Practice variation in the management of intrapartum fetal distress in The Netherlands and the Western world

Bullens, Lauren M.; Moors, Suzanne; Heimel, Pieter J. van Runnard; Jagt, M.B. van der Hout-van der; Oei, S.G.

doi:10.1016/j.ejogrb.2016.08.012

Cited by 8 publications

(2 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Discussion:-Management policy provided for enrolled women with ruptured membrane and thick-meconium stained amniotic fluid (MSAF) consisted of maternal hydration, and oxygenation and fetal monitoring using CTG with discontinuation of oxytocin infusion if any was provided. Such policy coincided with Bullens et al (13) who conducted a survey among 86 Dutch hospitals, and found that in 100% of hospitals CTG was used for fetal monitoring and when fetal distress was suspected, oxytocin is discontinued and tocolytic drugs are applied and 98% of hospitals use maternal reposition for fetal resuscitation, 33% use amnioinfusion (AI), and 58% provide maternal hyperoxygenation.…”

Section: Results:-mentioning

confidence: 99%

Intrapartum Trans-Cervical Amnioinfusion as Adjuvant to Conventional Management of Women Had Ruptured Membranes With Thick Meconium-Stained Amniotic Fluid.

Sherbeny¹,

B²

2017

IJAR

View full text Add to dashboard Cite

Section: Results:-mentioning

confidence: 99%

Intrapartum Trans-Cervical Amnioinfusion as Adjuvant to Conventional Management of Women Had Ruptured Membranes With Thick Meconium-Stained Amniotic Fluid.

Sherbeny¹,

B²

2017

IJAR

View full text Add to dashboard Cite

“…For example, in a recent survey of 86 Dutch hospitals, 98% used FBGA on a routine basis. [ 3 ] The rate of FBGA use, however, strongly varies between hospitals and between countries and the frequency of FBGA use within the population of parturients depends on local practice. [ 1 ] It can be estimated that institutions using FBGA on a routine basis will apply this method in 1% to 4% of term deliveries.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of intrapartum fetal blood gas analysis by scalp sampling

Hilal

Mrkvicka²,

Rezniczek³

et al. 2017

Medicine

View full text Add to dashboard Cite

Fetal blood gas analysis (FBGA) using scalp blood is commonly used to identify serious fetal distress. However, there is a lack of data regarding its accuracy and reliability. The aim of this study was to determine the positive predictive value (PPV) and negative predictive value (NPV) of FBGA for predicting postpartum acidosis in case of nonreassuring fetal heart rate tracings (NRFHRT). To this end, we conducted a retrospective cohort study of singleton term deliveries with NRFHRT according to Fédération Internationale de Gynécologie et d’Obstétrique and Fisher cardiotocography scores undergoing FBGA in a university hospital. The PPV and NPV of FBGA regarding neonatal acidosis (defined as a pH value ≤ 7.15 in arterial or venous umbilical cord blood) and Apgar scores indicating neonatal depression (defined as a 5-min Apgar score ≤5) were evaluated. Multivariate analysis was used to determine the influence of cardiotocography variations and the time delay between FBGA and delivery on the accuracy of FBGA. We analyzed 343 deliveries with NRFHRT. In 32 (9%) of these cases, fetal acidosis was confirmed by a postpartum umbilical cord blood pH value ≤ 7.15. In 308/343 (90%) cases, FBGA identified NRFHRT as false positive (as confirmed by nonacidotic postpartum pH values) and thus avoided unnecessary interventions such as operative delivery. The overall test accuracy of FBGA was 91%. FBGA accurately predicted postpartum cord blood pH values with a margin of ±0.2 in 319/343 (93%) cases. On the other hand, the false negative rate of FBGA was 8% (29/343). The PPV and NPV of FBGA for predicting postpartum acidosis were 50% and 91%, respectively. The sensitivity was 9% and the specificity was 99%. In a multivariate logistic regression analysis, maternal body mass index (odds ratio [OR] 1.1; 95% confidence interval [CI] 1.01–1.17; P = .029) and cardiotocography variations (OR 0.80; 95% CI 0.66–0.98; P = .029) independently affected the predictive value of FBGA. The PPV of FBGA regarding neonatal depression according to Apgar scores was low with only 17%. We conclude that FBGA may be used in clinical practice to rule out, but not to rule in, neonatal acidosis in parturients with NRFHRT. It can avoid unnecessary interventions such as cesarean section or operative vaginal delivery in up to 90% of cases, but cannot reliably detect fetal acidosis.

show abstract

The effect of intrauterine resuscitation by maternal hyperoxygenation on perinatal and maternal outcome: a randomized controlled trial

Moors

Bullens

Heimel

et al. 2020

American Journal of Obstetrics & Gynecology MFM

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Maternal hyperoxygenation is widely used during labor as an intrauterine resuscitation technique. However, robust evidence regarding its beneficial effect and potential side effects is scarce, and previous studies show conflicting results. OBJECTIVE: To assess the effect of maternal hyperoxygenation upon suspected fetal distress during the second stage of term labor on fetal heart rate, neonatal outcome, maternal side effects, and mode of delivery. MATERIALS AND METHODS: In a single-center randomized controlled trial in a tertiary hospital in The Netherlands, participants were randomized in case of an intermediary or abnormal fetal heart rate pattern during the second stage of term labor, to receive either conventional care or 100% oxygen at 10 L/min until delivery. The primary outcome was the change in fetal heart rate pattern. Prespecified secondary outcomes were Apgar score, umbilical cord blood gas analysis, neonatal intensive care unit admission, perinatal death, free oxygen radical activity, maternal side effects, and mode of delivery. We performed subgroup analyses for intermediary and abnormal fetal heart rate, and for small for gestational age fetuses. RESULTS: From March 2016 through April 2018, a total of 117 women were included. Fetal heart rate patterns could be analyzed in 71 women. Changes in fetal heart rate (defined as improvement, equal, or deterioration) in favor of maternal hyperoxygenation were significant (odds ratio, 5.7; 95% confidence interval, 1.7À19.1) using ordinal logistic regression. Apgar score, umbilical cord blood gas analysis, free oxygen radicals, and mode of delivery showed no significant differences between the intervention and control group. Among women with an abnormal fetal heart rate, there were fewer episiotomies on fetal indication in the intervention group (25%) than in the control group (65%, P < .01). CONCLUSION: Maternal hyperoxygenation has a positive effect on the fetal heart rate in the presence of suspected fetal distress during the second stage of labor. There was no significant difference in the mode of delivery or neonatal outcome; however, significantly fewer episiotomies on fetal indication were performed following maternal hyperoxygenation in the subgroup with abnormal fetal heart rate pattern.

show abstract

Practice variation in the management of intrapartum fetal distress in The Netherlands and the Western world

Cited by 8 publications

References 13 publications

Intrapartum Trans-Cervical Amnioinfusion as Adjuvant to Conventional Management of Women Had Ruptured Membranes With Thick Meconium-Stained Amniotic Fluid.

Intrapartum Trans-Cervical Amnioinfusion as Adjuvant to Conventional Management of Women Had Ruptured Membranes With Thick Meconium-Stained Amniotic Fluid.

Accuracy of intrapartum fetal blood gas analysis by scalp sampling

The effect of intrauterine resuscitation by maternal hyperoxygenation on perinatal and maternal outcome: a randomized controlled trial

Contact Info

Product

Resources

About