Open AccessIdentification of cases with adverse neonatal outcome monitored by cardiotocography versus ST analysis: secondary analysis of a randomized trial
Author(s) -
WESTERHUIS MICHELLE E.M.H.,
PORATH MARTINA M.,
BECKER JEROEN H.,
VAN DEN AKKER ELINE S.A.,
VAN BEEK ERIK,
VAN DESSEL HENDRIKUS J.H.M.,
DROGTROP ADDY P.,
VAN GEIJN HERMAN P.,
GRAZIOSI GIUSEPPI C.M.,
GROENENDAAL FLORIS,
VAN LITH JAN M.M.,
MOL BEN WILLEM J.,
MOONS KAREL G.M.,
NIJHUIS JAN G.,
OEI SWAN G.,
OOSTERBAAN HERMAN P.,
RIJNDERS ROBBERT J.P.,
SCHUITEMAKER NICO W.E.,
WIJNBERGER LIA D.E.,
WILLEKES CHRISTINE,
WOUTERS MAURICE G.A.J.,
VISSER GERARD H.A.,
KWEE ANNEKE
Publication year - 2012
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/j.1600-0412.2012.01431.x
Subject(s) - medicine , cardiotocography , fetal distress , randomized controlled trial , umbilical artery , adverse effect , obstetrics , umbilical cord , neonatal encephalopathy , apgar score , pregnancy , pediatrics , fetus , encephalopathy , surgery , genetics , anatomy , biology
Objective. To evaluate whether correct adherence to clinical guidelines might have led to prevention of cases with adverse neonatal outcome. Design. Secondary analysis of cases with adverse outcome in a multicenter randomized clinical trial. Setting. Nine Dutch hospitals. Population. Pregnant women with a term singleton fetus in cephalic position. Methods. Data were obtained from a randomized trial that compared monitoring by STAN® (index group) with cardiotocography (control group). In both trial arms, three observers independently assessed the fetal surveillance results in all cases with adverse neonatal outcome, to determine whether an indication for intervention was present, based on current clinical guidelines. Main outcome measures. Adverse neonatal outcome cases fulfilled one or more of the following criteria: (i) metabolic acidosis in umbilical cord artery (pH < 7.05 and base deficit in extracellular fluid >12 mmol/L); (ii) umbilical cord artery pH < 7.00; (iii) perinatal death; and/or (iv) signs of moderate or severe hypoxic ischemic encephalopathy. Results. We studied 5681 women, of whom 61 (1.1%) had an adverse outcome (26 index; 35 control). In these women, the number of performed operative deliveries for fetal distress was 18 (69.2%) and 16 (45.7%), respectively. Reassessment of all 61 cases showed that there was a fetal indication to intervene in 23 (88.5%) and 19 (57.6%) cases, respectively. In 13 (50.0%) vs. 11 (33.3%) cases, respectively, this indication occurred more than 20 min before the time of delivery, meaning that these adverse outcomes could possibly have been prevented. Conclusions. In our trial, more strict adherence to clinical guidelines could have led to additional identification and prevention of adverse outcome.