Comparison of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation in detecting fetal acidemia at birth

• Published in: American journal of obstetrics and gynecology Vol. 173; no. 4; pp. 1021 - 1024
• Main Authors: Vintzileos, Anthony M., Nochimson, David J., Antsaklis, Aris, Varvarigos, Ioannis, Guzman, Edwin R., Knuppel, Robert A.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01-10-1995; Elsevier
• Subjects: Acidosis - blood; Acidosis - diagnosis; Acidosis, Respiratory - diagnosis; auscultation; Biological and medical sciences; Delivery. Postpartum. Lactation; Electrodiagnosis; Electronic heart rate monitoring; Female; fetal acidemia; Fetal Blood - metabolism; Fetal Diseases - blood; Fetal Diseases - diagnosis; Fetal Monitoring - methods; Gynecology. Andrology. Obstetrics; Heart Auscultation; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Maternal, fetal and perinatal monitoring; Medical sciences; Predictive Value of Tests; Pregnancy; Sensitivity and Specificity; fetal acidemia; Electronic heart rate monitoring; auscultation; Human; Blood gas; Electronic equipment; Pregnancy disorders; Circulatory velocity; Blood; Acidemia; Blood flow; Heart rate; Fetal diseases; Female; Fetal distress; Clinical investigation; Umbilical cord; Comparative study; Monitoring
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/0002-9378(95)91320-3

OBJECTIVE: Our purpose was to compare continuous intrapartum electronic fetal heart rate monitoring with intermittent auscultation for detecting fetal acidemia at birth.
STUDY DESIGN: Data from a previously published randomized trial of electronic fetal heart rate monitoring versus intermittent auscultation were analyzed to identify any differences between the two methods in detecting fetal acidemia at birth. Fetal acidemia at birth was defined as the presence of cord blood arterial pH <7.15.
RESULTS: A total of 1419 patients with umbilical cord blood acid-base measurements were identified, 739 in the electronic FHR monitoring group and 680 in the auscultation group. Electronic FHR monitoring had significantly better sensitivity (97% vs 34%,
p < 0.001), lower specificity (84% vs 91%,
p < 0.001), higher positive predictive value (37% vs 22%,
p < 0.05), and higher negative predictive value (99.5% vs 95%,
p < 0.001) in detecting fetal acidemia at birth. In addition, electronic FHR monitoring was significantly better in detecting all types of acidemia: metabolic (95.5% vs 26.5%,
p < 0.001), mixed (95% vs 37.5%,
p < 0.001), and respiratory (100% vs 41.5%,
p < 0.001).
CONCLUSION: These data suggest that electronic FHR monitoring is superior to intermittent auscultation in detecting fetal acidemia at birth.