Fetal heart rate changes on the cardiotocograph trace secondary to maternal COVID-19 infection. (September 2020)

• Record Type: Journal Article
• Authors: Gracia-Perez-Bonfils, Anna; Martinez-Perez, Oscar; Llurba, Elisa; Chandraharan, Edwin
• Is Part Of: European journal of obstetrics, gynecology, and reproductive biology. Volume 252(2020)
• Page Start: 286
• Page End: 293
• Publication Date: 2020-09
• Subjects: COVID-19 -- CTG -- Cardiotocograph -- Cytokine storm -- Physiological CTG interpretation -- ZigZag pattern; Obstetrics -- Periodicals; Gynecology -- Periodicals; Reproductive health -- Periodicals; Gynecology -- Periodicals; Obstetrics -- Periodicals; Reproduction -- Periodicals; Obstétrique -- Périodiques; Gynécologie -- Périodiques; Reproduction -- Périodiques; Verloskunde; Gynaecologie; Voortplanting (biologie); Gynecology; Obstetrics; Reproduction; Electronic journals; Periodicals; Electronic journals; 618.05
• DOI: 10.1016/j.ejogrb.2020.06.049
• Languages: English
• ISSNs: 0301-2115

Abstract

Highlights: Fetuses of COVID-19 patients are under the effect of maternal pyrexia, maternal inflammatory response and the "cytokine storm". Cardiotocograph showed a raised baseline FHR (>10 %), loss of accelerations and cycling, late decelerations and ZigZag pattern. Perinatal outcomes appear to be favourable. Clinicians should optimise the maternal environment prior to rapidly transferring the mother for an operative delivery for a "pathological CTG". Abstract: Objective: To determine the cardiotocograph (CTG) changes in women with symptomatic COVID-19 infection. Study design: 12 anonymised CTG traces from 2 hospitals in Spain were retrospectively analysed by 2 independent assessors. CTG parameters were studied based on fetal pathophysiological responses to inflammation and hypoxia that would be expected based on the pathogenesis of COVID-19 patients. Correlation was made with perinatal outcomes (Apgar score at 5 min and umbilical cord pH). Results: All fetuses showed an increased baseline FHR > 10 percent compared to the initial recording, in addition to absence of accelerations. 10 out of 12 CTG traces (83.3 percent) demonstrated late or prolonged decelerations and 7 out of 12 fetuses (58.3 percent) showed absence of cycling. Not a single case of sinusoidal pattern was observed. ZigZag pattern was found in 4 CTG traces (33 percent). Excessive uterine activity was observed in all CTG traces where uterine activity was monitored (10 out of 12). Apgar scores at 5 min were normal (>7) and absence of metabolic acidosis was found in the umbilical cord arterial pH (pH > 7.0) in the cases that were available (11 and 9, respectively). Conclusion: Fetuses of COVID-19 patients showed a raised baseline FHR (>10 percent), loss of accelerations, late decelerations, ZigZag pattern and absence of cycling probably due to the effects of maternal pyrexia, maternal inflammatory response and the "cytokine storm". However, the perinatal outcomes appear to be favourable. Therefore, healthcare providers should optimise the maternal environment first to rectify the reactive CTG changes instead of performing an urgent operative intervention.