title: Identification of cases with adverse neonatal outcome monitored by cardiotocography versus ST analysis: secondary analysis of a randomized trial.
abstract: OBJECTIVE
  To evaluate whether correct adherence to clinical guidelines might have led to prevention of cases with adverse neonatal outcome.
  
  
  METHODS
  Secondary analysis of cases with adverse outcome in a multicenter randomized clinical trial.
  
  
  METHODS
  Nine Dutch hospitals.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, the Netherlands. m.e.m.h.westerhuis@umcutrecht.nl
authors.forename: Michelle E M H
authors.initials: ME
authors.lastname: Westerhuis
authors.forename: Martina M
authors.initials: MM
authors.lastname: Porath
authors.forename: Jeroen H
authors.initials: JH
authors.lastname: Becker
authors.forename: Eline S A
authors.initials: ES
authors.lastname: Van Den Akker
authors.forename: Erik
authors.initials: E
authors.lastname: Van Beek
authors.forename: Hendrikus J H M
authors.initials: HJ
authors.lastname: Van Dessel
authors.forename: Addy P
authors.initials: AP
authors.lastname: Drogtrop
authors.forename: Herman P
authors.initials: HP
authors.lastname: Van Geijn
authors.forename: Giuseppi C M
authors.initials: GC
authors.lastname: Graziosi
authors.forename: Floris
authors.initials: F
authors.lastname: Groenendaal
authors.forename: Jan M M
authors.initials: JM
authors.lastname: Van Lith
authors.forename: Ben Willem J
authors.initials: BW
authors.lastname: Mol
authors.forename: Karel G M
authors.initials: KG
authors.lastname: Moons
authors.forename: Jan G
authors.initials: JG
authors.lastname: Nijhuis
authors.forename: Swan G
authors.initials: SG
authors.lastname: Oei
authors.forename: Herman P
authors.initials: HP
authors.lastname: Oosterbaan
authors.forename: Robbert J P
authors.initials: RJ
authors.lastname: Rijnders
authors.forename: Nico W E
authors.initials: NW
authors.lastname: Schuitemaker
authors.forename: Lia D E
authors.initials: LD
authors.lastname: Wijnberger
authors.forename: Christine
authors.initials: C
authors.lastname: Willekes
authors.forename: Maurice G A J
authors.initials: MG
authors.lastname: Wouters
authors.forename: Gerard H A
authors.initials: GH
authors.lastname: Visser
authors.forename: Anneke
authors.initials: A
authors.lastname: Kwee
mesh_terms: D000138:Acidosis / Q000175:diagnosis; D000328:Adult; D015148:Cardiotocography; D004562:Electrocardiography; D005260:Female; D005316:Fetal Distress / Q000175:diagnosis*; D005323:Fetal Monitoring / Q000379:methods*; D019983:Guideline Adherence; D006340:Heart Rate, Fetal; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D011247:Pregnancy; D011256:Pregnancy Outcome; D014469:Umbilical Arteries