Download PDF
Am J Perinatol 2016; 33(08): 786-790
DOI: 10.1055/s-0036-1572531
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Fetal Sex Differences in Intrapartum Electronic Fetal Monitoring

Anne C. Porter
1   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
Jourdan E. Triebwasser
1   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
Methodius Tuuli
1   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
Aaron B. Caughey
2   Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
,
George A. Macones
1   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
Alison G. Cahill
1   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
› Author Affiliations
Further Information

Publication History

28 June 2015

16 December 2015

Publication Date:
23 February 2016 (online)

    Permissions and Reprints

Abstract

Objective The article aimed to estimate differences in electronic fetal monitoring (EFM) patterns in term gestations attributable to fetal sex.

Study Design We conducted a prospective cohort study of consecutive, singleton, nonanomalous, term gestations that labored during admission. EFM characteristics in the 30 minutes prior to delivery were evaluated. Logistic regression models estimated adjusted risks for EFM features by sex. To further estimate the impact of sex, we limited the analysis to gestations without composite morbidity (morbidity defined as arterial cord pH <7.20, 5-minute Apgar <7, or neonatal intensive care unit admission).

Results Of 2,639 deliveries, 1,400 (53%) were male. Male fetuses had a higher number of decelerations (median [interquartile range]: 8 [5, 11] vs. 7 [4, 10], p < 0.003) and increased total deceleration area (adjusted odds ratio [aOR]: 1.11, 95% confidence interval [CI] :1.04, 1.18). Male fetuses were at increased risk for prolonged decelerations (aOR: 1.21, 95% CI: 1.03, 1.42) and repetitive variable decelerations (aOR: 1.24, 95% CI: 1.05, 1.47). Among neonates without composite morbidity (n = 2,446, 92.7%), male sex conferred an increased risk of late decelerations (aOR: 1.21, 95% CI: 1.02, 1.43) and increased total deceleration area (aOR: 1.12, 95% CI: 1.05, 1.20).

Conclusion There are significant sex differences in EFM patterns at term among pregnancies without evidence of acidemia. This suggests that interpretation of EFM patterns may need to take into account factors such as fetal sex.

Keywords

electronic fetal monitoring - labor - fetal sex
 

  • References

  • 1 Dawes NW, Dawes GS, Moulden M, Redman CW. Fetal heart rate patterns in term labor vary with sex, gestational age, epidural analgesia, and fetal weight. Am J Obstet Gynecol 1999; 180 (1, Pt 1): 181-187
    CrossrefPubMedGoogle Scholar
  • 2 Lange S, Van Leeuwen P, Geue D, Hatzmann W, Grönemeyer D. Influence of gestational age, heart rate, gender and time of day on fetal heart rate variability. Med Biol Eng Comput 2005; 43 (4) 481-486
    CrossrefPubMedGoogle Scholar
  • 3 Sheiner E, Levy A, Katz M, Hershkovitz R, Leron E, Mazor M. Gender does matter in perinatal medicine. Fetal Diagn Ther 2004; 19 (4) 366-369
    CrossrefPubMedGoogle Scholar
  • 4 Aibar L, Puertas A, Valverde M, Carrillo MP, Montoya F. Fetal sex and perinatal outcomes. J Perinat Med 2012; 40 (3) 271-276
    PubMedGoogle Scholar
  • 5 Bernardes J, Gonçalves H, Ayres-de-Campos D, Rocha AP. Sex differences in linear and complex fetal heart rate dynamics of normal and acidemic fetuses in the minutes preceding delivery. J Perinat Med 2009; 37 (2) 168-176
    PubMedGoogle Scholar
  • 6 Gonçalves H, Bernardes J, Ayres-de-Campos D. Gender-specific heart rate dynamics in severe intrauterine growth-restricted fetuses. Early Hum Dev 2013; 89 (6) 431-437
    CrossrefPubMedGoogle Scholar
  • 7 McKenna DS, Ventolini G, Neiger R, Downing C. Gender-related differences in fetal heart rate during first trimester. Fetal Diagn Ther 2006; 21 (1) 144-147
    CrossrefPubMedGoogle Scholar
  • 8 Oguch O, Steer P. Gender does not affect fetal heart rate variation. Br J Obstet Gynaecol 1998; 105 (12) 1312-1314
    CrossrefPubMedGoogle Scholar
  • 9 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol 2009; 114 (1) 192-202
    CrossrefPubMedGoogle Scholar
  • 10 Cahill AG, Roehl KA, Odibo AO, Macones GA. Association and prediction of neonatal acidemia. Am J Obstet Gynecol 2012; 207 (3) 206.e1-206.e8
    CrossrefPubMedGoogle Scholar
  • 11 Royston P. A pocket-calculator algorithm for the Shapiro-Francia test for non-normality: an application to medicine. Stat Med 1993; 12 (2) 181-184
    CrossrefPubMedGoogle Scholar
  • 12 Sheiner E, Hadar A, Hallak M, Katz M, Mazor M, Shoham-Vardi I. Clinical significance of fetal heart rate tracings during the second stage of labor. Obstet Gynecol 2001; 97 (5, Pt 1): 747-752
    CrossrefPubMedGoogle Scholar
  • 13 Greenough A, Lagercrantz H, Pool J, Dahlin I. Plasma catecholamine levels in preterm infants. Effect of birth asphyxia and Apgar score. Acta Paediatr Scand 1987; 76 (1) 54-59
    CrossrefPubMedGoogle Scholar
  • 14 Bruckner TA, Cheng YW, Singh A, Caughey AB. Economic downturns and male cesarean deliveries: a time-series test of the economic stress hypothesis. BMC Pregnancy Childbirth 2014; 14: 198
    CrossrefPubMedGoogle Scholar