Lior Katz; Yair Binyamin; Reut Rotem; Adi Yehuda Weintraub; Shimrit Yaniv Salem

doi:10.1007/s00404-023-07240-0

Correlation between total deceleration area in CTG records and cord blood pH in pregnancies with IUGR

Arch Gynecol Obstet. 2024 Jan 16. doi: 10.1007/s00404-023-07240-0. Online ahead of print.

Authors

Neta Geva¹, Yael Geva², Lior Katz³, Yair Binyamin⁴, Reut Rotem⁵, Adi Yehuda Weintraub², Shimrit Yaniv Salem²

Affiliations

¹ Department of Neonatology, Ben-Gurion University of the Negev Faculty of Health Sciences, Sheril and Hain Saban Children Hospital, Soroka Medical Center, Beer-Sheva, Israel. ntgeva@gmail.com.
² Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
³ Pediatric Division, Rambam Health Care Campus, Haifa, Israel.
⁴ Department of Anesthesiology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
⁵ Division of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel.

PMID: 38225432
DOI: 10.1007/s00404-023-07240-0

Abstract

Purpose: Fetal cardiotocography is the most common method to assess fetal well-being during labor. Nevertheless, its predictive ability for acidemia is limited, both in low-risk and high-risk pregnancies (Nelson et al. in N Engl J Med 334: 613-9, 1996; Rinciples P et al. in Health and Human Development Workshop Report on Electronic Fetal Monitoring : Update on Definitions. no. 2007, 510-515, 2008), especially in high-risk pregnancies, such as those complicated by growth restriction. In this study we aim examine the association between deceleration and acceleration areas and other measure of fetal heart rate in intrapartum fetal monitoring and neonatal arterial cord blood pH in pregnancies complicated by growth restriction.

Materials and methods: A retrospective cohort study of 100 deliveries complicated by growth restriction, delivered during 2018, was conducted. Known major fetal anomalies, non-vertex presentation and elective cesarean deliveries were excluded. Total deceleration and acceleration areas were calculated as the sum of the areas within the deceleration and acceleration, respectively.

Results: In deliveries complicated by growth restriction, cord blood pH is significantly associated with total deceleration area (p = 0.05) and correlates with cumulative duration of the decelerations (Spearman's rank -0.363, p < 0.05), and total acceleration area (-0.358, p < 0.05). By comparing the cord blood pH in deliveries with a total deceleration area that was above and below the median total deceleration area, we demonstrated a significant difference between the categories.

Conclusions: Cord blood pH significantly correlates with total deceleration area and other fetal monitoring characteristics in neonates with growth restriction. Future studies using real-time, machine-learning based techniques of fetal heart rate monitoring, may provide population specific threshold values that will support bedside clinical decision making and perhaps achieve better outcomes.

Keywords: Deceleration area; Electronic fetal monitoring; Intrauterine Growth Restriction (IUGR); Neonatal acidemia; Neonatal morbidity; Term infants.