The article below summarizes a roundtable discussion of a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed:
Heuser CC, Knight S, Esplin MS, et al. Tachysystole in term labor: incidence, risk factors, outcomes, and effect on fetal heart tracings. Am J Obstet Gynecol 2013;209:32.e1-6.
See related article, page 32
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What was the aim of this study?
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How are studies of tachysystole relevant to clinical practice?
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What did you think of the outcomes evaluated?
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Was the incidence of tachysystole what you would expect?
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Which of the authors’ conclusions were most important?
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How might the results of this study change your practice?
Degrees of tachysystole
Within the study’s large retrospective term-birth cohort, 10.65% of all deliveries had at least 1 tachysystolic event. Rather than evaluating all the tachysystolic events as equivalent, the authors took a unique approach to the analysis. While they evaluated risk factors and outcomes associated with all tachysystolic events, they also divided tachysystolic events into 4 categories: tachysystole alone (TS); tachysystole with FHR changes (TS-F); tachysystole necessitating intervention (TS-I); and tachysystole leading to expedited delivery (TS-D).
Journal Club participants believed that this approach was helpful to clinicians because it differentiated excessive uterine activity that was clinically significant from isolated tachysystole. The authors found that even isolated tachysystolic events were related to higher rates of cesarean and operative vaginal delivery, as well as increased neonatal intensive care unit (NICU) admission, neonatal sepsis and the composite adverse neonatal outcome. This finding should heighten obstetricians’ awareness of the potential impact of tachysystole, even in cases not resulting in FHR changes or need for intervention.
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