Refining the Prediction and Prevention of Emergency Operative Deliveries with the Fetal Reserve Index.

Abstract:

:Electronic fetal monitoring (EFM) is a poor predictor of outcomes attributable to delivery problems. Contextualizing EFM by adding maternal, obstetrical, and fetal risk-related information to create an index called the Fetal Reserve Index (FRI) improves the predictive capacity and facilitates the timing of interventions. Here, we test critical assumptions of FRI as a clinical tool. Our conceptualization implies that the earlier one reaches the red zone (FRI ≤25) and the longer one spends in the red zone, the greater the likelihood of emergency operative deliveries (EOD). METHODS:We analyzed 1,402 patients using logistic regression predicting the probability of EOD and employed qualitative methodology techniques to refine predictive capabilities. RESULTS:Reaching the red zone early and staying there > 1 h increases the probability of EOD. When these risk factors are paired with intrauterine resuscitation (IR) in Stage 1, the reduction of EOD is substantial. CONCLUSION:FRI is a capable predictor of EOD because it accurately identifies the level of malleable risk. FRI analysis increases the risk of using IR in Stage 1. Matching risk and resources dramatically reduces the chances of EOD. Earlier IR improves the outcomes if the calculated risk is high.

journal_name

Fetal Diagn Ther

authors

Britt DW,Evans MI,Schifrin BS,Eden RD

doi

10.1159/000494617

subject

Has Abstract

pub_date

2019-01-01 00:00:00

pages

159-165

issue

3

eissn

1015-3837

issn

1421-9964

pii

000494617

journal_volume

46

pub_type

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