Oral Concurrent Session 2 - Clinical Obstetrics and Quality
Oral Concurrent Sessions
Kristen A. Cagino, MD
Maternal Fetal Medicine Fellow
UT Houston
Houston, Texas, United States
Rachel L. Wiley, MD, MPH (she/her/hers)
MFM Fellow
University of California, San Diego
San Diego, California, United States
Aaron W. Roberts, MD
Assistant Professor
McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Claudia J. Ibarra, MD, MPH (she/her/hers)
MFM Fellow
McGovern Medical School at UTHealth
Houston, TX, United States
Natalie L. Neff, MD
Maternal Fetal Medicine Fellow
McGovern Medical School at UT Health
Houston, Texas, United States
Kimen S. Balhotra, MD (she/her/hers)
Maternal Fetal Medicine Fellow
McGovern Medical School at UTHealth
Houston, TX, United States
Khalil M. Chahine, MD
Resident
McGovern Medical School at UTHealth
Houston, Texas, United States
Christina Cortes, MD (she/her/hers)
Resident
McGovern Medical School at UTHealth
Houston, Texas, United States
Shareen Patel, MD
Resident
McGovern Medical School at UTHealth
Houston, Texas, United States
Tala Ghorayeb, MD
McGovern Medical School at UTHealth
Houston, Texas, United States
Holly Flores, DO
Resident
University of Texas Health Science Center
Houston, Texas, United States
Fabrizio Zullo, MD (he/him/his)
Ob/Gyn Resident
University of Rome La Sapienza
Rome, Lazio, Italy
Hector M. Mendez-Figueroa, MD
Associate Professor
McGovern Medical School at UTHealth
Houston, Texas, United States
Suneet Chauhan, DSc, MD
Christiana Care
Newark, Delaware, United States
To ascertain if the proportion of time spent in Category II fetal heart rate tracing (FHRT) among singleton term (> 37 wks) laboring patients was associated with adverse outcomes.
Study Design:
Obstetricians—blinded to maternal characteristics and outcomes—reviewed the available FHRT (120 minutes before delivery, at 20 min segments) for all deliveries within a 15-month period. Term, non-anomalous, singleton pregnancies who attempted labor were included. We excluded those that only had persistent category I or any segment with category III. Cohort was divided into 3 groups: Category II for < 33% of the time (Group 1), for 33-66% of the time (Group 2), and > 66% of the time (Group 3). The primary outcome was the rate of composite neonatal adverse outcomes (CNAO); the secondary outcomes were cesarean delivery (CD) for non-reassuring FHRT and composite maternal adverse outcomes (CMAO). Adjusted odds ratio (OR) with 95% confidence intervals (CI) were calculated.
Results:
Among the 5,160 consecutive deliveries, 2,780 (54%) met the inclusion criteria. Of the 321,980 min of FHRT reviewed, 223,000 min (69%) were category II. Specifically, 10% were in Group 1, 26% in Group 2, and 64% in Group 3. Characteristics of FHRT which differed among the 3 groups were frequency of minimal variability, as well as variable, late and prolonged decelerations (Table 1). CD for non-reassuring FHRT differed significantly between the groups (p < 0.01). The rate of CNAO did not differ among the groups (p=0.72), however the CMAO differed significantly (p=0.02). Adjusted OR comparing category II for Group 1 vs. Group 2 and for Group 1 vs. Group 3 indicated that CD for NR-FHRT, CNAO and CMAO did not differ significantly among the groups (Table 2).
Conclusion:
Among term deliveries, the majority of FHRTs are category II for over two-thirds of the total time during the last 120 min of labor. The proportion of time fetal heart rate tracing was in category II did not significantly influence cesarean delivery for non-reassuring tracing and adverse outcomes for the neonatal-maternal dyad.
