Intrapartum Fetal Electrocardiogram in Small- and Large-for-Gestational Age Fetuses

Lena Braginsky; Steven J. Weiner; George R. Saade; Michael W. Varner; Sean C. Blackwell; Uma M. Reddy; John M. Thorp Jr.; Alan T.N. Tita; Russell S. Miller; David S. McKenna; Edward K.S. Chien; Dwight J. Rouse; Yasser Y. El-Sayed; Yoram Sorokin; Steve N. Caritis; for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units (MFMU) Network

doi:10.1055/s-0041-1735285

American Journal of Perinatology, Table of Contents

Am J Perinatol 2021; 38(14): 1465-1471
DOI: 10.1055/s-0041-1735285

SMFM Fellowship Series Article

Intrapartum Fetal Electrocardiogram in Small- and Large-for-Gestational Age Fetuses

Authors

Lena Braginsky

¹Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
Steven J. Weiner

²Department of Obstetrics and Gynecology, George Washington University Biostatistics Center, Washington, District of Columbia
George R. Saade

³Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
Michael W. Varner

⁴Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
Sean C. Blackwell

⁵Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, McGovern Medical School-Children's Memorial Hermann Hospital, Houston, Texas
Uma M. Reddy

⁶Department of Obstetrics and Gynecology, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
John M. Thorp Jr.

⁷Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Alan T.N. Tita

⁸Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
Russell S. Miller

⁹Department of Obstetrics and Gynecology, Columbia University, New York City, New York
David S. McKenna

¹⁰Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
Edward K.S. Chien

¹¹Department of Obstetrics and Gynecology, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio
Dwight J. Rouse

¹²Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
Yasser Y. El-Sayed

¹³Department of Obstetrics and Gynecology, Stanford University, Stanford, California
Yoram Sorokin

¹⁴Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
Steve N. Caritis

¹⁵Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania

for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units (MFMU) Network

Abstract

Objective This study aimed to evaluate whether intrapartum fetal electrocardiogram (ECG) tracings with ST-elevation or depression occur more frequently in each stage of labor in small-for-gestational age (SGA) or large-for-gestational age (LGA), as compared with appropriate-for-gestational age (AGA) fetuses.

Study Design We conducted a secondary analysis of a large, multicenter trial in which laboring patients underwent fetal ECG waveform-analysis. We excluded participants with diabetes mellitus and major fetal anomalies. Birth weight was categorized as SGA (<10th percentile), LGA (>90th percentile), or AGA (10–90th percentile) by using a gender and race/ethnicity specific nomogram. In adjusted analyses, the frequency of ECG tracings with ST-depression or ST-elevation without depression was compared according to birthweight categories and labor stage.

Results Our study included 4,971 laboring patients in the first stage and 4,074 in the second stage. During the first stage of labor, there were no differences in the frequency of ST-depression in SGA fetuses compared with AGA fetuses (6.7 vs. 5.5%; adjusted odds ratio [aOR]: 1.41, 95% confidence interval [CI]: 0.93–2.13), or in ST-elevation without depression (35.8 vs. 34.1%; aOR: 1.17, 95% CI: 0.94–1.46). During the second stage, there were no differences in the frequency of ST-depression in SGA fetuses compared with AGA fetuses (1.6 vs. 2.0%; aOR: 0.69, 95% CI: 0.27–1.73), or in ST-elevation without depression (16.2 vs. 18.1%; aOR: 0.90, 95% CI: 0.67–1.22). During the first stage of labor, there were no differences in the frequency of ST-depression in LGA fetuses compared with AGA fetuses (6.3 vs. 5.5%; aOR: 0.97, 95% CI: 0.60–1.57), or in ST-elevation without depression (33.1 vs. 34.1%; aOR: 0.80, 95% CI: 0.62–1.03); during the second stage of labor, the frequency of ST-depression in LGA compared with AGA fetuses (2.5 vs. 2.0%, aOR: 1.36, 95% CI: 0.61–3.03), and in ST-elevation without depression (15.5 vs. 18.1%; aOR: 0.83, 95% CI: 0.58–1.18) were similar as well.

Conclusion The frequency of intrapartum fetal ECG tracings with ST-events is similar among SGA, AGA, and LGA fetuses.

Key Points

SGA and LGA neonates are at increased risk of cardiac dysfunction.
Fetal ECG has been used to evaluate fetal response to hypoxia.
Fetal ST-elevation and ST-depression occur during hypoxia.
Frequency of intrapartum ST-events is similar among SGA, AGA and LGA fetuses.

Keywords

fetal ECG - small-for-gestational age - fetal growth restriction - large-for-gestational age - ST-segment analysis - ST-events

Full Text

References

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