Intrapartum cardiotocography in pregnancies with and without fetal CHD.
congenital heart defects (CHD)
congenital heart disease
fetal cardiac malformation
fetal heart rate (FHR)
fetal heart tracing
intrapartum
intrapartum cardiotocography (CTG)
Journal
Journal of perinatal medicine
ISSN: 1619-3997
Titre abrégé: J Perinat Med
Pays: Germany
ID NLM: 0361031
Informations de publication
Date de publication:
27 Sep 2022
27 Sep 2022
Historique:
received:
19
03
2021
accepted:
24
03
2022
pubmed:
10
5
2022
medline:
14
9
2022
entrez:
9
5
2022
Statut:
epublish
Résumé
Congenital heart defects (CHD) are the most common inherited abnormalities. Intrapartum cardiotocography (CTG) is still considered a "gold standard" during labor. However, there is a lack of evidence regarding the interpretation of intrapartum CTG in fetuses with CHD. Therefore, the study aimed to compare intrapartum CTG in normal fetuses and fetuses with CHD and describe the association between CTG and neonatal outcomes. The present study is a retrospective analysis of the CTG of 395 fetuses. There were three study groups: Group 1: 185 pregnancies with a prenatal diagnosis of CHD, Group 2: 132 high-risk pregnancies without CHD, and Group 3: 78 low-risk pregnancies without CHD. Abnormal CTG was present statistically OR=3.4 (95%CI: 1.61-6.95) more often in Group 1. The rate of the emergency CS was higher in this group OR=3 (95%CI: 1.3-3.1). Fetuses with CHD and abnormal CTG were more often scored ≤7 Apgar, with no difference in acidemia. The multivariate regression model for Group 1 does not show clinical differences between Apgar scores or CTG assessment in neonatal acidemia prediction. CTG in fetuses with CHD should be interpreted individually according to the type of CHD and conduction abnormalities. Observed abnormalities in CTG are associated with the fetal heart defect itself. Preterm delivery and rapid cesarean delivery lead to a higher rate of neonatal complications. Health practitioners should consider this fact during decision-making regarding delivery in cases complicated with fetal cardiac problems.
Identifiants
pubmed: 35534874
pii: jpm-2021-0139
doi: 10.1515/jpm-2021-0139
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
961-969Informations de copyright
© 2022 Walter de Gruyter GmbH, Berlin/Boston.
Références
Hamela Olkowska, A, Szymkiewicz Dangel, J, Romejko Wolniewicz, E. Cardiotocography in fetal heart arrhythmia – analysis of cases. Ginekol Pol 2010;81:622–8.
Yagel, S, Weissman, A, Rotstein, Z, Manor, M, Hegesh, J, Anteby, E, et al.. Congenital heart defects: natural course and in utero development. Circulation 1997;96:550–5. https://doi.org/10.1161/01.cir.96.2.550.
Hoffman, JIE. Incidence of congenital heart disease: II. Prenatal incidence. Pediatr Cardiol 1995;16:155–65. https://doi.org/10.1007/BF00794186.
Nicolaides, K, Shawwa, L, Brizot, M, Snijders, R. Ultrasonographically detectable markers of fetal chromosomal defects. Ultrasound Obstet Gynecol 1993;3:56–69. https://doi.org/10.1046/j.1469-0705.1993.03010056.x.
Stoll, C. Distribution of single organ malformations in European populations. Ann Genet 1995;38:32–43.
Sultana, J, Chowdhury, TA, Begum, K, Khan, MH. Comparison of normal and abnormal cardiotocography with pregnancy outcomes and early neonatal outcomes. Mymensingh Med J 2009;18:103–7.
Brocklehurst, P, Field, D, Greene, K, Juszczak, E, Kenyon, S, Linsell, L, et al.. Computerised interpretation of fetal heart rate during labour (INFANT): a randomised controlled trial. Lancet 2017;389:1719–29. https://doi.org/10.1016/s0140-6736(17)30568-8.
Khalid, N, Iqbal, K, Akhtar, N. Fetal outcome in pathological cardiotocography. Pak J Med Health Sci 2013;7:317–21.
Tranquilli, AL, Biagini, A, Greco, P, Di Tommaso, M, Giannubilo, SR. The correlation between fetal bradycardia area in the second stage of labor and acidemia at birth. J Matern Fetal Neonatal Med 2013;26:1425–9. https://doi.org/10.3109/14767058.2013.784263.
Cahill, AG, Caughey, AB, Roehl, KA, Odibo, AO, Macones, GA. Terminal fetal heart decelerations and neonatal outcomes. Obstet Gynecol 2013;122:1070–6. https://doi.org/10.1097/aog.0b013e3182a8d0b0.
