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

OBJECTIVE: Our purpose was to evaluate the validity of intrapartum fet al heart rate tracings in predicting short- and long-term outcomes of infants delivered between 24 and 26 weeks. STUDY DESIGN: Fetal heart r ate tracings obtained during the last hour before delivery of fetuses delivered at 24 to 26 weeks' gestation were reviewed. Two perinatologi sts blinded to neonatal outcome evaluated the tracings for the followi ng 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; intraven tricular hemorrhage; duration of assisted ventilation; and hospitaliza tion, survival, and developmental status at 1 year. RESULTS: The fetal heart rate attribute that was found to be predictive of neonatal outc ome was the presence of any bradycardia or tachycardia found in any 10 -minute window (designated ''baseline rate abnormality''). This correl ated with neonatal death (p < 0.007). None of the other fetal heart ra te attributes were associated with any neonatal outcome. Intraobserver agreement was ''fair to good'' (kappa 0.5). CONCLUSION: Fetal baselin e rat abnormalities (either tachycardia or bradycardia) were predictiv e of neonatal death in extremely premature fetuses.