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. 2022 May 10;50(7):961-969.
doi: 10.1515/jpm-2021-0139. Print 2022 Sep 27.

Intrapartum cardiotocography in pregnancies with and without fetal CHD

Stepan Feduniw  1 , Katarzyna Muzyka-Placzyńska  1 , Anna Kajdy  1 , Marcin Wrona  2 , Dorota Sys  1 , Joanna Szymkiewicz-Dangel  3
Affiliations

Intrapartum cardiotocography in pregnancies with and without fetal CHD

Stepan Feduniw et al. J Perinat Med. .

Abstract

Objectives: Congenital heart defects (CHD) are the most common inherited abnormalities. Intrapartum cardiotocography (CTG) is still considered a "gold standard" during labor. However, there is a lack of evidence regarding the interpretation of intrapartum CTG in fetuses with CHD. Therefore, the study aimed to compare intrapartum CTG in normal fetuses and fetuses with CHD and describe the association between CTG and neonatal outcomes.

Methods: The present study is a retrospective analysis of the CTG of 395 fetuses. There were three study groups: Group 1: 185 pregnancies with a prenatal diagnosis of CHD, Group 2: 132 high-risk pregnancies without CHD, and Group 3: 78 low-risk pregnancies without CHD.

Results: Abnormal CTG was present statistically OR=3.4 (95%CI: 1.61-6.95) more often in Group 1. The rate of the emergency CS was higher in this group OR=3 (95%CI: 1.3-3.1). Fetuses with CHD and abnormal CTG were more often scored ≤7 Apgar, with no difference in acidemia. The multivariate regression model for Group 1 does not show clinical differences between Apgar scores or CTG assessment in neonatal acidemia prediction.

Conclusions: CTG in fetuses with CHD should be interpreted individually according to the type of CHD and conduction abnormalities. Observed abnormalities in CTG are associated with the fetal heart defect itself. Preterm delivery and rapid cesarean delivery lead to a higher rate of neonatal complications. Health practitioners should consider this fact during decision-making regarding delivery in cases complicated with fetal cardiac problems.

Keywords: congenital heart defects (CHD); congenital heart disease; fetal cardiac malformation; fetal heart rate (FHR); fetal heart tracing; intrapartum; intrapartum cardiotocography (CTG).

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