Emergency Cesarean Delivery for Nonreassuring Fetal Heart Rate Tracings: Compliance With ACOG Guidelines

Abstract

The American College of Obstetricians and Gynecologists (ACOG), in 1995, recommended that, before starting cesarean delivery for fetal distress, a scalp pH be obtained if feasible and intrauterine resuscitation attempted with tocolytic agents or amnioinfusion. It was further proposed that, if fetal heart rate (FHR) abnormalities persisted, the skin incision for cesarean delivery be made within 30 minutes of the decision to operate. In 1998, the ACOG determined that, because most newborn infants delivered for fetal distress are in good condition, the term nonreassuring fetal status is preferable. Practitioners have been slow to accept these recommendations. The authors undertook a PubMed search of the English-language literature from 1990 to 2000 to estimate compliance with the ACOG guidelines. There were 169 relevant publications. In 3 relevant reports, scalp blood pH was determined in 5% of 1128 emergency cesarean section deliveries. Three reports found that tocolytics were used for intrauterine resuscitation in 16% of 1261 cases. Five reports found that the interval between the decision to operate and the incision was less than 30 minutes in 59% of 446 cases. In 5 reports of 340 cases in which the cord blood pH was determined, the umbilical arterial pH was less than 7.00 in 10% of instances. Little attention has been given in the recent obstetric literature to compliance with the ACOG guidelines concerning how best to manage emergency cesarean delivery for fetal distress. The authors conclude from this review of the recent literature that compliance is infrequent and incomplete.