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Saturday, August 30, 2014

Trailers (93): Fetal heart rate monitoring

Graham et al. Diagnostic accuracy of fetal heart rate monitoring in the identification of neonatal encephalopathy

Why should you read about this topic?

What obstetrician does not think about neonatal encephalopathy and its consequences?

What were the authors trying to do?

Estimate the diagnostic accuracy of electronic fetal heart rate monitoring immediately prior to delivery for neonatal encephalopathy

Who participated and in what setting?

Neonates (N=39) treated with whole-body hypothermia for neonatal encephalopathy matched with controls (N=78) born in the Johns Hopkins system between 2007 and 2013

What was the study design?

Retrospective case control study of the last hour of electronic fetal heart rate monitoring

What were the main outcome measures?

Neonatal encephalopathy treated with whole body hypothermia; the primary exposure was worst category tracing in the hour prior to delivery

What were the results?

There was no significant difference between groups for tracing category.  Multivariable logistic regression showed that cases had a decrease in frequency of early decelerations, and an increase in total deceleration area 30 and 60 minutes prior to delivery.  Sensitivity and specificity were poor for all associations.

What is the most interesting image in the paper?

Table 6

What were the study strengths and weaknesses?

Strengths:  systematic, comprehensive approach to interpretation of fetal heart tracings; well-defined cases.  Weaknesses: suboptimal inter-observer agreement for tracing characteristics

What does the study contribute for your practice?

Current methods of interpreting fetal heart tracings in the hour prior to delivery are not helpful for predicting neonatal encephalopathy