{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T17:59:46Z","timestamp":1784829586704,"version":"3.55.0"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,10,27]],"date-time":"2023-10-27T00:00:00Z","timestamp":1698364800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>It is a shortcoming of traditional cardiotocography (CTG) classification table formats that CTG traces are frequently classified differently by different users, resulting in poor interobserver agreements. A fast\u2010and\u2010frugal tree (FFTree) flow chart may help provide better concordance because it is straightforward and has clearly structured binary questions with understandable \u201cyes\u201d or \u201cno\u201d responses. The initial triage to determine whether a fetus is suitable for labor when utilizing fetal ECG ST analysis (STAN) is very important, since a fetus with restricted capacity to respond to hypoxic stress may not generate STAN events and therefore may become falsely negative. This study aimed to compare physiology\u2010focused FFTree CTG interpretation with FIGO classification for assessing the suitability for STAN monitoring.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>A retrospective study of 36 CTG traces with a high proportion of adverse outcomes (17\/36) selected from a European multicenter study database. Eight experienced European obstetricians evaluated the initial 40\u2009minutes of the CTG recordings and judged whether STAN was a suitable fetal surveillance method and whether intervention was indicated. The experts rated the CTGs using the FFTree and FIGO classifications at least 6\u2009weeks apart. Interobserver agreements were calculated using proportions of agreement and Fleiss\u2019 kappa (<jats:italic>\u03ba<\/jats:italic>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The proportions of agreement for \u201cnot suitable for STAN\u201d were for FIGO 47% (95% confidence interval [CI] 42%\u201352%) and for FFTree 60% (95% CI 56\u201364), ie a significant difference; the corresponding figures for \u201cyes, suitable\u201d were 74% (95% CI 71\u201377) and 70% (95% CI 67\u201374). For \u201cintervention needed\u201d the figures were 52% (95% CI 47\u201356) vs 58% (95% CI 54\u201362) and for \u201cexpectant management\u201d 74% (95% CI 71\u201377) vs 72% (95% CI 69\u201375). Fleiss\u2019 <jats:italic>\u03ba<\/jats:italic> agreement on \u201csuitability for STAN\u201d was 0.50 (95% CI 0.44\u20130.56) for the FIGO classification and 0.57 (95% CI 0.51\u20130.63) for the FFTree classification; the corresponding figures for \u201cintervention or expectancy\u201d were 0.53 (95% CI 0.47\u20130.59) and 0.57 (95% CI 0.51\u20130.63).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The proportion of agreement among expert obstetricians using the FFTree physiological approach was significantly higher compared with the traditional FIGO classification system in rejecting cases not suitable for STAN monitoring. That might be of importance to avoid false negative STAN recordings. Other agreement figures were similar. It remains to be shown whether the FFTree simplicity will benefit less experienced users and how it will work in real\u2010world clinical scenarios.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14680","type":"journal-article","created":{"date-parts":[[2023,10,27]],"date-time":"2023-10-27T23:50:15Z","timestamp":1698450615000},"page":"68-76","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Is the fetus fit for labor? Introducing fast\u2010and\u2010frugal trees (<scp>FFTrees<\/scp>) to simplify triage of women for <scp>STAN<\/scp> monitoring: An interobserver agreement comparison with traditional classification"],"prefix":"10.1111","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7167-9052","authenticated-orcid":false,"given":"Susana","family":"Pereira","sequence":"first","affiliation":[{"name":"Fetal Medicine Unit, The Royal London Hospital, Barts Health NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"Bakker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Amsterdam UMC  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Zaima","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Kingston Hospital NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tullio","family":"Ghi","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery University of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Kessler","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, and Department of Clinical Science University of Bergen  Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna","family":"Timonen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Turku University Hospital  Turku Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Vayssi\u00e8re","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Paule de Viguier Hospital Toulouse III University  Toulouse France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrin","family":"L\u00f6ser","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology South Jutland Hospital Aabenraa Campus  Aabenraa Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaisa","family":"Holmberg","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Turku University Hospital  Turku Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yves","family":"Jacquemyn","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Antwerp University Hospital, Edegem, and Global Health Institute, Antwerp University  Antwerp Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5711-8515","authenticated-orcid":false,"given":"Edwin","family":"Chandraharan","sequence":"additional","affiliation":[{"name":"Global Academy of Medical Education &amp; Training  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1672-3970","authenticated-orcid":false,"given":"David","family":"Wertheim","sequence":"additional","affiliation":[{"name":"School of Computing and Information Systems, Faculty of Science, Engineering and Computing, Kingston University  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0792-1393","authenticated-orcid":false,"given":"Per","family":"Olofsson","sequence":"additional","affiliation":[{"name":"Institution of Clinical Sciences Malm\u00f6, Lund University  Malm\u00f6 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,10,27]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2007.01479.x"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1220774"},{"key":"e_1_2_11_4_1","first-page":"1","article-title":"Physiological CTG categorization in types of hypoxia compared with MRI and neurodevelopmental outcome in infants with HIE","volume":"13","author":"Pereira S","year":"2022","journal-title":"J Matern Fetal Neonatal Med"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2015.06.020"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2020.1869931"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.14201"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.14296"},{"key":"e_1_2_11_9_1","first-page":"159","article-title":"Guidelines for the use of fetal monitoring","volume":"25","author":"FIGO Subcommittee on Standards in Perinatal Medicine","year":"1987","journal-title":"Int J Gynecol Obstet"},{"key":"e_1_2_11_10_1","unstructured":"Intrapartum care for healthy women and babies. 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