Fetal Heart Rate Observations in 300 Term Brain-damaged Infants

>Objective: To describe the fetal heart rate (FHR) patterns of 300 term brain-damaged infants.Methods: The fetal monitor strips of 300 singleton term neurologically impaired neonates were retrospectively analyzed.Results: Of the 300 infants, the admission FHR patterns were: reactive, 152 (51%); nonreactive, 135 (45%); bradycardia, 9 (3%); or unclassifiable, 4 (1%). In the reactive group, the FHR did the following: 1) remained reactive throughout labor [24 (16%)]; 2) developed an elevated baseline FHR in association with repetitive FHR decelerations and, in most instances, a loss of variability [67 (22%)]; or 3) developed a sudden prolonged FHR deceleration that lasted until delivery [61 (20%)]. Finally, the nonreactive admission group exhibited the following: 1) a persistent fixed baseline rate from admission (149 +/- 16 beats/min) [97 (72%)]; 2) a prolonged FHR deceleration that lasted until delivery [12 (9%)]; or 3) a stair steps to death pattern [26 (19%)].Conclusions: While term infants later found to be neurologically impaired do not manifest a uniform FHR pattern, these fetuses do manifest distinct FHR patterns intrapartum that can be easily categorized and identified on the basis of the fetal admission test and subsequent changes in the baseline heart rate. This distinction should prove helpful in the management of obstetrical patients in labor.