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Am J Obstet Gynecol. 2018 Dec 27. pii: S0002-9378(18)32288-9. doi: 10.1016/j.ajog.2018.12.037. [Epub ahead of print]

Computerized analysis of cardiotocograms and ST signals is associated with significant reductions in hypoxic-ischemic encephalopathy and cesarean delivery: an observational study in 38 466 deliveries.

Author information

1
Dept. Obstetrics and Gynecology, Medical School - University of Porto, Centro Hospitalar S. João, Portugal. Electronic address: joanaslopespereira@gmail.com.
2
Dept. Obstetrics and Gynecology, Medical School - University of Porto, Centro Hospitalar S. João, Portugal; Institute of Biomedical Engineering, I3s, Porto, Portugal.
3
Institute of Biomedical Engineering, I3s, Porto, Portugal; Health Information and Decision Sciences Dept. and Center for Research in Health Technology and Services (CINTESIS), Medical School - University of Porto, Portugal; Dept. of Obstetrics, Gynecology and Reproductive Medicine, Santa Maria Hospital, Medical School - University of Lisbon, Portugal.
4
Health Information and Decision Sciences Dept. and Center for Research in Health Technology and Services (CINTESIS), Medical School - University of Porto, Portugal.
5
Dept. Obstetrics and Gynecology, Medical School - University of Porto, Centro Hospitalar S. João, Portugal.

Abstract

BACKGROUND:

Intrapartum cardiotocography (CTG) is widely used in high-resource countries and remains at the centre of fetal monitoring and the decision to intervene, but there is ample evidence of poor reliability in visual interpretation, as well as limited accuracy in identifying fetal hypoxia. Combined monitoring of CTG and ST segment signals was developed to increase specificity, but analysis relies heavily on CTG interpretation and is therefore also affected by the previously referred problems. Computerized analysis was developed to overcome these limitations, aiding in the quantification of parameters that are difficult to evaluate visually, such as variability, integrating the complex guidelines of combined CTG and ST analysis, and using visual and sound alerts to prompt healthcare professionals to re-evaluate features associated with fetal hypoxia.

OBJECTIVE:

To evaluate the effect of introducing a central fetal monitoring system with computerized analysis of CTG and ST signals into the labor ward of a tertiary care university hospital where all women are continuously monitored with CTG. The incidence of adverse perinatal outcomes and intervention rates was evaluated over time.

STUDY DESIGN:

In this retrospective cohort study, yearly rates of hypoxic-ischemic encephalopathy, instrumental vaginal delivery, overall cesarean delivery, and urgent cesarean delivery were obtained from the hospital's clinical databases. The rates occurring in the period from January 2001 to December 2003, before the introduction of central monitoring system with computerized analysis of CTG and ST signals (Omniview-SisPorto), were compared to those occurring from January 2004 to December 2014, after introduction of the system. All rates were calculated with 95% confidence intervals (95% CI).

RESULTS:

A total of 38 466 deliveries occurred during this period. After introduction of the system, there was a significant decrease in the number of hypoxic-ischemic encephalopathy cases per 1000 births (5.3‰, 95%CI=[4.0,7.0] vs. 2.2‰, 95%CI=[1.7,2.8]; RR=0.42, 95%CI=[0.29,0.61]), overall cesarean delivery rates (29.9%, 95%CI=[28.9,30.8] vs. 28.3%, 95%CI=[27.8,28.8]; RR=0.96, 95% CI=[0.92,0.99]), and urgent cesarean deliveries (21.6%, 95%CI=[20.7-22.4] vs. 19.2%, 95%CI=[18.8-19.7]; RR=0.91, 95% CI=[0.87,0.95]). The instrumental vaginal delivery rate increased (19.5%, 95%CI=[18.7-20.3] vs. 21.4%, 95%CI=[21.0-21.9; RR=1.07, 95% CI 1.02-1.13].

CONCLUSION:

Introduction of computerized analysis of CTG and ST signals in a tertiary care hospital was associated with a significant reduction in the incidence of hypoxic-ischemic encephalopathy and a modest reduction in cesarean deliveries.

KEYWORDS:

Central monitoring; electronic fetal monitoring; fetal; fetal distress; heart rate; intrapartum surveillance; neonatal acidemia; neonatal asphyxia; neonatal encephalopathy; non-reassuring heart rate tracings; real-time alerts

PMID:
30594567
DOI:
10.1016/j.ajog.2018.12.037

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