Pathological fetal heart rate tracing patterns and neonatal outcomes among parturients beyond 32 weeks of gestation: A prospective observational study

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This study aimed to determine and differentiate neonatal outcomes amongst the clinical phenotypes of pathological FHR tracing. Methods This prospective observational study included women in labour with pathological fetal heart rate tracing during delivery. Pathological fetal heart rate tracings were characterized into 11 clinical phenotypes and corresponding neonatal and maternal outcomes were recorded. Neonates and mothers were followed till discharge from the hospital. The primary outcome was a 5-minute APGAR score. The secondary outcomes were NICU admission, mode of delivery, mode of anesthesia, neonatal morbidity and mortality. Result 271 women with pathological fetal heart rate tracing at the time of delivery were included in the study. Most of the women (64%) underwent cesarean delivery. The most common pathological fetal heart rate tracing was repetitive late decelerations (24.7%), followed by reduced variability with repetitive variable decelerations (24.4%). The 5-minute APGAR score was comparable across all clinical phenotypes of pathological fetal heart rate tracing. Tachycardia with reduced variability was associated with a significantly higher likelihood of NICU admission (aOR = 5.03, 95% CI: 1.32–19.27, p = 0.018). Reduced variability, repetitive late decelerations and the combination of repetitive late decelerations with prolonged decelerations and reduced variability showed moderately increased odds of NICU admission. Conclusions The 5-minute APGAR score remained comparable in all clinical phenotypes of pathological fetal heart rate tracing. Nonetheless, the odds of NICU admission were significantly higher in women with tachycardia and reduced variability. Pathological fetal heart rate tracing Neonatal Outcome Neonatal Intensive Care Unit Anesthesia Cesarean Introduction Intrapartum fetal surveillance using cardiotocography (CTG) has become the standard of care in obstetrics practice for early recognition and management of fetal hypoxia or acidemia. CTG characterization into different categories is based on baseline fetal heart rate (FHR), variability and decelerations [ 1 ]. Fetal heart rate (FHR) tracing classifications have been provided by International Federation of Gynecology and Obstetrics (FIGO), American College of Obstetrics and Gynecology (ACOG) and National Institute for Health and Care Excellence (NICE). FIGO and NICE stratified FHR tracings into normal, suspicious and pathological varieties, while ACOG differentiates FHR tracings into type I (normal), type II (indeterminate) and type III categories [ 1 , 2 ]. A pathological FHR tracings indicate a high probability of fetal hypoxia or acidosis and may require urgent intrauterine resuscitation measures and delivery. Traditionally, repetitive late or prolonged decelerations with reduced variability have been considered ominous [ 1 ]. Nevertheless, several pathological FHR phenotypes that may not necessarily indicate fetal hypoxia/acidemia. Furthermore, in all these phenotypes, inadvertent cesarean delivery is performed to improve neonatal outcomes. Prior studies differentiated neonatal outcomes based on gross stratification into three phenotypes (normal, suspicious and pathological) [ 3 – 5 , 7 ]. However, there is a paucity of data related to neonatal outcomes on the basis of pathological FHR phenotype stratification [ 3 – 6 ]. Therefore, decision-making process related to the mode and urgency of delivery is not uniform and appears contentious. Furthermore, despite adequate training and technical skill, FHR tracing’s interpretation is associated with interindividual and intraindividual variability [ 1 ]. We hypothesized that neonatal outcomes would vary among pathological FHR phenotypes. This study aimed to analyze the difference in neonatal outcomes within various clinical phenotypes of pathological FHR tracings. Additionally, we studied the obstetric and anestheic practices in each clinical phenotype within pathological FHR patterns. Material and Methods This prospective observational analytical study was conducted at the Women and Children Hospital, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, located in the southern part of India. The study was approved by the scientific committee and the Institute Ethics committee of the Institute ( JIP/IEC-OS/O66/2023) . Ours tertiary care teaching hospital is managing 1000–1100 high risk deliveries per month. Patients provided written informed consent for participation in the study. Women who had a singleton pregnancy of ≥ 32 weeks of gestation, fetus in cephalic presentation, and pathological FHR tracing were included in this study Women with significant fetal congenital anomaly, cord prolapse, fetal growth restriction, and chorioamnionitis were excluded. All included women were followed up from the time of delivery until discharge from the hospital. Decisions regarding the intrauterine resuscitation measures, mode of delivery, anesthesia technique, intraoperative and postoperative management were made by the treating obstetrician in consultation with attending anesthesiologists. Intrauterine resuscitation measures included left lateral position, supplemental fluid bolus and discontinuation of oxytocin infusion in all patients. Neonatal resuscitation was performed according to the NRP 2020 guidelines [ 8 ]. The study did not affect clinical decision making at any stage of maternal and neonatal management. Relevant data was collected from the case records. Gestational age at delivery, the onset of labour, induction procedures, oxytocin augmentation, presence of tachysystole, intrauterine resuscitation techniques, mode of delivery, and decision to delivery interval were noted in predesigned proforma. The FHR tracings (baseline FHR, variability, accelerations, decelerations) were recorded and analyzed simultaneously to facilitate decision making. Neonatal parameters included birth weight centile, APGAR scores at 1 and 5, resuscitation, neonatal intensive care unit (NICU) admission, duration of NICU stay, respiratory support, respiratory distress syndrome (RDS), hypoxic ischemic encephalopathy (HIE), sepsis and neonatal death. Statistical Analysis Data was collected using REDCap and exported to STATA 14 for statistical analysis. Continuous variables were assessed for normality using the Kolmogorov-Smirnov test. Continuous data was expressed as mean and standard deviation or median and interquartile range. Categorical variables were summarized as frequencies and percentages. Pathological FHR tracings were described as proportions and 95% confidence interval. Correlation between pathological FHR tracing and outcomes was analyzed using Pearson’s chi-squared test or Fischer’s exact test. Predictors associated with NICU admission were analyzed using logistic regression. Multivariable logistic regression analysis was performed for factors significant in univariate analysis. p value < 0.05 was considered significant. Results 3002 deliveries were performed during the study period, and 271 women had a pathological FHR tracing. 95% of women had at least one risk factor for high-risk pregnancy. Most women (61%) were primigravida and 18.4% of women had a prior caesarean delivery. The fetal growth restriction (FGR) (34.7%) and oligohydramnios (26.2%) were frequently noted. Hypertensive disorders of pregnancy and diabetes mellitus were reported in 17.7% and 15.5% of women, respectively (Table 1 ). Table 1 Demographic and clinical characteristics of parturients with pathological FHR tracings (n = 271) Frequency (n) Percentage (%) Mean Age in years (SD) 26.3 4.0 Gravida Primigravida 167 61.6 Multigravida 104 38.4 Risk factors Gestational hypertension 18 6.6 Preeclampsia 17 6.3 Diabetes mellitus 42 15.5 Gestational diabetes mellitus 38 14.0 Pregestational diabetes mellitus 4 1.5 Oligohydramnios (AFI 25cm) 2 0.7 Post-date (> 40 weeks) 42 15.5 Fetal growth restriction (FGR) 94 34.7 Stage 1 (with normal end-diastolic flow in umbilical artery) 87 32.1 Stage 2 (with absent end- diastolic flow in umbilical artery) 7 2.6 Moderate anemia (Hb 8-10g%) 6 2.2 Hypothyroidism 53 19.6 Previous caesarean delivery 50 18.4 Premature rupture of the membranes 27 10.0 Preterm premature rupture of the membranes 5 1.8 Placenta previa 2 0.7 Heart disease 4 1.5 134 women out of 271 underwent induction of labour. Meconium-stained liquor was noted in 107 (39.4%) women, and 31(11.4%) women had thick meconium-stained liquor. Two women had abruptio placentae. All women with pathological FHR tracing required intrauterine resuscitation measures with maternal positional change and intravenous fluid administration. 15 (5%) women received amnioinfusion during variable deceleration. Amnioinfusion could not resolve variable deceleration in any woman. The decision to delivery interval was < 15 minutes in 93 (34.4%) women. Nevertheless, it exceeded 30 minutes in 43.3% of women ( Table S1 ). 174 (64.2%) women underwent cesarean delivery, and the rest of the women underwent assisted vaginal delivery. Most caesarean deliveries were performed under regional anaesthesia (89.7%). Fever was the most noticeable complication (5.9%) ( Table S2 ). Among 271 live births, 28 neonates (10.3%) were preterm, and 94 neonates (34.7%) had birth weight below the third centile for gestational age (FGR). The 1-minute and 5-minute APGAR score was < 7 in 42 (15%) and 7 (2.5%) neonates. The majority of the neonates (85.2%) cried immediately after birth or after stimulation. Positive pressure ventilation, intubation or chest compressions were required in 40 neonates. The most common complication in the first seven days of life was respiratory distress (36%). Four neonates developed mild hypoxic ischemic encephalopathy (HIE); one neonate developed severe HIE and expired on day 4 of NICU admission. Seventy-seven neonates (28.6%) were admitted to NICU within the first seven days of life, and 19 neonates among them required the highest level of critical care (Level 3 NICU) (Table 2 ). Table 2 Neonatal outcomes (n = 271) Frequency (n) Percentage (%) Maturity Preterm (32–37 weeks POG) 28 10.3 Term (37–42 weeks POG) 241 88.6 Post-term (> 42 weeks POG) 2 0.7 Birth weight < 3rd centile (FGR)* 94 34.7 3rd -10th centile (SGA)** 45 16.60 APGAR score at 1 minute < 7 42 15.5 ≥ 7 229 84.5 APGAR score at 5 minutes < 7 7 2.5 ≥ 7 264 97 Resuscitation at birth Routine care 231 85.2 Positive pressure ventilation (bag and mask ventilation) 27 10.0 Intubation 12 4.4 Chest compressions and intubation 1 0.4 Respiratory support in NICU Continuous positive airway pressure 67 24.7 Oxygen prongs 7 2.6 High flow nasal cannula 21 7.8 Non-invasive ventilation 8 3.0 Synchronized intermittent mandatory ventilation (SIMV) 1 0.4 NICU admission 