Skip to main content
SpringerLink
Log in

Estimation of neonatal outcome artery pH value according to CTG interpretation of the last 60 min before delivery: a retrospective study. Can the outcome pH value be predicted?

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to analyze whether the umbilical artery pH value can be estimated throughout CTG assessment 60 min prior to delivery and if the estimated umbilical artery pH value correlates with the actual one. This includes analysis of correlation between CTG trace classification and actual umbilical artery pH value. Intra-and interobserver agreement and the impact of professional experience on visual analysis of fetal heart rate tracing were evaluated.

Methods

This was a retrospective study. 300 CTG records of the last 60 min before delivery were picked randomly from the computer database with the following inclusion criteria; singleton pregnancy >37 weeks, no fetal anomalies, vaginal delivery either spontaneous or instrumental-assisted. Five obstetricians and two midwives of different professional experience classified 300 CTG traces according to the FIGO criteria and estimated the postnatal umbilical artery pH.

Results

The results showed a significant difference (p < 0.05) in estimated and actual pH value, independent of professional experience. Analysis and correlation of CTG assessment and actual umbilical artery pH value showed significantly (p < 0.05) diverging results. Intra- and interobserver variability was high. Intraobserver variability was significantly higher for the resident (p = 0.001). No significant differences were detected regarding interobserver variability.

Conclusion

An estimation of the pH value and consequently of neonatal outcome on the basis of a present CTG seems to be difficult. Therefore, not only CTG training but also clinical experience and the collaboration and consultation within the whole team is important.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Pattison N, McCowan L (2000) Cardiotocography for antepartum fetal assessment. Cochrane Database Syst Rev 2010:CD001068

    Google Scholar 

  2. Donker DK, van Geijn HP, Hasman A (1993) Interobserver variation in the assessment of fetal heart rate recordings. Eur J Obstet Gynecol Reprod Biol 52:21–28

    Article  CAS  PubMed  Google Scholar 

  3. Palomäki O, Luukkaala T, Luoto R, Tuimala R (2006) Intrapartum cardiotocography—the dilemma of interpretational variation. J Perinat Med 34:298–302

    Article  PubMed  Google Scholar 

  4. Westerhuis ME, van Horen E, Kwee A, van der Tweel I, Visser GH, Moons KG (2009) Inter- and intra-observer agreement of intrapartum ST analysis of the fetal electrocardiogram in women monitored by STAN. BJOG 116:545–551

    Article  CAS  PubMed  Google Scholar 

  5. Devane D, Lalor J (2005) Midwives’ visual interpretation of intrapartum cardiotocographs: intra- and inter-observer agreement. J Adv Nurs 52:133–141

    Article  PubMed  Google Scholar 

  6. Epstein AJ, Twogood S, Lee RH, Opper N, Beavis A, Miller DA (2013) Interobserver reliability of fetal heart rate pattern interpretation using NICHD definitions. Am J Perinatol 30:463–468

    PubMed  Google Scholar 

  7. Ayres-de-Campos D, Bernardes J, Costa-Pereira A, Pereira-Leite L (1999) Inconsistencies in classification by experts of cardiotocograms and subsequent clinical decision. Br J Obstet Gynaecol 106:1307–1310

    Article  CAS  PubMed  Google Scholar 

  8. Rhöse S, Heinis AMF, Vandenbussche F, van Drongelen J, van Dillen J (2014) Inter- and intra-observer agreement of nonreassuring cardiotocography analysis and subsequent clinical management. Acta Obstet Gynecol Scand 93:596–602

    Article  PubMed  Google Scholar 

  9. Blix E, Sviggum O, Karen SK, Oian P (2003) Inter-observer variation in assessment of 845 labour admission tests: comparison between midwives and obstetricians in the clinical setting and two experts. BJOG 110:1–5

    Article  PubMed  Google Scholar 

  10. Figueras F, Albela S, Bonino S, Palacio M, Barrau E, Hernandez S, Casellas C, Coll O, Cararach V (2005) Visual analysis of antepartum fetal heart rate tracings: inter- and intra-observer agreement and impact of knowledge of neonatal outcome. J Perinat Med 33:241–245

