(524) Clark Algorithm for the Evaluation of NTSV Cesarean Deliveries for the Indication of NRFHT

Category II tracings, the second most common cause of cesarean delivery, are indeterminate resulting in significant variation in how these tracings are managed. Use of category II tracing algorithms such as those created by Clark et Al, (2013) have the potential to aid decision making and thus have the potential to decrease cesarean section for the indication of abnormal/indeterminate/non reassuring fetal tracing. 

Study Design:

WellSpan York Hospital is a tertiary-care and regional referral center, serving a population base of over 800,000. In October of 2021 a review board was developed to look at the NTSV c-sections.  Slicer dicer was used to create a report of the NRFHT c-sections and provider level data was produced and charts and fetal heart rate tracing were reviewed. Data was then complied for individual providers. In October of 2021, Clark Algorithm was provided to all providers on labor and delivery. After October 2021, provider level compliance to the Clark algorithm was generated. Hospital level data was also obtained for poor outcomes, including APGARs < 5 at 1 minute and episiotomies.

Results:

The median number of NTSV c-sections performed in 2021 was 243. 81 were for NRFHT and 54.3% were indicated per the Clark Algorithm. In Quarter 1 (January 2022 to March 2022), the compliance with the Clark Algorithm improved to 75% for all providers. APGARs < 5 at 1 minute and episiotomy rates showed no significant difference. In the first quarter of data collection the caesarean delivery rate for January, February, and March was 22.9%, 21%, and 30% respectively.

Conclusion: This quality improvement study showed that there is opportunity to improve adherence to the Clark Algorithm which may in turn influence providers decision making around the need for cesarean delivery among patients with category II fetal heart rate tracings. Also improving the cesarean delivery rate also had no effect on poor outcomes.