654: Does central fetal heart rate monitoring system improve perinatal outcomes?

Poster Session IV

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Epidemiology, Global Maternal-Fetal Public Health, Infectious Disease, Intrapartum Fetal Assessment, Operative Obstetrics

Figure 1 Relationship between umbilical arterial blood gas pH and 5-tier color-code of 10 min-segment before delivery.

653 Follow-up of the Dutch STAN trial: the association of umbilical artery pH with neurologic and behavioural development at the age of 2 years Jeroen Becker1, Martine Depmann1, Anneloes van Baar2, BenWillem Mol3, Carl Moons1, Gerard Visser1, Anneke Kwee1

STUDY DESIGN: Retrospective cohort study of all term deliveries at a single institution. Central fetal heart rate (FHR) monitoring was first introduced in 2001. Due to technical limitations, central monitoring became unavailable for deliveries between 02-2009 and 09-2009 (NoCM), and was reinstated for those between 10-2009 and 052010 (CM). All other aspects of clinical care remained similar during these periods. The records for the deliveries occurring within these 2 periods were reviewed for selected outcomes. Preterm deliveries, multifetal gestations, IUFD and deliveries not requiring fetal monitoring such as elective cesareans were excluded. Data are reported as mean ⫾ standard deviation or n (%) RESULTS: 2786 and 2360 term pregnant women delivered in the absence (no-CM) or presence (CM) of central FHR monitoring. Maternal demographics were similar between the 2 groups. More women were obese, preeclamptic and postterm in the no-CM group, whereas more underwent induction of labor in CM group. Rates of cesarean sections and operative deliveries were higher in CM group, but the difference did not reach statistical significance (Table). Rates of NICU admission and low Apgar score at 1 minute were significantly higher in the CM group. CONCLUSIONS: Central FHR monitoring did not improve perinatal outcomes

1

University Medical Center Utrecht, Utrecht, 2Utrecht University, Utrecht, 3Academic Medical Center, Amsterdam

No CM Nⴝ2786

OBJECTIVE: This study has been performed to evaluate the association

between umbilical artery pH at birth and neurologic and behavioural outcome at the age of 2 years. STUDY DESIGN: We performed a secondary analysis of children included in a randomised trial comparing fetal monitoring with STAN® or CTG. At 2 years of age, parents of included children were asked to complete the Ages and Stages Questionnaire (ASQ-3), the Child Behaviour Checklist (CBCL) and a questionnaire about the child’s medical history and the parents education level. Questionnaire scores were compared to the appropriate reference values. We approached random samples of parents whose child had a pH ⬍ 7.05 (n⫽105), parents whose child had a pH between 7.05 and 7.15 (n⫽87), and parents with a child with a pH ⬎ 7.15 (n⫽126). For this analysis, we compared the pH to the ASQ-3 and the CBCL scores. We looked at mean scores as well as the number of children with borderline and abnormal development. RESULTS: Of 318 questionnaires sent out, 213 were returned (67%). Lost to follow-up was 41% in children born with pH⬍7.05, 22% of children born with pH between 7.05 and 7.15 and 34% of children born with pH ⬎ 7.15. Mean scores of both ASQ-3 and CBCL did not differ significantly between the three groups (P-values varying between .06 and .94 on 20 different items). The number of children with borderline and abnormal neurologic and behavioural development was comparable in the different pH groups. For example, on gross motor development 21%, 19% and 20% of the children scored borderline or clinical abnormal in each of the three groups, respectively. Linear regression did not show correlation between pH at birth and scores of neurologic or behavioural development at 2-years of age. CONCLUSIONS: Metabolic acidosis at birth is not associated with abnormal scores of the Ages and Stages Questionnaire (ASQ-3) and the Child Behaviour Checklist (CBCL) at 2 years of age.

1

202 (8.6)

⬍0.001

Morbid obesity

107 (3.8)

80 (3.4)

0.19

.......................................................................................................................................................................................... ..........................................................................................................................................................................................

Preeclampsia * 267 (9.6) 165 (7.0) ⬍0.001 .......................................................................................................................................................................................... Postterm pregnancy* 731 (26.2) 488 (20.7) ⬍0.001 .......................................................................................................................................................................................... Gestational Diabetes

184 (6.6)

159 (6.7)

0.85

..........................................................................................................................................................................................

Oligohydramnios 232 (8.3) 190 (8.1) 0.72 .......................................................................................................................................................................................... Induction of Labor * 539 (19.4) 556 (23.6) ⬍0.001 .......................................................................................................................................................................................... Spontaneous vaginal delivery

2173 (78)

1791 (75.9)

0.07

..........................................................................................................................................................................................

Operative vaginal delivery 110 (3.9) 103 (4.4) 0.45 .......................................................................................................................................................................................... Primary cesarean delivery

503 (18.1)

466 (19.8)

0.12

Cesarean or Operative vaginal delivery

613 (22.0)

569 (24.2)

0.07

..........................................................................................................................................................................................

..........................................................................................................................................................................................

NRFHT as indication for CD 192 (38.2) 197 (42.3) 0.19 .......................................................................................................................................................................................... Chorioamnionitis/endometritis 189 (6.8) 166 (7.0) 0.72 .......................................................................................................................................................................................... Blood transfusion 18 (0.65) 19 (0.81) 0.50 .......................................................................................................................................................................................... Fetal

..........................................................................................................................................................................................

NICU admission

55 (2.0)

76 (3.2)

0.004

..........................................................................................................................................................................................

Apgar score @ 1 min ⬍ 4 * 25 (0.90) 43 (1.8) 0.003 .......................................................................................................................................................................................... Apgar score @ 5 min ⬍ 7 14 (0.50) 16 (0.68) 0.41 .......................................................................................................................................................................................... Birthweight *

3398.4 ⫾ 435.8

3355.2 ⫾ 430.8

⬍0.001

..........................................................................................................................................................................................

Neonatal death 2 (0.07) 2 (0.08) 0.87 .......................................................................................................................................................................................... * P⬍0.05

655 FHR category alone does not predict short-term newborn outcome Intermountain Healthcare, Salt Lake City, UT

1

The University of Texas Medical Branch, Galveston, TX

OBJECTIVE: To evaluate whether the use of a central fetal heart rate

S258

367 (13.2)

1

1

Maged Costantine , Giuseppe Chiossi , Antonio Saad , Alberto Falquez1, Ruth Soulsby-Monroy1, Luis Pacheco1, Gary Hankins1, George Saade1 monitoring system improves perinatal outcomes

P

Obesity *

Marc Jackson1, Calla M. Holmgren1, Sean Esplin1, Nancy Rose1, Erick Henry1

654 Does central fetal heart rate monitoring system improve perinatal outcomes? 1

CM Nⴝ2360

OBJECTIVE: To determine whether the time in NICHD fetal heart rate

(FHR) categories is different in women in term labor with a medicalobstetric complication (MOC) compared to those without, and whether FHR category (Cat) differences predict adverse neonatal outcome.

American Journal of Obstetrics & Gynecology Supplement to JANUARY 2011