Fetal Tachycardia in the Setting of Maternal Intrapartum Fever and Perinatal Morbidity
Year: 2021
Type: article
Abstract: OBJECTIVE: The fetal consequences of intrapartum fetal tachycardia with maternal fever or clinical chorioamnionitis are not well studied. We evaluated the association between perinatal morbidity and fetal tachycardia in the setting of intrapartum fever. STUDY DESIGN: Secondary analysis of a multicenter randomized control trial that enrolled 5,341 healthy laboring nulliparous women ≥36 weeks' gestation. Women with intrapartum fever ≥ 38.0°C (including those meeting criteria for clinical chorioamnionitis) after randomization were included in this analysis. Isolated fetal tachycardia was defined as fetal heart rate (FHR) ≥160 beats per minute for at least 10 minutes in the absence of other FHR abnormalities. FHR abnormalities other than tachycardia were excluded from the analysis. The primary outcome was a perinatal composite (5-minute Apgar's score ≤3, intubation, chest compressions, or mortality). Secondary outcomes included low arterial cord pH (pH < 7.20), base deficit ≥12, and cesarean delivery. RESULTS: A total of 986 (18.5%) of women in the trial developed intrapartum fever, and 728 (13.7%) met criteria to be analyzed; of these, 728 women 336 (46.2%) had maternal-fetal medicine (MFM) reviewer-defined fetal tachycardia, and 349 of the 550 (63.5%) women during the final hour of labor had validated software (PeriCALM) defined fetal tachycardia. After adjusting for confounders, isolated fetal tachycardia was not associated with a significant difference in the composite perinatal outcome (adjusted odds ratio [aOR] = 3.15 [0.82-12.03]) compared with absence of tachycardia. Fetal tachycardia was associated with higher odds of arterial cord pH <7.2, aOR = 1.48 (1.01-2.17) and of infants with a base deficit ≥ 12, aOR = 2.42 (1.02-5.77), but no significant difference in the odds of cesarean delivery, aOR = 1.33 (0.97-1.82). CONCLUSION: Fetal tachycardia in the setting of intrapartum fever or chorioamnionitis is associated with significantly increased fetal acidemia defined as a pH <7.2 and base excess ≥12 but not with a composite perinatal morbidity. KEY POINTS: · The perinatal outcomes associated with fetal tachycardia in the setting of maternal fever are undefined.. · Fetal tachycardia was not significantly associated with perinatal morbidity although the sample size was limited.. · Fetal tachycardia was associated with an arterial cord pH <7.2 and base deficit of 12 or greater..
Source: American Journal of Perinatology
DOI: 10.1055/a-1675-0901
Authors: Alan T. N. Tita, Paula L. McGee, Uma M. Reddy, Steven L. Bloom, Michael W. Varner, Susan M. Ramin, Steve N. Caritis, Alan M. Peaceman, Yoram Sorokin, Anthony Sciscione, Marshall W. Carpenter, Brian M. Mercer, John M. Thorp, Fergal D. Malone, Catalin Buhimschi, for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units (MFMU) Network
Institutions: University of Alabama at Birmingham, George Washington University, Eunice Kennedy Shriver National Institute of Child Health and Human Development, The University of Texas Southwestern Medical Center, University of Utah, University of Utah Health Care, Memorial Hermann, The University of Texas Health Science Center at Houston, University of Pittsburgh, Northwestern University, Wayne State University, Drexel University, Brown University, MetroHealth, MetroHealth Medical Center, Case Western Reserve University, University of North Carolina at Chapel Hill, Columbia University, The Ohio State University
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G1216570417, General Clinical Research Center, Maternal Fetal Medicine Network: Data Coordinating Cent*, G1882602020, Eunice Kennedy Shriver NICHD Maternal Fetal Medicine Units Network, Maternal Fetal Medicine Units Network, G2254024324, NICHD Maternal Fetal Medicine Units Network, G2594613454, NICHD Maternal-Fetal Medicine Units (MFMU) Network, G284963502, G2925552923, G29782494, NICHD Maternal Fetal Medicine Units Network, Eunice Kennedy Shriver NICHD Maternal Fetal Medicine Units Network, Cooperative Multicenter Maternal Fetal Medicine Units Networks, G3786447104, G3875946430, G4027080872, Co-Operative Multicenter Trials in Obstetrics & Maternal Fetal Medicine, Data Coord Ctr-NICHD Cooperative Multicenter Maternal Medicine Units Research Net, MULTICENTER NETWORK OF MATERNAL-FETAL MEDICINE UNITS, Multicenter Network of Maternal Fetal Medicine Units, G4657398957, Eunice Kennedy Shriver NICHD Maternal Fetal Medicine Units Network (U10), G6657596466, G673807916, Brown/WIH Eunice Kennedy Shriver NICHD MFM Units Network Site, Maternal Fetal Medicine Network, NICHD Materal Fetal Medicine Units Network, MULTICENTER NETWORK OF MATERNAL-FETAL MEDICINE UNITS, UofU Maternal-Fetal Medicine Units (MFMU) Network: Clinical Centers, Brown University/Women & Infants Hospital of Rhode Island (WIH) Center Application for the Eunice Kennedy Shriver NICHD Maternal Fetal Medicine Units Network, Maternal Fetal Medicine Units Network - Northwestern Study Center, Maternal-Fetal Medicine Units (MFMU) Network, Case Western Reserve University Center of the NICHD MFMU Network, Columbia University Maternal-Fetal Medicine Units Network Clinical Center, NICHD maternal fetal medicine units network, UNC MFMU: Advancing Perinatal Health via Definitive, Multi-Site Clinical Studies, Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units (MFMU) Network (UG1), G922324195
OpenAlex ID: W3206753422