Objective To assess whether intrapartum acidosis affects specific components of fetal heart rate variability.Design Prospective clinical study.Setting Twelve Nordic delivery units.Subjects Fetal heart rate variability was studied in 334 fetuses divided into two groups according to cord pH value: the acidotic group (cord arterial pH <7.05 at birth, n ¼ 15) and the control group (cord arterial pH !7.05 at birth, n ¼ 319). Methods In spectral analysis of fetal heart rate variability, frequencies were integrated over the total frequency band (0.04 -1.0 Hz), low-frequency band (0.04 -0.15 Hz) and high-frequency band (0.15 -1.0 Hz). We also calculated the low-to-high frequency ratio. Main outcome measures The spectral bands of fetal heart rate variability were compared between the acidotic and control fetuses. Results We found that during the last hour of monitoring, baseline fetal heart rate gradually decreased, whereas total, low-frequency and high-frequency fetal heart rate variability initially increased but then, near the delivery, decreased in the acidotic fetuses when compared with the controls. Low-to-high frequency ratio was greater in the acidotic group during the whole study period (P ¼ 0.002). Cord artery pH was inversely associated with total fetal heart rate variability (P < 0.001), low-frequency fetal heart rate variability (P < 0.001) and low-to-high frequency ratio (P ¼ 0.004). Conclusions Marked fetal acidosis was associated with frequency-specific changes in fetal heart rate variability as reflecting the compensation ability of autonomic nervous activation during the last hour of labour.

Re-analysis of data according to the ITT principle showed that regardless of the method of analysis, the Swedish randomized controlled trial maintained its ability to demonstrate a significant reduction in metabolic acidosis rate when using CTG+ST analysis for fetal surveillance in labor.

Background Colic causes crying in 10–30% of infants and is one of the primary reasons parents seek health care. Treatments are generally not totally effective and some cause side effects. In this study we aimed to test the effect of light needling (minimal acupuncture) on crying. Methods Forty children (median six weeks of age) with excessive crying unresponsive to conventional therapies, were recruited from 21 Child Welfare Clinics within an area of western Sweden, and quasi-randomised to control or light needling treatment. Parents were unaware of which group their child was assigned to. Children were given light needling acupuncture on one point (LI4) on both hands for approximately 20 seconds on four occasions, or received the same care except needling. Parental assessment questionnaires were used pre- and post-treatment to assess crying intensity, frequency, duration of crying and pain related behaviour throughout the day in six hour periods. Results Light needling resulted in a significant reduction in the rated crying intensity (assessed by a numeric rating scale, 0 to 10). For example, during the morning time period 0600–1200 hours, the median (range) rated crying intensity changed from 6 (1 to 9) pre-treatment to 2 (0 to 5) post-treatment (P=0.002), in the light needling group. The corresponding ratings for the children in the control group was 6 (0 to 10) and 5 (0 to 10) respectively. The difference between the groups was significant (P=0.016). There were also significant differences between the groups for the afternoon (1200–1800 hours), and evening (1800–midnight) time periods. Pain related behaviour like facial expression, was also significantly less pronounced in the light needling group as compared to the control group post-treatment, (P=0.027). The parents rated the light needling as more effective in improving symptoms than the control group (P<0.001). Conclusion Four treatments with light needling on one point in the hand may alleviate crying and pain related behaviour without any noted side effects.

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