Knowledge of adverse neonatal outcome alters clinicians’ interpretation of the intrapartum cardiotocograph
Please cite this paper as: Ayres‐de‐Campos D, Arteiro D, Costa‐Santos C, Bernardes J. Knowledge of adverse neonatal outcome alters clinicians’ interpretation of the intrapartum cardiotocograph. BJOG 2011;978:985–984. Objective To evaluate the impact of knowledge of neonatal outcome on clinicians’ i...
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Published in | BJOG : an international journal of obstetrics and gynaecology Vol. 118; no. 8; pp. 978 - 984 |
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Main Authors | , , , |
Format | Journal Article |
Language | English |
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Oxford, UK
Blackwell Publishing Ltd
01.07.2011
Blackwell Wiley Subscription Services, Inc |
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Abstract | Please cite this paper as: Ayres‐de‐Campos D, Arteiro D, Costa‐Santos C, Bernardes J. Knowledge of adverse neonatal outcome alters clinicians’ interpretation of the intrapartum cardiotocograph. BJOG 2011;978:985–984.
Objective To evaluate the impact of knowledge of neonatal outcome on clinicians’ interpretation of the intrapartum cardiotocograph (CTG).
Design Prospective evaluation of pre‐recorded cases.
Setting Five maternity hospitals.
Population From a database of intrapartum CTGs acquired with a scalp electrode in singleton near‐term fetuses, 20 tracings were sequentially selected from cases with newborn umbilical artery pH < 7.05 and 20 from cases with pH > 7.20.
Methods Five experienced obstetricians practising in different maternity hospitals were asked to analyse the 40 tracings individually, according to the International Federation of Gynaecology and Obstetrics guidelines. In a first round, clinicians were given no information on neonatal outcome. In a second round, carried out 2 months later, clinicians were asked to analyse the same tracings, but the order was randomly altered and information on the newborn’s arterial pH was provided. Clinicians were not informed of the purpose of the study or whether the tracings were the same.
Main outcome measures The incidence of individual fetal heart rate feature identification and tracing classification, before and after neonatal outcome was made available.
Results In the group with pH < 7.05, repetitive decelerations and reduced variability were more common in the second round (P < 0.001 and P = 0.001, respectively), as was a pathological classification (P = 0.002); variable decelerations were less common (P = 0.008). In the group with normal pH, less tracings in the second round had prolonged decelerations (P = 0.013) and no accelerations (P = 0.013), but more had pronounced decelerations (P = 0.031) and reduced variability (P = 0.007); there was a reduction in pathological classifications, but this difference failed to reach statistical significance (P = 0.051).
Conclusions A knowledge of adverse neonatal outcome leads to a more severe classification of the intrapartum CTG, which derives mainly from the evaluation of decelerations and variability. |
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AbstractList | OBJECTIVETo evaluate the impact of knowledge of neonatal outcome on clinicians' interpretation of the intrapartum cardiotocograph (CTG).DESIGNProspective evaluation of pre-recorded cases.SETTINGFive maternity hospitals.POPULATIONFrom a database of intrapartum CTGs acquired with a scalp electrode in singleton near-term fetuses, 20 tracings were sequentially selected from cases with newborn umbilical artery pH < 7.05 and 20 from cases with pH > 7.20.METHODSFive experienced obstetricians practising in different maternity hospitals were asked to analyse the 40 tracings individually, according to the International Federation of Gynaecology and Obstetrics guidelines. In a first round, clinicians were given no information on neonatal outcome. In a second round, carried out 2 months later, clinicians were asked to analyse the same tracings, but the order was randomly altered and information on the newborn's arterial pH was provided. Clinicians were not informed of the purpose of the study or whether the tracings were the same.MAIN OUTCOME MEASURESThe incidence of individual fetal heart rate feature identification and tracing classification, before and after neonatal outcome was made available.RESULTSIn the group with pH < 7.05, repetitive decelerations and reduced variability were more common in the second round (P < 0.001 and P = 0.001, respectively), as was a pathological classification (P = 0.002); variable decelerations were less common (P = 0.008). In the group with normal pH, less tracings in the second round had prolonged decelerations (P = 0.013) and no accelerations (P = 0.013), but more had pronounced decelerations (P = 0.031) and reduced variability (P = 0.007); there was a reduction in pathological classifications, but this difference failed to reach statistical significance (P = 0.051).CONCLUSIONSA knowledge of adverse neonatal outcome leads to a more severe classification of the intrapartum CTG, which derives mainly from the evaluation of decelerations and variability. Objective: To evaluate the impact of knowledge of neonatal outcome on clinicians' interpretation of the intrapartum cardiotocograph (CTG). Design: Prospective evaluation of pre-recorded cases. Setting: Five maternity hospitals. Population: From a database of intrapartum CTGs acquired with a scalp electrode in singleton near-term fetuses, 20 tracings were sequentially selected from cases with newborn umbilical artery pH<7.05 and 20 from cases with pH>7.20. Methods: Five experienced obstetricians practicing in different maternity hospitals were asked to analyze the 40 tracings individually, according to the International Federation of Gynaecology and Obstetrics guidelines. In a first round, clinicians were given no information on neonatal outcome. In a second round, carried out 2months later, clinicians were asked to analyze the same tracings, but the order was randomly altered and information on the newborn's arterial pH was provided. Clinicians were not informed of the purpose of the study or whether the tracings were the same. Main outcome measures: The