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National Guideline Alliance (UK). Addendum to intrapartum care: care for healthy women and babies. London: National Institute for Health and Care Excellence (NICE); 2017 Feb. (Clinical Guideline, No. 190.1.)

Cover of Addendum to intrapartum care: care for healthy women and babies

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

Contents

Appendix IGRADE tables

The GRADE tables in this section provide further detail about the quality assessment for the studies included in the guideline reviews.

I.1. Intermittent auscultation compared with cardiotocography on admission

Table 3. GRADE findings for comparison of continuous cardiotocography compared with intermittent auscultation on admission

I.2. Intermittent auscultation compared with cardiotocography during labour

Table 4. GRADE findings for comparison of electronic fetal monitoring compared with intermittent auscultation during established labour

I.3. Intermittent auscultation compared with cardiotocography in the presence of meconium stained liquor

Table 5. GRADE findings for comparison of continuous cardiotocography with intermittent auscultation

I.4. Interpretation of cardiotocograph traces

I.4.1. Low risk and mixed populations

I.4.1.1. Baseline fetal heart rate (tachycardia and bradycardia)

Table 6. GRADE findings for predictive value of tachycardia and bradycardia for adverse neonatal outcomes

Table 7. GRADE findings for umbilical arterial pH and base excess in babies with intrapartum tachycardia or bradycardia

Table 8. GRADE findings for association between FHR (bradycardia and tachycardia) and umbilical artery blood gas values or adverse neonatal outcomes

Table 9. GRADE findings for fetal heart rate in babies born with umbilical cord blood acidaemia compared with those born without acidaemia

Table 10. GRADE findings for correlation of marked tachycardia to neonatal convulsions

I.4.1.2. Baseline variability

Table 11. GRADE findings for predictive value of fetal heart rate baseline variability for neonatal adverse outcomes

Table 12. GRADE findings for predictive value of fetal heart rate baseline variability for mode of birth

Table 13. GRADE findings for association between fetal heart rate variability and neonatal adverse outcomes or umbilical artery blood gas values

Table 14. GRADE findings for association between variability (with or without accelerations or decelerations) and umbilical artery blood gas values

I.4.1.3. Accelerations

Table 15. GRADE findings for predictive value of lack of fetal heart rate accelerations for adverse neonatal outcomes

Table 16. GRADE findings for association of sporadic accelerationsa and perinatal mortality

Table 17. GRADE findings for association of presence of accelerations and adverse neonatal outcomes

Table 18. GRADE findings for predictive value of a reactive trace for adverse neonatal outcomes

Table 19. GRADE findings for association between a reactive trace and adverse neonatal outcomes

I.4.1.4. Decelerations

Table 20. GRADE findings for predictive value of fetal heart rate early decelerations for adverse neonatal outcomes

Table 21. GRADE findings for association between decelerations (in general), early decelerations and prolonged decelerations and adverse neonatal outcomes

Table 22. GRADE findings for correlation of fetal heart rate early decelerations with neonatal convulsions

Table 23. GRADE findings for predictive value of fetal heart rate late decelerations for adverse neonatal outcomes

Table 24. GRADE findings for association between fetal heart rate late decelerations and adverse neonatal outcome

Table 25. GRADE findings for correlation of fetal heart rate late decelerations with neonatal convulsions

Table 26. GRADE findings for predictive value of variable fetal heart rate decelerations for adverse neonatal outcome

Table 27. GRADE findings for association between variable fetal heart rate decelerations and adverse neonatal outcome

Table 28. GRADE findings for association between variable fetal heart rate decelerations and maternal outcome

Table 29. GRADE findings for number of fetal heart rate decelerations (> 15 bpm/15 seconds) and association with fetal acadaemia

Table 30. Correlation of fetal heart rate decelerations and neonatal convulsions

I.4.1.5. Combinations of fetal heart rate trace features

Table 31. GRADE findings for predictive value of combinations of features

I.4.1.6. Categorisation/classification of fetal heart rate traces

Table 32. GRADE findings for predictive value of published categorisation of fetal heart rate traces for adverse neonatal outcomes

Table 33. GRADE findings for predictive value of published categorisations of fetal heart rate traces for mode of birth

Table 34. GRADE findings for association between categorisation of fetal heart rate traces and adverse neonatal outcomes

Table 35. GRADE findings for association between categorisation of fetal heart rate traces and mode of birth

Table 36. GRADE findings for umbilical cord arterial pH in women with normal and abnormal fetal heart rate tracing

I.4.2. High risk populations

I.4.2.1. Accelerations

Table 37. GRADE findings for association between absence of, or decreased, fetal heart rate accelerations and fetal metabolic acidosis

I.4.2.2. Decelerations

Table 38. GRADE findings for association between no decelerations/early decelerations and adverse neonatal outcomes

Table 39. GRADE findings for association between no decelerations /variable decelerations and adverse neonatal outcomes

Table 40. GRADE findings for association between no decelerations/late decelerations and adverse neonatal outcomes

