Fetal Pulse Oximetry and Cesarean Delivery

American Journal of Obstetrics and Gynecology

et al. 2012

Self Cite

OBJECTIVE To compare pregnancy outcomes by completed week of gestation after 39 weeks with outcomes at 39 weeks. STUDY DESIGN Secondary analysis of a multicenter trial of fetal pulse oximetry in spontaneously laboring or induced nulliparous women ≥36 weeks’ gestation. Maternal outcomes included a composite (treated uterine atony, blood transfusion and peripartum infections) and cesarean delivery. Neonatal outcomes included a composite of death, neonatal respiratory and other morbidities and neonatal ICU admission. RESULTS Among the 4086 women studied, the risks of the composite maternal outcome (p-value for trend<0.001), cesarean delivery (p<0.001) and composite neonatal outcome (p=0.047) increased with increasing gestational age from 39 to ≥41 completed weeks. Adjusted odds ratios (95% CI) for 40 and ≥41 weeks respectively compared with 39 weeks were 1.29 (1.03–1.64) and 2.05 (1.60–2.64) for composite maternal outcome, 1.28 (1.05–1.57) and 1.75 (1.41–2.16) for cesarean delivery and 1.25 (0.86–1.83) and 1.37 (0.90–2.09) for composite neonatal outcome. CONCLUSIONS Risks of maternal morbidity and cesarean delivery but not neonatal morbidity increased significantly beyond 39 weeks.

Section: Methodsmentioning

confidence: 99%

Timing of delivery and pregnancy outcomes among laboring nulliparous women

Tita

Lai

American Journal of Obstetrics and Gynecology

et al. 2012

Self Cite

“…We conducted a secondary analysis of a prospective trial of fetal pulse oximetry conducted by the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network (8). In the original study, women were eligible to participate if they were nulliparous with a singleton, cephalic, living fetus at or beyond 36 weeks of gestation.…”

Section: Methodsmentioning

confidence: 99%

Association of Cervical Effacement With the Rate of Cervical Change in Labor Among Nulliparous Women

Langen

Weiner

Obstetrics &Amp; Gynecology

et al. 2016

Self Cite

Objective To assess the association of cervical effacement with the rate of intrapartum cervical change among nulliparous women. Methods We conducted a secondary analysis of a prospective trial of intrapartum fetal pulse oximetry. For women who had vaginal deliveries, interval censored regression was used to estimate the time to dilate at one centimeter intervals. For each given centimeter of progressive cervical dilation, women were divided into those who had achieved 100% cervical effacement and those who had not. The analysis was performed separately for women in spontaneous labor and those who were given oxytocin. Results Three thousand nine hundred two women were included in this analysis, 1,466 (38%) who underwent labor induction, 1,948 (50%) who underwent labor augmentation (combined for the analysis), as well as 488 (13%) who labored spontaneously. For women in spontaneous labor, the time to dilate 1 cm was shorter for those who were 100% effaced starting at 4 cm of cervical dilation (P = 0.01 to P < 0.001). For women who received oxytocin, the time to dilate 1 cm was shorter for those who were 100% effaced throughout labor (P < 0.001). Conclusion The rate of cervical dilation among nulliparous women is associated with not only the degree of cervical dilation, but also with cervical effacement. Clinical Trial Registration ClinicalTrials.gov, www.clinicaltrials.gov, NCT00098709.

“…15 The study protocol required that 10,000 women with term pregnancies all have their labors monitored with both an electronic fetal monitor and a fetal pulse oximeter. Women were randomly assigned to a group in which the fetal oxygen saturation data were made available to the managing clinicians or to a group in which the fetal oxygen saturation data were masked.…”

Section: Fetal Pulse Oximetrymentioning

confidence: 99%

What we have learned about intrapartum fetal monitoring trials in the MFMU Network

Seminars in Perinatology

Belfort

Saade

2016

Self Cite

The vast majority of pregnant women in the United States are subjected to electronic fetal heart monitoring during labor. There is limited evidence to support its benefit compared with intermittent auscultation. In addition, there is significant variability in interpretation and its false positive rate is high. The latter may have contributed to the rise in operative deliveries. In order to address the critical need for better approaches to intrapartum monitoring, the MFMU Network has completed 2 large multi-site randomized trials, one to evaluate fetal pulse oximetry and the other to evaluate fetal ECG ST segment analysis (STAN). Both of these technologies had been approved for clinical use in the U.S. based on prior smaller trials. These technologies were evaluated in laboring women near term and their primary outcomes were overall cesarean delivery for the oximetry trial and a composite adverse neonatal outcome for STAN. Both trials failed to show a benefit of the technology, neither in the rates of operative deliveries nor in the rates of adverse neonatal outcomes. The experience with these trials, summarized in this report, highlights the need for rigorous evidence before introduction of new technology into clinical practice and provide a blueprint for future such trials to address the need for better intrapartum monitoring approaches.