Table 58, GRADE findings for additional fetal blood sampling when using ST analysis of fetal electrocardiogram - Addendum to intrapartum care: care for healthy women and babies

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Table 58GRADE findings for additional fetal blood sampling when using ST analysis of fetal electrocardiogram

Quality assessment							Number of women		Effect		Quality
Number of studies	Design	Limitations	Inconsistency	Indirectness	Imprecision	Other considerations	According to trial protocol^a	Not according to trial protocol^a	Relative (95% CI)	Absolute (95% CI)	Quality
FBS pH > 7.25^b
1 study (Becker 2011)	Observational study	Serious¹	No serious inconsistency	Serious²	Serious³	None	112/171 (65.5%)	96^c/126 (76.2%)	RR 0.86 (0.74 to 0.99)	107 fewer per 1000 (from 8 fewer to 198 fewer)	Very low
FBS pH 7.20 to 7.25^b
1 study (Becker 2011)	Observational study	Serious¹	No serious inconsistency	Serious²	Serious³	None	33/171 (19.3%)	15^d/126 (11.9%)	RR 1.62 (0.92 to 2.85)	74 more per 1000 (from 10 fewer to 220 more)	Very low
FBS pH < 7.20^b
1 study (Becker 2011)	Observational study	Serious¹	No serious inconsistency	Serious²	Very serious⁴	None	17/171 (9.9%)	10^e/126 (7.9%)	RR 1.25 (0.59 to 2.64)	20 more per 1000 (from 33 fewer to 130 more)	Very low

CI confidence interval, FBS fetal blood sampling, RR relative risk

a

In the trial protocol FBS was recommended in three situations:

(1): Start of ST analysis registration with an intermediary or abnormal CTG trace
(2): Abnormal CTG trace for more than 60 minutes without ST events
(3): Poor ECG signal quality in the presence of an intermediary or abnormal CTG trace.

b

Classification at sample level not at participant level

c

n = 19/96 had at least one ST event, n = 77/96 had no ST indication to intervene

d

n = 5/15 had at least one ST event, n = 10/15 had no ST indication to intervene

e

n = 8/10 had at least one ST event, n = 2/10 had no ST indication to intervene

1

Large number of women with at least on FBS performed was excluded from the analysis for various reasons that were not specified. Data from a published randomised trial were used.

2

Study populations consisted of women with a high risk pregnancy

3

Wide CI

4

Very wide CI

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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