Severe variable deceleration is associated with intestinal perforation in infants born at 22-27 weeks' gestation.

Objective: Intestinal perforation in extremely premature infants is an important cause of death. The aim of the study was to identify fetal heart rate patterns, which were associated with intestinal perforation.
Methods: A retrospective cohort study was performed in 92 women who delivered at 22-27 weeks' gestation at a tertiary center in Miyazaki. They delivered 74 singletons, 17 twins and one triplet. Intrapartum fetal heart rate monitoring charts of at least 2-h were examined. Intestinal perforation was diagnosed by the clinical manifestations and operative findings. Multiple logistic regression analysis was used to compare between intestinal perforation group and non-perforation group.
Results: Of the 111 neonates, 17 had intestinal perforation. Severe variable deceleration (p < 0.05), prematurity (p < 0.05), postnatal corticosteroid (p < 0.05), intraventricular hemorrhage of grade III or IV (p < 0.01) and poor survival (p < 0.05) were more frequent in infants with perforation than in the 94 without perforation. Multivariate analysis adjusted for the other risk factors revealed that only severe variable deceleration remained as a risk factor: (odds ratio 3.7; 95% CI 1.1-12.1; p = 0.03).
Conclusions: Intrapartum severe variable deceleration is associated with subsequent intestinal perforation in extremely premature infants, suggesting that preventing prolonged periods of these decelerations may prevent intestinal perforation.