title: Diagnostic Accuracy of the FIGO and the 5-Tier Fetal Heart Rate Classification Systems in the Detection of Neonatal Acidemia.
abstract: ObjectiveThe objective of this study was to determine ability to detect neonatal acidemia and interobserver agreement with the FIGO 3-tier and 5-tier fetal heart rate (FHR) classification systems.DesignThis was a case-control study.SettingThis study was set at the University Medical Center.PopulationA total of 202 FHR tracings of 102 women who delivered an acidemic fetus (umbilical arterial cord gas pH ≤ 7.10 and BE < - 8) and 100 who delivered a nonacidemic fetus (umbilical arterial cord gas pH > 7.10) were assessed. A subanalysis was performed for those fetuses who suffered severe metabolic acidemia (pH ≤ 7.0 and BE < - 12).MethodsTwo reviewers blind to clinical and outcome data classified tracings according to the new 3-tier system proposed by the FIGO and the 5-tier system proposed by Parer and Ikeda.Main Outcome MeasuresSensitivity and specificity for detecting neonatal acidemia and interobserver agreement in classifying FHR tracings into categories of both systems were studied.ResultsThe 3-tier system showed a greater sensitivity and lower specificity to detect neonatal acidemia (43.6% sensitivity, 82.5% specificity) and severe metabolic acidemia (71.4% sensitivity, 74.0% specificity) compared with the 5-tier system (36.3% sensitivity, 88% specificity and 61.9% sensitivity, 80.1% specificity, respectively). Both systems were compared by area under the receiver-operating characteristic curve, with comparable predictive ability for detecting neonatal acidemia (FIGO-area under the curve [AUC]: 0.63 [95% confidence interval [CI]: 0.57-0.68] and Parer-AUC: 0.62 [95% CI: 0.56-0.67]). Interobserver agreement was moderate for both systems, but performance at each specific category showed a better agreement for the 5-tier system identifying a pathological tracing (orange or red, κ: 0.625 vs. pathological category, κ: 0.538).ConclusionBoth systems presented a comparable ability to predict neonatal acidemia, although the 5-tier system showed a better interobserver agreement identifying pathological tracings.
authors: Department of Obstetrics, Miguel Servet University Hospital, Zaragoza, Spain.
authors: Sabina
authors: S
authors: Martí Gamboa
authors: Department of Obstetrics, Miguel Servet University Hospital, Zaragoza, Spain.
authors: Olga Redrado
authors: OR
authors: Giménez
authors: Department of Obstetrics, Miguel Servet University Hospital, Zaragoza, Spain.
authors: Jara Pascual
authors: JP
authors: Mancho
authors: Department of Obstetrics, Miguel Servet University Hospital, Zaragoza, Spain.
authors: María Lapresta
authors: ML
authors: Moros
authors: Department of Obstetrics, Miguel Servet University Hospital, Zaragoza, Spain.
authors: Julia Ruiz
authors: JR
authors: Sada
authors: Department of Obstetrics, Miguel Servet University Hospital, Zaragoza, Spain.
authors: Sergio Castan
authors: SC
authors: Mateo
mesh_terms: D000137:Acid-Base Imbalance / Q000503:physiopathology; D000138:Acidosis / Q000175:diagnosis* / Q000503:physiopathology*; D000328:Adult; D019540:Area Under Curve; D015148:Cardiotocography / Q000145:classification*; D016022:Case-Control Studies; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D006340:Heart Rate, Fetal; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D015588:Observer Variation; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult