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Am J Perinatol 2016; 33(07): 688-695
DOI: 10.1055/s-0036-1571325
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Easy as ABC: A System to Stratify Category II Fetal Heart Rate Tracings

Christina A. Penfield
1   Department of Obstetrics and Gynecology, University of California Irvine, Orange, California
2   Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
,
Connie Hong
2   Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
,
Samia El Haj Ibrahim
2   Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
,
Sarah J. Kilpatrick
2   Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
,
Kimberly D. Gregory
2   Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
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Publikationsverlauf

01. September 2015

03. Dezember 2015

Publikationsdatum:
12. Februar 2016 (online)

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Abstract

Objective To evaluate whether a subcategory system for category II tracings can improve team communication and perinatal outcomes.

Study Design We collected data prospectively for 15 months, first using the NICHD system, followed by the ABC system, which divides category II tracings into subcategories A, B, and C, each representing increased risk for metabolic acidemia. We surveyed providers about communication effectiveness and agreement on tracing interpretation for each system. In cases where the communication system was used to alert an off-site physician about a category II tracing, we compared arrival to L&D and NICU admissions.

Results The ABC system was preferred (69%, n = 152) and considered a more effective tool for communicating concerning fetal status (80% vs. 43%, p < 0.01). Participants also reported greater agreement on tracing interpretation (79% for ABC vs. 64% for NICHD, p = 0.046). When an off-site physician was contacted about a category II tracing (n = 95), they were more likely to arrive to L&D (44% vs. 20%, p < 0.01) and have fewer NICU admissions (0% vs. 6%, p < 0.01) with the ABC system.

Conclusion The ABC system resulted in improved team communication, increased physician response, and decreased NICU admissions. Using standardized communication may offer a useful strategy for identifying and expediting care.

Keywords

category II fetal heart rate tracings - electronic fetal monitoring - team communication - intrapartum fetal assessment

The findings of this study were presented at the 35th Annual Meeting for the Society for Maternal Fetal Medicine, February 2–7, 2015 in San Diego, CA.