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

Autor: Reif P; Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria., Schott S; Department of Obstetrics and Gynaecology, Heidelberg University Hospital, Heidelberg, Germany., Boyon C; Department of Obstetrics and Gynaecology, Lille University Hospital, Lille, France., Richter J; Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium., Kavšek G; Department of Obstetrics and Gynaecology, University Clinical Centre Ljubljana, Ljubljana, Slovenia., Timoh KN; Department of Obstetrics and Gynaecology, Paris Sud 11 University, Paris, France., Haas J; Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria., Pateisky P; Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria., Griesbacher A; Department for Risk Assessment, Data and Statistics, Austrian Agency for Health and Food Safety, Vienna, Austria., Lang U; Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria., Ayres-de-Campos D; Department of Obstetrics and Gynaecology, Medical School - University of Porto, Porto, Portugal.
Jazyk: angličtina
Zdroj: BJOG : an international journal of obstetrics and gynaecology [BJOG] 2016 Dec; Vol. 123 (13), pp. 2208-2217. Date of Electronic Publication: 2016 Feb 16.
DOI: 10.1111/1471-0528.13882
Abstrakt: Objective: To investigate whether knowledge of fetal outcome influences retrospective interpretation of cardiotocographic tracings and subsequent management recommendations.
Design: Prospective online study.
Setting: Seven university hospitals in five European countries.
Population: Forty-two intrapartum tracings from women with singleton pregnancies and uneventful antepartum courses.
Methods: Using an online questionnaire, 123 healthcare professionals interpreted 42 tracings without any knowledge of fetal outcome and provided management recommendations according to the 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, overall tracing classification, 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% (8.8-2.1%, P < 0.001), whereas classification as 'pathologic' increased 51% (44.7-67.5%, P < 0.001). In newborns with pH 7.06-7.19, classification of tracings as 'normal' decreased 36% (22.4-14.4%, P < 0.001), and in those with pH ≥ 7.20, classification of tracings as 'pathologic' decreased 40% (23.4-14.1%, P < 0.001). In the group of newborns with umbilical artery pH ≤ 7.05, the recommendations 'no attention needed' decreased 75% (10.2-2.6%, P < 0.001), and the number of recommendations 'rapid reversal of hypoxic cause or immediate delivery' increased 70.3% (42.1-71.7%, 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.
Tweetable Abstract: Knowledge of adverse fetal outcome leads to more pessimistic CTG evaluation and management recommendations.
(© 2016 Royal College of Obstetricians and Gynaecologists.)
Databáze: MEDLINE
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