The value of daily fetal heart rate home monitoring in addition to serial ultrasound examinations in pregnancies complicated by fetal gastroschisis

Objectives: To audit the practice of daily fetal heart rate home monitoring (FHM) in pregnancies complicated by fetal gastroschisis (GS).

Methods: Prenatal records and pregnancy outcome were reviewed of all cases with fetal GS between 1999 and 2010, managed with a consistent protocol, which included weekly fetal cardiotocography and ultrasound examinations after 30 weeks, and option of daily FHM. Data were collected including gestational age (GA) at FHM and the presence of fetal heart rate anomaly. Follow-up included fetal growth, amniotic fluid volume, gastrointestinal appearance and cardiotocography findings.

Results: One hundred five cases of GS were identified. Stillbirth rate was 1.9% (2/105). FHM was performed in 97/105 (92.4%) cases. Abnormal FHM was recorded in 24 cases. Fetuses with abnormal versus normal FHM were more likely to have C-section for fetal heart rate anomaly (50% vs 24%, p=0.025) at an earlier gestational age (34.9 ± 1.7 vs 35.8 ± 1.4 weeks, p=0.016). There was no difference in Apgar score or umbilical artery pH at birth.

Conclusion: Fetal heart rate abnormalities are frequent in fetuses with GS. FHM appears useful in detecting fetal distress necessitating expedited delivery. However, the impact of a daily FHM policy on neonatal outcome should be evaluated in a randomized study.