Prediction of neonatal state by computer analysis of fetal heart rate tracings: the antepartum arm of the SisPorto® multicentre validation study

Objective: To evaluate the capacity of computer analysis of antepartum cardiotocographs performed by SisPorto® 2.0 in predicting neonatal outcome. Study design: A prospective observational study was conducted in eight tertiary care centres in Europe and Australia, involving pregnant women in the absence of labor, scheduled for elective caesarean section, whose last fetal heart rate (FHR) tracing was performed within 4 h of delivery. After exclusion of fetal malformations, multiple pregnancies, tracings with less than 30 min, tracings with more than 15% signal loss, difficult fetal extractions, and anesthesia complications, a total of 345 cases were analyzed. Computer quantification of cardiotocographic parameters was compared with newborn Apgar score, umbilical artery pH, metabolic acidosis and neonatal hypoxic-ischemic encephalopathy, by means of receiver operating characteristic (ROC) curves. Results: Acceleration number, mean short-term variability, percentage of abnormal short-term variability and percentage of abnormal long-term variability had an excellent discriminative capacity to predict 1-min Apgar scores under or equal to 4 (areas under the ROC curve 0.96-1.00). The same parameters showed a slightly lower capacity to predict 5-min Apgar scores under or equal to 6 (areas under the ROC curve 0.81-0.89). The best cut-off values for these parameters, derived from the previously referred calculations, detected all cases of hypoxic-ischemic encephalopathy (n=2). Cardiotocographic parameters showed a lower discriminative capacity in prediction of umbilical artery pH <7.20 (maximum area under the ROC curve 0.66) and <7.15 (maximum area under the ROC curve 0.69). Conclusions: Computerized quantification of accelerations and variability in the antepartum allows a good prediction of 1 and 5-min Apgar scores, and to a much lesser degree umbilical artery pH.