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Published in: Archives of Gynecology and Obstetrics 5/2017

01-11-2017 | Maternal-Fetal Medicine

Estimation of neonatal outcome artery pH value according to CTG interpretation of the last 60 min before delivery: a retrospective study. Can the outcome pH value be predicted?

Authors: S. Kundu, E. Kuehnle, C. Schippert, J. von Ehr, P. Hillemanns, Ismini Staboulidou

Published in: Archives of Gynecology and Obstetrics | Issue 5/2017

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Abstract

Purpose

The aim of this study was to analyze whether the umbilical artery pH value can be estimated throughout CTG assessment 60 min prior to delivery and if the estimated umbilical artery pH value correlates with the actual one. This includes analysis of correlation between CTG trace classification and actual umbilical artery pH value. Intra-and interobserver agreement and the impact of professional experience on visual analysis of fetal heart rate tracing were evaluated.

Methods

This was a retrospective study. 300 CTG records of the last 60 min before delivery were picked randomly from the computer database with the following inclusion criteria; singleton pregnancy >37 weeks, no fetal anomalies, vaginal delivery either spontaneous or instrumental-assisted. Five obstetricians and two midwives of different professional experience classified 300 CTG traces according to the FIGO criteria and estimated the postnatal umbilical artery pH.

Results

The results showed a significant difference (p < 0.05) in estimated and actual pH value, independent of professional experience. Analysis and correlation of CTG assessment and actual umbilical artery pH value showed significantly (p < 0.05) diverging results. Intra- and interobserver variability was high. Intraobserver variability was significantly higher for the resident (p = 0.001). No significant differences were detected regarding interobserver variability.

