Physiological CTG categorization in types of hypoxia compared with MRI and neurodevelopmental outcome in infants with HIE

Pereira, Susana; Patel, Ryan; Zaima, Ahmed; Tvarozkova, Katarina; Chisholm, Philippa; Kappelou, Olga; Evanson, Jane; Chandraharan, Edwin; Wertheim, David; Shah, Divyen K.

doi:10.1080/14767058.2022.2050366

Cited by 6 publications

(4 citation statements)

References 34 publications

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“…Recent evidence has also shown that a regional CTG training programme based on fetal physiology showed a significant improvement in the professionals' interpretation of CTG at short term and stable results at long term [57].…”

Section: What Does the Emerging Scientific Evidence On Physiological ...mentioning

confidence: 99%

Physiological Interpretation of Cardiotocograph: Does the Emerging Scientific Evidence Suggest a Reversal in the “Thunder and Lightning” Phenomenon?

Chandraharan¹

2023

J Clin Med Surgery

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Section: What Does the Emerging Scientific Evidence On Physiological ...mentioning

confidence: 99%

Physiological Interpretation of Cardiotocograph: Does the Emerging Scientific Evidence Suggest a Reversal in the “Thunder and Lightning” Phenomenon?

Chandraharan¹

2023

J Clin Med Surgery

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“…If the training in physiological interpretation of CTG is to be effective, then the tools to interpret CTG traces whilst using the STAN technology should mirror what is taught during the training. There have been several publications supporting the use of physiological interpretation of CTG [44][45][46][47][48][49][50][51][52][53][54], and therefore, failure to change the CTG STAN interpretation tool to improve maternal and perinatal outcomes cannot be justified in the era of evidence-based clinical practice, founded on sound scientific principles. It has been reported that fetal ECG changes occur in approximately 40% of subacute hypoxia during second stage of labour [55], and therefore, the use of the same CTG interpretation tool with the same parameters without considering the different types of hypoxia, may lead to poor outcomes when the hypoxic stress rapidly evolves during the second stage of labour.…”

Section: Is Stan Clinically and Scientifically Dead Requiring A Requiem?mentioning

confidence: 99%

Fetal Electrocardiograph (ST-Analyser or STAN): Is it time for the Requiem?

Chandraharan¹

2023

J Clin Med Surgery

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“…It has been shown in retrospective cardiotocography (CTG) assessments that about 30% of neonates with hypoxic ischemic encephalopathy show abnormal CTG patterns already at the start of recording, which would disqualify them from STAN monitoring. 2,3 The CTG interpretation is the weakest link in the STAN system and recent efforts to improve and simplify the CTG classification have not solved the problem, and possibly made it worse: after an update of the Swedish national guidelines in 2017, inspired by the new International Federation of Gynecology & Obstetrics (FIGO) guidelines from 2015 (FIGO2015), the national incidences of birth acidemia and low Apgar scores have worsened. 4,[5][6][7] The traditional CTG classification systems are based on visual "pattern recognition" and clustering of the different FHR element categories (baseline, variability, accelerations, decelerations) into a fixed matrix.…”

Section: Introductionmentioning

confidence: 99%

“…The initial triage to judge a fetus fit for labor is thus critical for the STAN system to be reliable. It has been shown in retrospective cardiotocography (CTG) assessments that about 30% of neonates with hypoxic ischemic encephalopathy show abnormal CTG patterns already at the start of recording, which would disqualify them from STAN monitoring 2,3 …”

Section: Introductionmentioning

confidence: 99%

Is the fetus fit for labor? Introducing fast‐and‐frugal trees (FFTrees) to simplify triage of women for STAN monitoring: An interobserver agreement comparison with traditional classification

Pereira,

Bakker,

Zaima

et al. 2023

Acta Obstet Gynecol Scand

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IntroductionIt is a shortcoming of traditional cardiotocography (CTG) classification table formats that CTG traces are frequently classified differently by different users, resulting in poor interobserver agreements. A fast‐and‐frugal tree (FFTree) flow chart may help provide better concordance because it is straightforward and has clearly structured binary questions with understandable “yes” or “no” responses. The initial triage to determine whether a fetus is suitable for labor when utilizing fetal ECG ST analysis (STAN) is very important, since a fetus with restricted capacity to respond to hypoxic stress may not generate STAN events and therefore may become falsely negative. This study aimed to compare physiology‐focused FFTree CTG interpretation with FIGO classification for assessing the suitability for STAN monitoring.Material and methodsA retrospective study of 36 CTG traces with a high proportion of adverse outcomes (17/36) selected from a European multicenter study database. Eight experienced European obstetricians evaluated the initial 40 minutes of the CTG recordings and judged whether STAN was a suitable fetal surveillance method and whether intervention was indicated. The experts rated the CTGs using the FFTree and FIGO classifications at least 6 weeks apart. Interobserver agreements were calculated using proportions of agreement and Fleiss’ kappa (κ).ResultsThe proportions of agreement for “not suitable for STAN” were for FIGO 47% (95% confidence interval [CI] 42%–52%) and for FFTree 60% (95% CI 56–64), ie a significant difference; the corresponding figures for “yes, suitable” were 74% (95% CI 71–77) and 70% (95% CI 67–74). For “intervention needed” the figures were 52% (95% CI 47–56) vs 58% (95% CI 54–62) and for “expectant management” 74% (95% CI 71–77) vs 72% (95% CI 69–75). Fleiss’ κ agreement on “suitability for STAN” was 0.50 (95% CI 0.44–0.56) for the FIGO classification and 0.57 (95% CI 0.51–0.63) for the FFTree classification; the corresponding figures for “intervention or expectancy” were 0.53 (95% CI 0.47–0.59) and 0.57 (95% CI 0.51–0.63).ConclusionsThe proportion of agreement among expert obstetricians using the FFTree physiological approach was significantly higher compared with the traditional FIGO classification system in rejecting cases not suitable for STAN monitoring. That might be of importance to avoid false negative STAN recordings. Other agreement figures were similar. It remains to be shown whether the FFTree simplicity will benefit less experienced users and how it will work in real‐world clinical scenarios.

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Physiological CTG categorization in types of hypoxia compared with MRI and neurodevelopmental outcome in infants with HIE

Cited by 6 publications

References 34 publications

Physiological Interpretation of Cardiotocograph: Does the Emerging Scientific Evidence Suggest a Reversal in the “Thunder and Lightning” Phenomenon?

Physiological Interpretation of Cardiotocograph: Does the Emerging Scientific Evidence Suggest a Reversal in the “Thunder and Lightning” Phenomenon?

Fetal Electrocardiograph (ST-Analyser or STAN): Is it time for the Requiem?

Is the fetus fit for labor? Introducing fast‐and‐frugal trees (FFTrees) to simplify triage of women for STAN monitoring: An interobserver agreement comparison with traditional classification

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