Intrapartum repetitive maternal heart rate deceleration pattern simulating nonreassuring fetal status

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Cardiology

Background:

• Uterine contraction-associated accelerations in maternal heart rate are linked to increased cardiac output and catecholamines.
• Uterine contraction-associated decelerations in maternal heart rate are infrequent and poorly understood.
• Systemic lupus erythematosus (SLE) can impact pregnancy and renal function, necessitating careful monitoring.

Purpose of the Study:

• To report a rare case of significant maternal heart rate decelerations during labor.
• To highlight the potential for confusion between maternal and fetal heart rate patterns.
• To emphasize the importance of accurate maternal and fetal heart rate identification.

Main Methods:

• Continuous intrapartum maternal and fetal heart rate monitoring.
• Case report of a multiparous patient with SLE and a history of renal transplant.
• Clinical observation during early labor at 39 weeks gestation.

Main Results:

• Repetitive maternal heart rate decelerations (60 bpm, 2 min duration) associated with uterine contractions were observed.
• The fetal heart rate remained reassuring throughout the monitoring period.
• The maternal heart rate pattern mimicked nonreassuring fetal status.

Conclusions:

• Uterine contractions can uncommonly cause profound maternal heart rate decelerations.
• Misinterpretation of maternal bradycardia as fetal distress can occur.
• Distinguishing maternal from fetal heart rates is critical for appropriate intrapartum management.