Conclusion

An estimation of the pH value and consequently of neonatal outcome on the basis of a present CTG seems to be difficult. Therefore, not only CTG training but also clinical experience and the collaboration and consultation within the whole team is important.
Literature
1.
go back to reference Pattison N, McCowan L (2000) Cardiotocography for antepartum fetal assessment. Cochrane Database Syst Rev 2010:CD001068 Pattison N, McCowan L (2000) Cardiotocography for antepartum fetal assessment. Cochrane Database Syst Rev 2010:CD001068
2.
go back to reference Donker DK, van Geijn HP, Hasman A (1993) Interobserver variation in the assessment of fetal heart rate recordings. Eur J Obstet Gynecol Reprod Biol 52:21–28CrossRefPubMed Donker DK, van Geijn HP, Hasman A (1993) Interobserver variation in the assessment of fetal heart rate recordings. Eur J Obstet Gynecol Reprod Biol 52:21–28CrossRefPubMed
3.
go back to reference Palomäki O, Luukkaala T, Luoto R, Tuimala R (2006) Intrapartum cardiotocography—the dilemma of interpretational variation. J Perinat Med 34:298–302CrossRefPubMed Palomäki O, Luukkaala T, Luoto R, Tuimala R (2006) Intrapartum cardiotocography—the dilemma of interpretational variation. J Perinat Med 34:298–302CrossRefPubMed
4.
go back to reference Westerhuis ME, van Horen E, Kwee A, van der Tweel I, Visser GH, Moons KG (2009) Inter- and intra-observer agreement of intrapartum ST analysis of the fetal electrocardiogram in women monitored by STAN. BJOG 116:545–551CrossRefPubMed Westerhuis ME, van Horen E, Kwee A, van der Tweel I, Visser GH, Moons KG (2009) Inter- and intra-observer agreement of intrapartum ST analysis of the fetal electrocardiogram in women monitored by STAN. BJOG 116:545–551CrossRefPubMed
5.
go back to reference Devane D, Lalor J (2005) Midwives’ visual interpretation of intrapartum cardiotocographs: intra- and inter-observer agreement. J Adv Nurs 52:133–141CrossRefPubMed Devane D, Lalor J (2005) Midwives’ visual interpretation of intrapartum cardiotocographs: intra- and inter-observer agreement. J Adv Nurs 52:133–141CrossRefPubMed
6.
go back to reference Epstein AJ, Twogood S, Lee RH, Opper N, Beavis A, Miller DA (2013) Interobserver reliability of fetal heart rate pattern interpretation using NICHD definitions. Am J Perinatol 30:463–468PubMed Epstein AJ, Twogood S, Lee RH, Opper N, Beavis A, Miller DA (2013) Interobserver reliability of fetal heart rate pattern interpretation using NICHD definitions. Am J Perinatol 30:463–468PubMed
7.
go back to reference Ayres-de-Campos D, Bernardes J, Costa-Pereira A, Pereira-Leite L (1999) Inconsistencies in classification by experts of cardiotocograms and subsequent clinical decision. Br J Obstet Gynaecol 106:1307–1310CrossRefPubMed Ayres-de-Campos D, Bernardes J, Costa-Pereira A, Pereira-Leite L (1999) Inconsistencies in classification by experts of cardiotocograms and subsequent clinical decision. Br J Obstet Gynaecol 106:1307–1310CrossRefPubMed
8.
go back to reference Rhöse S, Heinis AMF, Vandenbussche F, van Drongelen J, van Dillen J (2014) Inter- and intra-observer agreement of nonreassuring cardiotocography analysis and subsequent clinical management. Acta Obstet Gynecol Scand 93:596–602CrossRefPubMed Rhöse S, Heinis AMF, Vandenbussche F, van Drongelen J, van Dillen J (2014) Inter- and intra-observer agreement of nonreassuring cardiotocography analysis and subsequent clinical management. Acta Obstet Gynecol Scand 93:596–602CrossRefPubMed
9.
go back to reference Blix E, Sviggum O, Karen SK, Oian P (2003) Inter-observer variation in assessment of 845 labour admission tests: comparison between midwives and obstetricians in the clinical setting and two experts. BJOG 110:1–5CrossRefPubMed Blix E, Sviggum O, Karen SK, Oian P (2003) Inter-observer variation in assessment of 845 labour admission tests: comparison between midwives and obstetricians in the clinical setting and two experts. BJOG 110:1–5CrossRefPubMed
10.
go back to reference Figueras F, Albela S, Bonino S, Palacio M, Barrau E, Hernandez S, Casellas C, Coll O, Cararach V (2005) Visual analysis of antepartum fetal heart rate tracings: inter- and intra-observer agreement and impact of knowledge of neonatal outcome. J Perinat Med 33:241–245PubMed Figueras F, Albela S, Bonino S, Palacio M, Barrau E, Hernandez S, Casellas C, Coll O, Cararach V (2005) Visual analysis of antepartum fetal heart rate tracings: inter- and intra-observer agreement and impact of knowledge of neonatal outcome. J Perinat Med 33:241–245PubMed
11.
go back to reference Spencer JA, Badawi N, Burton P, Keogh J, Pemberton P, Stanley F (1997) The intrapartum CTG prior to neonatal encephalopathy at term: a case-control study. Br J Obstet Gynaecol 104:25–28CrossRefPubMed Spencer JA, Badawi N, Burton P, Keogh J, Pemberton P, Stanley F (1997) The intrapartum CTG prior to neonatal encephalopathy at term: a case-control study. Br J Obstet Gynaecol 104:25–28CrossRefPubMed
12.
