Development, Validation, and Diagnostic Accuracy of the Fetal Lack of Responsiveness Scale for Diagnosis of Severe Perinatal Hypoxia.

IF 3.2 Q1 OBSTETRICS & GYNECOLOGY Journal of Pregnancy Pub Date : 2024-10-16 eCollection Date: 2024-01-01 DOI:10.1155/2024/9779831
Luis Carlos Franco, Sandra M Buitrago, Isabel Arbelaez, Laura F Pinto, Daniela Blanco, María C Pizarro, Laura Santamaria, Catalina Trillos
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Abstract

Background: There are limitations to predicting perinatal asphyxia, as current tools rely almost entirely on fetal cardiotocography (CTG). The fetal lack of responsiveness scale (FLORS) is a new diagnostic alternative based on the physiological phenomena associated with fetal hypoxia. Objectives: The objective of this study was to develop, validate, and assess the diagnostic accuracy of the FLORS for predicting severe perinatal hypoxia (SPH). Study Design: A two-phase retrospective observational cross-sectional analytical study was conducted. Phase 1 involved the formulation and retrospective validation of the FLORS. A total of 366 fetal CTG records were evaluated twice by seven readers. Phase 2 was a collaborative, retrospective, multicenter diagnostic test study that included 37 SPH and 366 non-SPH cases. Results: Phase 1: A numeric, physiology-based scale was developed and refined based on expert opinions. The median time to apply the scale per reading was 38 s. Cronbach's alpha, which is a reliability measure, was significant (p = 0.784). The kappa index for test-retest agreement was moderate to reasonable, with a median value of 0.642. For interobserver agreement, the kappa index per variable was as follows: baseline, 0.669; accelerations, 0.658; variability, 0.467; late/variable decelerations, 0.638; slow response decelerations, 0.617; and trend to change, 0.423. Phase 2, including 37 SPH and 366 non-SPH cases, showed a sensitivity of 62.2% and specificity of 75.4% for the 2-point score, whereas the 3-point score had a sensitivity of 35.1% and specificity of 89.9%. The area under the curve (AUC) was significant at 0.73 (CI 0.645-0.818). Conclusions: FLORS demonstrated significant internal consistency and observer agreement, with a promising sensitivity-specificity balance and significant AUC. Further research is needed to assess its impact on perinatal hypoxia and cesarean delivery.

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用于诊断围产期严重缺氧的胎儿无反应量表的开发、验证和诊断准确性。
背景:由于目前的工具几乎完全依赖于胎儿心动图(CTG),因此预测围产期窒息存在局限性。胎儿缺氧反应量表(FLORS)是一种基于胎儿缺氧相关生理现象的新诊断方法。研究目的本研究旨在开发、验证和评估 FLORS 预测围产期严重缺氧(SPH)的诊断准确性。研究设计:分两个阶段进行回顾性观察横断面分析研究。第一阶段包括制定和回顾性验证 FLORS。共有 7 位读者对 366 份胎儿 CTG 记录进行了两次评估。第二阶段是一项合作性、回顾性、多中心诊断测试研究,包括 37 例 SPH 和 366 例非 SPH 病例。结果:第 1 阶段:根据专家意见制定并完善了基于生理学的数字量表。每次读数应用量表的中位时间为 38 秒。信度指标 Cronbach's alpha 具有显著性(p = 0.784)。测试-重复测试一致性的卡帕指数为中等至合理水平,中值为 0.642。在观察者之间的一致性方面,每个变量的卡帕指数如下:基线,0.669;加速度,0.658;可变性,0.467;晚期/可变减速,0.638;慢反应减速,0.617;变化趋势,0.423。第二阶段包括 37 例 SPH 和 366 例非 SPH 病例,结果显示 2 点评分的灵敏度为 62.2%,特异性为 75.4%,而 3 点评分的灵敏度为 35.1%,特异性为 89.9%。曲线下面积(AUC)为 0.73(CI 0.645-0.818),差异显著。结论:FLORSFLORS显示出明显的内部一致性和观察者一致性,具有良好的敏感性-特异性平衡和显著的AUC。需要进一步研究以评估其对围产期缺氧和剖宫产的影响。
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来源期刊
Journal of Pregnancy
Journal of Pregnancy OBSTETRICS & GYNECOLOGY-
CiteScore
6.10
自引率
0.00%
发文量
15
审稿时长
14 weeks
期刊介绍: Journal of Pregnancy is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies related to all aspects of pregnancy and childbirth. The journal welcomes submissions on breastfeeding, labor, maternal health and the biomedical aspects of pregnancy.
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