Observer variation in visual analysis of fetal heart rate (FHR) records is reportedly high, but can be avoided by computerized numerical analysis. The FHRs of 394 women in labor at 37 or more weeks' gestation were recorded on-line and analyzed to examine how different patterns related to outcome, as judged by umbilical arterial base deficit or Apgar score on delivery. The range of normality and the diversity of patterns of those delivered without acidemia were great. Late decelerations were of poor prognostic value. There was an increase in FHR variation during labor averaging 40%. In this preliminary study, conventional attributes of the FHR, alone or in combination, did not predict metabolic acidemia. Epidural analgesia in 240 women was identified as a confounding variable that significantly affected FHR patterns without influencing the condition of the infant at birth. It was associated with a higher FHR, less FHR variation and fewer decelerations, primiparity, longer labors, more operative deliveries, and a threefold greater cesarean rate. The rise in basal FHR, perhaps due to a rise in maternal temperature, may partly explain the high intervention rate in those without fetal acidemia.
(C) 1991 The American College of Obstetricians and Gynecologists