    PubMed  Google Scholar 

  11. Spencer JA, Badawi N, Burton P, Keogh J, Pemberton P, Stanley F (1997) The intrapartum CTG prior to neonatal encephalopathy at term: a case-control study. Br J Obstet Gynaecol 104:25–28

    Article  CAS  PubMed  Google Scholar 

  12. Schiermeier S, van Leeuwen P, Butterwegge M et al (2005) Cardiotocography—an established diagnostic method with current perspectives. Gynakol Prax 29:431–441

    Google Scholar 

  13. Ayres-de-Campos D, Spong CY, Chandraharan E (2015) FIGO consensus guidelines on intrapartum fetal monitoring: cardiotocography. Int J Gynaecol Obstet 131:13–24

    Article  PubMed  Google Scholar 

  14. Seliger G, Stenzel A, Kowalski EM, Hoyer D, Nowack S, Seeger S, Schneider U (2016) Evaluation of standardized, computerized Dawes/Redman heart-rate analysis based on different recording methods and in relation to fetal beat-to-beat heart rate variability. J Perinat Med 44:785–792

    Article  PubMed  Google Scholar 

  15. Cheng YW, Snowden JM, Handler SJ, Tager IB, Hubbard AE, Caughey AB (2014) Litigation in obstetrics: does defensive medicine contribute to increases in cesarean delivery? J Matern Neonatal Med 27:1668–1675

    Article  Google Scholar 

  16. Reif P, Schott S, Boyon C, Richter J, Kavsek G, Timoh KN, Haas J, Pateisky P, Griesbacher A, Lang U, Ayres-de-Campos D (2016) Does knowledge of fetal outcome influence the interpretation of intrapartum cardiotocography and subsequent clinical management? A multicenter European study. BJOG 123:2208–2217

    Article  CAS  PubMed  Google Scholar 

  17. Costa A, Santos C, Ayres-de-Campos D, Costa C, Bernardes J (2010) Access to computerized analysis of intrapartum cardiotocographs improves clinicians’ prediction of newborn umbilical artery blood pH. BJOG 117:1288–1293

    Article  CAS  PubMed  Google Scholar 

  18. Kuehnle E, Herms S, Kohls F, Kundu S, Hillemanns P, Staboulidou I (2016) Correlation of fetal scalp blood sampling pH with neonatal outcome umbilical artery pH value. Arch Gynecol Obstet 294:763–770

    Article  CAS  PubMed  Google Scholar 

  19. Spencer JA (1993) Clinical overview of cardiotocography. Br J Obstet Gynaecol 100(Suppl. 9):4–7

    Article  PubMed  Google Scholar 

  20. Nielsen PV, Stigsby B, Nickelsen C, Nim J (1987) Intra- and inter-observer variability in the assessment of intrapartum cardiotocograms. Acta Obstet Gynecol Scand 99:421–424

    Article  Google Scholar 

  21. Spila J, Chudacek V, Janku P, Hruban L, Bursa M, Huptych M, Zach L, Lhotska L (2014) Analysis of obstetricians’ decision making on CTG recordings. J Biomed Inform 51:72–79

    Article  Google Scholar 

  22. Hruban L, Spilka J, Chudacek V, Janku P, Huptych M, Bursa M, Hudec A, Kacerovsky M, Koucky M, Prochazka M, Korecko V, Seget’a J, Simetka O, Mechurova A, Lhotska L (2015) Agreement on intrapartum cardiotocogram recordings between expert obstetricians. J Eval Clin Pract 21:694–702

    Article  PubMed  Google Scholar 

  23. Ayres-de-Campos D, Bernardes J (1999) Early, variable and late decelerations: can consensus be reached in their identification? Int J Gynaecol Obstet 65:305–306

    Article  CAS  PubMed  Google Scholar 

  24. Keith RD, Beckley S, Garibaldi JM, Westgate JA, Ifeachor EC, Greene KR (1995) A multicentre comparative study of 17 experts and an intelligent computer system for managing labour using the cardiotocogram. BJOG 102:688–700

