Segregation of Patients for Intrapartum Monitoring, using Robson's Classification.

Abstract

Monitoring labour by intermittent or continuous foetal heart rate monitoring has been discussed widely in literature. Robson's classification has categorized pregnant women in ten groups. The study proposes to examine in which patients one must recommend continuous or intermittent foetal heart rate monitoring. To study the effect of Continuous Electronic Foetal Monitoring (CEFM) on the overall rate of operative deliveries as well as the rate using Robson's classification and the neonatal outcome. After Institutional Review Board approval, low risk parturients with a reactive foetal heart rate at arrival in labour were prospectively analysed. Women with a previous caesarean section, those requiring elective caesarean section and having high risk factors were excluded. Patient details, history, examination findings and the method of monitoring, whether continuous or intermittent was noted. 1803 women were monitored by CEFM and 2107 by intermittent auscultation. In both the groups of intrapartum monitoring, suspected foetal distress was followed by immediate intervention in the form of caesarean section or operative vaginal delivery without resorting to any other monitoring methods such as foetal scalp blood sampling, as per the institutional policy. Comparison was based on the need for operative deliveries in view of presumed foetal distress and the neonatal outcome between the two groups of monitoring and further in each Robson's class. Results were assessed using IBM® SPSS Version 22.0, Chi-square test, considering p<0.05 as significant. Operative deliveries in view of suspected foetal distress increased and the neonatal outcome was better with CEFM. Assessing in each Robson's class, only class 4A, 7A and 10A results were consistent with the overall outcome. In others (class 2A), women experienced reduced rate of operative deliveries and better neonatal outcome with CEFM. In yet others, there was no benefit with CEFM as there were increased operative deliveries without any difference in the neonatal outcome. Segregation of patients for intrapartum monitoring using Robson's classification would result in decreased operative deliveries and a better neonatal outcome.