Identification of cases with adverse neonatal outcome monitored by cardiotocography versus ST analysis: secondary analysis of a randomized trial.

Autor:	Westerhuis ME; Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, the Netherlands. m.e.m.h.westerhuis@umcutrecht.nl, Porath MM, Becker JH, Van Den Akker ES, Van Beek E, Van Dessel HJ, Drogtrop AP, Van Geijn HP, Graziosi GC, Groenendaal F, Van Lith JM, Mol BW, Moons KG, Nijhuis JG, Oei SG, Oosterbaan HP, Rijnders RJ, Schuitemaker NW, Wijnberger LD, Willekes C, Wouters MG, Visser GH, Kwee A
Jazyk:	angličtina
Zdroj:	Acta obstetricia et gynecologica Scandinavica [Acta Obstet Gynecol Scand] 2012 Jul; Vol. 91 (7), pp. 830-7.
DOI:	10.1111/j.1600-0412.2012.01431.x
Abstrakt:	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. (© 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.)
Databáze:	MEDLINE
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