(222) Impact of a Real-Time Intrapartum Monitoring Dashboard on Delivery Outcomes

In January 2023, our center introduced a real-time intrapartum digital monitoring dashboard, allowing clinicians in each of the 16 delivery rooms to view continuous fetal heart rate and contraction tracings from all laboring patients. We aimed to determine whether this intervention influenced delivery outcomes.



Study Design:

A retrospective cohort study at a single university-affiliated tertiary medical center with approximately 13,000 deliveries annually. All women ≥24 weeks’ gestation who underwent a trial of labor between January 2019 and December 2024 were included. Cesarean deliveries (CD) without labor and non-viable fetuses were excluded. Patients were grouped into pre-implementation (January 2019–December 2022) and post-implementation (January 2023–December 2024) cohorts. The primary outcome was operative delivery (cesarean delivery or vacuum-assisted delivery [VAD]). Secondary outcomes included prolonged second stage (PSS), third- or fourth-degree perineal injury, and 5-minute Apgar < 7. Multivariable logistic regression adjusted for key clinical covariates.

Results:

1. A total of 59,046 deliveries were analyzed—33,780 (57.2%) pre-implementation and 25,266 (42.8%) post-implementation.


2. Cesarean delivery occurred in 5,147 women (11.5%) in the pre-implementation group and 1,820 (9.2%) in the post-implementation group (p< 0.001).


3. Vacuum-assisted delivery increased from 4,606 (10.3%) to 2,236 (11.2%) (p< 0.001).


4. No significant differences were observed in the rates of prolonged second stage (6.0% vs. 5.8%), third- or fourth-degree perineal injury (0.5% vs. 0.5%), or 5-minute Apgar < 7 (0.9% vs. 1.1%).


5. In multivariable analysis, dashboard implementation was independently associated with reduced odds of intrapartum CD (aOR 0.84, 95% CI 0.79–0.89, p< 0.001), without increased odds of VAD (aOR 1.04, 95% CI 0.98–1.10, p=0.186).

Implementation of a continuous intrapartum digital dashboard was associated with a significant reduction in intrapartum cesarean rates, without adverse maternal or neonatal effects. This tool may enhance clinical awareness and support proactive labor management.