Computerised Analysis of Foetal Heart Rate Variation: Prediction of Adverse Perinatal Outcome in Patients Undergoing Prostaglandin Induction of Labour at Term

The aim of this study was to determine the value of antenatal numerical assessment of foetal heart rate variation in the prediction of adverse perinatal outcome in patients undergoing prostaglandin induction of labour at term. Two hundred and seven patients who underwent prostaglandin cervical ripening after 37 weeks’ gestation for the indications of pregnancy-induced hypertension, foetal growth retardation or post-dates pregnancy were included in this study. Prior to commencement of cervical ripening, a 30-minute cardiotocography tracing was recorded on the System 8000 machine and the long-term and short-term variations were calculated.

Forty-three patients (20.8%) had a long-term variation of less than 30 ms; nine (4.3%) had a short-term variation of less than 3 ms. The sensitivity and positive predictive values of long-term variation in the prediction of admission to the neonatal special care unit were 25.6% and 23.2%, respectively. Corresponding values for short-term variation were 2.6% and 11.1%, respectively. The sensitivity and positive predictive values of long-term variation in the prediction of caesarean section for foetal distress were 33.3% and 9.3%, respectively. Corresponding values for short-term variation were 8.3% and 11.1%, respectively.

Long-term and short-term variations appeared to be poor predictors of adverse perinatal outcome. However, of the four foetuses with both reduced antenatal heart rate variation and who were subsequently delivered by caesarean section for foetal distress in labour, all four were admitted to the neonatal special care unit (NSCU). Foetuses with intrapartum evidence of foetal distress were more likely to be admitted to the NSCU when antenatal foetal heart rate variation was reduced.

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