Managing nonreassuring fetal heart rate patterns before cesarean delivery - Compliance with ACOG recommendations

OBJECTIVE: To determine the rate of compliance with current American Colleg e of Obstetricians and Gynecologists (ACOG) recommendations for management of parturients undergoing cesarean delivery for persistent nonreassuring fe tal heart rare (FHR) tracings. STUDY DESIGN: We per formed a retrospective chart review (July 1995-June 19 98) of all parturients who underwent cesarean delivery for nonreassuring FH X tracings. Outcome measures included maneuvers for fetal assessment (scalp stimulation or scalp blood pH) and therapeutic interventions (tocolytic ag ents for reducing uterine activity or amnioinfusion). Patients with multipl e gestations and cesarean delivery for other indications were excluded. Stu dent's t test, chi (2) and Fisher's exact tests were used; odds ratio and 9 5% confidence interval were calculated. P < .05 was considered significant. RESULTS: Cesarean delivery for persistent nonreassuring FHR patterns includ ed 134 (3.6%) of the 3,671 deliveries during three years. Thirty patients p roduced intrapartum FHR tracings containing persistent variable deceleratio ns; 12 (40%) of these patients received amnioinfusion. In only 37% (50/134) of cases was there a documented attempt at scalp or acoustic stimulation p rior to delivery. Scalp pH was obtained in 15% (15/98) of patients whose ce rvix was at least 3 cm dilated. Tocolytic agents were used for intrauterine resuscitation in 25% (34/134) of casts; their use varied significantly (P = .006) with the type of FHR abnormality, CONCLUSION: At our tertiary center, ACOG rerommendations for management of nonreassuring intrapartum FHR tracings were used in a limited number of cas es.