Diagnostic capacity and interobserver variability in FIGO, ACOG, NICE and Chandraharan cardiotocographic guidelines to predict neonatal acidemia

Pozo, Clara Zamora Del; Ezquerro, Marta Chóliz; Mejía, Inmaculada; Martínez-Berganza, Elisa Díaz de Terán; Esteban, Luis; Alonso, Almudena Rivero; Larraz, Berta Castán; Garcı́a, M. C.; Cornudella, Ricardo Savirón

doi:10.1080/14767058.2021.1986479

Cited by 21 publications

(22 citation statements)

References 16 publications

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“…Additionally, given that all the CTG traces were evaluated by consensus between three senior obstetricians with specialised expertise in the physiological interpretation of the CTG, such evaluation is expected to be reliable. It should be highlighted that the use of physiological guidelines of the CTG interpretation seems more reproducible than the traditional assessment, even though the former approach has not been endorsed by the main international scientific societies, which may represent a matter of controversy 26,27,33–36 …”

Section: Discussionmentioning

confidence: 99%

“…In the last few years, a new approach based on physiology has been proposed for the interpretation of intrapartum CTG. The approach relies on the timing and velocity of onset of the hypoxic insult and not on pattern recognition, and has been demonstrated to be associated with the highest sensitivity and specificity in predicting neonatal acidaemia 27 …”

Section: Introductionmentioning

confidence: 99%

“…The approach relies on the timing and velocity of onset of the hypoxic insult and not on pattern recognition, and has been demonstrated to be associated with the highest sensitivity and specificity in predicting neonatal acidaemia. 27 Based on such a physiological approach, the following subtypes of fetal hypoxia are claimed to occur prior to or during labour: acute, subacute, gradually evolving and chronic antepartum hypoxia. 25,[28][29][30] The aim of the present study was to evaluate and compare the labour characteristics and the type of intrapartum hypoxia among acidaemic neonates with and without an adverse outcome.…”

Section: Introductionmentioning

confidence: 99%

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Short‐term morbidity and types of intrapartum hypoxia in the newborn with metabolic acidaemia: a retrospective cohort study

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Commare

Masturzo

et al. 2022

BJOG

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Population: 431 neonates born with acidaemia ≥36 weeks.Methods: Intrapartum CTG traces were assigned to one of these four types of labour hypoxia: acute, subacute, gradually evolving and chronic hypoxia. The presence of CAO was defined by the occurrence of at least one of the following: Sarnat Score grade ≥2, seizures, hypothermia and death <7 days from birth. Main outcome measures:To compare the type of hypoxia on the intrapartum CTG traces among the acidaemic neonates with and without CAO. Results:The occurrence of a CAO was recorded in 15.1% of neonates. At logistic regression analysis, the duration of the hypoxia was the only parameter associated with CAO in the case of an acute or subacute pattern (odds ratio [OR] 1.3; 95% CI 1.02-1.6 and OR 1.04; 95% CI 1.0-1.1, respectively), whereas both the duration of the hypoxic insult and the time from PROM to delivery were associated with CAO in those with a gradually evolving pattern (OR 1.13; 95% CI 1.01-1.3 and OR 1.04; 95% CI 1.0-1.7, respectively). The incidence of CAO was higher in fetuses with chronic antepartum hypoxia than in those showing CTG features of intrapartum hypoxia (64.7 vs. 13.0%; P < 0.001). Conclusions:The frequency of CAO seems related to the duration and the type of the hypoxic injury, being higher in fetuses showing CTG features of antepartum chronic hypoxia.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Short‐term morbidity and types of intrapartum hypoxia in the newborn with metabolic acidaemia: a retrospective cohort study

Pasquo

Commare

Masturzo

et al. 2022

BJOG

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“…When multiple indications were listed, deliveries were due to EB indications if at least one of them was consistent with the adopted guidelines. The following were considered EB LP twin delivery indications: preeclampsia with severe features/HELLP syndrome/eclampsia, pPROM in MC twins, FGR with abnormal antenatal testing (abnormal testing included a biophysical pro le of 6/10 or worse, abnormal umbilical artery or ductus venosus Doppler, or coexisting oligohydramnios), vaginal bleeding due to placental abruption, non-reassuring fetal heart tracing (a category III fetal heart tracing requiring immediate delivery) [31], twin to twin transfusion syndrome stage II ore above [32], clinical chorioamnionitis [27], and pre-gestational diabetes mellitus not under metabolic control. Deliveries de ned as non EB included stable patients such as those with mild chronic hypertension [33], prior myomectomy, prior classical cesarean delivery, or mild cholestasis [34] of pregnancy.…”

Section: Outcome Measuresmentioning

confidence: 99%

Perinatal outcomes in twin late preterm pregnancies: results from an Italian area-based, prospective cohort study.

