Abstract
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
-
There is a potential to further standardize management of Category II fetal heart
rate tracings.
-
In our practice, 25% of cesareans performed for fetal distress were consistent with
the algorithm.
-
A subset of patients (45%) with cesarean for fetal distress may have been able to
labor longer.
Keywords
nonreassuring fetal heart rate tracing - Category II fetal heart rate tracing - cesarean
delivery - intrapartum fetal heart rate - acidosis - fetal distress
