• Theodore Mark Hale, Manonmani Arul, Arul Veerappan, Jimmy Nguyen, Zoila Velastegui, Rebecca Shiffman, Benamanahalli Rajegowda, Daniel Skupski, and Ray Mercado.
• Department of Obstetrics and Gynecology, Lincoln Medical and Mental Health Center, New York City Hospital and Health Corporation, 224 East 149th Street, Bronx, NY 10451, USA. Theodore.hale@nychhc.org
• J Perinat Med. 2011 Jan 1; 39 (1): 47-50.

ObjectiveTo evaluate whether National Institute of Child Health and Human Health and Development (NICHD) fetal heart rate categories were predictive of neonatal survival in periviable pregnancies.MethodsWe reviewed the charts of 57 infants delivered at 23 and 24 weeks' gestation. Fetal heart rate tracings were evaluated following the NICHD 2008 criteria, using the acceleration height of 10 bpm and duration of 10 s. Multiple logistic regression analyses were performed using survival, fetal morbidities, and cord pH <7.1 as dependent variables. Independent variables included fetal heart rate category, mode of delivery, resuscitation, and histological chorioamnionitis. Outcomes of infants delivered at 23 and 24 weeks were also compared.ResultsIn 23-week pregnancies, fetal heart rate category 2 was associated with improved short-term survival compared to category 3 (OR 1.3, 95% CI 0.11-15.7). Cesarean delivery and histological chorioamnionitis were not predictive of survival [(OR 0.5, 95% CI 0.04-7.1, and OR 0.4, 95% CI 0.02-6.85), respectively]. Long-term survival for infants born at 23 and 24 weeks was 8% and 56%, respectively.ConclusionsThe NICHD fetal heart rate category during labor may be associated with survival for infants born at 23 and 24 weeks of gestation. Cesarean delivery was not associated with improved survival.

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