Key result
Standardized algorithms for variant fetal heart rates fail to improve Apgar scores or operative deliveries.
Why the study?
Do notification guidelines and a management algorithm for variant intrapartum fetal heart rate tracings improve fetal outcome and operative delivery rates in deliveries?
Cohort (n=3,428)
No
Do notification guidelines and a management algorithm for variant intrapartum fetal heart rate tracings improve fetal outcome and operative delivery rates in deliveries?
Implementation of standardized notification guidelines and a management algorithm for fetal heart rate monitoring did not improve fetal outcomes or change operative delivery rates compared to historical controls.
Standardized algorithms for variant fetal heart rate tracings may reduce decision variability; leaves open whether they improve fetal outcomes.
CONTEXT: Numerous randomized controlled trials have demonstrated limited efficacy of intrapartum fetal heart rate monitoring in improving fetal outcome. A potential reason is the wide variability in clinical decision making seen with its use. Standardizing management of variant intrapartum fetal heart rate tracings may reduce this variability and lead to improvement in fetal outcome. OBJECTIVE: We sought to develop notification guidelines and a management algorithm for variant intrapartum fetal heart rate tracings that improve fetal outcome and do not increase the operative delivery rate. DESIGN: Outcomes for cases involving the use of our notification guidelines and management algorithm over six months (1181 deliveries) were compared with outcomes for historical control subjects (2247 deliveries). MAIN OUTCOME MEASURES: The main outcome measures were Apgar scores <7 and the operative delivery rate. RESULTS: We found no change in fetal outcome or operative delivery rate. CONCLUSION: Our notification guidelines and management algorithm are safe and do not increase the operative delivery rate. A large multicenter trial is needed to demonstrate improvement in fetal outcome.
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Downs et al. (2007) conducted a cohort in Intrapartum fetal heart rate monitoring (n=3,428). Fetal Heart Rate Tracing Notification Guidelines and Management Algorithm vs. Historical control (standard care) was evaluated on 5-minute Apgar scores <7 and operative delivery rate. Implementation of standardized notification guidelines and a management algorithm for variant intrapartum fetal heart rate tracings resulted in no change in the rate of 5-minute Apgar scores <7 or operative delivery rates compared to historical controls.
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