{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T17:17:36Z","timestamp":1788283056449,"version":"build-2803163510"},"reference-count":27,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,1,28]],"date-time":"2022-01-28T00:00:00Z","timestamp":1643328000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>A revised intrapartum cardiotocography (CTG) classification was introduced in Sweden in 2017. The aims of the revision were to adapt to the international guideline published in 2015 and to adjust the classification of CTG patterns to current evidence regarding intrapartum fetal physiology. This study aimed to investigate adverse neonatal outcomes before and after implementation of the revised CTG classification.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>A before\u2010and\u2010after design was used. Cohort I (<jats:italic>n<\/jats:italic>\u00a0=\u00a0160\u00a0210) included births from June 1, 2014 through May 31, 2016 using the former CTG classification, and cohort II (<jats:italic>n<\/jats:italic>\u00a0=\u00a0166\u00a0558) included births from June 1, 2018 through May 31, 2020 with the revised classification. Data were collected from the Swedish Pregnancy and Neonatal Registers. The primary outcome was moderate to severe neonatal hypoxic ischemic encephalopathy (HIE 2\u20133). Secondary outcomes were birth acidemia (umbilical artery pH &lt;7.05 and base excess &lt; \u221212\u00a0mmol\/L or pH &lt;7.00), A\u2010criteria for neonatal hypothermia treatment, 5\u2010min Apgar scores &lt;4 and &lt;7, neonatal seizures, meconium aspiration, neonatal mortality and delivery mode. Logistic regression was used (period II vs period I), and results are presented as adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were no statistically significant differences in HIE 2\u20133 (aOR 1.27; 95% CI 0.97\u20131.66), proportion of neonates meeting A\u2010criteria for hypothermia treatment (aOR 0.96; 95% CI 0.89\u20131.04) or neonatal mortality (aOR 0.68; 95% CI 0.39\u20131.18) between the cohorts. Birth acidemia (aOR 1.36; 95% CI 1.25\u20131.48), 5\u2010min Apgar scores &lt;7 (aOR 1.27; 95% CI 1.18\u20131.36) and &lt;4 (aOR 1.40; 95% CI 1.17\u20131.66) occurred more often in cohort II. The absolute risk difference for HIE 2\u20133 was 0.02% (95% CI 0.00\u20130.04). Operative delivery (vacuum or cesarean) rates were lower in cohort II (aOR 0.82; 95% CI 0.80\u20130.85 and aOR 0.94; 95% CI 0.91\u20130.97, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although not statistically significant, a small increase in the incidence of HIE 2\u20133 after implementation of the revised CTG classification cannot be excluded. Operative deliveries were fewer but incidences of acidemia and low Apgar scores were higher in the latter cohort. This warrants further in\u2010depth analyses before a full re\u2010evaluation of the revised classification can be made.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14296","type":"journal-article","created":{"date-parts":[[2022,1,29]],"date-time":"2022-01-29T05:54:38Z","timestamp":1643435678000},"page":"183-192","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Implementation of a revised classification for intrapartum fetal heart rate monitoring and association to birth outcome: A\u00a0national cohort study"],"prefix":"10.1111","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2657-1958","authenticated-orcid":false,"given":"Maria","family":"Jonsson","sequence":"first","affiliation":[{"name":"Department of Women\u2019s and Children\u2019s Health Uppsala University  Uppsala Sweden"},{"name":"Uppsala University Hospital  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"S\u00f6derling","sequence":"additional","affiliation":[{"name":"Department of Medicine, Solna Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7512-2059","authenticated-orcid":false,"given":"Lars","family":"Ladfors","sequence":"additional","affiliation":[{"name":"Institute of Clinical Sciences, Sahlgrenska Academy Gothenburg University  Gothenburg Sweden"},{"name":"Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7547-2569","authenticated-orcid":false,"given":"Lennart","family":"Nordstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department Women\u2019s and Children\u2019s Health Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"Nilsson","sequence":"additional","affiliation":[{"name":"Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Algovik","sequence":"additional","affiliation":[{"name":"V\u00e4stervik Hospital  V\u00e4stervik Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikael","family":"Norman","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Neonatal Medicine Karolinska University Hospital  Stockholm Sweden"},{"name":"Swedish Neonatal Quality Register  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2640-0753","authenticated-orcid":false,"given":"Malin","family":"Holzmann","sequence":"additional","affiliation":[{"name":"Department Women\u2019s and Children\u2019s Health Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Neonatal Medicine Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,1,28]]},"reference":[{"issue":"236","key":"e_1_2_10_2_1","first-page":"e1","article-title":"The intrapartum deceleration in center stage: a physiologic approach to the interpretation of fetal heart rate changes in labor","volume":"197","author":"Westgate JA","year":"2007","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.82"},{"key":"e_1_2_10_4_1","article-title":"Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour","volume":"2017","author":"Alfirevic Z","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2012.735726"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/0020-7292(87)90012-9"},{"key":"e_1_2_10_7_1","volume-title":"2019 Surveillance of Intrapartum Care for Healthy Women and Babies (NICE Guideline CG190)","year":"2019"},{"key":"e_1_2_10_8_1","unstructured":"Gynaecologists RAaNZCoOa. 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