Temporal Evolution of Intrapartum Fetal Heart Rate Features

Johann Vargas-Calixto1, Yvonne Wu2, Michael Kuzniewicz3, Marie-Coralie Cornet2, Heather Forquer3, Lawrence Gerstley3, Emily Hamilton4, Philip Warrick4, Robert Kearney1
1McGill University, 2University of California San Francisco, 3Kaiser Permanente Northern California, 4Perigen Inc., McGill University


Our research goal is to improve the intrapartum identification of tracings associated with severe acidosis at birth and subsequent hypoxic-ischemic encephalopathy so that timely interventions could avoid such complications without causing excessive unnecessary interventions in births with normal outcomes. The present study examines the evolution of fetal heart rate (FHR) features over the course of labor. We analyzed FHR signals collected in the last 6 hours before delivery in 21,853 births with normal neonatal outcomes and in 163 that developed hypoxic-ischemic encephalopathy (HIE) from 15 hospitals of Kaiser Permanente Northern California. We divided these six hours into 18 nonoverlapping 20-minute epochs. The power spectral density of each epoch was divided into three bands: low frequency (LF, 30–150 mHz), movement frequency (MF, 150–500 mHz), and high frequency (HF, 500–1000 mHz). We also estimated the LF/(MF+HF) ratio, the mean and standard deviation of the FHR signal, the approximate entropy (ApEn), and the deceleration capacity (DC). In our results, ApEn, the standard deviation, and DC showed a promising ability to detect risk of HIE as early as 120 minutes before birth, which gives enough leading time for timely interventions.