A Prospective Comparison of Selective and Universal Electronic Fetal Monitoring in 34,995 Pregnancies

Leveno, Kenneth J.; Cunningham, Gary F.; Nelson, Sheryl; Roark, Micki; WILLIAMS, LYNNE M.; Guzick, David S.; Dowling, Sharon; Rosenfeld, Charles R.; Buckley, Ann

doi:10.1097/00006254-198703000-00007

Cited by 3 publications

(14 citation statements)

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“…A study by Levens et al published in the New England journal of medicine confirms, higher caesarean section rates for foetal distress with no significant difference in the perinatal mortality rates in the caesarean versus vaginal route of delivery. 4 In case of NICU admissions, there were total of 99 admissions out of 474 LSCS cases. Most common cause for NICU admission was LBW accounting for 30.6% cases followed by respiratory distress accounting for 27.3% cases.…”

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confidence: 99%

LSCS audit in a tertiary care center in Mumbai: to study indications and risk factors in LSCS and it's effect on early peri-natal morbidity and mortality rate

Katke

Zarariya

Desai

2014

Int J Reprod Contracept Obstet Gynecol

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Background: Caesarean section has become a relatively safer and so common procedure in the practice of modern obstetrics. Audit plays an important role in the analysis of changing trends in caesarean delivery. The present retrospective analytical study attempts to critically analyze 474 cases of caesarean deliveries performed in tertiary hospital over a span of six months with an aim to identify the indications and risk factors involved in early peri-natal morbidity and mortality. Methods: The Cama and Albless hospital is a tertiary care center located in South Mumbai, which cares for over 3000 deliveries per year. In the present retrospective analytical study, all cases of caesarean delivery from August 2013 to January 2014 were analyzed regarding the indication, associated risks factors, and all NICU admissions were studied. The decision to perform a caesarean section in each of these patients was made by a consultant on duty in consultation with the unit head telephonically. The primary objective of the study was to do LSCS audit with the secondary objective to analyse relationship of early peri-natal morbidity with indication of LSCS and risk factors associated. Results: In the present study we found that the overall incidence of LSCS is 25.7%, incidence of primary LSCS is 23.1 %, incidence of LSCS in Referred cases is 61.7 %. So overall high incidence of LSCS is justified as our's is a tertiary care referral unit. 3.5% of total LSCS cases were elderly gravidas and teenage pregnancies each. In our study, 11.8% and 3.5% patients were less than 37 weeks and 34 weeks respectively. However 30.6 % of NICU admissions were due to low birth weight. So IUGR in near term patients is an important morbid factor. Previous LSCS was the leading indication in 35.2% of cases followed by foetal distress in 14.9% of cases and Previous 2 LSCS 10.5%. Two important relative indications we found were Previous 1 LSCS and PIH contributing for nearly half of the total cases. Average duration of surgery was 86 minutes in our study and average stay in hospital was 9 days. In our study early perinatal mortality was 1.6% and morbidity in the form of NICU admissions was 20.8%. Most common cause for NICU admission was LBW followed by Respiratory distress. After comparing high risks factors and indications with NICU admissions we found highest morbidity in neonates who underwent LSCS for fetal distress, multiple pregnancy and premature rupture of membranes. Conclusions: Individualization of the indication and careful evaluation can help us limiting early peri-natal morbidity and mortality. Obstetric audits in the institution, following standardized guidelines and practice of evidenced-based medicine will help us a lot in reducing the peri-natal morbidity and mortality.

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confidence: 99%

LSCS audit in a tertiary care center in Mumbai: to study indications and risk factors in LSCS and it's effect on early peri-natal morbidity and mortality rate

Katke

Zarariya

Desai

2014

Int J Reprod Contracept Obstet Gynecol

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“…Six other trials (20,21,27,35,37,64) found no significant difference. Six RCTs (20,21,27,35,54,64) found a greater likelihood of Cesarean section with EFM. In two trials (37,38), there was no significant difference.…”

Section: Conduct Of Randomized Controlled Clinical Trials Of Efmmentioning

confidence: 82%

“…An example was history of prior vertical Cesarean section prompting repeat Cesarean section. Only four (27,35,37,38) of eight studies had a reject log.…”

Section: Specification Of Eligibility Criteriamentioning

confidence: 99%

“…Six of the trials (20,21,35,37,38,54) had explicit prior hypotheses. In two trials (27,64), hypotheses were nonspecific, seeking to "evaluate the usefulness of continuous fetal heart rate monitoring" or "to determine the effects, beneficial or otherwise, of fetal heart rate monitoring."…”

Section: Prior Hypothesesmentioning

confidence: 99%

“…Nonetheless, widespread introduction of this technology prompted national controversy (44), which was heightened after four random ized clinical trials (RCTs) indicated no benefit with EFM (20,21,27,54) . Four additional RCTs have been published (35,37,38,64)-all with negative results-but established policies for intrapartum surveillance with EFM have not been altered as a result of these trials. Although the controversy surrounding EFM has diminished substantially during the 1980s, the proper role of EFM in intrapartum care is unsettled.…”

Section: Introductionmentioning

confidence: 99%

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