American journal of obstetrics & gynecology MFM · 2026
High-risk category II electronic fetal monitoring features in the first stage of labor is a risk factor for neonatal acidemia.
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Chaffay Julia, Woolfolk Candice, Kelly Jeannie C, Frolova Antonina, Russell Sharman, Macones George A, Cahill Alison G, Raghuraman Nandini
Аннотация
BACKGROUND: High-risk category II electronic fetal monitoring patterns in labor are associated with neonatal acidemia and associated adverse outcomes. However, the impact of the stage of labor at the time of these patterns on neonatal outcomes is unknown.
OBJECTIVE: Our objective was to compare neonatal outcomes among patients with high-risk category II electronic fetal monitoring based on the stage of labor at the time of delivery.
STUDY DESIGN: We performed a secondary analysis of a prospective cohort study of singleton deliveries at≥37 weeks between 2010 and 2015. Electronic fetal monitoring data were extracted from the 60 minutes before delivery by nurses who were blinded to outcomes. This analysis included only patients with high-risk category II electronic fetal monitoring features, defined as at least one of the following: recurrent variable decelerations, recurrent late decelerations, >1 prolonged deceleration, tachycardia, minimal variability, or total deceleration area ≥75th percentile. The primary outcome was neonatal acidemia, defined as umbilical artery pH ≤7.10. Secondary outcomes included a composite of neonatal morbidity. Outcomes were compared between patients who delivered in the first vs the second stage of labor. A subgroup analysis in nulliparas and a sensitivity analysis of only patients who underwent cesarean delivery (first vs second stage) were performed. Multivariable logistic regression was used to adjust for potential confounders.
RESULTS: Of note, 588 patients who underwent cesarean delivery in the first stage of labor were compared with 4685 patients who delivered in the second stage (vaginal and cesarean deliveries). Neonates delivered in the first stage with high-risk category II electronic fetal monitoring had a significantly higher risk of acidemia (adjusted odds ratio, 5.55 [95% confidence interval, 3.81-8.11]) as well as composite neonatal morbidity (adjusted odds ratio, 2.44 [95% confidence interval, 1.92-3.09]), even when the analysis was restricted to nulliparous patients. In a sensitivity analysis including only patients who underwent cesarean delivery (n=737), there was no difference in the risk of neonatal acidemia (adjusted odds ratio, 0.56 [95% confidence interval, 0.30-1.03) or composite neonatal morbidity (adjusted odds ratio, 0.90 [95% confidence interval, 0.54-1.45]) between the group delivered in the first stage and the group delivered in the second stage by cesarean delivery; however, this analysis was limited by a small sample size. Recurrent variable decelerations, recurrent late decelerations, and >1 prolonged deceleration were more frequent high-risk electronic fetal monitoring features in the group delivered in the first stage of labor.
CONCLUSION: High-risk category II electronic fetal monitoring features prompting a first-stage cesarean identify a fetal population at significantly higher risk of acidemia, supporting the clinical rationale for performing first-stage cesareans in response to these electronic fetal monitoring features. These findings suggest that high-risk category II electronic fetal monitoring features should be incorporated into flow diagrams for category II electronic fetal monitoring management.
OBJECTIVE: Our objective was to compare neonatal outcomes among patients with high-risk category II electronic fetal monitoring based on the stage of labor at the time of delivery.
STUDY DESIGN: We performed a secondary analysis of a prospective cohort study of singleton deliveries at≥37 weeks between 2010 and 2015. Electronic fetal monitoring data were extracted from the 60 minutes before delivery by nurses who were blinded to outcomes. This analysis included only patients with high-risk category II electronic fetal monitoring features, defined as at least one of the following: recurrent variable decelerations, recurrent late decelerations, >1 prolonged deceleration, tachycardia, minimal variability, or total deceleration area ≥75th percentile. The primary outcome was neonatal acidemia, defined as umbilical artery pH ≤7.10. Secondary outcomes included a composite of neonatal morbidity. Outcomes were compared between patients who delivered in the first vs the second stage of labor. A subgroup analysis in nulliparas and a sensitivity analysis of only patients who underwent cesarean delivery (first vs second stage) were performed. Multivariable logistic regression was used to adjust for potential confounders.
RESULTS: Of note, 588 patients who underwent cesarean delivery in the first stage of labor were compared with 4685 patients who delivered in the second stage (vaginal and cesarean deliveries). Neonates delivered in the first stage with high-risk category II electronic fetal monitoring had a significantly higher risk of acidemia (adjusted odds ratio, 5.55 [95% confidence interval, 3.81-8.11]) as well as composite neonatal morbidity (adjusted odds ratio, 2.44 [95% confidence interval, 1.92-3.09]), even when the analysis was restricted to nulliparous patients. In a sensitivity analysis including only patients who underwent cesarean delivery (n=737), there was no difference in the risk of neonatal acidemia (adjusted odds ratio, 0.56 [95% confidence interval, 0.30-1.03) or composite neonatal morbidity (adjusted odds ratio, 0.90 [95% confidence interval, 0.54-1.45]) between the group delivered in the first stage and the group delivered in the second stage by cesarean delivery; however, this analysis was limited by a small sample size. Recurrent variable decelerations, recurrent late decelerations, and >1 prolonged deceleration were more frequent high-risk electronic fetal monitoring features in the group delivered in the first stage of labor.
CONCLUSION: High-risk category II electronic fetal monitoring features prompting a first-stage cesarean identify a fetal population at significantly higher risk of acidemia, supporting the clinical rationale for performing first-stage cesareans in response to these electronic fetal monitoring features. These findings suggest that high-risk category II electronic fetal monitoring features should be incorporated into flow diagrams for category II electronic fetal monitoring management.