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Application of a Proposed Algorithm to Cesarean Deliveries for Nonreassuring Fetal Heart Rate Tracing
| Content Provider | Scilit |
|---|---|
| Author | Berger, Dana Senderoff Crosland, Adam Newman, Rachel Bosse, Bradley Makhoul, Joshua Chan, Kenneth Seet, Emily L. |
| Copyright Year | 2021 |
| Description | Objectives The aim of the study is to evaluate how current management of Category II fetal heart rate tracings compares with that suggested by a published algorithm and whether these differences lead to disparate neonatal outcomes. Study Design This is a retrospective observational study from the resident service at an academic-community tertiary care center from 2013 to 2018. We reviewed archived fetal heart rate tracings from patients with cesarean delivery performed for nonreassuring fetal heart rate tracing and interpreted tracings against the algorithm. We assigned tracings to one of three categories: Group A—consistent; Group B—inconsistent too early (algorithm permits the patient to labor longer); Group C—inconsistent too late (algorithm suggests performing the cesarean delivery sooner). Maternal demographics, features of labor, and neonatal outcomes were compared. Results Of the 110 cases, 27 (24.5%) had a cesarean delivery performed in group A, 49 (44.5%) in group B, and 34 (30.9%) in group C. Baseline characteristics were similar. Of the 49 in group B, 46 (93.9%) violated the algorithm at the same branchpoint. In group C, cesarean deliveries would have been performed on average 244 minutes earlier had the algorithm been used. Neonatal outcomes were not significantly different among the groups, including 5-minute Apgar <7, pH <7.1, and NICU admit. Conclusion Our retrospective application of the algorithm showed that 44.5% of patients who have cesarean delivery for nonreassuring fetal heart rate tracing may be able to labor longer and that violation at a common decision point on the algorithm (moderate variability or accelerations, but a lack of recurrent decelerations) is responsible for nearly all such cesarean deliveries. More studies are needed to evaluate if cesarean delivery rates for nonreassuring fetal heart rate tracing can be reduced without impacting neonatal outcomes using the algorithm. Key Points This project was presented as a poster at The Society for Maternal Fetal Medicine's $40^{th}$ Annual Pregnancy Meeting in Grapevine, Texas on February 3 to 8, 2020 (Abstract #1086). Received: 25 October 2020 Accepted: 06 October 2021 Publication Date: 28 November 2021 (online) © 2021. Thieme. All rights reserved. Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA |
| Related Links | http://www.thieme-connect.de/products/ejournals/pdf/10.1055/s-0041-1739412.pdf |
| Ending Page | 348 |
| Page Count | 7 |
| Starting Page | 342 |
| ISSN | 07351631 |
| e-ISSN | 10988785 |
| DOI | 10.1055/s-0041-1739412 |
| Journal | American Journal of Perinatology |
| Issue Number | 04 |
| Volume Number | 39 |
| Language | English |
| Publisher | Georg Thieme Verlag KG |
| Publisher Date | 2021-11-28 |
| Access Restriction | Open |
| Subject Keyword | Journal: American Journal of Perinatology Obstetrics and Gynecology Nonreassuring Fetal Heart Rate Tracing Category Ii Fetal Heart Rate Tracing Cesarean Delivery Intrapartum Fetal Heart Rate Fetal Distress |
| Content Type | Text |
| Resource Type | Article |
| Subject | Pediatrics, Perinatology and Child Health Obstetrics and Gynecology |
