Reducing Primary Cesarean Delivery Rate Through Implementation of a Smart Intrapartum Surveillance System in a Labor and Delivery Unit

Abstract

The rapid changes in clinical maternity situations that occur in a labor and delivery unit can lead to unpredictable maternal and newborn morbidities. Cesarean section (CS) rate is a key indicator of the accessibility and quality of a labor and delivery unit. This retrospective cross-sectional study assesses the nulliparous, term, singleton, vertex (NTSV) cesarean delivery rates before and after the implementation of a smart intrapartum surveillance system. Research data were collected from the electronic medical records of a labor and delivery unit. The primary outcome was the CS rate of the NTSV population. The data of 3648 women admitted for delivery were analyzed. Of the studied deliveries, 1760 and 1888 occurred during the preimplementation and postimplementation periods, respectively. The CS rate for the NTSV population was 31.0% and 23.3% during the preimplementation and postimplementation periods, respectively, indicating a significant 24.7% (p = 0.014) reduction in CS rate after the implementation of the smart intrapartum surveillance system (relative risk, 0.75; 95% confidence interval, 0.71–0.80). In the NTSV population, the normal and CS birth groups, no significant difference in terms of newborn weight, neonatal Apgar scores, and the occurrence of the following: neonatal intensive care unit admission, neonatal meconium aspiration, chorioamnionitis, shoulder dystocia, perineal laceration, placental abruption, postpartum hemorrhage, maternal blood transfusion, and hysterectomy before and after the implementation of the smart intrapartum surveillance system. This study reveals that the use of the smart intrapartum surveillance system can effectively reduce the primary CS rate for low-risk NTSV pregnancies without significantly affecting perinatal outcomes.

TCP BBR-n: Increased throughput for wireless-AC networks

“…The BBR v2 has its pacing gain [11] paced at four cyclic values, BBR v2 keeps sampling the bandwidth and getting values for new BtlBW from the windowed maximum recent bandwidth sample -obtained using the BBR v2 delivery rate sampling algorithm [39]. We will soon see in the next sections that the pacing gain values in the ProbeBW phase are very conservative and do not suit for Wi-Fi 5 scenario in which frame aggregation [40] is used to deliver higher throughput.…”