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CTG interpretation templates affect residents' decision making.

Frida Ekengård1, Monika Cardell1, Andreas Herbst1

  • 1Department of Obstetrics and Gynecology Skåne University Hospital, Institution of Clinical Sciences Lund, Lund University, Sweden; Study Conducted in Malmö and Lund, Sweden.

European Journal of Obstetrics, Gynecology, and Reproductive Biology
|April 30, 2023
PubMed
Summary

The study found that different cardiotocography (CTG) guidelines significantly impacted residents' decisions on intervention for neonates. While older guidelines (SWE09) showed higher sensitivity for detecting acidemia, newer guidelines (SWE17) improved specificity.

Keywords:
BirthCTGEducationFetal monitoring

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Area of Science:

  • Obstetrics and Gynecology
  • Neonatal Health
  • Medical Education

Background:

  • Cardiotocography (CTG) interpretation is crucial for fetal well-being.
  • Clinical guidelines for CTG interpretation have evolved.
  • Resident education and adherence to guidelines impact clinical decision-making.

Purpose of the Study:

  • To evaluate the impact of revised CTG guidelines and education on resident-perceived need for intervention.
  • To assess the diagnostic accuracy (sensitivity and specificity) of resident classifications using different CTG guidelines in identifying neonatal acidemia.

Main Methods:

  • Retrospective analysis of 446 CTGs from neonates with and without acidemia (cord blood pH < 7.05 or < 7.10 vs. ≥ 7.15).
  • Two groups of residents, trained on either SWE09 or SWE17 guidelines, classified CTGs and judged the need for intervention.
  • Calculated sensitivity, specificity, and agreement rates for intervention decisions and pathological classifications.

Main Results:

  • Residents using SWE09 indicated intervention more frequently (84.8%) than those using SWE17 (75.8%) for acidemic neonates.
  • SWE09 showed higher sensitivity (85%) but lower specificity (70%) for perceived intervention need compared to SWE17 (76% sensitivity, 78% specificity).
  • Classification of 'pathological' showed higher sensitivity with SWE09 (91%) and higher specificity with SWE17 (76%).

Conclusions:

  • CTG guideline revisions and associated education significantly influence resident perceptions of intervention necessity.
  • Differences in intervention decisions were less pronounced than differences in pathological classifications between guidelines.
  • SWE09 demonstrated superior sensitivity, while SWE17 offered improved specificity in identifying neonatal acidemia based on resident interpretations.