Neonatal outcomes after introduction of a national intrapartum fetal surveillance education program: a retrospective cohort study

Abstract

Objective: To determine the impact of a multidisciplinary fetal surveillance education program (FSEP) on term neonatal outcomes.

Methods: A retrospective cohort study of term neonatal outcomes before (1998–2004) and after (2005–2010) introduction of a FSEP. Clinical data was collected for all term infants admitted to a neonatal intensive care unit (NICU) in Australia between 1998 and 2010. Infants with congenital abnormalities were excluded. Neonatal mortality and severe neonatal morbidity (admission to a NICU, respiratory support, hypoxic encephalopathy) were compared before and after the FSEP was introduced. The rates of operative delivery during this time were assessed.

Results: There were 3 512 596 live term births between 1998 and 2010. The intrapartum hypoxic death rate at term decreased from 2.02 to 1.07 per 10 000 total births. More neonates were admitted to NICU after 2005 (10.6 versus 14.6 per 10 000 live births), however fewer babies admitted to the neonatal unit had Apgar scores < 5 at five minutes (55.1–45.5%, RR 0.82, 95% CI 0.7–0.87); and rates of hypoxic ischemic encephalopathy fell from 36% to 30% (RR 0.83, 95% CI 0.76–0.90). There was no increase in rates of emergency in labour caesarean sections (11.7% pre versus 11.1% post, RR 0.95, 95% CI 0.95–0.96).

Conclusions: Introduction of a national FSEP was associated with increased neonatal admissions but a reduction in intrapartum hypoxia, without increasing emergency caesarean section rates.

Keywords:

• Fetal monitoring
• intrapartum
• neonatal outcome
• hypoxic ischemic encephalopathy

Acknowledgements

The authors would like to thank Mark Beaves, the RANZCOG FSEP Co-ordinator for FSEP course attendance data.

Declaration of interest

Prof Permezel is the current president of the RANZCOG but has not been involved in the conception and running of the FSEP, or any financial gain.

Funding

No funding was obtained for this paper.

Ethics approval

This study was reviewed and approved by the Mercy Health Human Ethics Committee on the 24 September 2012 (R12/53).