The most common indications for primary cesarean delivery (PCD) in the US are labor dystocia and abnormal fetal heart tracing (FHT). Category II tracings make up the majority of intrapartum tracings and management may differ among providers (Obstetricians [OB], midwives [CNM], and family medicine physicians [FM]). This study aims to determine the characteristics of FHT which resulted in PCD at UI Health (UIH) by provider type.
IRB approved, retrospective cohort study of primary CD at UIH during 2018. Data was abstracted from electronic medical records and analyzed in SPSS.
357 PCD occurred during the study period. The most common indication for PCD was abnormal FHT (45.1%), malpresentation (18.2%), followed by labor dystocia (18.1%). When stratifying for provider type, FM had more CD for labor dystocia, while OB and CNM had more for FHT. However, when removing other objective indications, such as placenta previa and malpresentation, FHT was the most common regardless of which service managed antepartum and intrapartum care (45.1%, P=.12). The majority of tracings at the time of decision for CD were category II (84%). Minimal variability was present in (56%, P=.16). Late decelerations were most common at time of CD (46.6%, P=.17), followed by variable (41%, P=.55) and prolonged (15%, P=.14).
Since standardization of categories of FHT by NICHD, there seems to be agreement among providers in terms of the management of category II tracings. More data is needed to confirm this trend, while continuing efforts to improve intrauterine resuscitation in order to decrease the PCD rate.