Access to computerised analysis of intrapartum cardiotocographs improves clinicians’ prediction of newborn umbilical artery blood pH

Abstract

Objective To evaluate the impact of access to computerised cardiotocograph (CTG) analysis on reproducibility and accuracy of clinicians' predictions of umbilical artery blood pH (UAB pH) and 5-minute Apgar score.Design Prospective evaluation of pre-recorded cases.Setting A tertiary-care university hospital.Population From databases of intrapartum CTGs acquired in singleton term pregnancies, 204 tracings with low signal loss and short time interval to delivery were consecutively selected.Methods Tracings were randomly assigned to computer analysis by the Omniview-SisPorto 3.5 Ò system (study group n = 104) or to no analysis (control group n = 100). Three experienced clinicians evaluated all tracing printouts independently and were asked to predict the newborns' UAB pH and 5-minute Apgar scores from them. Conclusions Prediction of UAB pH is more reproducible and accurate when clinicians have access to computerised analysis of CTGs.

Computerized analysis of fetal heart rate variability signal during the stages of labor

“…Instead, the use of cCTG to alert clinicians has been shown to be beneficial in predicting the pH of the umbilical artery at birth, especially since the development of a computerized algorithm for the recognition of maternal heart rate in order to avoid erroneous monitoring of maternal heart rate as fetal during labor . Computerized International Federation of Gynecology and Obstetrics (FIGO) analysis of CTG, however, has been associated with high sensitivity but low specificity …”

“…At the same time, CTG has been implicated in the raising of cesarean delivery and operative vaginal delivery rates especially for 'fetal distress', the majority of which are considered unnecessary because objective criteria of hypoxia (low pH and low Apgar score) are not met. [23][24][25] Instead, the use of cCTG to alert clinicians has been shown to be beneficial in predicting the pH of the umbilical artery at birth, 26 especially since the development of a computerized algorithm for the recognition of maternal heart rate in order to avoid erroneous monitoring of maternal heart rate as fetal during labor. 27 Computerized International Federation of Gynecology and Obstetrics (FIGO) analysis of CTG, however, has been associated with high sensitivity but low specificity.…”

An overview of central fetal monitoring systems in labour

“…The last hour of 204 intrapartum CTGs from term singleton pregnancies, monitored with a scalp electrode until very close to delivery, was randomly assigned to display or not to display the results of computer analysis, and three clinicians were asked to predict umbilical artery pH based solely on this information. A signifi cantly higher interobserver agreement and accuracy were found in the group of tracings displaying computer analysis, which suggests that evaluation of fetal state is more reproducible and accurate in this condition [13] .…”

Continuous cardiotocography during labour: Analysis, classification and management

“…The use of a computer to analyse CTG traces so as to alert clinicians has been shown to be beneficial in predicting the pH of umbilical artery at birth [28]. Currently, randomized controlled trials are underway to assess the usefulness of such computerized decision-support tools in improving perinatal outcomes.…”