Kajdy, A, Modzelewski, J, Jakubiak, M, Pokropek, A, Rabijewski, M. Effect of antenatal detection of small-for-gestational-age newborns in a risk stratified retrospective cohort. PLoS One 2019;14:e0224553. https://doi.org/10.1371/journal.pone.0224553.
Dore, S, Ehman, W. No. 396-fetal health surveillance: intrapartum consensus guideline. J Obstet Gynaecol Can 2020;42:316–48.e9. https://doi.org/10.1016/j.jogc.2019.05.007.
Ayres-de-Campos, D, Spong, CY, Chandraharan, E, Panel, FIFMEC. FIGO consensus guidelines on intrapartum fetal monitoring: cardiotocography. Int J Gynecol Obstet 2015;131:13–24. https://doi.org/10.1016/j.ijgo.2015.06.020.
Ueda, K, Ikeda, T, Iwanaga, N, Katsuragi, S, Yamanaka, K, Neki, R, et al.. Intrapartum fetal heart rate monitoring in cases of congenital heart disease. Am J Obstet Gynecol 2009;201:64.e1–6. https://doi.org/10.1016/j.ajog.2009.03.015.
Arnold, JJ, Gawrys, BL. Intrapartum fetal monitoring. Am Fam Physician 2020;102:158–67.
Sholapurkar, SL. Intermittent auscultation (surveillance) of fetal heart rate in labor: a progressive evidence-backed approach with aim to improve methodology, reliability and safety. J Matern Fetal Med 2020. https://doi.org/10.1080/14767058.2020.1811664.
Parisaei, M, Harrington, KF, Erskine, KJ. Acceptability of the fetal electrocardiographic (STAN) monitoring system by staff at a high risk maternity unit. J Perinat Med 2010;38:187–90. https://doi.org/10.1515/jpm.2010.023.
Grignaffini, A, Cavatorta, E, Stefanini, A. Congenital cardiac disease: cardiotocographic manifestations (author’s transl). Ateneo Parmense Acta Biomed 1980;51:53–536.
Gay, E, Bornallet, G, Gaucherand, P, Doret, M. Intrapartum electrocardiogram alteration in fetuses with congenital heart disease: a case-control study. Eur J Obstet Gynecol Reprod Biol 2015;194:111–4. https://doi.org/10.1016/j.ejogrb.2015.08.013.
Morikawa, M, Endo, D, Yamada, T, Cho, K, Yamada, T, Minakami, H. Electronic fetal heart rate monitoring in five fetuses with Ebstein’s anomaly. J Obstet Gynaecol Res 2014;40:424–8. https://doi.org/10.1111/jog.12190.
Schlotter, CM, Uhlhorn, G, Holzgreve, W, Westendorp, A, Pfefferkorn, J. Interpretational difficulties of echocardiograms in cases of atrio-ventricular block in the foetal heart. Geburtshilfe Frauenheilkd 1989;49:192–4. https://doi.org/10.1055/s-2008-1026576.
Garite, TJ, Michael Linzey, E, Freeman, RK, Dorchester, W. Fetal heart rate patterns and fetal distress in fetuses with congenital anomalies. Obstet Gynecol 1979;53:716–20.
Mah, DY, O’Leary, ET, Harrild, DM, Porras, D, Gurvitz, M, Marx, G, et al.. Resynchronizing right and left ventricles with right bundle branch block in the congenital heart disease population. JACC Clin Electrophysiol 2020;6:1762–72. https://doi.org/10.1016/j.jacep.2020.06.006.
Meller, CH, Grinenco, S, Aiello, H, Córdoba, A, Sáenz-Tejeira, MM, Marantz, P, et al.. Congenital heart disease, prenatal diagnosis and management. Arch Argent Pediatr 2020;118:e149–61. https://doi.org/10.5546/aap.2020.eng.e149.
Leszczyńska, K, Chojnicki, M, Ilaponiuk, I, Preis, K, Ciach, K, Gierat-Haponiuk, K, et al.. Analysis of pregnancy, labor and neonatal course in babies with prenatallydiagnosed complete atrioventricular heart block. Ginekol Pol 2015;86:366–71. https://doi.org/10.17772/gp/2424.
Yamada, R, Takei, K, Kaneshi, Y, Morikawa, M, Cho, K, Minakami, H. Decreased baseline variability on fetal heart rate pattern in a fetus with heterotaxy syndrome. J Obstet Gynaecol Res 2015;41:1988–90. https://doi.org/10.1111/jog.12824.
Chia, LE, Ho, TF, Wong, YC, Yip, WCL. Ventricular bigeminy misdiagnosed as fetal bradycardia by cardiotocography – the value of non-invasive fetal electrocardiography. J Perinat Med 2004;32:532–4. https://doi.org/10.1515/JPM.2004.133.
