A Comprehensive Evaluation of the Predictive Abilities of Fetal Electrocardiogram-Derived Parameters during Labor in Newborn Acidemia: Our Institutional Experience

Abstract

This study aimed to identify cardiotocography patterns that discriminate fetal acidemia newborns by comprehensively evaluating the parameters obtained from Holter monitoring during delivery. Between June 1, 2015, and August 1, 2016, a prospective observational study of 85 patients was conducted using fetal Holter monitoring at the Beijing Obstetrics and Gynecology Hospital, Capital Medical University, China. Umbilical cord blood was sampled immediately after delivery and fetal acidemia was defined as umbilical cord arterial blood pH < 7.20. Fetal electrocardiogram- (FECG-) derived parameters, including basal fetal heart rate (BFHR), short-term variation (STV), large acceleration (LA), deceleration capacity (DC), acceleration capacity (AC), proportion of episodes of high variation (PEHV), and proportion of episodes of low variation (PELV), were compared between 16 fetuses with acidemia and 47 without. The areas under the curve (AUC) of receiver operating characteristics (ROC) were calculated. Although all the computerized parameters showed predictive values for acidemia (all AUC > 0.50), STV (AUC = 0.84, P<0.001), DC (AUC = 0.84, P<0.001), AC (AUC = 0.80, P<0.001), and PELV (AUC = 0.71, P=0.012) were more strongly associated with fetal acidemia. Our institutional experience suggests that FECG-derived parameters from Holter monitoring are beneficial in reducing the incidence of neonatal acidemia.