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Fetal heart rate short term variation during labor in relation to scalp blood lactate concentration
KTH, School of Technology and Health (STH).ORCID iD: 0000-0002-3256-9029
Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;Karolinska Univ Hosp, Patient Area Pregnancy & Delivery Care, Stockholm, Sweden..ORCID iD: 0000-0002-2640-0753
Karolinska Inst, Inst Environm Med, Stockholm, Sweden.;Karolinska Univ Hosp Huddinge, Dept Clin Physiol, Stockholm, Sweden..
KTH, School of Technology and Health (STH). Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden..ORCID iD: 0000-0003-4853-7731
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2018 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 10, p. 1274-1280Article in journal (Refereed) Published
Abstract [en]

IntroductionFetal heart rate short term variation (STV) decreases with severe chronic hypoxia in the antenatal period. However, only limited research has been done on STV during labor. We have tested a novel algorithm for a valid baseline estimation and calculated STV. To explore the value of STV during labor, we compared STV with fetal scalp blood (FBS) lactate concentration, an early marker in the hypoxic process. Material and methodsSoftware was developed which estimates baseline frequency using a novel algorithm and thereby calculates STV according to Dawes and Redman in up to four 30-minute blocks prior to each FBS. Cardiotocography traces from 1070 women in labor who had had FBS performed on 2134 occasions were analyzed. ResultsIn acidemic cases (lactate >4.8mmol/L; Lactate Pro), median STV 30minutes prior to FBS was 7.10milliseconds compared with 6.09milliseconds in the preacidemic (4.2-4.8mmol/L) and 5.23milliseconds in the normal (<4.2mmol/L) groups (P<.05). There was a positive correlation between lactate and STV (rho=0.16-0.24; P<.05). Median lactate concentration in cases with STV <3.0milliseconds (n=160) was 2.3mmol/L. When 2 FBS were performed within 60minutes the change rate of lactate correlated to STV (rho=0.33; P<.001). Cases with increasing lactate concentration had a median STV of 5.29milliseconds vs 4.41milliseconds in those with decreasing lactate (P<.001). ConclusionsIn the early stages of intrapartum hypoxia, STV increases, contrary to findings regarding chronic hypoxia in the antenatal period. The increase in the adrenergic surge is a likely explanation.

Place, publisher, year, edition, pages
Wiley , 2018. Vol. 97, no 10, p. 1274-1280
Keywords [en]
computer analysis, fetal heart rate monitoring, fetal scalp blood sampling, hypoxia, intrapartum, lactate, short-term variation
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:kth:diva-235432DOI: 10.1111/aogs.13390ISI: 000444070900017PubMedID: 29799630Scopus ID: 2-s2.0-85052990496OAI: oai:DiVA.org:kth-235432DiVA, id: diva2:1251414
Note

QC 20180927

Available from: 2018-09-27 Created: 2018-09-27 Last updated: 2018-10-22Bibliographically approved

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Lu, KeLindecrantz, Kaj

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Lu, KeHolzmann, MalinLindecrantz, KajLindqvist, Pelle G.
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