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All asphyxiated newborns were delivered by emergency cesarean section due to acute fetal distress, defined according to the American College of Obstetricians and Gynecologists as non-reassuring fetal status (bradycardia, late deceleration of the fetal heart rate, severe and repetitive variable deceleration of the fetal heart rate, reduced beat-to-beat variability).
We hypothesized that variable deceleration severity is highly correlated with fetal base deficit accumulation.
Severe variable deceleration was defined as the lowest point, which was less than 70 bpm, and it continued for more than 30 sec, or the lowest point, which was more than 70 bpm and less than 80 bpm, and it continued for more than 60 sec [ 13].
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The FHR pattern observed two hours before delivery was defined as abnormal if one of the following patterns was detected: recurrent late decelerations, minimal or absent variability lasting for 40 60 min, severe variable decelerations, prolonged decelerations, tachycardia or bradycardia [ 11, 12].
Signs of fetal distress: the following cardiotocogram (CTG) characteristics [ 39]. ○ Baseline heart frequency <100 or >170 ○ Reduced variability: <5 bpm during >60 min ○ Complicated variable decelerations, duration >60 sec Repeated late uniform decelerations.
Results: Patients with normal variability and accelerations, even in the presence of late decelerations or variable decelerations, maintained an umbilical artery pH 7.0 or greater in more than 97% of cases.
Increasing frequency of severe variable decelerations is associated with acidemia.
Late decelerations and severe variable decelerations were significant factors associated with fetal acidosis.
Recent guidelines classify variable decelerations without detail as to degree of depth.
Results: Umbilical cord occlusion caused variable decelerations, with sustained hypertension in the 1 5 group and little change in acid-base status (pH = 7.34 ± 0.07 after 4 hours).
When the Doppler study showed a systolic/diastolic ratio of >90th percentile or the nonstress testing was equivocal (ie, variable decelerations), an amniotic fluid index was performed, as an additional screening test.
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Justyna Jupowicz-Kozak
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