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Implications of prolonged fetal heart rate deceleration during the second stage of labor.

In order to evaluate the neonatal outcomes of infants who had prolonged fetal heart rate (FHR) deceleration during the second stage of labor, the neonatal outcomes of 24 infants born after vaginal delivery at 37 to 42 weeks of gestation with prolonged FHR deceleration during the second stage of labor were compared with the outcomes of 28 infants of a similar gestational age who had normal FHR patterns. No differences in the Apgar scores, mean umbilical PaCO2, PaO2, HCO3- or base deficit values were observed between the two groups, but the mean pH values differed significantly. The occurrences of a 1-minute Apgar score < 7, umbilical arterial pH < 7.20, presence of meconium and admission to the neonatal intensive care unit were higher in the study group, but were not significantly different. None of the 24 infants with prolonged FHR deceleration experienced birth trauma, meconium aspiration, neonatal seizure or neonatal death, but three were found to have congenital heart disease. We conclude that prolonged FHR deceleration during the second stage of labor without FHR abnormalities during the first stage of labor is not always associated with an adverse neonatal outcome and does not mandate the need for surgical or immediate vaginal delivery. Their appearance on FHR tracings requires the implementation of additional methods to assess fetal well-being and also to diagnose fetal distress.