Fetal heart rate abnormalities associated with uterine rupture: a case-control study: A new time-lapse approach using a standardized classification.

Abstract

OBJECTIVE:

The aim of this study was to identify fetal heart rate abnormalities (FHRA) in the two hours preceding uterine rupture during trial of labor after a previous C-section compared with successful vaginal birth after cesarean controls.

STUDY DESIGN:

A multicenter case-control study was conducted from 2006 to 2012. Fetal heart rate tracings of the two-hour period preceding delivery were segmented, anonymized and independently classified by two obstetricians according to a standardized grid based on FIGO guidelines (4 grades: 1 - normal, 2 - intermediate, 3 - abnormal, 4 - preterminal). Each case of uterine rupture was matched to 2 controls. Survival curves were generated for both groups using the Kaplan-Meier method to analyze the occurrence of each FHR category across time.

RESULTS:

During the study period, 39,773 patients gave birth. 2649 involved women with a previous C-section (6.6%). A total of 33 uterine rupture/scar dehiscence cases occurred (0.08% of all births), of which 22 were included. These were matched to 44 controls. FIGO grade-3 FHRA were significantly associated with uterine rupture in the hour preceding its diagnosis: odds ratios were 4.1 (95% CI 1.2-14.0), 4.3 (95% CI 1.4-13.0) and 3.7 (95% CI 1.2-11.3), in the 60-40 min, 40-20 min and last 20 min before childbirth, respectively. Agreement between the two reviewers (Cohen's kappa) was 84% (CI 95%: 0.79-0.89).

CONCLUSION:

In the hour preceding uterine rupture, there are often significant FHRA. This leads us to consider the possibility of an earlier C-section when faced with grade-3 FHRA, before the onset of terminal bradycardia jeopardizing maternal and fetal prognosis.

• Authors: David Desseauve, Marion Bonifazi-Grenouilleau, Xavier Fritel, Julie Lathélize, Mélie Sarreau, Fabrice Pierre
• Journal: European journal of obstetrics, gynecology, and reproductive biology (Eur J Obstet Gynecol Reprod Biol) Vol. 197 Pg. 16-21 (Feb 2016) ISSN: 1872-7654 [Electronic] Ireland
• PMID: 26696557 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Topics

• Adult
• Bradycardia (epidemiology)
• Case-Control Studies
• Female
• Fetal Diseases (epidemiology)
• Heart Rate, Fetal
• Humans
• Kaplan-Meier Estimate
• Odds Ratio
• Pregnancy
• Risk Assessment
• Tachycardia (epidemiology)
• Time Factors
• Trial of Labor
• Uterine Rupture (epidemiology)
• Vaginal Birth after Cesarean