Fetal heart rate patterns in patients with thick meconium staining of amniotic fluid and its association with perinatal outcome

Background: This study assesses the role of abnormal fetal heart rate tracing patterns in patients with thick meconium staining of the amniotic fluid and its association with perinatal outcomes.Methods: Prospective unmatched case-control study on 2 groups of 136 subjects each- cases had thick MSAF and controls had clear liquor with abnormal fetal heart rate tracings on cardiotocography.Results: Gestational age (GA) >40 weeks, was found to have a significant association with MSAF (p value 0.01556 CI 95%). Premature Rupture of membranes at term (PROM) showed a significant association with MSAF with an OR of 2.25 (95% CI 1.37, 3.7); Post datism had significantly higher odds for being a risk factor for MSAF with an OR (3.194) (CI 95% 1.003-10.165). MSAF was not found to be significantly associated with abnormal trace on CTG. Neonatal morbidity (MAS, birth asphyxia, sepsis, HIE) had statistically higher odds in cases 1.669 (0.884-3.150) as compared to controls.Conclusions: No particular cardio-tocograph pattern can be considered to have a poor prognostic value in the presence of thick MSAF and the decision to deliver and the mode of delivery should be based on the overall assessment and the stage and progress of labor. While management should be individualized, a higher Caesarean section rate in thick MSAF can be justified to ensure a better outcome for the neonate even in the presence of a normal CTG trace.

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Comparative analysis of maternal and fetal outcome in meconium stained amniotic fluid and clear liquor in primigravida

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20200061 ◽

2020 ◽

Vol 9 (2) ◽

pp. 482

Author(s):

Deepali S. Kapote ◽

Apeksha M. Mohite ◽

Anam Syed

Keyword(s):

Heart Rate ◽

Amniotic Fluid ◽

Apgar Score ◽

Fetal Heart Rate ◽

Fetal Heart ◽

Birth Asphyxia ◽

Fetal Outcome ◽

Control Group ◽

Singleton Pregnancy ◽

Meconium Staining

Background: The present study was undertaken to evaluate the significance of MSAF and its fetal outcome in parturients.Methods: A total of 121 pregnant women who had completed more than 37 weeks of gestation with live singleton pregnancy, spontaneous onset of labor and at term with adequate pelvis were included in the study. All (121) low risk primigravida with MSAF were studied to identify maternal and fetal outcome and compared with equal number of cases with clear amniotic fluid. Meconium stained cases were clinically classified into two groups- thin (54 cases) and thick (67 cases). MSAF on spontaneous or artificial rupture of membranes were monitored with fetal heart rate abnormality, 1- and 5-minutes Apgar score, NICU admissions and neonatal complications as outcome variables.Results: Overall incidence of meconium staining of AF during labour was 7.71%. The common fetal heart rate abnormalities i.e. bradycardia was seen in 36% in MSG. Apgar score of less than 7 was observed in MSG at 5 minutes in 5% of cases, in thick group. Major neonatal complication was birth asphyxia in MSG (18.18%) that was more in thick MSG (14.87%). MAS were observed in 6 cases in thick and 4 cases in thin meconium stained cases. NICU care was required in 18% cases in MSG and in control group it was required in 7% cases. Neonatal morbidity was more in newborn with thick meconium group (52%) compared to thin meconium group (20%).Conclusions: The present study confirmed that meconium staining of amniotic fluid adversely influences the fetal outcome.

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Study of perinatal outcomes in normal and borderline oligamnios

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20196034 ◽

2019 ◽

Vol 9 (1) ◽

pp. 279

Author(s):

Divya R. Prasad ◽

Neelima V. Nair

Keyword(s):

Heart Rate ◽

Caesarean Section ◽

Amniotic Fluid ◽

Fetal Heart Rate ◽

Perinatal Outcome ◽

Fetal Heart ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Amniotic Fluid Index ◽

Meconium Staining

Background: Oligamnios is a common cause of perinatal mortality and morbidity, but the outcome of borderline oligamnios, defined as Amniotic Fluid Index (AFI) between 5 and 8, is less clear. This study aims to find out the effect of borderline oligamnios on perinatal outcomes in pregnancies beyond 37 weeks.Methods: An observational prospective study of 131 antenatal mothers with AFI between 5 and 8, after 37 weeks of gestation was conducted in Sree Gokulam Medical College and Research Foundation from October 2017 to September 2019. These observations were compared with that of 131 antenatal mothers with normal AFI beyond 37 weeks of gestation. The observations according to fetal heart rate abnormalities, meconium staining of amniotic fluid, mode of delivery, low birth weight babies, APGAR score, the need of neonatal intensive care unit (NICU) admissions due to neonatal complications were statistically analysed.Results: Both groups were comparable with respect to age, parity and gestational age. In those with borderline oligamnios, fetal heart rate abnormality was seen in 21% (28), meconium stained amniotic fluid in 18% (23), 70% (91) delivered vaginally and 30% (40) underwent caesarean section, 31% (41) babies weighed below 2.5 kg and 21% (27) neonates needed NICU admissions. In those with normal AFI, none showed fetal heart rate abnormality, 2% (3) showed meconium staining, 93% (122) delivered vaginally and 7% (9) underwent caesarean section, 11% (14) babies weighed below 2.5 kg and 3% (4) neonates needed NICU admissions.Conclusions: Borderline oligamnios is associated with poor perinatal outcome. AFI can be used as an adjunct to other fetal surveillance methods. It helps to identify those infants at risk of poor perinatal outcome.

