Emergency cesarean delivery for nonreassuring fetal heart rate tracings. Compliance with ACOG guidelines.
OBJECTIVE
To review the English-language literature from 1990 to 2000 on cesarean delivery for "fetal distress" and assess compliance with American College of Obstetricians and Gynecologists (ACOG) guidelines.


METHODS
A PubMed search with the search items cesarean, fetal distress, cesarean, nonreassuring fetal heart rate, cesarean, neonatal acidosis and cesarean, umbilical arterial pH was undertaken. Excluded from the search were case reports, letters to the editor, focus on fetal anomaly, combinations with other reasons for operative delivery (either abdominally or vaginally) or absence of pertinent information.


RESULTS
Among 392 articles from the search, 169 met the inclusion criteria. Three reports provided detailed information on use of scalp pH; use occurred in 5% (60/1,128) of emergency cesareans. Three reports provided data on the use of tocolytics for intrauterine resuscitation; the combined result was 16% (201/1,261). Five reports assessed the decision-to-incision interval within 30 minutes; in 59% (262/446) of cases it was achieved. Five reports contained cord pH information on 340 emergency cesarean deliveries; umbilical arterial pH was < 7.00 in 10%.


CONCLUSIONS
Physician use of, and compliance with, ACOG guidelines for emergency cesarean deliveries is difficult to assess, and incomplete compliance appears commonplace.
Chauhan
Suneet P
SP
Departments of Obstetrics and Gynecology, Spartanburg Regional Medical Center, Spartanburg, South Carolina, USA. mfmchauhan@aol.com
Magann
Everett F
EF
Scott
John R
JR
Scardo
James A
JA
Hendrix
Nancy W
NW
Martin
James N
JN
D000138:Acidosis / Q000151:congenital / Q000453:epidemiology*; D002585:Cesarean Section / Q000592:standards*; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D005316:Fetal Distress / Q000601:surgery*; D005323:Fetal Monitoring / Q000592:standards; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D007226:Infant Mortality; D007231:Infant, Newborn; D011247:Pregnancy; D012151:Resuscitation / Q000592:standards