Advances in Clinical and Experimental Medicine

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Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 9, September, p. 1193–1198

doi: 10.17219/acem/103843

Publication type: original article

Language: English

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Creative Commons BY-NC-ND 3.0 Open Access

Continuous electronic fetal heart monitoring versus intermittent auscultation during labor: Would the literature outcomes have the same results if they were interpreted following the NICHHD guidelines?

Mariarosaria Di Tommaso1,A,B,C,D,E,F, Serena Pinzauti1,C,D,E,F, Silvia Bandinelli1,B,C, Chiara Poli1,B,C, Antonio Ragusa2,E,F

1 Department of Health Sciences, University of Florence, Italy

2 San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy

Abstract

Background. All guidelines regarding electronic fetal heart monitoring (EFM) before 2008 were designed to avoid more hypoxia than acidosis. In addition, the results of the Cochrane meta-analysis of 2013 do not show a significant improvement in neonatal outcomes using EFM or intermittent auscultation (IA).
Objectives. We retrospectively evaluated the results on delivery outcomes arising from a comparison between EFM and IA during labor of 2 specific and high-quality trials. We hypothesized that revisiting the delivery outcomes through the adoption of the recent National Institute of Child Health and Human Development (NICHHD) guidelines, the reported delivery outcomes would be different.
Material and Methods. The study retrospectively evaluated the results on delivery outcomes arising from the comparison between EFM and IA during labor of the “Dublin trial” and “Vintzileos trial” published, respectively, in 1985 and 1993. A translational model was constructed to recalculate these results, applying a correction factor to estimate the number of pathological patterns using the NICHHD guidelines for EFM.
Results. After the reevaluation of the 2 trials using the proposed correction factor, the comparison of the recalculated cesarean section and operative delivery rates for fetal distress between EFM and IA group were no longer statistically significant, both in the Dublin trial and Vintzileos trial. Even the comparison of the recalculated incidence of the rate of non-reassuring fetal heart rate (FHR) patterns in the EFM and IA groups has not given any indication of significance for the Vintzileos trial.
Conclusion. Our results lead to reconsidering the results of the Dublin trial and Vintzileos trial in terms of operational rates of births, hypothesizing that these results would have been significantly lower if FHR traces were interpreted using the current NICHHD guidelines, which aim to identify potential acidotic fetuses rather than hypoxic ones.

Key words

fetal heart rate, intermittent auscultation, fetal hypoxia, fetal acidosis, electronic fetal heart monitoring

References (18)

  1. Boylan P. Intrapartum fetal monitoring. Baillieres Clin Obstet Gynaecol. 1987;1(1):73–95.
  2. Macones GA, Hankins GDV, Spong CY, Hauth J, Moore T. The 2008 National Institute of Child Health and Human Development Workshop Report on Electronic Fetal Monitoring. Obstet Gynecol. 2008;112(3):661–666.
  3. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists, Number 70, December 2005 (Replaces Practice Bulletin Number 62, May 2005). Intrapartum fetal heart rate monitoring. Obstet Gynecol. 2005;106(6):1453–1460.
  4. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: Nomenclature, interpretation, and general management principles. Obstet Gynecol. 2009;114(1):192–202.
  5. Madaan M, Trivedi SS. Intrapartum electronic fetal monitoring vs intermittent auscultation in postcesarean pregnancies. Int J Gynaecol Obstet. 2006;94(2):123–125.
  6. Haverkamp AD, Orleans M, Langendoerfer S, McFee J, Murphy J, Thompson HE. A controlled trial of the differential effects of intrapartum fetal monitoring. Am J Obstet Gynecol. 1979;134(4):399–412.
  7. Wood C, Renou P, Oats J, Farrell E, Beischer N, Anderson I. A controlled trial of fetal heart rate monitoring in a low-risk obstetric population. Am J Obstet Gynecol. 1981;141(5):527–534.
  8. Di Tommaso M, Seravalli V, Cordisco A, Consorti G, Mecacci F, Rizzello F. Comparison of five classification systems for interpreting electronic fetal monitoring in predicting neonatal status at birth. J Matern Neonatal Med. 2013;26(5):487–490.
  9. Alfirevic Z, Devane D, Gyte GM. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. In: Alfirevic Z, ed. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2013.
  10. Belfort MA, Saade GR, Thom E, et al. A randomized trial of intrapartum fetal ECG ST-segment analysis. N Engl J Med. 2015;373(7):632–641.
  11. MacDonald D, Grant A, Sheridan-Pereira M, Boylan P, Chalmers I. The Dublin randomized controlled trial of intrapartum fetal heart rate monitoring. Am J Obstet Gynecol. 1985;152(5):524–539.
  12. Vintzileos AM, Nochimson DJ, Guzman ER, Knuppel RA, Lake M, Schifrin BS. Intrapartum electronic fetal heart rate monitoring versus intermittent auscultation: A meta-analysis. Obstet Gynecol. 1995;85(1):149–155.
  13. ACOG technical bulletin. Fetal heart rate patterns: Monitoring, interpretation, and management. Number 207 – July 1995 (replaces No. 132, September 1989). Int J Gynaecol Obstet. 1995;51(1):65–74.
  14. Steer PJ, Eigbe F, Lissauer TJ, Beard RW. Interrelationships among abnormal cardiotocograms in labor, meconium staining of the amniotic fluid, arterial cord blood pH, and Apgar scores. Obstet Gynecol. 1989;74(5):715–721.
  15. Clark SL, Nageotte MP, Garite TJ, et al. Intrapartum management of category II fetal heart rate tracings: Towards standardization of care. Am J Obstet Gynecol. 2013;209(2):89–97.
  16. Blackwell SC, Grobman WA, Antoniewicz L, Hutchinson M, Gyamfi Bannerman C. Interobserver and intraobserver reliability of the NICHD 3-Tier Fetal Heart Rate Interpretation System. Am J Obstet Gynecol. 2011;205(4):378.e1–378.e5.
  17. American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric care consensus No. 1: Safe prevention of the primary cesarean delivery. Obstet Gynecol. 2014;123(3):693–711.
  18. Barber EL, Lundsberg LS, Belanger K, Pettker CM, Funai EF, Illuzzi JL. Indications contributing to the increasing cesarean delivery rate. Obstet Gynecol. 2011;118(1):29–38.