{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:33:22Z","timestamp":1776094402459,"version":"3.50.1"},"reference-count":39,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T00:00:00Z","timestamp":1694390400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>With category II fetal heart rate tracings, the preferred timing of interventions to prevent fetal hypoxic brain damage while limiting operative interventions remains unclear. We aimed to estimate fetal extracellular base deficit (BD<jats:sub>ecf<\/jats:sub>) during labor with category II tracings to quantify the timing of potential interventions to prevent severe fetal metabolic acidemia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>A longitudinal study was conducted using the database of the Recurrence Prevention Committee, Japan Obstetric Compensation System for Cerebral Palsy, including infants with severe cerebral palsy born at \u226534\u2009weeks' gestation between 2009 and 2014. Cases included those presumed to have an intrapartum onset of hypoxic\u2013ischemic insult based on the fetal heart rate pattern evolution from reassuring to an abnormal pattern during delivery, in association with category II tracings marked by recurrent decelerations and an umbilical arterial BD<jats:sub>ecf<\/jats:sub>\u2009\u2265\u200912\u2009mEq\/L. BD<jats:sub>ecf<\/jats:sub> changes during labor were estimated based on stages of labor and the frequency\/severity of fetal heart rate decelerations using the algorithm of Ross and Gala. The times from the onset of recurrent decelerations to BD<jats:sub>ecf<\/jats:sub> 8 and 12\u2009mEq\/L (Decels\u2010to\u2010BD8, Decels\u2010to\u2010BD12) and to delivery were determined. Cases were divided into two groups (rapid and slow progression) based upon the rate of progression of acidosis from onset of decelerations to BD<jats:sub>ecf<\/jats:sub> 12\u2009mEq\/L, determined by a finite\u2010mixture model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median Decels\u2010to\u2010BD8 (28 vs. 144\u2009min, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) and Decels\u2010to\u2010BD12 (46 vs. 177\u2009min, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) times were significantly shorter in the rapid vs slow progression. In rapid progression cases, physicians' decisions to deliver the fetus occurred at ~BD<jats:sub>ecf<\/jats:sub> 8\u2009mEq\/L, whereas the \u201cdecisions\u201d did not occur until BD<jats:sub>ecf<\/jats:sub> reached 12\u2009mEq\/L in slow progression cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Fetal BD<jats:sub>ecf<\/jats:sub> reached 12\u2009mEq\/L within 1\u2009h of recurrent fetal heart rate decelerations in the rapid progression group and within 3\u2009h in the slow progression group. These findings suggest that cases with category II tracings marked by recurrent decelerations (i.e., slow progression) may benefit from operative intervention if persisting for longer than 2\u2009h. In contrast, cases with sudden bradycardia (i.e., rapid progression) represent a challenge to prevent severe acidosis and hypoxic brain injury due to the limited time opportunity for emergent delivery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14675","type":"journal-article","created":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T05:49:01Z","timestamp":1694497741000},"page":"1730-1740","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Prevention of fetal brain injury in category <scp>II<\/scp> tracings"],"prefix":"10.1111","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1137-027X","authenticated-orcid":false,"given":"Masahiro","family":"Nakao","sequence":"first","affiliation":[{"name":"The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy Japan Council for Quality Health Care  Tokyo Japan"},{"name":"Department of Obstetrics and Gynecology Mie University Graduate School of Medicine  Tsu Mie Japan"},{"name":"Department of Obstetrics and Gynecology Sakakibara Heart Institute  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5500-404X","authenticated-orcid":false,"given":"Michael G.","family":"Ross","sequence":"additional","affiliation":[{"name":"The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy Japan Council for Quality Health Care  Tokyo Japan"},{"name":"Department of Obstetrics and Gynecology Geffen School of Medicine at UCLA  Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9322-135X","authenticated-orcid":false,"given":"Shoichi","family":"Magawa","sequence":"additional","affiliation":[{"name":"The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy Japan Council for Quality Health Care  Tokyo 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Yokohama Hospital  Yokohama Kanagawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naohiro","family":"Kanayama","sequence":"additional","affiliation":[{"name":"The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy Japan Council for Quality Health Care  Tokyo Japan"},{"name":"Department of Obstetrics and Gynecology Hamamatsu University School of Medicine  Shizuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shoji","family":"Satoh","sequence":"additional","affiliation":[{"name":"The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy Japan Council for Quality Health Care  Tokyo Japan"},{"name":"Maternal and Perinatal Care Center Oita Prefectural Hospital  Oita 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Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy Japan Council for Quality Health Care  Tokyo Japan"},{"name":"Department of Obstetrics and Gynecology Fukushima Medical University  Fukushima Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsugio","family":"Maeda","sequence":"additional","affiliation":[{"name":"The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy Japan Council for Quality Health Care  Tokyo Japan"},{"name":"Maeda Clinic Incorporated Association Anzu\u2010kai  Shizuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1840-0788","authenticated-orcid":false,"given":"Akira","family":"Oka","sequence":"additional","affiliation":[{"name":"The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy Japan Council for Quality Health Care  Tokyo Japan"},{"name":"Department of Pediatrics 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