Table 41. GRADE findings for association between marked patterns of total decelerations, moderate/marked pattern of late decelerations and fetal asphyxia

Table 42. GRADE findings for predictive value of fetal heart rate decelerations for adverse neonatal outcomes in prolonged pregnancy (> 42 weeks of gestation)

I.4.2.3. Categorisation/classification of fetal heart rate traces

Table 43. GRADE findings for predictive value of published categorisations of fetal heart rate traces on adverse neonatal outcomes among high risk group

Table 44. GRADE findings for predictive value of published categorisations of fetal heart rate traces on mode of birth among high risk group

Table 45. GRADE findings for association between published categorisations of fetal heart rate traces and adverse neonatal outcomes

Table 46. GRADE findings for association between published categorisations of fetal heart rate traces and mode of birth

I.5. Care in labour as a result of cardiotocography

Table 47. GRADE findings for comparison of reducing or stopping oxytocin and not reducing or stopping oxytocin in the presence of an abnormal fetal heart rate tracing

Table 48. GRADE findings for comparison of outcomes before and after introduction of a 5-tier colour-coded fetal heart rate management system

Table 49. GRADE findings for comparison of outcomes before and after introduction of consult-led (obstetric) review of abnormal cardiotocograph traces prior to decision to measure fetal scalp lactate

I.6. Fetal scalp stimulation

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

Table 51. GRADE findings for predictive accuracy of no fetal heart rate acceleration following digital massage as stimulus

Table 52. GRADE findings for predictive accuracy of no fetal heart rate acceleration following Allis clamp as stimulus

Table 53. GRADE findings for predictive accuracy of no fetal heart rate acceleration following 3 or 5 seconds of vibroacoustic stimulation

I.7. Fetal blood sampling as an adjunct to cardiotocography

Table 54. GRADE findings for comparison of cardiotocography plus fetal blood sampling with intermittent auscultation (Alfirevic 2013) or cardiotocography alone in labour (Stein 2006)

Table 55. GRADE findings for distribution of fetal blood sampling findings and ST guideline indication to intervene: marked acidosis (cord artery pH < 7.06)

Table 56. GRADE findings for distribution of fetal blood sampling and ST guideline indication to intervene: moderate acidaemia (cord artery pH 7.06 – 7.09)

Table 57. GRADE findings for participants with abnormal or intermediary cardiotocogram noted at start of ST analysis recording

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

I.8. Fetal blood sampling – time to result

Table 59. GRADE findings for the time from the decision to perform a fetal blood sample to having the scalp pH result

I.9. Predictive value of fetal blood sampling

Table 60. GRADE findings for lactate compared with pH for fetal blood sampling

Table 61. GRADE findings for predictive accuracy of fetal blood sampling for composite neonatal outcomes

Table 62. GRADE findings for predictive accuracy of fetal blood sampling for Apgar score at 5 minutes

Table 63. GRADE findings for correlation of fetal blood sampling with high and low Apgar scores at 5 minutes

Table 64. GRADE findings for predictive accuracy of fetal blood sampling for arterial pH at birth

Table 65. GRADE findings for correlation of fetal scalp blood sample values with umbilical artery values at time of birth

I.10. Women’s experience of fetal monitoring

There are no GRADE tables for this review question.

I.11. Cardiotocography with electrocardiogram analysis compared with cardiotocography alone

Table 66. GRADE findings for comparison of continuous cardiotocography plus fetal electrocardiogram PR interval analysis with continuous cardiotocography alone in labour

Table 67. GRADE findings for comparison of continuous cardiotocography plus fetal electrocardiogram ST waveform analysis with continuous cardiotocography alone in labour

I.12. Automated interpretation of cardiotocograph traces

Table 68. GRADE profile for predictive accuracy of computerised cardiotocograph interpretation to identify adverse outcomes

Table 69. GRADE profile for comparison of computerised cardiotocograph interpretation with human interpretation

Copyright © National Institute for Health and Care Excellence 2017.

Bookshelf ID: NBK550627

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National Guideline Alliance (UK). Addendum to intrapartum care: care for healthy women and babies. London: National Institute for Health and Care Excellence (NICE); 2017 Feb. (Clinical Guideline, No. 190.1.) Appendix I, GRADE tables.
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In this Page

Intermittent auscultation compared with cardiotocography on admission
Intermittent auscultation compared with cardiotocography during labour
Intermittent auscultation compared with cardiotocography in the presence of meconium stained liquor
Interpretation of cardiotocograph traces
Care in labour as a result of cardiotocography
Fetal scalp stimulation
Fetal blood sampling as an adjunct to cardiotocography
Fetal blood sampling – time to result
Predictive value of fetal blood sampling
Women’s experience of fetal monitoring
Cardiotocography with electrocardiogram analysis compared with cardiotocography alone
Automated interpretation of cardiotocograph traces

Related NICE guidance and evidence

NICE Clinical Guideline 190: Intrapartum Care: Care of Healthy Women and Their Babies During Childbirth

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