77 28.6 Level 1 (room air, full feeds) 10 3.7 Level 2 (oxygen by prongs, IV fluids, orogastric feeds) 48 17.8 Level 3 (ventilator, nil per oral) 19 7.1 Median duration of NICU stay in days (IQR) 4 2–15 Complications Frequency (n) % Respiratory distress 97 35.8 Hypoxic ischemic encephalopathy 5 1.8 Mild 4 1.5 Moderate 0 0 Severe 1 0.4 Sepsis 10 3.7 Neonatal death 1 0.4 *Fetal Growth Restriction **Small-for-Gestational Age The study identified 11 different patterns of pathological fetal heart rate patterns. Reduced variability was reported in 151 (55.7%) women. The most common pathological CTG pattern was repetitive late decelerations (24.7%) followed by reduced variability with repetitive variable decelerations (24.4%). (Table 3 ) Table 3 Proportions of pathological CTG patterns (n = 271) Pathological CTG pattern Frequency % 95% CI Baseline FHR < 100 8 3.0 1.3–5.7 Reduced variability ( 3 minutes) 31 11.4 7.9–15.8 Tachycardia with late deceleration 3 1.1 0.2–3.2 Tachycardia with reduced variability 9 3.3 1.5–6.2 Reduced variability with repetitive variable decelerations 66 24.4 19.4–29.9 Reduced variability with repetitive late decelerations 26 9.6 6.4–13.7 Reduced variability with prolonged decelerations 10 3.7 1.8–6.7 Repetitive late decelerations with prolonged decelerations and reduced variability 6 2.2 0.8–4.8 Repetitive late decelerations with prolonged deceleration 11 4.1 2.0–7.2 Nearly 2/3rd of women underwent caesarean (64% vs 36% instrumental; p < 0.001). Spinal was the more common mode of anesthesia than general anesthesia (5:1; p = 0.001) (Table 4 ). Table 4 Pathological fetal heart rate patterns with maternal outcomes (n = 271) CTG Pattern (N) Mode of delivery Mode of anesthesia Maternal complications Instrumental delivery N (%) Caesarean delivery N (%) Spinal N (%) General N (%) PPH N (%) ICU admission N (%) Wound infection N (%) Fever N (%) Blood transfusion N (%) Baseline FHR < 100 (8) 1 (12.5) 7 (87.5) 5 (62.5) 2 (25.0) 0 (0) 0 (0) 0 (0) 0 (0) 1 (12.5) Reduced variability (34) 3 (8.8) 31 (91.2) 30 (88.2) 1 (2.9) 0 (0) 0 (0) 1 (2.94) 5 (14.7) 1 (2.9) Repetitive late decelerations (67) 29 (43.3) 38 (56.7) 34 (50.8) 4 (6.0) 1 (1.5) 1 (1.5) 2 (2.99) 4 (6.0) 1 (1.5) Prolonged deceleration (31) 13 (41.9) 18 (58.1) 6 (19.4) 12 (38.7) 0 (0) 1 (3.2) 0 (0) 3 (9.7) 1 (3.2) Tachycardia with late deceleration (3) 0 (0) 3 (100) 3 (100) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Tachycardia with reduced variability (9) 0 (0) 9 (100) 9 (100) 0 (0) 0 (0) 0 (0) 0 (0) 1 (11.1) 0 (0) Reduced variability with repetitive variable decelerations (66) 23 (34.8) 43 (65.2) 39 (59.1) 4 (6.1) 3 (4.6) 1 (1.5) 0 (0) 1 (1.5) 2 (3.0) Reduced variability with repetitive late decelerations (26) 17 (65.4) 9 (34.6) 9 (34.6) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 1 (3.8) Reduced variability with prolonged decelerations (10) 3 (30.0) 7 (70.0) 5 (50.0) 2 (20.0) 0 (0) 0 (0) 0 (0) 0 (0) 1 (10.0) Repetitive late decelerations with prolonged decelerations and reduced variability (6) 3 (50.0) 3 (50.0) 1 (16.7) 2 (33.3) 0 (0) 0 (0) 0 (0) 1 (16.7) 0 (0) Repetitive late decelerations with prolonged deceleration (11) 5 (45.4) 6 (54.6) 5 (45.4) 1 (9.1) 0 (0) 0 (0) 0 (0) 1 (9.1) 0 (0) P value < 0.001 < 0.001 0.789 0.866 0.789 0.135 0.604 A low (< 7) 5-minute APGAR score was observed in women with repetitive late decelerations, prolonged deceleration and the combination of reduced variability with repetitive variable decelerations. Respiratory distress was more likely associated with tachycardia with reduced variability (67%), reduced variability (47%) and prolonged decelerations (45%). The median duration of NICU stay was longer in women with reduced variability with prolonged decelerations (Table 5 ) Table 5 Association of pathological CTG patterns with adverse neonatal outcomes (n = 271) CTG Pattern Neonatal outcomes Birth weight < 3rd centile N (%) Preterm birth N (%) = APGAR score at 1 minute < 7 N (%) = 42 (7.3) APGAR score at 5 minutes < 7 N (%) = 7 (2.58) Required significant resuscitation at birth N (%) NICU admission N (%) Median duration of NICU stay in days (IQR) Respiratory distress N (%) Hypoxic ischemic encephalopathy N (%) Sepsis N (%) Baseline FHR < 100 (8) 6 (75.0) 5 (62.5) 2 (25.0) 0 (0.00) 2 (25.0) 5 (62.5) 18 (15,18) 3 (37.5) 0 (0) 1 (12.5) Reduced variability (34) 13 (38.2) 4 (11.8) 6 (17.6) 0 (0.00) 7 (20.6) 12 (35.3) 5 (1.5, 21.5) 16 (47.1) 2 (5.9) 2 (5.9) Repetitive late decelerations (67) 20 (29.8) 7 (10.4) 10 (14.9) 3 (4.4) 10 (14.9) 21 (31.3) 3 (2, 9) 25 (37.3) 2 (3.0) 4 (6.0) Prolonged deceleration (31) 7 (22.6) 1 (3.2) 7 (22.6) 1 (3.2) 7 (22.6) 5 (16.1) 4 (2, 8) 14 (45.2) 0 (0) 0 (0) Tachycardia with late deceleration (3) 2 (66.7) 0 (0) 0 (0) 0 (0) 0 (0) 1 (33.3) 17 (17,17) 1 (33.3) 0 (0) 0 (0) Tachycardia with reduced variability (9) 3 (33.3) 2 (22.2) 0 (0) 0 (0.00) 0 (0) 5 (55.6) 1 (1, 2) 6 (66.7) 0 (0) 1 (11.1) Reduced variability with repetitive variable decelerations (66) 21 (31.8) 5 (7.6) 12 (18.2) 2 (3.0) 10 (15.2) 16 (24.2) 3.5 (1.5, 12.5) 21 (31.8) 1 (1.5) 1 (1.5) Reduced variability with repetitive late decelerations (26) 8 (30.8) 1 (3.8) 2 (7.7) 0 (0.00) 1 (3.8) 5 (19.2) 2 (2, 5) 7 (26.9) 0 (0) 0 (0) Reduced variability with prolonged decelerations (10) 4 (40.0) 2 (20.0) 0 (0) 0 (00.0) 0 (0) 3 (30.0) 20 (4, 47) 0 (0) 0 (0) 1 (10.0) Repetitive late decelerations with prolonged decelerations and reduced variability (6) 6 (100) 0 (0) 2 (33.3) 0 (0.00) 2 (33.3) 2 (33.3) 1.5 (1, 2) 1 (16.7) 0 (0) 0 (0) Repetitive late decelerations with prolonged deceleration (11) 4 (36.4) 1 (9.1) 1 (9.1) 1 (9.1) 1 (9.1) 2 (18.2) 5.5 (4, 7) 3 (27.3) 0 (0) 0 (0) P value 0.015 0.011 0.545 0.864 0.327 0.179 0.091 0.098 0.826 0.272 Tachycardia with reduced variability (aOR = 5.03, 95% CI: 1.32–19.27, p = 0.018) was associated with a significantly higher odds of NICU admission. Reduced variability, repetitive late decelerations or the combination of repetitive late decelerations with prolonged decelerations and reduced variability showed moderately increased odds of NICU admission (Table 5 ; Figure S1 ). Additionally, the decision to delivery interval > 30 minutes was also associated with non-signifcantly higher odds of NICU admission. The presence of loop of cord around the neck, meconium-stained liquor, scar dehiscence, fetal growth restriction, and cephalopelvic disproportion did not appear to be a significant predictor NICU admission (Table 6 ). Table 6 Multivariable regression analysis for prediction of NICU admission (n = 271) Variables NICU admission present N (%) NICU admission absent N (%) Adjusted Odds Ratio (aOR) 95% CI of aOR p-value Pathological CTG pattern (N) Reduced variability (34) 12 (35.3) 22 (64.7) 2.64 0.77-9.00 0.121 Repetitive late decelerations (67) 21 (31.3) 46 (68.7) 2.59 0.83–8.06 0.101 Prolonged deceleration (31) 5 (16.1) 26 (83.8) 1.94 0.74–8.35 0.312 Tachycardia with late deceleration (3) 1 (33.3) 2 (66.7) 2.74 0.30-24.61 0.368 Tachycardia with reduced variability (9) 5 (55.6) 4 (44.4) 5.03 1.32–19.27 0.018 Reduced variability with repetitive variable decelerations (66) 16 (24.2) 50 (75.8) 2.16 0.66–7.08 0.204 Reduced variability with repetitive late decelerations (26) 5 (19.2) 21 (80.8) 1.64 0.44–6.14 0.462 Reduced variability with prolonged decelerations (10) 3 (30.0) 7 (70.0) 1.77 0.38–8.27 0.469 Repetitive late decelerations with prolonged decelerations and reduced variability (6) 2 (33.3) 4 (66.7) 3.64 0.77–17.24 0.103 Repetitive late decelerations with prolonged deceleration (11) 2 (18.2) 9 (81.8) 1.30 0.24–7.01 0.757 Mean Age in Years (SD) 26.7 (4.0) 26.1 (4.0) 0.99 0.94–1.05 0.833 Maternal Risk factors Absent 4 (36.4) 7 (63.6) Present 73 (28.0) 187 (71.9) 0.80 0.35–1.85 0.609 Onset of labor Spontaneous 39 (31.4) 85 (68.6) - Induced 28 (20.9) 106 (79.1) 0.72 0.45–1.14 0.160 Decision to delivery interval <15 minutes 22 (23.7) 71 (76.3) 15–30 minutes 15 (25.0) 45 (75.0) 1.04 0.56–1.93 0.909 30–60 minutes 40 (33.9) 78 (66.1) 1.11 0.66–1.82 0.688 Loop of cord around neck 6 (23.1) 20 (76.9) 1.18 0.54–2.61 0.675 Meconium-stained liquor 30 (29.1) 73 (70.9) 1.16 0.76–1.76 0.504 Scar dehiscence 3 (33.3) 6 (66.7) 0.42 0.09–1.99 0.275 Fetal growth restriction 33 (32.7) 68 (67.3) 0.91 0.58–1.44 0.684 Cephalopelvic disproportion 1 (9.1) 10 (90.9) 0.39 0.06–2.65 0.333 Maturity at birth Preterm 22 (78.6) 6 (21.4) 2.87 1.73–4.75 < 0.001 Post-term 1 (50.0) 1 (50.0) 1.83 0.44–7.57 0.405 Contribution to Authorship TS: Helped in literature search, extraction of data and preparation of final draft of manuscript NJ: Helped in data extraction, statistical analysis, interpretation of result and preparation of final draft of manuscript RR: Helped in data extraction, statistical analysis, interpretation of result and preparation of final draft of manuscript Discussion Our centre mostly admits high-risk pregnancies, and in the study period, a pathological FHR pattern was observed in 271 women out of 3002 deliveries. In this study, we observed comparable neonatal APGAR scores in all clinical phenotypes of pathological FHR tracings. Furthermore, we did not observe a significant association between pathological FHR patterns and other neonatal outcomes, namely requirement for newborn resuscitation, duration of NICU stay, RDS, HIE and neonatal sepsis. However, the odds of NICU admission were significantly higher in those who were delivered from mothers having tachycardia with reduced variability. The types and frequencies of pathological FHR patterns observed in this study are consistent with a previously published report [ 9 ]. However, we observed fewer incidences of fetal tachycardia compared to an earlier study (4% vs 15%). The most common pathological CTG pattern was repetitive late decelerations (24.7%) followed by reduced variability and repetitive variable decelerations (24.4%). Severe variable or late deceleration with tachycardia was associated with a higher lactate concentration 1.6 mmol/l vs 0.9 mmol/l) than the reference group, suggesting a higher frequency of fetal hypoxia/acidosis in this particular pattern of pathological FHR [ 9 ]. Additionally, median lactate doubled in fetus with tachycardia and reduced variability. Though, the neonatal outcomes were comparable in our study, we observed a higher incidence of NICU admission in women with tachycardia and reduced variability. In earlier reports, severe variable and late decelerations were associated with poor neonatal outcomes [ 10 – 12 ]. However, in a large cohort of high-risk pregnancies, 60% of the foetuses showing pathological features such as bradycardia and decelerations did not have acidemia and fetal PH < 7.25 [ 13 ]. Recent studies suggested that 95% of the pathological FHR patterns were not associated with cerebral palsy [ 14 , 15 ]. In our institution, the average caesarean section rate is 35%. Nearly 20% of emergency caesarean delivery was performed due to pathological FHR tracing. Continuous CTG monitoring was reported to increase the risk of caesarean and instrumental deliveries by 15% and 63%, respectively [ 16 ]. Kale et al reported a much lower incidence (11%) of cesarean delivery due to pathological FHR tracing. Nonetheless, the incidence of good APGAR scores (1-minute and 5-minute APGAR scores > 7, 85% and 97%, respectively) was similar to those reported by Kale et al. It seems that cesarean section decision-making based on fetal scalp blood sampling could have resulted in fewer cesarean delivery [ 17 ]. Non-reassuring fetal heart detected by cardiotocography did not correlate well with the adverse neonatal outcomes and resulted in a high incidence of unnecessary caesarean delivery rate at ≥ 36 weeks during labour [ 18 ]. The spinal and general anaesthesia resulted in comparable perinatal outcomes, and our findings are consistent with previous published report. Regional anaesthesia may be preferred for obvious maternal benefit and general anaesthesia may be utilized for prolonged bradycardia, abruptio placenta, uterine rupture, and cord-related complications. The incidence of post-partum hemorrhage, fever, blood transfusion and wound infection were comparable across all pathological FHR patterns. 