Intrapartum management of nonreassuring fetal heart rate patterns: a randomized controlled trial of fetal pulse oximetry.
OBJECTIVE
We tested if fetal pulse oximetry in addition to electronic fetal monitoring (CTG) and scalp blood sampling improves the accuracy of fetal assessment and allows safe reduction of operative deliveries (-50%) and scalp blood sampling (-50%) performed because of nonreassuring fetal status. Study design A randomized controlled trial was conducted in 146 patients with term pregnancies in active labor and abnormal fetal heart rate patterns: 73 had electronic fetal heart rate monitoring (CTG) and fetal scalp blood sampling (control group), 73 had CTG, fetal scalp blood sampling, and continuous fetal pulse oximetry (study group).


RESULTS
There was a reduction of -50% in operative deliveries and fetal scalp blood sampling performed because of nonreassuring fetal status in the study group: operative deliveries, study versus control 25/49 (P </= .001); fetal scalp sampling, study versus control 32/64 (P </= .001). An increase in cesarean sections because of dystocia in the study group did not change the net number of operative deliveries. There was no difference between the 2 groups in adverse maternal or neonatal outcomes, as well as for the end points of metabolic acidosis and need for resuscitation.


CONCLUSIONS
There was a safe reduction in operative deliveries (-50%) and scalp blood sampling (-50%) performed because of nonreassuring fetal status. The increase in cesarean sections because of dystocia in the study group was a well-documented arrest of labor, but it did not change the total number of operative deliveries in this group.
Kühnert
Maritta
M
Department of Obstetrics and Perinatology, University of Marburg, Marburg, Germany. dres-Kuehnert@t-online.de
Schmidt
Stephan
S
D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005311:Fetal Hypoxia / Q000175:diagnosis; D005323:Fetal Monitoring / Q000379:methods*; D005500:Follow-Up Studies; D006340:Heart Rate, Fetal / Q000502:physiology*; D006801:Humans; D007743:Labor, Obstetric; D010092:Oximetry / Q000379:methods*; D010101:Oxygen Consumption / Q000502:physiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012680:Sensitivity and Specificity