Ekengård Frida, Cardell Monika, Herbst Andreas
Department of Obstetrics and Gynecology Skåne University Hospital, Institution of Clinical Sciences Lund University, Lund, Sweden.
Eur J Obstet Gynecol Reprod Biol X. 2020 Nov 25;9:100120. doi: 10.1016/j.eurox.2020.100120. eCollection 2021 Jan.
In 2015, new FIGO guidelines for CTG interpretation were presented (FIGO-15). In 2017, the previous Swedish guidelines (SWE-09) were replaced with guidelines adapted to FIGOs (SWE-17). The performance of these three templates had not been scientifically evaluated before its clinical implementation. The objective of this study was to compare the sensitivity and specificity to detect fetal acidosis at birth using these three templates during the second stage of labor.
This case-control study included 295 neonates with cord blood pH < 7.05 and 591 controls with pH ≥ 7.15, born 2012-2017. Tracings from the last 30-80 min of labor were classified independently by three assessors (midwives, residents and obstetricians), blinded to group and outcome.
The classification pathological using FIGO-15 had a sensitivity of 50 % and specificity of 88 % in detecting fetuses with acidosis. For SWE-17, the sensitivity was 62 % and the specificity 85 %. For SWE-09 the sensitivity was 87 % and the specificity 56 %.By combining suspicious and pathological patterns the sensitivity for FIGO-15 increased to 97 %, and for SWE-17 to 83 %, whereas the specificity decreased to 23 % and 68 % respectively.
The FIGO classification seemed to be insufficiently discriminative in the second stage of labor; most patterns in acidotic cases were classified as merely suspicious with this template, and the sensitivity of pathological patterns was low at 50 %. Combined pathological and suspicious patterns detected fetal acidosis at a specificity that was too low to be useful (23 %). SWE-09 showed the best ability to detect acidosis with pathological patterns (sensitivity 87 %). SWE-17 reached almost the same sensitivity (83 %) with the combination of suspicious and pathological patterns, and at a higher specificity (68 %).
2015年发布了新的FIGO产时电子胎心监护（CTG）解读指南（FIGO - 15）。2017年，先前的瑞典指南（SWE - 09）被更新为符合FIGO标准的指南（SWE - 17）。这三种模板在临床应用前尚未经过科学评估。本研究的目的是比较在第二产程中使用这三种模板检测出生时胎儿酸中毒的敏感性和特异性。
本病例对照研究纳入了295例脐血pH < 7.05的新生儿和591例pH≥7.15的对照新生儿，均为2012年至2017年出生。由三名评估人员（助产士、住院医师和产科医生）对产程最后30 - 80分钟的监护图进行独立分类，评估人员对分组和结局不知情。
使用FIGO - 15分类为病理性的在检测酸中毒胎儿时敏感性为50%，特异性为88%。对于SWE - 17，敏感性为62%，特异性为85%。对于SWE - 09，敏感性为87%，特异性为56%。将可疑和病理性模式合并后，FIGO - 15的敏感性增至97%，SWE - 17增至83%，而特异性分别降至23%和68%。
FIGO分类在第二产程中似乎鉴别能力不足；酸中毒病例中的大多数模式用该模板仅被分类为可疑，病理性模式的敏感性低至50%。合并病理性和可疑模式检测胎儿酸中毒时特异性过低，无实际应用价值（23%）。SWE - 09在病理性模式下检测酸中毒的能力最佳（敏感性87%）。SWE - 17通过合并可疑和病理性模式达到了几乎相同的敏感性（83%），且特异性更高（68%）。