Di Mauro, A, Caroli Casavola, V, Favia Guarnieri, G, Calderoni, G, Cicinelli, E, Laforgia, N. Antenatal and postnatal combined therapy for autoantibody-related congenital atrioventricular block. BMC Pregnancy Childbirth 2013;13:220. https://doi.org/10.1186/1471-2393-13-220.
Towers, CV, Juratsch, CE, Garite, TJ. The fetal heart monitor tracing in pregnancies complicated by a spontaneous umbilical cord hematoma. J Perinatol 2009;29:517–20. https://doi.org/10.1038/jp.2008.247.
Donders, GGG, Delport, SD, Potze, F. Isolated complete congenital heart block diagnosed prenatally in down’s syndrome; a case report. Eur J Obstet Gynecol Reprod Biol 1989;31:283–7. https://doi.org/10.1016/0028-2243(89)90165-2.
Koren, I, Michaelson-Cohen, R, Chen, D, Michaeli, J, Schimmel, M, Tsafrir, A, et al.. Intrapartum fetal heart rate patterns of trisomy 21 fetuses: a case-control study. Early Hum Dev 2016;92:25–8. https://doi.org/10.1016/j.earlhumdev.2015.11.002.
Yli, BM, Källén, K, Stray-Pedersen, B, Amer-Wåhlin, I. Intrapartum fetal ECG and diabetes. J Matern Fetal Neonatal Med 2008;21:231–8. https://doi.org/10.1080/14767050801924431.
Shoham, I, Aricha-Tamir, B, Weintraub, AY, Mazor, M, Wiznitzer, A, Holcberg, G, et al.. Fetal heart rate tracing patterns associated with congenital hypothyroidism. Am J Obstet Gynecol 2009;201:48.e1–48.e4. https://doi.org/10.1016/j.ajog.2009.03.007.
Kaneko, M, Sameshima, H, Ikeda, T, Ikenoue, T, Minematsu, T. Intrapartum fetal heart rate monitoring in cases of cytomegalovirus infection. Am J Obstet Gynecol 2004;191:1257–62. https://doi.org/10.1016/j.ajog.2004.03.015.
Weiner, Z, Thaler, I, Farmakides, G, Barnhard, Y, Maulik, D, Divon, MY. Fetal heart rate patterns in pregnancies complicated by maternal diabetes. Eur J Obstet Gynecol Reprod Biol 1996;70:111–5. https://doi.org/10.1016/s0301-2115(95)02549-9.
Jabak, S, Hameed, A. Continuous intrapartum fetal monitoring in gestational diabetes, where is the evidence? J Matern Fetal Med 2020. https://doi.org/10.1080/14767058.2020.1849117.
Visser, GHA. 8 abnormal antepartum fetal heart rate patterns and subsequent handicap. Baillieres Clin Obstet Gynaecol 1988;2:117–24. https://doi.org/10.1016/s0950-3552(88)80067-1.
Chauhan, SP. Fetal heart rate abnormalities among smallversus appropriate-for gestational age: utilization of pattern recognition software. Am J Obstet Gynecol 2017;216:S507–8. https://doi.org/10.1016/j.ajog.2016.11.797.
Van Geijn, HP. Developments in CTG analysis. Baillieres Clin Obstet Gynaecol 1996;10:185–209. https://doi.org/10.1016/s0950-3552(96)80033-2.
Alfirevic, Z, Devane, D, Gyte, GML, Cuthbert, A. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev 2017. https://doi.org/10.1002/14651858.CD006066.pub3.
Walsh, CA, MacTiernan, A, Farrell, S, Mulcahy, C, McMahon, CJ, Franklin, O, et al.. Mode of delivery in pregnancies complicated by major fetal congenital heart disease: a retrospective cohort study. J Perinatol 2014;34:901–5. https://doi.org/10.1038/jp.2014.104.
Fricke, TA, Konstantinov, IE, Grigg, LE, Zentner, D. Pregnancy outcomes in women after the arterial switch operation. Heart Lung Circ 2019;29:1087–92.
Biringer, K, Zubor, P, Kudela, E, Kolarovszki, B, Zibolen, M, Danko, J. Arteriovenous malformation of vein of Galen as a rare non-hypoxic cause of changes in fetal heart rate pattern during labor. J Obstet Gynaecol Res 2016;42:346–9. https://doi.org/10.1111/jog.12909.
Peterson, AL, Quartermain, MD, Ades, A, Khalek, N, Johnson, MP, Rychik, J. Impact of mode of delivery on markers of perinatal hemodynamics in infants with hypoplastic left heart syndrome. J Pediatr 2011;159:64–9. https://doi.org/10.1016/j.jpeds.2011.01.004.