Contribution of the CAESARE tool in the management of non-reassuring fetal status at risk of acidosis

Introduction

Developed in 2020, the CAESARE tool is a decision-support tool for interpreting fetal heart rate (FHR). In a preliminary study, the use of CAESARE led to a significant reduction in caesarean section rates.

Methods

We assessed the ability of the CAESARE tool to predict acidosis earlier by reducing the time-to-intervention in cases of non-reassuring fetal status (NRFS). We performed a retrospective, single-center case-control analysis evaluating associations between CAESARE scoring and the onset of neonatal acidosis. The primary outcome was presence or absence of fetal acidosis at birth based on CAESARE score. The case population was patients whose fetuses had fetal heart rate abnormalities and an arterial pH < 7.00 at birth. The control population was patients who had fetal heart rate abnormalities without the fetuses having acidosis at birth.

Results

CAESARE influenced decisions regarding the continuation of labor. It was associated with increased end of labor in the case group (p < 0.01) and greater expectant management in the control group (p < 0.01). CAESARE sensitivity and specificity were 0.97 and 0.88, respectively.

Conclusion

In our study, 32.1% of neonatal acidosis cases could have potentially been avoided if CAESARE had been used. The tool enabled extended expectant management in 42% of cases where end of labor was recommended. These findings support the implementation of a procedure for improved FHR analysis practices.