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Correlation of reduced amniotic fluid index with neonatal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172320 ◽

2017 ◽

Vol 6 (6) ◽

pp. 2401 ◽

Cited By ~ 1

Author(s):

Rachna Chaudhary ◽

Vandana Dhama ◽

Shakun Singh ◽

Madhumita Singh

Keyword(s):

Heart Rate ◽

Birth Weight ◽

Low Birth Weight ◽

Amniotic Fluid ◽

Fetal Heart Rate ◽

Neonatal Death ◽

Neonatal Outcome ◽

Fetal Heart ◽

Birth Asphyxia ◽

Apgar Scores

Background: Amniotic fluid assessment is an essential part of evaluation of fetus health in terms of fetal distress, meconium aspiration, IUGR, Non-reassuring fetal heart rate patterns, birth asphyxia, low birth weight, low Apgar-scores and NICU Admissions.Methods: This prospective observational study included 200 antenatal patients of term gestation of which 100 cases with AFI<8 and 100 controls with AFI ≥8 but ≤ 15 were included in study. Ultrasonography and NST were done and results of both groups compared for the presence of meconium passage, non-reactive NST, birth asphyxia, low Apgar-scores, low birth weight, NICU admissions and neonatal deaths.Results: There was increased incidence of non-reactive NST (40% vs 12%), meconium stained (33% vs 10%) in oligohydramnios group. In cases 49% of patients had vaginal delivery while in controls 78%. 51% underwent LSCS in cases while in controls 22%. Apgar score <7 was found in 7% vs 4%. Birth weight was <2.5 kg in 35% vs 13%. NICU admissions in study group was 15% vs 11%. The neonatal death was similar in both cases groups.Conclusions: Oligohydramnios affect the neonatal outcome in terms of meconium stained liquor, non-reassuring fetal heart rate, low birth weight, birth asphyxia, low Apgar-scores and NICU Admissions and neonatal death but the difference was not statistically significant. Early detection of oligohydramnios and its management may help in reduction of perinatal morbidity and decreased caesarean deliveries.

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Discussion: ‘Abnormal fetal heart rate tracings in patients with thick meconium staining of the amniotic fluid’ by Xu et al

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2009.01.001 ◽

2009 ◽

Vol 200 (3) ◽

pp. e1-e4 ◽

Cited By ~ 13

Author(s):

Alison G. Cahill ◽

Laura Parks ◽

Lorie Harper ◽

Erica Heitmann ◽

Kathleen O'Neill

Keyword(s):

Heart Rate ◽

Amniotic Fluid ◽

Fetal Heart Rate ◽

Fetal Heart ◽

Meconium Staining

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Prolonged Fetal Bradycardia as the Presenting Clinical Sign in Congenital Syphilis Complicated by Necrotizing Funisitis: A Case Report

ISRN Obstetrics and Gynecology ◽

10.5402/2011/320246 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3 ◽

Cited By ~ 4

Author(s):

Jun Kakogawa ◽

Miyuki Sadatsuki ◽

Norio Masuya ◽

Hideto Gomibuchi ◽

Shigeki Minoura ◽

...

Keyword(s):

Heart Rate ◽

Fetal Heart Rate ◽

Fetal Heart ◽

Congenital Syphilis ◽

Histopathological Examination ◽

Treponema Pallidum ◽

Birth Asphyxia ◽

Neonatal Morbidity ◽

Fetal Heart Rate Monitoring ◽

Histopathological Evidence

Syphilis remains a serious cause of neonatal morbidity and mortality worldwide. In this paper, we describe a case of congenital syphilis that was fully supported by abnormal fetal heart rate patterns and placental histopathological evidence. A 24-year-old para 4 woman, who did not attend antenatal care, was admitted to our hospital with a complaint of abdominal discomfort at an estimated 31-week gestation. Fetal heart rate monitoring showed prolonged bradycardia. A neonate weighting 1,423 g with severe birth asphyxia was immediately delivered by cesarean section. Following delivery, the mother and the neonate were diagnosed with syphilis. Histopathological examination confirmed severe chorioamnionitis and necrotizing funisitis with numerous Treponema pallidum. Conclusions. Challenges in establishing the diagnosis of necrotizing funisitis are essential for optimal management of a fetus with a systemic inflammatory response in utero.

