Table 50, GRADE findings for predictive accuracy of no fetal heart rate acceleration following fetal scalp blood sampling puncture as stimulus - Addendum to intrapartum care: care for healthy women and babies

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Table 50GRADE findings for predictive accuracy of no fetal heart rate acceleration following fetal scalp blood sampling puncture as stimulus

Quality assessment							Number of women & baby pairs	Measure of diagnostic accuracy (95% CI)				Quality
Number. of studies	Design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Number of women & baby pairs	Sensitivity	Specificity	Positive likelihood ratio	Negative likelihood ratio	Quality
Fetal scalp pH < 7.20
1 study (Edersheim 1987)	Case series	No serious risk of bias	No serious inconsistency	Serious¹	No serious imprecision	pH < 7.20 = 6/188 (3% of samples)	188 samples; women & baby pairs	100% (Not calculable [NC])^a	43.41% (36.21 to 61)^a	1.77 (1.56 to 2.01)^a	(NC)^a	Very low
1 study (Elimian 1997)	Case series	Serious²	No serious inconsistency	Serious¹	No serious imprecision	pH < 7.20 = 15/108 (14%)	108	100% (NC)^b	53.76% (43.63 to 9)^b	2.16 (1.73 to 69)^a	(NC)^a Useful	Low
1 study (Lazebnik 1992)	Case series	No serious risk of bias	No Serious inconsistency	Serious³	No serious imprecision	pH < 7.20 = 15/104 (14%)	104	73% (50.95 to 71)^b	17% (9.08 to 63)^b	0.88 (0.64 to 21)^a	1.58 (0.61 to 12)^a	Very low
1 study (Spencer 1991)	Case series	Serious²	No serious inconsistency	Serious⁴	No serious imprecision	pH < 7.20 = 6/138 (4%)	138	100% (NC)^a	52.27% (43.75 to 79)^a	2.10 (1.75 to 50)^a	0 (NC)^a	Very low
1 study (Umstad 1992)	Case series	No serious risk of bias	No serious inconsistency	Serious⁵	No serious imprecision	pH < 7.20 = 8/60 (13%)	60	62.5% (28.95 to 96.05)^b	67.3% (54.56 to 80.06)^b	1.91 (0.98 to 71)^a	0.56 (0.22 to 39)^a	Moderate
Fetal scalp pH < 7.21
1 study (Clark 1982)	Case series	Serious⁶	No serious inconsistency	Serious⁷	No serious imprecision	pH < 7.21 = 19/200 (10%)	200	100% (NC)^a	93.37% (89.75 to 96.99)^a	15.08 (8.73 to 26.06)^a	0 (NC)^a Useful	Very low
Fetal scalp pH < 7.25
1 study (Spencer 1991)	Case series	Serious²	No serious inconsistency	Serious⁴	No serious imprecision	pH < 7.25 = 17/138 (5%)	138	65.38% (47.10 to 83.67)^a	53.57% (44.33 to 62.81)^a	1.41 (1.00 to 1.96)^a	0.87 (0.79 to 0.95)^a	Very low
1 study (Umstad 1992)	Case series	No serious risk of bias	No serious inconsistency	Serious⁵	No serious imprecision	pH < 7.25 = 23/60 (38%)	60	82.6% (67.12 to 98.10)^b	91.9% (83.10 to 100)^b	10.19 (3,39 to 30.63)^a	0.19 (0.08 to 0.46)^a	Moderate
Apgar score < 7 at 5 minutes
1 study (Spencer 1991)	Case series	Serious²	No serious inconsistency	Serious⁴	No serious imprecision	Apgar < 7 = 1/138 (0.7%)	138	100% (NC)^a	50.36% (41.99 to 58.74)^a	2.01 (1.70 to 2.38)^a	0 (NC)^a	Very low

: CI confidence interval, NC not calculable
a: Calculated by the 2014 NCC-WCH technical team
b: As reported in study, confidence intervals calculated by the 2014 NCC-WCH technical team
1: Included gestational age > 34 weeks and unclear whether any included women were considered high risk
2: Unclear whether FHR tracing assessor blinded to outcome. Period of FHR observation following stimulation not reported
3: Positive predictive test defined as mean change in FHR < 15 bpm (rather than absence of an acceleration). Insufficient reporting of population, and inclusion and exclusion criteria to assess indirectness
4: Included gestational age < 37 weeks and unclear whether any women were considered high risk
5: Included gestational age > 36 weeks and unclear whether any included women were considered high risk
6: Unclear whether consecutive women were included in the study
7: Insufficient reporting of population and inclusion and exclusion criteria to assess indirectness

From: Appendix I, GRADE tables

Addendum to intrapartum care: care for healthy women and babies.

Clinical Guideline, No. 190.1.

National Guideline Alliance (UK).

London: National Institute for Health and Care Excellence (NICE); 2017 Feb.

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