{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T14:35:02Z","timestamp":1753886102334,"version":"3.41.2"},"reference-count":41,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T00:00:00Z","timestamp":1729036800000},"content-version":"vor","delay-in-days":289,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Pregnancy"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> There are limitations to predicting perinatal asphyxia, as current tools rely almost entirely on fetal cardiotocography (CTG). The fetal lack of responsiveness scale (FLORS) is a new diagnostic alternative based on the physiological phenomena associated with fetal hypoxia.<\/jats:p><jats:p><jats:bold>Objectives:<\/jats:bold> The objective of this study was to develop, validate, and assess the diagnostic accuracy of the FLORS for predicting severe perinatal hypoxia (SPH).<\/jats:p><jats:p><jats:bold>Study Design:<\/jats:bold> A two\u2010phase retrospective observational cross\u2010sectional analytical study was conducted. Phase 1 involved the formulation and retrospective validation of the FLORS. A total of 366 fetal CTG records were evaluated twice by seven readers. Phase 2 was a collaborative, retrospective, multicenter diagnostic test study that included 37 SPH and 366 non\u2010SPH cases.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Phase 1: A numeric, physiology\u2010based scale was developed and refined based on expert opinions. The median time to apply the scale per reading was 38\u2009s. Cronbach\u2019s alpha, which is a reliability measure, was significant (<jats:italic>p<\/jats:italic> = 0.784). The kappa index for test\u2013retest agreement was moderate to reasonable, with a median value of 0.642. For interobserver agreement, the kappa index per variable was as follows: baseline, 0.669; accelerations, 0.658; variability, 0.467; late\/variable decelerations, 0.638; slow response decelerations, 0.617; and trend to change, 0.423. Phase 2, including 37 SPH and 366 non\u2010SPH cases, showed a sensitivity of 62.2% and specificity of 75.4% for the 2\u2010point score, whereas the 3\u2010point score had a sensitivity of 35.1% and specificity of 89.9%. The area under the curve (AUC) was significant at 0.73 (CI 0.645\u20130.818).<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> FLORS demonstrated significant internal consistency and observer agreement, with a promising sensitivity\u2013specificity balance and significant AUC. Further research is needed to assess its impact on perinatal hypoxia and cesarean delivery.<\/jats:p>","DOI":"10.1155\/2024\/9779831","type":"journal-article","created":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T09:48:41Z","timestamp":1729072121000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development, Validation, and Diagnostic Accuracy of the Fetal Lack of Responsiveness Scale for Diagnosis of Severe Perinatal Hypoxia"],"prefix":"10.1155","volume":"2024","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1170-4049","authenticated-orcid":false,"given":"Luis Carlos","family":"Franco","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5634-9602","authenticated-orcid":false,"given":"Sandra M.","family":"Buitrago","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9573-3168","authenticated-orcid":false,"given":"Isabel","family":"Arbelaez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0175-8846","authenticated-orcid":false,"given":"Laura F.","family":"Pinto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1273-4215","authenticated-orcid":false,"given":"Daniela","family":"Blanco","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6875-2211","authenticated-orcid":false,"given":"Mar\u00eda C.","family":"Pizarro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5799-1461","authenticated-orcid":false,"given":"Laura","family":"Santamaria","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8719-5374","authenticated-orcid":false,"given":"Catalina","family":"Trillos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,10,16]]},"reference":[{"key":"e_1_2_9_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)71048-5"},{"key":"e_1_2_9_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000445580.65983.d2"},{"volume-title":"Colombia. 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