title: Mechanism of reduction of newborn metabolic acidemia following application of a rule-based 5-category color-coded fetal heart rate management framework.
abstract: Abstracts Objective: We have reported a 7-fold reduction in newborn umbilical arterial (UA) metabolic acidemia after adoption of a rule-based 5-category color-coded fetal heart rate (FHR) management framework. We sought evidence for the relationship being causal by detailed analysis of FHR characteristics and acid-base status before and after training.
  
  
  METHODS
  Rates of UA pH and base excess (BE) were determined over a 5-year period in a single Japanese hospital, serving mainly low-risk patients, with 3907 deliveries. We compared results in the 2 years before and after a 6-month training period in the FHR management system. We used a previously published classification schema, which was linked to management guidelines.
  
  
  RESULTS
  After the training period, there was an increase in the percentage of normal patterns (23%), and a decrease in variable decelerations (14%), late decelerations (8%) and prolonged decelerations (12%) in the last 60 min of labor compared to the pre-training period. There was also a significant reduction in mean UA pH and BE in the groups with decelerations after introduction of the FHR management framework.
  
  
  CONCLUSIONS
  The adoption of this FHR management system was associated with a reduction of decelerations and metabolic acidemia, without a change in cesarean or vacuum delivery rates. These results suggest that the obstetrical providers were able to better select for intervention those patients destined to develop more severe acidemia, demonstrating a possible causal relationship between the management system and reduced decelerations and metabolic acidemia.
authors.affiliation: a Department of Obstetrics and Gynecology , Sakakibara Heart Institute , Fuchu , Japan .
authors.forename: Shinji
authors.initials: S
authors.lastname: Katsuragi
authors.forename: Julian T
authors.initials: JT
authors.lastname: Parer
authors.forename: Shunichi
authors.initials: S
authors.lastname: Noda
authors.forename: Junji
authors.initials: J
authors.lastname: Onishi
authors.forename: Hitomi
authors.initials: H
authors.lastname: Kikuchi
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ikeda
mesh_terms: D000138:Acidosis / Q000151:congenital* / Q000503:physiopathology / Q000628:therapy*; D001784:Blood Gas Analysis; D015148:Cardiotocography / Q000379:methods* / Q000592:standards*; D059019:Clinical Coding / Q000379:methods*; D003116:Color; D005260:Female; D005312:Fetal Blood / Q000737:chemistry / Q000378:metabolism; D006340:Heart Rate, Fetal / Q000502:physiology*; D006771:Hospitals, Maternity / Q000458:organization & administration; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D011247:Pregnancy; D012720:Severity of Illness Index
keywords: Fetal BE; fetal heart rate; fetal pH