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  • Title: Recognition and response to electronic fetal heart rate patterns: impact on newborn outcomes and primary cesarean delivery rate in women undergoing induction of labor.
    Author: Clark SL, Meyers JA, Frye DK, Garthwaite T, Lee AJ, Perlin JB.
    Journal: Am J Obstet Gynecol; 2015 Apr; 212(4):494.e1-6. PubMed ID: 25460835.
    Abstract:
    OBJECTIVE: The objective of the study was to examine the clinical impact of specific fetal monitoring-related practices during induced labor. STUDY DESIGN: This was a prospective, nonrandomized study. RESULTS: We studied 14,398 women undergoing oxytocin induction of labor. A decrease in the infusion rate of oxytocin in the face of specified category II fetal heart rate tracings was associated with a significantly reduced rate of neonatal intensive care unit admission (3.8% vs 5.2%, P = .01) and Apgar score less than 7 at 1 and 5 minutes (4.9% vs 6.4%, P = .01, 0.6% vs 1.1%, P = .04). Compliance with an in-use checklist was associated with both a reduction in the rate of neonatal intensive care unit admission (2.9 vs 4.4, P = .00) and a reduction in the cesarean delivery rate (15.8% vs 18.8%, P = .00). CONCLUSION: Electronic fetal heart rate monitoring improves neonatal outcomes when unambiguous definitions of abnormal fetal heart rate and tachysystole are coupled with specific interventions. Utilization of a checklist for oxytocin monitoring is associated with improved neonatal outcomes and a reduction in the cesarean delivery rate.
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