{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:40:12Z","timestamp":1756291212368,"version":"3.44.0"},"reference-count":16,"publisher":"Knowledge E DMCC","issue":"7","license":[{"start":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:00:00Z","timestamp":1756252800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":["knepublishing.com"],"crossmark-restriction":true},"short-container-title":["IJRM"],"abstract":"<jats:p>Background: Fetal heart rate (FHR) monitoring is a routine, non-invasive method for assessing fetal well-being during labor. However, its low sensitivity and high false-positive rate often lead to unnecessary cesarean deliveries. While fetal scalp blood sampling offers a more accurate assessment of intrauterine hypoxia, it is invasive, technically challenging, and prone to failure.\r\nObjective: To evaluate the association between intrapartum FHR beat-to-beat variability (within the normal range) and umbilical cord arterial blood gas parameters, and to assess their predictive value for neonatal outcomes, such as Apgar scores and acidosis.\r\nMaterials and Methods: This cross-sectional study reviewed medical records of all mothers who had delivered at Yas hospital, Tehran, Iran between August and December 2022. A total of 120 women with term, singleton pregnancies (\u2265 37 wk) who were candidates for vaginal delivery were included. FHR monitoring was conducted on admission and 30 min before delivery. Umbilical cord arterial blood gas analysis was performed immediately after birth. Neonates were grouped based on cord pH &lt; 7.2 (acidosis) vs. \u2265 7.2 (non-acidosis).\r\nResults: 17 neonates (14.2%) had pH &lt; 7.2. The acidosis group had significantly lower beat-to-beat variability at both time points (p = 0.002 and p &lt; 0.001) and greater variability reduction during labor (p &lt; 0.001). Cesarean rates and lower Apgar scores were significantly more frequent. Multiple regression analysis confirmed associations between reduced variability, neonatal acidosis, and lower Apgar scores.\r\nConclusion: Even within normal limits, reduced FHR variability may signal fetal compromise. Monitoring variability trends could enhance intrapartum care and neonatal outcomes.<\/jats:p>","DOI":"10.18502\/ijrm.v23i7.19487","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:02:54Z","timestamp":1756288974000},"update-policy":"https:\/\/doi.org\/10.18502\/knecrossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Association of normal-range fetal heart rate variations during labor with umbilical cord arterial blood gas parameters and neonatal outcomes: A cross-sectional study"],"prefix":"10.18502","volume":"23","author":[{"given":"Mohadese","family":"Dashtkoohi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marjan","family":"Ghaemi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shima","family":"Rahimi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nasim","family":"Eshraqi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad","family":"Haddadi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elham","family":"Sedighi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sedigheh","family":"Hantoushzadeh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatemeh","family":"Golshahi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"7770","published-online":{"date-parts":[[2025,8,27]]},"reference":[{"key":"288335","doi-asserted-by":"crossref","unstructured":"[1] Bajpayee D, Sarin E, Dastidar SG, Chandra S, Mohanty JS, Bisht N, et al. Strengthening fetal heart rate monitoring during labor with a standard handheld doppler - implementation experience from India. Indian J Community Med 2022; 47: 405\u2013409.","DOI":"10.4103\/ijcm.ijcm_818_21"},{"key":"288336","doi-asserted-by":"crossref","unstructured":"[2] Ribeiro M, Monteiro-Santos J, Castro L, Antunes L, Costa-Santos C, Teixeira A, et al. Non-linear methods predominant in fetal heart rate analysis: A systematic review. Front Med 2021; 8: 661226.","DOI":"10.3389\/fmed.2021.661226"},{"key":"288337","doi-asserted-by":"crossref","unstructured":"[3] Mendis L, Palaniswami M, Brownfoot F, Keenan E. Computerised cardiotocography