iPREFACE score: integrated score index to predict foetal acidaemia by
intrapartum foetal heart rate monitoring
Abstract
Objective: Cardiotocography is used worldwide to evaluate foetal
well-being during pregnancy and labour. In past guidelines, the
management plan was determined based on the assessment of the most
severe waveform of the deceleration. There are no guidelines for
evaluating the integrated recurrent decelerations; however, we believe
their assessment to be essential for predicting the status of the
foetus. The objective of this study was to propose an indicator for
performing medical interventions during labour by creating a scoring
system that reflects integrated recurrent decelerations. Design: A
retrospective cohort study. Sample: Full-term single foetus births from
vaginal deliveries. Methods: iPREFACE score, the integrated score index
to predict foetal acidemia by intrapartum foetal heart rate monitoring
was calculated using cardiotocography findings from approximately 30 min
before delivery. Main Outcome Measures: We examined the iPREFACE score
and fetal acidemia association and calculated the cut-off iPREFACE
scores for acidaemia using receiver operating characteristic curves.
Results: The study included 469 delivery cases. Their iPREFACE scores
exhibited a significant negative correlation with the umbilical artery
blood pH (correlation coefficient -0.43). The cut-off iPREFACE scores
for the umbilical artery blood with pH <7.20, <7.10,
and <7.0 were 44, 46, and 67, respectively (the areas under
the curve were 0.776, 0.962, and 0.996, respectively). Conclusions: The
iPREFACE score may predict foetal acidaemia and could be used as an
indicator for timely medical interventions during labour. Because
assessments using a cardiotocography are quick and easy to perform, the
iPREFACE score could be a valuable tool in clinical practice.