go back to reference Schiermeier S, van Leeuwen P, Butterwegge M et al (2005) Cardiotocography—an established diagnostic method with current perspectives. Gynakol Prax 29:431–441 Schiermeier S, van Leeuwen P, Butterwegge M et al (2005) Cardiotocography—an established diagnostic method with current perspectives. Gynakol Prax 29:431–441
13.
go back to reference Ayres-de-Campos D, Spong CY, Chandraharan E (2015) FIGO consensus guidelines on intrapartum fetal monitoring: cardiotocography. Int J Gynaecol Obstet 131:13–24CrossRefPubMed Ayres-de-Campos D, Spong CY, Chandraharan E (2015) FIGO consensus guidelines on intrapartum fetal monitoring: cardiotocography. Int J Gynaecol Obstet 131:13–24CrossRefPubMed
14.
go back to reference Seliger G, Stenzel A, Kowalski EM, Hoyer D, Nowack S, Seeger S, Schneider U (2016) Evaluation of standardized, computerized Dawes/Redman heart-rate analysis based on different recording methods and in relation to fetal beat-to-beat heart rate variability. J Perinat Med 44:785–792CrossRefPubMed Seliger G, Stenzel A, Kowalski EM, Hoyer D, Nowack S, Seeger S, Schneider U (2016) Evaluation of standardized, computerized Dawes/Redman heart-rate analysis based on different recording methods and in relation to fetal beat-to-beat heart rate variability. J Perinat Med 44:785–792CrossRefPubMed
15.
go back to reference Cheng YW, Snowden JM, Handler SJ, Tager IB, Hubbard AE, Caughey AB (2014) Litigation in obstetrics: does defensive medicine contribute to increases in cesarean delivery? J Matern Neonatal Med 27:1668–1675CrossRef Cheng YW, Snowden JM, Handler SJ, Tager IB, Hubbard AE, Caughey AB (2014) Litigation in obstetrics: does defensive medicine contribute to increases in cesarean delivery? J Matern Neonatal Med 27:1668–1675CrossRef
16.
go back to reference Reif P, Schott S, Boyon C, Richter J, Kavsek G, Timoh KN, Haas J, Pateisky P, Griesbacher A, Lang U, Ayres-de-Campos D (2016) Does knowledge of fetal outcome influence the interpretation of intrapartum cardiotocography and subsequent clinical management? A multicenter European study. BJOG 123:2208–2217CrossRefPubMed Reif P, Schott S, Boyon C, Richter J, Kavsek G, Timoh KN, Haas J, Pateisky P, Griesbacher A, Lang U, Ayres-de-Campos D (2016) Does knowledge of fetal outcome influence the interpretation of intrapartum cardiotocography and subsequent clinical management? A multicenter European study. BJOG 123:2208–2217CrossRefPubMed
17.
go back to reference Costa A, Santos C, Ayres-de-Campos D, Costa C, Bernardes J (2010) Access to computerized analysis of intrapartum cardiotocographs improves clinicians’ prediction of newborn umbilical artery blood pH. BJOG 117:1288–1293CrossRefPubMed Costa A, Santos C, Ayres-de-Campos D, Costa C, Bernardes J (2010) Access to computerized analysis of intrapartum cardiotocographs improves clinicians’ prediction of newborn umbilical artery blood pH. BJOG 117:1288–1293CrossRefPubMed
18.
go back to reference Kuehnle E, Herms S, Kohls F, Kundu S, Hillemanns P, Staboulidou I (2016) Correlation of fetal scalp blood sampling pH with neonatal outcome umbilical artery pH value. Arch Gynecol Obstet 294:763–770CrossRefPubMed Kuehnle E, Herms S, Kohls F, Kundu S, Hillemanns P, Staboulidou I (2016) Correlation of fetal scalp blood sampling pH with neonatal outcome umbilical artery pH value. Arch Gynecol Obstet 294:763–770CrossRefPubMed
19.
20.
go back to reference Nielsen PV, Stigsby B, Nickelsen C, Nim J (1987) Intra- and inter-observer variability in the assessment of intrapartum cardiotocograms. Acta Obstet Gynecol Scand 99:421–424CrossRef Nielsen PV, Stigsby B, Nickelsen C, Nim J (1987) Intra- and inter-observer variability in the assessment of intrapartum cardiotocograms. Acta Obstet Gynecol Scand 99:421–424CrossRef
21.
go back to reference Spila J, Chudacek V, Janku P, Hruban L, Bursa M, Huptych M, Zach L, Lhotska L (2014) Analysis of obstetricians’ decision making on CTG recordings. J Biomed Inform 51:72–79CrossRef Spila J, Chudacek V, Janku P, Hruban L, Bursa M, Huptych M, Zach L, Lhotska L (2014) Analysis of obstetricians’ decision making on CTG recordings. J Biomed Inform 51:72–79CrossRef
22.
go back to reference Hruban L, Spilka J, Chudacek V, Janku P, Huptych M, Bursa M, Hudec A, Kacerovsky M, Koucky M, Prochazka M, Korecko V, Seget’a J, Simetka O, Mechurova A, Lhotska L (2015) Agreement on intrapartum cardiotocogram recordings between expert obstetricians. J Eval Clin Pract 21:694–702CrossRefPubMed Hruban L, Spilka J, Chudacek V, Janku P, Huptych M, Bursa M, Hudec A, Kacerovsky M, Koucky M, Prochazka M, Korecko V, Seget’a J, Simetka O, Mechurova A, Lhotska L (2015) Agreement on intrapartum cardiotocogram recordings between expert obstetricians. J Eval Clin Pract 21:694–702CrossRefPubMed
23.
go back to reference Ayres-de-Campos D, Bernardes J (1999) Early, variable and late decelerations: can consensus be reached in their identification? Int J Gynaecol Obstet 65:305–306CrossRefPubMed Ayres-de-Campos D, Bernardes J (1999) Early, variable and late decelerations: can consensus be reached in their identification? Int J Gynaecol Obstet 65:305–306CrossRefPubMed
24.