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Abnormal fetal heart rate tracings in patients with thick meconium staining of the amniotic fluid: Xu et al

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2008.12.054 ◽

2009 ◽

Vol 200 (3) ◽

pp. 342-343 ◽

Cited By ~ 1

Author(s):

Alison G. Cahill ◽

Laura Parks ◽

Lorie Harper ◽

Erica Heitmann ◽

Kathleen O'Neill

Keyword(s):

Heart Rate ◽

Amniotic Fluid ◽

Fetal Heart Rate ◽

Fetal Heart ◽

Meconium Staining

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Abnormal fetal heart rate tracing patterns in patients with thick meconium staining of the amniotic fluid: association with perinatal outcomes

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2008.08.043 ◽

2009 ◽

Vol 200 (3) ◽

pp. 283.e1-283.e7 ◽

Cited By ~ 23

Author(s):

Hairong Xu ◽

Marie Mas-Calvet ◽

Shu-Qin Wei ◽

Zhong-Cheng Luo ◽

William D. Fraser

Keyword(s):

Heart Rate ◽

Amniotic Fluid ◽

Fetal Heart Rate ◽

Fetal Heart ◽

Perinatal Outcomes ◽

Meconium Staining

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Bayes Theorem and Protopathic Bias: Methodological Concerns When Addressing the Impact of Fetal Heart Rate Patterns on the Cesarean Section Rate

American Journal of Perinatology Reports ◽

10.1055/s-0040-1713786 ◽

2020 ◽

Vol 10 (03) ◽

pp. e342-e345

Author(s):

Jacques Balayla ◽

Ariane Lasry ◽

Yaron Gil ◽

Alexander Volodarsky-Perel

Keyword(s):

Heart Rate ◽

Caesarean Section ◽

Fetal Heart Rate ◽

Predictive Power ◽

Fetal Heart ◽

Caesarean Section Rate ◽

Bayes Theorem ◽

The Poor ◽

Clinical Scenarios ◽

The Impact

AbstractOver the last 30 years, the caesarean section rate has reached global epidemic proportions. This trend is driven by multiple factors, an important one of which is the use and inconsistent interpretation of the electronic fetal monitoring (EFM) system. Despite its introduction in the 1960s, the EFM has not definitively improved neonatal outcomes, yet it has since significantly contributed to a seven-fold increase in the caesarean section rate. As we attempt to reduce the caesarean rates in the developed world, we should consider focusing on areas that have garnered little attention in the literature, such as physician sensitization to the poor predictive power of the EFM and the research method biases that are involved in studying the abnormal heart rate patterns—umbilical cord pH relationship. Herein, we apply Bayes theorem to different clinical scenarios to illustrate the poor predictive power of the EFM, as well as shed light on the principle of protopathic bias, which affects the classification of research outcomes among studies addressing the effects of the EFM on caesarean rates. We propose and discuss potential solutions to the aforementioned considerations, which include the re-examination of guidelines with which we interpret fetal heart rate patterns and the development of noninvasive technologies that evaluate fetal pH in real time.

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Effect of Oligohydramnios on Fetal Heart Rate Patterns during Term Labor Induction

American Journal of Perinatology ◽

10.1055/s-0038-1675152 ◽

2018 ◽

Vol 36 (07) ◽

pp. 715-722

Author(s):

Janine S. Rhoades ◽

Molly J. Stout ◽

George A. Macones ◽

Alison G. Cahill

Keyword(s):

Heart Rate ◽

Fetal Heart Rate ◽

Fetal Heart ◽

Secondary Analysis ◽

Neonatal Morbidity ◽

Fetal Monitoring ◽

Secondary Outcome ◽

Significant Difference ◽

Electronic Fetal Monitoring ◽

Consecutive Term

Objective To estimate the effect of oligohydramnios on fetal heart rate (FHR) patterns in patients undergoing induction of labor (IOL) at term. Study Design Secondary analysis of a prospective cohort study of consecutive term, singleton deliveries from 2010 to 2015. We included all patients who underwent IOL. Our primary outcomes were electronic fetal monitoring (EFM) characteristics in the 2 hours preceding delivery. Outcomes were compared between those induced with oligohydramnios and those induced without a diagnosis of oligohydramnios. Our secondary outcome was composite neonatal morbidity. Logistic regression was used to control for confounders. Results Of 3,787 patients who underwent IOL, 147 had a diagnosis of oligohydramnios and 3,640 were included in the no oligohydramnios group. There was no significant difference in EFM characteristics between the two groups. There was no difference in composite neonatal morbidity. In patients with oligohydramnios, EFM patterns with baseline tachycardia for 30 minutes or greater were significantly associated with composite neonatal morbidity (31.3 vs. 5.3% adjusted odds ratio 8.63, 95% confidence interval 2.18, 34.1]). Conclusion Term patients undergoing IOL with oligohydramnios had EFM patterns that did not differ from their induced peers.

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