Accuracy of predicting neonatal distress using a five‐level classification of fetal heart rate monitoring

Abstract

AimTo assess the accuracy of neonatal distress prediction using the five‐level classification of fetal heart rate (FHR) and management protocol of the Japan Society of Obstetrics and Gynecology (JSOG).MethodsA case–control study was conducted. Vertex singleton pregnant women who delivered after 37 weeks' gestation from 2013 to 2015 were enrolled. The participants were categorized into two groups; controls were levels 1–3 (n = 1184), whereas cases were levels 4–5 (n = 117) group. Neonatal distress was defined as Apgar score < 8 points at 5 min or umbilical cord artery pH < 7.1.ResultsThere were 117 cases (9.0%). The frequency of the neonatal distress was observed in 1.3% controls and 6.8% cases (P < 0.01). Diagnostic accuracy of neonatal distress for cases showed a 6.8% positive‐predictive value, 34.8% sensitivity, 91.5% specificity and 98.7% negative‐predictive value. Among various obstetrical conditions, high sensitivity (100%) for prediction of neonatal distress was observed in women with chromosome abnormalities, placental abruption, umbilical cord abnormalities and excessive labor pain. Conversely, relatively low specificity (<50%) was observed in cases with oligohydramnios and excessive labor pain.ConclusionThe five‐level classification scheme was efficient for neonatal distress prediction. However, depending on the obstetric condition, the FHR findings and neonatal condition might be independent.

Ultrasound Doppler fetal heart rate detection algorithm analyzesthe correlation between twin selective fetal growth restriction and cord blood SFass fasL level

“…When it exceeds this range, fetal distress occurs. 5 , 6 At present, the most commonly used method for fetal heart rate detection is ultrasound Doppler. 7 However, because the Doppler detected by the ultrasound Doppler fetal heart rate detector often contains a large amount of messy, large variability, and uneven noise, it will cause a large degree of interference to the calculation of fetal heart rate.…”

Prevention of fetal brain injury in category II tracings

“…Several guidelines provide recommendations for clinical decisionmaking and actions using three or five-tiered classifications. [1][2][3] However, there remain concerns regarding the broad intermediate categories and low predictive ability for fetal acidemia, [4][5][6] and the efficacy of intrapartum EFM for reducing cerebral palsy (CP) remains unclear. 7 Clark et al proposed an algorithm-based approach to the management of category II tracings with recurrent severe variable (lasting >60 s and decreasing >60 bpm below baseline or reaching a nadir <60 bpm) or late decelerations, in which decisions for operative delivery were dependent in part upon normal labor progress.…”

“…Several guidelines provide recommendations for clinical decision‐making and actions using three or five‐tiered classifications. 1 , 2 , 3 However, there remain concerns regarding the broad intermediate categories and low predictive ability for fetal acidemia, 4 , 5 , 6 and the efficacy of intrapartum EFM for reducing cerebral palsy (CP) remains unclear. 7 …”