ABSTRACT
OBJECTIVE: Despite its routine use in intrapartum care, the technique of fetal cardiotocography has some limitations. The aim of this study is to analyze the predictive capacity and interobserver agreement in the latest versions of four international cardiotocography guidelines: Federation of Gynecology and Obstetrics (FIGO), American College of Obstetrics and Gynecology (ACOG), the National Institute for Health and Care Excellence (NICE) and Chandraharan, used to predict neonatal acidemia. STUDY DESIGN: The last 30 min of 150 cardiotocographic records were analyzed over all the pH ranges and were blindly evaluated by three independent reviewers. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) were calculated to assess the predictive capacity of each fetal cardiotocographic guideline. The degree of interobserver agreement was evaluated with the Fleiss Kappa coefficient. RESULTS: Observers found fetal cardiotocography guidelines to have a variable sensitivity and specificity. The Chandraharan classification reached the highest sensitivity (78.79%), while ACOG had the highest specificity (95.73%). On average for the three observers, Chandraharan had the highest discrimination capacity for neonatal acidemia, although this was only moderate (AUC 0.66; 95%CI, 0.55-0.77) and did not differ significantly from the remaining guidelines. The degree of agreement among the three observers, assessed according to the Fleiss Kappa coefficient, was generally acceptable or moderate for all items and classifications, being highest with the FIGO classification (ĸ = 0.35; 95%CI, 0.28-0.41) and lowest with the ACOG (ĸ = 0.23; 95%CI, 0.16-0.30). CONCLUSION: Although all the guidelines have a moderate capacity to predict neonatal acidemia, the Chandraharan guideline has the highest capacity. This follows a different approach from the others in that it relies on interpretations of cardiotocographic traces based on fetal physiology. The degree of interobserver agreement is, in general, acceptable for the four guidelines, and is the highest for FIGO.
Subject(s)
Acidosis , Heart Rate, Fetal , Pregnancy , Infant, Newborn , Female , Humans , Heart Rate, Fetal/physiology , Observer Variation , Cardiotocography/methods , Acidosis/diagnosis , Sensitivity and SpecificityABSTRACT
Aunque los quistes en el cordón umbilical son una entidad relativamente frecuente, no pueden considerarse un hallazgo ecográfico no patológico. La prevalencia de quistes del cordón umbilical se ha descrito en alrededor del 3% de las gestaciones durante el primer trimestre. En ocasiones se asocian con otras malformaciones estructurales y/o cromosómicas. Si son persistentes y progresivos en su tamaño, pueden ocasionar una restricción del flujo sanguíneo fetal. Presentamos un caso de diagnóstico prenatal ecográfico en el primer trimestre de múltiples quistes del cordón umbilical en una paciente de 31 años de edad. Tanto la amniocentesis (46XY) como el seguimiento ecográfico posterior fueron normales. Los quistes de cordón presentaron una disminución progresiva en su tamaño hasta desaparecer en el control ecográfico del tercer trimestre. Nació un varón de 3.930 g a las 40 semanas sin ninguna anomalía asociada
Although umbilical cord cysts are a relatively frequent entity they cannot be considered a nonpathological sonographic finding. In the first trimester pregnancies the prevalence of umbilical cord cysts has been reported about 3%. Sometimes are associated to other chromosomal and/or structural abnormalities. If they are persistent and progressive in the size, could restrict the fetal sanguineous flow. We report a case in which was detected prenatally in the first trimester multiple cysts of the umbilical cord in a 31-year-old woman. The amniocentesis (46XY) and later sonographic examination were normal. The cord cysts presented a progressive decrease in the size until they resolved in the sonographic control of the third trimester. A 3930 g male was delivered at 40 weeks without associate abnormalities
