Knowledge of adverse neonatal outcome alters clinicians' interpretation of the intrapartum cardiotocograph

• Type: Article in International Scientific Journal
• Date: 2011

Authors

Ayres de Campos, D (Author) FMUP; Arteiro, D (Author) Other; Costa Santos, C (Author) FMUP; Bernardes, J (Author) FMUP

Journal

Title: BJOG: An International Journal of Obstetrics and Gynaecology

Vol. 118 No. 8

Pages: 978-984

ISSN: 1470-0328

Publisher: Wiley-Blackwell

Indexing

ISI Web of Knowledge - 32 Citations

Scopus - 36 Citations

Scientific classification

FOS: Medical and Health sciences > Clinical medicine

Other information

Authenticus ID: P-002-Q2X

DOI: 10.1111/j.1471-0528.2011.03003.x

Abstract (EN): Objective To evaluate the impact of knowledge of neonatal outcome on clinicians' interpretation of the intrapartum cardiotocograph (CTG). Design Prospective evaluation of pre-recorded cases. Setting Five maternity hospitals. Population From a database of intrapartum CTGs acquired with a scalp electrode in singleton near-term fetuses, 20 tracings were sequentially selected from cases with newborn umbilical artery pH < 7.05 and 20 from cases with pH > 7.20. Methods Five experienced obstetricians practising in different maternity hospitals were asked to analyse the 40 tracings individually, according to the International Federation of Gynaecology and Obstetrics guidelines. In a first round, clinicians were given no information on neonatal outcome. In a second round, carried out 2 months later, clinicians were asked to analyse the same tracings, but the order was randomly altered and information on the newborn's arterial pH was provided. Clinicians were not informed of the purpose of the study or whether the tracings were the same. Main outcome measures The incidence of individual fetal heart rate feature identification and tracing classification, before and after neonatal outcome was made available. Results In the group with pH < 7.05, repetitive decelerations and reduced variability were more common in the second round (P < 0.001 and P = 0.001, respectively), as was a pathological classification (P = 0.002); variable decelerations were less common (P = 0.008). In the group with normal pH, less tracings in the second round had prolonged decelerations (P = 0.013) and no accelerations (P = 0.013), but more had pronounced decelerations (P = 0.031) and reduced variability (P = 0.007); there was a reduction in pathological classifications, but this difference failed to reach statistical significance (P = 0.051). Conclusions A knowledge of adverse neonatal outcome leads to a more severe classification of the intrapartum CTG, which derives mainly from the evaluation of decelerations and variability.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 7