Management, Outcome, Risk, and Expectation classification for structural fetal anomalies to aid antenatal counseling:...

Area of Science:

• Medical Imaging
• Fetal Medicine
• Surgical Decision Making

Background:

• Increasing antenatal detection of fetal anomalies necessitates improved risk stratification and counseling frameworks.
• Traditional methods lack the multifactorial approach required for complex decision-making.
• The MORE (Management, Outcome, Risk, Expectation) classification was developed to standardize antenatal counseling.

Purpose of the Study:

• To evaluate the inter-rater reliability and construct validity of the MORE classification system.
• To assess the system's utility in guiding structured antenatal counseling for fetal anomalies.

Main Methods:

• Prospective evaluation of the MORE classification by three senior pediatric surgeons on 55 cases.
• Application of Management (M), Outcome (O), and Risk (R) components; Expectation (E) was excluded.
• Statistical analysis included Intraclass Correlation Coefficients (ICC), Fleiss' kappa, Cronbach's alpha, and Spearman's correlation.

Main Results:

• Acceptable to good internal consistency (Cronbach's α: 0.757-0.812) and high construct validity (Spearman's ρ = 0.812).
• Fair-to-moderate inter-rater agreement observed (ICC: 0.398-0.584).
• Variable agreement for components: slight for Management (κ=0.163), fair for Outcome (κ=0.293), moderate for Risk (κ=0.409). Excellent test-retest reliability.

Conclusions:

• The MORE classification demonstrates good reliability and strong validity for antenatal counseling by experienced surgeons.
• The Outcome domain showed the highest consistency; Management and Risk domains require refinement for broader application.
• The system offers a pragmatic framework for multidisciplinary decision-making and standardizing antenatal counseling, particularly in resource-limited settings.