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Acidemia Can Occur Despite Category I Tracing
Ann M Bruno1, Julia D López1, Molly J Stout1
1Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
American Journal of Perinatology
|May 24, 2019
Summary
Electronic fetal monitoring (EFM) category I tracings do not rule out neonatal acidemia. Some infants experienced acidemia even with category I tracings for over 40 minutes before birth.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Health
- Fetal Monitoring
Background:
- Electronic fetal monitoring (EFM) is standard for assessing fetal well-being during labor.
- Category I tracing is generally considered reassuring.
Purpose of the Study:
- To test if a category I tracing in the 60 minutes before delivery rules out neonatal acidemia.
- Investigating the predictive value of reassuring EFM patterns.
Main Methods:
- Secondary analysis of a prospective cohort study involving 8,580 singleton pregnancies.
- Review of EFM tracings at 10-minute intervals within 60 minutes of delivery.
- Primary outcome: neonatal acidemia (umbilical cord arterial pH ≤ 7.10).
Main Results:
- Neonatal acidemia occurred in 0.98% of 4,274 analyzed infants.
- 31% of infants with acidemia had category I tracings within 30 minutes of delivery.
- 7% of infants with acidemia had category I tracings for over 40 minutes before delivery.
Conclusions:
- Category I tracings do not completely exclude the possibility of neonatal acidemia.
- Clinical context and a priori risk assessment are crucial when interpreting EFM findings.
- Reassuring EFM patterns should be considered alongside other clinical factors.
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