Oral Concurrent Session 8 - Labor & Delivery
Oral Concurrent Sessions
Jessica Page, MD, MSCI (she/her/hers)
Intermountain Health, University of Utah
Salt Lake City, UT, United States
Brett D. Einerson, MD, MPH (he/him/his)
Assistant Professor, Director of The Utah Placenta Accreta Program
University of Utah Health
Salt Lake City, UT, United States
Flint Porter, MD, MPH
Medical Director, Maternal-Fetal Medicine
Intermountain Healthcare
Salt Lake City, UT, United States
To determine the effect of system-wide implementation of and compliance with a standardized algorithm for the management of category II (cat II) FHR tracings on rates of composite neonatal morbidity associated with intrapartum hypoxia.
Study Design:
We performed a pre (Pre-I)- and post (Post-I)-implementation study following initiation of a standardized approach to management of cat II FHR tracings at 21 hospitals from a single healthcare system. The program included education/training, published algorithm with specific indications for team communication, and time frames for intervention. All singleton, nonanomalous pregnancies at > 35 wk were included. The primary outcome was a neonatal morbidity composite including unexpected admission to the NICU and at least 1 of the following: Need for cooling, art pH < 7.10, base deficit > 12, 5-min Apgar < 7, or documented HIE. Logistic regression was performed to control for GA, parity, OB complications, and race-ethnicity between Pre-I and Post-I groups and to assess the effect of compliance (defined as receiving intervention when indicated) on the composite outcome among the Post-I group alone.
Results:
There were 34,754 pregnancies in the Pre-I group (1/1/20-6/1/21) and 33,146 pregnancies in the Post-I group - (1/1/22-6/1/23). Table 1 compares demographics and outcomes. There were significantly fewer admissions to the NICU in the Post-I group. There was a small but significant increase in delivery by CS and operative vaginal delivery after implementation. Logistic regression confirmed the absence of significant difference in the primary outcome (aOR 1.03; CI 0.88-1.20) between the Pre-I and Post-I groups. Although compliance with the algorithm increased from 15% to 61% in the Post-I group across the study we could not confirm an association with lower rates of the composite outcome (aOR 0.79; CI 0.61-1.03).
Conclusion:
Implementation of a standardized approach to management of cat II FHR tracing in a large healthcare system was not associated with reduced rates of the composite outcome among Pre-I and Post-I groups.