title: Practice variation in the management of intrapartum fetal distress in The Netherlands and the Western world.
abstract: OBJECTIVE
  Solid evidence on the effect of intrauterine resuscitation on neonatal outcome is limited, and superiority of one intervention over the others is not clear. We therefore surveyed the clinical practice variation in fetal monitoring and the management of fetal distress during labor, in Dutch labor wards. In addition, we have compared recommendations from international guidelines.
  
  
  METHODS
  We conducted a survey among all 86 Dutch hospitals, using a questionnaire on fetal monitoring and management of fetal distress. In addition, we requested international guidelines of 28 Western countries to study international recommendations regarding labor management.
  
  
  RESULTS
  The response rate of the national survey was 100%. Labor wards of all hospitals use CTG for fetal monitoring, 98% use additional fetal scalp blood sampling, and 23% use ST-analysis. When fetal distress is suspected, oxytocin is discontinued and tocolytic drugs are applied in all hospitals. Nearly all hospitals (98%) use maternal reposition for fetal resuscitation, 33% use amnioinfusion, and 58% provide maternal hyperoxygenation. Management is mainly based on the Dutch national guideline (58%) or on local guidelines (26%). Eight international guidelines on fetal monitoring were obtained for analysis. Fetal scalp blood sampling facilities are recommended in all the obtained guidelines. Use of ST-analysis is recommended in three guidelines and advised against in three guidelines. Five guidelines also advised on intrauterine resuscitation: discontinuation of oxytocin and use of tocolytic drugs was advised in all guidelines, amnioinfusion was recommended in two guidelines and advised against in two guidelines, whereas maternal hyperoxygenation was recommended in two guidelines and advised against in one guideline.
  
  
  CONCLUSIONS
  Nationwide clinical practice, and recommendations from international guidelines agree on the use of fetal scalp blood sampling in addition to cardiotocography during labor. The opinion on the use of ST-analysis differs per clinic and per guideline. Discontinuation of oxytocin, administration of tocolytic drugs and maternal repositioning are rather uniform, on national and international level. However, there is a large variation in the use of amnioinfusion and maternal hyperoxygenation, which may be explained by the contradictory recommendations of the different guidelines.
authors: Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands. Electronic address: laurenbullens@gmail.com.
authors: Lauren M
authors: LM
authors: Bullens
authors: Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands.
authors: Suzanne
authors: S
authors: Moors
authors: Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands.
authors: Pieter J
authors: PJ
authors: van Runnard Heimel
authors: Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
authors: M Beatrijs
authors: MB
authors: van der Hout-van der Jagt
authors: Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
authors: S Guid
authors: SG
authors: Oei
mesh_terms: D015148:Cardiotocography / Q000592:standards*; D005260:Female; D005316:Fetal Distress / Q000175:diagnosis*; D005323:Fetal Monitoring / Q000592:standards*; D019538:Health Care Surveys; D006340:Heart Rate, Fetal / Q000502:physiology*; D006801:Humans; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011247:Pregnancy
keywords: Clinical practice; Fetal distress; Fetal monitoring; Guideline; Intrauterine resuscitation