Impact of fetal pulse oximetry and ST analysis surveillance withdrawal on rates of obstetric surgery and frequency of low birth umbilical artery pH: A cause of rising caesarean rates?

Abstract

A retrospective observational study on a sample of 13,413 deliveries analysed the effect of a withdrawal of the CTG additional diagnostic methods of fetal hypoxia (fetal pulse oximetry and ST analysis of the fetal ECG) on operative delivery rates and frequency of the umbilical arterial pH < 7.15. Following the withdrawal, obstetricians are more likely to perform caesarean sections for fetal hypoxia (OR 2.23, 95% CI 1.94–2.55, p < 0.0001) and labour dystocia (OR 1.45, 95% CI 1.18–1.77, p = 0.0003), which increases the overall caesarean rate (OR 1.49, 95% CI 1.38–1.61, p < 0.0001), although decreases the incidence of birth umbilical arterial pH < 7.15 (OR 0.43, 95% CI 0.22–0.85, p = 0.015). This also leads to the significant decline in overall frequency of instrumental vaginal deliveries (OR 0.58, 95% CI 0.48–0.71). In order to decrease the overall caesarean rate, obstetricians need to be supported by more accurate and possibly automated diagnostic tools for intrapartum fetal hypoxia.

Keywords::

• Caesarean rate
• fetal pulse oximetry
• operative delivery
• ST analysis

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

This work was supported by the grants of the ‘Science and Technology Assistance Agency’ under the No. APVT-20-033104 and the project with ITMS code 26110230067 co-financed from EU sources.