go back to reference Keith RD, Beckley S, Garibaldi JM, Westgate JA, Ifeachor EC, Greene KR (1995) A multicentre comparative study of 17 experts and an intelligent computer system for managing labour using the cardiotocogram. BJOG 102:688–700CrossRef Keith RD, Beckley S, Garibaldi JM, Westgate JA, Ifeachor EC, Greene KR (1995) A multicentre comparative study of 17 experts and an intelligent computer system for managing labour using the cardiotocogram. BJOG 102:688–700CrossRef
25.
go back to reference Murphy KW, Johnson P, Moorcraft J, Pattinson R, Russell V, Turnbull A (1990) Birth asphyxia and the intrapartum cardiotocograph. BJOG 97:470–479CrossRef Murphy KW, Johnson P, Moorcraft J, Pattinson R, Russell V, Turnbull A (1990) Birth asphyxia and the intrapartum cardiotocograph. BJOG 97:470–479CrossRef
26.
go back to reference Bernardes J, Costa-Pereira A, Ayres-de-Campos D, van Geijn HP, Pereira-Leite L (1997) Evaluation of interobserver agreement of cardiotocograms. Int J Gynaecol Obstet 57:33–37CrossRefPubMed Bernardes J, Costa-Pereira A, Ayres-de-Campos D, van Geijn HP, Pereira-Leite L (1997) Evaluation of interobserver agreement of cardiotocograms. Int J Gynaecol Obstet 57:33–37CrossRefPubMed
27.
go back to reference Bernardes J, Costa-Pereira A, Ayres-de-Campos D, van Geijn HP, Pereira-Leite L (1996) A more objective fetal heart rate baseline estimation. BJOG 103:714–715CrossRef Bernardes J, Costa-Pereira A, Ayres-de-Campos D, van Geijn HP, Pereira-Leite L (1996) A more objective fetal heart rate baseline estimation. BJOG 103:714–715CrossRef
28.
go back to reference Taylor GM, Mires GJ, Abel EW et al (2000) The development and validation of an algorithm for real-time computerized fetal heart rate monitoring in labour. BJOG 107:1130–1137CrossRefPubMed Taylor GM, Mires GJ, Abel EW et al (2000) The development and validation of an algorithm for real-time computerized fetal heart rate monitoring in labour. BJOG 107:1130–1137CrossRefPubMed
29.
go back to reference Ayres-de-Campos D, Bernardes J (2010) FIGO Subcommittee: twenty-five years after the FIGO guidelines for the use of fetal monitoring: time for a simplified approach? Int J Gynaecol Obstet 110:16CrossRef Ayres-de-Campos D, Bernardes J (2010) FIGO Subcommittee: twenty-five years after the FIGO guidelines for the use of fetal monitoring: time for a simplified approach? Int J Gynaecol Obstet 110:16CrossRef
30.
go back to reference Rei M, Tavares S, Pinto P, Machado AP, Monteiro S, Costa A, Costa-Santos C, Bernardes J, Ayres-de-Campos D (2016) Interobserver agreement in CTG interpretation using the 2015 FIGO guidelines for intrapartum fetal monitoring. Eur J Obstet Gynecol Reprod Biol 205:27–31CrossRefPubMed Rei M, Tavares S, Pinto P, Machado AP, Monteiro S, Costa A, Costa-Santos C, Bernardes J, Ayres-de-Campos D (2016) Interobserver agreement in CTG interpretation using the 2015 FIGO guidelines for intrapartum fetal monitoring. Eur J Obstet Gynecol Reprod Biol 205:27–31CrossRefPubMed
31.
go back to reference Ayres-de-Campos D, Arteiro D, Costa-Santos C, Bernardes J (2011) Knowledge of adverse neonatal outcome alters clinicians’ interpretation of the intrapartum cardiotocograph. BJOG 118:978–984CrossRefPubMed Ayres-de-Campos D, Arteiro D, Costa-Santos C, Bernardes J (2011) Knowledge of adverse neonatal outcome alters clinicians’ interpretation of the intrapartum cardiotocograph. BJOG 118:978–984CrossRefPubMed
32.
go back to reference Reif P, Schott S, Boyon C, Rihcter J, Kavsek G, Timoh KN, Haas J, Pateisky P, Griesbacher A, Lang U, Ayres-de-Campos D (2016) Does knowledge of fetal outcome influence the interpretation of intrapartum cardiotocography and subsequent clinical management? A multicentre European study. BJOG. doi:10.1111/1471-0528.13882 PubMed Reif P, Schott S, Boyon C, Rihcter J, Kavsek G, Timoh KN, Haas J, Pateisky P, Griesbacher A, Lang U, Ayres-de-Campos D (2016) Does knowledge of fetal outcome influence the interpretation of intrapartum cardiotocography and subsequent clinical management? A multicentre European study. BJOG. doi:10.​1111/​1471-0528.​13882 PubMed
33.
go back to reference Schiermeier S, Westhof G, Leven A, Hatzmann H, Reinhard J (2011) Intra- and interobserver variability of intrapartum cardiotocography: a multicenter study comparing the FIGO classification with computer analysis software. Gynecol Obstet Invest 72:169–173CrossRefPubMed Schiermeier S, Westhof G, Leven A, Hatzmann H, Reinhard J (2011) Intra- and interobserver variability of intrapartum cardiotocography: a multicenter study comparing the FIGO classification with computer analysis software. Gynecol Obstet Invest 72:169–173CrossRefPubMed
Metadata
Title
Estimation of neonatal outcome artery pH value according to CTG interpretation of the last 60 min before delivery: a retrospective study. Can the outcome pH value be predicted?
Authors
S. Kundu
E. Kuehnle
C. Schippert
J. von Ehr
P. Hillemanns
Ismini Staboulidou
Publication date
01-11-2017
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 5/2017
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-017-4516-4

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