95% of women with pathological FHR had one or more risk factors, namely oligohydramnios, hypothyroidism, post-caesarean pregnancy, hypertensive disorder, diabetes in pregnancy, post-datism and premature rupture of membranes. Meconium-stained liquor was present in 107 women (39.4%), of which 31 women (11.4%) had thick meconium-stained liquor. Augmentation of labour was performed in women with grade 1 and 2 meconium-stained liqour. Any deceleration in the presence of meconium was considered an indication of emergent delivery, as meconium itself may be a sign of fetal distress. However, we did not observe any significant association between meconium staining and adverse outcomes, as our labour room protocols and monitoring are stringent. All women with pathological FHR tracing received intrauterine resuscitation measures that included maternal positional change and intravenous fluid administration. Fifteen (5%) women received amnioinfusion for variable deceleration, and FHR tracing did not return to normal. The decision to delivery interval after pathological FHR diagnosis will likely to affect perinatal outcomes. In this study, the decision to delivery interval was < 15 minutes in 93 (34.4%) women, 15–30 minutes in 60 women (22.5%) and 30–60 minutes in 43.3% of women. Nevertheless, the NICU admission rate was comparable across all decision to delivery interval. These findings were consistent with those of a previous report. Intentional shortening of decision to delivery interval ≤ 30 minutes may not improve neonatal outcome [ 18 ]. Pathological FHR represents the variable extent of fetal acidemia/hypoxia. In the absence of coexisting maternal or fetal complications, the fetus tolerates hypoxia by mounting an effective compensatory response. Therefore, neonatal outcomes may be affected due to concomitant uteroplacental insufficiency, meconium-stained liquor, chorioamnionitis, sepsis, and intrapartum placenta-related accident [ 19 ]. Clinical Implications Categorization of FHR is introduced in clinical practice without robust evidence. The guidelines (FIGO, ACOG and NICE) have done arbitrary grouping without adequate data related to the pathophysiology and outcomes of different categories. The available evidence from trials does not support the role of CTG in improving perinatal outcomes [ 20 ]. Nevertheless, the evolution, duration and characterization of FHR patterns have been advocated for routine use in clinical practice [ 21 ]. Therefore, we assessed perinatal outcomes according to FHR characteristics, and noted that all FHR patterns affect neonatal outcomes similarly. This study would provide further evidence base for categorising FHR patterns based on neonatal outcomes. Nevertheless, both FIGO and ACOG say that the probability of hypoxia/acidemia increases in pathological or Catergory III fetal heart rate tracings. All patterns of pathological FHR could be associated with hypoxia/acidosis. All patterns of pathological FHR should be considered equal, and their pathophysiological basis could be similar with minor differences. We need consensus worldwide to have a common classification of fetal heart rate tracings. Strengths and Limitation of the Study Due to our prospective study design, we were able to evaluate and analyze all the predefined outcome measures to build a robust dataset. We believe this is the largest study aimed at stratifying perinatal outcomes based on types of FHR tracings within pathological FHR patterns. Mothers and neonates were followed till discharge. Moreover, we analyzed several other obstetric and anesthetic variables in addition to pathological FHR patterns as predictors of perinatal outcomes in a large cohort of women. Obstetric care providers and the treating team were homogenous in experience and skills. This may have reduced bias due to the interpretation of FHR tracings in obstetric decision-making. According to the standard protocol in our institute, all FHR traces are analyzed by a team of senior residents. Disagreement in FHR tracing decision-making was resolved by treating consultants. Intrauterine resuscitation measures such as stoppage of oxytocin, oxygenation, maternal positional change and intravenous fluid administration were uniform and were continued till delivery. Single-center study is the most obvious limitation. We did not categorize FHR tracing based on ACOG guideline. The pathological tracings that could have occurred in the early phases of labour and were resolved with intrauterine resuscitation were not studied. We did not study the duration of pathological FHR and, therefore, did not study the impact of duration of pathological FHR on neonatal outcomes. Moreover, a decision based on fetal scalp sampling could have reduced cesarean delivery further. Conclusion The 5-minute APGAR score remained comparable in all clinical phenotypes of pathological fetal heart rate tracing. Nonetheless, the odds of NICU admission were significantly higher in women with tachycardia and reduced variability. Declarations Statement and Declarations Conflicts of interest - Nil Funding- GJ Strauss Short Term Studentship Awards and Funds, JIPMER Ethical Approval UGRMC Reg No. JIP/UGRMC/GJSTRAUS/2023/13and Institute Ethics Committee (JIPMER, Puducherry, India) approval (Project No. JIP/IEC-OS/O66/2023). Acknowledgement: None Consent to Participate : Patients provided consent for participation Consent to Publish : Patients provided consent for publication Data Availability Statement : The data underlying this article will be shared on reasonable request to the corresponding author. Contribution to Authorship Name: Theresa Soni , MBBS Contribution: This author helped with intellectual content, study design, data collection, writing and editing all sections of manuscript, and approving manuscript for publication Name : Nivedita Jha, MBBS, MS Contribution: This author helped with intellectual content, study design, writing and editing all sections of manuscript, and approving manuscript for publication Name: Ruben Raj, MBBS, MD, Contribution: This author helped with intellectual content, study design, writing and editing all sections of manuscript, and approving manuscript for publication References Ayres-de-Campos D, Spong CY, Chandraharan E (2015) FIGO Intrapartum Fetal Monitoring Expert Consensus Panel. FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography. Int J Gynaecol Obstet 131(1):13–24 American College of Obstetricians and Gynecologists (2010) Practice bulletin 116: Management of intrapartum fetal heart rate tracings. Obstet Gynecol 116(5):1232–1240 Alfirevic Z, Devane D, Gyte GM, Cuthbert A (2017) Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev 2(2):CD006066 Devane D, Lalor JG, Daly S, McGuire W, Cuthbert A, Smith V (2017) Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing. Cochrane Database Syst Rev 1(1):CD005122 Arnold JJ, Gawrys BL (2020) Intrapartum Fetal Monitoring. Am Fam Physician 102(3):158–167 Al Wattar BH, Honess E, Bunnewell S et al (2021) Effectiveness of intrapartum fetal surveillance to improve maternal and neonatal outcomes: a systematic review and network meta-analysis. CMAJ 193(14):E468–E477 Shrestha S, Shrestha I (2019) Admission Cardiotocography in Predicting Perinatal Outcome. Kathmandu Univ Med J 17(67):201–205 Aziz K, Lee HC, Escobedo MB et al (2020) Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 142(16suppl2):S524–S550 Holzmann M, Wretler S, Cnattingius S, Nordström L (2015) Cardiotocography patterns and risk of intrapartum fetal acidemia. J Perinat Med 43(4):473–479 Althaus JE, Petersen SM, Fox HE, Holcroft CJ, Graham EM (2005) Can electronic fetal monitoring identify preterm neonates with cer- ebral white matter injury? Obstet Gynecol 105:458–465 Nelson KB, Dambrosia JM, Ting TY, Grether JK (1996) Uncertain value of electronic fetal monitoring in predicting cerebral palsy. N Engl J Med 334:613–618 Parer JT, Krueger TR, Harris JL (1980) Fetal oxygen consumption and mechanisms of heart rate response during artificially produced late decelerations of fetal heart rate in sheep. Am J Obstet Gynecol 136:478–482 Beard RW, Filshie GM, Knight CA, Roberts GM (1971) The significance of the changes in the continuous fetal heart rate in the first stage of labour. J Obstet Gynaecol Br Commonw 78:865–881 Pinas A, Chandraharan E (2016) Continuous cardiotocography during labour: analysis, classification and management. Best Pract Res Clin Obstet Gynaecol 30:33–47 Nelson KB, Dambrosia JM, Ting TY, Grether JK (1996) Uncertain value of electronic fetal monitoring in predicting cerebral palsy. N Engl J Med 334:613–618 Alfirevic Z, Devane D, Gyte GM, Cuthbert A (2017) Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev 2:CD006066 Kale I (2022) Does continuous cardiotocography during labor cause excessive fetal distress diagnosis and unnecessary cesarean sections? J Matern Fetal Neonatal Med 35(6):1017–1022 Roy KK, Baruah J, Kumar S, Deorari AK, Sharma JB, Karmakar D (2008) Cesarean section for suspected fetal distress, continuous fetal heart monitoring and decision to delivery time. Indian J Pediatr 75(12):1249–1252 Jia YJ, Ghi T, Pereira S, Gracia Perez-Bonfils A, Chandraharan E (2023) Pathophysiological interpretation of fetal heart rate tracings in clinical practice. Am J Obstet Gynecol Jun 228(6):622–644 Vintzileos AM (2009) Evidence-based compared with reality-based medicine in obstetrics. Obstet Gynecol 114:930 Vintzileos AM, Smulian JC (2021) Timing intrapartum management based on the evolution and duration of fetal heart rate patterns. J Matern Fetal Neonatal Med 1–6 Cite Share Download PDF Status: Published Journal Publication published 23 Oct, 2024 