Thyroid hormone (TH) is the most important endocrine hormone in the body, which can promote the synthesis of protein, RNA, DNA, and special enzymes in fetal tissues and cells, TH can regulate the metabolism of carbohydrates, calcium, phosphorus, fat, and other energy substances in pregnant women and fetus, and promote the growth and development of fetal bones and reproductive organs, and is very important to maintain the normal development and maturity of fetus (1, 2). Thyroid dysfunction is one of the common endocrine complications in pregnancy, especially hypothyroidism in pregnancy. Comparison of Fetal Growth and Development Between the Two Groups.Comparison of Adverse Pregnancy Outcomes Between the Two Groups.Comparison of Blood Lipid Levels in Each Group.Comparison of Blood Glucose Levels in Each Group.Incidence of Hypothyroidism During Pregnancy.Therefore, this pattern should be considered in FHR interpretation to optimise intrapartum fetal surveillance. The risk of neonatal acidaemia was high for neonates with category-III FHR tracings, at nearly 20%, and marked variability did not significantly increase this risk.Īuthors found that marked variability was associated with an increased risk of neonatal acidosis. In category-II FHR tracings, neonates with marked variability had a twofold increased risk of neonatal acidosis and the absolute risk was high: 18.5% of neonates with marked variability developed neonatal acidosis. However, the absolute risk remained low in this subgroup, with only 6.5% of neonates with marked variability developing neonatal acidosis. In category-I FHR tracings, marked variability was associated with a fivefold increased risk of neonatal acidosis. Neonates with a prenatal marked variability had a twofold increased risk of acidosis. In this prospective cohort study, marked variability in FHR patterns occurred in 4% of the neonates in the hour before birth. In subgroup analyses, the association between marked variability and neonatal acidosis remained significant in NICHD category-I and category-II groups. In the multivariable analysis, marked variability was significantly associated with neonatal acidosis (aRR 2.30). Acidosis occurred in 6.0% (265/4394) of the neonates. Secondary outcomes were severe acidosis, Apgar score of <7 at 5minutes, respiratory distress, neonatal intensive care unit admission, neonatal infection and neonatal death.Īmong the 4394 women included, 177 (4%) had marked variability in fetal heart rate in the 60minutes before delivery. The primary outcome was neonatal acidosis, defined as an umbilical artery pH of ≤7.10, obtained after delivery from a clamped segment of the umbilical cord. They then conducted subgroup analyses according to the US National Institute of Child Health and Human Development (NICHD) category of the associated fetal heart rate. To assess the association between marked variability and neonatal acidosis, authors used multivariable modified Poisson regression modelling. The exposure was marked variability in FHR in the 60minutes before delivery, defined as a variability greater than 25 beats per minute, with a minimum duration of 1 minute. Women with intrauterine fetal death or medical termination, multiple pregnancies or non-cephalic presentation were excluded. Study included women in labour at ≥37weeks of gestation, with continuous FHR monitoring until delivery. This bicentric prospective cohort study was conducted from 1 January 2019 to 31 December 2019 in two French tertiary care maternity units (Toulouse and Poissy). A recent review stated that marked variability can indicate fetal compromise and highlighted the need for further research on this pattern.Aim of study by Loussert L et al was to assess the association between marked variability in FHR patterns during labour and neonatal acidosis. Fetal heart rate (FHR) variability is mainly determined by the autonomous nervous system and marked variability could reflect fetal autonomic instability resulting from impaired fetal oxygenation. Reduced variability can reflect decreased autonomic activity, in situations such as fetal acidosis or the administration of some maternal medications. Normal FHR variability generally ensures a normal fetal acid–base status. CDSCO (Central Drugs Standard Control Organisation) Newsįetal heart rate (FHR) variability is a pattern of major importance in FHR analysis.
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