    Article  CAS  Google Scholar 

  25. Murphy KW, Johnson P, Moorcraft J, Pattinson R, Russell V, Turnbull A (1990) Birth asphyxia and the intrapartum cardiotocograph. BJOG 97:470–479

    Article  CAS  Google Scholar 

  26. Bernardes J, Costa-Pereira A, Ayres-de-Campos D, van Geijn HP, Pereira-Leite L (1997) Evaluation of interobserver agreement of cardiotocograms. Int J Gynaecol Obstet 57:33–37

    Article  CAS  PubMed  Google Scholar 

  27. Bernardes J, Costa-Pereira A, Ayres-de-Campos D, van Geijn HP, Pereira-Leite L (1996) A more objective fetal heart rate baseline estimation. BJOG 103:714–715

    Article  CAS  Google Scholar 

  28. Taylor GM, Mires GJ, Abel EW et al (2000) The development and validation of an algorithm for real-time computerized fetal heart rate monitoring in labour. BJOG 107:1130–1137

    Article  CAS  PubMed  Google Scholar 

  29. Ayres-de-Campos D, Bernardes J (2010) FIGO Subcommittee: twenty-five years after the FIGO guidelines for the use of fetal monitoring: time for a simplified approach? Int J Gynaecol Obstet 110:16

    Article  Google Scholar 

  30. Rei M, Tavares S, Pinto P, Machado AP, Monteiro S, Costa A, Costa-Santos C, Bernardes J, Ayres-de-Campos D (2016) Interobserver agreement in CTG interpretation using the 2015 FIGO guidelines for intrapartum fetal monitoring. Eur J Obstet Gynecol Reprod Biol 205:27–31

    Article  PubMed  Google Scholar 

  31. Ayres-de-Campos D, Arteiro D, Costa-Santos C, Bernardes J (2011) Knowledge of adverse neonatal outcome alters clinicians’ interpretation of the intrapartum cardiotocograph. BJOG 118:978–984

    Article  CAS  PubMed  Google Scholar 

  32. Reif P, Schott S, Boyon C, Rihcter J, Kavsek G, Timoh KN, Haas J, Pateisky P, Griesbacher A, Lang U, Ayres-de-Campos D (2016) Does knowledge of fetal outcome influence the interpretation of intrapartum cardiotocography and subsequent clinical management? A multicentre European study. BJOG. doi:10.1111/1471-0528.13882

    PubMed  Google Scholar 

  33. Schiermeier S, Westhof G, Leven A, Hatzmann H, Reinhard J (2011) Intra- and interobserver variability of intrapartum cardiotocography: a multicenter study comparing the FIGO classification with computer analysis software. Gynecol Obstet Invest 72:169–173

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Prof. Sibbertsen and Dr. Betram, Institute of Statistics of the Leibniz-University of Hanover, for the statistical analysis.

Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany

    S. Kundu, E. Kuehnle, C. Schippert, J. von Ehr, P. Hillemanns & Ismini Staboulidou

Authors
  1. S. Kundu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Kuehnle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Schippert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. von Ehr
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Hillemanns
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ismini Staboulidou
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SK and IS conceived the study design, prepared the study protocol with input of PH. IS was in charge of overall project coordination and data management. SK, IS and EK interpreted the data and prepared the first draft of the manuscript. EK, CS, JvE, SK and IS have been examiners in the study. All authors contributed to interpretation of the results, provided input to all stages of the article and revised the manuscript for intellectual content. All authors approved the manuscript for publication.

Corresponding author

Correspondence to Ismini Staboulidou.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Ethical approval

The study was approved by the Ethics Committee of Hanover Medical School on 29th of January 2015 (no: 2572-2015).

Funding

There was no funding.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kundu, S., Kuehnle, E., Schippert, C. et al. Estimation of neonatal outcome artery pH value according to CTG interpretation of the last 60 min before delivery: a retrospective study. Can the outcome pH value be predicted?. Arch Gynecol Obstet 296, 897–905 (2017). https://doi.org/10.1007/s00404-017-4516-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-017-4516-4

Keywords

Search

Navigation