Table 51, GRADE findings for predictive accuracy of no fetal heart rate acceleration following digital massage as stimulus - Addendum to intrapartum care: care for healthy women and babies

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Quality assessment							Number of women & baby pairs	Measure of diagnostic accuracy				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 (Elimian 1997)	Case series	Serious¹	No serious inconsistency	Serious²	No serious imprecision	pH < 7.20 = 15/108 (14%) sec of stimulation	108	100% (Not calculable [NC])^a	54.84% (44.72 to 95)^a	2.21 (1.77 to 77)^b	0 (NC)^b	Low
Fetal scalp pH ≤7.20
1 study (Trochez 2005)	Case series	Serious³	No serious inconsistency	Serious⁴	No serious imprecision	pH < 7.20 = 5/70 (7% of samples) Vaginal examination (VE) acting as stimulus	samples; 54 women & baby pairs	40% (7.26 to 96)^a	69.23% (56.4 to 76)^a	1.3 (0.27 to 24)^a	0.87 (0.44 to 70)^a	Very low
Umbilical cord pH ≤7.20
1 study (Trochez 2005)	Case series	Serious⁵	No serious inconsistency	Serious⁴	Serious⁶	pH < 7.20 = 5/70 (7% of samples) VE acting as stimulus	34 women & baby pairs	40% (0 to 94)^b	75.86% (60.29 to 44)^b	1.66 (0.47 to 80)^b	0.79 (0.38 to 67)^b	Very low
Apgar score < 7 at 5 minutes
1 study (Trochez 2005)	Case series	Serious⁷	No serious inconsistency	Serious⁴	No serious imprecision	Apgar < 7 = 4/50 (8%) VE acting as stimulus	50	50% (1 to 99)^b	69.57% (56.27 to 82.66)^b	1.64 (0.56 to 4.80)^b	0.72 (0.26 to 1.95)^b	Very low

: NC not calculable, VE vaginal examination
a: As reported in study, confidence intervals calculated by the 2014 NCC-WCH technical team
b: Calculated by the 2014 NCC-WCH technical team
1: Unclear whether FHR tracing assessor blinded to outcome, period of FHR observation following stimulation not reported
2: Included gestational age > 34 weeks and unclear whether any included women were considered high risk
3: Data were available for 78% of those eligible for study
4: Method and time period of stimulation not reported. Unclear whether any included women were considered high risk
5: Data available for 63% of those included in study
6: Wide confidence intervals (more than 40%) for two or three out of sensitivity, specificity, PPV and NPV
7: Data available for 93% of those included in study

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

Clinical Guideline, No. 190.1.

National Guideline Alliance (UK).

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