Category II Tracings, Algorithms and Recognition of Metabolic Acidemia
This study by Clark et al. (AJOG, 2017) compared the performance of the expert opinion algorithm for the management of category II fetal heart rate tracings to real life practice in the context of neonatal metabolic academia.
Outcomes-blinded validation study using matched controls
120 infants with an arterial cord blood base deficit of > 12mM/L were studied, along with controls (base deficit <8 mM/L). In actual practice,30% of fetuses with metabolic acidemia had operative intervention based on abnormal fetal heart rate tracings compared to the expert algorithm, which would have led to intervention in 45.8% of cases (a statistically significant difference P = 0.016). In cases where the algorithm-assisted review suggested operative delivery, the decision to deliver would have been made over two hours before the actual delivery. The expert review did not suggest early delivery for 65/120 patients with metabolic acidemia, but these cases were most often associated with a sudden turn of events prior to delivery, where there would not have been a sufficient time frame for the algorithm to be put in to effect. The authors conclude that expert, algorithm-based fetal heart rate interpretation has the modest potential to help recognize certain tracings associated with acidemia in a clinical setting. Presently, there are still no technologies available that can actually prevent neonatal metabolic academia.
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