incidence of individual fetal heart rate feature identification and tracing classification, before and after neonatal outcome was made available. Results: In the group with pH<7.05, repetitive decelerations and reduced variability were more common in the second round (P<0.001 and P=0.001, respectively), as was a pathological classification (P=0.002); variable decelerations were less common (P=0.008). In the group with normal pH, less tracings in the second round had prolonged decelerations (P=0.013) and no accelerations (P=0.013), but more had pronounced decelerations (P=0.031) and reduced variability (P=0.007); there was a reduction in pathological classifications, but this difference failed to reach statistical significance (P=0.051). Conclusions: A knowledge of adverse neonatal outcome leads to a more severe classification of the intrapartum CTG, which derives mainly from the evaluation of decelerations and variability. [PUBLICATION ABSTRACT] Please cite this paper as: Ayres‐de‐Campos D, Arteiro D, Costa‐Santos C, Bernardes J. Knowledge of adverse neonatal outcome alters clinicians’ interpretation of the intrapartum cardiotocograph. BJOG 2011;978:985–984. Objective To evaluate the impact of knowledge of neonatal outcome on clinicians’ interpretation of the intrapartum cardiotocograph (CTG). Design Prospective evaluation of pre‐recorded cases. Setting Five maternity hospitals. Population From a database of intrapartum CTGs acquired with a scalp electrode in singleton near‐term fetuses, 20 tracings were sequentially selected from cases with newborn umbilical artery pH < 7.05 and 20 from cases with pH > 7.20. Methods Five experienced obstetricians practising in different maternity hospitals were asked to analyse the 40 tracings individually, according to the International Federation of Gynaecology and Obstetrics guidelines. In a first round, clinicians were given no information on neonatal outcome. In a second round, carried out 2 months later, clinicians were asked to analyse the same tracings, but the order was randomly altered and information on the newborn’s arterial pH was provided. Clinicians were not informed of the purpose of the study or whether the tracings were the same. Main outcome measures The incidence of individual fetal heart rate feature identification and tracing classification, before and after neonatal outcome was made available. Results In the group with pH < 7.05, repetitive decelerations and reduced variability were more common in the second round (P < 0.001 and P = 0.001, respectively), as was a pathological classification (P = 0.002); variable decelerations were less common (P = 0.008). In the group with normal pH, less tracings in the second round had prolonged decelerations (P = 0.013) and no accelerations (P = 0.013), but more had pronounced decelerations (P = 0.031) and reduced variability (P = 0.007); there was a reduction in pathological classifications, but this difference failed to reach statistical significance (P = 0.051). Conclusions A knowledge of adverse neonatal outcome leads to a more severe classification of the intrapartum CTG, which derives mainly from the evaluation of decelerations and variability. To evaluate the impact of knowledge of neonatal outcome on clinicians' interpretation of the intrapartum cardiotocograph (CTG). Prospective evaluation of pre-recorded cases. Five maternity hospitals. From a database of intrapartum CTGs acquired with a scalp electrode in singleton near-term fetuses, 20 tracings were sequentially selected from cases with newborn umbilical artery pH < 7.05 and 20 from cases with pH > 7.20. Five experienced obstetricians practising in different maternity hospitals were asked to analyse the 40 tracings individually, according to the International Federation of Gynaecology and Obstetrics guidelines. In a first round, clinicians were given no information on neonatal outcome. In a second round, carried out 2 months later, clinicians were asked to analyse the same tracings, but the order was randomly altered and information on the newborn's arterial pH was provided. Clinicians were not informed of the purpose of the study or whether the tracings were the same. The incidence of individual fetal heart rate feature identification and tracing classification, before and after neonatal outcome was made available. In the group with pH < 7.05, repetitive decelerations and reduced variability were more common in the second round (P < 0.001 and P = 0.001, respectively), as was a pathological classification (P = 0.002); variable decelerations were less common (P = 0.008). In the group with normal pH, less tracings in the second round had prolonged decelerations (P = 0.013) and no accelerations (P = 0.013), but more had pronounced decelerations (P = 0.031) and reduced variability (P = 0.007); there was a reduction in pathological classifications, but this difference failed to reach statistical significance (P = 0.051). A knowledge of adverse neonatal outcome leads to a more severe classification of the intrapartum CTG, which derives mainly from the evaluation of decelerations and variability. |
Author | Bernardes, J Ayres‐de‐Campos, D Costa‐Santos, C Arteiro, D |
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Keywords | Human Neonatal Cardiotocography Newborn Prognosis Gynecology Physician Delivery Knowledge Obstetrics |
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Snippet | Please cite this paper as: Ayres‐de‐Campos D, Arteiro D, Costa‐Santos C, Bernardes J. Knowledge of adverse neonatal outcome alters clinicians’ interpretation... To evaluate the impact of knowledge of neonatal outcome on clinicians' interpretation of the intrapartum cardiotocograph (CTG). Prospective evaluation of... Objective: To evaluate the impact of knowledge of neonatal outcome on clinicians' interpretation of the intrapartum cardiotocograph (CTG). Design: Prospective... OBJECTIVETo evaluate the impact of knowledge of neonatal outcome on clinicians' interpretation of the intrapartum cardiotocograph (CTG).DESIGNProspective... |
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Title | Knowledge of adverse neonatal outcome alters clinicians’ interpretation of the intrapartum cardiotocograph |
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