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Am J Perinatol 2008; 25(6): 359-372
DOI: 10.1055/s-2008-1078761
© Thieme Medical Publishers

Fetal Heart Rate Monitoring Patterns in Women with Amniotic Fluid Proteomic Profiles Indicative of Inflammation

Catalin S. Buhimschi1 , Sonya Abdel-Razeq1 , Michael Cackovic1 , Christian M. Pettker1 , Antonette T. Dulay1 , Mert Ozan Bahtiyar1 , Eduardo Zambrano2 , Ryan Martin1 , Errol R. Norwitz1 , Vineet Bhandari3 , Irina A. Buhimschi1
  • 1Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
  • 2Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
  • 3Department of Pediatrics, Division of Perinatal Medicine, Yale University School of Medicine, New Haven, Connecticut
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Publication History

Publication Date:
29 May 2008 (online)

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ABSTRACT

We hypothesized that abnormal fetal heart rate monitoring patterns (FHR-MPs) occur more often in pregnancies complicated by intra-amniotic inflammation. Therefore, our objective was to examine the relationships among FHR-MP abnormalities, intra-amniotic inflammation and/or infection, acute histological chorioamnionitis, and early-onset neonatal sepsis (EONS) in pregnancies complicated by preterm birth. Additionally, the ability of various FHR-MPs to predict EONS was investigated. FHR-MPs from 87 singleton premature neonates delivered within 48 hours from amniocentesis (gestational age, mean ± SD: 28.9 ± 3.3 weeks) were analyzed blindly using strict National Institute of Child Health and Human Development criteria. Strips were evaluated at three time points: at admission, at amniocentesis, and prior to delivery. Intra-amniotic inflammation was established based on a previously validated proteomic fingerprint (mass-restricted score). Diagnoses of histological chorioamnionitis and EONS were based on well-recognized pathological, clinical, and laboratory criteria. We determined that fetuses of women with severe intra-amniotic inflammation had a higher FHR baseline throughout the entire monitoring period and an increased frequency of a nonreactive FHR-MP at admission. Of all FHR-MPs, a nonreassuring test at admission had 32% sensitivity, 95% specificity, 73% positive predictive value, 77% negative predictive value, and 76% accuracy in predicting EONS. Although a nonreassuring FHR-MP at admission was significantly associated with EONS after correcting for gestational age (odds ratio, 5.6; 95% confidence interval, 1.2 to 26.2; p = 0.030), the majority of the neonates that developed EONS had an overall reassuring FHR-MP. Nonreassuring FHR-MPs at either amniocentesis or delivery had no association with EONS. We conclude that in cases complicated by preterm birth, a nonreassuring FHR-MP at the initial evaluation is a specific but not a sensitive predictor of EONS. An abnormal FHR-MP can thus raise the level of awareness that a fetus with EONS may be born, but it is not a useful clinical indicator of the need for antibiotic treatment of the neonate.

KEYWORDS

Preterm labor - fetal heart rate monitoring - chorioamnionitis - prematurity - inflammation - proteomics - neonatal sepsis

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Dr. Catalin S Buhimschi

Director of Perinatal Research, Yale University, Department of Obstetrics, Gynecology and Reproductive Sciences

333 Cedar Street, LLCI 804, New Haven, CT 06520