The Influence of a Fetal Monitoring Algorithm on the C-Section Rate in Patients Over 37 Weeks Gestation [14D]

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A recently published expert opinion on interpretation and management of category II fetal heart tracings was adopted at our institution in 2014. Local Providers expressed concern that implementation of the algorithm may lead to an increase in the primary cesarean section rate for non-reassuring fetal heart tracings.


A retrospective chart review was performed to assess the potential effect of the algorithm on the cesarean section rate. Term Delivery records for pre and post implementation were reviewed. Inclusion criteria were singleton term pregnancies. Exclusion criteria were preterm pregnancies, multiple gestations, fetal anomalies, abnormal placentation, fetal malposition, uterine anomalies, prior uterine surgery, and other indications for cesarean delivery. Patient data included maternal demographics, obstetrical history and delivery outcomes. The primary outcome was the cesarean section rate. Secondary outcomes included NICU admissions, maternal and neonatal morbidity, and Apgar scores.


The total number of deliveries during the study period was 7,214 (3507 pre-implementation and 3707 post-implementation) with the primary cesarean sections for all causes at 716 (20.4%) and 739 (19.9%) respectively. There was no difference in the primary cesarean section rate for non-reassuring fetal heart tracing between the groups (5.7% pre-algorithm; 5.5% post algorithm, P=.9). No difference was observed between groups for maternal age, parity, birth weight, or Apgars. A 33% reduction in NICU admissions was observed (7.4% vs 4.8%, P=.2) although not statistically significant.


Implementation of a category II algorithm did not affect the primary cesarean section rate for non-reassuring fetal heart tracings and may decrease NICU admissions.

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