Monari

Chiossi

Menichini

et al. 2022

Preprint

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Background: Multiple gestations represent a considerable proportion of pregnancies delivering in the late preterm (LP) period. Only 30% of LP twins are due to spontaneous preterm labor and 70% are medically indicated; among this literature described that 16-50% of indicated LP twin deliveries are non-evidence based. As non-evidence-based delivery indications account for iatrogenic morbidity that could be prevented, the objective of our observational study is to investigate first neonatal outcomes of LP twin pregnancies according to gestational age at delivery, chorionicity and delivery indication, then non evidence-based delivery indications. Methods: Prospective cohort study among twins infants born between 34 + 0 and 36 + 6 weeks, in Emilia Romagna, Italy, during 2013-2015. The primary outcome was a composite of adverse perinatal outcomes. Results: Among 346 LP twins, 84 (23.4%) were monochorionic and 262 (75.7%) were dichorionic; spontaneous preterm labor accounted for 85 (24.6%) deliveries, preterm prelabor rupture of membranes for 66 (19.1%), evidence based indicated deliveries were 117 (33.8%), while non-evidence-based indications were 78 (22.5%). When compared to spontaneous preterm labor or preterm prelabor rupture of membranes, pregnancies delivered due to maternal and/or fetal indications were associated with higher maternal age (p<0.01), higher gestational age at delivery (p<0.01), Caucasian race (p 0.04), ART use (p<0.01), gestational diabetes (p<0.01), vaginal bleeding (p<0.01), antenatal corticosteroids (p<0.01), diagnosis of fetal growth restriction (FGR) (p<0.01), and monochorionic (p<0.01). Two hundred twenty-six pregnancies (65.3%) had at least one fetus experiencing one composite of adverse perinatal outcome. Multivariate analysis confirmed that delivery indication did not affect the composite of adverse perinatal outcomes; the only characteristic that affect the outcome after controlling for confounding was gestational age at delivery (p<0.01). Conclusion: Our study suggests that the decision to deliver or not twins in LP period should consider gestational age at delivery as the main determinant infants’ prognosis. Delivery indications should be accurately considered, to avoid iatrogenic early birth responsible of preventable complications.

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“…When multiple indications were listed, deliveries were due to EB indications if at least one of them was consistent with the adopted guidelines. The following were considered EB LP twin delivery indications: elective CS in MC twin, preeclampsia with severe features/HELLP syndrome/eclampsia, pPROM in MC twins, FGR with abnormal antenatal testing (abnormal testing included a biophysical profile of 6/10 or worse, abnormal umbilical artery or ductus venosus Doppler, or coexisting oligohydramnios), vaginal bleeding due to placental abruption, non-reassuring fetal heart tracing (a category III fetal heart tracing requiring immediate delivery) [34], twin to twin transfusion syndrome stage II ore above [35], clinical chorioamnionitis [30], and pregestational diabetes mellitus not under metabolic control. Deliveries defined as non EB included stable patients such as those with mild chronic hypertension [18], prior myomectomy, prior classical cesarean delivery, or mild cholestasis [36] of pregnancy.…”

Section: Outcome Measuresmentioning

confidence: 99%

Perinatal outcomes in twin late preterm pregnancies: results from an Italian area-based, prospective cohort study

et al. 2022

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Background Multiple gestations represent a considerable proportion of pregnancies delivering in the late preterm (LP) period. Only 30% of LP twins are due to spontaneous preterm labor and 70% are medically indicated; among this literature described that 16–50% of indicated LP twin deliveries are non-evidence based. As non-evidence-based delivery indications account for iatrogenic morbidity that could be prevented, the objective of our observational study is to investigate first neonatal outcomes of LP twin pregnancies according to gestational age at delivery, chorionicity and delivery indication, then non evidence-based delivery indications. Methods Prospective cohort study among twins infants born between 34 + 0 and 36 + 6 weeks, in Emilia Romagna, Italy, during 2013–2015. The primary outcome was a composite of adverse perinatal outcomes. Results Among 346 LP twins, 84 (23.4%) were monochorionic and 262 (75.7%) were dichorionic; spontaneous preterm labor accounted for 85 (24.6%) deliveries, preterm prelabor rupture of membranes for 66 (19.1%), evidence based indicated deliveries were 117 (33.8%), while non-evidence-based indications were 78 (22.5%). When compared to spontaneous preterm labor or preterm prelabor rupture of membranes, pregnancies delivered due to maternal and/or fetal indications were associated with higher maternal age (p < 0.01), higher gestational age at delivery (p < 0.01), Caucasian race (p 0.04), ART use (p < 0.01), gestational diabetes (p < 0.01), vaginal bleeding (p < 0.01), antenatal corticosteroids (p < 0.01), diagnosis of fetal growth restriction (FGR) (p < 0.01), and monochorionic (p < 0.01). Two hundred twenty-six pregnancies (65.3%) had at least one fetus experiencing one composite of adverse perinatal outcome. Multivariate analysis confirmed that delivery indication did not affect the composite of adverse perinatal outcomes; the only characteristic that affect the outcome after controlling for confounding was gestational age at delivery (p < 0.01). Moreover, there was at least one adverse neonatal outcome for 94% of babies born at 34 weeks, for 73% of those born at 35 weeks and for 46% of those born at 36 weeks (p < 0.01). Conclusion Our study suggests that the decision to deliver or not twins in LP period should consider gestational age at delivery as the main determinant infants’ prognosis. Delivery indications should be accurately considered, to avoid iatrogenic early birth responsible of preventable complications.

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Diagnostic capacity and interobserver variability in FIGO, ACOG, NICE and Chandraharan cardiotocographic guidelines to predict neonatal acidemia

Cited by 21 publications

References 16 publications

Short‐term morbidity and types of intrapartum hypoxia in the newborn with metabolic acidaemia: a retrospective cohort study

Short‐term morbidity and types of intrapartum hypoxia in the newborn with metabolic acidaemia: a retrospective cohort study

Perinatal outcomes in twin late preterm pregnancies: results from an Italian area-based, prospective cohort study.

Perinatal outcomes in twin late preterm pregnancies: results from an Italian area-based, prospective cohort study

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