Tocolysis and delayed delivery versus emergency delivery in cases of non-reassuring fetal status during labor.
OBJECTIVE
To determine whether fetal intrauterine resuscitation using tocolysis and delayed delivery is better for the fetus than emergency delivery when fetal hypoxia is suspected because of a non-reassuring fetal heart-rate (FHR) pattern using conventional heart rate monitoring.


METHODS
This was a prospective and randomized study, conducted between 2001 and 2004 at Pereira Rossell Hospital, Montevideo, Uruguay. The population consisted of 390 fetuses, in which intrauterine distress was diagnosed using electronic FHR monitoring. Of these, 197 were randomly assigned to the emergency delivery group and 193 to the fetal intrauterine resuscitation group. The inclusion criteria were: term singleton pregnancy, in labor, cephalic presentation, and no placental accidents.


RESULTS
The time between randomization and birth was 16.9 +/- 7.6 min (mean +/- SD) for the emergency delivery group, and 34.5 +/- 11.7 min (mean +/- SD) for the resuscitation group. The relative risk (RR) of acidosis in the umbilical artery (pH < 7.1) in the emergency delivery group was 1.47 (0.95-2.27). The RR of base deficit < or =12 mEq/L in the emergency delivery group was higher than in the resuscitation group (RR = 1.48 [1.0-2.2], P = 0.04). When considering the need for admission to the neonatal care unit, the relative risk was higher in the emergency delivery group than in the resuscitation group (RR = 2.14 [1.23.3.74], P = 0.005). No maternal adverse effects were reported.


CONCLUSIONS
Tocolysis and delayed delivery renders better immediate neonatal results than emergency delivery when fetal distress is suspected because of a non-reassuring fetal heart pattern. In addition, it may decrease the need for emergency delivery without increasing maternal and fetal adverse side-effects.
Briozzo
Leonel
L
Department of Obstetrics and Gynecology, University of Uruguay, School of Medicine, Pereira Rossell Hospital, Ministry of Public Health, Montevideo, Uruguay.
Martinez
Alma
A
Nozar
Maria
M
Fiol
Veronica
V
Pons
Jose
J
Alonso
Justo
J
D000037:Abruptio Placentae / Q000378:metabolism; D000138:Acidosis / Q000378:metabolism / Q000517:prevention & control; D001034:Apgar Score; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D005280:Fenoterol / Q000009:adverse effects / Q000627:therapeutic use*; D005316:Fetal Distress / Q000378:metabolism / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D011247:Pregnancy; D011446:Prospective Studies; D015145:Tocolysis / Q000009:adverse effects / Q000706:statistics & numerical data; D015149:Tocolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D017211:Treatment Failure; D014469:Umbilical Arteries / Q000378:metabolism
D015149:Tocolytic Agents; D005280:Fenoterol