Antenatal electronic fetal heart monitoring for extremely and very preterm newborns

A. Saphia, A. Filipescu, A.A. Simionescu

Rezumat: Prematurity ranging from 24 to 32 weeks is an important cause of neonatal mortality and morbidity. A remarkable progress has been made over the last years into maternal-fetal medicine and into resuscitating babies at the borderline of viability, between 24 and 32 weeks of gestation. Cardiotocographic recording (CTG) is an important part of the fetal surveillance, a CTG within normal limits theoretically allowing for the prolongation of pregnancy. Nevertheless, the interpretation of CTG at these gestational ages, outside labor, is difficult, as is the definition of a suspicious/pathological CTG trace; there, the interobserver variability must also be born in mind. The clinical and laboratory test results must be taken into account as well: maternal perception of fetal movements, obstetrical associated pathologies (premature rupture of membranes, high blood pressure, intrauterine growth restriction etc.). The purpose of this article is to review the usefulness of performing an antepartum CTG between 28 and 32 weeks of gestation and to define the proper interpretation of the recorded parameters. A CTG trace with persistent decelerations in case of premature rupture of membranes or in a foetus with early onset of an intrauterine growth restriction can contribute to an indication for caesarean section. A reduction or absence of the baseline variability of fetal heart rate or the isolated occurrence of deceleration associated with a normal baseline variability should be interpreted with caution for these cases.
Cuvinte cheie: antepartum cardiotocography, extreme prematurity, reactive trace, accelerations, decelerations.