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

L D Brown1, M Permezel1,2, J R Holberton3

  • 1a Department of Obstetrics and Gynaecology , Mercy Hospital for Women , Heidelberg , Victoria , Australia.

The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
|August 19, 2016
PubMed

Insights

A fetal surveillance education program (FSEP) reduced intrapartum hypoxia and related deaths in term neonates. While neonatal intensive care unit admissions increased, severe morbidity like hypoxic encephalopathy decreased, with no rise in emergency C-sections.

Area of Science:

  • Perinatal medicine
  • Neonatal outcomes research
  • Medical education and patient safety

Background:

  • Intrapartum hypoxia remains a significant concern for term neonates.
  • Effective fetal surveillance is crucial for improving neonatal outcomes.
  • Standardized education programs can enhance clinical practice in obstetric and neonatal care.

Purpose of the Study:

  • To evaluate the impact of a multidisciplinary Fetal Surveillance Education Program (FSEP) on term neonatal outcomes.
  • To assess changes in neonatal mortality and severe morbidity following FSEP implementation.
  • To determine if the FSEP influenced rates of operative delivery.

Main Methods:

  • Retrospective cohort study comparing outcomes before (1998-2004) and after (2005-2010) FSEP introduction.
  • Analysis of clinical data for term infants admitted to a neonatal intensive care unit (NICU) in Australia.
  • Exclusion of infants with congenital abnormalities; comparison of neonatal mortality, NICU admissions, Apgar scores, hypoxic encephalopathy, and operative delivery rates.

Main Results:

  • A significant decrease in intrapartum hypoxic death rate at term (2.02 to 1.07 per 10,000 births).
  • Increased NICU admissions post-FSEP (10.6 to 14.6 per 10,000 live births), but with fewer neonates having Apgar scores < 5.
  • Reduced rates of hypoxic ischemic encephalopathy (36% to 30%) and no increase in emergency cesarean sections.

Conclusions:

  • Implementation of a national FSEP was associated with improved neonatal outcomes, specifically reduced intrapartum hypoxia.
  • The program led to an increase in neonatal intensive care unit admissions but a decrease in severe neonatal morbidity.
  • The FSEP demonstrated effectiveness in reducing adverse outcomes without compromising delivery intervention rates.
Abstract

Keywords:
Fetal monitoringhypoxic ischemic encephalopathyintrapartumneonatal outcome

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