Access to computerised analysis of intrapartum cardiotocographs improves clinicians’ prediction of newborn umbilical artery blood pH

<jats:p> <jats:italic>Please cite this paper as:</jats:italic> Costa A, Santos C, DAyres‐, de‐Campos, Costa C, Bernardes J. Access to computerised analysis of intrapartum cardiotocographs improves clinicians’ prediction of newborn umbilical artery blood pH. BJOG 2010;117:1288–1293.</jats:p><jats:p><jats:bold>Objective </jats:bold> To evaluate the impact of access to computerised cardiotocograph (CTG) analysis on reproducibility and accuracy of clinicians’ predictions of umbilical artery blood pH (UAB pH) and 5‐minute Apgar score.</jats:p><jats:p><jats:bold>Design </jats:bold> Prospective evaluation of pre‐recorded cases.</jats:p><jats:p><jats:bold>Setting </jats:bold> A tertiary‐care university hospital.</jats:p><jats:p><jats:bold>Population </jats:bold> From databases of intrapartum CTGs acquired in singleton term pregnancies, 204 tracings with low signal loss and short time interval to delivery were consecutively selected.</jats:p><jats:p><jats:bold>Methods </jats:bold> Tracings were randomly assigned to computer analysis by the O<jats:sc>mniview‐</jats:sc>S<jats:sc>is</jats:sc>P<jats:sc>orto</jats:sc> 3.5<jats:sup>®</jats:sup> system (study group <jats:italic>n</jats:italic> = 104) or to no analysis (control group <jats:italic>n</jats:italic> = 100). Three experienced clinicians evaluated all tracing printouts independently and were asked to predict the newborns’ UAB pH and 5‐minute Apgar scores from them.</jats:p><jats:p><jats:bold>Main outcome measures </jats:bold> Interobserver agreemen<jats:bold>t</jats:bold> (measured by the intraclass correlation coefficient [ICC]) and accuracy in prediction of neonatal outcomes with 95% CI.</jats:p><jats:p><jats:bold>Results </jats:bold> Agreement on prediction of UAB pH was significantly higher in the study group (ICC = 0.70; 95% CI 0.61–0.77) than in the control group (ICC = 0.43; 95% CI 0.21–0.60), and a trend towards better agreement was also seen in estimation of 5‐minute Apgar scores (ICC = 0.55; 95% CI 0.38–0.68 versus ICC = 0.43; 95% CI 0.25–0.57). Observers predicted UAB pH values correctly within a 0.10 margin in 70% of cases in the study group (95% CI 0.61–0.79) versus 46% in the control group (95% CI 0.35–0.56). They predicted 5‐minute Apgar scores within a margin of one in 81% of cases in the study group (95% CI 0.73–0.88) and in 70% of cases in the control group (95% CI 0.61–0.79).</jats:p><jats:p><jats:bold>Conclusions </jats:bold> Prediction of UAB pH is more reproducible and accurate when clinicians have access to computerised analysis of CTGs.</jats:p>