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted Reviewers agreed at journal 14 Mar, 2024 Reviewers invited by journal 05 Mar, 2024 Editor invited by journal 04 Mar, 2024 Editor assigned by journal 04 Mar, 2024 First submitted to journal 03 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4010685","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":276558602,"identity":"1b3fa963-433d-4c45-a4e2-41c841713b59","order_by":0,"name":"Theresa Soni","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Theresa","middleName":"","lastName":"Soni","suffix":""},{"id":276558603,"identity":"8f8b59b7-528c-49a5-8388-d7c5b2e3d7f5","order_by":1,"name":"Nivedita Jha","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIiWNgGAWjYDCCA0CcwMDA2AakjRkYbIAUY+MB4rSwgbWkgbQ0ENYCVgbUwszAcBhZEDvgu32A7cHDNhvZPvnmB8UFNeft1rYfBtpSYxONS4vkuQR2g8S2NOM2NjYD4xnHbidvO5MI1HIsLbcBhxaDMwxsEglnDicC/WJgzMN2O9nsAFALY8NhQlr+A7WwfzDm+Xcu2ez8Q2K0VBwAauExMOZtO2BndoOALZJnGNuAWpKBfskpMObtS04wuwG0JQGPX/jOMB+T/GFgJzu/+fg2Y55vdvZm59MfPvhQY4NTCyhGYCw2AyCRCOYm4FSOCpgfAAl7IhWPglEwCkbBCAIAZ3dgarGadx4AAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-0183-0773","institution":"Jawaharlal Institute of Postgraduate Medical Education and Research","correspondingAuthor":true,"prefix":"","firstName":"Nivedita","middleName":"","lastName":"Jha","suffix":""},{"id":276558604,"identity":"5d60c4c0-d7b2-46da-b187-018c24cadd92","order_by":2,"name":"Ruben Raj","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Ruben","middleName":"","lastName":"Raj","suffix":""}],"badges":[],"createdAt":"2024-03-04 05:38:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4010685/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4010685/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00404-024-07791-w","type":"published","date":"2024-10-23T15:58:22+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":67682810,"identity":"7c95cf01-19fb-4e3a-ba71-42809f5dedb5","added_by":"auto","created_at":"2024-10-28 16:15:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1119666,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4010685/v1/29e84955-cfff-4025-aaab-ddeced7a9dc4.pdf"}],"financialInterests":"","formattedTitle":"Pathological fetal heart rate tracing patterns and neonatal outcomes among parturients beyond 32 weeks of gestation: A prospective observational study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIntrapartum fetal surveillance using cardiotocography (CTG) has become the standard of care in obstetrics practice for early recognition and management of fetal hypoxia or acidemia. CTG characterization into different categories is based on baseline fetal heart rate (FHR), variability and decelerations [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Fetal heart rate (FHR) tracing classifications have been provided by International Federation of Gynecology and Obstetrics (FIGO), American College of Obstetrics and Gynecology (ACOG) and National Institute for Health and Care Excellence (NICE). FIGO and NICE stratified FHR tracings into normal, suspicious and pathological varieties, while ACOG differentiates FHR tracings into type I (normal), type II (indeterminate) and type III categories [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A pathological FHR tracings indicate a high probability of fetal hypoxia or acidosis and may require urgent intrauterine resuscitation measures and delivery. Traditionally, repetitive late or prolonged decelerations with reduced variability have been considered ominous [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Nevertheless, several pathological FHR phenotypes that may not necessarily indicate fetal hypoxia/acidemia. Furthermore, in all these phenotypes, inadvertent cesarean delivery is performed to improve neonatal outcomes. Prior studies differentiated neonatal outcomes based on gross stratification into three phenotypes (normal, suspicious and pathological) [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, there is a paucity of data related to neonatal outcomes on the basis of pathological FHR phenotype stratification [\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Therefore, decision-making process related to the mode and urgency of delivery is not uniform and appears contentious. Furthermore, despite adequate training and technical skill, FHR tracing\u0026rsquo;s interpretation is associated with interindividual and intraindividual variability [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. We hypothesized that neonatal outcomes would vary among pathological FHR phenotypes.\u003c/p\u003e \u003cp\u003eThis study aimed to analyze the difference in neonatal outcomes within various clinical phenotypes of pathological FHR tracings. Additionally, we studied the obstetric and anestheic practices in each clinical phenotype within pathological FHR patterns.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003eThis prospective observational analytical study was conducted at the Women and Children Hospital, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, located in the southern part of India. The study was approved by the scientific committee and the Institute Ethics committee of the Institute (\u003cb\u003eJIP/IEC-OS/O66/2023)\u003c/b\u003e. Ours tertiary care teaching hospital is managing 1000\u0026ndash;1100 high risk deliveries per month. Patients provided written informed consent for participation in the study.\u003c/p\u003e \u003cp\u003eWomen who had a singleton pregnancy of \u0026ge;\u0026thinsp;32 weeks of gestation, fetus in cephalic presentation, and pathological FHR tracing were included in this study Women with significant fetal congenital anomaly, cord prolapse, fetal growth restriction, and chorioamnionitis were excluded.\u003c/p\u003e \u003cp\u003eAll included women were followed up from the time of delivery until discharge from the hospital. Decisions regarding the intrauterine resuscitation measures, mode of delivery, anesthesia technique, intraoperative and postoperative management were made by the treating obstetrician in consultation with attending anesthesiologists. Intrauterine resuscitation measures included left lateral position, supplemental fluid bolus and discontinuation of oxytocin infusion in all patients. Neonatal resuscitation was performed according to the NRP 2020 guidelines [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The study did not affect clinical decision making at any stage of maternal and neonatal management.\u003c/p\u003e \u003cp\u003eRelevant data was collected from the case records. Gestational age at delivery, the onset of labour, induction procedures, oxytocin augmentation, presence of tachysystole, intrauterine resuscitation techniques, mode of delivery, and decision to delivery interval were noted in predesigned proforma. The FHR tracings (baseline FHR, variability, accelerations, decelerations) were recorded and analyzed simultaneously to facilitate decision making. Neonatal parameters included birth weight centile, APGAR scores at 1 and 5, resuscitation, neonatal intensive care unit (NICU) admission, duration of NICU stay, respiratory support, respiratory distress syndrome (RDS), hypoxic ischemic encephalopathy (HIE), sepsis and neonatal death.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData was collected using REDCap and exported to STATA 14 for statistical analysis. Continuous variables were assessed for normality using the Kolmogorov-Smirnov test. Continuous data was expressed as mean and standard deviation or median and interquartile range. Categorical variables were summarized as frequencies and percentages. Pathological FHR tracings were described as proportions and 95% confidence interval. Correlation between pathological FHR tracing and outcomes was analyzed using Pearson\u0026rsquo;s chi-squared test or Fischer\u0026rsquo;s exact test. Predictors associated with NICU admission were analyzed using logistic regression. Multivariable logistic regression analysis was performed for factors significant in univariate analysis. p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e3002 deliveries were performed during the study period, and 271 women had a pathological FHR tracing. 95% of women had at least one risk factor for high-risk pregnancy.\u003c/p\u003e \u003cp\u003eMost women (61%) were primigravida and 18.4% of women had a prior caesarean delivery. The fetal growth restriction (FGR) (34.7%) and oligohydramnios (26.2%) were frequently noted.\u003c/p\u003e \u003cp\u003eHypertensive disorders of pregnancy and diabetes mellitus were reported in 17.7% and 15.5% of women, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and clinical characteristics of parturients with pathological FHR tracings (n\u0026thinsp;=\u0026thinsp;271)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean Age in years (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGravida\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimigravida\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultigravida\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRisk factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational hypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreeclampsia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational diabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregestational diabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOligohydramnios (AFI\u0026thinsp;\u0026lt;\u0026thinsp;5 cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolyhydramnios (AFI\u0026thinsp;\u0026gt;\u0026thinsp;25cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-date (\u0026gt;\u0026thinsp;40 weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFetal growth restriction (FGR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage 1 (with normal end-diastolic flow in umbilical artery)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage 2 (with absent end- diastolic flow in umbilical artery)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate anemia (Hb 8-10g%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypothyroidism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious caesarean delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePremature rupture of the membranes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreterm premature rupture of the membranes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacenta previa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e134 women out of 271 underwent induction of labour. Meconium-stained liquor was noted in 107 (39.4%) women, and 31(11.4%) women had thick meconium-stained liquor. Two women had abruptio placentae.\u003c/p\u003e \u003cp\u003eAll women with pathological FHR tracing required intrauterine resuscitation measures with maternal positional change and intravenous fluid administration. 15 (5%) women received amnioinfusion during variable deceleration. Amnioinfusion could not resolve variable deceleration in any woman.