Immediate newborn outcome and mode of delivery: use of standardized fetal heart rate pattern management

J Matern Fetal Neonatal Med. 2013 Jan;26(1):71-4. doi: 10.3109/14767058.2012.728645. Epub 2012 Oct 3.


Objective: To determine whether a rule-based system for fetal heart rate interpretation can result in reduced metabolic acidemia without increasing obstetrical intervention.

Methods: Rates of vacuum-assisted delivery and Cesarean sections, and umbilical artery pH and base excess values were determined over a 5-year period in a single hospital with 3907 deliveries in Japan. Results were compared for 2 years before and 2 years after a 6-month training period in rule-based fetal heart rate interpretation.

Results: The pre- and post-training rates of unscheduled Cesarean deliveries (4.8% vs. 6.0%) and vacuum deliveries (21.2% vs. 18.1%) did not differ significantly. The rates of umbilical arterial pH <7.15 (1.51% vs. 0.18%, p < 0.05) and base excess <-12 mEq/L (1.76% vs. 0.25%, p < 0.05) were significantly lower after training.

Conclusion: A standardized fetal heart rate pattern management system was associated with a 7-fold reduction of newborn metabolic acidemia with no change in operative intervention.

MeSH terms

  • Acidosis / prevention & control*
  • Cardiotocography / standards*
  • Delivery, Obstetric / statistics & numerical data*
  • Education
  • Heart Rate, Fetal*
  • Humans
  • Infant, Newborn / blood*