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Olofsson P, Ekengård F, Herbst A. Time to reconsider: Have the 2015 FIGO and 2017 Swedish intrapartum cardiotocogram classifications led us from Charybdis to Scylla? Acta Obstet Gynecol Scand 2021; 100:1549-1556. [PMID: 34060661 DOI: 10.1111/aogs.14201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/11/2021] [Accepted: 05/25/2021] [Indexed: 11/28/2022]
Abstract
In 2015, FIGO revised the 1987 intrapartum cardiotocography (CTG) classification (FIGO1987). A less radical FIGO2015 version was introduced in Sweden 2017 (SWE2017). Now, post hoc simulation studies show that FIGO2015 and SWE2017 are less reliable than (a modified) FIGO1987. FIGO2015 shows significantly better interobserver agreement for normal CTG traces than FIGO1987, but significantly worse for pathological traces. Agreements between templates are moderate to good, but different classifications of mainly variable decelerations and tachycardia cause significant heterogeneities. FIGO2015 shows insufficient sensitivity to identify fetal acidemia compared with FIGO1987. In connection with fetal electrocardiogram ST analysis, one study showed no template was superior in identifying fetal acidemia, but in a series of only academia, FIGO1987 had significantly higher sensitivity than FIGO2015 (73% vs. 43%) and set of an alarm for fetal acidemia considerably earlier. With SWE2017, operative interventions declined significantly in Sweden but several adverse neonatal outcomes increased significantly. It remains to investigate the development with FIGO2015.
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Affiliation(s)
- Per Olofsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Cura Mödravård, Malmö, Sweden
| | - Frida Ekengård
- Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Malmö, Sweden
| | - Andreas Herbst
- Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Malmö, Sweden
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Odendaal H, Groenewald C, Hankins GDV, du Plessis C, Myers MM, Fifer WP. Transabdominal recordings of fetal heart rate in extremely small fetuses. J Matern Fetal Neonatal Med 2017; 32:1044-1047. [PMID: 29065802 DOI: 10.1080/14767058.2017.1397120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION As part of the fetal assessment for the Safe Passage Study, we recorded raw data of the fetal ECG via five maternal abdominal wall electrodes from 20 weeks to 23 weeks 6 days' gestation. MATERIALS For this study were extracted and analyzed the FHR patterns from the stored raw data in 16 stillbirths where the fetus weighed less than 1000 g and where autopsy was performed. RESULTS Birth weights ranged from 190 to 970 g. The proportion FHR signal loss ranged from 0.3% to 21.1%. In the smallest fetus the heart weighed 1.3 g, yet the FHR signal loss was only 0.9%.
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Affiliation(s)
- Hein Odendaal
- a Department of Obstetrics and Gynecology, Faculty of Medicine & Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Coen Groenewald
- a Department of Obstetrics and Gynecology, Faculty of Medicine & Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Gary D V Hankins
- b Department of Obstetrics and Gynecology , University of Texas Medical Branch , Galveston , TX , USA
| | - Carlie du Plessis
- a Department of Obstetrics and Gynecology, Faculty of Medicine & Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Michael M Myers
- a Department of Obstetrics and Gynecology, Faculty of Medicine & Health Sciences , Stellenbosch University , Cape Town , South Africa.,c Department of Psychiatry , Columbia University Medical Center , New York , NY , USA.,d Department of Pediatrics , Columbia University Medical Center , New York , NY , USA.,e Division of Developmental Neuroscience , New York State Psychiatric Institute , New York , NY , USA
| | - William P Fifer
- a Department of Obstetrics and Gynecology, Faculty of Medicine & Health Sciences , Stellenbosch University , Cape Town , South Africa.,c Department of Psychiatry , Columbia University Medical Center , New York , NY , USA.,d Department of Pediatrics , Columbia University Medical Center , New York , NY , USA.,e Division of Developmental Neuroscience , New York State Psychiatric Institute , New York , NY , USA
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Prior T, Kumar S. Expert review--identification of intra-partum fetal compromise. Eur J Obstet Gynecol Reprod Biol 2015; 190:1-6. [PMID: 25917435 DOI: 10.1016/j.ejogrb.2015.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/31/2015] [Accepted: 04/07/2015] [Indexed: 09/30/2022]
Abstract
Whilst most cases of cerebral palsy occur as a consequence of an ante-natal insult, a significant proportion, particularly in the term fetus, are attributable to intra-partum hypoxia. Intra-partum monitoring using continuous fetal heart rate assessment has led to an increased incidence of operative delivery without a concurrent reduction in the incidence of cerebral palsy. Despite this, birth asphyxia remains the strongest and most consistent risk factor for cerebral palsy in term infants. This review evaluates current intra-partum monitoring techniques as well as alternative approaches aimed at better identification of the fetus at risk of compromise in labour.
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Affiliation(s)
- Tomas Prior
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Du Cane Road, London W12 0HS, UK; Institute for Reproductive and Developmental Biology, Imperial College London, London W12 0HS, UK
| | - Sailesh Kumar
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Du Cane Road, London W12 0HS, UK; Institute for Reproductive and Developmental Biology, Imperial College London, London W12 0HS, UK; Mater Research Institute/University of Queensland, Aubigny Place, Raymond Terrace, South Brisbane, QLD 4101, Australia.
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