The association between uterine contraction frequency and fetal scalp pH in women with suspicious or pathological fetal heart rate tracings: A retrospective study

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 271; pp. 1 - 6
• Main Authors: Frenken, M.W.E., van der Woude, D.A.A., Dieleman, J.P., Oei, S.G., van Laar, J.O.E.H.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-04-2022
• Subjects: Fetal acidosis; Fetal hypoxia; Fetal scalp pH; Tachysystole; Uterine activity; Uterine contractions; Fetal scalp pH; Uterine activity; Fetal hypoxia; Tachysystole; Uterine contractions; Fetal acidosis
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2022.01.023

•Recommendations on optimal contraction frequency are poorly substantiated by literature.•No distinction in recommendations is made based on presence/absence of FHR abnormalities.•In case of FHR abnormalities, >4 contractions are associated with fetal hypoxia.•We suggest to aim for a maximum contractions frequency of 4 in these women.
Current guidelines provide little supporting literature for the definition of uterine tachysystole during labour and no distinction is made for optimal contraction frequency depending on the clinical situation. We hypothesize that fetal hypoxia is frequently caused by uterine tachysystole and that high uterine contraction frequencies are especially harmful when fetal heart rate (FHR) abnormalities are present. We studied the association between contraction frequency and fetal scalp pH values in women with an indication for fetal blood sampling (FBS) based on FHR abnormalities.
A retrospective study including 762 women was performed in a tertiary teaching hospital in the Netherlands from January 2015 until January 2020. Women with a singleton pregnancy with a gestational age ≥ 34+0 weeks were included when FBS was performed because of suspicious or pathological FHR tracings. Exclusion criteria were maternal age < 18 years, failed fetal scalp pH values, lack of thirty minute registration by tocodynamometry prior to FBS, poor quality of uterine monitoring, intrauterine resuscitation in the thirty minutes prior to FBS, maternal body mass index ≥ 30 kg/m2 and neonatal birth weight < 10th percentile.
Uterine contractions in the thirty minutes prior to FBS were manually annotated by a researcher who was blinded to FBS values, FHR and other obstetrical data. Linear and logistic analysis were used to explore the association between uterine contraction frequency and FBS results.
Low fetal scalp pH values were significantly associated with contraction frequency prior to FBS. Fetuses of women with four to five contractions per ten minutes prior to FBS were 2.4 times more likely to have hypoxia as compared to fetuses of women with two to three contractions per ten minutes (aOR 2.4, 95% CI 1.1–5.4). With increasing contraction frequency, the risk of fetal hypoxia further increased.
Contraction frequency above four per ten minutes prior to FBS is significantly associated with fetal hypoxia in women with FHR abnormalities. We suggest to aim for a maximum contraction frequency of four per ten minutes in these women.