Einfluss der Fetalblutanalyse auf die Prozess- und Ergebnisqualität in der Perinatalmedizin

Objectives: The clinical benefit of fetal blood analysis (FBA) opens a controversial national and international discussion. Is this biochemical procedure, which should be carried out on pathological cardiotocography (CTG), a good tool for optimising medical decision making and therefore improving quality of process and outcome in obstetrics. Study Design: We tried to answer this question with the data of the Perinatal survey of Hesse, a register of clinical births in one state of Germany. We included only cases with continuous or intermitted CTG with pathological results. Excluded were all cases with other pathological risks of birth. From a total number of 785766 deliveries (1990-2003) 20335 cases were chosen. Frequency of caesarean section was taken as a measurement of process quality. To compare fetal outcome we used the APGAR-Score, umbilical-artery pH, transfer in a neonatal intensive care unit and the early neonatal mortality. These items were compared for deliveries with or without FBA and also for each of these both groups for the mode of delivery (spontaneous or caesarean section). Results: In 22.5% of all deliveries with pathological CTG a FBA was performed for verification. In this group the rate of caesarean section was 13.1% compared to 20.6% in the group without FBA (p<.05). The number of neonates with APGAR < 7 could also been reduced significantly (0.9% vs. 0.5%, p<.05). The number of newborns with clinical depression (umbilical-artery pH < 7.0) and the requirement of transfer to neonatal intensive care units was also reduced by this procedure (0.6% vs. 0.4%, n.s. / 7.4% vs. 5.9%, p< .05). This difference is more distinct in spontaneous deliveries than in deliveries by caesarean section. Risks of pregnancy had no influence on these results. A difference in neonatal mortality was not measurable. Conclusion: The consistent use of fetal blood analysis to verify pathological cardiotocograms can improve the quality of care in obstetrics.