Heart rate patterns in trisomic fetuses.

Abstract

A survey of the clinical records of fifteen fetuses with trisomy 21, six fetuses with trisomy 18, and two fetuses with trisomy 13 was made in order to find out typical patterns of fetal heart rate (FHR) possibly associated with these conditions. Antepartal FHR patterns of 55 normal pregnancies and intrapartal FHR patterns of 14 normal labors were used as a control material. Trisomic fetuses showed significantly fewer FHR accelerations than did the controls. Fetuses with trisomy 18 and 13 had more antepartal decelerations than fetuses with trisomy 21. Trisomic fetuses also showed more intrapartal late decelerations and epochs of silent FHR pattern than did the controls. The abnormal FHR patterns of the trisomic fetuses thus were similar to those in placental insufficiency. Cesarean section was performed for both fetuses with trisomy 13, for five of the six fetuses with trisomy 18 and for nine of fifteen fetuses with trisomy 21. In eleven of sixteen cesarean sections the main indication was abnormal cardiotocogram. Fetal karyotyping from an amniotic fluid sample should perhaps be considered when decelerations and silent patterns of FHR in a growth-retarded, late second or early third trimester fetus are seen. In most cases, however, the decision for optimal management o labor must be based on FHR patterns solely.