{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T06:43:49Z","timestamp":1786171429666,"version":"build-2736575974"},"reference-count":35,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100009780","name":"Region Sk\u00e5ne","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Current international (FIGO) and Swedish cardiotocography (CTG) interpretation templates exhibit limited diagnostic accuracy for the detection of fetal acidemia. The objective of this study was to develop a novel intrapartum CTG classification template incorporating CTG parameters demonstrated to be strongly associated with acidemia, and to evaluate the diagnostic performance of the models by assessing their sensitivity and specificity in identifying CTG recordings from neonates with acidemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>A retrospective case\u2013control study based on 1092 births in Region Sk\u00e5ne. The study material included 364 cases with umbilical cord blood pH &lt;7.05, or &lt;7.10 after 1st stage cesarean, and 728 controls with pH \u22657.15 and Apgar scores \u22659 at 5 and 10\u2009min. CTG patterns were systematically evaluated across a set of predefined variables, and associations between specific patterns and fetal acidemia were quantified using ORs. Two models defining pathological patterns were created: Model 1 based on the presence of one of several listed criteria resulting in a positive test and Model 2 also including the presence of \u22652 B\u2010criteria resulting in a positive test. The main outcomes, sensitivity, and specificity to identify fetal acidemia at birth were calculated and compared with the current FIGO, NICE, and SWE guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The sensitivity to identify fetal acidemia was 86.3%, 86.5%, 50.8%, 57.1%, and 87.4% for Model 1, Model 2, FIGO, SWE, and NICE, respectively. The corresponding specificity was 77.9%, 76.4%, 92.6%, 91.2%, and 70.6%. The sensitivity to identify severe acidemia (pH &lt;7.0) was 90.4% for Model 1 and for NICE; 64.4% for SWE, and 56.7% for FIGO. A variable not included in current classification systems, \u201cfetal heart rate below baseline for &gt;50% of the time during 30 minutes\u201d was the criterion contributing most to the sensitivity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our models show higher sensitivity but lower specificity for the defined outcome compared with SWE and FIGO, and similar sensitivity but higher specificity compared with NICE. Validating the model on a new material is essential before considering clinical use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.70287","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T05:40:31Z","timestamp":1781156431000},"page":"1749-1760","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An attempt to improve recognition of fetal acidemia by a remodeled intrapartum cardiotocography classification: A case\u2013control study"],"prefix":"10.1111","volume":"105","author":[{"given":"Maria","family":"Fogelberg","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Skane University Hospital  Malm\u00f6 Sweden"},{"name":"Institution for Clinical Sciences Lund Lund University  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna Wagner","family":"Bjurstr\u00f6m","sequence":"additional","affiliation":[{"name":"Institution for Clinical Sciences Lund Lund University  Lund Sweden"},{"name":"Department of Obstetrics and Gynecology Holb\u00e6k Hospital, Region Zealand  Holb\u00e6k Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Dahlb\u00e4ck","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Skane University Hospital  Malm\u00f6 Sweden"},{"name":"Institution for Clinical Sciences Malm\u00f6 Lund University  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frida","family":"Ekeng\u00e5rd","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Skane University Hospital  Malm\u00f6 Sweden"},{"name":"Institution for Clinical Sciences Lund Lund University  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gisela","family":"Rickle","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Skane University Hospital  Malm\u00f6 Sweden"},{"name":"Institution for Clinical Sciences Malm\u00f6 Lund University  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"K\u00e4ll\u00e9n","sequence":"additional","affiliation":[{"name":"Institution for Clinical Sciences Lund Lund University  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2540-7339","authenticated-orcid":false,"given":"Andreas","family":"Herbst","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Skane University Hospital  Malm\u00f6 Sweden"},{"name":"Institution for Clinical Sciences Lund Lund University  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2015.06.020"},{"key":"e_1_2_14_3_1","volume-title":"Intrapartum Care for Healthy Women and Babies","author":"National Institute for Health and Care Excellence: Guidelines","year":"2022"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurox.2020.100120"},{"issue":"5","key":"e_1_2_14_5_1","first-page":"508","article-title":"Diagnostic accuracy of the FIGO and the 5\u2010tier fetal heart rate classification systems in the detection of neonatal acidemia","volume":"34","author":"Marti Gamboa S","year":"2017","journal-title":"Am J Perinatol"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2021.1986479"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2024.2394845"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2025.04.027"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2022.2157717"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurox.2025.100389"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1979.tb11275.x"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2012.03335.x"},{"issue":"2","key":"e_1_2_14_13_1","first-page":"159","article-title":"Guidelines for the use of fetal monitoring","volume":"25","author":"Rooth G","year":"1987","journal-title":"FIGO News Int J Gynecol Obstet"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2018.1456523"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0412.2002.811003.x"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12939"},{"key":"e_1_2_14_17_1","unstructured":"Fetal monitoring in labour.2022www.nice.org.uk\/guidance\/ng229"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.14007"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1159\/000504941"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13277"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2015.05.007"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.01949.x"},{"key":"e_1_2_14_23_1","volume-title":"CTG och foster\u00f6vervakning","author":"SFOG","year":"2017"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.2307\/2531595"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1447-0756.2004.00186.x"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2016.08.017"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13224-024-02028-x"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13090"},{"issue":"3","key":"e_1_2_14_29_1","first-page":"361","article-title":"Acidosis in the vigorous newborn","volume":"65","author":"Suidan JS","year":"1985","journal-title":"Obstet Gynecol"},{"key":"e_1_2_14_30_1","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2016.214"},{"key":"e_1_2_14_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-025-07917-1"},{"key":"e_1_2_14_32_1","doi-asserted-by":"publisher","DOI":"10.1159\/000512658"},{"key":"e_1_2_14_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-022-06594-1"},{"key":"e_1_2_14_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2025.07.014"},{"key":"e_1_2_14_35_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2020.1869931"},{"key":"e_1_2_14_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2023.04.022"}],"container-title":["Acta Obstetricia et Gynecologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.70287","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/aogs.70287","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.70287","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T06:05:53Z","timestamp":1786169153000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/aogs.70287"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,10]]},"references-count":35,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/aogs.70287"],"URL":"https:\/\/doi.org\/10.1111\/aogs.70287","archive":["Portico"],"relation":{},"ISSN":["0001-6349","1600-0412"],"issn-type":[{"value":"0001-6349","type":"print"},{"value":"1600-0412","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,10]]},"assertion":[{"value":"2025-11-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}