\u003c/p\u003e \u003cp\u003eThe decision to delivery interval was \u0026lt;\u0026thinsp;15 minutes in 93 (34.4%) women. Nevertheless, it exceeded 30 minutes in 43.3% of women (\u003cb\u003eTable \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e\u003c/b\u003e).\u003c/p\u003e \u003cp\u003e174 (64.2%) women underwent cesarean delivery, and the rest of the women underwent assisted vaginal delivery. Most caesarean deliveries were performed under regional anaesthesia (89.7%). Fever was the most noticeable complication (5.9%) (\u003cb\u003eTable S2\u003c/b\u003e).\u003c/p\u003e \u003cp\u003eAmong 271 live births, 28 neonates (10.3%) were preterm, and 94 neonates (34.7%) had birth weight below the third centile for gestational age (FGR). The 1-minute and 5-minute APGAR score was \u0026lt;\u0026thinsp;7 in 42 (15%) and 7 (2.5%) neonates. The majority of the neonates (85.2%) cried immediately after birth or after stimulation. Positive pressure ventilation, intubation or chest compressions were required in 40 neonates. The most common complication in the first seven days of life was respiratory distress (36%). Four neonates developed mild hypoxic ischemic encephalopathy (HIE); one neonate developed severe HIE and expired on day 4 of NICU admission. Seventy-seven neonates (28.6%) were admitted to NICU within the first seven days of life, and 19 neonates among them required the highest level of critical care (Level 3 NICU) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNeonatal outcomes (n\u0026thinsp;=\u0026thinsp;271)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaturity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreterm (32\u0026ndash;37 weeks POG)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTerm (37\u0026ndash;42 weeks POG)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e241\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-term (\u0026gt;\u0026thinsp;42 weeks POG)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBirth weight\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3rd centile (FGR)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd -10th centile (SGA)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAPGAR score at 1 minute\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAPGAR score at 5 minutes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResuscitation at birth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoutine care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive pressure ventilation (bag and mask ventilation)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntubation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChest compressions and intubation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRespiratory support in NICU\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContinuous positive airway pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxygen prongs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh flow nasal cannula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-invasive ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSynchronized intermittent mandatory ventilation (SIMV)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNICU admission\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 1 (room air, full feeds)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 2 (oxygen by prongs, IV fluids, orogastric feeds)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 3 (ventilator, nil per oral)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedian duration of NICU stay in days (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFrequency (n)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypoxic ischemic encephalopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSepsis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeonatal death\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e*Fetal Growth Restriction **Small-for-Gestational Age\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe study identified 11 different patterns of pathological fetal heart rate patterns. Reduced variability was reported in 151 (55.7%) women. The most common pathological CTG pattern was repetitive late decelerations (24.7%) followed by reduced variability with repetitive variable decelerations (24.4%). (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eProportions of pathological CTG patterns (n\u0026thinsp;=\u0026thinsp;271)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathological CTG pattern\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline FHR\u0026thinsp;\u0026lt;\u0026thinsp;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3\u0026ndash;5.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced variability (\u0026lt;\u0026thinsp;5bpm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.8\u0026ndash;17.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepetitive late decelerations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.7\u0026ndash;30.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProlonged deceleration (\u0026gt;\u0026thinsp;3 minutes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.9\u0026ndash;15.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTachycardia with late deceleration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.2\u0026ndash;3.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTachycardia with reduced variability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.5\u0026ndash;6.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced variability with repetitive variable decelerations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.4\u0026ndash;29.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced variability with repetitive late decelerations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.4\u0026ndash;13.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced variability with prolonged decelerations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.8\u0026ndash;6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepetitive late decelerations with prolonged decelerations and reduced variability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.8\u0026ndash;4.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepetitive late decelerations with prolonged deceleration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.0\u0026ndash;7.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNearly 2/3rd of women underwent caesarean (64% vs 36% instrumental; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Spinal was the more common mode of anesthesia than general anesthesia (5:1; p\u0026thinsp;=\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePathological fetal heart rate patterns with maternal outcomes (n\u0026thinsp;=\u0026thinsp;271)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCTG Pattern (N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMode of delivery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eMode of anesthesia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c10\" namest=\"c6\"\u003e \u003cp\u003eMaternal complications\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInstrumental delivery\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCaesarean delivery\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpinal\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePPH\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eICU admission\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eWound infection\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eBlood transfusion\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline FHR\u0026thinsp;\u0026lt;\u0026thinsp;100 (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced variability (34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e(8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (91.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (88.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (2.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5 (14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(2.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepetitive late decelerations (67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (43.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (56.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (50.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e(6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (2.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e(6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProlonged deceleration (31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (41.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (58.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (38.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e(9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(3.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTachycardia with late deceleration (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTachycardia with reduced variability (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003cp\u003e(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003cp\u003e(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced variability with repetitive variable decelerations (66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (65.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 (59.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e(6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e(4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(3.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced variability with repetitive late decelerations (26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (65.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(3.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced variability with prolonged decelerations (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003cp\u003e(70.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1 (10.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepetitive late decelerations with prolonged decelerations and reduced variability (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepetitive late decelerations with prolonged deceleration (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (45.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (54.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (45.