analysis for the automated detection of fetal compromise during labour: A review. Bioengineering 2023; 10: 1007.","DOI":"10.3390\/bioengineering10091007"},{"key":"288338","doi-asserted-by":"crossref","unstructured":"[4] Uzianbaeva L, Yan Y, Joshi T, Yin N, Hsu C-D, Hernandez-Andrade E, et al. Methods for monitoring risk of hypoxic damage in fetal and neonatal brains: A review. Fetal Diagn Ther 2021; 49: 1\u201324.","DOI":"10.1159\/000520987"},{"key":"288339","doi-asserted-by":"crossref","unstructured":"[5] Alarc\u00f3n-Rodr\u00edguez R, Mart\u00edn-\u00c1lvarez MP, Garc\u00eda-Gonz\u00e1lez J, Requena-Mullor M, Rodr\u00edguez-Garc\u00eda MC, Zheng R, et al. Determination of foetal scalp blood sampling pH as an indicator of loss of foetal well-being in women undergoing caesarean section. Healthcare 2023; 11: 725.","DOI":"10.3390\/healthcare11050725"},{"key":"288340","doi-asserted-by":"crossref","unstructured":"[6] Cnattingius S, Johansson S, Razaz N. Associations between metabolic acidosis at birth and reduced Apgar scores within the normal range (7\u201310): A Swedish cohort study of term non-malformed infants. Paediatr Perinat Epidemiol 2020; 34: 572\u2013580.","DOI":"10.1111\/ppe.12663"},{"key":"288341","doi-asserted-by":"crossref","unstructured":"[7] Bailey EJ, Frolova AI, L\u00f3pez JD, Raghuraman N, Macones GA, Cahill AG. Mild neonatal acidemia is associated with neonatal morbidity at term. Am J Perinatol 2020; 38: e155-e161.","DOI":"10.1055\/s-0040-1708800"},{"key":"288342","doi-asserted-by":"crossref","unstructured":"[8] Wang B, Zeng H, Liu J, Sun M. Effects of prenatal hypoxia on nervous system development and related diseases. Front Neurosci 2021; 15: 755554.","DOI":"10.3389\/fnins.2021.755554"},{"key":"288343","doi-asserted-by":"crossref","unstructured":"[9] Lau SL, Lok ZLZ, Hui SYA, Fung GPG, Lam HS, Leung TY. Neonatal outcome of infants with umbilical cord arterial pH less than 7. Acta Obstet Gynecol Scand 2023; 102: 174\u2013180.","DOI":"10.1111\/aogs.14494"},{"key":"288344","unstructured":"[10] Umana O, Siccardi M. Prenatal nonstress test. StatPearls [Internet] Treasure Island (FL): StatPearls Publishing. 2022."},{"key":"288345","doi-asserted-by":"crossref","unstructured":"[11] Soncini E, Paganelli S, Vezzani C, Gargano G, Giovanni Battista LS. Intrapartum fetal heart rate monitoring: Evaluation of a standardized system of interpretation for prediction of metabolic acidosis at delivery and neonatal neurological morbidity. J Matern Fetal Neonat Med 2014; 27: 1465\u20131469.","DOI":"10.3109\/14767058.2013.858690"},{"key":"288346","doi-asserted-by":"crossref","unstructured":"[12] Tarvonen MJ, Lear CA, Andersson S, Gunn AJ, Teramo KA. Increased variability of fetal heart rate during labour: A review of preclinical and clinical studies. BJOG 2022; 129: 2070\u20132081.","DOI":"10.1111\/1471-0528.17234"},{"key":"288347","doi-asserted-by":"crossref","unstructured":"[13] Nainani R, Athwani V, Avasthi K, Bansal V, Sharma P. A study to correlate admission non stress test and immediate postpartum umbilical cord arterial pH with neonatal outcome. Int J Reprod Contracept Obstet Gynecol 2020; 9: 2081\u20132087.","DOI":"10.18203\/2320-1770.ijrcog20201809"},{"key":"288348","doi-asserted-by":"crossref","unstructured":"[14] Medeiros TKS, Dobre M, da Silva DMB, Brateanu A, Baltatu OC, Campos LA. Intrapartum fetal heart rate: A possible predictor of neonatal acidemia and Apgar score. Front Physiol 2018; 9: 1489.","DOI":"10.3389\/fphys.2018.01489"},{"key":"288349","doi-asserted-by":"crossref","unstructured":"[15] Faivre A-C, Tazi S, Chrusciel J, Sanchez S, Bednarek N, Gabriel R, et al. Association between fetal heart rate monitoring during labor and neonatal acidosis in full-term newborns: A retrospective multicenter cohort study. Open J Obstet Gynecol 2020; 10: 1265\u20131278.","DOI":"10.4236\/ojog.2020.1090117"},{"key":"288350","doi-asserted-by":"crossref","unstructured":"[16] Loussert L, Berveiller P, Magadoux A, Allouche M, Vayssiere C, Garabedian C, et al. Association between marked fetal heart rate variability and neonatal acidosis: A prospective cohort study. 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