{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T17:17:42Z","timestamp":1788283062069,"version":"build-2803163510"},"reference-count":34,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T00:00:00Z","timestamp":1738886400000},"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":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>A revised cardiotocography (CTG) classification was implemented in Sweden in 2017. Simultaneously, an updated version of the lactate meter, Lactate Pro 2\u2122, proved to measure 50% higher than the previous, necessitating new cutoffs for fetal blood sampling (FBS). We aimed to investigate frequencies of FBS, delivery modes, and neonatal outcomes. We hypothesized that with the revised CTG classification, which accepts more fetal heart rate patterns as normal than the previous, the frequency of FBS would be lower, the proportion of acidemia at FBS and adverse neonatal outcomes would be higher among sampled fetuses, but not among the entire laboring population, and the higher lactate readings might increase the proportion of cesarean delivery in general anesthesia and cesarean delivery above vacuum extraction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>A population\u2010based cohort study of electronic medical records of labors in Stockholm\u2010Gotland during 2014\u20132015 and 2018\u20132019, including singleton pregnancies &gt;34\u2009weeks, cephalic presentation, with spontaneous or induced start of labor. Outcome measures were FBS frequency, proportion of fetal acidemia, delivery modes, and neonatal outcomes with comparison between the two periods among sampled and nonsampled fetuses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 28\u2009841 and 30\u2009192 births during the two periods. In the latter period, the FBS frequency was lower (8.2% vs. 11.9% [<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001]), and the proportion of acidemia at FBS was higher, both among sampled fetuses (12.5% vs. 7.1% [<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001]), and in the total population (1.0% vs. 0.8% [<jats:italic>p<\/jats:italic>\u2009=\u20090.022]). Immediate cesareans in general anesthesia due to fetal distress were more frequent among sampled fetuses (3.1% vs. 2.0% [<jats:italic>p<\/jats:italic>\u2009=\u20090.006]) but not among nonsampled fetuses (0.4 vs. 0.4%). Incidence of Apgar scores\u2009&lt;\u20094 at 5\u2009min was unchanged after FBS (<jats:italic>p<\/jats:italic>\u2009=\u20090.66) but higher among nonsampled newborns (0.2 vs. 0.1 [<jats:italic>p<\/jats:italic>\u2009=\u20090.033]). Apgar scores &lt;7 at 5\u2009min were more frequent among both sampled and nonsampled groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>After implementation of a revised CTG classification and a differently calibrated lactate meter in Sweden, the use of FBS was substantially lower. Acidemia at FBS and immediate cesarean due to fetal distress were more frequent among sampled fetuses but still low in the total laboring population. Low Apgar scores were more frequent among newborns both with and without FBS.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.15063","type":"journal-article","created":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T09:48:27Z","timestamp":1738921707000},"page":"676-684","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Frequency of fetal blood sampling, delivery mode and neonatal outcome after revised <scp>CTG<\/scp>\u2010classification and updated lactate meter in Sweden: An observational study"],"prefix":"10.1111","volume":"104","author":[{"given":"Klara","family":"Gr\u00f6ndal","sequence":"first","affiliation":[{"name":"Department of Women's and Children's Health Karolinska Institutet  Stockholm 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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 of Women's and Children's Health Karolinska Institutet  Stockholm Sweden"},{"name":"Medical Unit Pregnancy and Delivery Care Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,7]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2015.06.020"},{"key":"e_1_2_12_3_1","article-title":"Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labor","volume":"2","author":"Alfirevic Z","year":"2017","journal-title":"Cochrane Database Syst 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