Intervention for fetal distress among obstetricians, registered nurses, and residents: similarities, differences, and determining factors.

OBJECTIVE

To explore the factors possibly associated with the intrapartum management of nonreassuring fetal status and the factors affecting the decision to expedite delivery for fetal distress among different obstetric health care providers.

METHODS

In a cross-sectional study, a standardized hypothetical clinical scenario of management of fetal distress was presented by a study investigator to labor and delivery personnel, including faculty obstetricians, residents, and registered nurses (N=52). An intervention index was calculated for each faculty by dividing the number of cesarean and operative deliveries for nonreassuring fetal status by the actual number of laboring patients supervised by each faculty in 2008.

RESULTS

Selection of the timing of delivery and characterization of nonreassuring fetal heart rate patterns was not different among the different providers (P=.3). However, compared with residents, registered nurses notified the attending obstetricians at an earlier stage and in response to different fetal heart rate tracing scenarios suggestive of fetal distress (P<.001). Personal or professional experience, type of clinical practice, and psychological traits did not affect the management of the standardized clinical scenario or the intervention index (P=.3-.9).

CONCLUSION

Different providers practicing in the same environment may develop a similar approach in the setting of nonreassuring fetal status that overcomes individual differences and follows the current guidelines on electronic fetal monitoring.

LEVEL OF EVIDENCE

II.