Intrapartum Resuscitation Interventions for Category II Fetal Heart Rate Tracings and Improvement to Category I. Issue 3 (September 2021)

• Record Type: Journal Article
• Authors: Reddy, Uma M.; Weiner, Steven J.; Saade, George R.; Varner, Michael W.; Blackwell, Sean C.; Thorp, John M.; Tita, Alan T.N.; Miller, Russell S.; Peaceman, Alan M.; McKenna, David S.; Chien, Edward K. S.; Rouse, Dwight J.; El-Sayed, Yasser Y.; Sorokin, Yoram; Caritis, Steve N.
• Is Part Of: Obstetrics and gynecology. Volume 138:Issue 3(2021)
• Publication Date: 2021-09
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/AOG.0000000000004508
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : OBJECTIVE: To evaluate intrapartum resuscitation interventions and improvement in category II fetal heart rate (FHR) tracings. METHODS: This secondary analysis of a randomized trial of intrapartum fetal electrocardiographic ST-segment analysis included all participants with category II FHR tracings undergoing intrauterine resuscitation: maternal oxygen, intravenous fluid bolus, amnioinfusion, or tocolytic administration. Fetal heart rate pattern-recognition software was used to confirm category II FHR tracings 30 minutes before intervention and to analyze the subsequent 60 minutes. The primary outcome was improvement to category I within 60 minutes. Secondary outcomes included FHR tracing improvement to category I 30–60 minutes after the intervention and composite neonatal outcome. RESULTS: Of 11, 108 randomized participants, 2, 251 (20.3%) had at least one qualifying intervention for category II FHR tracings: 63.7% improved to category I within 60 minutes and 50.5% improved at 30–60 minutes. Only 3.4% underwent cesarean delivery and 4.1% an operative vaginal delivery for nonreassuring fetal status within 60 minutes after the intervention. Oxygen administration was the most common intervention (75.4%). Among American College of Obstetricians and Gynecologists-defined subgroups that received oxygen, the absent FHR accelerations and absent–minimal FHR variability subgroup (n=332) was more likely to convert to category I within 60 minutes than the FHR accelerations or "moderate FHR variability" subgroup (n=1, 919) (77.0% vs 63.0%, odds ratio [OR] 2.0, 95% CI 1.4–2.7). The incidence of composite neonatal adverse outcome for category II tracings was 2.9% (95% CI 2.2–3.7%) overall; 2.8% (95% CI 2.0–3.8%) for improvement to category I within 60 minutes (n=1, 433); and 3.2% (95% CI 2.1–4.6%) for no improvement within 60 minutes (n=818). However, the group with improvement had 29% lower odds for higher level neonatal care (11.8% vs 15.9%, OR 0.71, 95% CI 0.55–0.91). CONCLUSION: Nearly two thirds of category II FHR tracings improved to category I within 60 minutes of intervention with a relatively low overall rate of the composite neonatal adverse outcome. FUNDING SOURCE: Funded in part by Neoventa Medical. Abstract : The majority of category II fetal heart rate tracings improve to category I within 60 minutes of intrapartum interventions.