Time to reconsider: have the 2015 FIGO and 2017 Swedish intrapartum cardiotocogram classifications led us from Charybdis to Scylla?

ABSTRACTIn 2015 FIGO revised the 1987 intrapartum CTG classification (FIGO1987). A less radical FIGO2015 version was introduced in Sweden 2017 (SWE2017). Now,post hoc simulation studies show that FIGO2015 and SWE2017 are less reliable than (a modified) FIGO1987. FIGO2015 shows significantly better inter-observer agreement for normal CTG traces than FIGO1987, but significantly worse for pathological traces. Agreements between templates are moderate-good, but different classifications of mainly variable decelerations and tachycardia cause significant heterogeneities. FIGO2015 shows insufficient sensitivity to identify fetal acidemia compared to FIGO1987. In connection with fetal electrocardiogram ST analysis (STAN), one study showed no template was superior in identifying fetal acidemia, but in a series of only acidemia FIGO1987 had significantly higher sensitivity than FIGO2015 (73% vs 43%) and alarmed for fetal acidemia considerably earlier. With SWE2017, operative interventions declined significantly in Sweden but several adverse neonatal outcomes increased significantly. It remains to investigate the development with FIGO2015.
Source: Acta Obstetricia et Gynecologica Scandinavica - Category: OBGYN Authors: Tags: COMMENTARY Source Type: research