Objective. To quantify inter-and intra-observer agreement of non-reassuring intrapartum cardiotocography (CTG) patterns and subsequent clinical management. Design. Methodological study. Setting. University Medical Center. Population. CTG patterns of 79 women beyond 37 weeks of gestation with a singleton fetus in vertex position in first stage of labor in whom fetal blood sampling (FBS) had been performed. Methods. Nine observers assessed CTG patterns, which were formerly clinically classified as non-reassuring and indicative for FBS, according to the guidelines of the International Federation of Gynecology and Obstetrics modified for ST analysis. They also proposed clinical management strategies without and with insight into clinical parameters. Weighted kappa values (j w ) and proportions of agreement (P a ) were calculated. Main outcome measures. Agreement on CTG classification and clinical management. Results. Inter-observer agreement on CTG classification and on clinical management were poor for most observer categories (j w range 0.31-0.50 and 0.20-0.45, respectively). Observers agreed best on abnormal CTG patterns (P a range 0.28-0.36) and on the clinical management option "continue monitoring" (P a range 0.32-0.40). Intra-observer agreement was fair to good for most observers (j w 0.33-0.70). Insight into clinical parameters resulted in similar inter-and intra-observer agreement. Conclusions. There was poor inter-observer agreement and fair to good intra-observer agreement on classification and clinical management of intrapartum CTG patterns, which had been classified as non-reassuring and indicative for FBS during birth.Abbreviations: CTG, cardiotocography; FBS, fetal blood sampling; FIGO/STAN guidelines, guidelines of the International Federation of Gynecology and Obstetrics modified for ST analysis; j w , weighted kappa (in case of three categories weights 1, 0.5 and 0, in case of four categories weights 1, 0.66, 0.33 and 0); P a , proportions of agreement; CI, confidence interval; RUNMC,
In the case of a non-reassuring fetal heart rate, fetal scalp blood lactate provides more accurate information on fetal acid-base status than does pH and/or BD.
Overall performance of both Lactate Pro and StatStrip Lactate was good, with StatStrip Lactate having smallest CVs and closest correlation to our reference method. Both StatStrip Lactate and Lactate Pro can be used as a lactate POCT device for obstetric use.
SSL is a reliable test to measure lactate in FBS with a low failure rate. As there are discrepancies between SSL and RLpH, and the cut-off values have not yet been evaluated prospectively regarding intervention rates and neonatal outcome, we recommend using SSL in addition to pH in FBS.
P erinatal death, maternal morbidity, and maternal mortality are all complications of preeclampsia. Women who have preeclampsia have higher rates of emergency cesarean sections, preterm births, and symptoms of posttraumatic stress after delivery. The authors of this study hypothesized that the physical and psychological consequences of preeclampsia might affect postpartum health-related quality of life, principally in women who experienced severe preeclampsia. Therefore, they measured quality of life parameters among postpartum women who had preeclampsia.Women who participated in the study were given the RAND 36-item Short Form Health Survey, a self-administered health-related quality of life questionnaire, at 6 and 12 weeks postpartum. The 3 study objectives of the questionnaire were to: (1) describe changes in all domains of health-related quality of life between 6 and 12 weeks postpartum after mild and severe preeclampsia; (2) assess the difference in health-related quality of life after mild and severe preeclampsia and; (3) determine the contributing factors of these differences in health-related quality of life. The study population was composed of 127 women who answered the questionnaires at both 6 and 12 weeks. Cohen's effect sizes "d " were estimated by dividing the difference in mean scores between subgroups by the largest standard deviation. Cohen's guidelines suggest 0.2rd < 0.5 indicates a "small effect"; 0.5 < d < 0.8 a "medium effect"; and dZ0.8 a "large effect." In general, d = 0.5 can be considered as a threshold for a "minimally important difference."Overall, 74% of the participants experienced severe preeclampsia, 79% were primiparous and the mean age was 31 ± 5 years. The women who experienced severe preeclampsia were more often younger (P < 0.01), more likely to have a cesarean section (P < 0.001), delivered at a lower gestational age (P < 0.001), delivered a lower birthweight infant (P < 0.001), and had infants who were more likely to be admitted to the neonatal intensive care unit (ICU) (P < 0.001) for longer periods of time (P < 0.001) compared with women who were not severely preeclamptic. These women were also more likely to be admitted to the obstetric ICU (55%), experience perinatal death (6%), and have multiple gestations (11%). None of the women who had mild preeclampsia were admitted to the ICU, experienced perinatal death, or had multiple gestations.Mean Short Form-36 scores were lower at 6 weeks postpartum in the study participants, especially the vitality, social functioning, and physical component scale scores (all scores P < 0.001 and dZ0.8). The scores on most of the physical scales remained low at 12 weeks postpartum but the mental scales did not. Health-related quality of life improved from 6 to 12 weeks in women who experienced mild preeclampsia for physical, vitality, and social functioning (all P < 0.001 and dZ0.5), and the physical, body pain, and social functioning scales improved for women who experienced severe preeclampsia (all P < 0.001 and dZ0.8). Women with severe ...
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