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Cardiotocography
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=== Zigzag pattern of fetal heart rate === A Zigzag pattern of fetal heart rate (FHR) is defined as FHR baseline amplitude changes of more than 25 beats per minute (bpm) with a minimum duration of 2 minutes and maximum of 30 minutes.<ref name=zigzag/> However, according to another study, even a >1 min duration of the zigzag pattern is associated with an increased risk of adverse neonatal outcomes.<ref name=saltatory>{{Cite journal|last1=Gracia-Perez-Bonfils|first1=Anna|last2=Cuadras|first2=Daniel|last3=Whelehan|first3=Virginia|last4=Archer|first4=Abigail|last5=Del RΓo|first5=Maria|last6=Chandraharan|first6=Edwin|date=March 2019|title=Saltatory pattern vs Zigzag pattern on the CTG, and perinatal outcomes|journal=[[European Journal of Obstetrics & Gynecology and Reproductive Biology]]|volume=234|pages=e55|doi=10.1016/j.ejogrb.2018.08.276|s2cid=86491442 |issn=0301-2115}}</ref> Despite the similarities in the shape of the FHR patterns, the zigzag pattern is distinguished from the saltatory pattern by its duration. According to the [[International Federation of Gynaecology and Obstetrics]] (FIGO), a saltatory pattern is defined as FHR baseline amplitude changes of more than 25{{nbsp}}bpm with durations of >30 minutes.<ref name=FIGOconsensus/> In a recently published large obstetric cohort study of the zigzag pattern in almost 5,000 term deliveries in [[Helsinki University Central Hospital]], Tarvonen et al. (2020)<ref name=zigzag/> reported: "ZigZag pattern and late decelerations of FHR were associated with cord blood acidemia, low [[Apgar score]]s, need for intubation and resuscitation, NICU admission and neonatal hypoglycemia during the first 24 hours after birth." Furthermore, the "ZigZag pattern precedes late decelerations, and the fact that normal FHR pattern precedes the ZigZag pattern in the majority of the cases suggests that the ZigZag pattern is an early sign of fetal hypoxia, which emphasizes its clinical importance."<ref name=zigzag/> Furthermore, in the recent study of 5150 deliveries, the hypoxia-related ZigZag pattern was associated with cord blood acidemia, low 5-min Apgar scores at birth, and need for neonatal resuscitation after birth, indicating increased occurrence of fetal hypoxia in GDM pregnancies.<ref>{{Cite journal|last1=Tarvonen|first1=Mikko|last2=Hovi|first2=Petteri|last3=Sainio|first3=Susanna|last4=Vuorela|first4=Piia|last5=Andersson|first5=Sture|last6=Teramo|first6=Kari|date=2021-06-21|title=Intrapartal cardiotocographic patterns and hypoxia-related perinatal outcomes in pregnancies complicated by gestational diabetes mellitus|journal=Acta Diabetologica|volume=58 |issue=11 |pages=1563β1573 |language=en|pmid=34151398 |doi=10.1007/s00592-021-01756-0| pmc=8505288 |issn=1432-5233|doi-access=free}}</ref>
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