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.604\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA low (\u0026lt;\u0026thinsp;7) 5-minute APGAR score was observed in women with repetitive late decelerations, prolonged deceleration and the combination of reduced variability with repetitive variable decelerations. Respiratory distress was more likely associated with tachycardia with reduced variability (67%), reduced variability (47%) and prolonged decelerations (45%). The median duration of NICU stay was longer in women with reduced variability with prolonged decelerations (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation of pathological CTG patterns with adverse neonatal outcomes (n\u0026thinsp;=\u0026thinsp;271)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCTG Pattern\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"10\" nameend=\"c11\" namest=\"c2\"\u003e \u003cp\u003eNeonatal outcomes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBirth weight\u0026thinsp;\u0026lt;\u0026thinsp;3rd\u003c/p\u003e \u003cp\u003ecentile\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePreterm birth\u003c/p\u003e \u003cp\u003eN (%) =\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAPGAR score at 1 minute\u0026thinsp;\u0026lt;\u0026thinsp;7\u003c/p\u003e \u003cp\u003eN (%)\u0026thinsp;=\u0026thinsp;42 (7.3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAPGAR score at 5 minutes\u0026thinsp;\u0026lt;\u0026thinsp;7\u003c/p\u003e \u003cp\u003eN (%)\u0026thinsp;=\u0026thinsp;7 (2.58)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRequired significant resuscitation at birth\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNICU admission\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMedian duration of NICU stay in days (IQR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eRespiratory distress\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHypoxic ischemic encephalopathy\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSepsis\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline FHR\u0026thinsp;\u0026lt;\u0026thinsp;100 (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e(15,18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced variability (34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003cp\u003e(20.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12 (35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e(1.5, 21.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e16 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(5.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepetitive late decelerations (67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (29.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003cp\u003e(14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21 (31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e(2, 9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e25 (37.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e(6.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProlonged deceleration (31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003cp\u003e(22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5 (16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e(2, 8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14 (45.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTachycardia with late deceleration (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e(17,17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTachycardia with reduced variability (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(1, 2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 (11.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced variability with repetitive variable decelerations (66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e(7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16 (24.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.5 (1.5, 12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e21 (31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced variability with repetitive late decelerations (26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5 (19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(2, 5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7 (26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced variability with prolonged decelerations (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (00.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20\u003c/p\u003e \u003cp\u003e(4, 47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 (10.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepetitive late decelerations with prolonged decelerations and reduced variability (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003cp\u003e(1, 2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepetitive late decelerations with prolonged deceleration (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003cp\u003e(4, 7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.545\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.864\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.826\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.272\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTachycardia with reduced variability (aOR\u0026thinsp;=\u0026thinsp;5.03, 95% CI: 1.32\u0026ndash;19.27, p\u0026thinsp;=\u0026thinsp;0.018) was associated with a significantly higher odds of NICU admission. Reduced variability, repetitive late decelerations or the combination of repetitive late decelerations with prolonged decelerations and reduced variability showed moderately increased odds of NICU admission (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e; \u003cb\u003eFigure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAdditionally, the decision to delivery interval\u0026thinsp;\u0026gt;\u0026thinsp;30 minutes was also associated with non-signifcantly higher odds of NICU admission. The presence of loop of cord around the neck, meconium-stained liquor, scar dehiscence, fetal growth restriction, and cephalopelvic disproportion did not appear to be a significant predictor NICU admission (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariable regression analysis for prediction of NICU admission (n\u0026thinsp;=\u0026thinsp;271)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNICU admission present\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNICU admission absent\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdjusted Odds Ratio (aOR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI of aOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003ePathological CTG pattern (N)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced variability (34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (64.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.77-9.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepetitive late decelerations (67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (68.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.83\u0026ndash;8.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProlonged deceleration (31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (83.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.74\u0026ndash;8.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.312\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTachycardia with late deceleration (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.30-24.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.368\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTachycardia with reduced variability (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.32\u0026ndash;19.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced variability with repetitive variable decelerations (66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (24.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (75.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.66\u0026ndash;7.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced variability with repetitive late decelerations (26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (80.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.44\u0026ndash;6.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.462\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced variability with prolonged decelerations (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (70.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.38\u0026ndash;8.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.469\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepetitive late decelerations with prolonged decelerations and reduced variability (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.77\u0026ndash;17.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.103\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepetitive late decelerations with prolonged deceleration (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (81.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.24\u0026ndash;7.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.757\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean Age in Years (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.7 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.1 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.94\u0026ndash;1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.833\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaternal Risk factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (28.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e187 (71.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.35\u0026ndash;1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.609\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOnset of labor\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpontaneous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85 (68.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInduced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (20.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106 (79.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.45\u0026ndash;1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDecision to delivery interval\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;15 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (76.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;30 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.56\u0026ndash;1.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.909\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;60 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (33.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (66.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.66\u0026ndash;1.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.688\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLoop of cord around neck\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (76.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.54\u0026ndash;2.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.675\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMeconium-stained liquor\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (29.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73 (70.