title: Recognition and response to electronic fetal heart rate patterns: impact on newborn outcomes and primary cesarean delivery rate in women undergoing induction of labor.
abstract: OBJECTIVE
  The objective of the study was to examine the clinical impact of specific fetal monitoring-related practices during induced labor.
  
  
  METHODS
  This was a prospective, nonrandomized study.
  
  
  RESULTS
  We studied 14,398 women undergoing oxytocin induction of labor. A decrease in the infusion rate of oxytocin in the face of specified category II fetal heart rate tracings was associated with a significantly reduced rate of neonatal intensive care unit admission (3.8% vs 5.2%, P = .01) and Apgar score less than 7 at 1 and 5 minutes (4.9% vs 6.4%, P = .01, 0.6% vs 1.1%, P = .04). Compliance with an in-use checklist was associated with both a reduction in the rate of neonatal intensive care unit admission (2.9 vs 4.4, P = .00) and a reduction in the cesarean delivery rate (15.8% vs 18.8%, P = .00).
  
  
  CONCLUSIONS
  Electronic fetal heart rate monitoring improves neonatal outcomes when unambiguous definitions of abnormal fetal heart rate and tachysystole are coupled with specific interventions. Utilization of a checklist for oxytocin monitoring is associated with improved neonatal outcomes and a reduction in the cesarean delivery rate.
authors.affiliation: Hospital Corporation of America, Nashville, TN; Baylor College of Medicine, Houston, TX. Electronic address: steven.clark1@hcahealthcare.com.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Clark
authors.affiliation: Hospital Corporation of America, Nashville, TN; Baylor College of Medicine, Houston, TX.
authors.forename: Janet A
authors.initials: JA
authors.lastname: Meyers
authors.affiliation: Hospital Corporation of America, Nashville, TN; Baylor College of Medicine, Houston, TX.
authors.forename: Donna K
authors.initials: DK
authors.lastname: Frye
authors.affiliation: Hospital Corporation of America, Nashville, TN; Baylor College of Medicine, Houston, TX.
authors.forename: Thomas
authors.initials: T
authors.lastname: Garthwaite
authors.affiliation: Hospital Corporation of America, Nashville, TN; Baylor College of Medicine, Houston, TX.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Lee
authors.affiliation: Hospital Corporation of America, Nashville, TN; Baylor College of Medicine, Houston, TX.
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Perlin
mesh_terms: D000328:Adult; D001034:Apgar Score; D002585:Cesarean Section / Q000706:statistics & numerical data*; D057189:Checklist; D005260:Female; D005323:Fetal Monitoring / Q000379:methods*; D006340:Heart Rate, Fetal / Q000187:drug effects*; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D007751:Labor, Induced / Q000009:adverse effects* / Q000379:methods; D017063:Outcome Assessment, Health Care; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects*; D010121:Oxytocin / Q000008:administration & dosage / Q000009:adverse effects*; D010343:Patient Admission / Q000706:statistics & numerical data; D011247:Pregnancy; D011446:Prospective Studies
chemical_list: D010120:Oxytocics; D010121:Oxytocin
keywords: fetal heart rate monitoring; oxytocin; patient safety