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Intrapartum Resuscitation Interventions for Category II Fetal Heart Rate Tracings and Improvement to Category I.
- Source :
-
Obstetrics & Gynecology . Sep2021, Vol. 138 Issue 3, p409-416. 7p. - Publication Year :
- 2021
-
Abstract
- <bold>Objective: </bold>To evaluate intrapartum resuscitation interventions and improvement in category II fetal heart rate (FHR) tracings.<bold>Methods: </bold>This secondary analysis of a randomized trial of intrapartum fetal electrocardiographic ST-segment analysis included all participants with category II FHR tracings undergoing intrauterine resuscitation: maternal oxygen, intravenous fluid bolus, amnioinfusion, or tocolytic administration. Fetal heart rate pattern-recognition software was used to confirm category II FHR tracings 30 minutes before intervention and to analyze the subsequent 60 minutes. The primary outcome was improvement to category I within 60 minutes. Secondary outcomes included FHR tracing improvement to category I 30-60 minutes after the intervention and composite neonatal outcome.<bold>Results: </bold>Of 11,108 randomized participants, 2,251 (20.3%) had at least one qualifying intervention for category II FHR tracings: 63.7% improved to category I within 60 minutes and 50.5% improved at 30-60 minutes. Only 3.4% underwent cesarean delivery and 4.1% an operative vaginal delivery for nonreassuring fetal status within 60 minutes after the intervention. Oxygen administration was the most common intervention (75.4%). Among American College of Obstetricians and Gynecologists-defined subgroups that received oxygen, the absent FHR accelerations and absent-minimal FHR variability subgroup (n=332) was more likely to convert to category I within 60 minutes than the FHR accelerations or "moderate FHR variability" subgroup (n=1,919) (77.0% vs 63.0%, odds ratio [OR] 2.0, 95% CI 1.4-2.7). The incidence of composite neonatal adverse outcome for category II tracings was 2.9% (95% CI 2.2-3.7%) overall; 2.8% (95% CI 2.0-3.8%) for improvement to category I within 60 minutes (n=1,433); and 3.2% (95% CI 2.1-4.6%) for no improvement within 60 minutes (n=818). However, the group with improvement had 29% lower odds for higher level neonatal care (11.8% vs 15.9%, OR 0.71, 95% CI 0.55-0.91).<bold>Conclusion: </bold>Nearly two thirds of category II FHR tracings improved to category I within 60 minutes of intervention with a relatively low overall rate of the composite neonatal adverse outcome.<bold>Funding Source: </bold>Funded in part by Neoventa Medical. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 00297844
- Volume :
- 138
- Issue :
- 3
- Database :
- Academic Search Index
- Journal :
- Obstetrics & Gynecology
- Publication Type :
- Academic Journal
- Accession number :
- 152615956
- Full Text :
- https://doi.org/10.1097/AOG.0000000000004508