Title Pending 6408

This is an accepted article with a DOI pre-assigned that is not yet published.IntroductionFetal metabolic acidosis (FMA), defined as umbilical cord arterial or venous pH <7.0 or base excess ≤ -12 mmol/L, is a critical marker of intrapartum hypoxia and a predictor of adverse neonatal outcomes. In this tertiary care hospital in Ohio, three patient safety initiatives were implemented over the past two decades – mandatory electronic fetal monitoring (EFM) training, a standardized low-dose oxytocin protocol, and a multidisciplinary Code Green response team – to reduce FMA incidence. This study evaluates the association between these interventions and FMA rates over time. MethodsWe conducted a retrospective cohort study of all neonates delivered ≥32 weeks’ gestation at a single tertiary care center from 2008 to 2023. FMA was identified using cord gas values. Validity testing was applied to confirm diagnoses. Data on maternal and neonatal characteristics were collected. FMA incidence was analyzed annually and across three intervention periods (pre- [2008–2009], during [2010–2012], and post-implementation [2013–2023]). Statistical analysis included chi-square, ANOVA, and t-tests. ResultsOf 65,535 eligible neonates, 1,014 met criteria for FMA, and 714 cases were confirmed after validity testing. Although FMA incidence was lowest in isolated years following intervention implementation, there was no statistically significant sustained reduction in FMA rates across the study period (p > 0.05). Cesarean delivery, low Apgar scores, NICU admission, and HIE were significantly more common in neonates with FMA (p < 0.001). ConclusionsDespite targeted safety initiatives, FMA rates did not decline significantly over time. Findings highlight the need for adaptive implementation strategies, ongoing surveillance, and multidisciplinary quality improvement to improve fetal outcomes.