摘要
Objective The objective of this study was to describe the incidence of baseline change within normal range during labor and its prediction of neonatal outcomes. Materials and Methods This was a prospective cohort of singleton, nonanomalous, term neonates with continuous electronic fetal monitoring and normal baseline fetal heart rate throughout the last 2 hours of labor. We determined baseline in 10-minute segments using Eunice Kennedy Shriver National Institute of Child Health and Human Development criteria. We evaluated baseline changes of >= 20 and >= 30 bpm for association with acidemia (umbilical cord arterial pH <= 7.10) and neonatal intensive care unit (NICU) admission. Finally, we performed a sensitivity analysis of normal neonates, excluding those with acidemia, NICU admission, or 5-minute Apgar < 4. Results Among all neonates (n = 3,021), 1,267 (41.9%) had change >= 20 bpm; 272 (9.0%) had >= 30 bpm. Among normal neonates (n = 2,939), 1,221 (41.5%) had change >= 20 bpm. Acidemia was not associated with baseline change of any direction ormagnitude. NICU admission was associated with decrease >= 20 bpm (adjusted odds ratio [aOR]: 2.93; 95% confidence interval [CI]: 1.19 - 7.21) or any direction >= 20 bpm (aOR: 4.06; 95% CI: 1.46-11.29). For decrease >= 20 bpm, sensitivity and specificity were 40.0 and 81.7%; for any direction >= 20 bpm, 75.0 and 58.3%. Conclusion Changes of normal baseline are common in term labor and poorly predict morbidity, regardless of direction or magnitude.
- 出版日期2017-7