Managing nonreassuring fetal heart rate patterns before cesarean delivery: Compliance with ACOG recommendations

N. W. Hendrix, S. P. Chauhan, J. A. Scardo, J. M. Ellings, Lawrence D Devoe

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

OBJECTIVE: To determine the rate of compliance with current American College of Obstetricians and Gynecologists (ACOG) recommendations for management of parturients undergoing cesarean delivery for persistent nonreassuring fetal heart rate (FHR) tracings. STUDY DESIGN: We performed a retrospective chart review (July 1995-June 1998) of all parturients who underwent cesarean delivery for nonreassuring FHR tracings. Outcome measures included maneuvers for fetal assessment (scalp stimulation or scalp blood pH) and therapeutic interventions (tocolytic agents for reducing uterine activity or amnioinfusion). Patients with multiple gestations and cesarean delivery for other indications were excluded. Student's t test, χ 2 and Fisher's exact tests were used; odds ratio and 95% confidence interval were calculated. P < .05 was considered significant. RESULTS: Cesarean delivery for persistent nonreassuring FHR patterns included 134 (3.6%) of the 3,671 deliveries during three years. Thirty patients produced intrapartum FHR tracings containing persistent variable decelerations; 12 (40%) of these patients received amnioinfusion. In only 37% (50/134) of cases was there a documented attempt at scalp or acoustic stimulation prior to delivery. Scalp pH was obatained in 15% (15/98) of patients whose cervix was at least 3 cm dilated. Tocolytic agents were used for intrauterine resuscitation in 25% (34/134) of cases; their use varied significantly (P = .006) with the type of FHR abnormality. CONCLUSION: At our tertiary center, ACOG recommendations for management of nonreassuring intrapartum FHR tracings were used in a limited number of cases.

Original languageEnglish (US)
Pages (from-to)995-999
Number of pages5
JournalJournal of Reproductive Medicine for the Obstetrician and Gynecologist
Volume45
Issue number12
StatePublished - Dec 1 2000

Fingerprint

Fetal Heart Rate
Scalp
Tocolytic Agents
Parturition
Acoustic Stimulation
Deceleration
Congenital Heart Defects
Resuscitation
Cervix Uteri
Odds Ratio
Outcome Assessment (Health Care)
Confidence Intervals
Students
Pregnancy

Keywords

  • Cesarean section
  • Fetal heart rate
  • Nonreassuring fetal heart rate patterns

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

Cite this

Managing nonreassuring fetal heart rate patterns before cesarean delivery : Compliance with ACOG recommendations. / Hendrix, N. W.; Chauhan, S. P.; Scardo, J. A.; Ellings, J. M.; Devoe, Lawrence D.

In: Journal of Reproductive Medicine for the Obstetrician and Gynecologist, Vol. 45, No. 12, 01.12.2000, p. 995-999.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE: To determine the rate of compliance with current American College of Obstetricians and Gynecologists (ACOG) recommendations for management of parturients undergoing cesarean delivery for persistent nonreassuring fetal heart rate (FHR) tracings. STUDY DESIGN: We performed a retrospective chart review (July 1995-June 1998) of all parturients who underwent cesarean delivery for nonreassuring FHR tracings. Outcome measures included maneuvers for fetal assessment (scalp stimulation or scalp blood pH) and therapeutic interventions (tocolytic agents for reducing uterine activity or amnioinfusion). Patients with multiple gestations and cesarean delivery for other indications were excluded. Student's t test, χ 2 and Fisher's exact tests were used; odds ratio and 95{\%} confidence interval were calculated. P < .05 was considered significant. RESULTS: Cesarean delivery for persistent nonreassuring FHR patterns included 134 (3.6{\%}) of the 3,671 deliveries during three years. Thirty patients produced intrapartum FHR tracings containing persistent variable decelerations; 12 (40{\%}) of these patients received amnioinfusion. In only 37{\%} (50/134) of cases was there a documented attempt at scalp or acoustic stimulation prior to delivery. Scalp pH was obatained in 15{\%} (15/98) of patients whose cervix was at least 3 cm dilated. Tocolytic agents were used for intrauterine resuscitation in 25{\%} (34/134) of cases; their use varied significantly (P = .006) with the type of FHR abnormality. CONCLUSION: At our tertiary center, ACOG recommendations for management of nonreassuring intrapartum FHR tracings were used in a limited number of cases.",
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