Does knowledge of fetal outcome influence the interpretation of intrapartum cardiotocography and subsequent clinical management? A multicentre European study

• Published in: Zeitschrift für Geburtshilfe und Neonatologie
• Main Authors: Reif, P, Schott, S, Boyon, C, Richter, J, Kavšek, G, Nyangoh Timoh, K, Pateisky, P, Haas, J, Griesbacher, A, Lang, U, Ayres-de-Campos, D
• Format: Conference Proceeding
• Language: English
• Published: 03.11.2015
• ISSN: 0948-2393; 1439-1651
• DOI: 10.1055/s-0035-1566724

Objective: To investigate whether knowledge of fetal outcome influences retrospective interpretation of cardiotocographic (CTG) tracings and subsequent management recommendations. Design: Prospective multicentre online study. Setting: Seven university hospitals in Austria, Belgium, France, Germany and Slovenia. Population: Forty-two intrapartum CTG tracings from women with singleton pregnancies and uneventful antepartum courses. Methods: Using an online questionnaire, 123 healthcare professionals (residents, consultants, heads of departments, midwives) interpreted 42 tracings without any knowledge of fetal outcome and provided management recommendations according to the 2008 National Institute of Clinical Excellence guidelines (Intrapartum Care). Two months later, 93 of the 123 participants re-interpreted the same re-ordered tracings, this time with information on the newborn's umbilical artery pH. Outcome Measures: Comparison of the evaluation of tracing features (baseline, accelerations, decelerations, variability), overall tracing classification (normal, suspicious, pathologic), and management recommendations between the initial analysis and re-interpretation. Results: In newborns with umbilical artery pH ≤7.05, knowledge of the pH value led to significant changes in the evaluation of all basic tracing features. In this group, classification of tracings as “normal” decreased 76% (8.8% vs. 2.1%, p < 0.001) while classification as “pathologic” increased 51% (44.7% vs. 67.5%, p < 0.001). In newborns with pH 7.06 – 7.19, classification of tracings as “normal” decreased 36% (22.4% vs. 14.4%, p < 0.001), and in those with pH ≥7.20, classification of tracings as “pathologic” decreased 40% (23.4% vs. 14.1%, p < 0.001). In the group of newborns with umbilical artery pH ≤7.05, the recommendations “no attention needed” decreased 75% (10.2% vs. 2.6%, p < 0.001), and the number of recommendations “rapid reversal of hypoxic cause or immediate delivery” increased 70.3% (42.1% vs. 71.7%, p < 0.001). Conclusions: When provided with information on adverse fetal outcome, healthcare professionals provide a more pessimistic evaluation of basic tracing features, overall classification, and clinical management recommendations. It is mandatory, that expert witnesses evaluate CTG tracings strictly under an ex ante view.