Prediction of fetal base excess values at birth using an algorithm to interpret fetal heart rate tracings: a retrospective validation
Article first published online: 12 OCT 2012
© 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 119, Issue 13, pages 1657–1664, December 2012
How to Cite
Uccella, S., Cromi, A., Colombo, G., Agosti, M., Bogani, G., Casarin, J. and Ghezzi, F. (2012), Prediction of fetal base excess values at birth using an algorithm to interpret fetal heart rate tracings: a retrospective validation. BJOG: An International Journal of Obstetrics & Gynaecology, 119: 1657–1664. doi: 10.1111/j.1471-0528.2012.03511.x
- Issue published online: 12 NOV 2012
- Article first published online: 12 OCT 2012
- Accepted 11 August 2012. Published Online 16 October 2012.
- Base excess;
- electronic fetal monitoring;
- fetal acidemia;
- fetal heart rate;
- inter-observer reproducibility;
- intra-observer reproducibility
Objective To evaluate whether a standardised algorithm to interpret fetal heart rate (FHR) tracings during the entire length of labour can predict umbilical artery base excess at birth, and to investigate its inter- and intra-observer reproducibility.
Design Retrospective study.
Setting Obstetrics and gynaecology department at a tertiary referral centre in a university hospital.
Population Group 1: 152 consecutive, generally low-risk, labouring women. Group 2: mixed group of 30 women who delivered a fetus with pH < 7.00 and 30 women who delivered a fetus with pH ≥ 7.00.
Methods Intrapartum FHR tracings were retrospectively and blindly evaluated by two independent assessors using an algorithm proposed by Ross and Gala to predict fetal base excess at birth.
Main outcome measures The accuracy in predicting the base excess values of newborns was expressed as the proportion of FHR tracings in which the operator was able to correctly calculate the actual base excess at birth (approximation of ±2 mmol/l). Inter- and intra-observer reproducibility were estimated using the Pearson correlation coefficient.
Results In the group of 152 low-risk labouring women, the two assessors correctly predicted the umbilical artery base excess in 73.1 and 76.3% of cases, respectively. Inter-observer (Pearson correlation coefficient = 0.75) and intra-observer (Pearson correlation coefficient = 0.80 and 0.82 for the first and second assessor, respectively) reproducibility was very good. In the 30 fetuses that were acidemic, the first and second observers correctly predicted base excess values in 23 (76.7%) and 21 (70%) cases, respectively (inter-observer reproducibility, Pearson correlation coefficient = 0.72).
Conclusions The algorithm proposed by Ross and Gala may be a valuable tool to estimate changes in umbilical base excess during active labour, with a high inter- and intra-observer reproducibility.