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Performance of five cardiotocography classification templates in labor: a cohort study
Denise Kling1, Mimmi Rehnström2, Andreas Herbst2,3
1Department of Obstetrics and Gynecology, Blekinge Hospital, Karlskrona, Sweden.
Comparing cardiotocography (CTG) interpretation guidelines, the NICE 2022 (National Institute for Health and Care Excellence) system demonstrated the highest sensitivity for detecting neonatal acidemia, indicating it as the safest current classification. Further improvements in diagnostic accuracy are needed.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Clinical Diagnostics
Background:
- Cardiotocography (CTG) is crucial for fetal well-being monitoring during labor.
- Several international and national guidelines exist for CTG interpretation, including FIGO (International Federation of Gynecology and Obstetrics) 2015, NICE (National Institute for Health and Care Excellence) 2017 and 2022, and Swedish templates (SWE-09, SWE-17).
- Discrepancies in CTG interpretation can impact the timely identification of neonatal acidemia.
Purpose of the Study:
- To compare the diagnostic performance of five different CTG interpretation templates.
- To evaluate sensitivity, specificity, and predictive values for identifying neonates with acidemia (cord artery pH <7.10).
- To determine the most effective CTG classification system among the evaluated guidelines.
Main Methods:
- A historical cohort study of singleton births at ≥34 weeks gestation with validated umbilical cord acid-base samples.
- Two independent assessors reviewed CTG traces from the last hour before birth, blinded to outcome.
- Each CTG trace was classified using five templates (FIGO-15, NICE-17, NICE-22, SWE-09, SWE-17), with a third assessor resolving discrepancies.
Main Results:
- NICE 2022 and SWE-09 showed the highest sensitivity (92%) for identifying acidemia when classifying CTGs as pathological.
- SWE-17 (91%) and FIGO-15 (90%) exhibited the highest specificity.
- Positive predictive values ranged from 15% to 24%, while negative predictive values were between 95% and 99%.
Conclusions:
- Current CTG interpretation templates present a trade-off between sensitivity and specificity for detecting neonatal acidemia.
- The NICE 2022 guideline offers the highest sensitivity, positioning it as the safest current system for identifying neonates with acidemia.
- Continued research is essential to enhance the diagnostic precision of CTG interpretation systems.
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