{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T09:36:49Z","timestamp":1788514609889,"version":"build-2803163510"},"reference-count":31,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,10,15]],"date-time":"2020-10-15T00:00:00Z","timestamp":1602720000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The aim of the present study was to identify possible associations of fetal heart rate (FHR) patterns during the last 2\u00a0hours of labor with fetal asphyxia expressed by umbilical artery acidemia at birth and with neonatal complications in a large obstetric cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>Cardiotocographic recordings from 4988 singleton term childbirths over 1\u00a0year were evaluated retrospectively and blinded to the pregnancy and neonatal outcomes in a university teaching hospital in Helsinki, Finland. Umbilical artery pH, base excess and pO<jats:sub>2<\/jats:sub>, low Apgar scores at 5\u00a0minutes, need for intubation and resuscitation, early neonatal hypoglycemia, and neonatal encephalopathy were used as outcome variables. According to the severity of the neonatal complications at birth, the cohort was divided into three groups: no complications (Group 1), moderate complications (Group 2) and severe complications (Group 3).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 4988 deliveries, the ZigZag pattern (FHR baseline amplitude changes of &gt;25\u00a0bpm with a duration of 2\u201030\u00a0minutes) occurred in 11.7%, late decelerations in 41.0%, bradycardia episodes in 52.9%, reduced variability in 36.7%, tachycardia episodes in 13.9% and uterine tachysystole in 4.6%. No case of saltatory pattern (baseline amplitude changes of\u00a0&gt;25\u00a0bpm with a duration of\u00a0&gt;30\u00a0minutes) was observed. The presence of the ZigZag pattern or late decelerations, or both, was associated with cord blood acidemia (odds ratio [OR] 3.3, 95% confidence interval [CI] 2.3\u20104.7) and severe neonatal complications (Group 3) (OR 3.3, 95% CI 2.4\u20104.9). In contrast, no significant associations existed between the other FHR patterns and severe neonatal complications. ZigZag pattern preceded late decelerations in 88.7% of the cases. A normal FHR preceded the ZigZag pattern in 90.4% of the cases, whereas after ZigZag episodes, a normal FHR pattern was observed in only 0.9%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>ZigZag pattern and late decelerations during the last 2\u00a0hours of labor are significantly associated with cord blood acidemia at birth and neonatal complications. The ZigZag pattern precedes late decelerations, and the fact that normal FHR pattern precedes the ZigZag pattern in the majority of the cases suggests that the ZigZag pattern is an early sign of fetal hypoxia, which emphasizes its clinical importance.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14007","type":"journal-article","created":{"date-parts":[[2020,9,27]],"date-time":"2020-09-27T12:19:57Z","timestamp":1601209197000},"page":"252-262","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Intrapartum zigzag pattern of fetal heart rate is an early sign of fetal hypoxia: A large obstetric retrospective cohort study"],"prefix":"10.1111","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3289-2173","authenticated-orcid":false,"given":"Mikko","family":"Tarvonen","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Helsinki, and Helsinki University Hospital Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petteri","family":"Hovi","sequence":"additional","affiliation":[{"name":"National Institute for Health and Welfare (THL) Helsinki Finland"},{"name":"Children\u2019s Hospital Pediatric Research Center University of Helsinki, and Helsinki University Hospital Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8908-8605","authenticated-orcid":false,"given":"Susanna","family":"Sainio","sequence":"additional","affiliation":[{"name":"Finnish Red Cross Blood Transfusion Service Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piia","family":"Vuorela","sequence":"additional","affiliation":[{"name":"Health and Social Welfare Department Vantaa Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sture","family":"Andersson","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Pediatric Research Center University of Helsinki, and Helsinki University Hospital Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kari","family":"Teramo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Helsinki, and Helsinki University Hospital Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,15]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199603073341001"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2001.111720"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15535"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.03.037"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1505261"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1999.tb08187.x"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12371"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2007.01602.x"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/00016340701797567"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12348"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2015.06.020"},{"key":"e_1_2_10_13_1","doi-asserted-by":"crossref","unstructured":"Gracia\u2010Perez\u2010BonfilsA VigneswaranK CuadrasD ChandraharanE.Does the saltatory pattern on cardiotocograph (CTG) trace really exist? 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Addendum to intrapartum care: care for healthy women and babies. Clinical guideline [CG190.1]; 2017. Methods evidence and recommendations. Final version. Pages: 136\u20137 141\u20132. 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