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C-Section Guide Seems to Be Flawed

MANAGED CARE November 2011. © MediMedia USA
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C-Section Guide Seems to Be Flawed

MANAGED CARE November 2011. ©MediMedia USA

The method physicians use to determine whether a Cesarean section must be done is badly flawed, according to researchers at Intermountain Medical Center. At issue are the Category II heart rate patterns that are monitored to cue doctors as to when a C-section should be done.

Category I means, essentially, that the baby is fine and all systems are go for a normal birth. Category II is indeterminate. Category III means that the heart rate is troubling and a C-section must be performed.

Category II heart rate patterns show up most often — 84 percent of the time. However, according to the study published in the October issue of Obstetrics & Gynecology, Category II is called the “indeterminate category” for a reason. The vast majority of Category II babies had no short-term problems after delivery.

“Combining so many different fetal heart rate patterns into a single ‘indeterminate’ category surely detracts from the use of fetal heart rate monitoring as an indicator of fetal condition,” the study says.

Researchers suggest that Category II be broken into subcategories “to differentiate those at highest risk from those at low risk for neonatal compromise and so to improve the predictive value of fetal heart rate monitoring.”

Researchers studied fetal heart patterns from more than 48,000 labor and delivery cases at 10 Intermountain Healthcare hospitals over nearly 2.5 years.