Metabolic acidosis at birth and suboptimal care - illustration of the gap between knowledge and clinical practice

• Objective   To evaluate the occurrence and nature of suboptimal intrapartum care in   cases with metabolic acidosis in the newborn, and to estimate the   degree to which this may be prevented.   Design   Case-control study. Clinical audit.   Setting   Delivery units at two university hospitals in Sweden.   Population   Out of 28 486 deliveries, 161 neonates >= 34 weeks of gestational age   were born with metabolic acidosis.   Methods   Cases (n = 161): umbilical artery pH < 7.05 and base deficit >= 12   mmol/l. Controls (n = 322): pH >= 7.05 and Apgar score >= 7 at 5   minutes. Obstetric characteristics and oxytocin administration were   recorded. The last 2 hours of electronic fetal monitoring before   delivery were evaluated blinded to outcome. Intrapartum management was   analysed for suboptimal care by using predefined criteria.   Main outcome measure   Suboptimal intrapartum care.   Results   Case and control comparisons displayed an occurrence of suboptimal care   in 49.1% versus 13.0% (P < 0.001), oxytocin misuse in 46.6% versus   13.0% (P < 0.001), a failure to respond to a pathological   cardiotocographic pattern in 19.9% versus 1.2% (P < 0.001) and   suboptimal care related to vacuum deliveries in 3.1% versus 0.3% (P <   0.01) respectively.   Conclusion   Metabolic acidosis at birth is often associated with suboptimal   intrapartum care. The high rate of suboptimal care with regard to   oxytocin use and fetal surveillance illustrate a gap between guidelines   and clinical practice. Metabolic acidosis and related neonatal   morbidity could potentially be prevented in 40-50% of cases. The   adherence to guidelines must be checked.

Nyckelord

metabolic acidosis

suboptimal care

oxytocin

foetal surveillance

labour

MEDICINE

MEDICIN

Obstetrik och gynekologi

Obstetrics and Gynaecology

Publikations- och innehållstyp

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