Fetal heart rate monitoring and neonatal mortality in the very preterm infant.

A retrospective study was performed to determine the usefulness of intrapartum fetal heart rate patterns in managing infants of 26 to 30 weeks' gestational age by a comparison of intrapartum tracings with neonatal outcome. Fetal heart rate patterns of 26 infants who died were matched for gestational age with those of infants who did not die or demonstrate developmental abnormalities after a 1-year follow-up were analyzed. A normal fetal heart rate pattern was associated with a good outcome (p less than 0.05), the only deaths (three) being secondary to unrelated factors. An abnormal fetal heart rate tracing predicted 90% of deaths; however, an abnormal fetal heart rate tracing was also found in 15 of 31 infants with no mortality or morbidity. Evidence would thus suggest that the very preterm infant can tolerate the stress associated with normal labor and that a normal fetal heart rate pattern predicts good fetal outcome in the absence of unrelated perinatal abnormality. With significantly abnormal patterns, however, further parameters must be evaluated before the diagnosis of fetal distress associated with subsequent mortality can be made with certainty.