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.76\u0026ndash;1.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.504\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eScar dehiscence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.09\u0026ndash;1.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.275\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFetal growth restriction\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (67.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.58\u0026ndash;1.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.684\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCephalopelvic disproportion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (90.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.06\u0026ndash;2.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.333\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaturity at birth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreterm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (78.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.73\u0026ndash;4.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-term\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.44\u0026ndash;7.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.405\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eContribution to Authorship\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eTS: Helped in literature search, extraction of data and preparation of final draft of manuscript\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNJ: Helped in data extraction, statistical analysis, interpretation of result and preparation of final draft of manuscript\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eRR: Helped in data extraction, statistical analysis, interpretation of result and preparation of final draft of manuscript\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur centre mostly admits high-risk pregnancies, and in the study period, a pathological FHR pattern was observed in 271 women out of 3002 deliveries. In this study, we observed comparable neonatal APGAR scores in all clinical phenotypes of pathological FHR tracings. Furthermore, we did not observe a significant association between pathological FHR patterns and other neonatal outcomes, namely requirement for newborn resuscitation, duration of NICU stay, RDS, HIE and neonatal sepsis. However, the odds of NICU admission were significantly higher in those who were delivered from mothers having tachycardia with reduced variability.\u003c/p\u003e \u003cp\u003eThe types and frequencies of pathological FHR patterns observed in this study are consistent with a previously published report [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, we observed fewer incidences of fetal tachycardia compared to an earlier study (4% vs 15%). The most common pathological CTG pattern was repetitive late decelerations (24.7%) followed by reduced variability and repetitive variable decelerations (24.4%). Severe variable or late deceleration with tachycardia was associated with a higher lactate concentration 1.6 mmol/l vs 0.9 mmol/l) than the reference group, suggesting a higher frequency of fetal hypoxia/acidosis in this particular pattern of pathological FHR [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Additionally, median lactate doubled in fetus with tachycardia and reduced variability. Though, the neonatal outcomes were comparable in our study, we observed a higher incidence of NICU admission in women with tachycardia and reduced variability. In earlier reports, severe variable and late decelerations were associated with poor neonatal outcomes [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, in a large cohort of high-risk pregnancies, 60% of the foetuses showing pathological features such as bradycardia and decelerations did not have acidemia and fetal PH\u0026thinsp;\u0026lt;\u0026thinsp;7.25 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Recent studies suggested that 95% of the pathological FHR patterns were not associated with cerebral palsy [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our institution, the average caesarean section rate is 35%. Nearly 20% of emergency caesarean delivery was performed due to pathological FHR tracing. Continuous CTG monitoring was reported to increase the risk of caesarean and instrumental deliveries by 15% and 63%, respectively [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Kale et al reported a much lower incidence (11%) of cesarean delivery due to pathological FHR tracing. Nonetheless, the incidence of good APGAR scores (1-minute and 5-minute APGAR scores\u0026thinsp;\u0026gt;\u0026thinsp;7, 85% and 97%, respectively) was similar to those reported by Kale et al. It seems that cesarean section decision-making based on fetal scalp blood sampling could have resulted in fewer cesarean delivery [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Non-reassuring fetal heart detected by cardiotocography did not correlate well with the adverse neonatal outcomes and resulted in a high incidence of unnecessary caesarean delivery rate at \u0026ge;\u0026thinsp;36 weeks during labour [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe spinal and general anaesthesia resulted in comparable perinatal outcomes, and our findings are consistent with previous published report. Regional anaesthesia may be preferred for obvious maternal benefit and general anaesthesia may be utilized for prolonged bradycardia, abruptio placenta, uterine rupture, and cord-related complications. The incidence of post-partum hemorrhage, fever, blood transfusion and wound infection were comparable across all pathological FHR patterns.\u003c/p\u003e \u003cp\u003e95% of women with pathological FHR had one or more risk factors, namely oligohydramnios, hypothyroidism, post-caesarean pregnancy, hypertensive disorder, diabetes in pregnancy, post-datism and premature rupture of membranes.\u003c/p\u003e \u003cp\u003eMeconium-stained liquor was present in 107 women (39.4%), of which 31 women (11.4%) had thick meconium-stained liquor. Augmentation of labour was performed in women with grade 1 and 2 meconium-stained liqour. Any deceleration in the presence of meconium was considered an indication of emergent delivery, as meconium itself may be a sign of fetal distress. However, we did not observe any significant association between meconium staining and adverse outcomes, as our labour room protocols and monitoring are stringent.\u003c/p\u003e \u003cp\u003eAll women with pathological FHR tracing received intrauterine resuscitation measures that included maternal positional change and intravenous fluid administration. Fifteen (5%) women received amnioinfusion for variable deceleration, and FHR tracing did not return to normal.\u003c/p\u003e \u003cp\u003eThe decision to delivery interval after pathological FHR diagnosis will likely to affect perinatal outcomes. In this study, the decision to delivery interval was \u0026lt;\u0026thinsp;15 minutes in 93 (34.4%) women, 15\u0026ndash;30 minutes in 60 women (22.5%) and 30\u0026ndash;60 minutes in 43.3% of women. Nevertheless, the NICU admission rate was comparable across all decision to delivery interval. These findings were consistent with those of a previous report. Intentional shortening of decision to delivery interval\u0026thinsp;\u0026le;\u0026thinsp;30 minutes may not improve neonatal outcome [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePathological FHR represents the variable extent of fetal acidemia/hypoxia. In the absence of coexisting maternal or fetal complications, the fetus tolerates hypoxia by mounting an effective compensatory response. Therefore, neonatal outcomes may be affected due to concomitant uteroplacental insufficiency, meconium-stained liquor, chorioamnionitis, sepsis, and intrapartum placenta-related accident [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eClinical Implications\u003c/h3\u003e\n\u003cp\u003eCategorization of FHR is introduced in clinical practice without robust evidence. The guidelines (FIGO, ACOG and NICE) have done arbitrary grouping without adequate data related to the pathophysiology and outcomes of different categories. The available evidence from trials does not support the role of CTG in improving perinatal outcomes [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Nevertheless, the evolution, duration and characterization of FHR patterns have been advocated for routine use in clinical practice [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Therefore, we assessed perinatal outcomes according to FHR characteristics, and noted that all FHR patterns affect neonatal outcomes similarly. This study would provide further evidence base for categorising FHR patterns based on neonatal outcomes. Nevertheless, both FIGO and ACOG say that the probability of hypoxia/acidemia increases in pathological or Catergory III fetal heart rate tracings. All patterns of pathological FHR could be associated with hypoxia/acidosis. All patterns of pathological FHR should be considered equal, and their pathophysiological basis could be similar with minor differences. We need consensus worldwide to have a common classification of fetal heart rate tracings.\u003c/p\u003e\n\u003ch3\u003eStrengths and Limitation of the Study\u003c/h3\u003e\n\u003cp\u003eDue to our prospective study design, we were able to evaluate and analyze all the predefined outcome measures to build a robust dataset. We believe this is the largest study aimed at stratifying perinatal outcomes based on types of FHR tracings within pathological FHR patterns. Mothers and neonates were followed till discharge. Moreover, we analyzed several other obstetric and anesthetic variables in addition to pathological FHR patterns as predictors of perinatal outcomes in a large cohort of women. Obstetric care providers and the treating team were homogenous in experience and skills. This may have reduced bias due to the interpretation of FHR tracings in obstetric decision-making. According to the standard protocol in our institute, all FHR traces are analyzed by a team of senior residents. Disagreement in FHR tracing decision-making was resolved by treating consultants. Intrauterine resuscitation measures such as stoppage of oxytocin, oxygenation, maternal positional change and intravenous fluid administration were uniform and were continued till delivery.\u003c/p\u003e \u003cp\u003eSingle-center study is the most obvious limitation. We did not categorize FHR tracing based on ACOG guideline. The pathological tracings that could have occurred in the early phases of labour and were resolved with intrauterine resuscitation were not studied. We did not study the duration of pathological FHR and, therefore, did not study the impact of duration of pathological FHR on neonatal outcomes. Moreover, a decision based on fetal scalp sampling could have reduced cesarean delivery further.