Table 52, GRADE findings for predictive accuracy of no fetal heart rate acceleration following Allis clamp 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 (Arulkumaran 1987)	Case series	Very serious¹	No serious inconsistency	Serious²	No serious imprecision	pH < 7.20 = 2/50 (4%)	50	100% (not calculable [NC])^a	83.33% (72.79 to 88)^a	6.0 (3.19 to 30)^a	0 (NC)^a	Very low
1 study (Clark 1984)	Case series	Serious³	No serious inconsistency	Very serious⁴	No serious imprecision	pH < 7.20 = 19/64 (30%)	64	100% (NC)^a	33.33% (19.56 to 11)^a	1.5 (1.22 to 84)^a	0 (NC)^a	Very low
Caesarean section
1 study (Arulkumaran 1987)	Case series	Very serious¹	No serious inconsistency	Serious²	No serious imprecision	Caesarean sections = 10/50 (20%)	50	60% (29.64 to 36)^a	90% (80.70 to 30)^a	6.0 (2.08 to 29)^a	0.44 (0.21 to 96)^a	Very low

: NC not calculable
a: Calculated by the 2014 NCC-WCH technical team
1: Unclear whether consecutive women were included. Period of fetal heart rate (FHR) observation following stimulation not reported
2: Insufficient reporting of population and inclusion and exclusion criteria to assess indirectness
3: Unclear whether consecutive women were included
4: Population were unborn babies who had not responded with an acceleration to initial digital scalp stimulation. Included gestational age < 37 weeks and > 42 weeks

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

Clinical Guideline, No. 190.1.

National Guideline Alliance (UK).

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