Background
Although there is a well-known association between fetal bradycardia and maternal
eclampsia, the characteristics of fetal heart rate tracings after an eclamptic seizure
have not previously been thoroughly described. Fetal heart rate changes are thought
to be related to maternal lactic acidemia caused by vasospasm and uterine hyperactivity
leading to placental hypoperfusion and fetal hypoxia. The decision to intervene in
the case of an abnormal fetal heart rate tracing after an eclamptic seizure is often
difficult; however, maternal resuscitation should be the primary focus.
Objective
This study aimed to quantify and characterize fetal heart rate changes associated
with a maternal eclamptic seizure. Moreover, we sought to document subsequent obstetrical
management following these seizures complicated by fetal heart rate decelerations.
Study Design
This was a retrospective study of fetal heart rate tracings associated with eclampsia
during a 13-year period at a single institution. Eclampsia was diagnosed following
the 2013 Executive Summary of the American College of Obstetricians and Gynecologists
criteria. Tracings were independently reviewed and classified by 3 physicians using
the National Institute of Child Health and Human Development Criteria. Hospital records
were reviewed to ascertain obstetrical management after the eclamptic seizure.
Results
A total of 107 women were diagnosed with eclampsia from January 2009 to December 2021.
Of these women, 31 experienced 34 intrapartum seizures during which time electronic
fetal heart rate monitoring was ongoing. During the 34 seizures, fetal heart rate
decelerations were documented in 79% of cases. The mean duration of bradycardia was
5.80±2.98 minutes with a range of 2 to 15 minutes. Fetal heart decelerations occurred,
on average, 2.7±1.6 minutes after the onset of the eclamptic seizure. In half of the
fetuses with fetal heart rate changes, fetal tachycardia followed, and in 48% of cases,
there was minimal variability noted. As a result of the fetal heart rate tracings
and clinical findings, 4 women underwent an emergent cesarean delivery, including
2 that were diagnosed with placental abruption. In this cohort, there were 4 cases
of abruption. The mean duration from the seizure to delivery was 299±353 minutes.
The mean neonatal cord pH was 7.20±0.11 with a mean base excess of −8.6±4.4 mmol/L.
There was no perinatal death.
Conclusion
After an eclamptic seizure, 79% of fetuses demonstrated prolonged decelerations, and
half of the fetuses developed fetal tachycardia after recovery from the episode of
bradycardia. Despite these periods of fetal heart rate decelerations associated with
eclampsia, prioritization of maternal support and stabilization resulted in a favorable
perinatal outcome without immediate operative intervention in more than two-thirds
of cases.
Key words
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Article Info
Publication History
Published online: June 02, 2022
Accepted:
May 27,
2022
Received in revised form:
May 26,
2022
Received:
March 16,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
F.G.C. reports receiving royalties from McGraw Hill and Wolter Kluwer, and C.E.W. reports receiving royalties from McGraw Hill. The other authors report no conflict of interest.
Cite this article as: Ambia AM, Wells CE, Yule CS, et al. Fetal heart rate tracings associated with eclamptic seizures. Am J Obstet Gynecol 2022;XX:x.ex–x.ex.
Identification
Copyright
Published by Elsevier Inc.