\u003c/p\u003e"},{"header":"Conclusion","content":" \u003cp\u003eThe 5-minute APGAR score remained comparable in all clinical phenotypes of pathological fetal heart rate tracing. Nonetheless, the odds of NICU admission were significantly higher in women with tachycardia and reduced variability.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eStatement and Declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest -\u003c/strong\u003eNil\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding-\u0026nbsp;\u003c/strong\u003eGJ Strauss Short Term Studentship Awards and Funds, JIPMER\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUGRMC Reg No. JIP/UGRMC/GJSTRAUS/2023/13and Institute Ethics Committee (JIPMER, Puducherry, India) approval (Project No. \u003cstrong\u003eJIP/IEC-OS/O66/2023).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u003c/strong\u003e None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e: Patients provided consent for participation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e: Patients provided consent for publication\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e:\u0026nbsp;The data underlying this article will be shared on reasonable request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContribution to Authorship\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eName: Theresa Soni\u003c/strong\u003e, MBBS\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContribution:\u0026nbsp;\u003c/strong\u003eThis author helped with intellectual content, study design, data collection, writing and editing all sections of manuscript, and approving manuscript for publication\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eName\u003c/strong\u003e: Nivedita Jha, MBBS, MS\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContribution:\u0026nbsp;\u003c/strong\u003eThis author helped with intellectual content, study design, writing and editing all sections of manuscript, and approving manuscript for publication\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eName:\u003c/strong\u003e Ruben Raj, MBBS, MD,\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContribution:\u0026nbsp;\u003c/strong\u003eThis author helped with intellectual content, study design, writing and editing all sections of manuscript, and approving manuscript for publication\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAyres-de-Campos D, Spong CY, Chandraharan E (2015) FIGO Intrapartum Fetal Monitoring Expert Consensus Panel. FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography. Int J Gynaecol Obstet 131(1):13\u0026ndash;24\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican College of Obstetricians and Gynecologists (2010) Practice bulletin 116: Management of intrapartum fetal heart rate tracings. Obstet Gynecol 116(5):1232\u0026ndash;1240\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlfirevic Z, Devane D, Gyte GM, Cuthbert A (2017) Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev 2(2):CD006066\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDevane D, Lalor JG, Daly S, McGuire W, Cuthbert A, Smith V (2017) Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing. Cochrane Database Syst Rev 1(1):CD005122\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArnold JJ, Gawrys BL (2020) Intrapartum Fetal Monitoring. Am Fam Physician 102(3):158\u0026ndash;167\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl Wattar BH, Honess E, Bunnewell S et al (2021) Effectiveness of intrapartum fetal surveillance to improve maternal and neonatal outcomes: a systematic review and network meta-analysis. CMAJ 193(14):E468\u0026ndash;E477\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShrestha S, Shrestha I (2019) Admission Cardiotocography in Predicting Perinatal Outcome. Kathmandu Univ Med J 17(67):201\u0026ndash;205\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAziz K, Lee HC, Escobedo MB et al (2020) Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 142(16suppl2):S524\u0026ndash;S550\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolzmann M, Wretler S, Cnattingius S, Nordstr\u0026ouml;m L (2015) Cardiotocography patterns and risk of intrapartum fetal acidemia. J Perinat Med 43(4):473\u0026ndash;479\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlthaus JE, Petersen SM, Fox HE, Holcroft CJ, Graham EM (2005) Can electronic fetal monitoring identify preterm neonates with cer- ebral white matter injury? Obstet Gynecol 105:458\u0026ndash;465\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNelson KB, Dambrosia JM, Ting TY, Grether JK (1996) Uncertain value of electronic fetal monitoring in predicting cerebral palsy. N Engl J Med 334:613\u0026ndash;618\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParer JT, Krueger TR, Harris JL (1980) Fetal oxygen consumption and mechanisms of heart rate response during artificially produced late decelerations of fetal heart rate in sheep. Am J Obstet Gynecol 136:478\u0026ndash;482\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeard RW, Filshie GM, Knight CA, Roberts GM (1971) The significance of the changes in the continuous fetal heart rate in the first stage of labour. J Obstet Gynaecol Br Commonw 78:865\u0026ndash;881\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePinas A, Chandraharan E (2016) Continuous cardiotocography during labour: analysis, classification and management. Best Pract Res Clin Obstet Gynaecol 30:33\u0026ndash;47\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNelson KB, Dambrosia JM, Ting TY, Grether JK (1996) Uncertain value of electronic fetal monitoring in predicting cerebral palsy. N Engl J Med 334:613\u0026ndash;618\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlfirevic Z, Devane D, Gyte GM, Cuthbert A (2017) Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev 2:CD006066\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKale I (2022) Does continuous cardiotocography during labor cause excessive fetal distress diagnosis and unnecessary cesarean sections? J Matern Fetal Neonatal Med 35(6):1017\u0026ndash;1022\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoy KK, Baruah J, Kumar S, Deorari AK, Sharma JB, Karmakar D (2008) Cesarean section for suspected fetal distress, continuous fetal heart monitoring and decision to delivery time. Indian J Pediatr 75(12):1249\u0026ndash;1252\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJia YJ, Ghi T, Pereira S, Gracia Perez-Bonfils A, Chandraharan E (2023) Pathophysiological interpretation of fetal heart rate tracings in clinical practice. Am J Obstet Gynecol Jun 228(6):622\u0026ndash;644\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVintzileos AM (2009) Evidence-based compared with reality-based medicine in obstetrics. Obstet Gynecol 114:930\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVintzileos AM, Smulian JC (2021) Timing intrapartum management based on the evolution and duration of fetal heart rate patterns. J Matern Fetal Neonatal Med 1\u0026ndash;6\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Pathological fetal heart rate tracing, Neonatal Outcome, Neonatal Intensive Care Unit, Anesthesia, Cesarean","lastPublishedDoi":"10.21203/rs.3.rs-4010685/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4010685/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eDistinct clinical phenotypes of pathological fetal heart rate (FHR) tracings may affect neonatal outcomes differently. This study aimed to determine and differentiate neonatal outcomes amongst the clinical phenotypes of pathological FHR tracing.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis prospective observational study included women in labour with pathological fetal heart rate tracing during delivery. Pathological fetal heart rate tracings were characterized into 11 clinical phenotypes and corresponding neonatal and maternal outcomes were recorded. Neonates and mothers were followed till discharge from the hospital. The primary outcome was a 5-minute APGAR score. The secondary outcomes were NICU admission, mode of delivery, mode of anesthesia, neonatal morbidity and mortality.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003e271 women with pathological fetal heart rate tracing at the time of delivery were included in the study. Most of the women (64%) underwent cesarean delivery. The most common pathological fetal heart rate tracing was repetitive late decelerations (24.7%), followed by reduced variability with repetitive variable decelerations (24.4%). The 5-minute APGAR score was comparable across all clinical phenotypes of pathological fetal heart rate tracing. Tachycardia with reduced variability was associated with a significantly higher likelihood of NICU admission (aOR\u0026thinsp;=\u0026thinsp;5.03, 95% CI: 1.32\u0026ndash;19.27, p\u0026thinsp;=\u0026thinsp;0.018). Reduced variability, repetitive late decelerations and the combination of repetitive late decelerations with prolonged decelerations and reduced variability showed moderately increased odds of NICU admission.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe 5-minute APGAR score remained comparable in all clinical phenotypes of pathological fetal heart rate tracing. Nonetheless, the odds of NICU admission were significantly higher in women with tachycardia and reduced variability.\u003c/p\u003e","manuscriptTitle":"Pathological fetal heart rate tracing patterns and neonatal outcomes among parturients beyond 32 weeks of gestation: A prospective observational study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-07 12:06:33","doi":"10.21203/rs.3.rs-4010685/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2024-03-14T10:30:19+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-03-05T16:35:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"Archives of Gynecology and Obstetrics","date":"2024-03-04T15:38:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-04T15:16:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Gynecology and Obstetrics","date":"2024-03-03T23:58:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"da862795-7a21-40ef-a089-b941ed2fc490","owner":[],"postedDate":"March 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-28T16:13:03+00:00","versionOfRecord":{"articleIdentity":"rs-4010685","link":"https://doi.org/10.1007/s00404-024-07791-w","journal":{"identity":"archives-of-gynecology-and-obstetrics","isVorOnly":false,"title":"Archives of Gynecology and Obstetrics"},"publishedOn":"2024-10-23 15:58:22","publishedOnDateReadable":"October 23rd, 2024"},"versionCreatedAt":"2024-03-07 12:06:33","video":"","vorDoi":"10.1007/s00404-024-07791-w","vorDoiUrl":"https://doi.org/10.1007/s00404-024-07791-w","workflowStages":[]},"version":"v1","identity":"rs-4010685","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4010685","identity":"rs-4010685","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}