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Am J Perinatol 2024; 41(02): 160-166
DOI: 10.1055/a-1675-0901
Original Article

Fetal Tachycardia in the Setting of Maternal Intrapartum Fever and Perinatal Morbidity

Alan T. N. Tita
1   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Paula L. McGee
2   George Washington University Biostatistics Center, Washington, Dist. of Columbia
,
Uma M. Reddy
3   Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
,
Steven L. Bloom
4   Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
,
Michael W. Varner
5   Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
,
Susan M. Ramin
6   Department of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston-Children's Memorial Herman Hospital Houston, Texas
,
Steve N. Caritis
7   Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Alan M. Peaceman
8   Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
,
Yoram Sorokin
9   Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
,
Anthony Sciscione
10   Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania
,
Marshall W. Carpenter
11   Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
,
Brian M. Mercer
12   Department of Obstetrics and Gynecology, MetroHealth Medical Center- Case Western Reserve University, Cleveland, Ohio
,
John M. Thorp
13   Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Fergal D. Malone
14   Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
Catalin Buhimschi
15   Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units (MFMU) Network › Author Affiliations Funding The project described was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; HD21410, HD27860, HD27869, HD27915, HD27917, HD34116, HD34136, HD34208, HD40485, HD40500, HD40512, HD40544, M01 RR00080 [NCRR]; HD40545, HD40560, and U01 HD36801). Comments and views of the authors do not necessarily represent views of the National Institute of Health.
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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.

Keywords

intrapartum fever - fever - intrapartum - fetal tachycardia - neonatal morbidity - fetal heart rate monitoring - umbilical artery pH - acidemia - fetal acidemia - base deficit

Supplementary Material



Publication History

Received: 26 August 2021

Accepted: 05 October 2021

Accepted Manuscript online:
20 October 2021

Article published online:
10 December 2021

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