Abstract 8: Impact on Maternal and Perinatal Outcomes after the Implementation of Physiological Interpretation of Cardiotocograph in the United Arab Emirates

Abstract Background: Misinterpretation of the features observed in the cardiotocograph (CTG) may lead to unnecessary intrapartum operative interventions to women due to over-reaction (“pathological” CTG) l or may result in hypoxic-ischaemic encephalopathy (HIE) or perinatal deaths. Physiological interpretation of CTG involves classification of CTG traces based on the type of hypoxic/non-hypoxic stress and determining the fetal responses to stress to individualise care. Aim: To determine the impact of implementing the principles of physiological interpretation of CTG at two premier tertiary referral hospitals specialising in complex obstetric care in the UAE on the rate of intrapartum emergency caesarean sections (EMLSCS) and HIE. Methods: All staff working in the labour and delivery rooms (LDR) at the Burjeel Medical City (BMC) and Burjeel Hospital, Abu Dhabi (BHAD) underwent intense training on the principles of physiological interpretation of CTG in May 2024. This was followed by implementation of International Expert Consensus Guidelines on Physiological Interpretation of CTG produced by > 50 CTG experts from > 20 countries. This was followed by monthly update sessions and “refreshers” on physiological interpretation of CTG to re-enforce knowledge. The rates of EMLSCS and HIE were analysed. Results: The rates of EMLSCS reduced from 37% and 34% from BHAD and BMC, respectively, to 20% at both maternity units within 13 months. There were no cases of HIE due to CTG misinterpretation during the same period. Conclusion: There was a notable reduction (>40%) in the rate of emergency caesarean section at both tertiary referral hospitals providing complex obstetric care within 13 months of implementing the principles of physiological interpretation of CTG. This decrease was accompanied by an absence of HIE due to CTG misinterpretation at both quaternary referral hospitals for over 13 months.