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PURPOSE: To validate the modified World Health Organization (WHO) classification in pregnant women with congenital and acquired heart diseases. PATIENTS AND METHODS: The database of pregnant women with heart disease, who delivered at Songklanagarind Hospital between January 1995 and December 2016, was retrieved from the Statistical Unit, Department of Obstetrics and Gynecology, along with the Hospital Information System of Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University. Each patient was retrospectively classified according to the modified WHO classification of maternal cardiovascular risk. Comparison of maternal and fetal outcomes among the modified WHO classes were analyzed using the chi-square test or Fisher's exact test and one-way ANOVA test. A p-value of <0.05 was considered statistically significant. RESULTS: A total of 331 cases were studied: 157 cases with congenital heart disease and 174 cases with acquired heart disease. There were 48, 173, 32 and 78 cases in the modified WHO class I, II, III and IV, respectively. Congestive heart failure was the most common complication. The overall maternal mortality rate was 3.6%, all of which were in the modified WHO class IV. Maternal cardiovascular events occurred in 24.2% of cases, increasing rates with higher modified WHO class: 4.2%, 15.0%, 25.0% and 56.4% in class I, II, III and IV, respectively (p<0.001). Adverse fetal outcomes including preterm delivery, low birth weight, small for gestational age and neonatal intensive care unit admission were also significantly increased in class III and IV (p<0.05). CONCLUSION: The modified WHO classification is useful not only for obtaining a cardiovascular risk assessment in pregnant women with heart disease but also for predicting adverse fetal outcomes. It must, therefore, be implemented into routine care service at all levels of health care systems.
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OBJECTIVE: To improve the predictive ability for identification of peripartum asphyxia neonates by using the 3-tier and 5-tier fetal heart rate (FHR) classification systems. STUDY DESIGN: A retrospective case-control study comparing peripartum asphyxia neonates and no asphyxia neonates was conducted. The FHR tracings were classified into the 3-tier and 5-tier systems by the two reviewers. Pearson's X2 or Fisher's exact tests was used for comparisons between the groups. Logistic regression models were used to identify factors associated with peripartum asphyxia neonates. Odds Ratios (OR) and Likelihood Ratios (LR) with 95% confidence intervals (CI) were calculated from the regression coefficients. RESULTS: A total of 36 peripartum asphyxia fetuses (5.0%) were enrolled. Overall, the performance of category II and suspicious tracings to detect peripartum asphyxia neonates was higher than the yellow and orange tracings with 61% and 67% sensitivity, respectively. The 5-tier FHR classification had higher specificity than the 3-tier system (82-99%). The predictive ability to detect peripartum asphyxia neonates by the 5-tier FHR classification was highest when combined with maternal-associated risk factors (AUC 0.67-0.72). CONCLUSION: Maternal-associated risk factors combined with an abnormal 5-tier FHR classification had high predictive ability and specificity to detect peripartum asphyxia neonates.
Asunto(s)
Asfixia Neonatal/diagnóstico , Cardiotocografía/clasificación , Frecuencia Cardíaca Fetal/fisiología , Adulto , Asfixia Neonatal/epidemiología , Estudios de Casos y Controles , Corioamnionitis/diagnóstico , Femenino , Humanos , Recién Nacido , Modelos Logísticos , Síndrome de Aspiración de Meconio/diagnóstico , Paridad , Valor Predictivo de las Pruebas , Embarazo , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
A prospective study was conducted in centre in Southern Thailand, to evaluate agreement in EFM interpretation among various physicians in order to find out the most practical system for daily use. We found strong agreement of very normal FHR tracings among the FIGO, NICHD 3-tier and 5-tier systems. The NICHD 3-tier was more compatible with the FIGO system than 5-tier system. Overall inter-observer agreement was moderate for the NICHD 3-tier system while inter-observer agreement of 5-tier system was fair also the intra-observer agreement was higher in the NICHD 3-tier system. So the 3-tier systems are more suitable than the 5-tier system in general obstetric practice. Impact statement What is already known on this subject: The 3-tier and 5-tier systems were widely used in general obstetrics practice. What the results of this study add: The inter- and intra-observer agreement of NICHD 3-tier system was higher than the 5-tier system. What the implications are of these findings for clinical practice and/or further research: The 3-tier systems were more suitable than the 5-tier systems in general obstetrics practice.