Objective Specific fetal heart rate (FHR) patterns are associated with fetal compromise. Several placental histopathology findings are associated with neonatal morbidity and adverse neurodevelopment. The relationships between FHR patterns and placental histopathology in infants with hypoxic ischaemic encephalopathy (HIE) remain uncertain. This study hypothesised that in infants with HIE, placental histopathology findings are related to abnormal FHR patterns. Design Retrospective observational study. Setting A single tertiary centre. Population Infants born at ≥ 36 weeks’ gestation with moderate or severe HIE between September 2006 and December 2021. Methods Placental histopathology was assessed by a perinatal pathologist using the Amsterdam Working Group Criteria. FHR, recorded from intrapartum cardiotocography (CTG) was assessed by an obstetrician using a structured proforma. Assessors were blinded to clinical course and outcomes. Main Outcome Measures Duration and type of FHR abnormality were compared across categories of placental histopathology findings. Results Fifty infants with moderate or severe HIE (with complete data relating to intrapartum CTG and placental histopathology) were included. Increased duration of FHR abnormality, and consecutive FHR abnormality (>1h) at any time during intrapartum CTG monitoring were associated with the presence of abnormal placental histopathology. There was no evidence of associations between placental histopathology findings and specific FHR features on intrapartum CTG. Conclusions This study demonstrates an association between abnormal placental histopathology findings and duration of FHR abnormality in near-term and term infants with moderate or severe HIE. Future research should investigate the utility of multi-modal assessment to improve risk stratification.

Objective To determine the accuracy of intrapartum fetal heart rate (FHR) abnormalities as defined by National Institute of Health and Care Excellence guidelines for the prediction of moderate-severe hypoxic-ischemic neonatal encephalopathy (HIE). Design Case-control study Setting Rotunda Hospital, Dublin, Ireland. Population or Sample Eligible babies were born between September 2006 and November 2017 at ≥35+0 weeks’ gestational age. Cases were eligible babies with moderate-severe HIE. Controls were eligible babies born before and after each case with normal Apgar scores. Methods Blinded manual marking of FHR trace features followed by automated categorisation of each 15-minute segment. Main Exposure Measures FHR pattern features: baseline, variability, accelerations, early, variable, deep/prolonged variable, late or prolonged decelerations, bradycardia, sinusoidal pattern FHR pattern categories: normal, suspicious, or pathological Results Adequate FHR traces results were available in 52 of 88 cases and 118 of 176 controls. The FHR pattern feature with the largest area under the receiving operator characteristic curve (AUROCC) was the maximum number of consecutive segments with the baseline >160bpm (0.71 [95% confidence interval {CI}: 0.62-0.80]). The FHR category variable with the highest AUROCC was the number of suspicious segments (0.76 [95% CI: 0.67-0.84]). A multivariate model incorporating the number of segments and the percentage of segments classed suspicious/pathological achieved an AUROCC of 0.782 (95% CI: 0.704-0.861). Conclusions The power of FHR analysis to predict HIE is hampered by poor sensitivity for the rarity of the outcome. When analysing a suspicious FHR trace, it is beneficial to consider the overall duration of the suspicious patterns

Background Increased uterine activity (UA) may not allow adequate recovery time for foetal oxygenation. Objectives To determine if increased UA during labour is associated with an increased risk of either short- or long-term neurological injury in term neonates, or with neonatal proxy measures of intrapartum hypoxia-ischemia. Search Strategy MEDLINE, CINAHL, and ClinicalTrials.gov using terms uterine activity, Excessive Uterine Activity, XSUA, Uterine hyperstimulation, and Tachysystole. Selection Criteria Any study that analysed the relationship between UA during term labour and neurological outcomes/ selected proxy neurological outcomes was eligible for inclusion. Data Collection and Analysis Outcomes from individual studies were reported in tables and presented descriptively with odds ratios (OR) and 95% confidence intervals (CI) for dichotomous outcomes and means with standard deviations for continuous outcomes. Where group numbers were provided, ORs and CIs were calculated according to Altman. Main Results Twelve studies met the inclusion criteria. Seven studies featured umbilical artery pH as an individual outcome. Umbilical artery base excess and Apgar scores were both reported as individual outcomes in four studies. No study examined long term neurodevelopmental outcomes and only one study reported on encephalopathy as an outcome. The evidence for a relationship between UA and adverse infant outcomes was inconsistent. The reported estimated effect size varied from non-existent to clinically significant. Conclusions There is some evidence that increased UA may be a non-specific predictor of depressed neurological function in the newborn, but it is inconsistent and insufficient to support the conclusion that an association generally exists.