Background. All guidelines regarding electronic fetal heart monitoring (EFM) before 2008 were designed toavoid more hypoxia than acidosis. Inaddition, the results of theCochrane meta-analysis of2013 do not show asignificant improvement inneonatal outcomes using EFM or intermittent auscultation (IA). Objectives. We retrospectively evaluated the results on delivery outcomes arising from a comparison between EFM and IA during labor of 2 specific and high-quality trials. We hypothesized that revisiting the delivery outcomes through the adoption of the recent National Institute of Child Health and Human Development (NICHHD) guidelines, thereported delivery outcomes would be different. Material and methods. The study retrospectively evaluated the results on delivery outcomes arising from thecomparison between EFM and IA during labor of the“Dublin trial” and “Vintzileos trial” published, respectively, in1985 and 1993. A translational model was constructed torecalculate these results, applying acorrection factor toestimate thenumber ofpathological patterns using the NICHHD guidelines for EFM. Results. After thereevaluation of the2 trials using theproposed correction factor, thecomparison of therecalculated cesarean section and operative delivery rates for fetal distress between EFM and IA group were no longer statistically significant, both inthe Dublin trial and Vintzileos trial. Even thecomparison of therecalculated incidence of the rate ofnon-reassuring fetal heart rate (FHR) patterns inthe EFM and IA groups has not given any indication of significance for the Vintzileos trial. Conclusions. Our results lead to reconsidering the results of the Dublin trial and Vintzileos trial in terms of operational rates of births, hypothesizing that these results would have been significantly lower if FHR traces were interpreted using thecurrent NICHHD guidelines, which aim toidentify potential acidotic fetuses rather than hypoxic ones
Continuous electronic fetal heart monitoring versus intermittent auscultation during labor: Would the literature outcomes have the same results if they were interpreted following the NICHHD guidelines?
Antonio Ragusa
2019-01-01
Abstract
Background. All guidelines regarding electronic fetal heart monitoring (EFM) before 2008 were designed toavoid more hypoxia than acidosis. Inaddition, the results of theCochrane meta-analysis of2013 do not show asignificant improvement inneonatal outcomes using EFM or intermittent auscultation (IA). Objectives. We retrospectively evaluated the results on delivery outcomes arising from a comparison between EFM and IA during labor of 2 specific and high-quality trials. We hypothesized that revisiting the delivery outcomes through the adoption of the recent National Institute of Child Health and Human Development (NICHHD) guidelines, thereported delivery outcomes would be different. Material and methods. The study retrospectively evaluated the results on delivery outcomes arising from thecomparison between EFM and IA during labor of the“Dublin trial” and “Vintzileos trial” published, respectively, in1985 and 1993. A translational model was constructed torecalculate these results, applying acorrection factor toestimate thenumber ofpathological patterns using the NICHHD guidelines for EFM. Results. After thereevaluation of the2 trials using theproposed correction factor, thecomparison of therecalculated cesarean section and operative delivery rates for fetal distress between EFM and IA group were no longer statistically significant, both inthe Dublin trial and Vintzileos trial. Even thecomparison of therecalculated incidence of the rate ofnon-reassuring fetal heart rate (FHR) patterns inthe EFM and IA groups has not given any indication of significance for the Vintzileos trial. Conclusions. Our results lead to reconsidering the results of the Dublin trial and Vintzileos trial in terms of operational rates of births, hypothesizing that these results would have been significantly lower if FHR traces were interpreted using thecurrent NICHHD guidelines, which aim toidentify potential acidotic fetuses rather than hypoxic onesI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
