THE PREDICTIVE VALUE OF INTRAPARTUM FETAL HEART-RATE ABNORMALITIES IN THE EXTREMELY PREMATURE-INFANT

OBJECTIVE: Our purpose was to evaluate the validity of intrapartum fetal heart rate tracings in predicting short- and long-term outcomes of infants delivered between 24 and 26 weeks. STUDY DESIGN: Fetal heart rate tracings obtained during the last hour before delivery of fetuses delivered at 24 to 26 weeks' gestation were reviewed. Two perinatologists blinded to neonatal outcome evaluated the tracings for the following attributes: baseline rate and variability, presence and severity of decelerations, and overall impression (reassuring, nonreassuring, or ominous). Measured outcomes were cord blood pH; Apgar scores; intraventricular hemorrhage; duration of assisted ventilation; and hospitalization, survival, and developmental status at 1 year. RESULTS: The fetal heart rate attribute that was found to be predictive of neonatal outcome was the presence of any bradycardia or tachycardia found in any 10-minute window (designated ''baseline rate abnormality''). This correlated with neonatal death (p < 0.007). None of the other fetal heart rate attributes were associated with any neonatal outcome. Intraobserver agreement was ''fair to good'' (kappa 0.5). CONCLUSION: Fetal baseline rat abnormalities (either tachycardia or bradycardia) were predictive of neonatal death in extremely premature fetuses.