在分娩过程中使用五种心脏病学分类模板的表现:一个队列研究
Denise Kling1, Mimmi Rehnström2, Andreas Herbst2,3
1Department of Obstetrics and Gynecology, Blekinge Hospital, Karlskrona, Sweden.
概括
通过比较心电图谱 (CTG) 解释准则,NICE 2022 (国家卫生和护理卓越研究所) 系统在检测新生儿酸性血症方面表现出最高的灵敏度,表示它是当前最安全的分类. 需要进一步提高诊断准确度.
科学领域:
- 产科和妇科 产科和妇科
- 新生儿医学 新生儿医学
- 临床诊断 临床诊断 临床诊断
背景情况:
- 心脏图谱 (CTG) 对于在分娩期间监测胎儿健康至关重要.
- 对于CTG的解释,有几个国际和国家指南,包括FIGO (国际妇科和产科联合会) 2015,NICE (国家卫生和护理卓越研究所) 2017年和2022年,以及瑞典模板 (SWE-09,SWE-17).
- 在CTG解释中的差异可能会影响新生儿酸性血症的及时识别.
研究的目的:
- 为了比较五种不同的CTG解释模板的诊断性能.
- 评估敏感性,特异性和预测值,以识别患有酸性血症的新生儿 (弦动脉pH <7.10).
- 在评估的指南中确定最有效的CTG分类系统.
主要方法:
- 一个历史的队列研究,单子出生在怀孕≥34周与验证的带酸样本.
- 两个独立评估人员审查了出生前最后一个小时的CTG痕迹,对结果视而不见.
- 每个CTG痕迹使用五个模板 (FIGO-15,NICE-17,NICE-22,SWE-09,SWE-17) 进行分类,第三个评估者解决了差异.
主要成果:
- 在将CTGs归类为病理时,NICE 2022和SWE-09显示出识别酸性血症的最高灵敏度 (92%).
- 其中SWE-17 (91%) 和FIGO-15 (90%) 的特异性最高.
- 积极的预测值在15%至24%之间,而负的预测值在95%至99%之间.
结论:
- 目前的CTG解释模板在检测新生儿酸血症时,在灵敏度和特异性之间进行了权衡.
- 尼斯2022指南提供了最高的灵敏度,将其定位为目前最安全的系统,用于识别患有酸性血症的新生儿.
- 持续的研究对于提高CTG解释系统的诊断精度至关重要.
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