Possibilities of a Combined Biophysical Non-Invasive Fetal Monitoring During Labour in Reducing the Frequency of Operative Deliveries – A Randomized Study

摘要

Objective. The aim of the study was to test the performance and safety of fetal pulse oximetry (FPO) in the management of non-reassuring CTG patterns in labour. Materials. A randomized controlled trial was conducted in 648 women in active labour and pregnancies > 36 weeks with reassuring admission CTG followed by non-reassuring patterns. All women were divided into 2 groups according to the mode of fetal intrapartum monitoring used. In the study group (n=324), women received a combined biophysical fetal monitoring with CTG plus FPO (n=324), while the control group of women had CTG alone monitoring. Main outcome measures were rates of operative deliveries and neonatal outcome. Results. The analysis showed a significant reduction of Caesarean deliveries in the study group receiving a combined fetal monitoring compared to controls (45/324 vs. 67/324; P=0.022). The total operative delivery rate was also lower, but not significantly (92/324 vs. 104/324, P=0.302). No comparative differences were observed in neonatal outcomes, except for 2 controls-group neonates born with pH-UA < 7.1, however completely normal further postnatal course. No such case was encountered in the study group neonates, and no perinatal deaths occurred during the study. Conclusions. A combined biophysical intrapartum fetal monitoring with CTG and fetal pulse oximetry enables safe reduction in Caesarean rate for non-reassuring CTG patterns, however it could not decrease a total operative delivery rate. Condensation: Fetal pulse oximetry safely reduces a Caesarean rate for non-reassuring patterns, but not the overall Caesarean rate.