Abstract
Objectives
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.
Methods
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.
Results
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.
Conclusions
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.
-
Research funding: None declared.
-
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
-
Competing interests: Authors state no conflict of interest.
-
Informed consent: Not applicable.
-
Ethical approval: Not applicable.
References
1. Hamela Olkowska, A, Szymkiewicz Dangel, J, Romejko Wolniewicz, E. Cardiotocography in fetal heart arrhythmia – analysis of cases. Ginekol Pol 2010;81:622–8.Search in Google Scholar
2. 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.Search in Google Scholar
3. Hoffman, JIE. Incidence of congenital heart disease: II. Prenatal incidence. Pediatr Cardiol 1995;16:155–65. https://doi.org/10.1007/BF00794186.Search in Google Scholar
4. 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.Search in Google Scholar
5. Stoll, C. Distribution of single organ malformations in European populations. Ann Genet 1995;38:32–43.Search in Google Scholar
6. 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.Search in Google Scholar
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.Search in Google Scholar
8. Khalid, N, Iqbal, K, Akhtar, N. Fetal outcome in pathological cardiotocography. Pak J Med Health Sci 2013;7:317–21.Search in Google Scholar
9. 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.Search in Google Scholar PubMed
10. 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.Search in Google Scholar
11. 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.Search in Google Scholar PubMed PubMed Central
12. 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.Search in Google Scholar PubMed
13. 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.Search in Google Scholar PubMed
14. 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.Search in Google Scholar PubMed
15. Arnold, JJ, Gawrys, BL. Intrapartum fetal monitoring. Am Fam Physician 2020;102:158–67.Search in Google Scholar
16. 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.Search in Google Scholar PubMed
17. 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.Search in Google Scholar PubMed
18. Grignaffini, A, Cavatorta, E, Stefanini, A. Congenital cardiac disease: cardiotocographic manifestations (author’s transl). Ateneo Parmense Acta Biomed 1980;51:53–536.Search in Google Scholar
19. 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.Search in Google Scholar PubMed
20. 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.Search in Google Scholar PubMed
21. 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.Search in Google Scholar PubMed
22. 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.Search in Google Scholar
23. 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.Search in Google Scholar PubMed
24. 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.Search in Google Scholar PubMed
25. 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.Search in Google Scholar PubMed
26. 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.Search in Google Scholar PubMed
27. 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.Search in Google Scholar PubMed
28. 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.Search in Google Scholar
29. 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.Search in Google Scholar
30. 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.Search in Google Scholar
31. 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.Search in Google Scholar
32. 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.Search in Google Scholar
33. 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.Search in Google Scholar
34. 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.Search in Google Scholar
35. 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.Search in Google Scholar
36. 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.Search in Google Scholar
37. 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.Search in Google Scholar
38. 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.Search in Google Scholar
39. 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.Search in Google Scholar
40. 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.Search in Google Scholar PubMed PubMed Central
41. 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.Search in Google Scholar PubMed
42. Fricke, TA, Konstantinov, IE, Grigg, LE, Zentner, D. Pregnancy outcomes in women after the arterial switch operation. Heart Lung Circ 2019;29:1087–92.10.1016/j.hlc.2019.07.016Search in Google Scholar PubMed
43. 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.Search in Google Scholar PubMed
44. 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.Search in Google Scholar PubMed
Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/jpm-2021-0139).
© 2022 Walter de Gruyter GmbH, Berlin/Boston
