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[How to define a non-reassuring FHR tracing online].

¹Institut für feto-maternale Medizin, Detmold. vmr.dr@t-online.de

Zeitschrift Fur Geburtshilfe Und Neonatologie

|September 1, 2010

Summary

A new computer-aided WAS score provides numerical criteria to reliably define non-reassuring fetal heart-rate (FHR) patterns. This method accurately distinguishes normal from abnormal FHR tracings, improving intrapartum fetal monitoring and outcomes.

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Area of Science:

Obstetrics and Gynecology
Fetal Monitoring
Neonatal Health

Background:

Evaluating intrapartum fetal heart-rate (FHR) patterns lacks objective numerical criteria for defining non-reassuring or pathological tracings.
The development of computer-aided analysis offers a potential solution for establishing reliable FHR assessment boundaries.

Purpose of the Study:

To establish numerical criteria for differentiating normal (reassuring) from abnormal (non-reassuring) intrapartum fetal heart-rate (FHR) tracings.
To validate a computer-aided method, the WAS score, for real-time assessment of FHR patterns and correlation with umbilical artery pH.

Main Methods:

Recorded electronic FHR tracings from 475 vaginally delivered fetuses, analyzing the last 30 minutes for WAS score computation.
Correlated WAS scores with umbilical artery (UA) pH and performed ROC analyses to determine sensitivity, specificity, false positive rate (FPR), and false negative rate (FNR).

Main Results:

A strong correlation (r=0.657) was found between WAS score and UA pH (mean 7.263).
A WAS score threshold of 1.816 achieved 100% sensitivity (0% FNR) and 10.7% FPR for identifying non-reassuring FHR tracings.
Abnormal FHR tracings (WAS score ≤1.816) were associated with significantly lower UA pH and increased risk of acidosis.

Conclusions:

The WAS scoring system provides a reliable, computer-aided method for online discrimination between normal and abnormal intrapartum FHR tracings.
This objective scoring system enhances the ability to identify fetuses at risk during labor, potentially improving neonatal outcomes.