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

Abstract

The aim of this study was to analyze whether the umbilical artery pH value can be estimated throughout CTG assessment 60min 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. This was a retrospective study. 300 CTG records of the last 60min before delivery were picked randomly from the computer database with the following inclusion criteria; singleton pregnancy >37weeks, 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. 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. 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.