Intrapartum electronic fetal monitoring and the identification of systemic fetal inflammation

OBJECTIVE: To determine if intrapartum electronic fetal heart rate monitoring (EFM) can identify the fetal in utero systemic inflammatory response or neonatal sepsis, risk factors for the development of brain injury. STUDY DESIGN: This case-control study matched cases with both histologic chorioamnionitis and funisitis (75 preterm and 63 term) to the next delivery without placental or cord inflammation by gestational age and mode of delivery. The last 2 hours of EFM prior to delivery were reviewed by 3 perinatologists blinded to placental pathology. RESULTS: Preterm and term cases had significantly increased baseline heart rates. Term cases had significant increases in tachycardia, total and late decelerations, and nonreactivity and also had fewer accelerations. EFM parameters had sensitivity of 29-65%, specificity of 46-93%, positive predictive value of 53-80% and negative predictive value of 54-58% in identifying fetal systemic inflammation in this matched, case-control sample. Of the preterm neonates, 9 with sepsis were compared to 141 with negative cultures and were found to have a significant increase in baseline fetal heart rate and tachycardia of longer duration. CONCLUSION: Although significant associations were found, EFM lacks precision in identifying the fetal in utero systemic inflammatory response and neonatal sepsis, predisposing conditions for the development of neonatal encephalopathy.