ArticleActa obstetricia et gynecologica Scandinavica2021
Intrapartum zigzag pattern of fetal heart rate is an early sign of fetal hypoxia: A large obstetric retrospective cohort study.
Article in Acta obstetricia et gynecologica Scandinavica, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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10 citing papers in PubMed, 17 citations in OpenAlex.
- An attempt to improve recognition of fetal acidemia by a remodeled intrapartum cardiotocography classification: A case-control study.Acta obstetricia et gynecologica Scandinavica · 2026Article
- Intrapartum CTG characteristics associated with isolated single umbilical artery in term fetuses: A matched case-control study.Acta obstetricia et gynecologica Scandinavica · 2026Article
- Twenty-year trends in fetal scalp-blood sampling and birth outcomes: A single-center retrospective cohort study of 40 309 women in labor.Acta obstetricia et gynecologica Scandinavica · 2026Article
- Predicting Intrapartum Acidemia: A Review of Approaches Based on Fetal Heart Rate.Bioengineering (Basel, Switzerland) · 2026Review
- Impact of missing electronic fetal monitoring signals on perinatal asphyxia: a multicohort analysis.NPJ digital medicine · 2025Article
- Time-Dependent Association Between Cardiotocographic Features and Hypoxic-Ischemic Encephalopathy.IEEE access : practical innovations, open solutions · 2025Article
- Increased variability of fetal heart rate during labour: a review of preclinical and clinical studies.BJOG : an international journal of obstetrics and gynaecology · 2022Review
- Approaches to Preventing Intrapartum Fetal Injury.Frontiers in pediatrics · 2022Review
- Intrapartal cardiotocographic patterns and hypoxia-related perinatal outcomes in pregnancies complicated by gestational diabetes mellitus.Acta diabetologica · 2021Article
- Intrapartum zigzag pattern of fetal heart rate is an early sign of fetal hypoxia: A large obstetric retrospective cohort study.Acta obstetricia et gynecologica Scandinavica · 2021Article
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Authors and funding
6 authors at 2 institutions in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
introductionThe aim of the present study was to identify possible associations of fetal heart rate (FHR) patterns during the last 2 hours of labor with fetal asphyxia expressed by umbilical artery acidemia at birth and with neonatal complications in a large obstetric cohort. MATERIAL AND
methodsCardiotocographic recordings from 4988 singleton term childbirths over 1 year were evaluated retrospectively and blinded to the pregnancy and neonatal outcomes in a university teaching hospital in Helsinki, Finland. Umbilical artery pH, base excess and pO
resultsOf the 4988 deliveries, the ZigZag pattern (FHR baseline amplitude changes of >25 bpm with a duration of 2-30 minutes) occurred in 11.7%, late decelerations in 41.0%, bradycardia episodes in 52.9%, reduced variability in 36.7%, tachycardia episodes in 13.9% and uterine tachysystole in 4.6%. No case of saltatory pattern (baseline amplitude changes of >25 bpm with a duration of >30 minutes) was observed. The presence of the ZigZag pattern or late decelerations, or both, was associated with cord blood acidemia (odds ratio [OR] 3.3, 95% confidence interval [CI] 2.3-4.7) and severe neonatal complications (Group 3) (OR 3.3, 95% CI 2.4-4.9). In contrast, no significant associations existed between the other FHR patterns and severe neonatal complications. ZigZag pattern preceded late decelerations in 88.7% of the cases. A normal FHR preceded the ZigZag pattern in 90.4% of the cases, whereas after ZigZag episodes, a normal FHR pattern was observed in only 0.9%.
conclusionsZigZag pattern and late decelerations during the last 2 hours of labor are significantly associated with cord blood acidemia at birth and neonatal complications. The ZigZag pattern precedes late decelerations, and the fact that normal FHR pattern precedes the ZigZag pattern in the majority of the cases suggests that the ZigZag pattern is an early sign of fetal hypoxia, which emphasizes its clinical importance.
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