title: The effect of intrapartum fetal pulse oximetry, in the presence of a nonreassuring fetal heart rate pattern, on operative delivery rates: a multicenter, randomized, controlled trial (the FOREMOST trial).
abstract: OBJECTIVE
  The objective of the study was to compare operative delivery rates for nonreassuring fetal status between 2 groups of laboring women: those having conventional cardiotocograph monitoring and those having cardiotocograph monitoring plus fetal pulse oximetry.
  
  
  METHODS
  The intrapartum fetal oximetry prospective, multicenter, randomized, controlled trial (the FOREMOST trial) was conducted in 4 Australian maternity hospitals. The primary outcome was operative birth rates for nonreassuring fetal status.
  
  
  RESULTS
  There was a statistically significant 23% relative risk reduction in operative delivery for nonreassuring fetal status in the fetal pulse oximetry + cardiotocograph group (n = 75 of 305, 25%), compared with those in the cardiotocograph-only group (n = 95/295, 32%) (relative risk 0.77, 95% confidence interval 0.599, 0.999, P = .048). There were no significant between-group differences in overall operative births (fetal pulse oximetry + cardiotocograph group 73%, cardiotocograph-only group 71%, relative risk 1.04, 95% confidence interval 0.94, 1.15, P = .478) or neonatal outcomes.
  
  
  CONCLUSIONS
  The use of fetal pulse oximetry to augment fetal well-being assessment during labor resulted in a statistically significant reduction in the operative intervention for nonreassuring fetal status, compared with the use of conventional cardiotocograph monitoring alone. This reduction was achieved with no significant difference in neonatal outcomes.
authors.affiliation: Perinatal Research Centre, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. ceast@somc.uq.edu.au
authors.forename: Christine E
authors.initials: CE
authors.lastname: East
authors.forename: Shaun P
authors.initials: SP
authors.lastname: Brennecke
authors.forename: James F
authors.initials: JF
authors.lastname: King
authors.forename: Fung Yee
authors.initials: FY
authors.lastname: Chan
authors.forename: Paul B
authors.initials: PB
authors.lastname: Colditz
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005323:Fetal Monitoring; D006340:Heart Rate, Fetal; D006801:Humans; D010092:Oximetry; D011247:Pregnancy; D011446:Prospective Studies