The relevance of Short-Term Variation (STV) value measured within 1 hour before delivery in predicting adverse neonatal outcome
, 1, 1, 1, 1, 1, 1
Abstract
Objectives: Computer CTG analysis (cCTG) included short-term variation (STV) is one of the methods of monitoring fetal condition during delivery. The aim of our study was to define appropriability of STV measured within 1 hour before delivery in prediction of neonatal outcomes.
Material and methods: The retrospective study included 1014 pregnant women, who gave birth in the Department of Obstetrics and Perinatology. Participants were divided into two groups: group 1 — term pregnancies (37–41 weeks) and group 2 — preterm pregnancies (lower than 37 weeks). In each of them, two subgroups have been separated: control (STV ≥ 3 ms) and study group (STV < 3 ms).
Results: In both groups 1 and 2, there were no statistically significant differences related to Apgar scores in 1st, 3rd and 5th minute between group with STV < 3 ms and group with STV > 3 ms Moreover, for 37–41 weeks the sensitivity, specificity, positive predictive value and negative predictive value were: 22.7%, 83.9%, 3.3% and 97.8% and for lower than 37: 45.7%, 65.4%, 47.1%, 64.2% in 1st minute after delivery. In group 1 the area under curve (AUC) measurements were 0.45 (95% CI: 0.32–0.58) for 1st minute and 0.55 (95% CI: 0.35–0.74) for 5th minute and in group 2: 0.58 (95% CI: 0.45–0.71) for 1st minute and 0.57 (95% CI: 0.42–0.72) for 5th minute.
Conclusions: High specificity and negative predictive value of STV indicates a good Apgar score of newborns in term pregnancies. Analysis of STV in preterm pregnancy is not clear. Fetal well-being in preterm pregnancy should include STV and other non-invasive and invasive tools.
Keywords: cardiotocography (CTG)short-term variationintrapartum monitoringAPGAR score
References
- Wretler S, Holzmann M, Graner S, et al. Fetal heart rate monitoring of short term variation (STV): a methodological observational study. BMC Pregnancy Childbirth. 2016; 16: 55.
- Galazios G, Tripsianis G, Tsikouras P, et al. Fetal distress evaluation using and analyzing the variables of antepartum computerized cardiotocography. Arch Gynecol Obstet. 2010; 281(2): 229–233.
- WHO recommendations on intervention to improve preterm birth outcomes . https://apps.who.int/iris/bitstream/handle/10665/183037/?sequence=1.
- Leeflang MMG. Systematic reviews and meta-analyses of diagnostic test accuracy. Clin Microbiol Infect. 2014; 20(2): 105–113.
- Hoo ZH, Candlish J, Teare D. What is an ROC curve? Emerg Med J. 2017; 34(6): 357–359.
- Cnattingius S, Norman M, Granath F, et al. Apgar Score Components at 5 Minutes: Risks and Prediction of Neonatal Mortality. Paediatr Perinat Epidemiol. 2017; 31(4): 328–337.
- Simon R. Sensitivity, Specificity, PPV, and NPV for Predictive Biomarkers. J Natl Cancer Inst. 2015; 107(8).
- Bandos AI, Guo B, Gur D. Estimating the Area Under ROC Curve When the Fitted Binormal Curves Demonstrate Improper Shape. Acad Radiol. 2017; 24(2): 209–219.
- Pinas A, Chandraharan E. Continuous cardiotocography during labour: Analysis, classification and management. Best Pract Res Clin Obstet Gynaecol. 2016; 30: 33–47.
- Leszczynska-Gorzelak B, Poniedzialek-Czajkowska E, Oleszczuk J. Intrapartum cardiotocography and fetal pulse oximetry in assessing fetal hypoxia. Int J Gynaecol Obstet. 2002; 76(1): 9–14.
- Gyllencreutz E, Lu Ke, Lindecrantz K, et al. Validation of a computerized algorithm to quantify fetal heart rate deceleration area. Acta Obstet Gynecol Scand. 2018; 97(9): 1137–1147.
- Giuliano N, Annunziata ML, Esposito FG, et al. Computerised analysis of antepartum foetal heart parameters: New reference ranges. J Obstet Gynaecol. 2017; 37(3): 296–304.
- Mullins E, Lees C, Brocklehurst P. Is continuous electronic fetal monitoring useful for all women in labour? BMJ. 2017; 359: j5423.
- Wolf H, Gordijn SJ, Onland W, et al. Computerized fetal heart rate analysis in early preterm fetal growth restriction. Ultrasound in Obstetrics & Gynecology. 2020; 56(1): 51–60.
- Verdurmen KMJ, Warmerdam GJJ, Lempersz C, et al. The influence of betamethasone on fetal heart rate variability, obtained by non-invasive fetal electrocardiogram recordings. Early Hum Dev. 2018; 119: 8–14.
