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Poster Session 3

Category: Intrapartum Fetal Assessment

Poster Session 3

(958) Fetal deceleration features associated with acidemia: is it type, depth, frequency, or duration that matters?

Thursday, February 12, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

Shannon E. Beermann, MD

MFM Fellow
Washington University School of Medicine
St. Louis, Missouri, United States

Coauthor(s)

Candice L. Woolfolk, PhD, MPH

Assistant Professor
Washington University School of Medicine
Washington University School of Medicine, Missouri, United States
Antonina I. Frolova, MD, PhD (she/her/hers)

Assistant Professor of Ob&Gyn
Washington University School of Medicine
St. Louis, Missouri, United States
Jeannie C. Kelly, MD, MS (she/her/hers)

Associate Professor
Washington University School of Medicine
Washington University School of Medicine, Missouri, United States
GM

George A. A. Macones, MD, MS, MSCE

Chair & Professor, Department of Women’s Health
Department of Women’s Health, Dell Medical School at the University of Texas at Austin
Austin, Texas, United States
Alison G. G. Cahill, MD, MSCI

Assoc. Dean, Translational Research; Prof, Women’s Health; Dir, Health Transformation Research Inst.
Department of Women’s Health, Dell Medical School at the University of Texas at Austin
Department of Women’s Health, Dell Medical School at the University of Texas at Austin, Texas, United States
NR

Nandini Raghuraman, MD, MSCI

Associate Professor
Washington University School of Medicine
St. Louis, Missouri, United States

Objective:
Total deceleration area (TDA) quantifies the cumulative depth and duration of fetal decelerations over time and is associated with neonatal acidemia. We investigated which specific deceleration features are associated with acidemia among patients with high TDA.

Study Design:
This is a nested case-control in a cohort of singleton term pregnancies admitted for induction or spontaneous labor from 2010-2014 at a single center with universal cord gas collection. Fetal heart rate data from the last hour before delivery was extracted by research nurses blinded to outcomes. We included only those with high TDA (≥ 75^th percentile). Cases were patients with high TDA and acidemia (umbilical artery pH ≤ 7.10) and controls were patients with high TDA without acidemia. We compared deceleration features including type, depth, duration, and frequency between cases and controls using multivariable logistic regression.

Results:
Among 1,958 patients with high TDA in the hour before delivery, 88 (4.5%) had acidemia. Acidemia was significantly associated with a greater number of prolonged decelerations (aOR, 1.18; 95% CI, 1.04-1.33), with duration contributing more to risk than depth. Recurrent late decelerations were also associated with acidemia (aOR, 2.54; 95% CI, 1.18-5.28), though neither the depth nor duration of lates were significant. Patients with acidemia were less likely to have recurrent variables, though greater depth of variables was significantly associated with acidemia.

Conclusion:
Among patients with high TDA, specific decelerations characteristics rather than frequency alone, contribute to acidemia risk. Deceleration depth and duration contribute differently to the risk of acidemia based on the type of deceleration. These findings suggest that more granular, quantitative features of decelerations may improve identification of fetuses at risk.