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Comparison of five classification systems for interpreting electronic fetal monitoring in predicting neonatal status at birth.
MedLine Citation:
PMID:  23039108     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Abstract Objective: to compare the accuracy of five different classification systems for interpreting electronic fetal monitoring (EFM) when predicting neonatal status at birth, as determined by the umbilical cord arterial pH. Methods: Ninety-seven cardiotocography traces were retrospectively interpreted according to five classification systems for EFM: DFHRMT, RCOG, SOCG, NICHD and Parer & Ikeda's. For each classification system, sensitivity, specificity, positive and negative predictive values were calculated. The capacity of the classifications to predict neonatal pH was also evaluated by ROC curves. Agreement between the five systems was estimated using weighted kappa statistic. Results: Considering pH≤7.15 as the cut off for low pH, the sensitivity and specificity values were: 100% and 18% (DFHRMT); 100% and 15% (RCOG); 88% and 37% (SOGC); 67% and 92% (NICHD); 55% and 67% (Parer & Ikeda). The ROC curves showed that all classifications analyzed had a low discriminative capacity when predicting umbilical artery pH ≤7.15. An excellent agreement was observed between DFHRMT and RCOG (weighted κ value: 0.860). Conclusions: Parer & Ikeda and NICHD classifications had the highest specificity in detecting umbilical cord arterial pH≤7.15. The high specificity of the NICHD classification is hindered by a high percentage of "intermediate" traces (80%). Parer & Ikeda classification is the one that best classify as pathological only the traces of fetuses that are truly at risk of acidemia, thus avoiding unnecessary intervention. It also showed the best trade-off between sensitivity and specificity and the lowest rate of traces considered "intermediate".
Authors:
Mariarosaria Di Tommaso; Viola Seravalli; Adalgisa Cordisco; Giada Consorti; Federico Mecacci; Francesca Rizzello
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-8
Journal Detail:
Title:  The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians     Volume:  -     ISSN:  1476-4954     ISO Abbreviation:  J. Matern. Fetal. Neonatal. Med.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101136916     Medline TA:  J Matern Fetal Neonatal Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Child and Woman's Health. University of Florence. Careggi University Hospital, Florence, Italy.
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