To evaluate the theoretical impact of the CAESARE decision-making tool (which is based on fetal heart rate) on the rate of cesarean section deliveries and the prevention of metabolic acidosis risk.

We conducted an observational, multicenter, retrospective study of all patients from 2018 to 2020 who had a cesarean section at term due to non-reassuring fetal status (NRFS) during labor. Primary outcome criteria were the rate of cesarean section births observed retrospectively compared to the theoretical rate by the CAESARE tool. Secondary outcome criteria were newborn umbilical pH (vaginal and cesarean delivery). A single-blind analysis was carried out in which two experienced midwives used the tool to decide whether to proceed with vaginal delivery or to seek the advice of an obstetric gynecologist (OB-GYN). The OB-GYN subsequently used the tool to decide between a vaginal or cesarean delivery.

Our study included 164 patients. The midwives proposed vaginal delivery in 90.2% of cases (of which 60% were without recourse to an OB-GYN). The OB-GYN proposed vaginal delivery for 141 patients (86%) (p<0.01). We found a difference in the umbilical cord arterial pH. The CAESARE tool affected the rapidity of the decision-making process whether to proceed with a cesarean section delivery of newborns with an umbilical cord arterial pH<7.1. The Kappa coefficient was calculated at 0.62.

The use of a decision-making tool was shown to reduce the rate of cesarean section births for NRFS while taking the risk of neonatal asphyxiation into account. Future prospective studies to assess whether the tool can reduce the cesarean rate without affecting the outcome of newborns should be conducted.