A modified fetal heart rate tracing interpretation system for prediction of cesarean section

• Published in: The journal of maternal-fetal & neonatal medicine Vol. 25; no. 7; p. 1055
• Main Authors: Schnettler, William T, Rogers, Jennifer, Barber, Rachel E, Hacker, Michele R
• Format: Journal Article
• Language: English
• Published: England 01.07.2012
• Subjects: Adult; Cardiotocography - standards; Cesarean Section - statistics & numerical data; Female; Heart Rate, Fetal; Humans; Pregnancy; Retrospective Studies; Young Adult
• ISSN: 1476-4954
• DOI: 10.3109/14767058.2011.614975

To investigate whether a modified version of the 2008 National Institute of Child Health and Human Development (NICHD) interpretation system upon admission decreases cesarean delivery risk. This retrospective cohort study ascribed a modified category to the first 30 min of fetal heart rate (FHR) tracings in labor. Category I was divided into two subsets (Ia and Ib) by the presence of accelerations. Category II was divided into four subsets (IIa-IId) based on baseline FHR, variability, response to stimulation and decelerations. Log-binomial regression was used to calculate risk ratios (RR) and 95% confidence intervals (CI). A category was ascribed to 910 women. Most FHR tracings were Category Ia (65.8%), Ib (7.7%), IIb (11.8%) and IId (14.0%). Category Ib tracings (fewer than two accelerations) were 2.26 (95% CI: 1.13-4.52) times more likely to result in cesarean delivery for abnormal FHR tracing than Category Ia tracings. A similar increase in risk was seen when comparing Category IIb and Category IId with Category Ia. Application of a modified version of the 2008 NICHD FHR interpretation system to the initial 30 min of labor can identify women at increased risk of cesarean delivery for abnormal FHR tracing.