The Regional Centralization of Electronic Fetal Heart Rate Monitoring and Its Impact on Neonatal Acidemia and the Cesarean Birth Rate

Abstract

Objective. The improvement of the accuracy of fetal heart rate (FHR) pattern interpretation to improve perinatal outcomes remains an elusive challenge. We examined the impact of an FHR centralization system on the incidence of neonatal acidemia and cesarean births. Methods. We performed a regional, population-based, before-and-after study of 9,139 deliveries over a 3-year period. The chi-squared test was used for the statistical analysis. Results. The before-and-after study showed no difference in the rates of acidemia, cesarean births, or perinatal death in the whole population. A subgroup analysis using the 4 hospitals in which an FHR centralization system was continuously connected (compliant group) and 3 hospitals in which the FHR centralization system was connected on demand (noncompliant group) showed that the incidence acidemia was significantly decreased (from 0.47% to 0.11%) without a corresponding increase in the cesarean birth rate due to nonreassuring FHR patterns in the compliant group. Although there was no difference in the incidence of nonreassuring FHR patterns in the noncompliant group, the total cesarean birth rate was significantly higher than that in the compliant group. Conclusion. The continuous FHR centralization system, in which specialists help to interpret results and decide clinical actions, was beneficial in reducing the incidence of neonatal acidemia (pH < 7.1) without increasing the cesarean birth rate due to nonreassuring FHR patterns.

A prospective cohort study of fetal heart rate monitoring: deceleration area is predictive of fetal acidemia

“…Original publications described the association between EFM patterns and fetal pH, 6,27–29 but not the ability of EFM to predict and prevent injury. A recent meta-analysis summarized the findings from 13 randomized controlled trials, comparing the ability of EFM to identify infants with acidemia and morbidity to intermittent auscultation or intermittent EFM.…”

Intrapartum Fetal Heart Rate: A Possible Predictor of Neonatal Acidemia and APGAR Score

“…The improvement in the accuracy of FHR pattern interpretation through a continuous FHR centralization system is envisaged to be beneficial in reducing the incidence of neonatal acidemia ( Michikata et al, 2016 ). To improve the predictive efficacy of cardiotocography FHR, diagnostic algorithms are currently being investigated to be used in real-time computerized systems for decision support ( van Scheepen et al, 2016 ).…”

A Comprehensive Evaluation of the Predictive Abilities of Fetal Electrocardiogram-Derived Parameters during Labor in Newborn Acidemia: Our Institutional Experience

“…Nevertheless, there is consensus that the expert and algorithm-assisted FHR interpretation has the potential to improve standard clinical performance by facilitating the early recognition of tracing that is associated with metabolic acidemia [ 66 ]. Recently, a large population-based study showed that centralization of FHR monitoring with the help of specialists to interpret the results and determine clinical actions achieved an effective decrease in the rate of fetal acidemia without an increase in the rate of C-section births [ 67 ]. This implies that our institutional experience in predicting acidemia through FECG-derived parameters can be incorporated into training the attending obstetricians to help them take action early enough to decrease the incidence of neonatal acidemia and intrapartum death.…”